1. Place of work and role:
Consultant in Sports and Exercise Medicine at ISEH, Healthshare and Pure Sports Medicine in London. I also work as a Sports Physician in military and have worked for various sporting teams across many sports including rugby, rugby league, football, Australian football and tennis. My interest in is tendon disease and imaging.
MBBS, Fellowship of Australasian College of Sports Physicians, Masters in Sports Medicine (research), FFSEM (UK)
3. When and why did you first get involved in diagnostic ultrasound?
I got involved in ultrasound when I was doing locum work in military. They had bought a Toshiba Aplio, but no one was trained to use it. I decided to start using ultrasound as an adjunct to my clinical assessment and quickly appreciated the power of ultrasound in the hands of a treating physician. I have never looked back.
4. Approximate number of years scanning:
Approximately 10 years ever since I performed my first locum job for the military
5. What machine do you use and what do you like about it?
I’m lucky that I work at centers that provide a dedicated ultrasound machine for their clinicians. I work with GE E9, Logiq-e and Supersonic for shearwave elastography. Each machine has their pros and cons but I think the GE Logiq-e is great for portability and low cost.
6. What are the key features you look out for when choosing a machine?
Obviously good resolution and penetrance. I scan and inject hips, so I prefer machines that have good resolution at increasing depth – difficult to find in some machines.
7. Do you have any key books or online resources that you recommend?
For those starting out at ultrasound, I strongly suggest Jon Jacobson’s ‘Fundamentals of Ultrasound’. I think I read this book three times when I started formal ultrasound training. My original book fell apart after a year because I read it so often. Luckily, the book has been updated to include online reading and videos.
8. What is the most challenging area to scan in MSK medicine and do you have any top tips to cope with it?
I think the fundamental challenge in MSK US is working with the concept of structure disconnect. Structure does not directly relate to function or pain in many areas of musculoskeletal medicine. As such, I strongly believe that imaging is best done in the hands of a clinician who can assess the patient and correlate clinical with ultrasound findings. Otherwise for me, it’s the areas I scan the least: hernias and hand and wrist.
9. What are the common mistakes you see beginners making?
The most common mistake I see in beginners is signing up for a course without having access to a machine. Similar analogy is learning to drive without having access to a car to practice: it’s almost impossible. If you don’t have access to a machine at work, I suggest you purchase an ex-demo or second hand portable machine. It’s the best investment you can make for your future.
10. Do you have any advise for those just starting out with ultrasound?
Just like Rome wasn’t built in a day, ultrasound isn’t learnt after a two day introductory course. I always tell sports medicine registrars or physiotherapists that they need to start learning ultrasound from day 1. It’s a travesty if they haven’t developed good skills by the end of their training. Although expensive (courses and machines), it’s the best investment for their future employability. Ultrasound is here to stay, and employers will soon demand that all their potential MSK employees have satisfactory ultrasound competency.
Lorenzo is one of the lead tutors on the cadaveric ultrasound guided injection course and he has a wealth of knowledge and experience.