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Avant-garde?Avant-garde?
Is ultrasound forward-Is ultrasound forward-thinking? thinking?
Cindy Allen Cindy Allen MSHS, RT-R, RDMS, RVT MSHS, RT-R, RDMS, RVT
Objectives Objectives
Recognize traditional and new users of Recognize traditional and new users of ultrasound.ultrasound.
Recall high-tech uses of ultrasound with EUS, Recall high-tech uses of ultrasound with EUS, combination imaging, elastography, 4D. combination imaging, elastography, 4D.
Realize ultrasound growth potential. Realize ultrasound growth potential.
Recall screening potential of u/s for disease. Recall screening potential of u/s for disease.
Know where to research information regarding Know where to research information regarding the profession. the profession.
““Traditional” Traditional”
Radiology Radiology
OB/GYN – MFM OB/GYN – MFM
Cardiology Cardiology
Vascular Surgery Vascular Surgery
““Newbies” Newbies”
Orthopedics – 1970’sOrthopedics – 1970’s
Rheumatology – 1980’sRheumatology – 1980’s
Sports Medicine - 1970s Sports Medicine - 1970s
Anesthesiology – 1980sAnesthesiology – 1980s
Internal Medicine – 1990 Internal Medicine – 1990
Family Medicine – 2000sFamily Medicine – 2000s
Surgeons -1990sSurgeons -1990s
Emergency Medicine -Emergency Medicine -1980s 1980s
Endocrinology Endocrinology
Nephrology Nephrology
IV Therapy nurses IV Therapy nurses
Respiratory therapy Respiratory therapy
Musculoskeletal Imaging Musculoskeletal Imaging
““Newbies” Newbies”
Orthopedics Orthopedics
Rheumatology Rheumatology
Sports Medicine Sports Medicine
Podiatrist Podiatrist
Musculo-Skeletal UltrasoundMusculo-Skeletal Ultrasound200% 200% ↑ MSK 1996-2006 ↑ MSK 1996-2006 based on CPT codesbased on CPT codes
Radiologist-based MSK exams only grew 42% (1996-Radiologist-based MSK exams only grew 42% (1996-2006) 2006) – Operator-dependent, equipment- dependent Operator-dependent, equipment- dependent – Concern about learning curveConcern about learning curve– Sonographers – learning anatomy and pathology Sonographers – learning anatomy and pathology – Musculoskeletal radiologists comfort with ultrasoundMusculoskeletal radiologists comfort with ultrasound– If…ultrasound paid better than MRI?If…ultrasound paid better than MRI?
– Erik L. RidleyErik L. Ridley AuntMinnie January 20, 2009 AuntMinnie January 20, 2009
Away from Radiology? Away from Radiology?
““If radiologists don't perform If radiologists don't perform musculoskeletal ultrasound, others will” musculoskeletal ultrasound, others will”
Diagnostic referrals and therapeutic Diagnostic referrals and therapeutic procedures are at riskprocedures are at risk
Most MSK radiologists are not ultrasound Most MSK radiologists are not ultrasound modality aware modality aware
Lack of ACR supportLack of ACR supportErik L. RidleyErik L. Ridley AuntMinnie January 20, 2009 AuntMinnie January 20, 2009
US Directly Benefits the Clinician US Directly Benefits the Clinician
Clinical evaluation and imaging in one visitClinical evaluation and imaging in one visitExtension of the physical examExtension of the physical examReduce costly MRI studies Reduce costly MRI studies Provide guidance for interventions Provide guidance for interventions Clinical physicians have an appreciation of Clinical physicians have an appreciation of disease states and functional anatomy disease states and functional anatomy Clinicians know the clinical history and Clinicians know the clinical history and differential diagnosisdifferential diagnosisIncrease patient convenienceIncrease patient convenience
– Erik L. RidleyErik L. Ridley AuntMinnie January 20, 2009 AuntMinnie January 20, 2009
Central/Peripheral Venous Central/Peripheral Venous Catheterization Catheterization
Implementation: Implementation: Anywhere an IV is inserted Anywhere an IV is inserted
centrally or peripherallycentrally or peripherally
Addressing a HealthCare ProblemAddressing a HealthCare ProblemCentral Line InfectionsCentral Line Infections
According to the Centers for Disease Control According to the Centers for Disease Control (CDC), there are > 80,000 infections/year.(CDC), there are > 80,000 infections/year.
