Evidence-based innovation in ultrasound practice

I have recently returned from ASUM's annual New Zealand conference and am surprised by two things – how diverse ultrasound practice is and how much I enjoyed listening to presentations outside my speciality area. This is because some of the challenges we face in terms of developing an evidence base for our practice of, and justification for, our scanning approaches are similar. Many of us are facing the pressure of ‘getting through lists’: some are advocating for reducing scanning protocols or performing targeted examinations; others are advocating for extending scopes of practice outside traditional boundaries; whilst some are even advocating for skipping ultrasound and moving straight to other imaging modalities.

Whatever your innovative idea is, it should be evidence-based and proven to alleviate the problem at hand; whether it be workforce shortages, time poverty or a long waitlist. In this issue of AJUM, we focus on the areas of innovation and research that could enhance practice if adopted widely. And as you read these articles, I challenge you to think about whether similar issues exist in your speciality areas. Are there innovations that could be introduced? Or are there teaching tips that could enhance everyone's practice? Is there a way to streamline our practice and training? One of the key strategic goals of ASUM is to deliver evidence-based standards and research, and this issue of our society's journal should tick a continuing education box for many of you. I'm hopeful it will also stimulate you to undertake your own research in your area or practice.

Rocha et al.¹ present an analysis of a large cohort of women investigated for endometriosis in which they evaluated the anatomical distribution of endometriosis with ultrasound and tested a recommended prediction model that used a patient-administered questionnaire from the World Endometriosis Research Foundation. They found the performance of the questionnaire added little clinical value and suggested further refinement of the questionnaire may be needed.

Samet et al.² present a small study where they investigated the difference between supine and prone patient positioning for identifying the popliteal fossa sciatic nerve and found supine positioning allowed for quicker identification with the potential to improve ultrasound-guided nerve block. Often, patient positioning is seen as a sonographer or patient preference, but quantifying one position's impact and potential benefit over another is useful and can inform future practice.

Another variation in practice is the choice of transducer. Lung ultrasound can be performed with either a curvilinear or phased array transducer, and preference may simply come down to which one is available at the time of the scan. There are reasons why operators may prefer one over the other, such as rib spaces or frequency, but many regard them as interchangeable. Walsh et al.³ undertook an experiment where they asked internists and trainees to interpret lung ultrasound performed with both transducers and found that for expert readers, no difference in accuracy was seen, but for novice readers, the curvilinear transducer led to higher accuracy. So, transducer selection may be important depending on operator experience.

Also, on the topic of practice variation, Ward et al.⁴ present an extensive survey about the documentation of placental cord insertion by sonographers in Australia and found there is little consensus about the inclusion of this in worksheets or reports, especially when it is normal. This highlights an important point about documentation in general – if we are only in the habit of documenting the abnormal, do we miss an opportunity for best practice by not documenting when findings are normal or as expected?

Finally, Necas et al.⁵ have written a review article about the continuum of intussusception seen with ultrasound, which may range from physiologic to so severe that the patient presents as an acute emergency. It is good to remember that pathology often occurs on a continuum, but often patients present at the more severe and acute end of that spectrum, so as health professionals, we may not always appreciate the early stages of the pathological process.

In preparing this issue of AJUM, I am reminded that all of our choices and approaches are based on knowledge, experience and research. But we can always question these approaches, and the best way to do this is to measure the impact of our approaches and decisions. Often, the approach passed on to us by our mentors is informed by research and evidence, but it behoves us to ensure that the knowledge and advice we pass on to our mentees is also evidence-based, up to date, improves our practice and, importantly, improves patient care. Research and dissemination are at the heart of that.