ERIC ED423735: Training in Diagnostic Ultrasound: Essentials, Principles, and Standards. Report of a WHO Study Group. Technical Report Series 875.

59 Pages·1998·0.62 MB·English

by  ERIC

DOCUMENT RESUME
HE 031 471
ED 423 735
Training in Diagnostic Ultrasound: Essentials, Principles,
TITLE
and Standards. Report of a WHO Study Group. Technical Report
Series 875.
World Health Organization, Geneva (Switzerland).
INSTITUTION
WHO-TRS-875
REPORT NO
ISBN-92-4-120875-9
ISBN
ISSN-0512-3054
ISSN
PUB DATE 1998-00-00
NOTE
57p.
AVAILABLE FROM
WHO Publications Center USA, 49 Sheridan Avenue, Albany, NY
12210; Tel: [phone]; Fax: [phone]; e-mail:
Qcorpgicompuserve.com ($12.60).
Guides - Classroom
PUB TYPE
Teacher (052)
EDRS PRICE MF01/PC03 Plus Postage.
Allied Health Personnel; Developing Nations; *Diagnostic
DESCRIPTORS
Tests; Foreign Countries; Higher Education; *Medical
Education; Medical Students; Nurses; Physicians;
*Professional Training; *Standards
*Ultrasonics; World Health Organization
IDENTIFIERS
ABSTRACT
This report defines the essential training and skills
necessary for the effective employment of diagnostic ultrasound in different
health care settings. It reviews the present situation in ultrasonography and
the trends in the utilization of diagnostic ultrasound in clinical pract*ce.
The report also examines worldwide practice with respect to ultrasonography
trainjng for physicians, sonographers, and other categories of medical
professionals, such as midwives, nurses, and assistant physicians. It
presents outlines of recommended training curricula for physicians in
general, advanced, and specialized ultrasonography and discusses various
other factors that must be taken into account in organizing the training
process. The report describes the recommended training for allied health
professionals specializing in ultrasonography and presents the basic science
and instrumentation aspects of the curricula. It then discusses the level of
competence that should be reached by those trained in the use of diagnostic
ultrasound, as well as the recommended standards for training programs,
including the requirements for instructors and training centers.
Recommendations for the implementation of training programs are included. An
appendix outlines the applications of diagnostic ultrasound. (Contains 36
references.)
(MDM)
********************************************************************************
Reproductions supplied by EDRS are the best that can be made
from the original document.
********************************************************************************
t
,
&to
Re ort
Ar) Vechnical
875
,
,
TRAINING IN DIAGNOSTIC
4,
ULTRASOUND: ESSENTIALS,
2
'
PRINCIPLES AND STANDARDS
Report of a
WHO Study Group
PERMISSION TO REPRODUCE AND
DISSEMINATE THIS MATERIAL HAS
BEEN GRANTED BY
WHO
TO THE EDUCATIONAL RESOURCES
INFORMATION CENTER (ERIC)
1
U.S. DEPARTMENT OF EDUCATION
Office of Educational Research and Improvement
EDUCATIONAL RESOURCES INFORMATION
CENTER (ERIC)
EliThis document has been reproduced as
received from the person or organization
originating it.
Organization
World
Health
I
I
0 Minor changes have been made to
Geneva
improve reproduction quality.
Points of view or opinions stated in this
document do not necessarily represent
official OERI position or policy.
The World Health Organization was established in 1948 as a specialized agency
of the United Nations serving as the directing and coordinating authority for
international health matters and public health. One of WHO's constitutional func-
tions is to provide objective and reliable information and advice in the field of
human health, a responsibility that it fulfils in part through its extensive programme
of publications.
The Organization seeks through its publications to support national health strate-
gies and address the most pressing public health concerns of populations around
the world. To respond to the needs of Member States at all levels of development,
WHO publishes practical manuals, handbooks and training material for specific
categories of health workers; internationally applicable guidelines and standards;
reviews and analyses of health policies, programmes and research; and state-of-
the-art consensus reports that offer technical advice and recommendations for
decision-makers. These books are closely tied to the Organization's priority activi-
ties, encompassing disease prevention and control, the development of equitable
health systems based on primary health care, and health promotion for individuals
and communities. Progress towards better health for all also demands the global
dissemination and exchange of information that draws on the knowledge and
experience of all WHO's Member countries and the collaboration of world leaders
in public health and the biomedical sciences.
