The focus of this issue of Applied Radiology is diagnostic
ultrasound. With the great advances of ultrasound, we have seen a
number of technological innovations that have led to improved
diagnostic ultrasound imaging. Real-time and color-flow
capabilities have improved, thus increasing diagnostic accuracy.
Recent advances such as power Doppler ultrasound contrast agents
have increased sonographic applications and will continue to
enhance the capability of ultrasound in the near future.
Concurrently, there has been a wide dispersion of ultrasound
services to a number of different users. In my experience, in many
situations, these exams are often in direct contrast to the
meticulous and well-documented exams performed by many imaging
groups. Individuals who have little or no training are using less
than optimal ultrasound equipment, and are often performing
examinations that are poorly documented. I have seen a number of
different examples of obvious misinterpretations by individuals who
have little knowledge or training in the field of sonography. One
such example I recently encountered was an advertisement for
"ultrasound for only $75.00." This ad was for "keepsake photos of
your baby" at each visit to their clinic. Such new "services"
reflect an evolution of almost a two-tiered system for the use of
ultrasound in the United States.
A number of ultrasound organizations have felt the need to
ensure a minimum level of competency and improve the practice of
ultrasound in the United States. Historically, a similar situation
existed a few years ago in mammography. There was wide variation in
the level of expertise, equipment, and product quality delivered to
patients for breast imaging. The American College of Radiology
(ACR) instituted a very successful program for accreditation of
mammography. This program has been adopted nationally under the
Mammography Quality Standards Act, which now requires mammography
accreditation. Ultrasound accreditation has been a little slower in
its inception, but different groups have an interest in increasing
its momentum. The Intersocietal Commission for Accreditation of
Vascular Labs (CAVL) was the first to develop a program for
accreditation of vascular laboratories. More recently, both the
American Institute Ultrasound in Medicine (AIUM) and the American
College of Radiology have launched global programs for
accreditation of ultrasound practices; the ACR has done this under
their umbrella accreditation program for imaging services. Both the
AIUM and the ACR have ultrasound accreditation in three categories.
These include I) general ultrasound; II) OB or OB/GYN ultrasound;
and III) vascular ultrasound.
When applying to these programs, an application workbook is
mailed to the interested practice. Application includes practice
demographics, records of physician and sonographer qualifications,
documentation of the type of equipment used, individuals training,
and questions concerning the facilities. Select images in each
category are requested to be returned with the application blank,
and are then reviewed by the accrediting agency's trained physician
reviewers.
To date, the ACR has accredited over 800 facilities, and the
AIUM has reviewed over 300. More recently, third party payors have
begun requiring either ACR or AIUM Accreditation for reimbursement
in ultrasound. One assumption is that other insurance carriers may
likewise look to these accreditation bodies for advice. More
information on these programs may be obtained by contacting:
Pamela Wilcox-Buchalia
Director of Accreditation
American College of Radiology
1891 Preston White Drive
Reston, VA 20191
Phone: (800) 770-0145
FAX: (703) 648-9176
E-mail: pamw@acr.org
Patricia Hooper
Acting Director of Accreditation
American Institute of Ultrasound in Medicine
14750 Sweitzer Lane, Suite 100
Laurel, MD 20707-5906
Phone: (301) 498-4100 & (800) 638-5352
FAX: (301) 498-4450
E-mail: phooper @aium.org
ICAVL
8840 Stanford Boulevard, Suite 4900
Columbia, MD 21045
Phone: (410) 872-0100
Dr. McGahan is Professor and Chief, Section of Abdominal Imaging
and Ultrasound at U.C. Davis Medical Center in Sacramento, CA; he
is also a member of the editorial advisory board of this
journal.