1. OVERVIEW OF ECNU- 2015 J. Woody Sistrunk, MD, FACE, ECNU

2. Endocrine Certification in Neck Ultrasound (ECNU) professional designation awarded to individuals who meet specified knowledge requirements, measured through a standardized examination and validation of competency process in diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

3. Endocrine Certification in Neck Ultrasound (ECNU)  The ECNU Program is voluntary process comprised 2 steps.  STEP 1: Comprehensive Certification Examination (CCE)  STEP 2: Validation of Competency Process (VCP) Validation of competency in the performance and interpretation of diagnostic US and UG FNA

4. ROUTE 1- Endocrinologists in Practice. 4

5. ROUTE 3- Endocrinology Fellows/Trainees 5

6. ATTESTATION STATEMENT 6

7. ATTESTATION STATEMENT 7

8. Additional ROUTES: 8 1. BC/BE Endocrinologists. 2. Endocrinologists prior to 1972 ABIM. 3. Endocrinology fellows/ trainees. 4. Cytopathologists. 5. Endocrine Surgeons. 6. Otolaryngologists/ Head and Neck Surgeons. 7. Radiologists. SEE ECNU HANDBOOK FOR FULL DETAILS.

9. STEP 1: Comprehensive Certification Examination (CCE)–  CONTENT OUTLINE  I.Principles of Ultrasound Imaging – 15%  II. Neck Anatomy – 15%  III. Thyroid Pathology – 34%  IV.Parathyroid Pathology – 10%  V.Lymph Node Pathology – 10%  VI.Ultrasound-Guided Fine Needle Aspiration (UGFNA) – 16%

10. STEP 1: Comprehensive Certification Examination (CCE)  The CCE is a multiple-choice, computer-based examination that covers major topic areas in neck ultrasound.  Candidates are given two (2) hours to complete the examination.  Offered twice a year (Note additional period this year with insurance requirement changes in NY/NJ.)  The examination will be administered at Prometric™ sites located throughout the United States.  To better prepare candidates for the CCE, candidates must participate in an ECNU-Approved Thyroid Ultrasound Course (minimum of 15.0 AMA PRA Category 1 Credits™), prior to taking the CCE.

11. STEP 1: Comprehensive Certification Examination (CCE)– REVIEW BOOKS 11

12. STEP 1: Comprehensive Certification Examination (CCE)– REVIEW THE GLOSSARY!!!! 12

13. STEP 2: Validation of Competency  Within 12 Months after passing CCE.  Cases may be 12 months BEFORE passing the CCE or 12 months AFTER.  Perform 100 (125) US studies.  70% Ultrasound  30% UG FNA  Submit 15 examinations and reports for review, as per ECNU handbook.

14. STEP 2: Validation of Competency TEACHING POINTS: 1.Don’t even start if you cannot finish it in a year. 2.KEEP UP WITH YOUR CASES!!!

15. Validation of Competency (VCP) case content:  A total of fifteen (15) separate US cases and reports, with a different patient for each case.  These must include:  1. Ten (10) diagnostic US studies comprised of the following:  a. Five (5) must demonstrate a thyroid nodule(s)  b. Two (2) must demonstrate parathyroid adenoma pathology  c. Two (2) must demonstrate a malignant lymph node(s)  d. One (1) must demonstrate autoimmune or Hashimoto’s thyroiditis findings  2. Five (5) UGFNA of thyroid nodule procedures (must include cytology report)

16. VCP –all reports  WHAT INFORMATION TO INCLUDE IN ALL REPORTS– READ THE ECNU MANUAL!!  While some may use a checklist to record ultrasound features, the Ultrasound Reports must be in a narrative form (NOT computer/ultrasound machine generated check boxes!)  They should be concise and contain all pertinent positive and negative findings (AS OUTLINED IN THE ECNU HANDBOOK)  Reports and accompanying cytology/pathology reports must be in English and contain an original date.

17. VCP –all reports  All reports must be copies of the original report as submitted to the patient record, and contain the following information:  1. The indication for performing the exam.  2. Measurement (Longitudinal X Anterior-Posterior X Transverse) of each Thyroid lobe & isthmus Anterior-Posterior  3. A diagnostic impression or differential diagnosis.  4. Disposition/plan indicating specifically what is to be done with the information obtained from the US (e.g., surgery, follow-up in six months, FNA, etc.). Terms like "Clinical correlation” are NOT acceptable.  5. Signature of the physician (Electronic signature is acceptable)  6. Original date(s) the examination or procedure was performed, including cytology.

18. VCP –Pitfalls and common problems.  Remove all patient identifiers from the packet before it is sent.  Use the ECNU Submission Blank -Powerpoint framework. This makes it easier for the candidate and the reviewers.  Keep in mind, all of the reviewers are ECNU certified physicians. They have a vested interest to make certain that those who carry the ECNU designation have appropriately earned it.  Do not “doctor” cases. If dates don’t match, or the dates have been altered on any of the documents, replacement cases will be requested. At times, additional work my be requested.  Submit your cases in a timely fashion. Ideally, before the 6 month mark.

19. VCP –Pitfalls and common problems.  No computer generated reports.  Documents pasted into Word or Powerpoint will be returned. The actual report submitted to the chart should be scanned for submission.  Doppler (with a capital “D”- proper name) grades apply to nodules, not nodes, not cysts, not parathyroids.  Doppler grades are in Arabic numbers, not Roman numerals.  Nodes are assigned a Roman numeral by location, not an Arabic Number.  Be advised that although we strive for consistency in grading, that some reviewers may require more information, and others may require less.  View the critique of the reports as a chance to improve your quality.

20. Why Certify with ECNU?  ECNU is recognized by American Institute of Ultrasound in Medicine(AIUM).  AIUM allows those with the ECNU credential to be directors of ultrasound labs and subsequently apply for AIUM Practice Accreditation.  AIUM credentials LABS not PHYSICIANS!.  ECNU is currently being required by a few insurance carriers, but more will follow.

21. ECNU certifies then AIUM accredits.  AIUM --American Institute of Ultrasound in Medicine(AIUM).  “If the practice is applying for initial accreditation in dedicated thyroid/parathyroid ultrasound, the designated physician director of ultrasound must have earned the Endocrine Certification in Neck Ultrasound (ECNU) credential within the past 12 months…”  http://www.aium.org/publications/viewStatem ent.aspx?id=26

22. COSTS of ECNU Certification

23. With COSTS and TIME Involved, MAKE SURE YOU UNDERSTAND:  One Year to finish the Validation of Competency portion of ECNU.  THEN, One Year to accredit with AIUM!!!  If you cannot find a 2 malignant nodes or a 2 parathyroid glands within 2 years, should you be doing thyroid ultrasound?  READ THE ENTIRE ECNU MANUAL AND FOLLOW THE EXPLICIT REQUIREMENTS!!  Don’t make it more difficult than it is!!!

24. STEP 3: ECNU Program Completion (Issuance of ECNU Certificate and ECNU Designation)  Upon successfully completing the VCP, the candidate will have earned the right to use the ECNU designation after his/her name.  A formal letter,  ECNU Certificate, and  ECNU lapel pin  will be sent to candidates who have successfully completed the ECNU Program.  Certification is valid for 10 years. To date 364 have become ECNU certified.

25. Recertification at 10 years