To ensure the widest possible availability of authoritative information and guidance
on health matters, WHO secures the broad international distribution of its publica-
tions and encourages their translation and adaptation. By helping to promote and
protect health and prevent and control disease throughout the world, WHO's books
contribute to achieving the Organization's principal objective
the attainment by
all people of the highest possible level of health.
The WHO Technical Report Series makes available the findings of various interna-
tional groups of experts that provide WHO with the latest scientific and technical
advice on a broad range of medical and public health subjects. Members of such
expert groups serve without remuneration in their personal capacities rather than
as representatives of governments or other bodies; their views do not necessarily
reflect the decisions or the stated policy of WHO. An annual subscription to this
series, comprising about 10 such reports, costs Sw.fr. 132.- (Sw.fr. 92.40 in
developing countries).
3
This report contains the collective views of an international group of experts and
does not necessarily represent the decisions or the stated policy of the World Health Organization
875
TRAINING IN DIAGNOSTIC
ULTRASOUND: ESSENTIALS, PRINCIPLES
AND STANDARDS
Report of a
WHO Study Group
World Health Organization
Geneva 1998
4
WHO Library Cataloguing in Publication Data
Training in diagnostic ultrasound essentials, principles and standards
report of a
WHO study group
(WHO technical report series ; 875)
1.Ultrasonography 2.Diagnostic imaging
standards 3.Guidelines 4.Health per-
sonnel
education I.Title II.Series
ISBN 92 4 120875 9
(NLM ClaSsification: WN 200)
ISSN 0512-3054
The World Health Organization welcomes requests for permission to reproduce or translate
its publications, in part or in full. Applications and enquiries should be addressed to the
Office of Publications, World Health Organization, Geneva, Switzerland, which will be glad
-to provide the latest information on any changes made to the text, plans for new editions,
and reprints and translations already available.
@ World Health Organization 1998
Publications of the World Health Organization enjoy copyright protection in accordance with
the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.
The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of the Secretariat of the World
Health Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers' products does not imply
that they are endorsed or recommended by the World Health Organization in preference to
others of a similar nature that are not mentioned. Errors and omissions excepted, the names
of proprietary products are distinguished by initial capital letters.
Typeset in Hong Kong
n Spain
Printed
97/11650
Best-set/Fotojae
7500
5
Contents
Introduction
1
1.
2
Background to the Study Group's report
1.1
5
Structure of the report
1 2
5
The world situation with respect to ultrasonography
2.
5
Assessment of current practice
2.1
5
Performance and interpretation
2.1.1
6
Delivery of services
2.1.2
7
Equipment and techniques
2.1.3
7
Recognized indications for ultrasonography
2.1.4
8
Trends in ultrasonography
2.2
8
Current ultrasonography training
2.3
8
Variations in training and practice
2.4
10
Sonographers
2.5
11
Trends in ultrasonography training
2.6
Ultrasonography curricula for medical students and physicians
1 1
3.
11
Curriculum for medical students
3.1
Curriculum for general (level I) ultrasonography for
3.2
12
physicians
12
General features of the curriculum
3.2.1
13
Specific content
3.2.2
16
Duration of training and required number of studies
3.2.3
16
Evaluation
3.2.4
17
Continuing medical education
3.2.5
Curriculum for advanced (level II and III) ultrasonography for physi-
3.3
17
cians
17
Purpose
3.3.1
17
Prerequisites
3.3.2
17
Areas covered
3.3.3
17
Content and duration
3.3.4
18
Practical training
3.3.5
18
Evaluation
3.3.6
18
Continuing medical education
3.3.7
19
Ultrasound in various specialties
3.3.8
Ultrasonography training for sonographers and other allied health
4.
