2006-Issue01 by EFSUMB

European Federation of Societies for Ultrasound in Medicine and Biology

Contents

Editorial

EFSUMB Officers and Committees .. 64

This edition of the News-

much in that period of time requires ex-

letter comes at the start of

treme dedication and focus.

Thoughts of a New President ......... 64

arrangement between Ul-

For those members of the Federation who

Reflections from the Past President 65

traschall in der Medizin

only receive this one edition of the Jour-

and the European Journal

nal, as well as encouraging you to subscri-

of Ultrasound. The last two years have

be to the EJU, either individually or by en-

gone by incredibly quickly and, looking

couraging your National Society to sub-

back, it seems hard to remember what

scribe, I would mention that up-to-date

the Newsletter used to look like. Whilst

news of the Federation is always availab-

we all hoped that the subscription num-

le on the website. A small Newsletter is

bers for the Journal would increase, I

produced every two months which is

think only the wildest optimist would

available, on the website, to all who ac-

have predicted that, at this stage, 65% of

cess the website, as well as being in paper

members would be receiving the Journal,

form in the European Journal.

Publisher Report ........................... 69

vidual Societies in incorporating the jour-

It hardly seems any time since the Geneva

nal subscription in their annual member-

meeting and Jean-Yves Meuwlyâ&#x20AC;&#x2122;s contri-

Epilogue from 17th Euroson Congress 2005, Geneva, Switzerland.... 70

ship subscription to the national socie-

bution reminds us of what a success this

ties. We are most grateful to them for this.

meeting was. Nothing stops however and

This Newsletter also publishes, formally,

the Bologna meeting is well advanced in

the minimum training standards docu-

its planning as you will see elsewhere.

ment which has been much heralded el-

We all look forward to a most exciting sci-

sewhere. Whilst this is available on the

entific meeting, as well as a great social

website as well, many people much value

event. For any who have not tried the Eu-

the paper version of all these documents.

ropean meeting, I can thoroughly recom-

The Education and Professional Stan-

mend it.

the third year of the new

Report from the Honorary Secretary ....................................... 66 Report from the Honorary Treasurer ....................................... 67 Report from the Education and Professional Standards Committee. 68 Report from Publications Committee .................................... 69

due largely to the foresight of their indi-

dards Committee must be congratulated for the hard work they have put into this

Finally, as the Newsletter Editor, I must

document and in their continuing efforts

again acknowledge the huge contributi-

to introduce some order into ultrasound

on to the Federation made by Gianna

education standards and training. Only

Stanford. Without her tactful guidance

time will tell how well their efforts pay

and encouragement, the Newsletter

off.

would never happen and my life would be a misery!

Ultraschall 2005; 26

In Geneva we said goodbye to a number of friends who have served the Federati-

Many thanks again Gianna, from me per-

on well on the Board of Directors or the

sonally and from all those involved in

Executive Bureau. The new term of office

EFSUMB.

of the Executive Bureau will bring with it

David W. Pilling

new challenges. Looking forward, two

Editor EFSUMB Newsletter

years seems a long time, but to achieve

Young Investigators Award 2005 ... 70 18th Euroson Congress 2006, Bologna, Italy................................. 73 Diary Dates .................................... 77 Minimum training requirements for the practice of medical ultrasound in Europe ..................... 79

EFSUMB Newsletter

Thoughts of a New President Our annual Euroson meeting, held in Geneva last September, saw a major change in the composition of the Executive Bureau (ExB) of EFSUMB. Both Michel Claudon from France and Niels Juul from Denmark retired from the board after serving for nine and six years respectively, and Nor-

bert Gritzman from Austria and Pietro Pavlica from Italy joined Executive Bureau

us. The three other members, Kurt Jaeger from Switzerland, Lucas

President: D H Evans (UK) President Elect: N Gritzmann (Austria) Past-President: K Jäger (Switzerland) Honorary Secretary: L Greiner (Germany) Honorary Treasurer: P Pavlica (Italy

Greiner from Germany, and I remain on the board, with Kurt be-

ECMUS — European Committee for Medical Ultrasound Safety Chairman: T A Whittingham (UK) Secretary: P Arbeille (France) Members: M Delius (Germany) L Klinghammer (Germany) R Laurini (Sweden) K Marsál (Sweden) Ex-officio: D H Evans (UK)

coming Past-President, Lucas continuing in his role of Honorary Secretary and myself becoming President. I would like to take this opportunity to thank all the members of the ‘old’ board and welcome our new members.

The past three years have been a very busy time for all of us, but also a very fruitful period due to the tremendous energy and enthusiasm of each and every member. I would like to record my thanks for their work, but particularly for their great friendship over the past three (and in the case of Michel, Niels and Kurt six) years. In welcoming our new members I know that the new board will continue in the tradition of friendship, which not only makes it a pleasure to work together, but also allows important progress to be made (I would not however want to give the impression that

Education and Professional Standards Committee Chairman: D Lindsell ( UK) Members: O H Gilja (Norway) C Nolsøe (Denmark) I Sporea (Romania) H Strunk (Germany) Ex-officio: N Gritzmann (Austria)

there is not, at times, ‘vigorous’ debate amongst the ExB, but such debate is both healthy and constructive). Before leaving the subject of the ExB, I must record the thanks of all of us to our ‘sixth member’, Gianna Stanford, our General Secretary, who continues to work tirelessly both for the ExB, and the whole of EFSUMB. All of our jobs would be very much more difficult if it were not for Gianna’s dedication to EFSUMB. Much of

Publication Committee Chairman: D W Pilling (UK) Members: C Dietrich (Germany) F Drudi (Italy) J Pirhonen (Norway) Ex-officio: L Greiner (Germany) M Bachmann Nielsen (Denmark)

the work of EFSUMB is of course carried out by our various committees, and I would also like, on behalf of EFSUMB, to thank the retiring members of those committees, and welcome the new members. In particular I would like to thank Lil Valentin who has chaired our Education and Professional Standards committee for the past six years. “The scientific programme was extremely strong“

EFSUMB Newsletter Editor: D W Pilling (UK) Secretariat

course the Euroson meeting, and the Swiss Society, and Jean-Yves Meuwly in particular, did an incredible job in organising a most excellent meeting in Geneva last September. The scientific programme was extremely strong, and the meeting greatly enjoyed by the large number of participants from throughout Europe, and indeed from the rest of the world. We now look forward to the 2006 meeting, being organised by the Italian Society, which is to be held in Bologna in September. Those of you lucky enough to have attended the joint EFSUMB/WFUMB meeting in Florence in 2000 will know what a treat we have in store. I hope to see you all there!

Contact addresses and brief CV's for officers of EFSUMB are to be found on the EFSUMB website: http://www.efsumb.org

Ultraschall 2005; 26

General Secretary: Mrs Gianna Stanford, Carpenters Court, 4a Lewes Road, Bromley, Kent BR1 2RN, UK Tel: +44 (0)20 8402 8973 Fax: +44 (0)20 8402 9344 E-mail: efsumb@efsumb.org Website: www.efsumb.org

The most important date in the EFSUMB calendar each year is of

EFSUMB Newsletter

“We need to continue to define our role, and to adapt to changing circumstances“ So what of the future? EFSUMB is now in a very healthy state with an ever increasing membership and a stable financial base. We need to build on this. Remaining static in a more and more rapidly changing world is not an option, and there are many challenges that we have to face. We need to continue to define our role, and to adapt to changing circumstances. Kurt, in his capacity of President, like Michel before him, made a tremendous contribution

to the organisation, so that EFSUMB in 2006 is certainly a much stronger, more coherent organisation than when I originally joi-

blems. Some of our member societies may be really active at

ned the ExB in 2000. I do hope that I can maintain the tradition set

home but are not yet an energetic part of the European family. On

by previous Presidents, so that I too can look back in two years

the other hand, the multifaceted aspect of the multicultural Eu-

time and feel that further progress has been made.

ropean aspect will be a challenge for our President whenever he has to act as a ringmaster to control the bunch of 28 fleas. In ad-

Prof. David Evans

dition, EFSUMB has to consider opening the gate for related Eu-

President EFSUMB

ropean Societies with the same bona fide interest in the development of ultrasound. An open door is, similar to an open mind, a first step to evolution and progress; however, it might be at the

Reflections of a Past President

same time an unprotected danger. When the Janus gate was closed, this represented peace within the Roman Empire. When the gates were open, it meant that Rome was at war. More than 2000 years have elapsed since then and the interpretation of the

The launch of a new year, a new era, was de-

fine tradition may have completely changed.

dicated by the Romans to Janus, the god of gates and doors. Janus is commonly depicted with two faces: One looking at regarding what is behind and one looking into the future. Ja-

It is my strong feeling that EFSUMB has to open the gates, must play a proactive role and will shall establish leadership in the domain of medical ultrasound in Europe.

nus could look both backward and forward at the same time, reminding us to eventually interrupt our hectic rush, to look backward in order to better understand where we are staying and

“EFSUMB has to consider opening the gate for related European Societies with the same bona fide interest in

mainly what we are heading for.

the development of ultrasound“ EFSUMB would be well advised to give further attention to trai-

The backward looking bearded face has a grimly appearance.

ning and education. Minimal training requirements and guideli-

Looking at the recent developments in EFSUMB I see now reason

nes for several specialties have been established. Now they need

for a face marked by sorrow. The European Federation seems to

to be applied and become operational in the daily routine. In

be in a very healthy and prosperous condition. Recently, three

some specialties young colleagues may be distracted by fancy

more national societies have joined the Federation and the num-

modern imaging modalities which may lead to inappropriate

ber of individual members has continuously increased, exceeding

training and education and thereby in an under use of ultrasound.

18,000. Most of our societies are playing an active role in the de-

The Euroson Congress may only partially compensate for this de-

velopment, spread and optimized use of Ultrasound in Medicine.

ficiency in education. In recent years successful annual Euroson

Training and education for the benefit of our patients is the main

Congresses have been held. This should not mask the fact that

goal of our societies. At the same time, EFSUMB has acquired got-

even well established congresses will be challenged. Funding of

ten again a scientific platform. Our Journal, Ultraschall in der Me-

meetings becomes an increasing challenge for organizers. Spon-

dizin/European Journal of Ultrasound, is on its way to being of a

sorship is flowing like a high viscosity fluid since the business si-

real successful, truly European Journal with a high scientific im-

tuation of the manufacturers has changed. New modalities need

pact (IF 1.5) and a circulation that exceeds all other ultrasound

to be designed and it might be that the consumers will have to co-

journals. Two thirds 2/3 of the EFSUMB members are subscribers

ver a part of the expenses. Educational meetings will go from

of our Journal.

strength to strength as long as they are professionally organized, based on a sound budget, not competing with other ultrasound

Ultraschall 2005; 26

“The European Federation seems to be in a very healthy and

events.

prosperous condition“ The face looking into the future is sometimes shown bearded, so-

The past was not bad, let us embark on an even better future!

metimes clean-shaven but always symbolizing youth, energy and a bright future. For the future time to come EFSUMB will need a

Prof. Kurt Jäger

strong leadership, since we will have to face and solve a few pro-

Past President EFSUMB

EFSUMB Newsletter

also for other societies subgroups promoting the application of ultrasound. This means an opening to a closer cooperation with other organizations dealing with ultrasonography with our Federation functioning as an “umbrella society“. The changes of the bylaws follow – in the sense of how to carry out the constitutional rules – their renewal concerning the new two-year-terms. In addition, some modifications were accepted concerning our Federation’s Newsletter, the Young Investigators Award, the composition of the Publications Committee, and Eu-

Old and New EFSUMB Officers New EFSUMB officers had to be elected during the General As-

roson School activities. Development of Membership

sembly in Geneva, on 29th September last year. The unanimous voting followed the proposals of the Executive Bureau, and we

As a whole, EFSUMB is a flourishing enterprise with a steady in-

can welcome – as highly renowned international experts in cli-

crease in members, at the time being as a total number compri-

nical ultrasonography – Prof. Dr. Norbert Gritzmann, radiologist,

sing 18639 members, with the following distribution:

from Austria as President Elect, and Dr. Pietro Pavlica, radiologist, from Italy, as Honorary Treasurer. The Honorary Secretary was

Austria 872

Macedonia 19

re-elected for a second period. We are greatly indebted to the for-

Belgium 278

Netherlands 47

mer officers who have been substituted by now according to our

Bulgaria 105

Norway 225

constitution, and a special word of acknowledgement for all the

Croatia 67

Poland 1200

work of Prof. Michel Claudon from France as former (Past-)Presi-

Czech Rep 40

Portugal 63

dent and Prof. Niels Juul from Denmark as former treasurer for

Denmark 689

Romania 300

the last nine and six years is really deserved. This is even the more

Finland 270

Russia 106

true and needed for the abundant workload and excellent perfor-

France 193

Slovak Rep 40

mance in any respect for the by now Past President, Prof. Kurt Jä-

Germany 6488

Slovenia 108

ger, from Switzerland, who among other milestone activities suc-

Greece 101

Spain 177

cessfully achieved the fusion of our official scientific journal – The

Hungary 48

Sweden 115

European Journal of Ultrasound – with Ultraschall in der Medizin.

