Everyone, I just wanted to introduce Heidi Wankowski. She is the Sonosim VP of Strategic Alliances. And we asked her here to give us a little bit of an overview about some benefits and uses of ultrasound. You know, and I think this will be a great introduction, you know, to our breakout sessions too about how we can use this in our office. So thank you, Heidi. Thank you, Lauren, for having me. Good morning, everyone. Like Lauren said, I am the Vice President of Sonosim's Strategic Alliances. I was with the company for the past six years in various capacities. And I'm going to tell you a little bit about what we do and how you can maybe integrate it into your practice and how ultrasound is being used for a host of many things, including ankle and foot-related scanning. So let's get started. Let me see if I can just pull up and forgive me. I'm going to be toggling between the presentation and I'm going to give you a little preview of how the simulator works. And we're going to scan a couple of front cases of the ankle and foot and an interesting challenge case, which let's see. All right, here we go. Let me see if I can, would I be able to share my screen? All right, let's see if you can see this. Yes? Thumbs up. Okay, great, thank you. All right, I'll tell you a little bit more about Sonosim first. Give me one second while I navigate through here. This is interesting. All right, there we are. Okay, let's move to the next screen. So the award-winning Sonosim Ultrasound Training Solution is really a laptop and cloud-based platform that provides an effective training solution to the difficult and complex nature of ultrasound education. We provide a full suite of services, including cloud-based courses, knowledge assessments, interactive scanning cases of virtual patients through the Sonosimulator and access to real patient pathology to provide learners with really comprehensive ultrasound education. And we also added a Sonosim mobile app recently. We have a suite of products that are also geared towards large institutions, med schools, residency programs, but today I'm going to be just focusing on just intended for an individual learner where you're able to just download on your regular laptop or computer and you'll be able to scan on your own time at home. So that's what we are going to just focus on. So we have been dedicated to improving and transforming medical care by serving as a global leader in ultrasound education and training. This year alone, we're in over 1,300 medical institutions. We've surpassed the 60,000 total members and we're in over 40 distributors and countries worldwide. So our library includes over 70 different topics, but today we'll be obviously focusing on just the foot and ankle. And every single module provides CME credits, AMA, PRA, Category 1. So very simply put, why ultrasound? We know that you have the benefits of ultrasound. You're able to provide real-time clinical information. It's a very safe form of, it's a very safe modality. It's radiation-free, it's portable and cost-effective. So there's a lot of advantages to actually trying to utilize ultrasound a little bit more in your practice. We're seeing that it really improves accuracy of diagnosis. It's certainly faster diagnosis where you're able to address the patient at the point of care. We're seeing lower complication rates. Like I said, less radiation because you're able to efficiently manage the patient. You're also able to decrease costs, overall costs, and essentially just improve patient outcomes and satisfaction. That's kind of the end goal is beyond it being something that's been easier and more portable. Ultimately, you're able to really use it as a easy and fast diagnostic tool in your toolkit, kind of an extension of the stethoscope that we've come to find. However, learning ultrasound is not as simple as it looks. There are a lot of barriers to ultrasound adoption. You need, obviously, a patient to scan, a qualified instructor. You need to have access to a machine. And hopefully, your patient has both normal, maybe pathological conditions, so you'll be able to see different anatomies. And so some of the adoption challenges include limited time and costs. It takes learners a significant amount of time and practice to be proficient using ultrasound. And a lot of the courses are time-consuming. They require travel, time out of your schedule. Certainly not this year, since no one is really traveling as much, but it does require instructor time for teaching, which is extremely valuable and limited. And sometimes, time with a patient is rushed and limited because you're beholden to the models at these specific events. Access to standardized training is difficult as well. Books and videos cannot teach hand-eye coordination and visuospatial skills. I mean, basically, you can't just learn ultrasound by reading about it. You have to actually work on the scanning component and build your acumen. Scanning volunteers doesn't always provide the standardized learning environments. You know, you'll have some limited patient pathology. We've even volunteered at many workshops where we've provided a pathology station where we can show abnormals and the rest of the locations only had healthy human volunteers. So that could be a limiting factor. And you're kind of limited to availability of the volunteers. Sometimes the machines aren't available in hospitals, particularly now where, you know, the resources are scarce. And we never discourage anyone from going to a real in-person ultrasound experience. But the feedback we get is, even if you go to a really robust two to three-day course, you're given some limited time for hands-on practice. And even if you've learned quite a bit, you know, we've been told that a week or two later, if you're not continuing to improve or build on that and continue scanning, you'll forget half of what you learned. So that skill decay is kind of critical. And