當日狀況及事後檢討
自身的心得與反思
小結
兒童風濕科的第三隻手：超音波解碼兒童風濕病的隱藏訊息
From Europe to Taiwan: Practical Insights and Challenges in Pediatric MSK Ultrasound
Author: Chi-Teng (Jeter) Tseng, MD-MPH
This past May, I had the honor of being invited by the Society to serve as a speaker at the 1st Taiwan Pediatric Rheumatology School. It was a privilege to share the clinical insights I’ve gathered from my fellowship at Chang Gung Memorial Hospital and my advanced training in pediatric musculoskeletal (MSK) ultrasound in Europe.
For this workshop, I was tasked with one of the more advanced topics in the field: Echo-guided aspiration and injection. From the moment I accepted this challenging assignment, I felt a surge of excitement—a feeling remarkably similar to the pure, hopeful anticipation I felt when I first got into medical school.
Bridging the Gap: The "Baker's Cyst" Model
Training on live patients has its limitations, so I sought to replicate the training models I encountered in Europe. Initially, I tried the "chicken breast and olive" method to simulate lesions, but I quickly realized it wasn't suitable for practicing fluid aspiration.
After brainstorming with a senior technician in our ultrasound suite, we successfully developed a custom Baker’s cyst simulation model. After rigorous testing, we confirmed that the model allowed for realistic aspiration and injection. With this breakthrough, I felt fully prepared and confident to demonstrate the procedure to our trainees.
Reflections on the Workshop
On the day of the event, I realized that time is always the greatest challenge. With a limited window for hands-on practice, not every participant could complete the procedure successfully. I also observed that many trainees were still mastering basic probe handling, which meant a significant portion of the session was spent correcting fundamental ultrasound techniques before we could even attempt real-time aspiration.
Despite these hurdles, seeing the focused and earnest expressions on the participants' faces was incredibly heartening. I feel as though we planted a small seed of interest in them, and I look forward to the day they can apply these skills in their own clinical practice.
The Behind-the-Scenes Journey
Organizing such an event is a massive undertaking. This workshop was just one component of the Pediatric Rheumatology School, yet the preparation spanned over six months—from finalizing the curriculum and securing the venue to coordinating with international speakers and testing remote connections. As a member of the organizing committee, I can attest that it was no easy feat. Even with multiple contingency plans, unexpected "surprises" on the day of the event kept us on our toes.
My only regret was the lack of time to interact more deeply with the students after the session to hear about their specific inspirations and takeaways.
Growth in Clinical Practice: From Fellow to Mentor
Returning to my daily routine, I’ve found that the applications for ultrasound in my practice have become even more diverse. Last month, I performed an echo-guided central venous catheter (CVC) insertion on a 2.5-year-old child. With the aid of ultrasound, I achieved "one-shot" success. I was even able to use the probe to immediately confirm the CVC’s placement in the femoral vein.
I felt a quiet sense of pride being able to demonstrate and explain the procedure to my younger colleagues simultaneously. It made me realize how much I have grown; this level of proficiency was something I could only dream of during my residency. Such competence is truly the result of years of cumulative effort and practice.
Conclusion
Ultrasound is not a replacement for comprehensive clinical judgment; it must always be integrated with the patient's symptoms and a thorough physical examination. However, it provides clinicians with unparalleled clarity regarding the underlying causes of a patient's discomfort.
With its advantages of being real-time, radiation-free, and dynamic, ultrasound remains an indispensable tool that bridges the gap between diagnosis and targeted therapy.
