Discovery/CIMT Carotid Ultrasound: Get Started
Welcome to Discovery carotid ultrasound scanning. As a dedicated CureCoach Scanner, you join the Proactive Medicine movement. This is your comprehensive guide to Discovery carotid ultrasound scan , a vital and easy first step to warn patients of serious threat to quality longevity.
You will find detailed instructions, step-by-step procedures, and best practices to get you started. Your dedication is key to a healthier tomorrow for your patients. Keep your patients/clients healthy, a fundamental customer retention strategy.
Please review the following and watch the videos in the links provided to make the most of your Discovery Scan training.
Order Gel
Recommended gel: Aquasonic 100 Ultrasonic Gel
If you do not have gel, hand sanitizer, hair gel, or other clear lubricants (or even water) can work. However, ultasound gel does not run or dry out as quickly as these other alternatives.
Get started with your Butterfly iQ ultrasound probe
Unbox your Butterfly probe: Click here for a video to “meet” your Butterfly device.
Charge your probe: Use the USB charging block that comes with the device to ensure reliable charging. Most charging issues happen when an alternative USB plug-in source is used.
Get to know the Butterfly iQ3 probe: Click here for a video introduction to the basics.
For more in depth understanding, take this brief Butterfly created course: https://www.butterflynetwork.com/introduction-to-pocus-course
Ensure the mobile device you are using with the Butterfly has enough memory to store images: If you are using an older model with little memory, consider an upgrade. See Butterfly Compatible Devices
Connect your mobile device to a reliable WiFi or fast cellular internet access. Slow or weak internet connection can lead to a more difficult imaging and download experience.
Screen sharing from computer and mobile device during online personal training: During online training, these skills come in quite handy. Click here for screen share meeting tips.
Connect to your CureCoach image archive: When you purchased your Butterfly Probe, a membership to your individual archive is required so that you can store images on your archive account for at least one year. In addition to your individual storage archive, CureCoach provides a CureCoach archive dedicated to CS@YourService as well as a CSTrainingScans option for practice. Everyone scanning in your service/practice will be assigned access to the CSTrainingScans AND to your dedicated archive. Every scanner needs their own Butterfly registration no matter the number of probes in service. HIPAA security and privacy requirements mean a separate user name and password access for everyone scanning, even if they are sharing a probe or image viewer. This also enables feedback using the Comments feature on each recorded image directly to the scanner. Click here to get acquainted with the Butterfly user interface and the CureScreen process: CureScreen steps on Butterfly iQ+. For a great Butterfly produced option, go to https://www.butterflynetwork.com/introduction-to-pocus-course
Please send a list of email addresses of your scanners to drbacks@thecurecoach.com. Each will receive an email from Butterfly inviting them to create access to your archive with their email user name and password. CureCoach will then authorize them to access your CS@YourService archive as well as CSTraining Scans, which is a general archive where you can store images while practicing without incurring interpretation costs. Everyone needs their own access; please do not share log in credentials. This enables us to provide feedback directly where it needs to go and answer questions using the robust message platform built within the Butterfly user interface. Sharing log in credentials is also a violation of sound security and privacy policies.
The video overview below will help you get started with:
Choosing the correct…
Archive:
CS@YourService for CureScreen carotid ultrasound and eventually Vasometric CIMT reports after experience and more training
CSTrainingScans for practice images for which you would not bill.
Your Organization for other images you choose for your circumstances
Preset: Vascular: Carotid
Scanning: Focus on Short Axis/Cross Section images till comfortable and confident; Record Video only; No still captures, please; Smooth steady slide from clavicle to chin and back to view common carotid, bifurcation (bulb) and internal/external carotid brances and back; keep the probe moving, move forward and backward on suspected plaque or inflammation thickened wall. Spend a little extra time on a “practice swing” to adust depth and gain focusing on any findings you suspect. If there are no findings, center and optimize gain for the bulb/bifurcation. “Measure twice, cut once” allows a nice concise recording that is a pleasure to interpret and share.
Saving images: 2 short axis views (RT and LT) per study; when you get comfortable with long axis images, save a long axis after the short axis on each side.