Israel 101

Switzerland 2593

Italy 1755

Turkey 157

Latvia 152

UK 2330

Changes to the EFSUMB Constitution and to the bylaws The General Assembly in Geneva on the 25th September, was the

Some national societies, however, develop better than others

right time and situation to discuss and vote on some changes to

with respect to their number of individual members, their scien-

the constitution of our Federation, This holds true as well for the

tific and educational activities and their representation within

changes in the Bylaws to be decided on by the Board of Directors

EFSUMB. The Executive Bureau gave expression to its hope that

Meeting in Geneva on the 24th September.

those national societies with a stable or maybe even declining number of members should be able to turn around such unwan-

Since changing the legal basis of our activities is a serious matter,

ted developments, and EFSUMB offers all possible support. Ap-

the processing of these modifications was discussed carefully and

plications for membership of the EFSUMB family were approved

repeatedly at the Executive Bureau sessions. These preparations

by the Board of Directors from the Turkish Society of Medical Ul-

turned out to highly effective since all the changes proposed were

trasonography and from the Macedonian Ultrasound Society, and

accepted after short discussions by all the delegates. Going into

both had a friendly and warm welcome.

all details would be too time consuming – so only two modifications to the Constitution will be focused on, and the bylaw chan-

On behalf of our active secretary, Mrs. Gianna Stanford, and as an

ges will be summarized. Details are given in the minutes (proto-

urgent wish of all Executive Bureau members, we kindly ask

cols) of the General Assembly and the Board of Directors Meeting

(again and again) all members as a whole and especially the se-

handed to each delegate and available from your national repre-

cretaries of each national society to provide us with as many ac-

sentative on request.

tive email member addresses as possible (and who is nowadays without an email address?).

The changes of the Constitution comprise – as most important Finally, a society as well as a federation is as much alive as are its

now two years. This is certainly a remarkable change in the life

members – so please do not hesitate to communicate with us, and

and “bio-rhythm“ of our Federation, and it was felt that the pros

do not forget our nice new website www.efsumb.org!

would by far outweigh the cons. Moreover, the changes to the Constitution allow from now membership within EFSUMB not

Lucas Greiner, MD

only for multidisciplinary national societies of ultrasound, but

Honorary Secretary EFSUMB

Ultraschall 2005; 26

topic – a reduction of the periods of office from hitherto three to

EFSUMB Newsletter

Report from the Honorary Treasurer This is my last financial report, since I will leave the Executive Bureau in September after 6 years as honorary treasurer. During these years the economy has stabilized and must at present be considered very healthy. There has been an economic surplus each year and EF-

SUMB has now got adequate reserves. EFSUMB Budget For The Year 2006 (In Pounds Sterling) This means that EFSUMB is able to take up activities with a foreseen economical deficit, provided the activity is found important.

Membership fee (17,162 x 8 €)

£ 92,768.00

Euroson SCHOOLS and CONGRESSES

£ 1,500.00

Bank deposit interests

£ 400.00

and since 2004 it has been integrated in Ultraschall in der Medi-

Total Income

£ 94,668.00

zin/European Journal of Ultrasound, which has reduced the costs

Expenditure

We have had the newsletter generously sponsored over the years

considerably. Every Euroson congress and school during the last

WFUMB fee (17,162 x 1.5 $)

£ 14,144.00

Newsletter

£ 24,000.00

Meetings, Executive Bureau

£ 12,000.00

Meetings, Committees

£ 6,000.00

Prizes etc

£ 675.00

The Budget for the year 2006 is seen in the table.

Website

£ 700.00

Wages

£ 18,000.00

At the end of my second term as treasurer I wish to express my

Printing, postage, stationery

£ 860.00

Auditors

£ 1,500.00

5 years has led to a financial surplus to EFSUMB. The fee has remained unchanged for the last six years at 8 € per member, which I think is still a very low membership fee, considering the advantages of being a member of EFSUMB.

thanks to my colleagues and friends in the Executive Bureau and in the Board of Directors for an excellent cooperation over the ye-

Office expenses

£ 8,500.00

Computer equipment

£ 1,000.00

have been possible.

Bank charges

£ 750.00

Depreciation

£ 41,000.00

I wish the future Executive Bureau all the best.

Total Expenditure

£ 99,129.00

Balance

— £ 4,461.00

ars. Last but not least, I wish to express my thanks to General Secretary Gianna Stanford. Without her help my task would not

Niels Juul

£/€ = 1.48

£/$ = 1.82 €/$ = 1.23

Honorary Treasurer EFSUMB

WORLD FEDERATION FOR ULTRASOUND IN MEDICINE AND BIOLOGY ECHOES NO 7 (WFUMB NEWSLETTER) IS ACCESSIBLE AT www.wfumb.org/newsletter

Ultraschall 2005; 26

WFUMB 2006 SE0UL — The 11th Congress of the World Federation for Ultrasound in Medicine And Biology — MAY 28 — JUNE 1, 2006, COEX CONVENTION CENTER, SEOUL, KOREA - WEB SITE: www.wfumb2006.com

EFSUMB Newsletter 68

both the nephrology and urology sections to ask for their ratification. A decision as to whether to do this will be taken when responses from member societies to the document have been received – The process for awarding CME credit points has been clarified. Any organisation in Europe running an ultrasound

Report of Education & Professional Standards Committee

course or meeting should apply to the most appropriate body in the host country to allocate an appropriate number of CME points to the meeting. The organising group needs then to submit this recommendation for CME points together with the programme etc to UEMS on its website (www.uems.net))

The main work of the committee has been

through its EACCME section. A fee proportionate to the likely

in developing Minimum Training Recom-

number of delegates is also payable. UEMS will then ratify

mendations from EFSUMB, in producing

the allocation of CME points for recognition in European Uni-

further guidelines and in looking at links

on countries.

with the European Union of Medical Specialists.

Other Publications

Minimum Training Recommendations for the Practice of Medical

During the course of the year the committee has commissioned

Ultrasound in Europe

the following publications for the EFSUMB newsletter: – Guidelines for Ultrasound Guided Breast Biopsy

This publication is now complete and it was published on the EF-

– A Commentary on the Complications of Interventional Ultra-

SUMB website in September 2005. It is available in paper form in

sound from a Paediatric Perspective

this Newsletter. It includes an introductory section on the prin-

– Ultrasound Guided Chest Interventions

ciples of minimum training recommendations, 6 recommended syllabuses and associated competence assessment sheets. The 6

Possible Future Work of Committee

syllabuses cover obstetrics, gynaecology, gastroenterology, nephro-urology, breast and vascular ultrasound. EFSUMB member

– To develop further syllabuses for the Minimum Training Re-

societies are now being asked to comment on these recommen-

commendations Document (see above)

dations. In particular they are being asked to comment on whe-

– To run courses based on these syllabuses

ther they have their own national guidelines and/or process for

– To produce educational material using CDs, DVDs etc

competence assessment and if so how these compare with the

– To organise educational sessions at Euroson Congresses

EFSUMB guidelines, if they do not have their own guidelines then

– To make proposals for Euroson Schools

we would like to hear what difficulty there might be with imple-

– To develop further guidelines for publication in the EFSUMB

menting the EFSUMB guidelines. We would also like to hear whe-

Newsletter

ther it would be useful to draw up other syllabuses in other areas eg musculoskeletal and emergency department ultrasound. The

Retiring Chair

committee considers this to be a dynamic document which will undergo revision from time to time and the views of member so-

Ass Prof Lil Valentin’s term of office as Chair of the Committee has

cieties are important in shaping any changes.

come to an end. The Committee is very grateful to her for her work in leading the committee to the production of the major pu-

European Union of Medical Specialists (UEMS)

blication on Minimum Training Recommendations as well as being instrumental in initiating other guidelines published in the

The committee has been in touch with the UEMS to discuss a va-

Newsletter.

riety of issues: – UEMS recognises discrete medical specialties and not technique based organisations – It is possible for individual syllabuses from the Minimum

Dr David RM Lindsell Chairman Education & Professional Standards Committee

Training Recommendations document to be sent to individual sections of UEMS eg the urology syllabus could be sent to Ultraschall 2005; 26

EFSUMB Newsletter

Publications Committee The Publications Committee has met twice during the year 2005, once in April, in Copenhagen, and then in September in Geneva. The September meeting was a meeting of the old Committee and the newly elected ones. We were sorry to say goodbye to Jean Michel de Bray and then welcomed Francesco Drudi to the Committee.

Publisher Report

Professors Dietrich and Pirhonen had been elected the previous day to the Committee but were unable to attend.

In January 2004 Ultraschall in der Medizin/EuThe Committee discussed at length the publication of the mini-

ropean Journal of Ultrasound (UiM/EJU) beca-

mum training standards document which you will find as part of

me the official journal of EFSUMB. Today we are looking back on

this Newsletter. The website causes a great deal of work for Gi-

two years of most successful cooperation. From January 2004 un-

anna and is in constant need of updating and refreshing. As well

til December 2005 as many as 1,900 additional members among

as us linking the EFSUMB website to all the individual Member

EFSUMB have subscribed to the journal. At present the members

Societies websites it was felt it would be helpful if all the EFSUMB

of the following countries receive UiM/EJU as part of their mem-

delegates provided a photograph of themselves and a short in-

bership: Austria, Germany, Denmark, Latvia, Norway and Swit-

troduction to their Society which could be provided on the EF-

zerland. Most recently, the Flemish and Macedonian societies

SUMB website.

also joined the journal with bulk subscriptions.

The European Journal of Ultrasound is proving a great success for

Under agreement between Thieme Publishers and EFSUMB all

the Federation. New members to the Advisory Board, proposed

members of EFSUMB are entitled to receive the journal for € 28.94

following the Copenhagen meeting, have been accepted by Thie-

per year (a little over 10% of the full price) when the entire society

me. The number of papers in English, submitted to the Editorial

subscribes and the fees are collected by the national society. For

Board, is growing and they were much encouraged by the fact

a slightly higher fee of € 35 individuals can subscribe via EFSUMB

that 65% of EFSUMB members receive the Journal and that the ci-

– this is still a substantial discount to receive a high quality jour-

tation index continues to increase.

nal representing some of the best science and clinical research in ultrasound. All members of EFSUMB who do not yet subscribe to

The whole new Committee are hoping to meet in the spring, in

the journal receive the first issue of 2006 free. We would like to

London, where we will incorporate the ideas of the new members

strongly encourage these members to recommend to their nati-

in improving the Journal and the website in particular.

onal society to subscribe to the journal so that UiM/EJU is made available to all members and they are enabled to remain

The Publications Committee would be unable to function without

up-to-date with some of the best ultrasound in Europe.

the hard work of Gianna Stanford, our long-suffering General SeIn line with its Europeanisation, the

cretary, who uncomplainingly serves the Committee and tries to UiM/EJU: Impact factor development

make sense of the Chairman’s ideas. David W. Pilling Chairman Publication Committee

quality of the journal has also increased in the past two years as can be seen from the rising impact factor (see ta-

Year

Impact factor

2000

0.925

2001

1.183

was a success and all contributions

2002

1.114

made in German are still accompanied

2003

1.473

by full English text for all illustrations

2004

1.480

and table legends.

ble). The move to a maximum of 50% English language papers in the journal

To facilitate the entire review process we have decided to provide an online submission system for both authors and editors of UiM/EJU. The system will be launched on March 1, 2006 and is accessible at http://mc.manuscriptcentral.com/eju. We are confiUltraschall 2005; 26

dent that online submission will be received very well by our authors and that this will contribute to a further increase in the number of manuscript submissions. Many thanks for your support of UiM/EJU! Volker Niem, Publishing Editor

EFSUMB Newsletter 70

Epilogue from 17th Euroson Congress 2005, Geneva, Switzerland Dear Friends and Colleagues,

dustry to help us in this project. Another criticism concerned the lack of gala dinner. Convivial meeting of colleagues is really an

There were more than 1900 of you in Geneva last September for

important role of a congress but cannot be assumed without fi-

our Annual Euroson Congress, held along with the “Ultra-

nancial security. With the actual reduction in sponsorship all so-

schall-Dreiländertreffen”. This multidisciplinary medical mee-

lutions have to be considered to assure the durability of our an-

ting has gathered together people from more than 40 European

nual meetings.

and non-European countries, linked by their common interest in medical ultrasound.

