How I got started: Educators in Ultrasound

by Bonnie Starr

Gulfcoast Ultrasound Hands-On
Bonnie Starr Hands-On Instructor at Gulfcoast Ultrasound Institute.

I started out in general radiology in 1971 and worked in that field for about 11 years.  They were performing ultrasound exams at the hospital nearby but we did not have the capability where I worked.  However, what little bit I did get to hear and see of this new field really interested me.  I was taking a class at the junior college at the time and needed to write an article for the program so I decided to accomplish two goals at one time the article was entitled “Ultrasound the New Kid on the Block”.  Surprisingly enough, it won an award and I was asked to present it at a national meeting in Atlanta.  I think it was the research for that article that planted the seed. I was hooked!  I asked my administrator if they would purchase an ultrasound unit if I went back to school to pick up the Ultrasound training and I’m grateful to say they said yes!  We’ve grown into 6 units at two different locations and we stay busy.

I think one of the accomplishments I’m most proud of is having taught myself the echocardiography portion without ever being in a setting where we got to do them on a daily basis.  With being able to shadow next to some excellent echocardiographers in our area and using the Echocardiography and Registry Review products that I got from Gulfcoast Ultrasound Institute, I was able to take the registry and pass it.  Once again, I was grateful!  30 years later I couldn’t be happier working in any other field with the opportunity to participate in the hands-on instruction with Gulfcoast Ultrasound Institute, and hopefully make someone else’s journey a little easier.  I’d recommend the field to anyone!

Bonnie Starr, BA, RDMS, RDCS, RVT


How an emphasis on cost effective medical practice and patient safety issues will influence the future of point of care ultrasound.

by: James Mateer MD RDMS

It is interesting to see how things go in cycles…  In the 80’s ACEP offered a curriculum entitled: “Cost containment in Emergency Medicine”.  This was a program used to train EM physicians and residents in the appropriate use of testing and provide the most efficient use of resources.  The program was developed during an economic downturn (remember mortgage rates of 18%?).

Intro to Emergency Medicine - Abdominal Scan
Emergency Ultrasound at Gulfcoast Ultrasound Institute

Today we are in the midst of another economic downturn and there are increasing pressures to reduce the cost of healthcare.  ACEP has recently developed a survey for members to help identify areas where Emergency Medicine can reduce the cost of care without sacrificing quality.

Some interesting health care statistics for the US include:

  • We use 15% of our GNP for healthcare vs. 8.6% average for other countries.
  • We do >10 times as many CT/MR studies per capita than other industrialized nations (if you have not looked recently, these are very expensive tests).
  • Despite this, USA ranks lower than many other countries in quality of health indicators.

At the same time, there has been an increased interest in patient safety issues.  There are many reports concerning the increasing levels of medical radiation that we are exposing patients to, and the potential long-term effects of these exposures.  New Ultrasound – First guidelines have been developed to encourage clinicians to avoid unnecessary radiation whenever appropriate.

A shift is occurring in Medicine – away from the current fee for service model and towards the pay for performance and cost containment models.  Since much of the cost of care is dictated by the cost of the tests we order, clinicians who utilize clinical judgment supplemented by low cost testing options will have the greatest success in reducing the overall costs of healthcare, while retaining reasonable compensation for their services.

It is clear that point of care ultrasound will have an essential role in reducing costs while providing quality and safety for patient care.

Side Note

One of the goals for this website is to present ultrasound topics with a focus on how the specific uses save time, increase safety and/or improve the cost effective practice of medicine.  We encourage participants attending ultrasound training seminars to respond with their experience and/or ideas on the same topic.  We anticipate continued improvements in the utilization of POC US through this free exchange from clinicians who are actively exploring the most effective uses for this technology (James Mateer MD RDMS).

Hot Tips – Locating the Common Bile Duct with Ultrasound


Here’s some quick pointers on how to easily locate and identify the common bile duct and portal splenic confluence using ultrasound. We even demonstrate this technique on easy as well as more challenging patients.
Demonstrated by Theresa Jorgensen, RDCS, RDMS, RVT, – Program Manager at Gulfcoast Ultrasound Institute.

To learn more techniques like this, please visit the course listings and browse our Abdominal ultrasound listings.

Esophageal rupture diagnosed with bedside ultrasound

By Derr C, Drake JM. University of South Florida, FL, USA.


A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows suggested a diagnosis of pneumopericardium. Based upon the patient’s presenting symptoms and ultrasound findings, an esophageal perforation was suspected. Esophageal perforation is a medical emergency. Deterioration and death due to sepsis can occur within hours of presentation [6]. Although there is a great deal of literature discussing the diagnosis of esophageal perforation by chest radiograph, computed tomography (CT), and esophagography, there are no articles on the role of ultrasound. Esophageal perforation may result in the communication of air between the esophagus and pericardium and the leakage of gastric contents into the chest and peritoneal cavity. The presence of air in the pericardial sac results in nonvisualization of the heart on ultrasound. Fluid in the chest and abdomen may be visualized in the posterior upper abdominal windows. Although these ultrasound findings alone are not entirely specific for esophageal perforation, when coupled with a high index of suspicion due to the patient presentation, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques to make the diagnosis of esophageal perforation.

Derr, C. & Drake, J. Esophageal rupture diagnosed with bedside ultrasound. The American journal of emergency medicine 30, 2093.e1–3 (2012).

or check out the full article on