IV tube, containing bacteria is inserted into a IV tube, containing bacteria is inserted into a large vein and infects the patient’s bloodstream. large vein and infects the patient’s bloodstream.
Cost the nation Cost the nation ≤≤ $2.3 billion. $2.3 billion.
Result in 20,000 deaths/year in intensive care Result in 20,000 deaths/year in intensive care units in the U.S. (2002) units in the U.S. (2002)
http://www.nchc.org/facts/quality.shtmlhttp://www.nchc.org/facts/quality.shtml
CVC CVC
Parenteral NutritionParenteral Nutrition
Intravascular depletion Intravascular depletion
Access for medications Access for medications
Hemodynamic monitoring Hemodynamic monitoring
IV accessIV access
Explosion – CVC Explosion – CVC
Preventable injuries related to CVC Preventable injuries related to CVC (Central Vascular Catheters) (Central Vascular Catheters) – Wire or Catheter Embolus Wire or Catheter Embolus – Cardiac Tamponade Cardiac Tamponade – Carotid Artery Cannulation or Puncture Carotid Artery Cannulation or Puncture – Hemothorax Hemothorax – Pneumothorax Pneumothorax
Source: Domino, K. et. Al. Source: Domino, K. et. Al. Injuries and Liability Injuries and Liability Related to Central Vascular Catheters.Related to Central Vascular Catheters. Anesthesiology. June 2004. Anesthesiology. June 2004.
Central Venous Catheterization Central Venous Catheterization
SOAP-3 trial SOAP-3 trial – Dynamic ultrasound had odds 53.5% higher Dynamic ultrasound had odds 53.5% higher
than landmark technique for access. (Milling, than landmark technique for access. (Milling, Critical Care Medicine, 2005) Critical Care Medicine, 2005)
Critical Care Ultrasound Critical Care Ultrasound
Intensivist, Pulmonologist, Intensivist, Pulmonologist, Internal Medicine, Family Internal Medicine, Family Medicine, Nephrologist, Medicine, Nephrologist,
Anesthesiologist, Primary CareAnesthesiologist, Primary Care
Importance Importance
Extension of bedside examinationExtension of bedside examination– Focused, targeted exam Focused, targeted exam
Increased safety of procedures Increased safety of procedures Not feasible for 24/7 coverage by Not feasible for 24/7 coverage by sonographer/cardiologist/radiologist. sonographer/cardiologist/radiologist. Proficiency in use of ultrasound to guide central line placement and thoracentesis is strongly recommended by American Board of Internal Medicine. www.abim.org
American Society of American Society of Echocardiography Echocardiography
Level 1 training Level 1 training – 150/75 exams (Imaging/Doppler)150/75 exams (Imaging/Doppler)– Introductory Level Introductory Level
Level 2 training Level 2 training – 150/150 exams (Imaging/Doppler)150/150 exams (Imaging/Doppler)– Ability to take call, Interpret Ability to take call, Interpret
Level 3 trainingLevel 3 training– Sufficient expertise to direct an echocardiography Sufficient expertise to direct an echocardiography
laboratorylaboratory- 450 examinations (using both imaging and Doppler)- 450 examinations (using both imaging and Doppler)
Explosion – Critical Care Explosion – Critical Care
Hemodynamic instability Hemodynamic instability – Ventricular failure -Hypovolemia Ventricular failure -Hypovolemia – PE - Cardiac Tamponade PE - Cardiac Tamponade – Acute valvular dysfunction Acute valvular dysfunction – Complications post-op Complications post-op
Infective endocarditis Infective endocarditis
Aortic dissection, rupture Aortic dissection, rupture
Unexplained hypoxia Unexplained hypoxia
Source of emboli Source of emboli
Explosion – Critical CareExplosion – Critical Care
Pericardiocentesis, Thoracentesis, etc. Pericardiocentesis, Thoracentesis, etc.
