Welcome to the June edition of WFUMB ECHOES where we highlight the successful Euroson meeting in Riga.
During EUROSON Prof Cristina Chammas from FLAUS stepped down as the WFUMB president, passing the baton to Prof Sudhir Vinayak from MASU. You can read about Prof. Vinayak's plans for his presidential term below. All committee member appointments have been finalised and can be viewed in this newsletter.
In this edition is our luminary interview with former WFUMB president Prof Seung Kim and federation reports from ASUM and EFSUMB and an interesting Ultrasound Training Programme from World Medical Colours (WMC).
WFUMB ECHOES - Spread the word
Along with an excellent selection of presentations we were treated to the Sonocave experience, lunchtime industry Symposiums and a sumptuous Gala Dinner in the spectacular location of the Latvian National Library. Get a glimpse of the Congress’s three days, including the Opening Ceremony and Gala Dinner!
Sudhir Vinayak is currently Professor and Chair, Department of Radiology - Aga Khan University Hospital, Nairobi, Kenya.
Prof. Vinayak has published numerous scientific articles in international peer-reviewed journals as well as domestic scientific papers. He has written chapters for Radiology text books and is on the editorial board for some journals. He has also delivered invited lectures in his area of expertise to international audiences.
He has trained at various institutions including King's College Hospital and St. Mary's Hospital, London. He has also done a visiting Fellowship in Cardio-thoracic Imaging in the Department of Radiology, Stanford University Medical Center, USA.
I have been affiliated with WFUMB for over ten years with tenures on various Committees, Administrative Council and as Hon Secretary on the Executive board of WFUMB. I am well aligned with all the goals and objectives of WFUMB and would like to list some broad objectives and programmes that I would implement now that I am President.
This is the last report I make as president of WFUMB, and I happily hand over the presidency to my successor, Sudhir Vinayak. When I took office virtually, we were in the middle of the pandemic, and no one knew for sure which way humanity would go, so we must celebrate that we have come back to meet and hold face-to-face meetings and congresses, thus allowing us to continue WFUMB's projects and mission.
Second, even though half of my mandate was virtual, we could move forward with several improvements within WFUMB, which I would like to list, including some challenges and successes.
My report intends to give a follow up about some issues.
We improved our working practices and updated the Constitution and bylaws in order to ensure that we were working effectively as a democratic, not for profit organization for the benefit of our participating federations. Many issues were improved. AIUM made some suggestions for improvements in governance and that we have done. Despite listening to their concerns and acting on them regrettably AIUM did not rejoin WFUMB.
Not only is AIUM absence at WFUMB leaving a gap in North American representation (we have been encouraging other partnerships in that continent), the situation led to other consequences. Deeply impacting (and on all of us on the board) the irreparable loss of being accompanied by our great collaborator and friend, Prof Jacques Abramowicz, who was involved in the Executive Board and WFUMB activities for many years. He held the president-elect position as the AIUM representative. As we no longer have AIUM as part of the WFUMB, the federations understood that it made no sense to have an AIUM representative as president. Therefore, unfortunately, our dear friend and president-elect had to leave the WFUMB Council and was not able to take on the role of President. I do think that was the worst and most difficult part of my term.
The new election occurred and Sudhir Vinayak is the new President, from MASU.
Apart from that there have been very positive changes.
Nowadays, we keep our committees as much as possible balanced among federations, giving all opportunities to collaborate, work, improve and be part of this great federation, which has a mission to spread the best practice of ultrasound.
Since pandemic times, the committees have worked together in online, more frequently than in the past.
Regarding COEs, we created a new kind of Centre of Education: WFUMB Mobile CoE, giving further possibilities for developing CoE's in parts of the world where there is no option for a conventional Centre.
Among all great committee works, by their presented report activities, I would like to highlight two committees’ actions: collaboration (Sudhir Vinayak, Chair) and congress committees (Ioan Sporea, Chair). They have worked hard to make easier our mission.
There was a fabulous World Congress in Timisoara in 2022 and we have worked hard to ensure that the next conference will be as a great success again in Oman, Muscat, between 4-7 November 2023.
AFSUMB will host the 2025 World Congress in Kyoto, also has started the great job to make another big successful congress.
FLAUS will host the 2027 World Congress in Peru, already started.