lastly, the educator measurement of student learning. There's the traditional methods that require the instructor oversight and observation. You want to make sure you're doing the right measurements, that you've taken the correct image, and testing your knowledge acquisition can be varied. So those are some of the barriers to learning ultrasound, and that's kind of what we focus on. So we call ourselves the easiest way to learn ultrasonography, because our sonosome was developed specifically to address these barriers. Because, you know, as ultrasound is more available, you want to be able to learn how to do it so that you can use it. A machine is no good if you are not able to properly scan. So, you know, like I mentioned before, we have about 70, over 70 courses at this point with the standardized knowledge assessments. So the first component is the course, and after you take the course, you're able to take a 20 question multiple choice test. And upon scanning, upon passing, you can print out your CME certificates. And the sonosimulator, that provides the hands-on scanning. We're going to be able to take a look at that of real patient cases, and we're going to do a hand and foot case sample. And then from a performance tracking standard, we have standardized performance tracking all across the board for particularly our institutions, where everybody sees the same imagery, faculty and staff. The instructors are able to view everyone's scores, images saved, provide real feedback. We've created, you know, our group training, particular simulation training with our sonosim life scan and case builder, where you're able to actually customize and create your own patient case. Sometimes I refer to that as creating your own Frankenstein monster. And lastly, we've also built out through our partners ultrasound guided procedural training as well. So the library has grown in leaps and bounds as we get more feedback of what is required. It's a symbiotic relationship with clinicians and physicians on what is required for training and what we can provide. And we have evolved quite a bit and really expanded our library to cover pretty much every specialty. So, and it just keeps growing. So with no further ado, let's jump into the simulator, the fun part. Any questions up until we get started? Let me see if I can close this out. Any questions? No. Let me see if I can open up the chat as well. All right. Excuse me. Let me share my sonosimulator here. I'm gonna go back to the main menu. Can you see the simulator screen or no, I'm gonna do a different one. No, we still see your other screen. Can you talk a little about what the actual system looks like? You know, is it, maybe there it is right there. You may be going into that anyway. I actually have the box with me. Let me see if I can pull up a picture of it. But basically the entire kit is this little box right here. And inside the box, we include the Sonosim probe. That's critical. And you plug that into your USB port of your laptop or the desktop computer, Mac or PC. We support both. And we also have some accessories like this, you know, jelly blue, jelly scanning pad as well. So you can have a soft cushy surface to put your placed your probe on top of. But that is the main software. And as well as a little USB stick where you can just download the software on your own computer. Now, keep in mind, we also have the mobile app where you can just download it on your own phone and also review the courses we've done. We have a ton of reference guides and different resources that people can just look at on the go. So that's really it. And the last accessory for any of the OBGYN courses, we also include a transvaginal scanning probe as well. So that's really, it's a small footprint to say the least. So, and it's designed so that you can just practice on your own time at home. That, you know, I, and as we know, a lot of clinicians are extremely busy. And so it's, that's, does that answer your question? Okay. All right. So let's jump into the simulated part. Can you guys see this screen with the main menu? Perfect. Okay. So like I said, you just download the software on your desktop, laptop, and this main, when you open up the, when you open up the icon, this main menu pops up. And like I mentioned before, we have both the courses, the didactic side, as well as the simulator. I'll show you just a peak of the, the courses themselves are quite robust. They're peer reviewed, evidence-based, and you're able to, like I said, once you complete each course, you have the opportunity to take a master exam and earn CME credit after that. But I'm going to focus just on the simulator. So we're going to kind of quickly go through just a couple of cases of real patient data. So as you noticed, when I first opened up my screen, I see this, I know we call it the Sonosome skill box. And this is oftentimes the fundamental, the fundamental course that we start most, most clinicians that have no knowledge of ultrasound, where we practice first on a skill box, where you're able to, you're trying to understand how a three-dimensional object works on a two-dimensional plane. And as you can see, I am scanning a sphere here. So as you, the circle, the transducer cuts through that sphere and gets smaller and larger, and it's tracking my hand movements exactly. So as I'm going right, left, you're able to move it exactly as I'm reviewing. Excuse me one second. Okay, there we go. Okay. And so all of our patient cases are real patients that we've collected. We're going to jump into the musculoskeletal area. I think we want to do an ankle first. Let's start with a basic ankle. We have various different musculoskeletal concentrations. We'll look at case number two. So as you can see, this is the first thing that pops up as a case history. This tells us that a 24-year-old female is a model of normal anatomy, and it asks us to scan and examine her lateral