Editorial on the Current Role of Ultrasound

Ultrasound education across European Federation of Radiographers Societies (EFRS) countries: Similarities and differences

INTRODUCTION

Ultrasound education varies greatly across European healthcare systems. This paper focuses on ultrasound academic education as a part of wider suite of surveys on radiographers working in ultrasound. The aim was to investigate sonography educational levels, methods of training, course duration and other factors in European Federation of Radiographers Societies (EFRS) member countries.

METHOD

In 2019 an online survey was sent to the 38 EFRS member societies to distribute to higher education institutions within their own country. The survey was in English and contained different types of questions such as closed questions, free text options, and scale responses, to investigate sonography education including academic course types and duration, curriculum content, learning and teaching methods.

RESULTS

A total of 45 responses were received, showing wide variation in the duration of training between the respective countries. Academic level 7 (part-time) ultrasound education was most frequently reported (n = 13), followed by direct entry ultrasound courses (n = 9) and bachelor's degree programmes at EQF level 6 (n = 7). The duration of part-time courses ranged from nine months up to four years.

CONCLUSION

Sonography training and education varies among EFRS member countries ranging from short focused courses to postgraduate awards. Few countries offer sonography education leading to an award. The majority of clinical teaching and learning takes place in the learner's workplace.

IMPLICATIONS FOR PRACTICE

High quality academic and clinical education for radiographers extending their role into ultrasound is important to ensure safe, effective sonography practice and good patient care.

Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service

Background and Aims

The use of ultrasound screening is primarily facilitated by point-of-care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal.

Methods

Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH.

Results

In our sample, 60% of cases were related to biliary pathology, 20% were liver-related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables "Sonographic Murphy sign" (V = 0.859; p = 0.001), "Cholelithiasis/Gallbladder sludge" (V = 0.840; p = 0.001), and "Intrahepatic biliary tract dilatation" (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the "Sonographic Murphy sign" (k = 0.664; p = 0.001) and the presence of "Cholelithiasis/Gallbladder sludge" (k = 0.712; p = 0.000).

Conclusion

Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.

Role extension in advanced ultrasound practice: A framework approach and case study

Introduction

Role extension into novel areas of ultrasound practice can be challenging for health care professionals. Expansion into existing areas of advanced practice typically occurs using established processes and accredited training; however, in areas where there is no formal training, there can be a lack of support for how to develop new and progressive clinical roles.

Topic Description

This article presents how the use of a framework approach for establishing areas of advanced practice can support individuals and departments with safely and successfully developing new roles in ultrasound. The authors illustrate this via the example of a gastrointestinal ultrasound role, developed in an NHS department.

Discussion

The framework approach comprises three elements, each interdependent upon and inform each other: (A) Scope of practice, (B) Education and competency and (C) Governance. (A) Defines (and communicates) the role extension and area(s) of subsequent ultrasound imaging, interpretation and reporting. By identifying the why, how and what is required this informs (B) the education and assessment of competency for those taking on new roles or areas of expertise. (C) Is informed by (A) and is an ongoing process of quality assurance to safeguard high standards in clinical care. In supporting role extension, this approach can facilitate new workforce configurations, skill expansion and enable increasing service demands to be met.

Summary

By defining and aligning the components of scope of practice, education/competency and governance, role development in ultrasound can be initiated and sustained. Role extension utilising this approach brings benefits for patients, clinicians and departments.

A Review of Clinical Applications for Super-resolution Ultrasound Localization Microscopy

Microvascular structure and hemodynamics are important indicators for the diagnosis and assessment of many diseases and pathologies. The structural and functional imaging of tissue microvasculature in vivo is a clinically significant objective for the development of many imaging modalities. Contrast-enhanced ultrasound (CEUS) is a popular clinical tool for characterizing tissue microvasculature, due to the moderate cost, wide accessibility, and absence of ionizing radiation of ultrasound. However, in practice, it remains challenging to demonstrate microvasculature using CEUS, due to the resolution limit of conventional ultrasound imaging. In addition, the quantification of tissue perfusion by CEUS remains hindered by high operator-dependency and poor reproducibility. Inspired by super-resolution optical microscopy, super-resolution ultrasound localization microscopy (ULM) was recently developed. ULM uses the same ultrasound contrast agent (i.e. microbubbles) in CEUS. However, different from CEUS, ULM uses the location of the microbubbles to construct images, instead of using the backscattering intensity of microbubbles. Hence, ULM overcomes the classic compromise between imaging resolution and penetration, allowing for the visualization of capillary-scale microvasculature deep within tissues. To date, many in vivo ULM results have been reported, including both animal (kidney, brain, spinal cord, xenografted tumor, and ear) and human studies (prostate, tibialis anterior muscle, and breast cancer tumors). Furthermore, a variety of useful biomarkers have been derived from using ULM for different preclinical and clinical applications. Due to the high spatial resolution and accurate blood flow speed estimation (approximately 1 mm/s to several cm/s), ULM presents as an enticing alternative to CEUS for characterizing tissue microvasculature in vivo. This review summarizes the principles and present applications of CEUS and ULM, and discusses areas where ULM can potentially provide a better alternative to CEUS in clinical practice and areas where ULM may not be a better alternative. The objective of the study is to provide clinicians with an up-to-date review of ULM technology, and a practical guide for implementing ULM in clinical research and practice.