21
professionals
21
Introduction
4.1
21
A definition of a sonographer
4.2
21
Limitation of practice
4.3
Curriculum for general (level I) ultrasonography for
4.4
22
sonographers and other allied health professionals
22
Purpose
4.4.1
22
Prerequisites
4.4.2
22
General and specialized training
4.4.3
22
Curriculum
4.4.4
23
Duration of training and required number of studies
4.4.5
23
Clinical and ancillary information
4.4.6
III
Principles of scanning
4.4.7
24
Requirements for teachers of sonographers
4.4.8
24
Evaluation
4.4.9
25
4.4.10 Continuing medical education
25
4.4.11 Specialized training
25
Basic sciences and instrumentation curricula
5.
26
Introduction
5.1
26
Prerequisites
5.2
27
Mathematics
5.2.1
27
Physics
5.2.2
27
Biology
5.2.3
27
Basic sciences and instrumentation curriculum for general
5.3
ultrasonography
28
Basic sciences
5.3.1
28
Equipment
5.3.2
29
Quality assurance
5.3.3
30
Equipment management
5.3.4
30
Artefacts
5.3.5
30
Basic sciences and instrumentation curriculum for advanced
5.4
ultrasonog raphy
31
Basic sciences
5.4,1
31
Equipment
5.4.2
33
Quality assurance
5.4.3
34
Artefacts
5.4.4
34
Course duration
5.5
35
Evaluation
5.6
35
Training centres and resources
6.
35
Needs and priorities
6.1
35
Teacher training
6.2
36
Materials and techniques
6.3
37
Evaluation
6.4
37
Teacher-training programmes
6.5
37
Licensing and accreditation
6.6
38
Continuing education
6.7
38
Training centres
6.8
38
Regional (international) centres
6.8.1
38
National centres
6.8.2
39
Equipment
6.9
39
Ultrasound equipment
6.9.1
39
Training equipment
6.9.2
40
6.10 Access to patients
40
6.11 Space and equipment requirements
40
Conclusions and recommendations
7.
40
Acknowledgements
41
References
41
Selected further reading
43
Annex
Applications of diagnostic ultrasound
45
iv
7
WHO Study Group on Training in Diagnostic Ultrasound:
Essentials, Principles and Standards
Philadelphia, USA, 22-26 March 1996
Members
Professor S. Bhargava, All India Institute of Medical Sciences, New Delhi, India
Professor C. Bruguera, Diagnostic Imaging Teaching Institute, Buenos Aires,
Argentina
Dr G.G. Cerri, University of sac) Paulo, São Paulo, Brazil
Professor S.H. Eik-Nes, National Centre for Fetal Medicine, Trondheim University
Hospital, Trondheim, Norway
Professor M.R. El-Meligy, Faculty of Medicine, Cairo University, Cairo, Egypt
Professor H.A. Gharbi, Department of Radiology, Children's Hospital, Tunis,
Tunisia
Professor B.B. Goldberg, The Jefferson Ultrasound Research and Education Insti-
tute, Thomas Jefferson University Medical College and Hospital, Philadelphia,
PA, USA (Chairman)
Professor H.T. Lutz, Department of Medicine, No.1 Medical Clinic, Bayreuth, Ger-
many
Professor C.R.B. Merritt, Department of Radiology, Ochsner Clinic, New Orleans,
LA, USA (Rapporteur)
Dr D.E. Robinson, Ultrasonic Laboratory, Division of Radiophysics, Commonwealth
Scientific and Industrial Research Organisation, Chatswood, New South Wales,
Australia
Mrs D. Szabunio, Ultrasound Department, Women's College Hospital, Toronto,
Ontario, Canada
Dr M.W. Wachira, Department of Diagnostic Radiology, University of Nairobi,
Nairobi, Kenya (Vice-Chairman)
Professor H. Watanabe, Kyoto Prefectural University of Medicine, Kyoto, Japan
Professor P.N.T. Wells, Department of Medical Physics and Bioengineering and
University Department of Hospital Medicine, Bristol General Hospital, Bristol,
England
Dr Xu Zhi-Zhang, Zhong Shan Hospital, Shanghai Medical University, Shanghai,
China
Representatives of other organizations
International Federation for Medical and Biological Engineering
Dr P.A. Lewin, Department of Electrical and Computer Engineering and Biomedical
Engineering and Science Institute, Drexel University, Philadelphia, PA, USA
International Society and Federation of Cardiology
Professor A.E. Belinsky, Buenos Aires, Argentina
International Society of Radiographers and Radiological Technologists
