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Am Fam Physician. 2000;61(1):259-260

Diagnostic Ultrasound of Fetal Anomalies

By Mark Deutchman and Phillip Loquet. Price, $175.00. HealthStream, 50 Beacon St., 3rd Floor, Boston, MA 02108, 1999. Phone: 617-557-7000. ISBN: 1-57276-043-5.

Deutchman and Loquet have produced a CD-ROM covering diagnostic ultrasound and fetal anomalies that will become a classic because it is easy to use and provides an innovative approach to learning. This compact disc should be in the computer libraries of all family practice residency programs. The outstanding graphics, challenging self-tests, flexibility and connection to other resources are just a few of the many benefits provided by this program.

Physicians who are learning or reviewing ultrasonographic findings in the fetus will discover an array of beautifully detailed images demonstrating important anatomic points. The principles and techniques of identifying fetal anomalies on ultrasonography are presented in an exceptional format that maximizes the learning experience. The brilliance of the sonograms and the flexibility of the computer program will have readers searching for hours. The color Doppler is spectacular and enhances the sonograms to bring out structural details. The learner is not only taught but also quizzed to ensure that personal learning objectives are met.

The disc covers 150 fetal anomalies, including head, skeletal, gastrointestinal and cardiac anomalies. The authors have selected the best sonograms illustrating each fetal anomaly, and no images appear fuzzy or marginal. Important findings of each fetal presentation are beautifully illustrated, and a zoom feature allows for clear magnification of each image. A table of contents allows the learner to randomly select specific organ systems or specific fetal anomalies.

Starting the disc is easy, and it loads rapidly onto the desktop. It is formatted for Windows PC and Macintosh, and the Macintosh version performs effortlessly. Specific directions are included for obtaining maximal color and detail from each computer platform, and approximately eight hours of CME credit are available.

The disc contains six case studies complete with real-time video, audio tests and a quiz for identifying anomalies. Real-time images are presented and maintained for about a minute, giving the viewer ample time to review each one. The learner then selects the sonographic findings present in each case, and instant feedback is given as to whether the learner has selected a correct or incorrect answer while the responses are automatically tallied. Like most video programs, the video can be stopped, rewound or advanced. Discussions follow some of the cases to illustrate important points and help direct the learner to further study. However, it would have been helpful to have discussions for all of the cases because they add key points to the nuances of fetal anomaly recognition.

The search engine allows the learner to go to specific sonograms, and it is possible to make an easily retrievable “carousel” of your own images by indexing key points and adding a frame of reference for recall at a later time. Cases or specific sonograms can be added to the personal carousel as learning evolves, and additions or deletions can be performed at any time to keep the carousel up-to-date. In a short time, the user can compile a comprehensive database specific to personal learning objectives.

There are several innovative possibilities for using the computer program. Images can be “marked” or highlighted with colored markers, and specific sonographic findings can be circled, allowing easy recollection at a later time. Once the learning objectives are achieved, an eraser returns the image to its original form. The markers can also be used to add other data such as simple text or numbers to the sonogram, providing a helpful and fun way to remember key parts of the image. Teachers who are using the disc as a projected image from a laptop to a screen will find the highlighting capability invaluable.

A notepad allows the learner to annotate by actually typing in personal text, which is easily retrieved from a pop-up menu. It is possible to print a transcript of the sequence of images, print the text of the discussion items or print an individual image. The reproductions are excellent.

All of the menu items performed quickly, and the help desk was able to respond to challenging queries. A pop-up menu with indexed items allows for instant retrieval of information. Returning to the main menu after completion of a peripheral task is simple.

One of the disc's most interesting features is the link to the World Wide Web. For those with Internet capability, the program will connect to Primary, a biweekly online journal update for primary care physicians. The topics are mainstream, up-to-date and include all subspecialties. It is possible to retrieve subspecialist and generalist comments about the particulars of a diagnosis or topic, and one could spend hours on just this link. It compares favorably with other online journal sites, and the search engine at this site retrieves specific areas of interest quickly and efficiently.

The authors of this disc have produced a masterful and comprehensive database of fetal anomalies as viewed by ultrasonography. If you are learning ultrasonography or just want to review a collection of fetal images, put this disc on your computer bookshelf. Congratulations to the authors for creating a visually entertaining and easy-to-use computer format. Prepare yourselves to be amazed by the technology used by the authors to make learning fun and comprehensive. The ability to evaluate technical skills is critical and, in this case, helps to ensure that fetal anomalies are not missed on ultrasound images.

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