TABLE 2.
Final consensus list of EUS competencies
| General principles |
| Identifies need to accurately label images with patient information |
| Places patient in appropriate position |
| Explains the exam to be performed to the patient |
| Selects appropriate probe |
| Selects appropriate exam preset |
| Adjusts depth to adequately identify all relevant anatomy and pathology |
| Adjusts gain to appropriately identify all relevant structures and pathology |
| Assures proper cleaning of probe before and after use |
| Relays findings to patient care team |
| Appropriately documents all findings in the medical record |
| Physics |
| Identifies posterior acoustic enhancement |
| Identifies acoustic shadowing |
| Identifies mirror artifact |
| Trauma: normal anatomy |
| Identify liver |
| Identify kidney |
| Identify diaphragm |
| Identify spine |
| Identify Morison's pouch |
| Identify splenorenal space |
| Identify splenodiaphragmatic space |
| Identify paracolic gutter bilaterally |
| Identify pleural space bilaterally |
| Identify bladder in transverse and sagittal planes |
| Identify uterus in a female patient |
| Identify prostate in a male patient |
| Identify pouch of Douglas in a female patient |
| Identify rectovesicular space in a male patient |
| Identify ribs |
| Identify lung pleura |
| Identify lung sliding |
| Trauma: pathology |
| Intraabdominal hemorrhage |
| Identify the anechoic appearance of intraabdominal free fluid |
| Identify the hypoechoic/mixed echogenic appearance of clotting intraperitoneal blood |
| Identify potential spaces where intraabdominal blood can accumulate |
| Pneumothorax |
| Identify loss of lung sliding |
| Identify the appearance of the lung point |
| Pleural effusion/hemothorax |
| Identify the pleural space where pleural fluid will accumulate |
| Identify the appearance of anechoic pleural fluid |
| Identify the appearance of mixed‐echogenicity complex pleural fluid |
| Identify the spine sign |
| Aorta: normal anatomy |
| Identify aorta in transverse, sagittal, and coronal plane |
| Identify spine |
| Identify IVC |
| Identify celiac axis |
| Identify SMA |
| Identify aortic bifurcation |
| Aorta: pathology |
| Aortic aneurysm |
| Measure abdominal aorta in transverse in proximal, mid, and distal abdomen |
| Measure outer to outer wall in anterior to posterior plane |
| Measure outer to outer wall |
| Aortic dissection |
| Identify aortic dissection flap |
| Measure aortic root |
| Lung: normal anatomy |
| Identify the different zones of the lung (upper/mid/lower) |
| Identify A‐lines |
| Lung: pathology |
| Interstitial pulmonary fluid |
| Identify B‐lines |
| Identify differential for diffuse bilateral B‐line pattern |
| Identify differential for focal bilateral B‐line pattern |
| Pneumonia |
| Identify pneumonia pattern of focal B‐line appearance |
| Identify lung consolidation |
| Identify subpleural effusion |
| Cardiac: normal anatomy |
| Identify RA in apical four chamber and subxiphoid views |
| Identify RV in parasternal long, parasternal short, apical four chamber, and subxiphoid views |
| Identify LA in parasternal long, apical four chamber, and subxiphoid views |
| Identify LV in parasternal long, parasternal short, apical four chamber, and subxiphoid views |
| Identify aortic outflow tract in parasternal long and apical four chamber views |
| Identify descending thoracic aorta in parasternal long view |
| Identify mitral valve in parasternal long, parasternal short, apical four chamber, and subxiphoid views |
| Identify tricuspid valve in apical four chamber and subxiphoid views |
| Identify aortic valve in parasternal long, apical four chamber, and subxiphoid views |
| Identify papillary muscles |
| Identify pericardium |
| Identify IVC in long and short axis |
| Identify hepatic vein confluence with IVC |
| Cardiac: pathology |
| Cardiac arrest |
| Identify sonographic appearance of cardiac standstill |
| Identify sonographic appearance of ventricular fibrillation |
| Identify sonographic appearance of agonal cardiac activity |
| Decreased ejection fraction |
| Accurately characterize ejection fraction into hyperdynamic/normal/mildly depressed/moderately depressed/severely depressed using subjective interpretation of cardiac contraction |
| Cardiac tamponade |
| Identifies where pericardial fluid accumulates |
| Identifies right atrial collapse |
| Identifies right ventricular collapse |
| Identifies plethoric IVC |
| Valvular |
| Identifies vegetation on valve |
| Measures aortic root diameter |
| Volume assessment |
| Demonstrate evaluation of IVC collapsibility 2 cm inferior from the confluence of the hepatic veins |
| Identifies plethoric IVC |
| Identifies collapsed IVC |
| Elevated right heart pressure |
| Identifies the D sign |
| Identifies an increased RV:LV ratio |
| Myocardial infarction |
| Identifies the septal wall of the heart on parasternal short |
| Identifies the anterior wall of the heart on parasternal short |
| Identifies the lateral wall of the heart on parasternal short |
| Identifies the posterior wall of the heart on parasternal short |
| Identifies the inferior wall of the heart on parasternal short |
| OBGYN: normal anatomy |
| Identifies uterus in transverse axis using transabdominal approach |
| Identifies uterus in the sagittal axis using the transabdominal approach |
| Identifies uterus in the coronal axis using the transvaginal approach |
| Identifies uterus in the sagittal axis using the transvaginal approach |
| Identifies bladder |
| Identifies ovaries |
| Identifies right ovary |
| Identifies left ovary |
| Identifies pouch of Douglas |
| Identifies endometrial stripe |