The UMB Editor-in-chief has been appointed and has already done great work improving the impact factor. We have launched the WFUMB open, our open-access journal, meaning that we have appointed an Editor in Chief for both journals during my term.
We made great partnerships with other bodies such as ISR, ICUS, WFPI, RAD-AID, WMC, ITW and IFMSA among others, and have extended our relationship with existing partners.
Exponential access to our website and publications were observed.
Just to have an idea:
March-October 2021 we had 199,014 (average visitors monthly).
April-September 2022 we had average visitors: 298,908 (visitors monthly).
May 2023 we had average visitors: 380,662 monthly, an increase of 13.1% on the last quarter.
I must thank all my board (from ExB and AC), co-opted members, Lynne, and Suzanne, as well as all the Committee members and friends, for working together, supporting and helping me to make this a great job and for guiding me in making difficult decisions, most of them I think, have been the correct ones.
Thank you all, for supporting me and making this challenging term a success and enabling us to look forward to better times. It was an honorable post being WFUMB president.
Maria Cristina Chammas
WFUMB President 2021- 2023
WFUMB Ultrasound Open is a new journal dedicated to the advancement of ultrasound research and clinical practice. As an official, international, peer-reviewed Open Access journal of the World Federation for Ultrasound in Medicine and Biology (WFUMB), the journal will focus particularly on the clinical applications of ultrasound. In addition, it aims to publish and disseminate novel research in basic and applied science. It will also welcome papers on advances in diagnostic and therapeutic applications of ultrasound, guidelines, pictorial reviews, clinical cases, letters and opinion pieces.
WFUMB Ultrasound Open is a sister journal to Ultrasound in Medicine and Biology (UMB).
We invite you to submit your manuscripts to WFUMB Ultrasound Open, and join us in advancing the science and practice of ultrasound. To submit your work, please visit our website. We look forward to your contributions.
The “Ultrasound Training Program” of the World Medical Colours (WMC): a game changer for the health system in Zanzibar Archipelago
WMC is an Italian association that has the aim to train in ultrasound health personnel working in public hospitals with limited resources and located in underserved areas of the world. To that aim, an ultrasound training program, which is a capacity building project, has been developed and conducted in Zanzibar Archipelago since 2006.
At that time, nobody was able to perform US exams or was at least aware of the benefits of diagnostic ultrasound. Since medical personnel in this area are scarce, the program was organized to include not only MDs but also Assistant Medical Officers, Clinical Officers, Radiographers, and Nurses. Care was taken to give them basic information about anatomy and pathology, as well as on-the-job ultrasound education. The official languages in Zanzibar Archipelago are Kiswahili and English. English is the official school language starting from the second grade.
Implementing the program (2006-2011):
The WMC “ultrasound training program” started in 2006 at the Chake-Chake Hospital in the middle of Pemba Island, which is the second largest isle of the Zanzibar Archipelago. When the program started, there was no radiologist performing US examinations in the public hospitals of the Archipelago and only X-ray equipment was available. The program lasted 5 years and included basic and advanced courses. Courses in sonography conducted by European experts were scheduled every 4 months for 2 consecutive weeks each time. During each course 24 hours of lectures and 36 hours of hands-on scanning was planned. The trainees performed sonographic examinations on outpatients and inpatients under the supervision of the teacher/tutor. At the beginning of each course the trainees received a multiple-choice entrance test with the purpose of evaluating their basic knowledge. At the end of every course the trainee’s proficiency was assessed with a multiple-choice test and a practical test conducted on patients. The trainees admitted to the following course should have reached a minimum score on both tests. The results obtained at the end of the first year of the program were impressive and were published in the American Journal of Roentgenology in 2007 (doi: 10.2214/AJR.07.2202).
The program continues (2011 and thereafter):
After this successful first experience, the project restarted in 2011 at Mnazi-Moja Hospital located in Unguja Island, which is the largest isle of the Archipelago. The attendees of the 2006-2011 program with the highest performance were trained to become trainers themselves and able to supervise the trainees and to give classes, supported by the WMC team. The local trainers included Dr. Khadija Suleiman Said, who is an OB/GYN specialist and the local representative and supervisor of the WMC and Mr Khamis Abraham and Mr Mahmoud Badru who are both radiographers as well as the local coordinators of the WMC. Currently, one of the three annual courses is held by them, therefore the ultrasound training program has almost reached the self-maintenance phase. Moreover, they are tutors for the on-job training of participants between course and responsible for a written report of all activities related to the program, including the number and quality of US examinations performed by the trainees.