Urinary Bladder scan Urinary Bladder scan
Focused Assessment of the Trauma Focused Assessment of the Trauma patient patient
Intra-aortic balloon counter-pulsationIntra-aortic balloon counter-pulsation
Pleural effusion evaluationPleural effusion evaluation
Pneumothorax Pneumothorax
Impact Impact
Targeted exam, not a replacement for Targeted exam, not a replacement for complete exam complete exam
Immediate diagnosis for the patient Immediate diagnosis for the patient
Treatment, quicker Treatment, quicker
Emergency MedicineEmergency Medicine
Trauma Surgeon, Emergency Trauma Surgeon, Emergency Physician Physician
Explosion – Emergency Medicine Explosion – Emergency Medicine
eFAST – extended Focused Assessment for eFAST – extended Focused Assessment for Sonography in Trauma. Sonography in Trauma. – Pleura slide Pleura slide – Subcostal 4 chamber Subcostal 4 chamber – Hepatorenal space (AKA Morrison’s pouch) Hepatorenal space (AKA Morrison’s pouch) – Splenorenal spaceSplenorenal space– Bladder Bladder
Ectopic pregnancy Ectopic pregnancy Abdomen Abdomen Cardiac Emergencies Cardiac Emergencies
Importance Importance
Point of care ultrasound in the Emergency Point of care ultrasound in the Emergency Department “improved patient care by Department “improved patient care by decreasing cost, length of stay and decreasing cost, length of stay and lowering mortality.” Melniker, L. 2006lowering mortality.” Melniker, L. 2006
Average fast exam time is 2.5 minutes, Average fast exam time is 2.5 minutes, varying from 2-10 minutes. varying from 2-10 minutes.
Implications Implications
Established ultrasound training programsEstablished ultrasound training programs
Residency programs for Emergency Residency programs for Emergency Medicine incorporate ultrasound training in Medicine incorporate ultrasound training in the US.the US.
Implementing ultrasound in care for > 20 Implementing ultrasound in care for > 20 years. years.
American College of Emergency American College of Emergency Physicians (ACEP) Physicians (ACEP)
Need for emergency ultrasound imaging on a Need for emergency ultrasound imaging on a 24-hour basis and that emergency room 24-hour basis and that emergency room physicians should perform such examinations.physicians should perform such examinations.(2001) (2001) 16-hour initial comprehensive course with 16-hour initial comprehensive course with foundation in emergency ultrasoundfoundation in emergency ultrasound≥ ≥ 25 -50 documented, reviewed cases in each 25 -50 documented, reviewed cases in each primary application: Trauma, IUP, Emergency primary application: Trauma, IUP, Emergency Cardiac, AAA, Biliary, Renal, DVT, Vascular Cardiac, AAA, Biliary, Renal, DVT, Vascular Access, etc. Access, etc.
ImplicationsImplications
Documented 15% decrease in length-of-Documented 15% decrease in length-of-stay of patients with gallbladder stay of patients with gallbladder examinations for experienced physicians examinations for experienced physicians (>100 gallbladder scans) compared with (>100 gallbladder scans) compared with on-call sonographer. (Blaivas, Academic on-call sonographer. (Blaivas, Academic Emergency Medicine, 1999) Emergency Medicine, 1999)
Implications Implications
Residents Learn to Use Hand-Held Residents Learn to Use Hand-Held Echocardiography at Bedside (Helman, Echocardiography at Bedside (Helman, The American Journal of Medicine, 2005) The American Journal of Medicine, 2005) – 30 residents studied 30 residents studied – One-on-one supervision given One-on-one supervision given Findings of needs: Findings of needs: – Minimum of 20 training studiesMinimum of 20 training studies– 3-5 directly supervised 3-5 directly supervised – 20 hours didatic 20 hours didatic
Implications Implications
DVT study: of 156, 34 diagnosed with DVT DVT study: of 156, 34 diagnosed with DVT with 99% agreement. ED time: 95 with 99% agreement. ED time: 95 minutes, triage to disposition: 220 minutes, triage to disposition: 220 minutes. (Theodoro, The American minutes. (Theodoro, The American Journal of Emergency Medicine, 2004) Journal of Emergency Medicine, 2004)
Radiology Studies Affected Radiology Studies Affected
Impact of Emergency Medicine Resident Impact of Emergency Medicine Resident Training in Ultrasonography on Ultrasound Training in Ultrasonography on Ultrasound Utilization. Michael Heller. 1999. Utilization. Michael Heller. 1999. – A significant increase (from 5.8% to 9.8%) A significant increase (from 5.8% to 9.8%)
Global trend Global trend
Awareness of indications and reason for Awareness of indications and reason for abdominal ultrasounds abdominal ultrasounds
