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Appendix 2


There is an ever increasing demand for the provision of ultrasound examinations at the ‘point of care’ where ultrasound is being used as a ‘tool’ to support a particular care or treatment pathway. Examples are numerous and include lithotripsy, gynaecological brachytherapy and  transcranial Doppler.

There is a shortage of qualified sonographers in the United Kingdom at present and there are not enough qualified staff available to train for or participate in examinations such as those listed above. The minimum qualification to become recognised as a sonographer, as recommended by the Consortium for the Accreditation of Sonographic Education (CASE) is a postgraduate certificate or diploma in medical ultrasound or equivalent.

In view of the shortage of sonographers and in order that care and treatment pathways are not compromised  local arrangements to provide these types of examination may need to be established, utilising staff who do not hold CASE accredited postgraduate certificates and diplomas.

The National Ultrasound Steering Group (a sub-group of the National Imaging Board) published ‘Ultrasound Clinical Governance’ in October 2008. This document gives advice on clinical governance issues and states that ultrasound can pose a significant clinical risk if examinations are undertaken by untrained or poorly trained individuals, the equipment is poorly specified or poorly maintained and if it is undertaken in the absence of clinical audit of performance.  It is important that the introduction of new services is evidence based and that expensive ultrasound equipment is properly utilised. 

The following should specifically apply and reference should also be made to the above document.

i) Those performing the examinations should have followed an ‘in-house’ course approved by
the Trust/Board management and delivered by appropriately qualified individuals. Such
courses should carry CASE or College of Radiographer’s approval or endorsement. If a
suitable CASE accredited ‘focused’ ultrasound course is available and accessible to the
student  this should be used in preference to a course designed ‘in-house’ 

  1. Examinations must take place within a recognised care management framework.
  2. There should be written protocols and schemes of work in place and the delegation of responsibility clearly articulated
  3. The members of staff involved must be assessed before scanning unsupervised to ensure they are competent to perform the task
  4. The safety aspects associated with diagnostic ultrasound exposure should be included in the training and due consideration given to the reduction of risk of musculo-skeletal injury to the person performing the examination
  5. There should be audit of performance and opportunities updating, both on a regular basis.
  6. The staff involved should be aware that their training may not be transferable to other departments
  7. The frequency with which the specific ultrasound examinations are carried out should be
  8. such that competency can be maintained.

1  CASE is a consortium comprising The British Medical Ultrasound Society, The British Society of Echocardiography, The College of Radiographers, The Institute of Physics and Engineering in Medicine, The Royal College of Midwives and the Society of Vascular Technology for Great Britain and Ireland.
2  Ultrasound Clinical Governance, National Ultrasound Steering Group. October 2008

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