In 2011, the first memorandum of understanding between the WMC and the Ministry of Health of Zanzibar Archipelago was signed. In June 2022, the fourth agreement was signed for the 2023-2025 edition of the ultrasound training program. Participants to the ultrasound courses were selected by Dr. Khadija Suleiman Said, Mr Khamis Abraham and Mr Mahmoud Badru. Younger participants working for a public hospital with fluency in English were the preferred applicants. Half of the seats were reserved for health personnel living and working on Pemba Island. Since the signing of the first memorandum of understanding all course attendees get an official diploma and are qualified as sonographers.
Over the years several sonographers have been trained by WMC and are capable of performing high-quality diagnostic ultrasound examinations in Zanzibar Archipelago.
2023-2025 edition of the program:
In January 2023 the fourth edition of the program started at Mnazi-Moja hospital with twenty participants selected. This time Richard Barr, Professor of Radiology at Northeast Ohio Medical University, and Leslie Scoutt, Professor of Diagnostic Radiology at Yale School of Medicine, joined us, at their own expense, to give lectures and hands-on training.
This is their report of the experience:
“Drs. Leslie Scoutt and Richard Barr were asked if we wanted to participate by Dr. Ferraioli and Dr. Meloni. We both are very dedicated to ultrasound education and were happy to say yes. When we arrived at Stone Town in Zanzibar, everyone was very friendly and inviting. The students were so energetic, committed and eager to learn. We were privileged to spend 5 days with the students at the very beginning of their 3-year course. We spent the mornings working alongside Drs. Ferraioli and Meloni as well as the local faculty providing didactic lectures reviewing basic US principles and scanning techniques, how to use the ultrasound machine, as well as the anatomy and some basic pathology in the abdomen, pelvis and breast. This was followed by several hours of hands on scanning each day. The students were very, very attentive, and all were taking notes as we were giving lectures and asked many questions. They especially wanted to do hands on training. They themselves,were the models, and it was so impressive to see what an excellent job they did helping each other learn as they grasped concepts and identified the anatomy. Even though the ultrasound equipment they had to use was old and of limited quality, that did not stop the students from learning or diminish their enthusiasm and effort! We are happy to report that they all showed significant improvement in their final exam!
Outside of class, everyone at Stone Town was very helpful and we felt completely safe while there. It is a very beautiful area with lots of history, and when we weren’t teaching, we had a lovely time learning about the local history and culture as we explored the area.
We are looking forward to following the students throughout their three-year course and helping them to become accomplished and certified ultrasound practitioners. We believe that medical care in the area will be significantly impacted by this group of health care professionals as they become competent in diagnostic ultrasound, and we understand that they have been specifically chosen from over 100 applicants such that they will practice throughout the Zanzibar Archipelago. Moreover, we are incredibly impressed by what this program has already accomplished. We taught alongside several local faculty who already have been trained through this program. They have become so adept that they are now themselves excellent teachers and respected local faculty. We anticipate that many of these current students will also become teachers and continue to train others to follow in their footsteps, making this a truly sustainable health care initiative with the goal of exponentially helping others to provide the best possible health care throughout the Zanzibar health care system. We are excited that the Ministry of Health is supporting this initiative, and honored that we were invited to participate in such a well-organized program that has already demonstrated such excellent results”.
Local benefits linked to the program and comments:
The 2022 Tanzania Zanzibar Census reports that there are 1,889,773 inhabitants in the region, and about half of them live in rural areas (https://www.nbs.go.tz/index.php/en/). There are well-equipped and well-staffed tertiary hospitals in mainland Tanzania, however the costs for travelling might be unaffordable for most of the population living in Zanzibar Archipelago. Currently ultrasound examinations are performed by sonographers trained by the WMC program, and the ultrasound facility at Mnazi-Moja hospital in Unguja Island is open 24/7 all year round. The Ministry of Health has acknowledged the importance of having efficient and effective ultrasound services by establishing the “sonographer” position that is given to the personnel trained by the WMC. Sonographers receive a better wage, and their working time is dedicated exclusively to US exams. The presence of US facilities has dramatically reduced the number of diagnostic errors and has led to an overall improvement of the quality of the healthcare delivered in Zanzibar Archipelago. There are now 24 sonographers actively working in this region. All of them were trained by the WMC.