Finally, nothing would be possible without the professional support of our CPO. They work very hard for the success of the mee-

Continuing medical education was an important part of the mee-

ting and I want to repeat how grateful I am for their efficiency.

ting, with about 200 hours of refresher courses, workshops and

Thus the projectors have been turned off, the exhibition tidied

state-of-art lectures divided among the different medical speci-

and everybody returned home with a little bit more knowledge.

alities. We had the chance to benefit from the experience of more

The remaining congress material (pens, pads and bags) have been

than 200 international ultrasound experts who were all enthusi-

distributed to a children’s association. I hope that every attendee

astic to share their knowledge with us. The participants were in-

will keep pleasant memories of this meeting and will be stimu-

deed unanimous in emphasising the high quality of the speakers

lated to participate in future ones, either in Bologna for the next

and I take this opportunity to thanks them all once more for their

Euroson meeting or in Graz for the next “Dreiländertreffen Ultra-

excellent job and their always-positive collaboration.

schall”… or both!

A medical speciality cannot survive without a regular renewal of

PD Dr med Jean-Yves Meuwly

basic concepts and general knowledge. Indeed the continuing

Congress President, Geneva 2005

education keeps the level high, but real breakthroughs come from research. This Euroson Congress was also particularly rich in scientific contents, with more than 200 scientific presentations and more than 150 posters. This large number of scientific papers re-

Young Investigator’s Award 2005

flects the high level and the thrust of European sonography. Both EFSUMB and SSUM-SGUM (Swiss Society of Sonography) actively sustain this aspect of medical sonography. The awards distributed by these Societies to young scientists during the Congress not only reward high quality scientific work but also stimulate researchers to produce future papers. A part of the program unanimously applauded by the attendees was the “Sonohöhle”, the room dedicated to practical work with the standing participation of tutors from the SSUM, particularly from the internal medicine and general practitioners sections. These people have produced a huge activity to organize and perform these tutorials and I also take the opportunity to thank them some have complained that not enough places were available. Unfortunately not all was perfect and some improvements may be proposed for future meetings. Practical work has to be enhanced with more places available. We hope we may rely on the in-

Chairmen: Prof. Jean-Yves Meuwly, Prof. David Evans; From left: D. Seybold, Germany, L. J. Salomon. France, K. Nylund, Norway, P. Tittoto, Italy, L. V. Coutts, United Kingdom, R. Jaworski, Poland, S. Degischer, Switzerland

Ultraschall 2005; 26

all. Indeed, the “Sonohöhle” has suffered from its success and

EFSUMB Newsletter 71

non-contributory in such cases. Finally, we would like to thank

First Prize

Congress Organisation Committees for a great conference, Geneva for a wonderful atmosphere and all the helpful people we met on the way preparing our presentation.

CV Radoslaw Jaworski Abstract My name is Radoslaw Jaworski, I was born on 30.3.1980 in Dobre Miasto in Poland. In 1999 I passed the high school exams and be-

Title: Why don’t we use ultrasonography in children with gastro-

gan medical study at the Medical University of Gdansk in Poland.

esophageal reflux? The ultrasonographic features of gastroeso-

Between 2002 and 2003 I continued my education at Medical Fa-

phageal reflux in children.

culty of University of Cologne in Germany as a SOKRATES/ERAS-

Authors: R. Jaworski1, D. Swieton2, W. Kosiak2, N. Irga3

MUS scholarship fellow. In 2003 I took part in a neurosurgery

1) Students Scientific Ultrasonography Group, Dept. Pediatric Nephrology, Medical University of Gdansk, Poland 2) Dept. Pediatric Nephrology, Medical University of Gdansk, Poland 3) Dept. of Pediatric, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Poland

course in St. Gallen in Switzerland led by Prof. G. Hilldebrandt. Also in 2003 I began a doctorate in surgical oncology with Prof. E. Bollschweiler at University of Cologne in Germany. I was member of both Surgical Oncology and Ultrasound Students Groups at Medical University of Gdansk in Poland. I am also a member of

Gastroesophageal reflux (GER) is defined as the presence of gas-

Academic Society of Oncology in Gdansk in Poland. I took part in

tric contents movement from stomach into the oesophagus. It

some medical student conferences for example: 10th, 12th and

may produce quite trivial symptoms like cough or irritability but

13th International Students` Scientific Conference for Students

it may also lead to really serious like oesophagitis, laryngitis or

and Young Doctors in Gdansk in Poland, 13th and 15th European

even sudden infants death syndrome. GER together with clinical

Students’ Conference for Future Doctors and Young Scientists in

symptoms is called as gastroesophageal reflux disease (GERD).

Berlin in Germany. Currently I have ended my medical study and

There is no gold standard diagnostic tool in this disease entity.

begun hospital internship with Prof. A. Kopacz in Surgical Onco-

Many of them are not straightforward for children for example

logy Department of Medical University of Gdansk in Poland. My

endoscopy, pH-metry or contrast radiography. In many guideli-

medical attention centres upon surgical oncology especially gas-

nes sonography is not taken into account as a diagnostic tool. That

trointestinal tracts tumors and ultrasonography especially inter-

is why the aim of our study was to determine usefulness of ultra-

ventional, contrast agents and preoperative staging sonography.

sound examination in GER in children. We examined sonographically 50 children with recurrent respi-

Summary

ratory infections. As a main GER diagnostic feature we chose in accordance with GER definition the presence of gastric fluid mo-

Ultraschall 2005; 26

With the aim of making students more interested in medicine,

vement into esophagus. Additionally we assessed the angle of His

two clinicians in Gdansk, Poland created scientific students group

and subdiaphragmatic esophagus length. The subdiaphragmatic

and started with scientific work. The aim of all studies was to

esophagus length was significantly shorter in the group of child-

show the strong connection between clinicians work and diag-

ren with GER than in children without reflux shown on sonogra-

nostic tool-ultrasonography and of course to present results of

phy. The angle of His was more often obtuse in children with GER

our work at Euroson conference. What made us really happy

than in children without GER. In all children with GER on the first

were interests of many clinicians in gastroesophageal reflux in

examination we observed clinical improvement in follow-up stu-

children – main subject of presented paper. Questions and sug-

dy after two months.

gestions were received, new ideas, how to plan further studies

Ultrasonography is in our opinion a useful method in GER diag-

and the great atmosphere of Geneva. The Euroson 2005 Young In-

nosis in children. The presence of the passage of gastric fluid into

vestigator’s Award makes us really proud and gives us more ea-

the abdominal oesophagus is the main feature of GER but we

gerness for further investigations. We hope that thanks to our

think that short subdiaphragmatic esophagus length and obtuse

work clinicians will think about sonography more as first-line di-

angle of His should be taken into consideration as characteristic

agnostic tool in gastroesophageal reflux in children than as

features of GER. We do not know why clinicians do not use sono-

EFSUMB Newsletter

young investigators award and want to warmly thank everyone for their help and support especially to Prof. Hamel and the EFSUMB Committee. – 2002–2005: Assistensarzt at the level I Trauma Centre Berg mannsheil, University Bochum – 1996–2002: Private University of Witten/Herdecke. Pre-clinical Medical School and Clinical/Medical School including two Electives in Sheffield (UK) and New York (USA) – 1996–2003: Rudolf Steiner School Stuttgart (Germany)

– 18.11.1974: Born in Stuttgart (Germany) graphy in GERD diagnostics. It seems to be a noninvasive, simple, informative, quick, repetitive and safe method, providing mor-

Abstract

phologic and functional information. Ultrasonography should be a gold standard in diagnosis of paediatric GERD, especially when

Title: Standardized imaging of the posterior tibial tendon by ul-

GERD symptoms are observed. We think, this method as a simple

trasound (13 MHz)

and useful tool should be promoted and employed in every situ-

Author: D. Seybold

ation in paediatric practice when GERD is suspected.

BG-Kliniken Bergmannsheil, Universitätsklinik Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, e-mail : dseybold@gmx.de

Objectives: Tibialis posterior dysfunction is often diagnosed at a very late stage in its development. However the early diagnosis of tibialis posterior dysfunction is crucial for therapeutic aspects and especially for the operative prognosis. The morphological correlate of the tibialis posterior dysfunction according to the literature consists of degenerative changes and thickening of the posterior tibial tendon. By means of a high-frequency linear array transducer a standardized technique of examination as well as reference values of cross sections of posterior tibial tendon are to be introduced. Material and Methods: Investigating 140 feet of 35 female and 35 male (the left and right sides were equally represented) wit-

Second Prize

hout any foot deformities, standardized planes were defined by use of a 13 MHz linear array transducer in order to display the posterior tibial tendon. In exactly defined loci of the tendon a di-

CV Dominik Seybold

ameter was measured using two longitudinal sections proximal and distal to the medial malleolus. Likewise, two diameters and the resulting cross section of the tendon were determined, using

2002, I have worked at a level I University Trauma Centre in Bo-

two transverse sections at the level of the subtalar joint facet and

chum. I have recently finished my 3rd year of specialisation in

the medial malleolus.

trauma and orthopaedics. Through my doctoral thesis I first came

Results: A healthy tendon appears homogenous and echo-rich in

in touch with musculoskeletal ultrasound in my 2nd year of Uni-

orthogonal ultrasounds and displays average areas of 18.6

versity. Being involved in several research projects led by Prof.

sq.mm. (SD 5.2 sq.mm.) for females and 20.9 sq.mm. (SD 5.8

Hamel we have established a standardised delineation of the ten-

sq.mm.) for males at subtalar joint facet level and 17.2 sq.mm. (SD

don of the tibialis posterior muscle in healthy probands and in pa-

3.6 sq.mm.) for females and 21.6 sq.mm (SD 4.3 sq. mm.) for ma-

tients with diseased tendons. This standardised ultrasound in-

les at medial malleolus level in transverse sections. In 89% of all

vestigation with evaluation of the intratendineal echopattern

feet examined at the height of the medial malleolus, the tendon

and the tendon diameter has become a helpful diagnostic tool for

is surrounded by a hypoechoic halo which has a size smaller than

the foot surgeon. It enables the early differentiation between a

twice the cross section of the flexor digitorum longus tendon.

healthy and degenerate tendon by ultrasound in an easy and

Conclusion and clinical relevance: Reference values of tendon

quick way. Tibialis posterior dysfunction, if diagnosed early

thickness and of intratendinal echostructure at reproducible loci

enough, is easier to treat than in later stages, and enables the pa-

facilitate delimitations from pathological tendon alterations. The

tient to regain normal foot function. Presenting my results at the

exact delineation of intratendineal echos by high frequency array

28th Dreiländertreffen DEGUM, SGUM, ÖGUM in Hannover and

transducers and standardized examination techniques that

at the Euroson in Geneva 2005 I had the chance to emphasise the

measure tendons size is the prerequisite to enable an early as-

importance of early diagnosis of the tibialis posterior tendon dys-

sessment and registration of degenerative alterations of the pos-

function by ultrasound. I appreciate very much winning the

terior tibial tendon.