Effect of point-of-care gastrointestinal ultrasound on decision-making and management in inflammatory bowel disease

BACKGROUND

Gastrointestinal ultrasound is increasingly used for point of care assessment of inflammatory bowel disease.

AIMS

To explore the utility of gastrointestinal ultrasound as a point-of-care assessment tool from the perspectives of the clinician and patient.

METHODS

A prospective, observational cohort study was designed utilising routine outpatient consultations. Adult patients with inflammatory bowel disease were allocated to receive gastrointestinal ultrasound or not at the discretion of their treating clinician. Patients completed self-reported session experience questionnaires at study entry, immediately after their consultation, and 4 and 16 weeks later. Clinicians reported disease activity status, therapeutic decisions and clinical management.

RESULTS

Of 259 participants, mean age 40 (SD: 13) years, 54% male, 73 (28%) underwent ultrasound. Time since diagnosis was 9.2 (8.5) years (ultrasound) and 11.3 (9.2) years (no ultrasound). Immediately after ultrasound, patients who self-reported active disease reported better understanding of all aspects of their disease and disease symptoms were more confident in their ability to make informed decisions about managing their disease and had improved knowledge domain scores compared with the non-ultrasound group (all P < 0.05). Ultrasound had no influence over the patients' ability to manage their own healthcare but tended to be associated with transient improvement in medication adherence. After the ultrasound, the clinician's assessment of patient's disease activity changed in 22% (16/73) and management was altered in 56% (41/73) with anti-inflammatory therapy escalated in 33. About 47% (23/49) patients with Crohn's disease had their medication changed in the ultrasound group, compared to only 22% (25/112) in the nonultrasound group (P = 0.002). For patients with ulcerative colitis, medications were altered in 68% (15/22) compared to 26% (24/70) in the nonultrasound group (P = 0.005) When stratified for disease activity, medication change was more likely in those having ultrasound (P = 0.024).

CONCLUSIONS

Point-of-care gastrointestinal ultrasound has the potential to enhance the clinical management of inflammatory bowel disease by contributing to clinician decision-making and education of patients regarding their disease.

Radiographers in ultrasound: Motivation and role expansion. A survey of European Federation of Radiographer Societies (EFRS)

INTRODUCTION

Variability in non-medical ultrasound practice across Europe has been highlighted in studies. Meanwhile, advanced practice in radiography has undergone rapid development in the United Kingdom (UK). This survey aimed to review results relating to extended role and advanced practice skills, motivation and job satisfaction from a wider survey of radiographers undertaking ultrasound examinations across the European Federation of Radiographer Societies' (EFRS) community.

METHODS

Following a pilot study, a SurveyMonkey™ on-line questionnaire was disseminated to EFRS member societies to share with their members, and via social media platforms. Quantitative questions for this article related to extended and advanced practice skills, communication of results, job satisfaction, motivation and career development. Theme analysis was used to assess qualitative feedback concerning priorities for future developments within the ultrasound role.

RESULTS

There were 561 responses, mainly from the UK, Ireland and Spain (81%). The majority (83.4%) of UK sonographers communicate findings to patients, compared with 27.1% in other EFRS countries. More engage with teaching (UK = 90.1%, non-UK 72.9%) compared with activities in the other advanced practice domains. The lowest involvement was the research domain, with only 33% actively involved in research. Radiographers were motivated to undertake ultrasound to develop their knowledge and skills and assume more responsibility.

CONCLUSION

Wide variations in ultrasound practice were seen across respondent countries. Generally, radiographers are happy with their ultrasound roles, although priorities include legislation for the sonographer role, remuneration, respect or support from medical colleagues, high quality education and role progression opportunities.

IMPLICATIONS FOR PRACTICE

The findings provide a better understanding of radiographer views which can assist radiographer societies and local teams to develop strategies to enhance advanced practice skills development and career prospects in ultrasound.

The role of point of care ultrasound in radiology department: update and prospective. A statement of Italian college ultrasound

Ultrasound, in its new point-of-care conception, has been called the stethoscope of the future. Goal-directed bedside ultrasound examination, performed by a healthcare provider to answer a specific diagnostic question or guide an invasive procedure, is currently revolutionizing medical practice. It is used by various specialties in multiple clinical contexts for procedural, diagnostic, and screening applications. Point-of-care ultrasound is also a strategic technique in clinical radiology; it brings the radiologist closer to the patient (in interaction and understanding) like interventional and angiography procedures and, as an integrative imaging modality, is a vital radiological tool for decision-making in many situations. In this commentary, we present our observations on the use of ultrasound, in a sincere appeal to refrain from omitting ultrasound as a diagnostic technique in this era of deep professional change, in which radiologists must return to being a true clinical semiologist.

Spleen-left kidney ratio and liver-right kidney ratio: novel measures of normal liver, spleen, and kidney dimensions in Southwestern Nigerian children

PURPOSE

Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased.

METHODS

This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20.

RESULTS

The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337).

CONCLUSION

The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.