Labeling optional: RT or LT. If missing, we will assume that the first image is RT and the second is LT. For Discovery Screen, location is not relevant. Presence or absence of disease is the question to be answered.
Save as Draft to identify studies for interpretation and reporting by CureCoach
CureCoach Video Training
Watch the video below for an example of the one-on-one training we will provide via Zoom after you review this resource.
Perform a Scan
You can practice on yourself, but it is best to practice on as many volunteers (staff, family, friends) as possible to gain experience, confidence and competence. You will also potentially alert them to a threat and opportunity to reduce their risk of harm from heart attack or stroke in the future. Don’t fear creating a little fear. It can save their lives when we offer the hope of a solution, a CurePlan that can dramatically decrease the risk of a stroke, heart attack or dementia.
Using the app on your Butterfly mobile device, choose the Carotid Vascular preset.
Take a “practice scan” short axis/cross section scan from clavicle to chin and back (common carotid to bifurcation/bulb to internal and external carotid branches) to swipe right/left to set gain (not too bright, not too dark) and swipe up/down to set depth (carotid cross section/short axis circle in the middle of the image) and identify suspected plaque/atheroma . The location of any suspected plaque should be the most centered and gain optimized part of the videa. Once recording starts, gain and depth can not be adjusted. If either need adjustment, just start over. Again, “practice twice, scan once.
Repeat the practice scan while recording video. 10 seconds is a good goal, though you have up to 15 seconds. Go smoothly but don’t hurry. Pause and slide back and forward on areas you suspect show plaque/atheroma. As a beginner, focus on getting comfortable and confident with short axis/cross section views showing the artery as a black circle. For long axis views (after you are confident with short axis views) image the intima media layer on the far wall where the CCA meets the bulb/bifurcation for 3 beats. With more experience you can provide views of the internal carotid and anterior wall and plaque in the long axis view, but be patient and master the basics of the short axis first.
Don’t bother taking still captures. The interpreter gets the needed information from the video review and can save still captures of findings from the video. Still captures add time, complexity and frustration, especially in the early experience. CureScreen is intended to be quick and simple. Master the basics before advancing to more challenging skills. Go slow and be patient. 🙂
Obtain Short Axis views, first on the patient right, then the left:
Short Axis Right
- Discovery Scan and Vasometric CIMT studies
- Clavicle to chin (Common Carotid Artery to bifurcation/bulb to Internal Carotid Artery/External Carotid Artery) and backMore experienced scanners: Long Axis Right after you are comfortable with short axis scans of Discovery Scan protocol
- Vasometric CIMT report enabled
- Three pulsation beats with IMT visualized just proximal to bulbShort Axis Left
- CureScreen and Vasometric CIMT studies
- Clavicle to chin (CCA to bifurcation to ICA/ECA) and backMore experienced scanners: Long Axis Left after you are comfortable with short axis scans of Discovery Scan protocol
- Vasometric CIMT report enabled
- Three pulsation beats with IMT visualized just proximal to bulb
After scanning and saving the two short axis images for Discovery Scan (or four images for Vasometric CIMT report), find the image reel counter in the upper-right corner and click on the reel counter. Find “Archive to” at the top of the screen and choose the CS@YourService archive.
Please enter the following identifying information:
First & Last Name: Use legal first and last names (including hyphenated last names) as they appear on insurance cards and ID. Avoid nicknames or shortened names unless they are truly their legal name so that we can match images and reports with existing medical records.
Sex/Gender
Date of Birth
Patient ID is their personal Email address - we prefer personal, not work email because it is less subject to change. Be very careful to ensure accuracy as this is used as the patient ID to connect them on https://CureCoach.App to receive the report securely and privately. If they can’t provide a unique email address, leave it blank. If a couple shares an email address, only one CureCoach.App account will be created and all reports attached to that account.
Accession #: Cell phone # - preferably personal, not work. Please leave out dashes and (). Eample: 1234567890. If no cell phone is available, use a landline and mark with “LL” at the end
Swipe down to see the images. Click on the first image. Click Edit (upper right corner). Click Label Capture. Tap on Aa and choose RT for the first image and click Done and Save. Click the second image and repeat, choosing LT for the label and click Done and Save. Then click the X upper left corner to go back to the entry view.
