Thursday 17 June 2021

A brief insight into expert witness work.

 

My niche ultrasound related activity is the craft of expert witnessing.  As a pastime it beats my other obsession (baking), being better for the waistline.  Like ultrasound practice it can be bad for the anxiety levels so you may wonder why anyone in their right mind would want to do it. 

My area of clinical practice is obstetrics and gynaecology and most of my expert witness work to date has been in cases of Wrongful Birth.  These are usually cases where a fetal anomaly has not been detected and the parent’s case is that they would have terminated had they known of the anomaly. 

Obstetrics is the most litigious area in the NHS, but I have noticed an increasing number of non-obstetric ultrasound cases recently.

Expert witnesses assist the court in legal cases by translating complex technical issues into plain language, usually evaluating work against the standard of the “reasonable, competent practitioner” and giving their opinion on the practice. 



Hierarchy of evidence (Greenhalgh. 2019)

My students can tell you that I do rather bang on about personal or expert opinion being unreliable and its place at the bottom of the hierarchy of evidence.

It is true that opinion is at the bottom of the pile, by its nature it is based on individual experience and prone to bias.   The requirement is in fact for opinion based on knowledge and experience, based on the contemporary guidelines, protocols and literature.

The timeline of a case is something like this –

A letter of approach arrives from a solicitor giving me details of a case, either for the claimant or the hospital trust against whom the claim is being made.  Expert witnesses can only be instructed by a solicitor with permission of the court and the duty of the expert is to the court and to be impartial.  Essentially the expert should write the same report whichever side instructs them.  I accept or reject based on if the work is within my scope of expertise, whether I have a conflict of interest, how much time I have available and the need to balance work instructed by defence and claimant.  If accepting the case, I send the solicitor my terms of appointment and my CV.

Then I wait………

This can be a slow process.

The bundle of evidence arrives.  This is the medical notes and can be one or more enormous boxes of lever arch files, sometimes meticulously organised and on a couple of occasions, in a disastrous state of disorganisation.  Recently the bundle is more frequently shared as a PDF via a secure portal. 

The instructions usually contain specific questions to answer and I identify other content relevant to the case.  The real work starts with sifting through the bundle, reviewing the ultrasound images, identifying key documents and creating the outline of the report.  Each report is essentially an essay and the heart of the report is a comprehensive literature review, so the work requires good academic writing skills with the ability to demonstrate critical evaluation, analysis and synthesis to explain the path to the opinion.   

In many cases, expert involvement ends with the report but in some cases, involvement extends to conferences with barristers, meetings between the experts from both sides in the case and in rare cases, court appearances.

When I took my first case I was not happy to start the work without training and was extremely fortunate to have a very supportive instructing solicitor (I did not realise how fortunate at the time but I have experienced the good, the bad and the ugly since and can definitely say I was lucky with my first one!).  My instructing solicitor was happy to wait while I did a course in medico legal report writing while I wrote the report.  I went on to complete a full certificate in expert witness practice, and I can safely say that I would not feel comfortable about practicing without it.  Earlier this year the Academy of Medical Royal Colleges published guidance for healthcare professionals acting as expert witnesses.  This includes the guidance that healthcare professionals doing this work should undertake specific training for being an expert witness.

The course is expensive, but the work is serious.  An expert who causes a case to collapse though incompetent advice can be sued.  It is very unlikely, but you absolutely do need to know what you are doing and must undertake CPD and have insurance.  We would not practice ultrasound without all of these.

Expert witness practice brings professional development opportunities and non-stop ultrasound CPD as to do the work you have to stay up to date and question everything.  It is by turns fascinating, alarming and satisfying.  In that way it is a bit like ultrasound itself!  It informs my teaching and has helped me to become a better sonographer. 

 


 

 

 

 

 

 

 

 

Wednesday 7 October 2020

Getting out of my comfort zone.

 And now for something completely different...


Being interviewed for TV is much harder than writing, lecturing with notes, attending case conference with barrister, conference between experts and giving evidence in court.


What have I learned?

Prone to imposter syndrome which threatens to strangle me even on a good day, I learned that there is no limit to the deviousness of my brain.  Since the interview it has rewritten the interview over and over again so now I am slightly alarmed about the prospect of watching it.

I was approached to give the interview after giving evidence in a case last year, the producer read the judgement and contacted me.  I spent a lot of time deciding if I wanted to take the step of being interviewed but in the end I decided to do it.  The ethos of the programme at City is to turn out sonographers who are not only clinically competent but who are confident and politely bolshy enough to stand up for the profession and patients at local and national level.  I had to practice what I preach!

