Diversity in ultrasound practice and education

While reviewing this edition of the journal, I began reflecting on the diversity of ultrasound delivery. In this AJUM issue, we have a unique and rare furcate umbilical cord insertion diagnosis,¹ a primer on emergency breast lesions,² a systematic review investigating the role of ultrasound in surgical patients in low and middle income countries,³ and two articles about teaching non-experts to undertake ultrasound, including to guide knee procedures⁴ and to diagnose bone fractures.⁵ I can remember a time when the education was largely informal and at the bedside – the so-called ‘see one, do one’ approach. Of course, it was never a single examination, it took hundreds, even thousands of patients and hours of scanning to become proficient. Ultrasound education was subject to the type of hospital and services it provided; to the range of pathology in patients that presented; and to referral patterns. Ultrasound education was delivered by clinical experts to people wishing to become ultrasound experts. Increasingly, ultrasound education is patient-centred and focussed on clinical need rather than speciality- or profession-specific.

Initially ultrasound was used to identify anatomy, later function and blood flow, and now we find ourselves able to characterise tissue. In this AJUM edition, there is an excellent review article from colleagues at the Mayo Clinic,² in which they describe the ultrasound appearances and characteristics of breast lesions presenting in emergency or urgent care facilities. Not only is ultrasound being used to diagnose these breast lesions but also ultrasound is an important part of the emergency care triage pathway.

In the acute care setting, is an original research paper by Snelling and colleagues,⁵ in which they describe the learning curve of novices for the diagnosis of distal forearm fractures in children. That ultrasound is proving to be an adjunct, even replacement, for X-ray shows how far ultrasound technology, and our knowledge, has evolved. The evolution in ultrasound users is also apparent in this paper in which they show that nurse practitioners can achieve diagnostic competency after just 15 scans. This approach has the potential to improve access and result in shorter times to diagnosis, without using ionising radiation.

Another area of clinical advancement is the use of ultrasound to support procedures. As a potential patient, it seems very logical to me that using ultrasound to guide needle or cannula placement is better than ‘going in blind’. As an ultrasound professional, and as a citizen, I want to know that the additional cost of ultrasound guidance is warranted. Deleskey et al.⁴ used a bespoke knee phantom to evaluate the use of ultrasound-guided versus landmark-guided knee arthrocentesis by medical students and found that ultrasound helped them find the target effusion, especially when the effusion was small.

We are already seeing a proliferation of non-traditional users of ultrasound and ultrasound training is slowly being integrated in medical school education around the world. Just as the clinical use of ultrasound is expansive, the users are also expanding. There is acceptance that a broad range of specialities now use ultrasound to better serve their patients. And, lastly, the way in which we teach ultrasound to our diverse community of practitioners is also changing.