Ultraschall 2005; 26

Since graduating from the University of Witten/Herdecke in

EFSUMB Newsletter

Diary Dates 2006 March 3–7, 2006 ECR 2006 Vienna, Austria. Contact: ECR office, Neutorgasse 9/6, Tel: +43 1 533 640, Fax: + 43 1 533 40 649, email: communications@ecr.org March 23–25, 2006 aium 2006 Annual Conference at Washington DC, Contact: Brenda Kinney, 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707, USA. Tel: +1 301 498 4100, Fax: +1 301 498 4450, email: bkinney@aium.org March 23–25, 2006 18th Symposium Neuroradiologicum of the world Federation of Neuroradiological societies (WFNRS) at Adelaide, Australia. Contact: Michael Sage, Tel: +618 8204405, Fax: + 618 8374 1731, email: Michael.sae@fmc.sa.gov.au, website : www.snr2006.sa.gov.au March 30–April 4, 2006 31st Annual Scientific Meeting, Society of Interventional Radiology at Toronto, Canada. Contact: Tel: +1 703 691 1805, Fax; 1 703 691 1855, email: annualmeeting@sirweb.org, May 18, 2006 April 7–9, 2006 65th Annual Meeting of Japan Radiological society at Yokohama, Japan. Contacts: Secretariat, NP-II Building, 5-1-16 Mongo, Bunkyo, tolyuo 113-0033 japan, Email: pr@radiology.or.jp

77 May 28–June 1, 2006 11th Triennial Congress World Federation for Ultrasound in Medicine and Biology. Venue: Seoul, Korea Contact: WFUMB'2006 Congress Secretariat, Insession International Convention Services, Inc.3rd Fl. 672-35 Yeoksam-dong, Gangnam-gu, Seoul 135-915 Korea . Tel: +82-2-3471-8555, Fax: +82-2-521-8683, email: info@wfumb2006.com. www.wfumb2006.com

June 9–10, 2006 13th Annual Meeting of the European Soceity of Musculoskeletal Radiology (ESSR) at Brugge, Belgium. Contact: Tel: +44 1691 404546, Fax: +44 1691 404057, email: www.essr.org

June 10–14, 2006 ISRRT – 14th World Congress at Denver, USA, Contact: email: www.asrt.org

April 29–May 5, 2006 44th Annual Meeting of the American society of Neuroradiology (ASNR) AT San Diego, California. Contact: Tel: +1 630 474 0220, Fax: 1 630 574 1740, email: meetings@asnr.org

April 30–May 5, 2006 106th Annual Meeting of the American Roentgen Ray Society (ARRS) at Vancouver, Canada. Contact: tel: + 1 703 7294839, Fax: + 1 703 729 4839, email: meeting@arrs.org May 11–13, 2006 Anatolian course of Interventional Radiology at Istanbul, Turkey. Contact: Kubaba, Kubaba Tourism and Travel Agency, Guniz Sk 44/1. Kavaklidere 06700, Ankara, turkey. Tel: +90 312 428 0400, Fax: +90 312 428 0305, email: nermine@kubaba.net, www.acir20006.org May 15–17, 2006 UKRC 2006 at Birmingham, UK, Contact: PO Box 2895 London, W1A 5RS, Tel: + 44 20 73071410/20, Fax: +44 20 7307 1414, email: conference@ukrc.org.uk, website: www.ukrc.org.uk/ May 15–20, 2006 49th annual Meeting of the Society for Paediatric Radiology (SPR) and the 43rd Annual Congress of the European Society of Paediatric Radiology (ESPR) at Montreal, Canada. Contact: Tel: +1 7139650566, Fax: +1 713 960 0488, email: spr@meetingmanagers.com

May 18–21, 2006 XIV World Congress on Breast Diseases at Zagreb, Croatia. Contact Congress Secretariat, Croatian Sonologic society, Ozegoziceva 7-10000 Zagreb, Croatia. Tel: + +385 0638, Fax: +385 91 507 5134, email: secretariat@senology2006.com, website: http://www.senology2006.com

May 18–21, 2006 X World Congress of Echocardiography and Vascular Ultrasound. Marrakesh, Morocco. Contact: N C. Narida, MD, President ISCU, PO Box 323, Gardendale, AL 35071, USA. Tel: +1 205 934 8256; Fax: +1 205 934 6747, email: isuc@iscu.org Ultraschall 2005; 26

May 24–27, 2006 87th Deutscher Roentgenkongress, Berlin, Germany. Contact: Tel: + 49 6172 488585, Fax: + 49 6172 488587, email: info@roentgentkongress.de

June 15–17, 2006 24th International EuroPACS Conference at Trondeheim, Norway. Contact: Tel: +47 7359 8600, Fax: +47 7359 8611, email: europacs2006@pacs.no, website: www.europacs.net/

June 19–23, 2006 ESGAR 2006, the European society of Gastrointestinal and Abdominal Radiology at Crete, Greece. Contact: Organising Secretariat, Central ESGAR Office, Neutergasse, 9/2a, AT-1010 Vienna, Austria. Tel: +43 1535 8927, Fax: +43 1 535 7037, email: office@esgar.org

June 23–24, 2006 Symposium interdisciplinaire, Tours, France, Plaque vulnérable Sous l’égide du Club Doppler Francophone avec le soutien de la Société Française NeuroVasculaire et de la Société de Chirurgie Cardiothoracique et cardiovasculaire. Contact: Virginie Frappreau, CIT Tours, CHRU Tours, 37044 Tours Cédex 9, email: v.frappreau@chu-tours.fr

September 15–19, 2006 Euroson 2006, 18th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology, Bologna Italy . Contact: Pyramide s.r.l. Via S.Godenzo, 164 – 00189 Roma, Tel: +39 06 3314114, Fax: +39 06 3314113, email: siumb2006@pyramide.it. Website: www.euroson2006.com/www.efsumb.org/

September 15–17, 2006 Australasian Society for Ultrasound in Medicine 36th Annual Scientific Meeting, Melbourne, Australia, www.icms.com.au/asum2006

October 18–21, 2006 Dreiländertreffen Ultraschall 2006, Graz, Austria. Contact: Secretariat Ultraschall 2006, Neutorgasse 9/7, A-1010 Wien, Austria, Tel: +43 1 535 13 05; Fax: +43 1 535 70 37, email: office@ultraschall2006.at, Website: www.ultraschall2006.at

EFSUMB Newsletter

European Federation of Societies for Ultrasound in Medicine and Biology

ultrasound experience into clinical training and accredi-

Dear members of EFSUMB

tation where appropriate. You are probably all aware of the document “Minimum training

1.2

This document makes recommendations for minimum

requirements for the practice of medical ultrasound in Europe”. If

ultrasound training requirements in the following areas:

not the document is available on this website, www.efsumb.org.

– gynaecological ultrasound – obstetric ultrasound

After a few years of work EFSUMB Education and Professional

– gastroenterological ultrasound

Standards Committee has developed guidelines for how the mi-

– nephro-urological ultrasound

nimum training requirements can be achieved at each level of

– breast ultrasound

practice. Structured theoretical and practical training should be

– vascular ultrasound

followed by competency assessment. In the document that follows you will find a description – for some medical specialties –

Aims and Principles

of the theoretical and practical training that the committee re-

2.1

The medical use of ultrasound remains highly operator

commends and also competency assessment sheets. We hope

dependent in spite of advances in technology and the in-

you will find that these guidelines from the Education and Pro-

terests of the patient are best served by the provision of

fessional Standards Committee will be helpful.

an ultrasound service which offers the maximum clinical benefit and optimal use of resources i.e. with appropria-

We would welcome general comments on these recommendati-

tely trained personnel using equipment of appropriate

ons, suggestions for ways in which they could be improved in the

quality

future and suggestions for additional syllabuses. Comments

2.2

All who provide an ultrasound service are ethically and legally vulnerable if they have not been adequately trai-

should be submitted by email to: efsumb@efsumb.org

ned. A defence against a claim for negligence is unlikely to be successful should an error of diagnosis be made by

Lil Valentin

an untrained practitioner of ultrasound.

Chairman of the EFSUMB Education and Professional Standards Committee

2.3

An appropriate level of training in ultrasound is one that allows for the provision of a safe and effective ultrasound service. This may be a purely diagnostic, predomi-

Minimum training recommendations for the practice of medical ultrasound

nantly interventional or a clinically focused service. 2.4

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has proposed minimal training requirements for the practice of medical ultrasound in Europe (Appendix 1). These identify three levels of training and expertise. The boundaries between

Ultraschall 2005; 26

Introduction

the three levels are difficult to define precisely and

1.1

Many medical specialists are increasingly wishing to un-

should be regarded as a guide to different levels of com-

dertake ultrasound examinations on patients referred to

petence and experience. In the detailed syllabuses ap-

them for their clinical opinion as a direct extension of

pended an attempt is made to indicate more specifically

their clinical examination. This may take place in the

the type of experience required for each level of training

outpatient department, on the wards and in the assess-

2.5

A system for recording the results of any ultrasound exa-

ment of emergency patients. Additionally there is a de-

mination in the patients’ record is mandatory. The per-

mand by some European Training Boards to incorporate

manent recording of images, where appropriate, is desi-

EFSUMB Newsletter

4. 4.1

Theoretical Training Preliminary theoretical training should cover the physics of ultrasound, levels and sophistication of equipment, image recording, reporting, artefacts and the relevance of other imaging modalities to ultrasound. This element of training may be best achieved by attending formal courses.

4.2

The theoretical module is set out in Appendix 2.

rable for the purposes of correlative imaging, future

Practical Training

comparison and audit.

5.1

2.6 2.7

2.8

A curriculum for each module for the three levels of trai-

Knowledge of the appropriate use and integration of

ning has been developed incorporating theoretical trai-

other imaging techniques should be required

ning on anatomy and pathology and a practical syllabus

The requirement to deliver training must acknowledge

listing conditions which should be included in the expe-

the time commitment of the trainer and trainee, the pro-

rience of the trainee. In appropriate circumstances, a li-

vision of funding, the content and practicability of the

mited anatomical or modular approach may also be ac-

curriculum and the availability of trainers and training

ceptable if full competence in that area is demonstrated

courses. It must be recognised that training requires ad-

and future clinical practice is confined to that area alone.

ditional time, space and equipment. Training should be

Practical experience should be gained under the

properly costed and funded.

guidance of a named trainer.

Training should be related to the specialist requirements

5.2

of the trainee i.e. training should be modular. Within any

The requirements for the different levels of training are as follows:

one level of training it may be appropriate for a trainee

2.9

to become proficient in some but not all of the individual

Level 1

modules and only undertake ultrasound practice in

5.2.1

ferent rates and the end-point of the training program-

Training should be given in departments which have a

me should be judged by an assessment of practical com-

multidisciplinary (medical, surgical, radiological etc)

petence.

philosophy, an adequate throughput of work, a trainer

5.2.2

Examinations should encompass the full range of patho-

5.2.3

A log book listing the number and type of examinations

with experience and an interest in training in the module required, appropriate equipment and an active audit

logical conditions listed in the modules.

process. 2.10

Different trainees will acquire the necessary skills at dif-

this/these areas.

Regular appraisal should take place during the training

undertaken by the trainee themselves should be kept. 5.2.4

An illustrated log book of specific normal and abnormal

5.2.5

Training should usually be supervised by a level 2 practi-

period. At the end of a period of training a â&#x20AC;&#x153;competency assessmentâ&#x20AC;&#x153; form should be completed for each trainee,

findings may be appropriate for some modules.

which will determine the area or areas in which they can

tioner. In certain circumstances it may be appropriate to

practice independently. The responsibility to be adequa-

delegate some of this supervision to an experienced le-

tely trained and to maintain those skills lies with the in-

vel 1 practitioner with at least two years of regular

dividual practising ultrasound. An assessment of compe-

practice.

tence is a reflection on the position at that moment in 2.11

time and no more.

Level 2

Following training, regular and relevant continued me-

5.2.6

This requires at least one year of experience at level 1,

5.2.7

A significant further number of examinations should

dical education (CME)/continued professional development (CPD) should be undertaken and documented. It is

with regular ultrasound clinics.

the responsibility of the trainee to ensure that their

have been undertaken in order to encompass the full

practical skills are maintained by ensuring regular ultra-

range of conditions and procedures encountered in each

sound clinics are undertaken and that there is an adequate range of pathology seen in their ultrasound

module. 5.2.8

A log book listing the numbers and types of examinati-

5.2.9

An illustrated log book of specific normal and abnormal

practice. Training Recommendations

3.1

Training should consist of a theoretical module (Appen-

findings may be appropriate for some modules. 5.2.10 Supervision of training should be undertaken by someo-

dix 2) and practical modules of training (Appendices 3â&#x20AC;&#x201C;

ne who has achieved at least level 2 competence and has

had at least two years experience at that level.