Click “Save Study” in the blue bar at the bottom. Then, click “Save as Draft” (top button) and click “Confirm” in the bottom blue bar. (Saving as a “draft” makes it easier to identify studies i n need of interpretation and reporting.)
Image Processing and Report by CureCoach/Vasolabs
CureCoach reader determines if study shows definite plaque, inflammation, or no disease.
“Red” if plaque is clearly visible
“Green” if no plaque or inflammation/thickening is visible
“Yellow” if inflammation/thickening is visible but no plaque; we err on the side of reporting false positives to avoid missing disease and opportunity for early intervention.
Incomplete exam. If no disease is seen, but parts of the entire carotid artery and branches are not imaged, the exam will be deemed incomplete and a repeat scan recommended at the earliest opportunity. If inflammation or plaque are seen on an incomplete scan, it will be classified as either Inflammation/Yellow or Plaque/Red
CureCoach provides a PDF Discovery report with findings and recommendations for further actions and patient education. It also includes image thumbnails that link to deidentified videos of the scan.
Vasometric CIMT report option for more advanced scanner submissions: If Long Axis views are provided and adequate for IMT measurement, images are sent to Vasolabs for Vasometric CIMT reports. Vasolabs will provide the report and CureCoach will forward to the patient a link to their Vasometric CIMT report including arterial age, Intima Media Thickness, %ile rank and plaque character/thickness. The provider will have access to the reports via www.portal.vasolabs.com
CureCoach creates a CureCoach.App record for each scan/patient. Reports and recommendations are attached to Results and Recommendations and Documents links in CureCoach.App for the provider and patient to review. A text will be sent to the patient, inviting them to register and view their results.
If a patient requests the report be emailed, they are informed that this method is less secure and private. However, we will send via email if the patient declines to use https://CureCoach.App and assumes the privacy and security risk.
We do not use postal mail due to administrative costs and difficulty tracking/ensuring receipt of information.
Discovery Zoom appointment
After the patient reviews their report, we offer a Discovery Zoom Appointment to review their images and describe the next steps, including cost, insurance coverage and scheduling. At that time, images will be sent for the Vasometric CIMT report if the images are adequate and charges created.
Here is a Discovery Zoom Appointment example. Scheduling and completion of registration documents is done here.
Suggested Script for Scanners (Written/Verbal)
“Arterial disease is the most likely cause of your premature death or disability. This scan offers you a better chance to avoid a disabling stroke or deadly heart attack.
Inflammation of the gums and dental abscesses contribute to atherosclerotic plaque that can rupture in the arteries to your brain, heart and other vital organs. Plaque is like an acne pimple in the wall or skin of your arteries. It can heal and resolve. Or it can rupture.
Sudden plaque rupture leads to a stroke or heart attack, disability or death. But this can be prevented if you know about it and act to stop it.
Like screening for a little bit of cancer, early detection and treatment saves lives.
With this quick, painless, and risk free ultrasound scan of the carotid arteries in your neck, we can discovery this threat. It is safe enough to use in pregnancy.
I’m just doing the scan, acquiring and uploading the images. After I scan, the images are reviewed by an experienced CureCoach reporter. You get a digital indication of healthy, inflammation or plaque. If plaque or inflammation is reported, you can request a more detailed report and schedule a Discovery Zoom with a CureCoach expert who knows how to help you to get rid of the threat.
You can get m more detailed reports measuring this reversible and even curable disease.
This includes an opportunity to discuss your scan on a Discovery Zoom and learn about options most doctors don’t offer. It is surprisingly affordable, including coverage by Medicare and most insurance for part or all charges.
If your arteries are free of plaque or inflammation, you get reassurance and peace of mind. Check again in a year or 2, just like checking your blood pressure or screening for cancer.
You have nothing to lose! This proactive step can save your life. You are worth it.”
Questions?
Email Dr. Craig Backs at drbacks@thecurecoach.com, text 217-717-6069 or call 217-321-1987 during office hours.