And bloody terrifying it was too.

But probably not as terrifying as if I had not had expert witness training and experience.  I discovered that the skills are similar.  Stay in your circle and don’t talk about stuff you are not there to talk about or stuff outside your scope.  I just hope I managed it, I was surprised at the length of time it took, the same question filmed from different angles. It was surprisingly tiring and with social distancing and cold as it was filmed in my back garden, a space best described as a work in progress.

No idea yet when it goes out, will be interesting to see (from behind the sofa or between my fingers) how it turns out.

The BBC piece can be found here...

Wednesday 26 February 2020

Taking a podcast moment. Obstetric ultrasound of the renal tract.




Today was all about writing an exam but I took a little time out to record a new podcast on the antenatal ultrasound appearances of the renal tract.  To improve the sound quality I used a trick stolen from my daughter and hid under a quilt to record.  Ruby has now adopted the quilt and I fear that I am not allowed to move my chair to get up as the quilt is partly resting on it!    
I hope you find the podcast useful, it is a brief overview of the embryology, normal sonographic appearance and anomalies of the renal tract.  The reference list and bibliography used in constructing the pod is below.
As always, the pod is designed for development of knowledge base and is based on evidence available at the time of writing.  It does not constitute advice or guidance for practice, please refer to your local protocols and national guidance.  If you become aware of any new evidence which contradicts or develops any of the content, or you wish to discuss any of the points raised, please let me know on twitter @peabodysono or via the blog.
                 
     


References

Avni, F.E., Garel, C., Cassart, M., D'Haene, N., Hall, M. & Riccabona, M. 2012, "Imaging and classification of congenital cystic renal diseases", AJR. American journal of roentgenology, vol. 198, no. 5, pp. 1004-1013. https://www.ajronline.org/doi/full/10.2214/AJR.11.8083 (accessed 4th December 2019)

Bornes, M., Spaggiari, E., Schmitz, T., Dreux, S., Czerkiewicz, I., Delezoide, A., El‐Ghoneimi, A., Oury, J. & Muller, F. 2013, "Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis", Prenatal Diagnosis, vol. 33, no. 12, pp. 1162-1166.

Chiodini, B., Ghassemi, M., Khelif, K. & Ismaili, K. 2019, "Clinical Outcome of Children With Antenatally Diagnosed Hydronephrosis", Frontiers in pediatrics, vol. 7, pp. 103.

Cuckow, P.M., Nyirady, P. & Winyard, P.J.D. 2001, "Normal and abnormal development of the urogenital tract", Prenatal Diagnosis, vol. 21, no. 11, pp. 908-916.

Dias, Tiran, MD (Obs & Gyn), MRCOG (UK), MD-Research (London), Dip (Fetal Med) UK, Sairam, Shanthi, MBBS, MRCOG & Kumarasiri, S., MBBS 2014, "Ultrasound diagnosis of fetal renal abnormalities", Best Practice & Research: Clinical Obstetrics & Gynaecology, vol. 28, no. 3, pp. 403-415.

Fontanella, F., Maggio, L., Verheij, J., Duin, L.K., van Scheltema, P. N. A, Cohen-Overbeek, T., Pajkrt, E., Bekker, M., Willekes, C., Bax, C., Gracchi, V., Oepkes, D. & Bilardo, C.M. 2019, "Fetal megacystis: a lot more than LUTO", Ultrasound in Obstetrics and Gynecology, vol. 53, no. 6, pp. 779-787.

Friedman, M.A., Aguilar, L., Heyward, Q., Wheeler, C. & Caldamone, A. 2018, "Screening for Mullerian anomalies in patients with unilateral renal agenesis: Leveraging early detection to prevent complications", Journal of Pediatric Urology, vol. 14, no. 2, pp. 144-149.

Kang, M., Kim, Y.C., Lee, H., Kim, D.K., Oh, K., Joo, K.W., Kim, Y.S., Chin, H.J. & Han, S.S. 2019, "Renal outcomes in adult patients with horseshoe kidney", Nephrology Dialysis Transplantation.

Liao, A.W., Sebire, N.J., Geerts, L., Cicero, S. & Nicolaides, K.H. 2003, "Megacystis at 10–14 weeks of gestation: chromosomal defects and outcome according to bladder length", Ultrasound in Obstetrics and Gynecology, vol. 21, no. 4, pp. 338-341.

