Getting to the Truth: A CAS and a GI Physician Discuss the Nuances of EUS Training and Experience
Summary: Olympus鈥 Clinical Applications Specialist Melissa Elliott-Walker, and Gastroenterologist Julie Yang, MD, were interviewed on the OlympusTalks podcast on the DeviceTalks platform. The two discussed their respective clinical roles at the intersection of endoscopic ultrasound to access, visualize, and treat GI conditions, as well as the value of training and experience in the quest to get clinical answers.
Melissa Elliott-Walker has been looking at ultrasound images for over three decades. Still, she understands that first-time viewers won鈥檛 鈥榞et it鈥 right away. 鈥淲hen you鈥檙e first looking at an ultrasound image, it looks like sonar鈥t looks like a weather map,鈥 said the Olympus庐 Clinical Applications Specialist (CAS). To the untrained eye, organs like the gallbladder or the pancreas may not be identifiable, she added. 鈥淚t鈥檚 pattern recognition.鈥 Gastroenterologist Julie Yang, MD, agrees, recalling her early experience. 鈥淚t was like TV back in the day when we had antennas,鈥 watching black and white static on the screen. But today, Yang refers to endoscopic ultrasound as 鈥渢he truth.鈥 So, what鈥攐r who鈥攃hanged her perspective?
The vantage point of EUS
combines an endoscopy procedure with ultrasound imaging technology. Yang recalls her training, thinking 鈥渨hy are we doing [EUS] instead of getting a CAT* scan?鈥 But Yang began to warm to EUS technology, first with the realization that, 鈥渨e can do endoscopy and get biopsies this way, instead of having to call interventional radiology,鈥 she said. 鈥淏ut really, what sets it apart is that it is the truth,鈥 said Yang.
In Yang鈥檚 experience, 鈥渋f there鈥檚 something on a CAT scan, something on MRI,* details may not be clear or may be missed,鈥 but EUS provides a different perspective. 鈥淚t鈥檚 really because of the proximity of where we are in the GI tract.鈥
Elliott-Walker explains that unlike CT or MRI scans, with EUS 鈥渢he end of the scope is in the stomach 鈥 it can be in the esophagus or the duodenum, but the only thing separating that transducer from the pancreas鈥s just the gastric wall,鈥 which is why it is increasingly important for pancreatic imaging, she said. Both Yang and Elliott-Walker stress that other imaging modalities have their place and can complement solving the clinical puzzle, but they view EUS in many instances as an important piece.
Experience, and developing relationships
Yang credits her appreciation of EUS to her work with Elliott-Walker. 鈥淚 think I have a pretty unique experience with CASs, particularly with Melissa,鈥 said Yang. 鈥淲e met when I first started as an attending right out of training, and I could immediately tell that Melissa was really special, and it鈥檚 鈥 because of the wealth of her experience. She wasn鈥檛 there to tell us which button does what鈥t was much more.鈥 Yang was impressed by 鈥渢he way that she can educate all of us, whether it鈥檚 me as a physician, my staff, my techs, [and] my fellows.鈥
Thus, the benefit of a CAS in general, and Elliott-Walker in particular, is to 鈥渞eally develop that conversation into something deeper to make everybody in the room understand what we鈥檙e doing, why it鈥檚 important, and why this particular technology is so significant,鈥 said Yang.
It鈥檚 about 鈥榖eing there鈥
To Elliott-Walker, her job, and those of her fellow CASs at Olympus, is about 鈥渂eing there.鈥 She adds, 鈥淎 lot of the relationship starts typically with the staff. Especially when a new endoscopic ultrasound program is started, we鈥檙e in there with the staff, teaching them how to handle the scopes鈥eaching them how to set them up properly for the procedure, and then being in the room with them when they鈥檙e doing their first handful of cases.鈥 And, she adds, 鈥淓very need is different based on the facility.鈥
In the end, 鈥淚t鈥檚 really just all about the patient,鈥 adds Elliott-Walker. As a CAS, 鈥淲e鈥檙e in there before the patient even gets in the room 鈥 helping [to] set up, making sure we have the appropriate scopes, and then being in there for the procedure, and then after the procedure too, we鈥檙e there helping [to] clean up.鈥
鈥淚t鈥檚 a very unique role,鈥 said Yang of Elliott-Walker鈥檚 expertise. Her combined experience, knowledge of the technology and overall understanding of clinical cases helps clinicians like her answer questions like: 鈥淲hat kind of images do I really need to get?鈥 or 鈥淲hat is the position that I need to be in to really maximize my yield?鈥 said Yang. 鈥淭hose are the subtleties that really get you from just being average to something really amazing.鈥
*NOTE: A (a.k.a. CAT or CT) scan is a noninvasive computerized X-ray procedure where a narrow beam of X-rays is aimed at a patient and quickly rotated around the body, generating cross sectional images or slices.1 Magnetic resonance imaging, or , is also noninvasive. The modality employs power magnets that force protons in the body, facilitating the production of three dimensional detailed anatomical images.2
Potential complications that may be associated with endoscopic ultrasound include, but are not limited to, the following: sore throat, infection, bleeding, perforation, and/or tumor seeding (when EUS-FNA or FNB is performed).
References
1. NIH. National Institute of Biomedical Imaging and Bioengineering. .
2. NIH. National Institute of Biomedical Imaging and Bioengineering.
Looking to Incorporate EUS in Your Practice?
According to the American Society for Gastrointestinal Endoscopy (ASGE), the demand continues to grow for endoscopists who are well trained in diagnosing diseases of the pancreas, bile duct, liver, spleen, and gallbladder, as well as staging of cancers. And while endoscopic ultrasound (EUS) expertise may be widely available in academic medical centers, these skills and technologies are needed in many community-based settings.
ASGE has partnered with 在线黑料门to provide 鈥淒iagnostic EUS Training: A Competency-Based Approach to Incorporating EUS into Your Practice.鈥 The course is focused on helping practicing physicians achieve competency in this high-demand area. The program鈥檚 online and hands-on curriculum covers the full spectrum of diagnostic EUS and FNA in four to six months and culminates in a proctorship with an EUS expert.
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Dr. Julie Yang is a paid consultant of 在线黑料门Corporation, its subsidiaries, and/or its affiliates. The positions and statements made herein made by Dr. Yang are based on Dr. Yang鈥檚 experiences, thoughts, and opinions.
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