Validity of emergency medicine findings Validity of emergency medicine findings
Confirm positive or negative findings Confirm positive or negative findings
AnesthesiologyAnesthesiology
Peripheral Nerve Blocks and Peripheral Nerve Blocks and Cardiothoracic MonitoringCardiothoracic Monitoring
Explosion – Anesthesiology Explosion – Anesthesiology
Cardiothoracic (TEE)Cardiothoracic (TEE)– ASD/VSD repairs ASD/VSD repairs – Valve replacement Valve replacement – CABGCABG
Nerve blocks Nerve blocks – Peripheral (Orthopedic surgery) Peripheral (Orthopedic surgery) – Abdominal (Hernia repairs, etc) Abdominal (Hernia repairs, etc)
Importance Importance
TEE: Monitoring patient during surgery to TEE: Monitoring patient during surgery to improve outcomeimprove outcome
Ultrasound-guided nerve blocks: Ultrasound-guided nerve blocks: – Increase safetyIncrease safety– Increased success of block Increased success of block
Without ultrasound, 60-95% (Neal, 2002) Without ultrasound, 60-95% (Neal, 2002)
With ultrasound, 80-100% (Schwemmer, 2006) With ultrasound, 80-100% (Schwemmer, 2006)
– Knowledge of anesthetic spread Knowledge of anesthetic spread – Decrease pain and discomfort Decrease pain and discomfort – Shorter ambulation time Shorter ambulation time
Healthcare Impact Healthcare Impact
Peripheral Nerve Blocks: Nerve Peripheral Nerve Blocks: Nerve Stimulator versus Ultrasound Stimulator versus Ultrasound
Sandhu, et. al calculated a minute of Sandhu, et. al calculated a minute of surgical time cost $8.00 (2004) surgical time cost $8.00 (2004)
Based on quicker, more accurate onset, a Based on quicker, more accurate onset, a successful ultrasound-guided nerve block successful ultrasound-guided nerve block saves $160.00 per patient. saves $160.00 per patient.
ImportanceImportance
Organized training for physicians by Organized training for physicians by physicians physicians
Guidelines for TEE training through Guidelines for TEE training through residency residency
Guidelines for nerve block training through Guidelines for nerve block training through residency residency
Ultrasound Is…Ultrasound Is…
Ultrasound is…Ultrasound is…
Pattern recognitionPattern recognition
Today’s ImagingToday’s Imaging
We see a mass and we look for size, We see a mass and we look for size, shape, location. We can get growth data. shape, location. We can get growth data.
What if: What if: – We could establish whether or not the mass is We could establish whether or not the mass is
malignant? malignant? – What if the ultrasound were capable of What if the ultrasound were capable of
distinguishing a pattern of a disease process distinguishing a pattern of a disease process from a normal person? from a normal person?
Futuristic Use of Ultrasound Futuristic Use of Ultrasound
Delivery of therapeutic drugs directly into Delivery of therapeutic drugs directly into the body where they need to be the body where they need to be – Selective introduction of drugs into diseased Selective introduction of drugs into diseased
tissue tissue – Activated by sound Activated by sound – Sonoluminescene (light from sound) dates to Sonoluminescene (light from sound) dates to
1930, but technology is coming to age1930, but technology is coming to age– May be ten years awayMay be ten years away
– Don Baker, December 31, 2008 SDMS News Wave Don Baker, December 31, 2008 SDMS News Wave
4D 4D
Ultrasound Contrast Ultrasound Contrast
Detection of liver mets Detection of liver mets Improved imaging with cirrhosis Improved imaging with cirrhosis Potential for assessment of buried grafts Potential for assessment of buried grafts
following oropharynx surgeryfollowing oropharynx surgeryScreen for calf peripheral artery diseaseScreen for calf peripheral artery diseaseMalignant vs. benign renal tumors Malignant vs. benign renal tumors
Imagify Imagify
Declined by FDA November 2008Declined by FDA November 2008
The product was administered to 1,194 subjects, The product was administered to 1,194 subjects, including 911 patients with known or suspected including 911 patients with known or suspected coronary artery disease coronary artery disease – 1% (11/911) reported serious adverse events 1% (11/911) reported serious adverse events
3 patients experienced vasovagal syncope. 3 patients experienced vasovagal syncope.
– 4% (38/911) experienced hypotension or decreased 4% (38/911) experienced hypotension or decreased blood pressure blood pressure
– 2% (16/911) had exam permanently discontinued 2% (16/911) had exam permanently discontinued because of adverse events. because of adverse events.