Ultraschall 2005; 26

ons undertaken by the trainee should be maintained.

EFSUMB Newsletter

Level 3 5.2.11 This requires a practitioner to spend a significant part of their time undertaking ultrasound examinations or teaching, research and development in the field of ultrasound. 5.3

The syllabus for each practical module is outlined in Appendix 3–8

Continuing Medical Education(CME) and Professional Development(CPD)

6.1

sound as outlined in each syllabus should be maintained. 6.2 6.3

The minimum amount of on-going experience in ultra1.5

EFSUMB, (which is a federation of national ultrasound

CME/CPD should be undertaken which incorporates ele-

societies in Europe), has established that, in Europe, the-

ments of ultrasound practice.

re is no standardisation of training requirements for ul-

Regular audit of the individual’s ultrasound practice

trasound practitioners, either between different coun-

should be undertaken to demonstrate that the indicati-

tries or between different medical disciplines [3].

ons, performance and diagnostic quality of the service is satisfactory.

This document is an attempt to stimulate national and pan-European speciality groups to consider training in ultrasound and to

The advice contained in this document draws on the work of the

work towards the setting of minimum Europe-wide standards for

United Kingdom Royal College of Radiologists, its committees

such training.

and members and Fellows, which resulted in the Publication of ‘Ultrasound Training Recommendations for Medical and Surgical

Levels of Practice

Specialties’, BFCR(05)2. EFSUMB would wish to acknowledge the

2.1

Most national associations and speciality groups will recognise that ultrasound can be practised at different le-

contribution of the Royal College of Radiologists and its Fellows

vels.

Appendix 1

2.2

However, because of variations in medical systems between countries and variations in the organisation of the different specialities in those countries, it is difficult to

Minimum Training Requirements for the Practice of Medical Ultrasound in Europe

strictly define the different levels of practice, and hence the training requirements for each level. 2.3

In the document 'Training in Diagnostic Ultrasound: Es-

Introduction

1.1

The increasing applications of ultrasound imaging

sentials, Principles and Standards' [4] a WHO Study

throughout medical practice, together with the increa-

Group have indicated that ultrasound training needs

sing availability of cheaper and smaller ultrasound scan-

may be defined according to equipment availability, and suggest three levels of training requirement.

ners, mean that more medical personnel are using ultrasound equipment to perform and interpret ultrasound 1.2

2.4

vel concept of ultrasound practice, based on clinical ex-

Ultrasound has an enviable safety record to date. Various

perience, ultrasound experience, practical competencies,

bodies, including scientific societies and manufacturers

research record and ability to teach, and are introducing regulated training requirements for each level.

associations have made recommendations concerning the safe and prudent operation of ultrasound equip-

1.3

In Europe, certain countries have pursued the multi-le-

scans.

2.5

Whilst it would be unrealistic to expect every speciality

ment, but, unlike imaging equipment, which makes use

group in every European country to agree upon the pre-

of ionising radiation [1, 2] there is virtually no national

cise definitions of the levels of practice, abilities for each

or international regulation of ultrasound usage.

level may be accepted. Recommendations for the mini-

More than with any other imaging modality, the medical

mum training requirements for each level of practice can

use of ultrasound is highly operator dependent and is

then be based on these principles

fraught with scope for diagnostic error, the potential for which is magnified by the on-going development of

Level 1

more sophisticated equipment with extended applicati-

Practice at this level would usually require the following abilities:

ons. Ultraschall 2005; 26

1.4

In order to gain maximum clinical benefit, as well as to achieve optimal use of resources, there is a need for operators of ultrasound equipment to have the appropriate skills for the performance and interpretation of ultrasound examinations.

a. to perform common examinations safely and accurately b. to recognise and differentiate normal anatomy and pathology c. to diagnose common abnormalities within certain organ systems

EFSUMB Newsletter

– ultrasound physics – safety of ultrasound and contrast agents – ultrasound instrumentation – scanning techniques – ultrasound artefacts – anatomy (of the relevant body systems) – pathology (of the relevant body systems) – ultrasound findings in the normal condition – ultrasound findings in pathological conditions – scan interpretation

d. to recognise when referral for a second opinion is in-

– indications for ultrasound and inter-relationship with

dicated

other imaging modalities – ultrasound-guided procedures

Within most medical specialities, the training requisite to this le-

3.3

Recommendations should include an indication of the

vel of practice would be gained during conventional post-gradu-

minimum numbers of scans, which should be performed

ate specialist training programmes.

(at the appropriate level) as: – supervised scanning

Level 2

– independent scanning, with review by a designated

Practice at this level would usually require the following abilities: a. to accept and manage referrals from Level 1 practitio-

trainer 3.4

ners

Training programmes should include recommendations and/or regulations for evaluinterpretive skills. In each

b. to recognise and correctly diagnose almost all patho-

country and/or speciality there should be a recognised

logy within the relevant organ system

competent authority with responsibility for the evaluati-

c. to perform basic, non-complex ultrasound-guided in-

on of training, using whatever methods are felt to be ap-

vasive procedures

propriate in that country and/or speciality. Similarly,

d. to teach ultrasound to trainees and to Level 1 practiti-

methods for, and the implications of, accreditation of in-

oners

dividuals who have completed training programmes will

e. to conduct some research in ultrasound

vary, and it is essential that there should be recognition of the necessity for limiting the use of ultrasound to sui-

The training requisite to this level of practice would be gained during a period of sub-speciality training, which may either be

tably trained individuals. 3.5

within or after the completion of a specialist training programme.

Continuing professional education and development is essential for any individual practising ultrasound. Training recommendations and/or regulations should inclu-

Level 3

de consideration of minimum scanning practice in order

This is an advanced level of practice, which involves the following

to maintain skills and minimum levels of educational ac-

abilities:

tivities in order for individuals to remain up-to-date in

a. to accept tertiary referrals from Level 1 and 2 practiti-

the rapidly developing field of medical ultrasound.

oners b. to perform specialised ultrasound examinations

c. to perform advanced ultrasound-guided invasive pro-

4.1

cedures

Sonographers are healthcare professionals without a medical degree who use ultrasound for medical purpo-

d. to conduct substantial research in ultrasound e. to teach ultrasound at all levels

Sonographers

ses in some specialities in some European countries. 4.2

f. to be aware of and to pursue developments in ultra-

In virtually all countries and medical specialities in Europe where sonographers currently practice, there are

sound

comprehensive training programmes for sonographers which require high standards of knowledge and practical

Minimum Training Requirements

scanning skills, and they are strictly regulated with well

3.1

For each level of ultrasound practice, national and/or Eu-

developed schemes for the evaluation and accreditation

ropean speciality groups should formulate a detailed

of the trainees.

syllabus with comprehensive recommendations for ne-

It is possible that the practice of ultrasound by sonographers will increase and will be introduced into more

bers).

countries over the next few years. It is therefore impor-

Syllabuses should include, at the appropriate level, theo-

tant that consideration be given to the setting up of sui-

retical knowledge of:

table training programmes in order to ensure that the sonographers are properly trained for their job.

Ultraschall 2005; 26

3.2

4.3

cessary amounts of practical experience (target num-

Conclusions

5.1

The medical use of ultrasound can be practised at diffe-

EFSUMB Newsletter

rent levels 5.2

Those physicians and sonographers practising ultrasound should be properly trained for the appropriate level of practice.

5.3

There should be mechanisms in place to evaluate the theoretical knowledge and practical skills of ultrasound trainees.

5.4

National and European speciality associations are urged to subscribe to these concepts, and to recommend and

Appendix 2

supervise the theoretical and practical training that is requisite for the various levels of ultrasound practice.

Recommended Theory Syllabus This basic theoretical training is a prerequisite to any practical

References 1. Council Directive 97 / 43 / Euratom of 30 June 1997. The Medical Exposures Directive (1997) Official Journal 180:22-27 2. Department of Health (2000) Ionising Radiation (Medical Exposure) Regulations IS 1999/3232. Norwich: Stationery Office 3. Training and accreditation: A report from the EFSUMB Education and Professional Standards Committee. EFSUMB Newsletter 2000: 14; 20. 4. Training in Diagnostic Ultrasound: Essentials, Principles and Standards: Report of WHO Study Group 1998. WHO technical report series: 875

training in ultrasound. Physics and Instrumentation • The basic components of an ultrasound system. • Types of transducer and the production of ultrasound, with an emphasis on operator controlled variables. • An understanding of the frequencies used in medical ultrasound and the effect on image quality and penetration. • The interaction of ultrasound with tissue including biological

Footnote This document has been prepared by the EFSUMB Education and Professional Standards Committee, and has been approved by the EFSUMB Executive Bureau. As part of the consultation process, this committee organised a Workshop at the Euroson Congress, which was held in Edinburgh, Scotland on Thursday 13th December 2001, to which representatives of different medical specialties in Europe were invited to contribute.

effects. • The safety of ultrasound and of ultrasound contrast agents. • The basic principles of real time and Doppler ultrasound including colour flow and power Doppler. • The recognition and explanation of common artefacts • Image recording systems. Ultrasound Techniques

Members of EFSUMB Education and Professional Standards

• Patient information and preparation.

Committee

• Indications for examinations.

Dr Lil Valentin (Sweden) – Chairman

• Relevance of ultrasound to other imaging modalities.

Dr Henry Irving (UK) – Secretary

• The influence of ultrasound results on the need for other

Prof David H Evans (UK) Prof Jochen Hackeloer (Germany) Prof Kurt Jäger (Switzerland)

imaging. • Scanning techniques including the use of spectral Doppler and colour Doppler.

Dr Pentii Lohela (Finland) Dr Ioan Sporea (Romania)

Administration • Image recording.

Contributors to Edinburgh Workshop

• Image storing and filing.

Prof. Dr. med. Uli Hoffmann, Representative of the International

• Reporting.

Union of Angiology

• Medico-legal aspects – outlining the responsibility to

Dr George R Sutherland, Chairman of the Echocardiography wor-

practice within specific levels of competence and the re-

king group 7 of the European Society of Cardiology

quirements for training

Prof. Juriy Wladimiroff, Education committee member of the In-

• Consent

ternational Society of Ultrasound in Obstetrics and Gynecology

• The value and role of departmental protocols in determining

Prof. Rolf W. Günther, President of the European Association of Radiology Prof. Carlo Trombetta, President of the Italian Society of UrologiUltraschall 2005; 26

cal Imaging and the coordinator of the European Society of Urological Imaging Dr Ioan Sporea, replaced Prof. Rapaccini as representative of European Gastroenterologists Prof. Michel Claudon, President of EFSUMB

the appropriate use of ultrasound

EFSUMB Newsletter

• Ultrasound based management of early pregnancy complications • Common abnormal ultrasound findings in the uterus, e.g. fibroids and their most important differential diagnoses (e.g., sarcomas, adenomyosis, and uterine malformations) • Ultrasound based management of pre- and post-menopausal bleeding (measurement of endometrial thickness, saline infusion sonography, etc) • Common abnormal ultrasound findings in the adnexae, e.g.

Appendix 3

Gynaecological Ultrasound

corpus luteum cysts, endometriomas, dermoid cysts, hydrosalpinges, para-ovarian cysts, peritoneal inclusion cysts, abscesses. • Ultrasound characteristics of benign and malignant pelvic

This curriculum is intended for clinicians who perform diagnostic gynecological ultrasound scans. It includes standards for theoretical knowledge and practical skills. It is recommended that all

masses. • Management of incidentally detected ovarian cysts in postmenopausal women.

gynaecologists obtain Level 1 competence, preferably during their specialist training.

