Dynamic Ultrasound Group (DUG)is a clinical interest group established to provide education, guidance and support for clinicians using ultrasound imaging. Though membership is made up primarily of chartered physiotherapists, associate membership is available to other related clinical groups.

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New technique for evaluating subscapularis activation using a trans scapula approach

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Ultrasound is now used for a wide range of applications in physiotherapy, including

Rehabilitation and biofeedback, Orthopaedic, Respiratory, Women’s health and continence, Haemophilia , 3-D assessment of muscle structure, Botox injections, Joint and soft tissue steroid injections, Shockwave therapy, Acupuncture needle placement, EMG electrode placement

Rehabilitation 

Real time ultrasound imaging is used to dynamically evaluate and quantify muscle activity during specific exercises and functional activities. Allowing the patient to observe muscle activity using ultrasound, while performing exercise is proving to be a potent biofeedback technique. These techniques are most often applied to the action of the deep abdominal and lumbar musculature.

Ultrasound image of relaxed abdominal wall Subject in standing	Concious active contraction of transverse abdominus

Women’s Health  

With ultrasound imaging contractions of the pelvic floor muscles can be observed, along with their effect on the bladder, vagina and urethra. This enables the therapist to make a more effective assessment not only of muscle function, but also its impact on the continence mechanism.

Orthopaedics  

Similarly, real time ultrasound can be used to assist in the clinical evaluation of musculoskeletal structures throughout the body. Ultrasound is particularly suited for assessing the morphology and behaviour of muscles, tendons, fascial planes and fluids along with their interaction with neighbouring structures. This is invaluable in the evaluation of adhesions, subluxations and effusions and has and obvious role in monitoring the response to treatment. Ultrasound is also the most appropriate method of image guidance for many therapeutic soft tissue injections, which are part of physiotherapy scope of practice in the UK.

Ultrasound image of calf tear. Sagital section (dual screen) through medial head of triceps showing large haematoma.

Respiratory

The use of ultasound in helping to examine the chest and lungs is increasing with both ITU medics and physiotherapists around the country assessing pleural effusions, collapse and consolidation objectively.

Ultrasound image of a large incidental right sided effusion. The top of the image represents the probe resting on the chest wall, the dark area (e) is the effusion which has completely displaced the lung. The bright band (d) is the diaphragm, with the liver (l) inferior (to the right)

Training

A training pathway and course structure for therapists is being developed by DUG and a number of introductory and basic courses are being run in 2007. For details of DUG and other courses click on Courses

Dynamic Ultrasound Group is drafting guidelines for training providers and physiotherapists using ultrasound in terms of training needs, competence and scope of practice. For an update on this process see our Training  page   

Courses

There are a range of courses run by different groups for clinicians using ultrasound. We have listed those we have organised or that we have been informed of that are suitable for physiotherapists. We plan to post a more comprehensive list in the next month or so.

How it Works

 The ultrasound image is created by first transmitting sound waves into the body and then interpreting the intensity of the reflected echoes.  This is achieved using a hand held probe which contacts the body via a water based gel.  The data collected is then processed within the body of the scanner and displayed as a black and white image generally referred to as grey scale.

The Physics and the technology involved in ultrasound imaging has a profound effect on how structures appear. The dynamic nature of ultrasound scanning makes understanding of the processes involved essential.