Abstract

Introduction

     Radiographers can elect to work within many different modalities, one being ultrasound. Within Europe there are differing opinions about how much of a role radiographers should take in relation to the ultrasound examination, particularly report writing. This paper provides findings exploring the radiographer’s views on working within sonography.

Methods

     In 2019 an electronic survey was disseminated to radiographer members by European Federation of Radiographer Societies (EFRS) national radiographer societies, following a pilot study. A mix of closed questions, free text, and scale responses aimed to investigate radiographers’ practice, legal responsibilities, report writing, educational level and experiences of support and mentoring.

Results

     Of 561 radiographers participating, most (92%) reported performing ultrasound scans. Challenges with legislation, medical protectionism and lack of high-quality education restricted other radiographers. On average, the respondents have practiced ultrasound for 13.5 years. A total of 60% had postgraduate education and carried out a wide range of examinations. A full interpretative report, including advice on further investigations is performed by 52%, whilst 22% provide a checklist or descriptive report. Over 55% of radiographers took legal responsibility for the examination and the majority had clear protocols, good mentoring and support in the workplace. Peer review of their work was less common.

Conclusion

     The result shows that in 21 (n = 25) countries radiographers perform ultrasound, however not without challenges. Educational levels range from no formal education or short courses to an MSc in ultrasound. Report writing practice differs across the EFRS countries responding to the survey, as does peer review to enhance skills and clinical practice.

Implications for practice

     National Radiographer societies could review findings to support campaigning for a change in legislation and improvements to educational offerings in ultrasound.

Introduction

     Radiographers perform ultrasound examinations in a number of European countries. They are recognised as an important part of the workforce, particularly as demands on ultrasound and other imaging services increase.1 Ultrasound is predominantly performed by radiologists in Europe, however, due to the shortage of radiologists, providing a qualified ultrasound workforce may become a future challenge in Europe.2,  ۳,  ۴,  ۵,  ۶,  ۷,  ۸,  ۹,  ۱۰,  ۱۱ Radiographers educated and trained as sonographers can help overcome this challenge in the future.

     Who should be performing ultrasound examinations? Questions have been raised about who should provide the written ultrasound report and whether this should be the radiographer performing the examination, the radiologist or other professionals.12 Ultrasound is a hands-on investigation, with the written report being the primary communication method and an essential part of the investigation, which is inseparable from sonographic imaging.13 In the United Kingdom (UK) the expectation is that the healthcare professionals performing the examination writes the report, due to dynamic nature of the examination, safety, and best practice.13,14 Besides having the responsibility of writing the examination report, there are other factors affecting radiographers in ultrasound such as educational level, salary, access to new equipment, and psychological support.15 The educational level and training for non-medical ultrasound is variable across Europe.16,17 This is also recognised by the European Society of Radiology (ESR).14 In the United States of America integration of ultrasound education for medical professionals was also found to be extremely inconsistent18 varying from “ad hoc” or “on the job” learning to formal postgraduate qualifications.17 Cultural differences between hospital or country will often determine the preferred educational approach preferred. Still, radiographers writing individual ultrasound reports are highly skilled.17 Hofmann and Vikestad (2013) investigated how radiographers perform in upper abdominal examinations compared to radiologists and found kappa agreement of 0.9.8 Studies have also found radiographer reporting comparable to radiologists in ultrasound and other modalities.19,  ۲۰,  ۲۱ The knowledge of radiographers’ perspectives, views, experiences and challenges in ultrasound is limited in current literature.

Conclusion

     In general, radiographers perceive sonography as an extension of their role with the addition of new responsibilities and skills. Previous literature supports that an essential component of completing an ultrasound examination is writing the report. Whilst many radiographers responding to this survey practise ultrasound, far fewer have the opportunity to write independent actionable reports. Although numbers were small, the majority of those who do not perform ultrasound would be interested to develop in this area.

     Overall, radiographers have different career, support and educational opportunities to engage in ultrasound practice across Europe. A wide range of clinical ultrasound examinations are undertaken by radiographers, particularly general medical, gynaecology, obstetrics and vascular. The main educational level is postgraduate (EQF level 7), although some radiographers have limited or no formal education and training, which is a concern as ultrasound is such an operator dependent modality. Previous studies suggest that radiographers can provide a safe, effective ultrasound service, but this does require good underpinning education, mentoring, support and on-going audit and peer review of practice.