Page 99 - JSOM Fall 2025

TABLE 1 Vascular Ultrasound Assessment Scoring System Used in This Study
Score
Criteria 1 2 3 4 5
Recording Recording is not Recording is slightly Recording is Recording is Recording is very
clarity clear – no structures clear – large structures/ moderately clear – sufficiently clear – clear – high quality
can be distinguished different tissue can be small structures can be relevant structures can
distinguished distinguished be distinguished
Gain Recording is distorted Recording is slightly Recording is not Recording is not Recording is not
by gain distorted by gain distorted, but there is distorted by gain and distorted by gain and
too much gain present mostly clear fully clear
Brightness Recording is distorted Recording is slightly Recording is not Recording is not Recording is not
by level of brightness distorted by level of distorted, but it is too distorted by brightness distorted by brightness
brightness light or dark and mostly clear and fully clear
Anatomy Vessel of interest is not Vessel of interest is Vessel of interest is Vessel of interest is Vessel of interest is
visible barely visible visible visible in full sagittal visible in full sagittal
plane plane and centered in
the recording
Vessel Proximal, middle, and Proximal, middle, and
characteristic distal diameter not distal diameter equal
equal

identified the aorta instead of the IVC, all participants man- maximum score for vessel characteristics, indicated by both
aged to identify the correct vessels. The recordings of the IVC the median and mode.
were achieved in an average of 50 (SD 26) seconds, all of
which were taken within the allotted 2 minutes. Recordings of Discussion
the PV were taken at an average of 1 minute and 26 seconds
(SD 55s), with five performers exceeding the 2-minute mark. This study shows that this microteaching training is an effec-
NSOCM-qualified participants were not significantly faster tive way to train military medical personnel with no ultra-
(P>.05). The total score for each category yielded a median sound experience in obtaining ultrasound images of the IVC
value of 3 out of 5, with interquartile ranges spanning from and PV. This first step toward on-site dive profile titration sug-
3 to 3 across all categories. There were no significant differ- gests that combat medics can perform vascular imaging proce-
ences observed between participants who had completed the dures to obtain usable high-quality images.
NSOCM course and those who had not (P>.05 for all ques-
tions in the questionnaire). See supplemental Figure 2 for more Obtaining recordings took significantly longer for the PV
details. than the IVC. This was an unexpected finding, as we assumed
that the PV would be easier to identify compared to the IVC.
Questionnaire The population of military divers participating in this study,
Seven participants reported having no prior experience with however, were all well-trained individuals with high physical
ultrasound procedures. Thirteen had some experience, includ- fitness levels. Participants had a low amount of body fat mak-
ing obtaining femoral artery access during resuscitative endo- ing identification of the IVC easier. Furthermore, some par-
vascular balloon occlusion of the aorta (REBOA) training, and ticipants showed signs of leg muscle hypertrophy along with
five participants had taken part in extensive ultrasound train- prominent collateral veins around the PV presenting as spider-
ing in the NSOCM course. No significant differences between webs on the ultrasound recordings, making it more difficult to
these groups were found (P>.05). identify the correct vessel.

The participants scored the preparation of the Lumify as easy Although a large amount of vascular gas emboli on Doppler
and did not find it hard to obtain a clear image of either ves- recordings has been shown to correlate with higher decom-
sel. Furthermore, they did not find it difficult to distinguish pression stress, further research is required to develop scoring
between the vein and the artery. The reported median score on systems to measure the severity decompression stress based on
the participants’ level of confidence using ultrasound on the vascular ultrasound recordings. This feasibility study rep-
6,7
waterside was neutral, with numerous participants reporting resents the first necessary step to proceed to a study assessing
a wish for extra practical training and anatomical education. the correlation between bubble observations in the IVC and
All except one participant, who had no diving experience, re- PV and high decompression stress and risk of decompression
ported that they would feel confident using ultrasound record- illness.
ings to determine decompression stress on their buddies if it
was considered the gold standard. Despite expressing confidence in their ultrasound recordings,
the majority of participants expressed a desire for additional
Image Quality training in both the use of ultrasound devices and understand-
The interobserver agreement exhibited limited consistency in ing of anatomy. A structured training system would improve
evaluations related to clarity, gain, brightness, and anatomy. the medics’ ultrasound performance and could also explore
Assessments of vessel characteristics demonstrated a moderate possible applications of simultaneous telemedicine, allowing
level of agreement. Despite the observed disparities in agree- for consultation with physicians (including dive medicine phy-
ment, both assessors assigned median and modal scores of at sicians) located elsewhere. Further research should also be
least 4 for all categories. Notably, the evaluations achieved a performed to determine the usability of specific ultrasound

Feasibility of Vascular Ultrasonography by SOF Medics | 97