Ms C. Babiak, Michener Institute for Applied Health Sciences, Toronto, Ontario,
Canada
International Society of Radiology
Dr P. Arger, Radiology Department, University Hospital of Pennsylvania, Philadel-
phia, PA, USA
Society of Diagnostic Medical Sonographers (USA)
Dr M. Berman, Roslyn Heights, NY, USA
World Federation of Sonographers
Dr R. Curry, Program Director, 1997 World Federation of Sonographers Meeting,
Sickerville, NJ, USA
Ms K. Griffiths, President, World Federation of Sonographers, Dundas, Australia
World Federation for Ultrasound in Medicine and Biology
Professor A.E. Belinsky Buenos Aires, Argentina
Secretariat
Dr S. Hancke, Head, Ultrasonic Laboratory, Gentofte Hospital, University of
Copenhagen, Copenhagen, Denmark (Temporary Adviser)
Professor Emeritus P.E.S. Palmer, University of California, Davis, California, CA,
USA ( Temporary Adviser)
Dr V. Volodin, Medical Officer, Radiation Medicine, WHO, Geneva, Switzerland
(Secretary)
Dr A. Wasunna, Director, Programme on Health Technology, WHO, Geneva,
Switzerland
Professor M.C. Ziskin, Center for Biomedical Physics, Temple University School of
Medicine, Philadelphia, PA, USA (Temporary Adviser)
9
vi
Introduction
1.
A WHO Study Group on Training in Diagnostic Ultrasound: Essen-
tials, Principles and Standards met in Philadelphia, PA, USA, from 22
to 26 March 1996 to consider methods of improving the training and
clinical performance of physicians and allied health professionals'
who use ultrasound for diagnostic applications. The meeting was
opened by Dr A. Wasunna, Director, Programme on Health Technol-
ogy, WHO, Geneva, on behalf of the Director-General.
Diagnostic ultrasound is a rapidly developing imaging technology
which is widely used in both industrialized and developing countries.
Since its introduction in the 1960s, ultrasound has found widespread
application in anatomical imaging, blood-flow measurement, and
evaluation of physiology in almost all aspects of medicine (/). As
ultrasound instruments have become smaller, less expensive, and
easier to use, diagnostic ultrasound has become increasingly popular
among a wide variety of physicians. Ultrasound imaging technique
has replaced or complemented a large number of radiographic and
nuclear medicine procedures and has opened new areas of diagnostic
investigation (see Annex). For example, in many cardiovascular dis-
eases diagnostic ultrasound has replaced invasive methods as the
primary means of evaluation. In obstetrics, where radiography is no
longer generally used, diagnostic ultrasound has provided an impor-
tant means of assessing fetal viability and age, evaluating fetal devel-
opment, and diagnosing fetal, uterine, and placental abnormalities. In
some countries (e.g. Austria, Germany, Iceland and Norway), routine
ultrasound examinations are offered through government pro-
grammes to all pregnant women during the second trimester. Ultra-
sound is considered as the primary imaging modality for the detection
of most gynaecological, hepatic, biliary, pancreatic, splenic, and renal
diseases and for examination of the scrotal contents, bladder, and
prostate. In many developing countries, diagnostic ultrasound may
find an important application as an epidemiological screening and
diagnostic procedure for a number of parasitic diseases, such as am-
oebiasis, schistosomiasis, and echinococcosis.
Good medical practice requires ultrasonography practitioners to con-
sider the risks and benefits of diagnostic examinations, and to take all
proper measures to ensure maximum patient benefit with minimum
risk. The use of diagnostic ultrasound should be encouraged where
there is a likelihood of clinical benefit and discouraged in cases for
Allied health professionals are recognized health professionals (e.g. sonographers,
midwives, nurses) who are not physicians.
1
1 0