Level 1 Competencies to be acquired At the end of training the trainee should be able to:

Level 1 • It is recommended that trainees should perform a minimum

• Perform a systematic examination of the pelvic organs, both transvaginally and transabdominally

of 300 examinations under supervision. However different

• Obtain optimal images of the uterus and adnexa

trainees will acquire the necessary skills at different rates

• Obtain accurate measurements of the uterus, endometrium

and the end point of the training programme should be judged by an assessment of competencies • Examinations should encompass the full range of pathological conditions listed below • A log book listing the types of examinations undertaken should be kept • An illustrated log book of 20 documented cases should be kept. This should include uterine fibroids, corpus luteum cysts and different types of abnormal early pregnancy • Training should usually be supervised by a level 2 practitioner. In certain circumstances it may be appropriate to delegate some of this supervision to an experienced level 1 practitioner with at least two years of regular practical experience.

and ovaries • Recognize physiological changes in the uterus and ovaries during the normal menstrual cycle. • Locate an intrauterine contraceptive device in the uterus. • Discriminate between normal and abnormal ultrasound findings in a non-pregnant woman • Recognize, measure and locate uterine fibroids • Detect an intrauterine gestational sac of at least 5 mm in mean diameter • Detect heart activity in an embryo of at least 10 mm in crown-rump-length. • Correctly use ultrasound to manage early pregnancy complications (miscarriage and tubal pregnancy)

• The training should include an appropriate theoretical course (see below) followed by a theoretical examination and the

Level 2

trainee should read appropriate textbooks and literature

• The training requisite to this level of practice would be gai-

• To maintain level 1 status the practitioner should perform at least 300 examinations each year • During the course of training the competency assessment sheet should be completed as this will determine in which area or areas the trainee can practise independently

ned during a period of sub-speciality training, which may either be within or after the completion of a specialist training programme. • Competencies will have been acquired during training for level 1 practice which will then be refined by performing a minimum of 30 clinic sessions at a centre where supervision by

Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical Course A minimum of 20 hours theoretical teaching is required preferably at the beginning of the training period. This should include: • Physics and Technology, Ultrasound Techniques and Administration (see Appendix 2) women • Normal ultrasound findings in early pregnancy (4–12 gestational weeks)

• Typically a level 2 practitioner will have undertaken at least 2000 gynaecological ultrasound examinations • A log book should be kept documenting 50 cases which amongst other conditions should include the following – uterine pathology, benign and malignant – ovarian pathology, benign and malignant – tubal pathology – ectopic pregnancy

Ultraschall 2005; 26

• Normal gynaecological ultrasound findings in non-pregnant

someone with level 2 competence is available.

EFSUMB Newsletter

• To maintain competence at level 2 practitioners should perform at least 500 examinations each year • The training should include a theoretical course of at least 30 hours (see below) followed by a theoretical examination and the trainee should read appropriate literature and textbooks Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical Course • New ultrasound modalities, e.g. ultrasound contrast agents • The role of ultrasound in relationship to other imaging moda-

lities, e.g., magnetic resonance imaging and computed tomo– reliably discriminate between benign and malignant

graphy

adnexal masses

• Uterine pathology including the use of Doppler and three-di-

– reliably diagnose endometrioma, dermoid cyst, hy-

mensional (3D) imaging

drosalpinx, peritoneal pseudocysts, paraovarian cysts,

a. Fibroids, sarcoma

and benign solid adnexal masses

b. Adenomyosis/adenomyomas

– recognise acute and chronic pelvic inflammatory di-

c. Uterine malformations

sease

• Endometrial pathology: ultrasound based management of

– assess by ultrasound the status of ectopic pregnan-

bleeding disturbances

cies of all kinds and plan treatment

• Cervical pathology including cancer

– assess the likelihood of torsion of normal adnexal

• Screening for ovarian and endometrial cancer

structures and adnexal masses

• Gynaecological oncology – Staging, recurrence, response to

– use ultrasound in infertility workup (for trainees wor-

treatment

king in this area)

• Extragenital pelvic pathology (bowel, appendix, urinary bladder)

– use ultrasound to monitor ovulation induction

• Pelvic inflammatory disease (PID) • Infertility – HysteroContrastSalpingography (HyCoSy), Saline

• Interventional ultrasound – aspirate and/or drain pelvic cysts, abnormal fluid coll-

Infusion Sonography (SIS), Follicle aspiration, Hyperstimula-

ections, abscesses etc under transabdominal and

tion Syndrome

transvaginal ultrasound guidance

• Early pregnancy complications – molar pregnancy and choriocarcinoma, all types of ectopic pregnancy (including both

– perform saline infusion Hysterosonography (SIH)

diagnosis and management)

– assess tubal patency with HysteroContrastSalpingography (HyCoSy) – not obligatory

• Use of ultrasound in the evaluation of women with pelvic pain including adnexal torsion, pelvic inflammatory disease,

• Have knowledge of – the common findings in children with precocious pu-

endometriosis and extragenital causes (eg appendicitis, di-

berty, menarche

verticulitis)

– thelarche, adrenarche and virilisation

• Paediatric and adolescent gynaecology

– possible findings in primary and secondary amenor-

– Assessment of normal development of the genital or-

rhoea

gans

– the role of ovarian and endometrial cancer screening

– Common findings in precocious puberty, adrenarche,

– the principles of oocyte collection by transvaginal ul-

thelarche, virilisation and primary amenorrhoea

trasound guided follicular aspiration

– diagnosis and management of adnexal masses in children Level 3

• Invasive procedures • puncture of ovarian cysts

A level 3 practitioner is likely to spend the majority of their time

• drainage of pelvic abscesses

undertaking gynaecological ultrasound and/or teaching, research

– fine needle and larger bore needle biopsy of pelvic

and development and will be an ‘expert’ in this area

masses Maintenance of Skills Level 2 Competencies to be acquired

Recommended numbers of examinations to be performed annu-

• Uterus

ally to maintain skills at each level are given in the text

– reliably discriminate between fibroids and adenomyUltraschall 2005; 26

• include ultrasound in their ongoing continued medical edu-

osis – recognize the features of endometrial cancer – use ultrasound correctly in the management of bleeding disturbances including postmenopausal bleeding • Adnexa

Practitioners should: cation (CME) and continued professional development (CPD) • audit their practice • participate in multidisciplinary meetings • keep up to date with relevant literature

Appendix 3: Gynaecological Ultrasound Training Competency Assessment Sheet, see page 96.

EFSUMB Newsletter

• Invasive procedures: amniocentesis, chorionic villus biopsy • Psychological aspects • Ethical aspects • Quality control Level 1 Competencies to be acquired At the end of the training the trainee should be able to • Perform a systematic abdominal ultrasound examination of the pregnant uterus, placenta, amniotic fluid and fetus

Appendix 4

Obstetric Ultrasound

• Optimize and correctly orientate the ultrasound image • Obtain accurate measurements of the fetal biparietal diameter, femur length and abdominal diameter or circumference for dating and/or weight estimation

This curriculum is intended for clinicians who perform obstetric

• Evaluate fetal anatomy, rerognizing the following structures

ultrasound scans. It includes standards for theoretical knowledge

and discriminating normal from abnormal findings in these

and practical skills. Level 1 competence should be obtained by

structures: – Skull/brain

anyone performing routine unsupervised scans in pregnancy

– Midline echo in brain Level 1

– Cavum septum pellucidum

• It is recommended that trainees should perform a minimum

– Cerebellum

of 500 examinations over a 3 to 4 month period under super-

– Cisterna magna

vision. However trainees will acquire the necessary skills at

– Cerebral ventricles

different rates and the end point of training should be judged

– Neck

by an assessment of competencies

– Thorax – Four chamber view of heart plus outflow tracts

• Examinations should encompass the full range of conditions

– Stomach

listed below

– Umbilical cord insertion

• A log book listing the types of examinations undertaken

– Kidneys

should be kept

– Urinary bladder

• Training should usually be supervised by a level 2 practitioner. In certain circumstances it may be appropriate to delega-

– Spine

te some of this supervision to an experienced level 1 practiti-

– Extremities (arms, legs, hands and feet)

oner with at least two years of regular practical experience.

– The ability to communicate both normal and abnormal findings to the pregnant woman

• Trainees should attend an appropriate theoretical course (see below) followed by a theoretical examination and the trainee should read appropriate textbooks and literature • To maintain level 1 status the practitioner should perform at least 500 examinations each year • During the course of training the competency assessment

Level 2 • Training should take the form of at least 30 clinic sessions in a centre under the supervision of at least a level 2 practitioner

sheet should be completed as this will determine in which

• A minimum of 800 examinations will have been undertaken

area or areas the trainee can practise independently

• A log book of 10 well documented cases (eg fetal malformations, intrauterine growth restriction, twin complications etc)

Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical Course A minimum of 30 hours theoretical teaching is required prefe-

should be kept. This should include ultrasound images, clinical data and literature research • The training requisite to this level of practice would be gai-

rably at the beginning of the training period. This should include:

ned by a period of subspecialty training which may either be

• Physics and Technology, Ultrasound Techniques and Admi-

within or after the completion of a specialist training pro-

nistration (see Appendix 2) • Dating of pregnancy • Weight estimation and fetal growth • Normal fetal anatomy • Common fetal anomalies • Placenta, amniotic fluid

sheet should be completed • Training should include a theoretical course of at least 30 hours (see below) followed by a theoretical examination • To maintain level 2 status the practitioner should perform at least 400 obstetric examinations per year

• Screening for fetal chromosomal anomalies: soft markers, nuchal translucency

Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical Course

Appendix 4: Obstetric Ultrasound Training Competency Assessment Sheet, see page 97.

Ultraschall 2005; 26

• Multiple pregnancy

gramme. • During the couse of training the competency assessment

EFSUMB Newsletter

• Safety of Ultrasound • Literature search, internet databases, etc • Fetal malformations (more advanced than level 1) • Role of ultrasound compared to other imaging modalities, e.g., magnetic resonance imaging • Fetal echocardiography • Fetal Doppler • Soft markers • Diagnosis of syndromes • Genetics

• Quality control • Examinations should encompass the full range of pathologi-

• Psychology, counselling

cal conditions listed below

• Ethics

• A log book listing the types of examinations undertaken should be kept

Level 2 Competencies to be acquired

• Training should usually be supervised by a level 2 practitio-

Be able to: • Diagnose common fetal malformations and have knowledge

ner. In certain circumstances it may be appropriate to delegate some of this supervision to an experienced level 1 practiti-

of their management • Diagnose intrauterine growth restriction and have know-

oner with at least two years of regular practical experience. • Trainees should attend an appropriate theoretical course and

ledge of its management • Diagnose complications in twin pregnancies and have know-

should read appropriate textbooks and literature • It is recommended that a medical practitioner performing le-

ledge of their management

vel 1 ultrasound should continue to perform at least 300 examinations each year on a regular basis and attend regular ul-

Level 3 A level 3 practitioner is likely to spend the majority of their time undertaking obstetric ultrasound and/or teaching, research and development and will be an ‘expert’ in this area

trasound meetings • During the course of training the competency assessment sheet should be completed as this will determine in which area(s) the trainee can practice independently

Maintenance of Skills Recommended numbers of examinations to be performed annu-

Knowledge Base

ally to maintain skills at each level are given in the text Practitioners should:

Physics and Technology, Ultrasound Techniques and Adminis-

• Include ultrasound in their ongoing continued medical edu-

tration:

cation (CME) and continued professional development (CPD)

see Appendix 2

• Audit their practice • Participate in multidisciplinary meetings

Sectional and Ultrasonic Anatomy

• Keep up to date with relevant literature

• Liver • Gallbladder

Appendix 5

• Bile ducts • Pancreas • Spleen

Gastroenterological Ultrasound

• Kidneys, Bladder and Adrenal Glands • Other structures (uterus, ovaries, lymph nodes, vessels, hol-

This curriculum is intended for clinicians who perform gastroen-

low digestive tube)

terological ultrasound scans. It includes standards for theoretical knowledge and practical skills. At least Level 1 competence

Pathology in relation to ultrasound

should be obtained by anyone performing gastroenterological ul-

• Liver: Cysts, benign and malignant tumours, metastatic disease, fatty change, cirrhosis.

trasound unsupervised

• Biliary system: Gallbladder stones, acute and chronic choleLevel 1

cystitis, gallbladder tumours, bile duct obstruction including

• It is recommended that at least 5–10 examinations are per-

level of obstruction, intra hepatic duct gas and stones.

Ultraschall 2005; 26

formed by the trainee (under supervision) per week and that a minimum of 300 examinations in total are undertaken. However different trainees will acquire the necessary skills at

• Pancreas: Pancreatitis (acute and chronic), duct stones, duct dilatation, pancreatic tumours. • Portal venous system and spleen: Splenic enlargement, por-

different rates and the end point of the training programme

tal venous distension, varices, thrombosis, ascites and locula-

should be judged by an assessment of competencies

ted fluid collections

Appendix 5: Gastroenterological Ultrasound Training Competency Assessment Sheet, see page 98.