McPherson, E (2007) 'Renal anomalies in families of individuals with congenital solitary kidney ', Genetics in Medicine, Vol. 9(No. 5), pp. 298 - 302.

Nguyen, H.T., Herndon, C.D.A., Cooper, C., Gatti, J., Kirsch, A., Kokorowski, P., Lee, R., Perez-Brayfield, M., Metcalfe, P., Yerkes, E., Cendron, M. & Campbell, J.B. 2010, "The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis", Journal of Pediatric Urology, vol. 6, no. 3, pp. 212-231.

Policiano, C., Djokovic, D., Carvalho, R., Monteiro, C., Melo, M.A. & Graça, L.M. 2015, "Ultrasound antenatal detection of urinary tract anomalies in the last decade: outcome and prognosis", The Journal of Maternal-Fetal & Neonatal Medicine, vol. 28, no. 8, pp. 959-963.

Public Health England (2019) National Congenital Anomaly and Rare Disease Registration Service, NCARDRS congenital anomaly statistics 2017: tables, Available at: https://www.gov.uk/government/publications/ncardrs-congenital-anomaly-annual-data (Accessed: 4th December 2019).

Public Health England (2019) National Congenital Anomaly and Rare Disease Registration Service Congenital anomaly statistics 2017, Available at: https://www.gov.uk/government/publications/ncardrs-congenital-anomaly-annual-data (Accessed: 4th December 2019).

Sairam, S., Al‐Habib, A., Sasson, S. & Thilaganathan, B. 2001, "Natural history of fetal hydronephrosis diagnosed on mid‐trimester ultrasound", Ultrasound in Obstetrics and Gynecology, vol. 17, no. 3, pp. 191-196.

Yulia, A. & Winyard, P. 2018, "Management of antenatally detected kidney malformations", Early Human Development, vol. 126, pp. 38-46.



Friday 12 July 2019

Further adventures in podcasting - placenta, membranes and liquor.

In between clinical assessments, I have managed a new podcast.  This one covers abnormalities of the placenta, membranes and liquor.  As always with these podcasts, it is based on the evidence available at the time of recording.  If you are aware of new evidence which contradicts or develops any of the content, I would love to hear from you.  You can get in touch via the blog or by Twitter where you can find me as @peabodysono

I hope you find this useful, it is designed to be used by everyone scanning in obstetric ultrasound, whether you are training or, if like me you have been around forever and could use a little CPD!  Do feel free to share it with your colleagues and keep an eye on the blog for the next one.

9.30pm 16th July 2019.  I am aware that the last two minutes of the podcast are very quiet, I will be updating it later this week.

The references used in the compilation of this podcast are below.




Jacqueline Torrington. June 2019.  Based on evidence available at the time of writing.  If you become aware of new evidence which contradicts or develops any of the content of this piece, or you wish to discuss any points raised, please let me know on twitter @peabodysono or via the blog.


Baraa Allaf, M. Andrikopoulou, M, Crnosijam N. Muscat, J. Chavez, M and Vintzileos, AM. (2019) 'Second trimester marginal cord insertion is associated with adverse perinatal outcomes', The Journal of Maternal Fetal and Neonatal Medicine, 32(18), pp. 2979-2984.

Beall, MH. van den Wijngaard, JPHM. Gemert, MJC and Ross, MG. (2007) 'Regulation of amniotic fluid volume', Placenta, 28(), pp. 824-832 [Online]. Available at: https://0-www-sciencedirect-com.wam.city.ac.uk/science/article/pii/S0143400406002943 (Accessed: 26th June 2019).

Coady, AM. (2015) 'Amniotic Fluid', in Bower, S and Coady, AM. (ed.) Twining's Textbook of Fetal Abnormalities. : Churchill Livingstone, pp. 81-99.

Costello Medical Consulting Ltd. (2017) Screening for vasa praevia in the second trimester of pregnancy External review against programme appraisal criteria for the UK National Screening Committee (UK NSC), London: UK National Screening Committee.

Ismail, KI. Hannigan, A. O'Donoghue, K and Cotter, A. (2017) 'Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis', Systematic Reviews, 6(242), pp. [Online]. Available at: https://link.springer.com/article/10.1186/s13643-017-0641-1#citeas (Accessed: 26th June 2019).

