Defining the New Clinical Sonography Specialist

By Ali F. Aburahma, MD

Sixteen medical organizations with a strong interest in the clinical evolution of diagnostic sonography met last summer to develop a consensus on the issues involved in advanced sonography practice. A key result of the conference was the definition of a new "clinical sonography specialist" and a basic enumeration of the functions such a new specialist might perform at the discretion of a supervising physician.

The primary objective of the Sonography Advanced Practice Consensus Conference held in Washington, was to engage the professional community in a dialogue related to the advanced practice in sonography and to reach a community consensus on some important issues.

The main focus was on the role of advanced practice in diagnostic medical sonography. After much discussion, participating organizations reached a consensus that advanced practice sonography is an actionable concept.

A consensus-based definition for the sonographer practitioner will be developed. Consensus support exists for moving the concept forward with the following provision: Information gaps related to sonographer and physician support will need to be addressed using the sonographer practitioner profile developed at the APCC.

This information should be acquired through survey work, the participants determined. Review of the survey results should be conducted by the APCC participants and used to guide the development of any future work products or efforts. It was also decided that a survey will be conducted and completed by June 2007, to guide APCC participants in this concept.

The consensus for the working title of the sonographer advanced practitioner envisioned by the APCC participants was the Clinical Sonography Specialist (CSS).

A profile for the CSS was developed. At the discretion of a supervising physician, the CSS will have the following functions:

• Performs oversight, oversees sonographers, directs sonographers to extend studies, rescans when necessary, and determines when patients can be discharged.
• Prepares a summary of findings to be used in interpretation by the physician.
• Communicates to referring physician.
• Oversees clinical activities.
• Performs procedures.
• Oversees quality assurance.
• Triages and clarifies orders with referring physicians.
• Educates sonographers and physicians.
• Interacts at a higher level with patients; may include obtaining detailed physical and or history, and/or informed consent.
• Reviews cases with the supervising physician.

The participants also listed several key qualifications for the new CSS. Individuals should possess a higher education (bachelor of arts, bachelor of science, or master's degree--the specific degree requirement and/or science course curriculum are yet to be determined). They should also demonstrates a minimum level of clinical experience (5 years recommended--specific requirement to be determined) as a practicing and credentialed sonographer.

They should have national, independent certification (of which specialty examinations will be an essential component--specific requirements to be determined). They should demonstrate specialty-specific clinical competencies and achieve a standardized advanced sonography credential.

With regard to the new CSS, the participants in the conference determined that they should work within limits, stating that "it is imperative that the final interpretation and formal reporting remain the responsibility of the supervising physician, and that the medical/legal responsibilities for patient care remain with the supervising physician."

Development and accreditation of the new CSS remain an ongoing process and the participating organizations will continue their efforts to foster its creation. Key participants include the Society for Vascular Surgery, the Society for Vascular Ultrasound, the American Registry of Diagnostic Medical Sonography, and the Joint Review Committee on Education in Diagnostic Medical Sonography.