Student-professor collaboration complements ultrasound education

Nathan Mitchell isn't just learning how to interpret ultrasounds – he's changing the way students at the Virginia-Maryland College of Veterinary Medicine practice performing them. 

His passion for radiology intersected with the expertise of Fawzy Elnady, known for his innovative tissue preservation techniques and original ultrasound simulator. Together, they developed a further refined simulator, offering students at the college a stress-free environment to practice ultrasound techniques.

A Chantilly, Virginia, native and member of the veterinary college’s Class of 2025, Mitchell found himself drawn to the power of visual diagnostic tools shortly after entering veterinary school. "I've always been a lot more of a visual person than auditory," Mitchell said. "I can forget something I hear in two seconds, but if I can see an image, that really sticks with me."

This visual learning style led him to develop a special interest in ultrasound, a noninvasive imaging technique that offers a valuable window into a patient's internal health. But it takes skill to find the correct probe placement and angle needed for a clear image. This is typically learned on live animals, which can be a stressful experience for both the animal and the student. 

"Anytime you want to perform an ultrasound exam on an animal, you need a patient that's in a stable, healthy condition and willing to tolerate a dozen students poking them with a probe they've never seen before," Mitchell said.

Inspired by a lecture on Elnady's original tissue-based ultrasound simulator, developed in conjunction with Lauren Trager-Burns and Yusuf Elnady, Mitchell envisioned refinements and sought to gain practical experience. He approached Elnady about a summer clerkship focused on developing these skills, and the professor readily agreed to mentor him.

“The students are the main thing for me,” said Elnady. “I love teaching them, especially students like Nathan who love to learn — I devote my time to them.”

Mitchell began his study by first learning the Elnady technique. Developed by the professor while at Cairo University, it is an innovative approach to tissue preservation designed to address sourcing challenges faced by veterinary schools. It offers a safer and more cost-effective alternative to traditional formalin-based preservation. The resulting specimens are realistic, long-lasting, and safe for student use.

“I published my work so others could use it,” he said. “Universities across the world — Chile, Kenya, Saudi Arabia, and others — have utilized the technique for educational purposes. It really brings me happiness.”

By embedding tiny sensor chips into preserved tissue, Mitchell's coding skills — honed with support from his brother, a software engineer — led to an innovative 3D-printed probe that interacts with a computer, imitating a real ultrasound. 

"The probe is constantly just talking back and forth to the computer, saying, 'OK, I'm in this orientation and reading this chip, you should be playing this video.’" Mitchell said. The result? As students manipulate the probe, they see corresponding ultrasound videos — courtesy of Trager-Burns — and images on-screen, allowing them to practice positioning and probe angles.

"This will also let you see pathological or diseased tissue," said Mitchell, "without the added stress factor of caring for a patient that's in critical condition." 

Mitchell’s first model, an equine limb simulator, took a year and three design iterations to complete and resides in the veterinary school's clinical skills lab. It's designed to ease the stress of equine ultrasound practice — a valuable skill, but one that can be especially intimidating on live horses. 

“There are textbooks dedicated to the distal limb,” explained Elnady. “Many reasons for lameness are found in this region, but it can be a dangerous place, especially for a student or new practitioner, to examine, which is why we started there.”

Mitchell and Elnady plan to expand the project to include additional models, such as a canine heart simulator for aspiring cardiologists.