Jauniaux, ERM. Alfirevic, Z, Bhide, AG. Belfort, MA. Burton, GJ. Collins, SL. Dornan, S. Jurkovic, D. Kayem, G. Kingdom, J. Silver, R and Sentilhes, L. (2018) 'Placenta Praevia and Placenta Accreta: Diagnosis and Management Green‐top Guideline No. 27a', BJOG: An International Journal of Obstetrics and Gynaecology, 126(1), pp. [Online]. Available at: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15306 (Accessed: 19th June 2019).

Kumar, B and Nwosu, EC. (2015) 'Placenta, amniotic membrane and amniotic fluid.', in Kumar, B and Alfirevic, Z. (ed.) Fetal Medicine. Cambridge: Cambridge Medicine, pp. 321-336.

Marshall, NE. Rongewi Fu, MCR and Guise, JM. (2011) 'Impact of multiple caesarean deliveries on maternal morbidity: a systematic review.', American Journal of Obstetrics and Gynecology, (), pp. 205:262 [Online]. Available at: https://0-www-sciencedirect-com.wam.city.ac.uk/science/article/pii/S0002937811007630 (Accessed: 19th June 2019).



Pavalagantharajah, S. Villani, LA and D'Souza, R. (2019) 'Prevalence of obstetric risk factors in pregnancies with vasa previa: A systematic review and meta- analysis', American Journal of Obstetrics and Gynecology, 220(1), pp. S483.

Ples, L. Sima, RM. Moisei, C. Moga, M and Dracea, L. (2017) 'Abnormal ultrasound appearance of the amniotic membranes – diagnostic and significance: a pictorial essay', Medical Ultrasonography, 19(2), pp. 1844-4172.

Shobeiri, F & Jenabi, E. (2017) Smoking and placenta previa: a meta-analysis, The Journal of Maternal-Fetal & Neonatal Medicine, 30:24, 2985-2990, DOI: 10.1080/14767058.2016.1271405

Delete

Sinkey, RG and Odibo, AO. (2018) 'Vasa previa screening strategies: decision and cost‐effectiveness analysis', Ultrasound in Obstertrics and Gynaecology, 5(), pp. 522-529 [Online]. Available at: https://0-obgyn-onlinelibrary-wiley-com.wam.city.ac.uk/doi/full/10.1002/uog.19098 (Accessed: 26th June 2019).

Vermey, B., Buchanan, A., Chambers, G., Kolibianakis, E., Bosdou, J., Chapman, M. & Venetis, C. 2019, "Are singleton pregnancies after assisted reproduction technology (ART) associated with a higher risk of placental anomalies compared with non‐ART singleton pregnancies? A systematic review and meta‐analysis", BJOG: An International Journal of Obstetrics & Gynaecology, vol. 126, no. 2, pp. 209-218.

Woo, GW. Rocha, FG. Gaspar-Oishi, M. Bartholomew, ML and Thompson, K. (2011) 'Placental Mesenchymal Dysplasia', American Journal of Obstetrics and Gynaecology., (), pp. e3-e5.

Zanardini, C. Papageorghiou, A. Bhide, A and Thilagnathan, B. (2010) 'Giant placental chorioangioma: natural history and pregnancy outcome', Ultrasound in Obstetrics and Gynaecology, 35(), pp. 332-336 [Online]. Available at: https://0-obgyn-onlinelibrary-wiley-com.wam.city.ac.uk/doi/epdf/10.1002/uog.7451 (Accessed: 26th June 2019).

Saturday 25 May 2019

Dipping a toe into podcast soup (or something unusually clean from Fascinating Aida)

Actually this is a post about flipped learning resources but as podcasting is so popular now I prefer to think of it as emulating Fascinating Aida and getting Down With the Kids! (see below...)




I am renewing some of the resources on the obstetric module of the ultrasound course and decided to go down the podcasting route.  In the past the online content has been video lectures which are excellent but now need replacing.  With ubiquitous smartphones and apparently endless data, podcasts, along with ultrasound images on the university virtual learning environment give the freedom to listen and think while out and about, doing the washing up, sitting on the bus...

The podcast is a starting point, covering the basic information and can be followed up by deeper reading.

Anyway, this is my first attempt.  Review by my home based critics suggested that I sound as if I am broadcasting from under a table deep in enemy territory but everyone has to start somewhere!  I may not be exactly down with the kids yet... (All constructive criticism is welcome - either here or on twitter.

(Note - this podcast references the 2012 NICE GG154 on ectopic pregnancy and miscarriage.  This guideline has now been replaced by 2019 NICE NG126 Ectopic pregnancy and miscarriage: diagnosis and initial management.)