The WMC ultrasound training program, which is free of charge for the participants, is devoted at spreading knowledge and expertise, fulfilling the WHO aims in this field. We strongly feel that a long-term US training under expert’s supervision can achieve amazing results even starting from the scratch in areas with limited resources.
Maria Franca Meloni, MD, President of the World Medical Colours (WMC)
Giovanna Ferraioli, MD, Secretary of the World Medical Colours (WMC)
WFUMB Safety Committee aims to raise awareness of safety, bio-effects and appropriate equipment settings when using ultrasound. A quiz has been designed to test your knowledge and a prize of a free registration to WFUMB 2023, Muscat, Oman 4-7 November will be offered to the winner of this quiz. If there is more than one winner the names will be entered into a draw to select a single winner. Good luck!
Deadline for entry is 31st July so hurry!
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Strategic plan implementation
Matters for noting
Our WFUMB Annual Report 2023 is now available and online. The report outlines all of the good work WFUMB has carried out in the last year. Take a look!
Thursday 17th to Saturday 19th August 2023. For intermediate and advanced users of ultrasound.
EOI must be submitted online through the link below no later than 19th July 2023.
A trademark of the EFSUMB was and is its successful, much-cited Clinical Practice Guidelines. We have raised the standards for the quality of these guidelines including the use of the PRISMA 2020 reporting system for systematic literature assessment. This demand has its price. The new methodological process consented in 2019, costs a lot of time. Nevertheless, we have succeeded in publishing the first part of the PoCUS guidelines in 2023 on the basis of this new methodological concept (Jarman RD et al. Ultraschall Med 2023; 44(01): e1-e24). The guidelines on multiparametric ultrasound of the thyroid, breast and scrotum will also follow this methodological process and the strict EFSUMB protocol for the development of guidelines (Jenssen C et al. Ultrasound Int Open 2019; 5: E2–E10). We have to admit that we are behind schedule here.
The ‘Professional Standards in Ultrasound’ Position Paper of our Education and Publication Committee (EPSC) has been published in October last year (Wüstner M et al. Ultraschall Med. 2022 Oct;43(5):e36-e48), and the manuscript on a comprehensive survey on Ultrasound Practices in European countries is in preparation (Radzina M et al.). A Task Force Group led by Christian B. Laursen started this year to develop ‘Professional Standards and Training Recommendations for Thoracic Ultrasound’. The EFSUMB ‘Head and Neck Training Recommendations’ have been published in October 2022 (Todsen T et al. Ultrasound Int Open 2022 Oct 7;8(1):E29-E34).
The update of the Dynamic Contrast Enhanced Ultrasound position paper (Dietrich CF et al.) is currently under review in Ultraschall Med/ EJU.
A cooperation between the European Society of Emergency Medicine (EuSEM) and EFSUMB resulted in a Joint Position Paper of both societies on ‘Emergency Point-of-Care Ultrasound Stewardship’ and was endorsed by WFUMB and the International Federation for Emergency Medicine (IFEM) (Osterwalder J et al. Ultraschall Med. 2023 Apr 28, online ahead of print).
We have recognized that we need to expand the reach of our guidelines beyond the circle of ultrasound professional societies. Therefore, we have integrated the GIUS guidelines on IBD (together with interactive tools like Ultrasound activity indices) and the WFUMB guidelines on CEUS of liver lesions into the United European Gastroenterology (UEG) Guideline App, which meanwhile contains 34 guidelines and has been downloaded by 25,000 users. Interestingly, about 30 % of those reading a guideline in the UEG App did not know about the guideline before using the App.
Much of what EFSUMB has been pushing for in recent years is about specialised, high-end multiparametric ultrasound. This is important and will remain an important field of EFSUMBs activities in the future. However, especially with the increasing use of small portable and hand-held ultrasound systems, the method is also available as point-of-care imaging outside of clinics, radiology practices and specialist practices. This opens up opportunities, but at the same time poses the challenge of providing adequate training to the many potential users of ultrasound in primary health care. Therefore, EFSUMB has initiated a TASK Force group that has been working very hard for about half a year to develop a PoCUS curriculum for GPs, family physicians, paediatricians, palliative care physicians and other "frontline physicians". Here we are progressing step by step and will discuss our concepts in two sessions here in Riga.