| Identifies cervix |
| First‐trimester intrauterine pregnancy |
| Identifies gestational sac |
| Identifies yolk sac |
| Identifies fetal pole |
| Identifies fetal heart rate |
| Measure fetal heart rate using M‐mode |
| Performs crown–rump length measurement to estimate gestational age |
| OBGYN: pathology |
| Ovarian cyst |
| Identifies echogenic fluid in the cul‐de‐sac |
| Ectopic pregnancy |
| Identifies empty uterus in setting of positive pregnancy test |
| Identifies pseudo‐gestational sac in setting of positive pregnancy test |
| Identifies yolk sac/fetal pole in a nonuterine location |
| Identifies free fluid in the pouch of Douglas |
| Identifies free fluid in Morison's pouch |
| Testicular: normal anatomy |
| Identifies testicle |
| Ocular: normal anatomy |
| Identifies anterior chamber |
| Identifies posterior chamber |
| Identifies pupil |
| Identifies lens |
| Identifies optic nerve sheath |
| Ocular: pathology |
| Posterior chamber |
| Identifies vitreous hemorrhage |
| Identifies vitreous detachment |
| Identifies retinal detachment |
| Distinguishes vitreous from retinal detachment via visualization of optic nerve sheath |
| Demonstrates dynamic evaluation of the eye via patient eye movement |
| Other |
| Identifies globe rupture |
| Venous: normal anatomy |
| Identifies greater saphenous vein |
| Identifies common femoral vein |
| Identifies deep femoral vein |
| Identifies superficial femoral vein |
| Identifies popliteal vein |
| Identifies popliteal trifurcation (anterior tibial, posterior tibial, peroneal) |
| Venous: pathology |
| DVT |
| Identifies compressibility of a normal vessel |
| Identifies lack of compressibility in the setting of a DVT |
| Performs compression at areas of venous bifurcation |
| Identifies presence of DVT in lower extremity |
| Biliary: normal anatomy |
| Identifies liver |
| Identifies gallbladder in long axis |
| Identifies gallbladder in short axis |
| Identifies portal triad |
| Identifies portal vein |
| Identifies hepatic artery |
| Identifies common bile duct |
| Biliary: pathology |
| Gallstones |
| Identifies gallstones |
| Identifies gallstone characteristics of echogenicity, shadowing, and mobility |
| Identifies WES sign (wall–echo–shadow) |
| Identifies gallbladder sludge |
| Cholecystitis |
| Identifies pericholecystic fluid |
| Identifies increase size of gallbladder wall |
| Measures anterior gallbladder wall in short axis |
| Identifies sonographic Murphy's sign |
| Choledocholithiasis/cholangitis |
| Identifies enlarged common bile duct |
| Measures common bile duct |
| Renal: normal anatomy |
| Identifies renal cortex |
| Identifies renal medulla |
| Identifies renal pelvis |
| Identifies ureter |
| Identifies bladder |
| Renal: pathology |
| Identifies mild hydronephrosis |
| Identifies moderate hydronephrosis |
| Identifies severe hydronephrosis |
| Identifies mimics of hydronephrosis |
| Uses color to differentiate hydronephrosis from vasculature |
| MSK: normal anatomy |
| Identifies muscle appearance |
| Identifies tendon appearance |
| Identifies peripheral nerve appearance ‐ anisotropy |
| Identifies peripheral nerve apperance ‐ hyperechoic honeycomb |
| Identifies normal appearance of dermis |
| Identifies appearance of lymph node |
| Identifies bone as hyperechoic line in longitudinal and transverse planes |
| MSK: pathology |
| General |
| Identifies joint dislocation |
| Identifies joint effusion |
| Soft tissue |
| Identifies cobblestoning |
| Identifies other causes of cobblestoning—lymphedema/edema |
| Identifies appearance of abscess |
| Identifies air echoes as sign of necrotizing fasciitis |
| Identifies foreign objects in subcutaneous tissue |
| Shoulder |
| Identifies humeral head |
| Identifies glenoid |
| Knee |
| Identifies patella |
| Identifies femur |
| Identifies tibia |
| Identifies patellar tendon |
| Ankle |
| Identifies Achilles tendon |
| Identifies Achilles tendon rupture |
| Head and neck |
| Identifies appearance of peritonsillar abscess using endocavitary probe |
| Bowel: pathology |
| SBO |
| Identifies to and fro peristalsis as sign of SBO |
| Procedures |
| Needle guidance |
| Identifies and tracks needle in long axis |
| Identifies and tracks needle tip in short axis |
| Identifies important nearby structures |
| Confirms location of guidewire within vessel |
| Confirms location of catheter within vessel |
| Correctly identifies appropriate vessel |
| Correctly identifies size and location of vessel |
| Identifies back‐walling of needle or guidewire in vessel |
| Identifies needle going through and through vessel |
| Fluid drainage |
| Identifies anechoic or hypoechoic fluid pocket |
| Procedures |
| Can place internal jugular CVC under ultrasound guidance |
| Can place femoral vein CVC under ultrasound guidance |
| Can place radial arterial line under ultrasound guidance |
| Can cannulate vessel in short and long axis |
| Can place femoral arterial line under ultrasound guidance |
| Can perform thoracentesis under ultrasound guidance |
| Can perform paracentesis under ultrasound guidance |
| Can perform paracentesis with ultrasound assistance |
| Can perform arthrocentesis under ultrasound guidance |
| Can perform pericardiocentesis under ultrasound guidance |
| Can perform nerve blocks under ultrasound guidance |
| Can place peripheral venous line under ultrasound guidance |
Abbreviations: CVC, central venous catheter; DVT, deep venous thrombosis; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; MSK, musculoskeletal; OBGYN, obstetrics and gynecology; RA, right atrium; RV, right ventricle; SBO, small bowel obstruction; SMA, superior mesenteric artery.