Seeing the Body’s Engine with Echocardiography

When he was a student, Jeffrey Hill, MSc, ACS, FASE, was fascinated by seeing the real-time images and functions of the heart with an ultrasound machine. He became an echocardiographer and has dedicated his career to clinical practice and education. In this episode, Hill explains the fascinating technology of cardiac ultrasound. He also discusses the important role of echocardiographers in diagnosing heart conditions in patients of all ages.

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Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the Secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives with the help of a thought leader from the university. MCPHS is 200 years old, and what better way to celebrate our bicentennial than with a podcast about longevity and well-being? Joining me today is Jeffrey Hill. He is assistant professor of Echocardiography in the and Therapeutics. Welcome. an. Thank you so much for having me, Jennifer. We're so excited you are joining us today. Before we dive into our conversation, we're going to start with an icebreaker. So my question for you is, if you had a time machine and could travel 200 years into the future or 200 years into the past, which would you pick and why? I think in the past, only because my field working in cardiovascular imaging and assessing heart disease, I think it would be important to find ways to improve the treatments and therapies for patients suffering from heart disease. Great answer. That lends really well into our conversation today. So before we get started into all of the work you do, can you just introduce yourself and tell us about your career and how you came to MCPHS? Oh, absolutely. Hello everyone. My name is Jeff Hill and I'm nearing my seventh year as an assistant professor and instructor at the School of Medical Imaging and Therapeutics here at the university on the Worcester campus. So I began my career in 1997 when I received my initial training in echocardiography at the Brigham and Women's Hospital in Massachusetts General Hospital in Boston, Massachusetts, where I spent nearly three years training an adult in pediatric cardiac ultrasound. And for those who aren't familiar with pediatric ultrasound or cardiac ultrasound that isn't interchangeable with the word echocardiography, that's the professional term, but we use cardiac ultrasound or ultrasound in general Okay. So from 2000 through 2011, I worked at UMass Medical School in Worcester, Massachusetts, where I performed clinical research and cardiovascular imaging. But during this time I assisted in multiple research to teaching cardiologists and trainings. They're also known as Fellows Fellows in cardiology. So given my passion for teaching, I moved into full-time education and developed a cardiovascular ultrasound school at the Kathy Gibbs School, which is in Boston, Massachusetts. Unfortunately, that school closed in 2013, so I was recruited to develop a first of its kind hospital-based heart catheterization school at St. Francis Hospital in Hartford, Connecticut. So all was going well when I received the call from Brian Dolt, my longtime friend and colleague and the program director of the echocardiography programs here at M-C-P-H-S University informing me of the diagnostic medical sonographer chair position that was vacant. So although I love the job at St. Francis with having a startup program with the heart catheterization school, I could not pass up the opportunity to apply for the position. So with a little skill and a lot of luck, I got the job and since then I am responsible for teaching a significant component of the education for the echocardiography program on the Worcester campus. In addition, I'm heavily involved in research studies with my students other MCPHS programs and hospitals and universities around the country. Suffice it to say this has been an exciting career for me and I've faced many challenges, but much more success. Wonderful. And you have so much experience as a practitioner in a clinical setting in research and an education. So what drew you to cardiac ultrasound over some other specialties or other types of sonography that you could have pursued? Although I trained in heart and vascular ultrasound, I was mesmerized by the images of the heart on the screen and physically seeing with ultrasound. That's the neat thing about ultrasound is that we can see with sound and create real-time imaging of the heart function, the valves moving and the heart squeezing. So the ability to create these moving images on a monitor was absolutely remarkable, which, and then I fell in love with echocardiography or importantly, knowing that the heart is the body's engine and maintaining normal heart function is critical to the rest of the body's health. So for the patients who are listening, because I think when we hear the word ultrasound, we all associate it often with pregnancy, but it can be used for many other things. So what are some of the reasons that somebody would need to see and echocardiographer like yourself and get a cardiac ultrasound? Given that heart disease is the number one cause of death in the United States, we often image patients with this disease knowing that heart disease comes in all shapes and sizes and can be due to the heart muscle not squeezing normally or the heart valves not opening properly or they're leaking. There are so many reasons to have an echocardiogram. So in layperson's terms, ultrasound of the heart provides detailed evaluation of heart structure, the valve functioning and the hemodynamics, which is the study of the blood flow through the heart and body. So the study of flow is possible through echocardiography by using the same technology we use on the weather channel, including the Doppler technique. So Christian Doppler is who we credit for this back in the early 18 hundreds, and this technique allows us to detect the distance over time, also known as the velocity and the direction of flow. And importantly, we can convert the flow to pressure. So the importance of converting flow to pressure allows us to noninvasively, meaning we don't intrude the body noninvasively. We can study different areas of the heart, but also the lung to see if there is high pressure in the lung. So this is a remarkable test allowing us to find a disease through seeing with ultrasound and by the Doppler technique. Some of the common symptoms that would warrant an echocardiogram include chest pain, shortness of breath, a heart murmur, which is due to flow that might be abnormal in a specific region of the heart, fatigue, fainting. This is just to name a few. In addition to heart disease as being a reason for the test, an echocardiogram might be ordered for a child or an infant with suspected congenital heart disease, which means that they were born with this malformation of heart and vascular structure. Some of these defects can be as simple as a small hole in the heart where the child and or young person can live their entire lives with or could be as severe as surgery requiring a complete repair of that heart in order for the baby or the child to survive. So you're talking