Canadian Association of Radiologists Journal 65 (2014) 1 www.carjonline.org

 Editorial / Editorial

The Changing Landscape of Radiology: Ultrasound Training for Nonradiologists Education is the most powerful weapon which you can use to change the world. Nelson R. Mandela (1918-2013), president of South Africa (1994-1999) Be the change that you wish to see in the world. Mohandas K. (Mahatma) Gandhi, Indian nationalist (1869-1948) Confusion of goals and perfection of means seems, in my opinion, to characterize our age. Albert Einstein, German-American physicist (1879-1955) This past year, 2013, was the 65th anniversary of medical diagnostic ultrasound. Training in ultrasound for nonradiologists still remains somewhat controversial in the world of radiology. Ultrasound is a modality coveted by numerous other medical specialties. In many parts of the world, echocardiography is largely done by cardiologists, and obstetrical ultrasound is largely in the hands of obstetricians and gynaecologists. These changes demonstrate that diagnostic ultrasound is not the sole possession of the diagnostic radiologist but rather a diagnostic tool that has readily been adopted into the armamentarium of our clinical colleagues. Training in ultrasound for nonradiologists has recently been brought back to the forefront with the widespread availability of handheld ultrasound, which provides the ability for a clinician to perform rapid bedside assessment of patients. This ultimately is being viewed as an extension of the physical examination and is meant to improve patient care. This technology is now being sought after and adopted into the clinical armament of many clinicians in the fields of emergency medicine, internal medicine, and surgery. There now are multiple courses available and run by nonradiologists for teaching clinicians about how to perform ultrasound at the bedside. Training in handheld ultrasound has now expanded into the medical school curriculum, including several sites in Canada. Some medical schools, including those in Canada are teaching medical students the basics of sonographic examination as part of the curriculum. The issue now is not so much with respect to ‘‘turf’’ but the role of the radiologist to be collaborative and be a medical expert consultant to help establish the criteria and, if feasible, even help provide training initially. Nonradiologists are well

established in doing many aspects of ultrasound imaging, and this will not change. The horse is out of the barn, and inflexibly in opposing having clinicians involved in this aspect of imaging is not only unrealistic at this point but impractical. Radiologists’ main concern with respect to diagnostic ultrasound examinations by nonradiologists should be that they have appropriate training and assessment, and that they are aware of their limitations so to ensure quality studies and patient safety. Such studies, as with any radiology study, should be subject to audit and peer review. Inherent to this entire topic are the issues of setting up proper training, which would start with guidelines and standards. Logistics such as time and compensation for a radiologist to train nonradiologists would have to be sorted out, but, more importantly, which regulating body is responsible for the quality of the diagnostic ultrasound studies done by nonradiologists would have to be determined. Ultimately, as diagnostic radiologists, we are medical expert consultants when it comes to the expanding field of diagnostic ultrasound studies in the hands of nonradiologists. Change is inevitable. As with an echocardiogram, certain diagnostic ultrasound studies may eventually move into the hands of nonradiologists and will be regulated by other nonradiology regulatory bodies. However, as the field expands, radiologists should have a key role in the initial training and setting of standards for diagnostic ultrasound procedures by nonradiologists. Basic ultrasound skill and knowledge will have to be taught to ensure quality studies. Diagnostic radiology should always remain in the forefront of diagnostic ultrasound. What many radiologists have found is that these bedside examinations by clinicians often result in referral either for detailed formal ultrasound examinations or other imaging studies. We are in no danger of finding ourselves under- let alone unemployed. We should continue to remain as leaders and set the standards and regulations for imaging studies as a specialty. Silvia D. Chang, MD, FRCPC Associate Professor of Radiology University of British Columbia Vancouver, BC, Canada Peter L. Munk, MDCM, FRCPC, FSIR Editor in Chief, CARJ Professor of Radiology, University of British Columbia Vancouver, BC, Canada E-mail address: [email protected]

0846-5371/$ - see front matter Ó 2014 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2013.12.001

The changing landscape of radiology: ultrasound training for nonradiologists.

The changing landscape of radiology: ultrasound training for nonradiologists. - PDF Download Free
83KB Sizes 1 Downloads 0 Views