ankle. So I'm going to go ahead and practice scanning throughout. I'm trying to dig through the, I'm at the first point. And as I'm scanning through, while you're doing this on your own time, you still have assistance if you're struggling with image acquisition and interpretation. So if I need assistance in understanding where would be the ideal image window, I can bring up my long and short access here. Let's take a look here. All right. One moment. And I can, as you can see, there's a ghost probe that pops up in the background. And if I match my probe exactly to that spot, it turns green and has a little ping, satisfying sound. And I know I'm in the right window. However, if I don't understand what I'm looking at, I can perhaps maybe enlarge. Let me see if I can hide this thumbnail image. I can adjust the depth and the gain. I'm able to freeze my image if I want to take a closer look. I'm able to bring on my instructor if I'm struggling to understand how to interpret this, the data. So the instructor comes on at every single scanning point and kind of, let's see if you are able to hear. We are using a linear array transducer. So he's telling me that we're using a linear array transducer to evaluate this 24-year-old. And this is a right lateral ankle. I'm gonna try to follow along with him. We can see the distal fibula right here. Very clear definition. And adjacent to that, we can see the perineal longest tendon. And forgive me if I'm butchering these clinical names as I'm not a clinician myself. So thanks for being patient with me. Let's see. Okay, we can see the outline of a superior retinaculum. And so as he's guiding me through the entire case, I can follow along and scan along with him and then move to each of the different scanning points. And so this is a healthy anatomy. There's nothing wrong with it. No broken bones or tendons. So we're simply scanning through and just appreciating proper somnographic technique. Let's see with point C. And as you can see, this is point-to-point scanning. There we can see some more artifacts and landmarks. And we have the capability to do a full, kind of recreates an ultrasound environment where you're able to freeze your image if you wish. We can bring our calipers. And this is just an example, but we can maybe do some measurements. And we can annotate and save our file to our records. And save it to the, there we are. So this is just a simple, and then once you get comfortable enough, you're able to kind of turn on, put it on test mode. And that turns off all the probe guides or the instructor. And you're able to practice scanning on your own with no assistance at all. And so you can take your time with this. This is not a timed portion of the software. And you were able to go back to it as many times as you wish until you become comfortable really working on those visuomotor, visuospatial skills. Any questions? Let's pop into perhaps take a look at a sample foot as well. So as you can see that we have multiple cases and we can go through each one. You have a variety of different anatomies. Every single one uses real patient data. So even though we're using a simulator, we're still looking at real patient cases. So you'll see that variation, which is kind of critical. Let me do one foot case as well. And then we can jump into a quick challenge case. And then I'd be more than happy to take some questions. So, okay, let's see foot case one. All right, let's see. This is a 27 year old female model of normal anatomy. We're gonna look at a right plantar foot. So let's take a look here. Okay. So I'm gonna start with actually point. Oh, actually I'm gonna skip to case three for the foot. I think that might be a little bit more interesting. So here I'm gonna go ahead and scan through. We're looking at, let me try to pull up my probe guide again. So I wanna see where the ideal image window is at the long access. You see that? So I'm gonna go ahead and try to match up my probe. And if I get it correct, there we go. Now, the interesting thing about this particular case is that if we have additional imagery or imaging modalities, we will absolutely include it here. So you can see what the ultrasound version is and what it looks like perhaps on an X-ray. And now this is a normal anatomy, but if it had some sort of pathological condition or a fracture, you would be able to see that as well on what that looks like on an X-ray versus ultrasound. So here we have our extensor hallucis longus tendon, forgive me, right here. And the first metatarsal can be seen in this kind of strong white line. And then, so we worked through the anatomy and, I'll go ahead and do point by point. And here's just another picture of that anatomy. And here we're seeing the flexor hallucis longus tendon again, and just another view with a proximal phalanx and a distal phalanx. And again, we have another imaging modality on the bottom as a reference. All right. So that's, again, simply put, you're able to work on your own time, go through and kind of study the different modalities. Now, let me see if I can pull up one challenge case. Oh, there we are. And now this one is interesting because there's an interesting story behind this particular challenge case. We actually had a employee who actually hurt, injured himself with, he was a very healthy 23-year-old male. Okay, let me see here. Let me see if I can pull it up. Excuse me. And he basically felt a pop along his posterior ankle while initiating a sprint and has localized pain and swelling. And so he was able to actually go to one of our sonographers and get scanned even before his physician was able to even see him. And it was clearly a cut tendon and he was able to go into and schedule surgery within just a several days of having the injury. So ultrasound can certainly, oh dear. Let me see if I can just download this really quickly. While I'm downloading this special case, may I take any questions about the