Link to podcast

The references used in the compilation of this podcast are below.


Jacqueline Torrington. February 2019.  Based on evidence available at the time of writing.  If you become aware of new evidence which contradicts or develops any of the content of this piece, or you wish to discuss any points raised, please let me know on twitter @peabodysono or via the blog.

References and Bibliography for molar pregnancy podcast

Hydatidiform Mole and Choriocarcinoma UK Information and Support Service http://hmole-chorio.org.uk/index.html

Kirk, E. 2017. Early Pregnancy Ultrasound, a practical guide.  Cambridge University Press,

Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RP. Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?. Clinics (Sao Paulo). 2015;70(12):810-5.

Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical guideline [CG154] Published date: December 2012  https://www.nice.org.uk/guidance/CG154/chapter/1-Recommendations#management-of-miscarriage

Royal College of Obstetricians and Gynaecologists. The Management of Gestational Trophoblastic Disease Green–top Guideline No. 38 February 2010 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_38.pdf

Parker, V and Tidy, J. Current management of gestational trophoblastic disease. Obstetrics, Gynaecology & Reproductive Medicine.  Volume 27, Issue 11, November 2017, Pages 338-345

Monday 16 April 2018

The view from here: A sonographer's view of scanning in the Fetal Anomaly Screening Programme.


Lorraine Walsh's excellent article entitled 'Why it is difficult for sonographers to talk' in Imaging Therapy and Practice (April 2018) got me thinking about communication in obstetric ultrasound and the experience of scanning within the screening programme.




Although the fetal anomaly screening programme is highly structured, the experience of scanning is more complicated than the structure suggests and the quality of a scan depends not only on the skill and experience of the operator but on factors relating to the patient.  It is important that true limitations to the scan are clearly and sensitively explained to the parents and recorded in the notes.  Antenatal ultrasound view is frequently impeded by fetal position, maternal obesity, fibroids or abdominal wall scarring.  The fetal anatomy may appear abnormal due to these factors and on further investigation be found to be normal.  On occasion, a sonographer may have an uneasy feeling about the fetus but will be unable to elucidate why.  Suspicion that an underlying abnormality is present may be based on something as subtle as the anatomy ‘not looking quite right’.    It is always advisable to seek a second opinion in these cases as sonographers see large numbers of normal pregnancies so if something about a fetus makes them uneasy a supportive Fetal Medicine Consultant will take it seriously.   Sometimes these ‘gut feeling’ referrals turn out to be abnormal. 

Ultrasound examinations require high levels of concentration and analysis by sonographers.  Standard 4 of the NHS Fetal Anomaly Screening Programme 2010 Standards requires that 30 minutes should be allowed for an anomaly scan of a single fetus; most other scans require 20 minutes.  It is common for ultrasound departments to have to fit in extra scans for which there are no available appointments. Many departments are chronically understaffed as in the UK there is a longstanding and worsening shortfall in sonographer staff numbers meaning that there is an insufficient number of trained Sonographers to meet the growing demand for ultrasound examinations.  In 2014 the Society of Radiographers conducted a workforce survey of sonographers and found the absence rate across responding departments to be 9% and vacancy rate of 18.1%; an increase on the 2011 vacancy rate of 10.9%.  33% of sonographers were over the age of 50 and only 35% under the age of 40.   65% of responding departments had sonographers working more than their contracted hours to meet demand. 

The increasing number of women with a BMI of over 30 combined with excessive hours of scanning and the technical difficulties of achieving the images required for the Nuchal Translucency measurement has led to an increase in the number of sonographers suffering from work related musculo skeletal disorders, particularly affecting the neck and dominant arm and hand of the sonographer.  In response to an increasing number of inquiries from sonographers suffering from work related musculo skeletal disorders The Society of Radiographers has produced guidance, most recently updated in 2016 giving advice on how to reduce the risk of developing or exacerbating problems.  A recommendation for those departments providing FASP scans is the provision of secondary monitors in the scan room, allowing the parents a view of the scan without the sonographer having to turn the screen for them to see.  In the absence of a secondary monitor the natural desire of the parents to see the scan can lead to the sonographer increasing their risk of injury by adopting a poor posture while turning the screen for the parents to see.

