USGRA Cadaveric Workshop

Module I: Ultrasound Physics & Principles

1. List the properties of sound
2. Review key moments in the development of ultrasound
3. Label the components of a sound wave
4. Explain the piezoelectric effect and how it is used to create an image
5. Describe how a transducer generates a sound wave
6. Compare and contrast high and low frequency ultrasound
7. State how an ultrasound image is created
8. Explain the Doppler effect and how it is used to augment your procedure

Module II: Sonoanatomy

1. State how an ultrasound image is created
2. Define acoustic impedance
3. Explain the concepts of reflection, refraction, scattering, and attenuation
4. Define sonoanatomy
5. Identify different anatomic structures by their sonoanatomy
6. Review common ultrasound artifacts and their origins

Module III: Scanning Basics

1. Name the basic components of an ultrasound system
2. Determine the appropriate transducer for performing various ultrasound-guided (USG) procedures
3. Understand the principles of transducer handling
4. Discuss the importance of transducer orientation
5. List the transducer movements approved the American Institute for Ultrasound in Medicine (AIUM)
6. Explain the functions essential to optimizing an image (depth, gain, focus, and color doppler)
7. Define ergonomics

Module IV: Ultrasound Safety

1. Review what is known about the bioeffects and biophysics of ultrasound.
2. Explain the potential thermal bioeffects related to ultrasound.
3. Describe the potential non-thermal bioeffects related to ultrasound.
4. List the risks vs. benefits of diagnostic ultrasound.
5. Define the ‘ALARA’ principle.
6. Give examples of how a provider can incorporate ALARA principles to ensure safe ultrasound scanning.

Module V: Essential Ultrasound-Guided Upper Extremity Peripheral Nerve Blocks

1. Review the functional anatomy of the brachial plexus.
2. List the indications and contraindications for each of the essential upper extremity peripheral nerve blocks.
3. Relate the neuromuscular innervation of the brachial plexus to the functional assessment of the patient.
4. For the interscalene, supraclavicular, and axillary plexus nerve blocks, state the anatomic landmarks, transducer placement, sonoanatomy, needle insertion point, and target goal for depositing local anesthetic.
5. Discuss local anesthetic dosing considerations based on the perioperative pain management goals.
6. Name the common side-effects and complications associated with each block.

Module VI: Essential Ultrasound-Guided Lower Extremity Peripheral Nerve Blocks

1. Review the functional anatomy of the lumbar and lumbosacral plexus.
2. List the indications and contraindications for each of the essential lower extremity peripheral nerve blocks.
3. Relate the neuromuscular innervation of the lumbar and lumbosacral plexus to the functional assessment of the patient.
4. For the femoral nerve block, adductor canal block, and popliteal block, state the anatomic landmarks, transducer placement, sonoanatomy, needle insertion point, and the goal for local anesthetic placement.
5. Discuss local anesthetic dosing considerations based on the perioperative pain management goals for each block.
6. Discuss the side-effects and complications associated with each block.

Module VII: Essential Ultrasound-Guided Truncal Blocks

1. Review the functional anatomy related to the rectus sheath, transversus abdominis plane, and thoracic erector spinae blocks.
2. List the indications and contraindications for each of the essential truncal blocks.
3. Describe the anatomic landmarks, transducer placement, and sonoanatomy.
4. State the proper needle insertion point and target goal for depositing local anesthetic.
5. Discuss local anesthetic dosing considerations based on the perioperative pain management goals.
6. Discuss the associated side-effects and complications.

Module VIII: Neuraxial Anatomy & Ultrasound Imaging

1. Identify key structural components of the spine, including vertebrae, ligaments, and cartilage, and explain their functional relationships.
2. Describe the neural and vascular supply of the vertebral column.
3. Differentiate the anatomical features and clinical significance of the epidural and subarachnoid spaces.
4. State the indications for neuraxial ultrasound
5. Describe the technique for neuraxial ultrasound imaging
6. Describe the sonoanatomy related to the different scanning planes to determine: interspinous level, interspinous space, and depth to the ligamentum flavum

Hands-On: Cadaveric Instruction of the Upper Extremity and Anterior Truncal Anatomy

1. Relate functional anatomy to the sonoanatomy for upper extremity and anterior truncal blocks.
2. Describe the sensory and motor innervation of the brachial plexus.
3. Identify the thoracoabdominal nerve pathways and their relevance to anterior truncal blocks.

Hands-On: Live Model Scanning of the Upper Extremity and Anterior Truncal Blocks

1. Relate transducer placement to functional anatomy for upper extremity and anterior truncal blocks.
2. Visualize essential sonoanatomy for upper extremity and anterior truncal blocks.

Hands-On: Cadaveric Needling for Upper Extremity and Anterior Truncal Blocks

1. Demonstrate safe needling techniques to avoid common complications when performing USGRA blocks.
2. Explain optimal local anesthetic placement to include volume and concentration.

Hands-On: Neuromuscular Assessment

1. Identify the neuromuscular function of the brachial and lumbar plexus.
2. Perform a neuromuscular assessment of the upper and lower extremities, evaluating for muscular strength and the location of nerve lesions when deficits are present.

Hands-On: Cadaveric Instruction of the Lower Extremity and Posterior Truncal Anatomy

1. Relate functional anatomy to the sonoanatomy for lower extremity and posterior truncal blocks.
2. Describe the sensory and motor innervation of the lumbar and lumbosacral plexi.
3. Identify posterior thoracolumbar anatomy relevant to ESP and neuraxial blocks.

Hands-On: Live Model Scanning of the Lower Extremity and Posterior Truncal Blocks

1. Relate transducer placement to functional anatomy for lower extremity and posterior truncal blocks.
2. Visualize essential sonoanatomy for lower extremity and posterior truncal blocks.

Hands-On: Cadaveric Needling for Upper Extremity and Anterior Truncal Blocks

1. Demonstrate safe needling techniques to avoid common complications when performing USGRA blocks.
2. Explain optimal local anesthetic placement to include volume and concentration.

Hands-On: Neuraxial Ultrasound

1. Relate the two scanning planes necessary for neuraxial imaging.
2. Describe the relevant sonoanatomy for identifying interspinous spaces.