The Case for Sonographers Dr Simon T Elliott Consultant Radiologist Freeman Hospital, Newcastle upon Tyne, UK
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
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?
What is a Sonographer?
UK National Profiles for Diagnostic & Therapeutic Radiography Salary 34,760 45,830 per annum
Job Evaluation Score for Reporting Sonographer
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
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
under current UK law there is no legal requirement for a Medical Practitioner to be trained or qualified in ultrasound
Surgeons performing ultrasound the surgeon must only become familiar with a limited number of control functions to create excellent sonographic images
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 19:130-133, 2011
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 9:617-20. 1994
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 18:36-40. 2010
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
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
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 199:555-560. 1996
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)1. 2007
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
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!
A good sonographer makes ultrasound look supremely easy Hazel Edwards Ultrasound 2010