Ultrasound is unique among most imaging modalities. It is
relatively inexpensive--compared to CT or MRI, uses no
radiation--compared to radiography or CT, and yet it has the
ability to produce rather detailed images in both two-dimensions
and three-dimensions. These and other advantages of ultrasound have
brought about an explosion of users throughout the world.
Simultaneously, improvements in the technology have led to a number
of newer applications of sonography. Two of these useful
applications of ultrasound are included in this issue of
Applied Radiology
: "Infant Hip in Developmental Dysplasia: Facts to Consider for a
Successful Diagnostic Ultrasound Examination" and "Ultrasound, CT,
or DPL for Evaluation of Blunt Abdominal Trauma". However, despite
wider acceptance of sonography for these newer applications, the
experience level of the medical personnel and the equipment used by
these individuals may still be vastly different from facility to
facility, and this has brought about questions of quality,
standards, and customer satisfaction.
The consumer, that is the patient, has historically held a
great deal of trust that his or her physician is a highly trained
individual who will provide a high quality examination (in the case
of ultrasound, this means quality imaging and interpretation). As a
comparison, when we, as consumers, obtain an engine tune-up for our
cars, we hope that there is a standard among mechanics as to what
comprises this service and a minimum standard of training that
these individuals must achieve before being permitted to "operate"
on our vehicles. We, in the medical profession, must be concerned
with a similar question: "Can a patient who obtains an ultrasound
trust that the physician performing the exam has achieved at least
a minimum standard of training and has performed a thorough, high
quality ultrasound examination by industry standards?"
Unfortunately, in my experience, the answer is often "no".
As an example of not having a minimum standard of training in
ultrasound, one may wonder if a weekend- or day-long tutorial in
ultrasound could provide sufficient background and experience to
begin imaging patients with sonography? Though it wouldn't seem
adequate, there currently are a number of individuals who, without
other ultrasound experience, do just that. The patient undergoing
an ultrasound examination in such a case has no real mechanism to
know if their physician has had a day's training, a week's
training, or longer amounts of training and experience in
sonography. Most patients assume their physicians are impeccably
trained in the modality being performed on them, which is not
always true. I offer a personal example of this. Several years ago,
a physician enrolled in a week-long ultrasound tutorial held at our
institution. He had no prior experience in sonography. On the first
day of instruction, I spent a great deal of time trying to show him
the difference between the fetal head and the fetal abdomen. On the
second day we talked about equipment specifications, and on days 3
through 5 this trainee was a "no show." One month later, an
equipment salesperson called me to thank me for the sale made to
the trainee, who is now practicing ultrasound in an outlying
community. Could this trainee possibly have conformed to a minimum
standard?
There are certain similarities between the situation existing
presently within ultrasonography and that which previously existed
in mammography. To our credit, we physicians took it upon ourselves
to improve the quality of the practice of mammography in the United
States, and great strides are in the process of being made. The
similar situation with ultrasound originally occurred with
pioneering efforts of the Intersocietal Commission for
Accreditation of Vascular Labs (ICAVL) for Accreditation of
Vascular Ultrasound. More recently, both the American College of
Radiology (ACR) and the American Institute of Ultrasound in
Medicine (AIUM) completed comprehensive programs for accreditation
of the practice of OB/GYN, general, and vascular sonography. The
primary focus of these programs is to set some minimum standards
that must be met before an ultrasound practice can receive
accreditation. To this end, a large number of individuals and
practitioners have embraced ultrasound accreditation. To date, the
ACR has accredited 1,272 sites; the AIUM has accredited 426 sites.
Not surprisingly, third party payers or Medicare payers also are
beginning to recognize these efforts, and in certain states these
groups are beginning to require an ultrasound facility be
accredited in order to receive payment on ultrasound examinations.
While it is voluntary to obtain ultrasound accreditation, we must
praise both the individual practices who have obtained this
accreditation and those physicians and other medical personnel who
have made efforts to set up the accreditation programs. They merit
the trust of our patients, the respect of their colleagues, and are
directly responsible for the maintenance of quality
sonography.
More information may be obtained by contacting:
American College of Radiology
1891 Preston White Drive
Reston, VA 22091
(703) 715-4389 or (800) 227-5463 x. 4141
Fax: (703) 648-9176
AIUM
14750 Sweitzer Lane
Suite 100
Laurel, MD 20707-5906
(301) 498-4100 or (800) 638-5352
Fax: (301) 498-4450
http://www.aium.org
ICAVL
8840 Stanford Blvd.
Suite 4900
Columbia, MD 21045
(410) 872-0100
Fax: (410) 872-0030
Dr. McGahan is Director of Abdominal Imaging and Ultrasound
at the University of California-Davis Medical Center in
Sacramento, CA. He is also a member of the editorial advisory
board of this journal.