The Case for Sonographers

Transcription

1 The Case for Sonographers Dr Simon T Elliott Consultant Radiologist Freeman Hospital, Newcastle upon Tyne, UK

2 what is a sonographer? role of the sonographer in non-obstetric obstetric ultrasound performing reporting advanced ultrasound techniques FNA, TRUS, CEUS based on UK experience

3 Controversy! What controversy? Dr L Pourcelot,, EFSUMB Newsletter 1998 sonographers: do US full time and take pride of their work participate in discussions with specialists are involved in physician & technician training are partners of physicians in research co-authors of >200 publications offer a very cost effective service French Sonographers Oui ou Non?

4 What is a Sonographer?

5 UK National Profiles for Diagnostic & Therapeutic Radiography Salary 34,760 45,830 per annum

6 Job Evaluation Score for Reporting Sonographer

7 Health Professionals Council registers and regulates Allied Health Professionals Radiographers Clinical Scientists Physiotherapists Paramedics Speech therapists Podiatrists etc Continuing Professional Development (CPD) maintain up-to-date accurate record mixed learning activities CPD must contribute to quality and service delivery CPD must benefit the user present written profile on request

8 Sonographer Career Path school leaver / graduate Radiography BSc or MSc 3 or 2 years University Sonography Diploma minimum 1 year College/University course Sonographer clinical department Consortium for the Accreditation of Sonographic Education (CASE) Reporting Sonographer Masters or PhD Consultant Sonographer

9 under current UK law there is no legal requirement for a Medical Practitioner to be trained or qualified in ultrasound

10 Surgeons performing ultrasound the surgeon must only become familiar with a limited number of control functions to create excellent sonographic images

11 Surgeons performing ultrasound survey of UK shoulder surgeons (respondents=89) 23% used US routinely 22% intended to use US soon training: none had completed RCR requirements 10 short course 5 shoulder surgery fellowship 7 a a video or a book 7 other Bidwai ASC, Casserly HB. Ultrasound 19: , 2011

12 Sonographer performance 1,046 non-obstetric obstetric exams by sonographers: 94% reports accurate account of findings 6.3% radiologist made additional comments 0.7% was sonographer report significantly altered 630/1,046 follow-up data available: 1 false positive US finding no other significant inaccuracy An audit of the role of the sonographer in non-obstetric ultrasound Bates JA et al. Clin Radiol 9:

13 Sonographer performance 248 MSK US exams 1 experienced sonographer v. 2 radiologists 95% complete agreement 2.8% major discrepancy likely to affect patient care Musculoskeletal ultrasound: audit of sonographer reporting Riley SJ et al. Ultrasound 18:

14 Sonographer performance TRUS biopsy 338 sonographer v. 414 radiologist biopsies no difference between 2 groups in positive detection rate complication rate re-biopsy rate waiting time decreased from 13 to 1 week National Radiology Service Improvement Programme, NHS Modernisation Agency December 2004

15 Sonographer performance FNA of neck masses: % adequacy thyroid non-thyroid Consultant Radiologist 87.5% (41) 86% (66) Sonographer no previous FNA experience 71% (17) 87% (23) Departmental audit Jan-Sep 2011, Freeman Hospital. A McQueen & B Stenberg

16 Sonographer performance 1,510 exams (Toronto, Canada) 74% overall concordance better for obstetric than abdominal concordance improved with sonographer experience active role of physician is essential Case for Active Physician Involvement in US Practice Chan V et al. Radiology 199:

17 Delegation a request for an imaging exam is a normally a request for a medical opinion a Radiologist may delegate requests to a competent radiographer/sonographer delegation of tasks must be agreed in writing with the lead Clinical Radiologist defined; legally & professionally accountable General Medical Council Royal College of Radiologists RCR/SCoR: BFCR(07)

18 My department 7 reporting sonographers 2 MSc; 2 MSK Diploma 1 studying for MSc; 1 for PhD each sonographer must attend at least one national or international scientific meeting or training course per annum weekly team meeting audit, discrepancy, clinical case reviews, de-briefing Consultant Radiologist available 24/7 for advice/scanning/second opinion

19 in favour of Sonographers highly motivated individuals well trained well qualified professionally registered operate within a defined and accountable legal framework mandatory professional development proven record of skill and accuracy but they must be part of a clinical team!

20 A good sonographer makes ultrasound look supremely easy Hazel Edwards Ultrasound 2010