Additional strains are caused by the public perceptions of ‘the scan’.  Most sonographers are very aware of the importance placed on the social aspects of the scan and wish to make the experience enjoyable and informative when they can.  An online survey of social and commercial aspects linked to the two NHS FASP scans conducted by the Society of Radiographers in 2015 gathered a 49% response rate from managers of ultrasound departments conducting FASP scans.  The high response rate to the online survey makes it likely that the themes in the answers are general across ultrasound departments.  The survey was designed to obtain information about parental expectations unrelated to the screening of the fetus.  Expectations include the mother being able to have her partner and other adults and children accompanying her, can learn the sex of the baby and be given pictures to take away with her.  A strong theme emerging from the survey responses are tensions between the clinical justification for the screening scan and the parent’s expectations which leads to distraction for the Sonographer when the requirement for concentration is very high.  The presence of others apart from the partner in the scan room can be a problem when a fetal anomaly is identified.  This is particularly difficult when children are present.  In my experience, most complaints received by antenatal ultrasound departments relate to communication and the social aspects of the scan.  My own experiences mirror the survey findings and include the increasingly common experience of partners attempting to covertly video recording scans.  Time spent by the sonographer dealing with disruption in the scan room without escalating tensions and precipitating conflict and subsequent potential complaint is a distraction from the screening scan.

All these elements create a stressful working environment for sonographers and increase the likelihood of abnormal appearances being missed.  The sustainable solution to this situation lies in the recruitment and retention of trained staff and the training of new sonographers.  The Society of Radiographers is conducting a survey of departmental training needs to identify current requirements and capacity.




The analysis of the sonographer workforce survey identified barriers to recruitment and training with 20 responding departments reporting a lack of suitable candidates for vacant roles and a lack of funding for training.  A variety of other themes emerged from the survey including reliance on agency sonographers and difficulty in retaining staff once qualified. 

From the analysis of both surveys a picture emerges of a profession working under continually increasing strain.  All of this is distracting and results in cumulative pressure, increasing the risk of anomalies being missed by stressed Sonographers. 

Under the circumstances outlined above it is necessary to question to what extent an individual sonographer should be held solely responsible for missing anomalies in a screening programme.  The individual sonographer has responsibility for the safe conduct of the scan; however, under the terms of the NHS Constitution the employing trust has the responsibility to provide the staff with a good working environment and ensure that staff have the tools, training and support to deliver compassionate care.

References
Department for Health. 2015. The NHS Constitution for England.Fetal Anomaly Screening Programme programme handbook. 2015.
NHS Fetal Anomaly Screening Programme. 2010. 18+0 to 20+6 Weeks Fetal Anomaly Scan National Standards and Guidance for England 
Public Health England. Down’s syndrome screening Quality Assurance Support Service (DQASS):  proposed changes to the threshold for red flag bias.  2017. 
Society and College of Radiographers (SCoR). 2015.  A survey of social and commercial aspects linked to the two NHS fetal anomaly screening scans:  an on-line survey.  
Society and College of Radiographers (SCoR).  2014.  Sonographer Workforce Survey Analysis.
Society and College of Radiographers (SCoR).   2016.  Work Related Musculo-Skeletal Disorders (Sonographers)

Friday 15 September 2017

Sonographers and advanced practice - where do we go from here?



There appears to be a broad consensus that radiography is in danger of being left behind as other professions advance.  The evidence that extended roles and advanced practice are commonly conflated is building.  As sonographers we have additional problems as we are in the main from radiography backgrounds, but have no direction as an independent profession as we are unregulated.







As artificial intelligence in medicine becomes more sophisticated things will change and sonographers may need to countenance the unthinkable which is that much of the work is ripe for pattern recognition image interpretation.  

I am playing devil’s advocate here but we need to consider a future where those who have the drive and the ability to progress to Advanced Practice will lead and those who do not will screen with the aid of software which is being developed by many manufacturers.  The technology is developing fast - today it is possible to purchase software to provide quality analytics which audit the completeness and quality of stored images, a potentially useful tool when it is difficult to spare sonographers from scanning to carry out regular image audit and in a time when litigation places increasing strain on the NHS budget.

The urgent question to be answered now is how do we use the evidence to shape the profession?  And how do we do that as work loads increase and staffing levels fall?  Our demographic time bomb is ticking - in 2014 the Society of Radiographers Sonographer Workforce Survey found that 66% of sonographers were over the age of 41 and 33% over the age of 50.  There are not enough trainees in the system to meet the current demand let alone the inevitable future increases.

Change is inevitable and it is best to be actively involved in making changes or it will be imposed on us.  If sonographers influence the development of sonography we may be able to build a profession in which career development and a growth mindset  will benefit patients and staff alike.