Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society

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.

Voices from the field: A qualitative exploration of sonography professionals in the United Arab Emirates through focus group discussions

INTRODUCTION

The practice of sonography in the United Arab Emirates is evolving rapidly. This study explores the professional landscape and challenges of sonography practice in the United Arab Emirates, focusing on identifying areas for improvement in education, practice scope, and professional development.

METHODS

Employing qualitative methodologies, using focus group discussions and thematic analysis, this research gathers insights from practicing sonographers across various healthcare settings in the UAE to assess current practices, educational needs, and workplace challenges.

RESULTS

Findings reveal a consensus among sonographers on the need for a structured professional framework, standardized education pathways, and clear career progression routes. Additionally, the study highlights a desire among sonographers for an expanded scope of practice, particularly in specialized areas, amidst challenges such as workload and equipment quality.

CONCLUSIONS

The study concludes that enhancing the sonography profession in the UAE requires a comprehensive approach that includes developing a regulatory framework, improving access to specialized training, and recognizing sonographers' advanced practice roles.

IMPLICATIONS OF PRACTICE

Recommendations include establishing accredited educational programs, developing a formal competency framework, and advocating for role expansion and professional recognition. These steps are essential for meeting the evolving needs of the healthcare system and improving patient care outcomes.

Analysis of neural networks for routine classification of sixteen ultrasound upper abdominal cross sections

PURPOSE

Abdominal ultrasound screening requires the capture of multiple standardized plane views as per clinical guidelines. Currently, the extent of adherence to such guidelines is dependent entirely on the skills of the sonographer. The use of neural network classification has the potential to better standardize captured plane views and streamline plane capture reducing the time burden on operators by combatting operator variability.

METHODS

A dataset consisting of 16 routine upper abdominal ultrasound scans from 64 patients was used to test the classification accuracy of 9 neural networks. These networks were tested on both a small, idealised subset of 800 samples as well as full video sweeps of the region of interest using stratified sampling and transfer learning.

RESULTS

The highest validation accuracy attained by both GoogLeNet and InceptionV3 is 83.9% using transfer learning and the large sample set of 26,294 images. A top-2 accuracy of 95.1% was achieved using InceptionV3. Alexnet attained the highest accuracy of 79.5% (top-2 of 91.5%) for the smaller sample set of 800 images. The neural networks evaluated during this study were also successfully able to identify problematic individual cross sections such as between kidneys, with right and left kidney being accurately identified 78.6% and 89.7%, respectively.

CONCLUSION

Dataset size proved a more important factor in determining accuracy than network selection with more complex neural networks providing higher accuracy as dataset size increases and simpler linear neural networks providing better results where the dataset is small.

The use of simulation in medical ultrasound: Current perspectives on applications and practical implementation (WFUMB state-of-the-art paper)

Simulation has been shown to improve clinical learning outcomes, speed up the learning process, and improve trainee confidence, while taking the pressure off initial face-to-face patient clinical areas. The second part of The World Federation for Ultrasound in Medicine and Biology state-of-the-art paper on the use of simulators provides a general approach on the practical implementation. The importance of needs assessment before developing a simulation-based training program is outlined. We describe the current practical implementation and critically analyze how simulators can be integrated into complex task scenarios to train small or large groups. A wide range of simulation equipment is available especially for those seeking interventional ultrasound training, ranging from animal tissue models, simple synthetic phantoms, to sophisticated high-fidelity simulation platforms using virtual reality. Virtual reality simulators provide feedback and thereby allow trainees to not only to practice their motor skills and hand eye coordination but also to interact with the simulator. Future developments will integrate more elements of automated assessment and artificial intelligence, thereby enabling enhanced realistic training experience and improving skill transfer into clinical practice.

Exploring the use of knobology for image optimisation in final year sonography students

Introduction

Image optimisation is essential for acquisition of quality images in ultrasound and critical to the diagnostic ability of the examination. These skills are taught to sonography students early in their education, but research has found that retention of non-rehearsed knowledge decreases significantly after a year. The aim of this study was to determine which optimisation tools (knobology) final year sonography students use, how often and why they chose to adjust parameters and assess barriers to optimisation of knobology tools.

Methods

A prospective study using data from an anonymous online survey of 34 final year sonography students.

Results

Survey results showed that 19/34 (55%) of students "frequently" optimise all Doppler settings and 23/34 (67%) of students "frequently" optimise basic parameter settings (depth, focus, time gain compensation). Time constraints (24/34 (70%)) and loss of gained knowledge of sonography principles and instrumentation (17/34 (50%)) were the major barriers to the use of knobology. The majority 28/34 (82%) believed they would benefit from further training.

Conclusion

This study demonstrates that although most students are optimising settings to improve image quality, sonography principles and instrumentation knowledge loss and time constraints prevent students from maximising machine capabilities. This study supports the need for further training prior to final year clinical placement.