Support Ultrasound Contrast Support Ultrasound Contrast
Join International Contrast Ultrasound Join International Contrast Ultrasound Society Society Objective: The promotion of safe and Objective: The promotion of safe and efficacious use of contrast-enhanced efficacious use of contrast-enhanced ultrasound (CEUS) in patients with diverse ultrasound (CEUS) in patients with diverse medical profiles and disease states. medical profiles and disease states. Free membership Free membership http://www.sonoworld.com/sonoworld/http://www.sonoworld.com/sonoworld/icus/Forms/ICUS_Letter-Form.PDFicus/Forms/ICUS_Letter-Form.PDF
Fusion Imaging Fusion Imaging
Researchers are working to perfect a fusion of Researchers are working to perfect a fusion of technologies to provide imaging: technologies to provide imaging: Non-ionizing Non-ionizing Higher dosesHigher doses to the tumor and periphery to the tumor and periphery Accurate dailyAccurate daily patient positioning patient positioning Dose escalationDose escalation in a given session in a given session Real-time targetingReal-time targeting of tumors and tumor beds of tumors and tumor beds Image-fusionImage-fusion between various visualization between various visualization modes (MRI, Ultrasound) modes (MRI, Ultrasound) On-line treatmentOn-line treatment planning planning procedures/protocols procedures/protocols
High Intensity Focused Ultrasound High Intensity Focused Ultrasound to fight Cancer to fight Cancer
The new findings from animal experiments suggest that The new findings from animal experiments suggest that once activated by the ultrasound, the once activated by the ultrasound, the immune system immune system might even seek and destroy might even seek and destroy cancer cells cancer cells , including , including those that have spread through the bloodstream to lurk those that have spread through the bloodstream to lurk in other parts of the body.in other parts of the body.This high-intensity focused ultrasound, or HIFU, is in use This high-intensity focused ultrasound, or HIFU, is in use or testing in China, Europe and the United States to kill or testing in China, Europe and the United States to kill tumors by heating them. But Duke researchers now find tumors by heating them. But Duke researchers now find that HIFU might work even better if it is first delivered in that HIFU might work even better if it is first delivered in a manner that just shakes the cells. That shaking a manner that just shakes the cells. That shaking ruptures tumor cell membranes, causing them to spill ruptures tumor cell membranes, causing them to spill their contents. The toxic spill then alerts the immune their contents. The toxic spill then alerts the immune system to the cancer threat, leading to the production of system to the cancer threat, leading to the production of tumor-fighting white blood cells.tumor-fighting white blood cells.
http://www.physorg.com/news105711171.htmlhttp://www.physorg.com/news105711171.html
Elastography Elastography
A non-invasive method in which stiffness A non-invasive method in which stiffness or strain images of soft tissue are used to or strain images of soft tissue are used to detect or classify tumors. detect or classify tumors. A tumor or a suspicious cancerous growth A tumor or a suspicious cancerous growth is normally 5-28 times stiffer than the is normally 5-28 times stiffer than the background of normal soft tissue. background of normal soft tissue. When a mechanical compression or When a mechanical compression or vibration is applied, the tumor deforms vibration is applied, the tumor deforms less than the surrounding tissue. less than the surrounding tissue.
Acoustic Radiation Force Impulse Acoustic Radiation Force Impulse Imaging (ARFI) – Research onlyImaging (ARFI) – Research onlyBreast mass imaging Breast mass imaging Colorectal tumor Imaging/Staging Colorectal tumor Imaging/Staging Liver Fibrosis quantification Liver Fibrosis quantification Imaging RF ablation lesions Imaging RF ablation lesions Artery characterization Artery characterization Cardiac imaging Cardiac imaging Prostate imaging Prostate imaging Thermal therapy Thermal therapy In vivo imaging of malignant tumors In vivo imaging of malignant tumors
Wikipedia.org Wikipedia.org
Screening Services Screening Services
Impact of AAA Impact of AAA
Positive for AAA: Positive for AAA: – Smoking Cessation Program Smoking Cessation Program – Follow-up at 6 months if 4.0-5.4 cm Follow-up at 6 months if 4.0-5.4 cm
Looking for variations of > 0.5 cm Looking for variations of > 0.5 cm
– Preliminary medication studies for Preliminary medication studies for Doxycycline, Macrolide antibiotics, Statins and Doxycycline, Macrolide antibiotics, Statins and A-tocpherol. A-tocpherol.
