When and how did you get involved with cardiovascular ultrasound?
In 1985, after completing undergraduate clinical physiology training, I was offered an opportunity to train in ultrasound. I had limited exposure, but I knew I loved looking a beating heart, a fuzzy beating heart by today’s standards, but still a beating heart. I stared in awe at the mitral valve and I knew I was being offered an opportunity of a lifetime. Thankfully I jumped in head first and have never regretted it. After a few years of training and clinical experience, I began working in a research center and was encouraged to study for my Masters and PhD by a great mentor and cardiologist, Professor Norman Sharpe. I maintained my interest in clinical echo and focused on clinical research that almost involved cardiovascular ultrasound in methodological studies, clinical trials, population studies and more recently meta-analysis.
What is the name and type of facility/institution at which you work, and what is your current position?
I’m a professor at the University of Otago in Dunedin. This is the oldest university and oldest medical school in New Zealand but we also teach a range of other health professional degrees. As well as teaching, my main role is research, which is, predictably focused on the heart and echocardiography.
What aspect of your work in cardiovascular ultrasound has been most rewarding?
Undoubtedly, research has been the most rewarding part of my career. I’ve been fortunate to work with several leading cardiologist researchers and to develop a wonderful international collaborative network. I’m privileged to have been involved in some major pieces of work and like to think that, in some small way, this research has influenced cardiology practice. My interest in echo research has also led to some wonderful volunteering opportunities. For example, I’ve been involved with several screening projects for rheumatic heart disease in children in remote locations around New Zealand, Northern Australia and Timor-Leste. It’s been hot and tiring work but so rewarding to support communities in need. Helping to identify and reduce the impact of heart disease, and especially rheumatic heart disease, in indigenous populations is something I will always make time to devote to.
When and why did you join the ASE?
I joined the ASE in 1987 and was keen to connect with international colleagues since I was geographically isolated at the bottom of the world! Echo was really in its infancy and there were very few cardiac sonographers in New Zealand so becoming part of a large collegial community was important for learning and growing. And I haven’t been disappointed. I’ve enjoyed presenting at the ASE Annual Scientific Sessions and have graded abstracts for a number of years as well. I’m now part of a community of like-minded colleagues who always impress me with their drive and passion for echocardiography. Many are now great friends.
How do think ASE membership benefits the international cardiovascular ultrasound community?
It is important for all echocardiographers and echo enthusiasts to be part of a wider community to share knowledge, research and best practice. Being part of the leading echo organization in the world ensures we all benefit from best practice and consistent approaches. I also like to think that having international members also benefits the ASE enabling the organization to have a global perspective and to understand the different needs that arise due to different ethnicity, different disease prevalence, and different access to healthcare. We can all benefit from teaching, and learning from, each other. I think this is very evident at the annual scientific meetings where we come together from all over the globe based upon our shared interest of echo. Experts share their experience and expertise so willingly. And we all take that knowledge back to share with our local networks. The reach of the ASE is large and immeasurable.
What is your advice for members who want to become more involved in their profession?
Always say yes when asked to do something: banish no from your vocabulary. Some of the best opportunities to learn, and the most rewarding opportunities I’ve had, were experiences I did not think about before saying yes. I didn’t allow doubts to form. For example, camping in remote locations in Timor-Leste for rheumatic fever screening. I was the oldest in the group and least experienced with camping. I’m more of luxury sheets and deep bubble bath kind of woman! Had I thought about it, I may have said no. But I trusted the colleagues who asked me and the experience was rewarding and memorable in so many ways. And I would jump at the opportunity to do it again in a heartbeat (pun intended!). Too often, I hear colleagues turn down opportunities because they are unpaid. “What’s in it for me?” they ask. And it’s hard to know how to reply. I know not everyone has the luxury of being able to work for free. But I encourage everyone to volunteer as much as they can. It’s usually always rewarding.
The other advice I would give is don’t shy away from opportunities to present talks at conferences. I hear many sonographers say “I’m not good at public speaking” and I’m going to tell you right now I was the kid who cried at elementary school speech competitions as I stood mute on the stage. If you’ve been invited to present, it’s because someone thinks you have important research findings or educational points to share. And if they think you are capable of doing it, you are. Say yes!
What is your vision for the future of cardiovascular sonography?
Cardiovascular sonography is at an interesting crossroads. The technology is so complicated and growing so rapidly that it’s difficult to imagine what we, as sonographers, will be doing in a “full service” lab in the future. The challenge is to ensure there is a clinical applicability for the technologies we love to play with. I think we have recently seen this play out with strain imaging, which is becoming clinically established, but I’m old enough to remember when people were similarly excited about contrast perfusion imaging, but outside of a few research centers, this has largely failed to find its clinical niche. Demonstration of clinical applicability will be essential or any new techniques.
I think we will see an exponential growth in automation and artificial intelligence in echo. Increasingly, we will not need to measure our images. The machines will do it for us and with better intra-observer variability than we can achieve manually in most cases. I think we will also see a move towards more post-processing manipulation of images, or rather a chunk of 3D data that we capture in a very short time frame. We will need to adapt to our changing world.
At the same time, point of care ultrasound (POCUS) is growing exponentially. I suspect there will be fewer referrals for routine imaging, but our patients will be complex and difficult to image. Our framework will shift. I think there is the potential for expert sonographer roles to teach and support clinicians who perform POCUS in places like the Emergency Department and ICU.