Tele-ultrasound in the Era of COVID-19: A Practical Guide

Telemedicine has evolved over the past 50 years, with video consultations and telehealth (TH) mobile apps that are now widely used to support care in the management of chronic conditions, but are infrequently used in acute conditions such as emergencies. In the wake of the COVID-19 pandemic, demand is growing for video consultations as they minimize health provider-patient interactions and thereby the risk of infection. Advanced applications such as tele-ultrasound (TUS) have not yet gained a foothold despite their achieving technical maturity and the availability of software from numerous companies for TUS for their respective portable ultrasound devices. However, ultrasound is indispensable for triage in emergencies and also offers distinct advantages in the diagnosis of COVID-19 pneumonia for certain patient populations such as pregnant women, children and immobilized patients. Additionally, recent work suggests lung ultrasound can accurately risk stratify patients for likely infection when immediate polymerase chain reaction (PCR) testing is not available and has prognostic utility for positive patients with respect to the need for admission and intensive care unit (ICU) treatment. Though currently underutilized, a wider implementation of TUS in TH applications and processes may be an important stepping-stone for telemedicine. The addition of ultrasound to TH may allow it to cross the barrier from being an application used mainly for primary care and chronic conditions to an indispensable tool used in emergency care, disaster situations, remote areas and low-income countries where it is difficult to obtain high-quality diagnostic imaging. The objective of this review was to provide an overview of the current state of telemedicine, insights into current and future use scenarios, its practical application as well as current TUS uses and their potential value with an overview of currently available portable and handheld ultrasound devices. In the wake of the COVID-19 pandemic we point out an unmet need and use case of TUS as a supportive tool for health care providers and organizations in the management of affected patients.

Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists' experiences of lung ultrasound training and its adoption in critical care

Introduction

Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS.

Methods

Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed.

Results

Five main themes emerged from the participants' responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists' motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars.

Conclusion

Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways.

Ultrasound clinical teaching capacity in England: A scoping exercise

INTRODUCTION

The United Kingdom has a sonographer shortage. Health Education England are working with stakeholders to address these shortages and increase clinical capacity for sonographer education. The aims of this survey were to ascertain current sonographer staffing levels, estimate staffing requirements in five years' time and review current clinical placement capacity.

METHODS

An on-line survey was used to explore the aims of the study. Questions included current and predicted sonographer staffing requirements and clinical capacity for teaching ultrasound. Free text comments were available for expanding on responses.

RESULTS

Of 72 completed responses the mean sonographer vacancy rate was 2.65 and the predicted number of sonographers needed to provide the service in five years was 4.6. Departments were teaching an average of two sonographers and 2 non-sonographers. A small number of departments had further capacity for sonography student training which was not being utilised for reasons including limited capacity, inadequate staffing levels or competing demands of teaching other health care professionals. Extended working days and weekend training lists were used to increase capacity, along with rolling programmes for teaching sonographers and the use of simulation.

CONCLUSION

The survey supported previous publications that have shown sonographer shortages in England and this is predicted to increase over the next five years. Departments were teaching a similar number of sonographers as other health care professionals. Many experienced competing demands, which challenged their ability to increase clinical capacity.

IMPLICATIONS FOR PRACTICE

Suggestions for increasing capacity are provided to help grow the sonography workforce. With the advent of new sonography programmes the departments with spare capacity could be utilised to support clinical practice for sonography students in need of a placement on a direct entry programme.

Charting the practical dimensions of understaffing from a managerial perspective: The everyday shape of the UK's sonographer shortage

INTRODUCTION

Across the last two decades, ultrasound services in many healthcare sectors have become increasingly pressurised as a consequence of upsurging demand and difficulties in recruiting viable clinicians. Indeed by 2013, the UK government's Migration Advisory Committee had listed sonography as an official 'shortage specialty'. Comparatively little research has to date, however, explored the impacts of this situation upon the departments themselves, and the individuals working therein. The core purpose of this study is, thus, to lend qualitative depth to current understandings of the frontline situation in the UK's ultrasound units, many of which are understaffed, from the perspective of their managers.

METHODS

Using a thematic analysis informed by a Straussian model of Grounded Theory, N = 20 extended accounts provided by ultrasound department leads in public (n = 18) and private (n = 2) units were explored.

RESULTS

Four global themes emerged from the analysis of which the first two (the broadly sociological matters) are described in this paper. Theme 1 addresses how a lack of staff in the broader ultrasound economy has created a troublesome migratory system in contemporary UK ultrasound. Theme 2 addresses how this economy works chiefly to the advantage of the most junior and the most senior clinicians, often leaving mid-career professionals in the borderline impossible situation of having to concurrently occupy both junior and senior roles.

CONCLUSIONS

The findings ideally open up debate on some key practical contingencies of the UK's sonographer shortage, and reflect upon literature regarding the nuanced aspects of a shifting healthcare workplace constitution.

The clinical ultrasound report: Guideline for sonographers

The reporting roles of sonographers in Australasia vary considerably. A large number of sonographers already routinely produce formal reports, while others are moving into clinical ultrasound roles where reporting is expected. This article summarises the best practice in reporting of ultrasound examinations based on international literature and addresses key topics including report structure, clinical content, style and language. Numerous examples and sample phrases are provided and common pitfalls are discussed.

Training Midwives to Perform Basic Obstetric Point-of-Care Ultrasound in Rural Areas Using a Tablet Platform and Mobile Phone Transmission Technology-A WFUMB COE Project

Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, review of images by a radiologist, communication between midwife and radiologist, use of this technique to identify high-risk patients and improvement of the education and teleradiology model components. The midwives had no previous experience in ultrasound. They were stationed in rural locations where POCUS was available for the first time. After scanning the patients, an interim report was generated by the midwives and sent electronically together with all images to the main hospital for validation. Unique software was used to send lossless images by mobile phone using a modem. Transmission times were short and quality of images transmitted was excellent. All reports were validated by two experienced radiologists in our department and returned to the centers using the same transmission software. The transmission times, quality of scans, quality of reports and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 min but reduced to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the pregnancies and diagnoses on the basis of reports generated by the midwives. Only 1 discrepancy was found in the midwives' reports. Scan results versus actual outcomes revealed 2 discrepancies in the 20 patients identified as high risk. In conclusion, we found that it is valuable to train midwives in POCUS to use an ultrasound tablet device and transmit images and reports via the internet to radiologists for review of accuracy. This focus on the identification of high-risk patients can be valuable in a remote healthcare facility.