EFSUMB Newsletter

Portal Venous System and Spleen To be able to: • Evaluate the size of the spleen and recognize focal lesions. • Evaluate the portal vein and its diameter and the presence of portal venous thrombosis Bowel To be able to: • Recognize normal stomach, small and large bowel • Recognize focal intestinal abnormalities and understand the

principles of further investigation. • Kidneys: Size, hydronephrosis and masses

• Recognize intestinal obstruction.

• Other structures: Gastrointestinal masses and masses of gynaecological origin including cysts, tumours, fibroids and un-

Other

expected pregnancy.

To be able to: • Recognize abdominal aortic aneurysm

Competencies to be acquired

• Recognize hydronephrosis and other renal abnormalities • Recognize free and loculated fluid collections

Liver

• Recognize lymphadenopathy

To be able to:

• Recognize gynaecological and other pelvic abnormalities

• Perform a thorough ultrasound examination of the liver in different scan planes. • Recognize normal hepatic anatomy and variants. • Recognize normal and abnormal liver texture such as fatty change and anatomical variants. • Recognize focal lesions and be able to determine those requiring further investigation. • Recognize normal hepatic and portal venous anatomy within the liver. • Perform ultrasound controlled biopsy for the evaluation of parenchymal liver disease.

Level 2 • Competencies will have been gained during training for level 1 practice and then refined during a period of practice, which will involve at least one year of experience at level 1 with a minimum of one ultrasound clinic per week. • A further 500 examinations should have been undertaken in order to encompass the full range of conditions and procedures listed below. • Supervision of training should be undertaken by someone who has achieved level 2 competence in gastrointestinal ultrasound and has had at least 2 years experience at that level.

Biliary System To be able to:

• The trainee should be competent to accept referrals from level 1 practitioners

• Perform a thorough evaluation of the biliary system • Recognize normal ultrasonic anatomy of the biliary system

Knowledge Base

and its frequent normal variants. • Recognize abnormalities of the gallbladder wall

Sectional and Ultrasonic Anatomy:

• Recognize gallbladder stones

• Detailed understanding of gastrointestinal, mesenteric, peri-

• Be able to assess bile duct dilatation at intra hepatic and ex-

toneal, omental, vascular and retroperitoneal anatomy.

tra hepatic levels Pathology in relationship to Ultrasound: Pancreas To be able to:• Perform a thorough examination of the pancreas • Recognize the limitations of pancreatic ultrasound because of bowel gas • Recognize solid and cystic tumours within the head and body of the pancreas • Recognize the changes seen in pancreatitis (acute and chronic) stones

toneal cavity, its mesenteries, ligaments and compartments. • An understanding of the pathways of spread of intraperitoneal and retroperitoneal disease. • An understanding of the role of ultrasound contrast agents in differentiating between different types of focal liver lesions • Hollow digestive tube tumours and other masses Competencies to be acquired • Perform a comprehensive ultrasound examination of all of the solid organs within the abdomen. • Be able to evaluate the small bowel for focal or diffuse disease.

Ultraschall 2005; 26

• Recognize pancreatic duct dilatation and pancreatic duct

• An understanding of disease processes which affect the peri-

EFSUMB Newsletter

• Be able to evaluate the large bowel for the presence of diverticular disease and its complications, tumours and obstruction. • Be able to evaluate the peritoneal cavity, its mesenteries, compartments and the omentum for the presence of infective or malignant disease. • Be able to undertake ultrasound guided drainage of peritoneal fluid collections.

• Be able to evaluate the hepatic and portal venous systems using spectral, colour and power doppler ultrasound. • Be able to undertake ultrasound guided biopsy of focal liver

Level 1 • Practical training should involve at least one ultrasound clinic per week over a period of 3–6 months, with approxima-

lesions. • Be able to undertake endoscopic ultrasound • Be able to undertake an ultrasound contrast examination of

tely 5–10 examinations performed by the trainee (under supervision) per clinic session. • A minimum of 250 examinations should be undertaken. Ho-

the liver • Be able to undertake some percutaneous ultrasound guided

wever, different trainees will acquire the necessary skills at

therapeutic procedures such as radiofrequency ablation

different rates, and the end point of the training programme

(RFA), percutaneous ethanol injection (PEI), laser and micro-

should be judged by an assessment of competencies. • Examinations should encompass the full range of pathologi-

wave tumour ablation.

cal conditions listed below. • A log book listing the types of examinations undertaken

Level 3 A level 3 practitioner is likely to spend the majority of their time undertaking gastrointestinal ultrasound or teaching, research and development and will be an ‘expert’ in this area.

should be kept. • Training should usually be supervised by a practitioner who has obtained at least level 2 competence in nephro-urological ultrasound. In certain circumstances it may be appropriate to delegate some of this supervision to an experienced le-

Maintenance of skills: Having been assessed as competent to practice there will be a

vel 1 practitioner with at least 2 years of regular practice.

need for continued professional development (CPD) and mainte-

• Trainees should attend an appropriate theoretical course and should read appropriate textbooks and literature.

nance of practical skills.

• During the course of training the competency assessment Practitioners should:-

sheet should be completed as this will determine in which

• include ultrasound in their ongoing continued medical edu-

area or areas the trainee can practise independently.

cation (CME) • audit their practice

Level 1 Knowledge Base

• participate in multidisciplinary meetings

• Physics and technology, ultrasound techniques and adminis-

• keep up to date with relevant literature

tration (see Appendix 2) • Sectional and ultrasonic anatomy – kidneys – ureters – other retro-peritoneal structures (adrenals, aorta, i.v.c.)

Appendix 6

– bladder – seminal vesicles

Nephro-Urological Ultrasound

– prostate – scrotal contents This curriculum is intended for clinicians who perform diagnostic nephrological and/or urological ultrasound. It includes standards for theoretical knowledge and practical skills. At least level 1 competence should be obtained by anyone performing neUltraschall 2005; 26

phro-urological scans unsupervised

– other pelvic structures (uterus, ovaries, lymph nodes, vessels, bowel) • Pathology in relation to ultrasound – kidneys: congenital anomalies, cysts, tumours (benign and malignant), stones, collecting system dilatati-

Appendix 6: Nephro-Urological Ultrasound Training Competency Assessment Sheet, see page 100.

EFSUMB Newsletter

– recognise and diagnose bladder diverticula – recognise and assess bladder tumours – recognise bladder calculi – use colour Doppler to assess ureteric jets – recognise abnormalities which need referral to a more experienced ultrasonologist and/or for further investigation • Scrotum (for Urologists) To be able to: – perform a thorough ultrasound examination of the

scrotal contents in different planes on, renal and peri-renal abscesses, trauma, diffuse re-

– recognise normal ultrasonic anatomy of the testes

nal diseases, acute and chronic renal failure

and epididymi and common normal variants

– ureters: dilatation, obstruction

– recognise and diagnose epididymal cysts

– bladder: tumours, diverticula, wall thickening, calculi,

– recognise and diagnose varicoceles

volume estimation

– use doppler to help differentiate torsion/inflammato-

– prostate: zonal anatomy, infection, hyperplasia, tumours

ry problems – recognise and assess intra-scrotal and intra-testicular

– scrotal contents: testicular tumours, cysts, torsion, hydrocele, inflammatory problems, trauma

calcifications – recognise and assess testicular tumours – recognise inflammatory changes in testes and epidi-

Level 1 Competencies to be Acquired • Kidneys

dymes – recognise abnormalities which need referral to a

To be able to:

more experienced ultrasonologist and/or for further

– perform a thorough ultrasound examination of the kidneys in different planes – recognise normal renal ultrasonic anatomy and common normal variants

investigation • Prostate (for Urologists) To be able to: – recognise normal ultrasonic anatomy and common

– measure renal length and assess variation from normality – recognise and assess the degree of collecting system dilatation – recognise and diagnose simple cysts

normal variants – perform trans-rectal ultrasound – measure prostatic volume – identify abnormal focal lesions – perform a standardised technique of trans-rectal pro-

– recognise complex cysts and refer for appropriate

static biopsy (optional depending on clinical

further investigation – recognise renal tumours and refer for appropriate

practice/national guidelines) – recognise abnormalities which need referral to a

further investigation

more experienced ultrasonologist and/or for further

– recognise diffuse renal medical diseases associated with renal dysfunction – recognise and diagnose renal stones – recognise peri-renal abnormalities and refer for appropriate further investigation – recognise abnormalities which need referral for scanning by a more experienced ultrasonologist and/or further investigation • Bladder To be able to: – perform a thorough ultrasound examination of the bladder in different planes – recognise normal ultrasonic anatomy of the bladder and common normal variants

• Other – To be able to recognise and, where appropriate, refer for further investigation: – normal aorta and aortic aneurysm – normal liver and liver masses – normal uterus and ovaries and gynaecological masses • To be able to use ultrasound in the assessment of patients presenting with: – haematuria – loin pain/renal colic – loin mass – renal failure – hypertension – abdominal trauma

Ultraschall 2005; 26

– measure bladder volume

investigation

EFSUMB Newsletter

– lower urinary tract symptoms – recurrent urinary tract infections – supra-pubic mass – palpable masses in the scrotum – scrotal pain Level 2 Training and Practice • Practical training should involve at least 1 year of experience at level 1 with a minimum of one ultrasound clinic per week. • A further 600 examinations should have been undertaken in

order to encompass the full range of conditions and procedures referred to below. • A log book listing all examinations undertaken should be

– perform ultrasound-guided invasive procedures, including cyst aspiration, abscess drainage, renal bio-

kept. • Supervision of training should be undertaken by someone who has achieved at least Level 2 competence in urological ultrasound and has had at least 2 years experience at that Le-

psy, percutaneous nephrostomy, supra-pubic bladder catheter insertion and trans rectal prostate biopsy – perform Doppler ultrasound studies relevant to the urinary tract

vel. • A Level 2 practitioner will be able to accept referrals from Level 1 practitioners.

– recognise abnormalities elsewhere in the abdomen and pelvis which need referral for scanning by another ultrasonologist and/or further investigation

Level 2 Knowledge Base • Physics and technology – in-depth knowledge and understanding of the physics of ultrasound – in-depth knowledge and understanding of the technology of ultrasound equipment • Ultrasound techniques – the advanced use of Doppler ultrasound, including spectral, colour and power Doppler – the use of ultrasound for guiding interventional procedures – further applications of trans-abdominal ultrasound – further application of endo-cavity ultrasound (e.g., trans-vaginal ultrasound

Level 3 Training and Practice • A Level 3 practitioner is likely to spend the majority of their time undertaking nephro-urological ultrasound, teaching, research and development and will be an ‘expert’ in this area. • He/she will have spent a continuous period of specialist training in nephro-urological ultrasound. • He/she will perform specialised examinations at the leading edge of ultrasound practice. • He/she will accept tertiary referrals from Level 1 and Level 2 practitioners and will perform specialised examinations (e.g., the use of intravascular ultrasound agents in evaluating possible malignancy) as well as performing advanced ultrasound guided invasive procedures.

– intra-operative ultrasound • Sectional and ultrasonic anatomy – the normal renal and pelvic vasculature, including an understanding of the Doppler signals obtained from these vessels – more detailed knowledge of structures outside the urinary tract in the abdomen and pelvis – ultrasound anatomy of the penis and female genital organs (for Urologists).

Maintenance of skills: All Levels • Having been assessed as competent to practise there will be a need for continued medical education (CME) and continued professional development (CPD) and maintenance of practical skills. • A trainee will need to continue to perform ultrasound scans throughout the remainder of their training programme. Such further ultrasound practice may be intermittent, but no more than 3 months should elapse without trainees using their ul-

Level 2 Competencies to be Acquired • Competencies will have been gained during training for Level 1 practice, and then refined during a period of clinical practice. • Kidneys, bladder, prostate, scrotal contents To be able to: Ultraschall 2005; 26

– recognise all pathology affecting the urinary tract and provide an accurate diagnosis in almost all cases – recognise abnormalities which are outside his/her experience and refer on appropriately to a more experienced ultrasound professional

trasound skills, and at least 100 examinations should be performed per year. • A medical practitioner performing Level 1 ultrasound should continue to perform at least 250 ultrasound examinations per year on a regular basis. • Practitioners should: • include ultrasound in their ongoing CME • audit their practice • participate in multidisciplinary meetings • keep up to date with relevant literature

EFSUMB Newsletter

Knowledge Base Physics and Technology, Ultrasound Techniques and Administration:see Appendix 2. Sectional and Ultrasound Anatomy • Normal Anatomy of female and male breast. • Anatomical, physiological and developmental anomalies associated with the breast.