a lot about figuring out what is going on with the heart through the cardiac ultrasound. So in your role as an echocardiographer and the students who are training to be one, how or how do they collaborate with other providers to help treat this patient? So an example of this would be collaboration with other healthcare providers in a patient who presents, say with a heart murmur, as I mentioned earlier, this would be somebody who has abnormal flow. Specifically, this would be flow that's abnormal across the aortic valve, which is the valve between the main heart pumping chamber on the left side and the aorta which the blood flows to, which then feeds the rest of the body. That person will be referred to a team of interventional and cardiothoracic surgeons. So these are folks who are basically working in the heart catheterization laboratory and also work in surgery. They team up together and they perform the special valve replacement that allows for a minimally invasive approach to replacing that squeaky valve. And it all started with some imaging that you found? Yes, exactly. It has to do with the diagnostic imaging that the sonographer detected in order to make the diagnosis. And I'll tell you that we teach our students here at the university that they must have these skills to properly diagnose these patients to ensure they receive appropriate types of care. So. You have also been working on a robotic lung ultrasound. Can you explain where that idea came from, how it works and what you hope it will be used. For the past five years, I've worked on robotic lung ultrasound with an international team of doctors and engineers at Worcester Polytechnic Institute here Before the pandemic, the technology was originally developed for resource limited environments and those who live in desolate areas. Now, believe it or not, there are multiple places among the United States where care is very difficult to get access to. When you live one to three hours away, it's really hard for those who live in those areas to receive quality care. So our idea was to come up with a concept where we could actually ship this to a patient's home, for example, and by having live interaction or tele operative interaction with them, we could allow for us to interact and then give directions to the patient and then display real-time imaging say of the lungs or the heart, and then the clinician can then make a diagnosis without the person ever having to go to the clinic. That may be, as I mentioned, one to three hours away, or they just can't travel. That's the other thing, they just can't make it to that area. So that was the original concept of developing the technology. However, when the pandemic hit, we felt that the technology would be best served for those infected by lung viruses, including obviously the COVID-19. But because most ultrasound testing requires the sonographer, who is the imager in the patient to be very, very close to one another during the actual imaging, the theory is to image the patient from a distance where we can have the patient somewhere else where they don't have as much interaction with other folks who are in the ER to mitigate the spread of the viral disease. That being said, the way it's set up, we can have cameras on the patient that's placed around them where we can have a two-way microphone, and we can have this live interaction with them. Kind of like when you go for an X-ray where they have you go into the room and then they give you commands over the overhead and you basically follow the directions. The same would apply for the lung ultrasound tele operative component of this study. That said, we have been very successful with the prototype and released the second version of this prototype, which is major improvements in its mobility size, and importantly the image quality. So we are currently piloting a study and MCPHS recruiting healthy subjects to assess ongoing safety and feasibility. So we're hoping this research leads to conducting a clinical trial someday. That's. Amazing. Where do you see this being used? So I think the application could be used in any emergency room within the United States, also shipped to those who live far away from medical imaging clinics who have resource limited environments. If we go internationally, my gosh, we could send this technology to the mountains of Nepal to someone who lives so far away. If we could get it to them and we have a signal, we can actually perform imaging there. Another important area would be to have this technology for those who are bedridden during their pregnancy, and we're able to ship this to them and have imaging of this person so they don't have any interruption in their care. So you have seen a lot of hearts throughout your career. You have seen a lot of diseased hearts and seen a lot of heart issues. So for listeners out there, why is it so important to be aware of our heart health and to do things to keep our hearts healthy? I have always been a proponent of a healthy heart. I think the key comes down to moderation. It's always been, I think the promotion of healthy lifestyle, importantly that we perform some type of exercise, although it's difficult to do some type of exercise from a cardiovascular component, not just sitting and lifting a dumbbell, but physically moving, I think is the key to success and the key to a healthy life spiritually is a major component as well. Having a great sense of self-awareness and staying healthy and happy and working with folks that you really enjoy working with, I think is the other thing here. That's one thing that I love the most is coming to work and seeing the students, faculty and other faculty from other departments and sharing the kindness and the caring and the seriousness that we have for our students. That's what keeps me going every day. I look forward to going to work every day. I care so much about the students and giving them the best possible education. That's my focus, and that's what keeps me healthy. Thanks so much, Jeff, for this conversation and shedd So we've come to the part of our show called Bread's Rapid Fire. I'm going to ask you a short series of questions, and the goal is to answer them as quickly as possible. Are you ready? Ready. What is your favorite food pizza. Cats or dogs? Both. Are you left-handed or right-handed? Lefty. What was the last movie you saw? Oppenheimer. Would you ever go skydiving? Yes. What is the most memorable place you've ever traveled to? Yosemite National Park. If you could live in one decade, would you pick the eighties? What is your biggest pet peeve? Neatness. If you didn't work at M-C-P-H-S, what would your job be? Volunteering as a healthcare provider, helping sick patients at a hospital. And what is one piece of advice you would give to your younger self? Every day is a new day. Wake up with inspiration and knowing that these days are numbered. As we age, the days go by a lot faster. So I think that it is truly important to have focus and have a plan every day. Thanks again, Jeff. And thank you for listening to this episode of The Secret to Living to 200. We hope you join us next time. And as always, stay curious. Cardinals.