Susan E. Wiegers, MD, FASE, FACC

October is Medical Ultrasound Awareness Month and seeks to increase awareness of ultrasound and sonography. In the days when all of our medical students are required to have skills in interprofessional learning and interaction, those of us in the echo and vascular labs are old hands at it. Every medical director knows that the most important component of any ultrasound lab is not the machines with all the latest applications, not the reporting system, not the other equipment, but rather the sonographers. It is the team spirit in our labs that makes work rewarding and the only way to guarantee excellent patient care. As such, it is important to have a safe and supportive lab where sonographers can flourish and do their best.

Most important in my view is open and honest communication. Just as I need to be able to ask the sonographer to go back to get a few more images of something I am concerned about on the study, the sonographer needs to be able to question me about my interpretations. I am pleased that the staff feels comfortable pointing out that yet again, I have produced a report with no mention of the mitral valve (a glitch in our old reporting system rather than a blatant disregard for my favorite valve). Some other questions can point to serious mistakes in interpretation or at least lead to further evaluation. If the sonographer doesn’t feel comfortable speaking up, patient care could suffer.

Education is another concern. Many health systems can’t support travel for their staff to attend educational conferences. But local societies and hospitals can allow interchange between labs and award CEU’s through ASE’s annual certificate program with local societies and hospitals. Our local Delaware Valley Echo Society just elected the Temple lead sonographer, Cathy Moser, as President. The local societies provide important leadership opportunities as well as educational ones. In addition, the available on-line resources for sonographer education make off-hour or lunchtime learning far easier. www.ASEUniversity.org , for instance, regularly offers CME credit for review of JASE articles. ASE has recently endorsed the Advanced Cardiovascular Sonographer (ACS) credential awarded by Cardiovascular Credentialing International (CCI). I have to admit that the timing of the initial offering of the exam surprised us a little, and we don’t yet have educational materials specifically directed at studying for this exam. However, it is our top priority, and we are working on these materials—the first of which should be available early next year. There are currently multiple alternative pathways to sit for the exam that rely on expertise gained from work in the field, but eventually the primary pathway is expected to be completion of an Advanced Cardiac Sonography educational program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

These schools are just being developed, and schools wishing to apply for ACS programmatic accreditation should contact the Committee on Accreditation for Advanced Cardiovascular Sonography (CoA-ACS) at www.coaacs.org . This is a separate organization which is also endorsed by the Society of Diagnostic Medical Sonography (SDMS). ASE does not accredit the schools or award the credential, but we do support this important development for sonographers.

Safety is a prime concern in hospitals today—but it is staff safety I am emphasizing here. Just as policies are important in promoting patient safety, clear policies for staff have to be in place and adhered to in order to ensure the safety of our staff. Cardiovascular sonography is one of the more physically demanding jobs in the hospital. While the number of portable inpatient studies varies by lab, in some hospitals it approaches 100%. But most hospital rooms were not built to accommodate the sonographer, the US machine, the hospital bed, and the patient. Nor is the ambient light ideal for imaging! Policies for ergonomic assessment, education, and equipment are key and make economic sense as they have been shown to reduce lost time and the treatment cost of injuries. Attention to radiation safety is another important consideration. Sonographers can be exposed to radiation in the catheterization lab, the hybrid operating room, and in the echo lab when patients who have received radioactive agents for diagnostic nuclear tests are scanned. ASE’s special report on Radiation Safety for the Cardiac Sonographer ( www.asecho.org/guidelines ) gives concrete advice about how to minimize sonographer exposure. A final area of safety includes appropriate attention to stress. After years of cardiology practice, I remain concerned and empathetic to my patients but running a code hasn’t reduced me to tears since I was an intern. Sonographers are often called to scan during a code or a “pre-code.” It is important to allow them time to debrief, particularly early career sonographers who may not have seen many critically ill patients. A quiet, quick chat, thanking them for their contribution to the care of the patient, as well as answering their questions about what was happening and an acknowledgment of their emotional response can make all the difference in the world.

Team work, motivated professionals, and a fascinating occupation make the cardiovascular ultrasound lab the best place to work in the hospital. I am grateful for all of the sonographers I have worked with over the years for all they have taught me and for the friendship and laughter. So let’s celebrate Medical Ultrasound Awareness Month—start by letting your sonographers know how important they are to the lab and to you.

Susan E. Wiegers, MD, FASE, FACC is Senior Associate Dean of Faculty Affairs and a Professor of Medicine at Temple University School of Medicine.