– Endovascular repair > 5.5 cm Endovascular repair > 5.5 cm – Open repair >5.5 cm Open repair >5.5 cm
1 in 6 AAA-related deaths from elected repair 1 in 6 AAA-related deaths from elected repair
Screening AAAScreening AAA
AAA – 1 in 250 people over the age of 50 AAA – 1 in 250 people over the age of 50 will die of a ruptured AAA. will die of a ruptured AAA.
AAA affects AAA affects ≤ 8% of people > 65%.≤ 8% of people > 65%.
1717thth leading cause of death. leading cause of death.
Asymptomatic. Asymptomatic.
Untreated, 50% die of rupture. Untreated, 50% die of rupture.
Men > Women 4 x more often.Men > Women 4 x more often.www.sirweb.org www.sirweb.org
Screening IMT Screening IMT
Intimal Media Thickness Intimal Media Thickness Screening for cardiovascular disease or Screening for cardiovascular disease or effectiveness of medications to treat CVD effectiveness of medications to treat CVD (statins) (statins) Measures the media thickness Measures the media thickness – anterior and posterior wall anterior and posterior wall – anterior, lateral and posterior windowsanterior, lateral and posterior windows– up to 1000 points along 1 inch of arteryup to 1000 points along 1 inch of artery– Plots on graph Plots on graph
Impact of IMT Impact of IMT
MedicareMedicare
Private Payors Private Payors
Cardiovascular Disease Cardiovascular Disease – Stroke Belt Stroke Belt – Cardiac DeathsCardiac Deaths– Monitor Statin use Monitor Statin use
Status of the ProfessionStatus of the Profession
ImpactImpact
Physicians hiring sonographers (PT/FT) Physicians hiring sonographers (PT/FT) – Internal Medicine Internal Medicine – CardiologyCardiology– Sports Medicine Sports Medicine – Vascular or General Medicine Vascular or General Medicine
Mobile services Mobile services
Implication – Sonographers Implication – Sonographers
Physicians are performing Focused Physicians are performing Focused studies, not a full routine. studies, not a full routine.
Documentation by sonographers, with Documentation by sonographers, with interpretation by a trained physician interpretation by a trained physician medically necessary. medically necessary.
Physicians tend to see the strengths. Physicians tend to see the strengths.
Ultimately gain respect for ultrasound. Ultimately gain respect for ultrasound.
Outlook – RDMS Outlook – RDMS
Job growth is expectedJob growth is expectedSonography becomes an increasingly attractive Sonography becomes an increasingly attractive alternative, as patients seek safer treatment alternative, as patients seek safer treatment methods. methods. Sonographic technology is expected to evolve Sonographic technology is expected to evolve rapidly. rapidly. Hospitals will remain the principal employer of Hospitals will remain the principal employer of diagnostic medical sonographers. diagnostic medical sonographers. Employment is expected to grow more rapidly in Employment is expected to grow more rapidly in offices of physicians and in medical and offices of physicians and in medical and diagnostic laboratories, including diagnostic diagnostic laboratories, including diagnostic imaging centers.imaging centers.
http://www.bls.gov/oco/ocos273.htmhttp://www.bls.gov/oco/ocos273.htm
Outlook – CardioVascular Outlook – CardioVascular
Growth will occur as the population ages, Growth will occur as the population ages, because older people have a higher incidence of because older people have a higher incidence of heart disease and other complications of the heart disease and other complications of the heart and vascular system. heart and vascular system. Procedures such as ultrasound are being Procedures such as ultrasound are being performed more often as a replacement for more performed more often as a replacement for more expensive and more invasive procedures. expensive and more invasive procedures. Employment of vascular technologists and Employment of vascular technologists and echocardiographers will grow as advances in echocardiographers will grow as advances in vascular technology and sonography reduce the vascular technology and sonography reduce the need for more costly and invasive procedures. need for more costly and invasive procedures.
http://www.bls.gov/oco/ocos100.htmhttp://www.bls.gov/oco/ocos100.htm
ComparisonsComparisons2006-2016 Outlook
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The Future of Ultrasound The Future of Ultrasound
By all appearance, is very strong. By all appearance, is very strong.
RDMS: RDMS: Employment change.Employment change. is expected to is expected to increase by about 19 percent through 2016—increase by about 19 percent through 2016—faster than the averagefaster than the average for all occupations—as for all occupations—as the population ages.the population ages.
RDCS/RVT: RDCS/RVT: Employment Employment is expected to is expected to increase by 26 percent through the year 2016, increase by 26 percent through the year 2016, much faster than the averagemuch faster than the average for all occupations. for all occupations.