Constitution and Bylaws
A year ago, in Timisoara, we adopted important modernisation of our constitution. The main issue was to strengthen the democratic culture and ethical policy of EFSUMB. Moreover, we have laid the foundation for strengthening cooperation with other European medical and scientific societies with an interest in ultrasound through formal partnerships. We have also brought these constitutional amendments to life. For the first time, the EFSUMB will be led by a female president, Caroline Ewertsen, for the next two years. 50 years after the founding of the EFSUMB, this was an overdue step that also acknowledges the great contribution that so many female EFSUMB members have made for decades. Currently, with Maija Radzina and Hazel Edwards, two more women are represented in the ExB as co-opted members and for the first time, with Hazel Edwards, a representative of sonographers was able to actively participate in the leadership of the EFSUMB. I consider it very important that we continue these developments and ask the BoD to ensure that the diversity of our membership can also be represented in the EFSUMB committees in the upcoming elections.
Meanwhile we have established formal partnerships by Memorandums of Understanding with 4 European Medical Societies. I have already mentioned results from those collaborations and would like to highlight the multifaceted cooperation with the ESR and the UEG.
On behalf of the Executive Bureau and all our member societies and individual members I like to express my gratitude and appreciation to Professor Maija Radzina and her organizing team together with the hosting Latvian Ultrasound Association (LUSA) very much for the preparation of EUROSON2023. They prepared this congress with great enthusiasm, imagination and dedication as a great opportunity to present the newest developments in ultrasound, up-to-date science and to exchange ideas on future projects.
Special accents will be created by the Pre-Congress educational program, public events, the SonoCave and the integration of the student congress STUC into EUROSON. A total of 160 submitted abstracts reflect the diversity and creativity of the engagement of young EFSUMB members with scientific ultrasound topics.
EFSUMB is fortunate to have Bracco sponsorship for four CEUS webinars each year. Two were focused on Europe and two with Chinese experts. These and all the other webinars related to EFSUMB key topics, such as the Head & Neck Ultrasound Webinar supported by GE Healthcare, the Webinar series on Ultrasound in Trauma and War Injury and the Webinars on liver fat and stiffness evaluation and on liver CEUS, are all available on the EFSUMB website to view free of charge.
Several EUROSON Schools an EFSUMB-endorsed courses took place and were highly successful. I would like to mention the International CEUS course in Munich, EUROSON School PoCUS in Family Medicine in Vienna, the Sardinian School on the Use of CEUS and Elastograhy, the Conference on Dermatological Ultrasound in Cluj-Napoca and the EUROSON School on Breast Ultrasound in Timisoara.
EFSUMB membership is stable with 29 National Member Societies, some with as few as 7 members to DEGUM with > 11,000 members (but DEGUM paying and voting only for 33% of the total EFSUMB membership = 6566 members), one affiliate member societies SGUM with 704 members and 90 individual members to date. We are pleased to have 322 individual members signed up for 2022/2023 through the website. Altogether, EFSUMB has had 16,208 members at the end of 2022. For details, see the report of the Hon. Secretary.
EFSUMB continued to be a very active member federation in the WFUMB with C.F. Dietrich succeeding Paul S. Sidhu as the Hon Treasurer of the WFUMB ExB and we also nominated him again for the position of Treasurer for the next term. Adrian Saftoiu has been actively involved as our Administrative Councillor and as Chair of the Publications Committee and I have been involved in modernising the WFUMB Constitution. In doing so, we have tried to advance reforms in the WFUMB called for by the AIUM. We are on the right track, but unfortunately the AIUM has decided not to remain in the WFUMB. We are very happy that the WFUMB has accepted our invitation to hold important committee meetings and the General Assembly here in Riga.
The latest statistics:
- Russian Federation
Passing the baton
I am very much looking forward to handing over the presidential baton to Caroline Ewertsen at the end of EUROSON2023. I wish the first female EFSUMB President every success, a good tailwind and a sure hand at the wheel!
EFSUMB Administrative Councillor 2023 - 2025
The Mongolian Society of Diagnostic Ultrasound in Association with AFSUMB conducted a AFSUMB Workshop on 9-10 June 2023.
Prof. Odd Helge Gilja was invited to the event and had the pleasure of handing over the hand-held Butterfly Ultrasound Device from WFUMB.