simulator? So I just have a question about, do you require everyone to go through these modules before they're certified and allowed to use it clinically or what's the process? So we are not a certification program. However, we do have a CME credit for every single module, the AMAPR in category one. We do match with AIUM's curriculum standards and guidelines. But I'm not entirely sure about the specific requirements for certification, particularly in this specialty, but I'd be happy to look it up and share that. But generally speaking, after studying through the simulator through SonoSim, you're able to, most physicians would be able to integrate in their practice. Okay. So we're just, I think that's, I have a question here from- There's another question in the chat. So there's another question in the chat saying, is that a real ultrasound probe or a prop? Like, will it be able to practice on a real person's foot? The SonoSim probe is simply a training probe. You can't use it on a real human. It's just simply a simulator. This is similar to a kind of video game remote control that only works with the software. And it mimics, the transducer itself is just this black probe. And as the different transducers change throughout the cases, it'll change on the virtual patient body. Okay. Let's see. Looks like it's almost done downloading. Well, either way, I think. So there's another question. If you're only interested in foot and ankle ultrasonography, can you only purchase that module? Absolutely. So for individuals, you're able to just go on the website on the SonoSim store and we call them modules specifically because they're modular in that you can just select the content that you're interested in. Some physicians only require one specific thing like an ocular module. And so we have that available, but the hardware is required across the board. So whether you get just one module or entire package, the hardware must come with it in order to make it work. And there's another question. I don't know if you know this. Is this a mechanism for preparation for the RMSK certification? That's a great question. I might have to get, I'm not exactly sure what the RMSK certification requires. Like I said, we're not a certification program. However, many clinicians use us to prepare for their certification exams. We're seeing a lot of sonography students use us for that clinical practice and just to get more confident in both scanning and the didactic side before jumping into those certification exams. So I can certainly get back to you on that. There's another question from Cassandra. Are we renting the equipment or buying it? Great question. So the hardware is yours to keep forever. Once you purchase it, it's just a one-time investment. It might be waived if you select a certain number of modules, but the actual modules are one year subscription. So if you, for example, if you get the ankle and foot modules after you take the course, the content does not disappear. Once you finish up the test, you're able to go back to it all throughout the year for refresher training or pulling it up on your mobile app. And then once the one-year mark hits, your license technically expires and you have an opportunity to renew it at a fraction of the cost, I believe $39 for an additional year. So the ankle module, for example, costs 399 on the shop and then retail without a promotional code. And the following year, the renewal cost is nominal, like $39. And a lot of clinicians opt to renew because like I said, we continue to add more patient cases, upgrade and update on a very regular basis. So they just like to have it in their library. All right, it looks like we just have a minute left. Do you want to share that case? I don't know if you have it or if there's anything else you wanted to- I apologize. I actually have about three different laptops I work off of. So I think that's kind of, I made the mistake. Ooh, yes, it's here. Great, let me just show you really, really quick. I have the luxury of having three different laptops. So I'll just show you really quick. And like I said, I am not a clinician at all. I actually use the Sonosim modules to study myself in different specialties as I need to. But as you can see here, so I'll just show you the really cool picture where you can really see that tear. So I think this indicates, so he came in, he heard a pop, and before he was able to even get to the doctor or get any kind of imaging done, he was able to get scanned by Ultrasound Tech, one of our in-house sonographers. And he was able to see, let me see if I can get the right image. We're going to scroll up here. Oh, geez. And he was able to see that there was, as we fanned back and forth, he did have a very significant tear right there. So that's kind of the key image. Okay, so like I said, we have a variety of different anatomies. It changes consistently. And so when we're looking at that last section here, we're able to see that there is a significant tear right over here on the tendon. This 23-year-old male felt a pop along his posture. As we pause here, we are fairly squarely over the calcaneus. We can see it. We are right here. We're over the calcaneus. The tendon is attached. This is the last section here. The tendon is attached here. So it's still nicely attached. So we can change angle and scan from here. You get a better look at the attachment in this location, but I don't think we're too worried about it. All right. Okay. Thank you very much for giving us that overview. Absolutely. Thank you for having me. And if you have any other questions, please feel free to reach out to me at Heidi at Sonosim.com. Do you think you could type your email address into the chat so everyone can have it? Of course. Absolutely. Thank you. Here we are. Great. Thanks again.

Heidi Wankowski

Sonosim

ultrasound benefits

Sonosimulator

ankle and foot scanning

hands-on scanning practice

CME credits