Registry vs. License Registry vs. License
Registry vs. License Registry vs. License Code of Virginia 54.1-100Code of Virginia 54.1-100
Regulations of professions and occupations. Regulations of professions and occupations.
The right of every person to engage in any lawful The right of every person to engage in any lawful profession, trade or occupation of his choice is profession, trade or occupation of his choice is clearly protected by both the Constitution of the clearly protected by both the Constitution of the United States and the Constitution of the United States and the Constitution of the Commonwealth of Virginia. The Commonwealth Commonwealth of Virginia. The Commonwealth cannot abridge such rights except as a reasonable cannot abridge such rights except as a reasonable exercise of its police powers when it is clearly exercise of its police powers when it is clearly found that such abridgment is necessary for the found that such abridgment is necessary for the preservation of the health, safety and welfare of preservation of the health, safety and welfare of the public. the public.
Code of Virginia, cont. Code of Virginia, cont. No regulation shall be imposed upon any profession or No regulation shall be imposed upon any profession or
occupation except for the exclusive purpose of protecting occupation except for the exclusive purpose of protecting the public interest when: the public interest when: The unregulated practice of the profession or occupation The unregulated practice of the profession or occupation can harm or endanger the health, safety or welfare of the can harm or endanger the health, safety or welfare of the public, and the potential for harm is recognizable and not public, and the potential for harm is recognizable and not remote or dependent upon tenuous argument; remote or dependent upon tenuous argument; The practice of the profession or occupation has inherent The practice of the profession or occupation has inherent qualities peculiar to it that distinguish it from ordinary qualities peculiar to it that distinguish it from ordinary work and labor; work and labor; The practice of the profession or occupation requires The practice of the profession or occupation requires specialized skill or training and the public needs, and will specialized skill or training and the public needs, and will benefit by, assurances of initial and continuing benefit by, assurances of initial and continuing professional and occupational ability; andprofessional and occupational ability; andThe public is not effectively protected by other meansThe public is not effectively protected by other means
Registry vs. License Registry vs. License
““States disinterested.” States disinterested.” SDMS has pushed for NATIONAL credentialing SDMS has pushed for NATIONAL credentialing to avoid the state issues to avoid the state issues – Licensure board representation Licensure board representation – Additional licensure fees Additional licensure fees – 50 different laws 50 different laws – State tests vs national tests State tests vs national tests – Problems with reciprocity – moving from one state to Problems with reciprocity – moving from one state to
another, etc.another, etc.– Denise Lewis, Society of Diagnostic Medical SonographyDenise Lewis, Society of Diagnostic Medical Sonography– February 23, 2009 February 23, 2009
LicenseLicense vs. Registeredvs. Registered
Mandatory minimum qualificationsProtects the consumerMinimum standards for practice defined by lawSets timetable for phasing out those who do not meet the requirementsIdentifies qualified sonographersMay enhance profession image of sonographersDrive educational programs to seek accreditationAllows access for statistical and records about sonographerMay reduce costs associated with repeated examinations from suboptimal testing
Annitta J. Morehead, BA, RDCS, FASE, Timothy P. Obarski, DO, FACC, FACPSDMS Syllabus 2003
Licensed vsLicensed vs. Registered . Registered Government control of the professionLicensure combined with other medical specialties– Without diverse sonographer representation on the
board– Without differentiation of echocardiography, vascular
area of practice– With lower minimum standards– With limitation to scope of practice.
Requirements of attendance of accredited education programs could limit entry into the program on the board
Annitta J. Morehead, BA, RDCS, FASE, Timothy P. Obarski, DO, FACC, FACP SDMS Syllabus 2003
Licensed vsLicensed vs. Registered. Registered, cont, cont
Benefits to the public of licensure is not evidentAdditional monetary cost to the sonographer, consumer, and state or provinceLicense in one state may not be accepted in another state (reciprocity)Enforcement and monitoring problems
Annitta J. Morehead, BA, RDCS, FASE, Timothy P. Obarski, DO, FACC, FACP SDMS Syllabus 2003
Additional Resources for You Additional Resources for You
www.imagegently.orgwww.imagegently.org
www.auntminnie.comwww.auntminnie.com
www.sonoworld.comwww.sonoworld.com
http://www.bls.govhttp://www.bls.gov
www.ultrasoundcases.infowww.ultrasoundcases.info
