History of CEUS
Throughout the history of medicine, new techniques have continually been introduced. Many of these new techniques were largely unproven when they began to be used. In a great number of cases, the new technique failed to benefit patients, thus ultimately proving to be a to be a waste of time and resources. A minority turned out to be frankly harmful.
Even those few that have stood the test of time had what can only be described as a difficult birth. All too often, physicians using the new technique practiced on live patients, with predictable results. The CEUS was born out of a desire to try to do things in a better, especially safer, way. Possibly for the first time in history, a technique has been introduced into a field of medicine with high standards from the outset.
Point-of-care ultrasound (POCUS) is far from being a new concept. It originated in Europe and Japan in the 70s and migrated to the United States in the early 90s. But Canadians, for better or for worse, approach things at a more measured pace. At the turn of the new millennium, there were exactly two hospitals in all of Canada where an ultrasound machine could be found outside of the radiology department. That is not a typo. Two. One less than three.
This began to change in 2001 with the arrival of EDE – the Emergency Department Echo course. By bringing ultrasound teaching directly to interested emergency departments, the EDE course dramatically altered the penetration of ultrasound into Canadian emergency medicine. Rather than being trained individually, Canadian Emergency Physicians were now being trained as groups. Every member of a group would “catch fire” about POCUS at the same time. As a result, they went forward together, having a much easier time overcoming the administrative, financial, and especially political resistance that lay before them as they brought POCUS into their practice.
Despite the enthusiasm generated by the EDE course, the early instructors felt strongly that an introductory course, no matter how good it might be, was not enough to ensure that physicians would use ultrasound in a safe and efficient manner. The CEUS was created specifically to promote the highest possible standards for the use of this modality. To this end, the standards in place in other national jurisdictions were reviewed. CEUS then set standards that exceeded all of these. To this day, CEUS standards remain the most exacting in the world for the use of POCUS. As for the CEUS Independent Practitioner training program, it is the most highly-recognized traineeship in Canada. The Independent Practitioner certificate is the only nationally recognized proof of competence in POCUS.
This remarkable achievement was arrived at only after significant opposition was overcome. Interestingly, this resistance came from both sides. Radiologists were appalled at what they saw as an incursion onto their “turf”, and they bitterly opposed the very notion of non-radiologists using ultrasound. The irony was that, in opposing CEUS, they were opposing the very people who were arguing for high standards for POCUS.
There was also resistance to the idea of such standards being imposed on the specialty within the emergency medicine community itself. Many Emergency Physicians, even some in leadership positions, felt that individuals could decide for themselves what training they needed, if any, before using ultrasound in their practice. Some emergency physicians even argued that the current program of morbidity and mortality rounds would be sufficient to correct any errors that might be made.
Through dogged persistence, the early adherents of CEUS continued to promulgate their point of view. Slowly, the idea that solid image generation and image interpretation skills are required for independent use of POCUS began to gain credence. It no doubt helped that those who had CEUS certification very rarely, if ever, made any errors in image interpretation. This went a long way towards reducing the opposition of the radiological community to POCUS. Simultaneously, the growing numbers of Independent Practitioners (now numbering in the thousands) have made CEUS certification the gold standard of POCUS training.
CEUS owes a large debt of gratitude to its founding Board, who laboured for over a decade to guide the society as it grew and developed. The contributions of Dr. Peter Ross (President), Dr. Andrew Kirkpatrick (VP), Dr. Ray Wiss (Secretary), Dr. Chuck Wurster (Atlantic rep), Dr. Sylvain Croteau (Québec rep), Dr. Robert Chen (Ontario rep) and Dr. Ben Ho (Western Canada rep) cannot be underestimated.
CEUS could not have evolved without the remarkable contribution of Dr. Claude Gervais, also a founding Board member. She was the first person to be certified as an Independent Practitioner after training done exclusively in Canada. She made invaluable contributions to the development both of the early teaching materials of the EDE course as well as to the content and processes of CEUS training. For years after that, she was the primary instructor for the EDE course in Québec. Later, when her focus on motherhood precluded travelling all over the country to teach POCUS, she became the best CEUS examiner in the country. Countless trainees benefited from her patience and remarkable insight.
Tragically, Dr. Gervais died in a boating accident in the Caribbean in December 2012. She was an outstanding pediatrician, a superlative teacher, an extraordinary parent and an incredible life partner. She is terribly missed by her family, friends and by everybody who ever wore the EDE shirt.