The Case for Sonographers - MIR-Online
The Case for Sonographers - MIR-Online
The Case for Sonographers - MIR-Online
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<strong>The</strong> <strong>Case</strong> <strong>for</strong> <strong>Sonographers</strong><br />
Dr Simon T Elliott<br />
Consultant Radiologist<br />
Freeman Hospital, Newcastle upon Tyne, UK
what is a sonographer<br />
role of the sonographer in<br />
non-obstetric obstetric ultrasound<br />
per<strong>for</strong>ming<br />
reporting<br />
advanced ultrasound techniques<br />
FNA, TRUS, CEUS<br />
based on UK experience
Controversy! What controversy<br />
Dr L Pourcelot, , EFSUMB Newsletter 1998<br />
sonographers:<br />
do US full time and take pride of their work<br />
participate in discussions with specialists<br />
are involved in physician & technician training<br />
are partners of physicians in research<br />
co-authors of >200 publications<br />
offer a very cost effective service<br />
French <strong>Sonographers</strong> – Oui ou Non
What is a Sonographer
UK National Profiles <strong>for</strong> Diagnostic<br />
& <strong>The</strong>rapeutic Radiography<br />
Salary €34,760 – €45,830 per annum
Job Evaluation Score<br />
<strong>for</strong> Reporting Sonographer
Health Professionals Council<br />
registers and regulates<br />
Allied Health Professionals<br />
• Radiographers<br />
• Clinical Scientists<br />
• Physiotherapists<br />
• Paramedics<br />
• Speech therapists<br />
• Podiatrists<br />
• etc…<br />
• Continuing Professional Development (CPD)<br />
• maintain up-to-date accurate record<br />
• mixed learning activities<br />
• CPD must contribute to quality and<br />
service delivery<br />
• CPD must benefit the user<br />
• present written profile on request
Sonographer Career Path<br />
school leaver / graduate<br />
Radiography BSc or MSc<br />
3 or 2 years<br />
University<br />
Sonography Diploma<br />
minimum 1 year<br />
College/University course<br />
Sonographer<br />
clinical department<br />
Consortium <strong>for</strong> the Accreditation of<br />
Sonographic Education (CASE)<br />
Reporting Sonographer<br />
Masters or PhD Consultant Sonographer
under current UK law<br />
there is no legal requirement<br />
<strong>for</strong> a Medical Practitioner<br />
to be trained or qualified in ultrasound
Surgeons per<strong>for</strong>ming ultrasound<br />
“the surgeon must only become familiar<br />
with a limited number of control functions<br />
to create excellent sonographic images”
Surgeons per<strong>for</strong>ming ultrasound<br />
<br />
<br />
<br />
<br />
survey of UK shoulder surgeons (respondents=89)<br />
23% used US routinely<br />
22% intended to use US soon<br />
training:<br />
none had completed RCR requirements<br />
10 short course<br />
5 shoulder surgery fellowship<br />
7 ‘a a video or a book’<br />
7 ‘other’<br />
Bidwai ASC, Casserly HB. Ultrasound 19:130-133, 2011
Sonographer per<strong>for</strong>mance<br />
<br />
<br />
1,046 non-obstetric obstetric exams by sonographers:<br />
94% reports accurate account of findings<br />
6.3% radiologist made additional comments<br />
0.7% was sonographer report significantly altered<br />
630/1,046 follow-up data available:<br />
1 false positive US finding<br />
no other significant inaccuracy<br />
An audit of the role of the sonographer in non-obstetric ultrasound<br />
Bates JA et al. Clin Radiol 9:617-20. 1994
Sonographer per<strong>for</strong>mance<br />
248 MSK US exams<br />
1 experienced sonographer v. 2 radiologists<br />
95% complete agreement<br />
2.8% major discrepancy<br />
likely to affect patient care<br />
Musculoskeletal ultrasound: audit of sonographer reporting<br />
Riley SJ et al. Ultrasound 18:36-40. 2010
Sonographer per<strong>for</strong>mance<br />
TRUS biopsy<br />
338 sonographer v. 414 radiologist biopsies<br />
no difference between 2 groups in<br />
positive detection rate<br />
complication rate<br />
re-biopsy rate<br />
waiting time decreased from 13 to 1 week<br />
National Radiology Service Improvement Programme, NHS Modernisation Agency<br />
December 2004
Sonographer per<strong>for</strong>mance<br />
FNA of neck masses: % adequacy<br />
thyroid<br />
non-thyroid<br />
Consultant<br />
Radiologist<br />
87.5% (41)<br />
86% (66)<br />
Sonographer<br />
no previous FNA experience<br />
71% (17)<br />
87% (23)<br />
Departmental audit Jan-Sep 2011, Freeman Hospital. A McQueen & B Stenberg
Sonographer per<strong>for</strong>mance<br />
1,510 exams (Toronto, Canada)<br />
74% overall concordance<br />
better <strong>for</strong> obstetric than abdominal<br />
concordance improved with sonographer<br />
experience<br />
“active role of physician is essential”<br />
<strong>Case</strong> <strong>for</strong> Active Physician Involvement in US Practice<br />
Chan V et al. Radiology 199:555-560. 1996
Delegation<br />
<br />
<br />
<br />
<br />
a request <strong>for</strong> an imaging exam is a normally a<br />
request <strong>for</strong> a medical opinion<br />
a Radiologist may delegate requests to a<br />
competent radiographer/sonographer<br />
delegation of tasks must be agreed in writing<br />
with the lead Clinical Radiologist<br />
defined; legally & professionally accountable<br />
General Medical Council<br />
Royal College of Radiologists<br />
RCR/SCoR: BFCR(07)1. 2007
My department<br />
<br />
<br />
<br />
<br />
<br />
7 reporting sonographers<br />
2 MSc; 2 MSK Diploma<br />
1 studying <strong>for</strong> MSc; 1 <strong>for</strong> PhD<br />
each sonographer must attend at least one<br />
national or international scientific meeting or<br />
training course per annum<br />
weekly team meeting<br />
audit, discrepancy, clinical case reviews, de-briefing<br />
Consultant Radiologist available 24/7 <strong>for</strong><br />
advice/scanning/second opinion
in favour of <strong>Sonographers</strong><br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
highly motivated individuals<br />
well trained<br />
well qualified<br />
professionally registered<br />
operate within a defined and accountable<br />
legal framework<br />
mandatory professional development<br />
proven record of skill and accuracy<br />
but they must be part of a clinical team!
“A good sonographer makes ultrasound<br />
look supremely easy”<br />
Hazel Edwards<br />
Ultrasound 2010
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