In August 2023 WFUMB signed an memorandum of understanding with RAD-AID which will encourage collaboration with ultrasound training in areas of need around the world.
The first joint course was run from 12th to 14th June 2023 at the Port Vila Central Hospital in Vanuatu, a small island in the Pacific region. Dr Sue Westerway from WFUMB & Jo McCann, the Pacific co-ordinator for RAD-AID facilitated the three day course in basic obstetrics. The free course was well received and included a combination of lectures and scanning routine antenatal clinic patients. By the end of the three days all attendees were capable of determining fetal lie, gestational age with estimated fetal weight, deepest pocket of amniotic fluid, recognise basic anatomy and placental position. The affordability of running these courses is only made possible with the assistance of self funding volunteers.
WFUMB has purchased multiple low cost, hand held Butterfly ultrasound units which can be utilised as extra training systems for courses whenever needed. These systems were used in Vanuatu and allowed for more opportunities for hands on scanning.
The success of this first course bodes well for the future of the WFUMB / RAD-AID collaboration and we look forward to offering training in many different regions.
The WFUMB-AFSUMB Student Webinars take place across 2023 – 2024 on the second Saturday of the scheduled months. Each webinar consists of two, 1 hour lectures (see the full enlarged scheduled below) and will take place via Zoom connection in English language.
Time: 10:00am Central European Time (CET or CEST).
Please register your interest using the registration form here >
How and when did you become involved in ultrasound?
I became involved in ultrasound when I was a first-year resident in the radiology department in 1980. At that time, static ultrasound machines with articulated arms were set up in my hospital, and drawing a quality ultrasound image was a significant accomplishment for a radiology resident. As I started my career as a radiologist of the urogenital subspecialty at Seoul National University Hospital in 1987, ultrasound was gaining increasing popularity as an important modality in clinical practice and research activity. During that time, radiology provided most of the ultrasound services at my hospital, except for echocardiography and primary obstetric ultrasound services.
Were there any particular people that influenced your work?
I learned ultrasound skills from Professor Chu-Wan KIM, who was the founder of the ultrasound section at Seoul National University Hospital. He also founded the Korean Society of Ultrasound in Medicine (KSUM) with specialists of echocardiography and obstetric ultrasound. Professor Byung Ihn CHOI, an abdominal radiologist at the same hospital, has been a prominent scholar in medical ultrasound in Korea. He has made significant contributions to the development of medical ultrasound through his work with organizations such as the KSUM, the Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB), and the World Federation for Ultrasound in Medicine and Biology (WFUMB). Professor Chu-Wan KIM donated a million USD to KSUM with a request for using that money for the internationalization of KSUM activity.
What were your career highlights?
Following the footsteps of my senior professors, Chu-Wan KIM and Byung Ihn CHOI, I became involved in KSUM, AFSUMB, and WFUMB. I served as the Secretary General of the Organizing Committee of the WFUMB 2006 Seoul, which was a successful congress thanks to the dedication of Korean and international colleagues and industrial partners.
After this congress, KSUM was upgraded by transforming the KSUM annual congress to an international one with a slogan of ‘KSUM Open’ adopting English as a congress language. These changes accelerated international communication and collaboration with WFUMB and WFUMB-affiliated organizations.
What are your impressions of the ultrasound technology available today?
Ultrasound machines are now widely used in various medical settings and specialties, from big hospitals to small clinics. Since its introduction in medicine, there have been continuous technical advances in grey-scale, Doppler, elastography, contrast imaging, 3D and 4D, and high-intensity focused ultrasound. One of the most significant advances in recent years has been the development of handheld ultrasound machines that make it easier to use in underserved or difficult-to-reach locations. Handheld ultrasound techniques play a vital role in the missions of WFUMB. The current state of ultrasound technology is promising, with continued improvements and innovations being made all the time.
Do you have any interesting stories about your time in ultrasound?
After retiring from my position as a urogenital radiologist at Seoul National University Hospital, I decided to concentrate my clinical and research efforts on a specific condition known as the nutcracker phenomenon/syndrome. This common yet often overlooked condition has become the focus of my post-retirement pursuits. Using ultrasound as the primary diagnostic modality, I take great pleasure in uncovering cases of this neglected diagnosis and improving the physical and psychological comfort of my patients.