Letter to the editor: Who’s doing your scan? A European perspective on ultrasound services by Edwards and Sidhu

Dear Editors,

We were delighted to read the article ‘Who’s doing your scan? A European perspective on ultrasound services’ in the October issue of Ultraschall in der Medizin [1]. We congratulate the authors on an excellent article. The authors share their feelings on the “hot potato” of the practice barriers experienced by sonographers (medical and non-medical), within Europe, and its impact on patient care.

The article contrasts the mainland European model of physicians and radiologists doing ultrasound scans against the models used in Australia, Canada, the United Kingdom (UK) and United States of America (USA). The authors show non-medical sonographers in the two North America countries, Australia and five European countries have been integrated and “accepted” to undertake ultrasound scans. In these countries, the non-medical sonographers have limited independence. Based on their scans, reports are issued by physicians and/or radiologists [1]. In comparison, the UK non-medical sonographers’ practice has evolved since the 1980 s, through stages, to being independent reporting practitioners. These autonomous practitioners undertake and manage/lead ultrasound services in the National Health Service [2]. We feel, currently, the latter is the acceptable model to use, given ultrasound is practitioner dependent and the responsibility of issuing the report should be the sonographer doing the scan [2].

The authors highlight the turf battles that exist in mainland European institutions with physicians and radiologists opposing a system similar to the one practiced in the UK [1]. The points the authors raise are a reality locally in Malta. The patient may be scanned by:

• General practitioners (GPs), medical subspecialists and/or non-medical sonographers, with/out formal ultrasound training. They do gynaecology and obstetrics ultrasound scans.

• Radiologists, in the medical imaging (radiology) department, with formal ultrasound training. They carry out abdominal, breast and superficial structure ultrasound scans.

As with many other European countries this practice has been adapted since the early eighties when physicians / radiologists included ultrasound as a modality falling under their remit.

We feel for the benefit of patient care and safety, all sonography practice, throughout Europe, should be undertaken by qualified and regulated healthcare practitioners [1] [2] [3]. Two types of sonography practice should be used, so ultrasound is more accessible to patients requiring professional care:

1. Point of care (Level 1 and 2 [3]). Health centres (primary care), critical care, out-patients and in-patients (secondary care). Scan done by GPs, sub-speciality physicians and physician assistants [1] [4].

2. Expert opinion (Level 2 and 3 [3]). Referral to medical imaging departments (secondary/tertiary care). Scan done by medical and non-medical sonographers [1] [2] [5].

Further discussions should address sonography practice in Europe including its impact on patient care and the workforce within medical imaging departments. Changes in legislation and amendments to regulations, within European countries, may be required to allow autonomy for medical and non-medical sonographers. In summary, the article is an ice-breaker, adds to the knowledge base and should be an impetus for a paradigm shift (culture change) for health administrators and healthcare professions to face our fears.

• References

• 1 Edwards H, Sidhu P. Who's doing your scan? A European perspective on ultrasound services. Ultraschall in der Medizin – European Journal of Ultrasound 2017; 38: 479-482
• 2 Gibbs V. The long and winding road to achieving professional registration for sonographers. Radiography 2013; 19 (02) 164-167
• 3 EFSUMB. Minimum Training Recommendations. 2017 Available at http://www.efsumb.org/blog/?p=1687
• 4 Monti J. Revolution or Evolution? A Proposal for the Integration of Point-of-Care Ultrasound Into Physician Assistant Clinical Practice. The Journal of Physician Assistant Education 2017; 28: 27-32
• 5 Parker P, Wolstenhulme S. A workforce review in diagnostic ultrasound. Ultrasound 2012; 20 (03) 165-170