Appendix 7

• The changes in ultrasound appearances associated with age, pregnancy and lactation, hormonal status, medication.

Breast Ultrasound Pathology in relation to ultrasound Level 1 • Trainees should initially attend an appropriate theoretical course to acquire the core knowledge base as itemised in Appendix 2 and should be familiar with anatomy and pathology of the breast in relation to ultrasound • Practical training should involve at least one ultrasound cli-

• Benign conditions including cysts, fibroadenomas, fibroadeno-lipomas, lipomas, haematomas, fat necrosis, hamartomas. • Indeterminate abnormalities including duct papillomas, radial scar. • Malignancy including ductal, lobular, inflammatory and other carcinomas.

nic per week over a period of around no less than six months

• Normal and abnormal appearances of axillary lymph nodes.

and no more than 1 year.

• Inflammatory breast conditions including infection and ab-

• A minimum of 100 examinations should be undertaken and a record of these kept. However different trainees will acquire

scess formation. • Iatrogenic appearances including breast implants, early and

the necessary skills at different rates and the end point of the

late post-operative changes, seromas, haematomas, radio-

training programme should be judged by an assessment of

therapy changes, fat necrosis, scarring.

competencies. • A log book of 50 cases should be kept which should record

Competencies to be acquired

details of the indications for the procedure, the interpretati-

To be able to:

on and a final report. These cases should be supported by

• Perform a thorough ultrasound examination of the breast

correlation with clinical examination and other imaging fin-

and axilla

dings and needle biopsy results and surgical histology where

• To recognise normal anatomy

appropriate.

• Understand the indications for and the importance of ultra-

• Examinations should encompass the full range of conditions listed below. • The cases scanned should include an appropriate range of normal and abnormal cases including palpable and impalpable lesions. They should also include patients presenting to symptomatic clinics, screening assessment clinics and post-operative surgical clinics. • Mentorship and training should be provided by a practitioner who who has reached at least Level 2 competence. In certain circumstances it may be appropriate to delegate some of this supervision to an experienced level 1 practitioner with at least 2 years experience of regular practical experience. • The practitioner should be working in line with National Occupational Standards. The practical experience should ideally be undertaken in conjunction with attendance on a recognised postgraduate course, such as that provided by some uni-

sound in the triple assessment process. • Understand the strengths, weaknesses and limitations of breast ultrasound. • Be aware of the interdependency and significance of mammographic and ultrasound appearances. • Be competent in recognising the criteria for lesion characterisation • Confidently exclude the presence of a sonographic lesion within the breast. • Write a detailed report of the ultrasound findings with grading, differential diagnosis, conclusion and recommendation for further management. • Understand the principle of Doppler ultrasound and its relevance to breast imaging. • Recognise personal limitations and ask for more expert advice if required

versities and trainees should read appropriate textbooks and literature

Level 2 Interventional Techniques gress to Level 2. This should involve a minimum of 1 scanning clinic per week (at least 10 cases per week) for at least 3 months.

Appendix 7: Breast Ultrasound Training Competency Assessment Sheet, see page 102.

Ultraschall 2005; 26

• After reaching competency at Level 1 practitioners may pro-

EFSUMB Newsletter

• Training for interventional techniques should include observation initially followed by performance of the examination and/or procedure under close supervision. When competence has been acquired then procedures may be undertaken alone but with support close to hand • A logbook of diagnostic and interventional procedures performed should be kept with pathological correlation Competencies to be Acquired • Cyst aspiration: Initially to perform a minimum of 10 guided cyst aspirations of which at least 5 should be of cysts less than 2cms

Appendix 8 Vascular Ultrasound

• Aspirate cysts of less than 1cm diameter • Guided fine needle aspiration biopsy (FNAB): Perform a minimum of 10* FNABs of solid lesions, with pathological correla-

Level 1 Training and Practice • Practical training should involve at least two half day ultra-

tion of cytology result and final pathology (if available)

sound clinics per week over a period of no less than 3 months

• If FNAB is not performed in the department to be aware of

and up to 6 months, with approximately four to six examina-

the uses and limitations of the technique • Guided core biopsies: Perform a minimum of 10* guided core biopsies with pathological correlation of core biopsy histology and final pathology (if available)

tions performed by the trainee under supervision per clinic. • A minimum of 100 imaging examinations of each type (eg carotid, lower limb venous etc) should be undertaken if this is the first practical training module undertaken.

• Perform guided abscess aspiration and drainage • Perform pre-operative guided localisations using skin marking and wire insertion techniques

• Examinations should encompass the full range of pathological conditions listed below. • A log book listing the types of examinations undertaken

• Perform guided marker or coil insertion prior to neo-adjuvant chemotherapy

should be kept. • Training should usually be supervised by a Level 2 practitio-

• Ability to accept referrals from level 1 practitioners

ner in vascular ultrasound. In certain circumstances it may be

• Absolute numbers may vary according to the practice of indi-

appropriate to delegate some of this supervision to an expe-

vidual breast units

rienced level 1 practitioner with at least two years of regular practical experience. This will usually mean that training is

Level 3

carried out in dedicated vascular duplex sessions supervised

Competencies to be Acquired

by an accredited vascular physician/scientist/technologist,

• To be able to accept referrals from level 1 and level 2 practitioners and undertake more complex ultrasound examinations • To mentor and supervise level 1 and 2 practitioners • To understand and be familiar with vacuum assisted breast biopsy.

specialist sonographer or radiologist. • Trainees should attend an appropriate theoretical course which fully covers all areas of the required knowledge base and should read appropriate textbooks and literature. • During the course of training the competency assessment

• To conduct research

sheet should be completed as this will determine in which

• To teach breast ultrasound at all levels

area or areas the trainee can practise independently.

• To be aware of and pursue developments in breast ultrasound including Doppler and the use of intravascular cont-

Level 1 Knowledge Base

rast agents

• Physics and technology, ultrasound techniques and administration (see Appendix 2).

Maintainance of Skills

• To have full working knowledge of the principles, techniques,

In order to maintain competence the practitioner should perform

instrumentation and practical working knowledge of real-ti-

at least 1 ultrasound clinic per week and a minimum of 500 exa-

me and Doppler ultrasound, and equipment controls. This in-

minations per year.

cludes colour flow and power Doppler, colour and pulsed

There should be continuing professional updating with atten-

wave, scale, gain, filter, angle correction, electronic steering,

dance at multidisciplinary breast meetings and relevant and ap-

invert, sample gating, power output, colour amplitude, velo-

propriate courses with a component relating to breast ultrasound

city measurement, spectral changes and all other parameters

scanning together with regular reviews of the current literature.

required to perform a complete diagnostic vascular duplex

Ultraschall 2005; 26

Regular audit of the individual’s ultrasound practice should be undertaken.

study. • Sectional and ultrasonic anatomy including common normal variants

Appendix 8: Vascular Ultrasound Training Competency Assessment Sheet, see page 104.

EFSUMB Newsletter

– perform vein mapping and marking • Abdominal vessels To be able to: – recognise and locate patency and occlusion of the abdominal aorta – recognise and size aneurysmal dilatation of the abdominal aorta • Extracranial vessels To be able to: – recognise and locate patency, occlusion, plaque and

stenoses in the carotid vessels – peripheral extremity arteries – peripheral extremity veins

Level 2 Training and Practice

– abdominal aorta

• Practical training should include at least one year of experi-

– extracranial vessels • Pathology and results of treatment in relation to ultrasound – peripheral extremity arteries: patency, stenosis, occlusion, aneurysmal dilatation – peripheral extremity veins: patency, occlusion, deep venous thrombosis, reflux and incompetence – abdominal vessels: patency, occlusion, aneurysmal

ence at Level 1 with continuous ongoing weekly ultrasound clinics. • A log book of all examinations undertaken should be kept. • Supervision of training should be undertaken by someone who has achieved at least Level 2 competence in vascular ultrasound and has had at least 2 years’ experience at that level.

dilatation of aorta – extracranial vessels: patency, occlusion, stenosis

Level 2 Knowledge Base

– appearances and sequelae of common surgical or per-

• Peripheral arteries and grafts

cutaneous interventions including angioplasty,

• Peripheral deep and superficial veins

stenting, grafts, Miller vein cuffs, dissections, and ne-

• Abdominal Aorta branches

ointimal hyperplasia

• Transcranial Doppler ultrasound: – ultrasonic anatomy, common normal variants and

Level 1 Competencies to be Acquired • To be able to perform continuous wave hand-held Doppler and segmental pressures (ABPI)

principles and practice of the technique – clinical indications and ultrasonic findings in common clinically relevant abnormalities

• Lower extremity peripheral arteries and grafts To be able to: – perform a complete imaging ultrasound examination of the external iliac to popliteal arteries – recognise and assess patency, occlusion, stenosis and aneurysmal dilatation, and measure approximate extent of abnormality

Level 2 Competencies to be acquired • Competencies will have been gained during training for Level 1 practice and then refined during a period of practice • To be able to: – perform a complete imaging ultrasound scan and identify all abnormalities detailed in Level 1 in the up-

– diagnose > 50% stenosis

per and lower extremities, from common iliac to pe-

– recognise common surgical interventions, arterio-ve-

dal vessels and subclavian to radial and ulnar arteries

nous (AV) fistulas and pseudoaneurysm formation • Peripheral veins Lower extremity deep veins To be able to: – perform a complete imaging ultrasound examination of external iliac to popliteal deep veins – perform compression and augmentation – recognise acute femoro-popliteal venous thrombosis – recognise, diagnose and locate reflux • Lower extremity superficial veins To be able to: junctions – recognise and locate clinically relevant venous reflux, incompetence and perforators

To be able to: – recognise and diagnose patency, occlusion, stenosis, reverse flow and steal in the carotid and vertebral vessels – grade degrees of carotid stenosis and plaque type in accordance with local criteria and standards • Abdominal vessels To be able to: – recognise common normal variants, aneurysmal dilatation, patency, stenosis and occlusion of the major abdominal and iliac vessels, including the mesenteric and renal vessels

Ultraschall 2005; 26

– identify the saphenofemoral and saphenopopliteal

and veins • Extracranial vessels

• A Level 3 practitioner is likely to spend the majority of their time undertaking vascular ultrasound. • He/she will accept tertiary referrals from Level 1 and 2 practitioners. • He/she should have the capability to utilise developing tech-

EFSUMB Newsletter

Level 3 Training and Practice

nologies and ultrasound techniques, develop research and teaching skills and the performance of specialised examinations including the use of non-invasive physiological studies, contrast agents, intravascular or intra-operative ultrasound and ultrasound guided invasive procedures. Maintenance of skills: all Levels • Having been assessed as competent to practise there will be a need for continued medical education and maintenance of practical skills. • A trainee should continue to perform ultrasound scans during the remainder of his/her training programme, ideally one session weekly and at least 50 examinations per year. • A similar minimum ongoing commitment should be required from a trained practitioner. It is recognised that due to training or clinical circumstances such further ultrasound practice may be intermittent. If a significant period has elapsed after the use of such skills, a period of re-training is required which should be agreed and documented with the practitioner, local trainers and assessors. • Practitioners should: – include ultrasound in their ongoing continued medical education (CME) and continued professional development(CPD) – audit their practice – participate in multidisciplinary meetings – keep up to date with relevant literature

Ultraschall 2005; 26

Trainer

______________

• Physiological changes in uterus & ovaries during menstrual cycle

• Localize position of an intrauterine contraceptive device

______________ ______________

• Passed theoretical examination

______________ ______________

• Ultrasound in bleeding disturbances before menopause

• Discriminate between benign & malignant adnexal masses ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________

• Recognise pelvic inflammatory disease

• Ectopic pregnancy and plan treatment

• Torsion of normal adnexae & adnexal masses

• Postmenopausal bleeding assessment

• Infertility workup — not obligatory

• Tubal patency using HyCoSy — not obligatory

• Aspirate/drain pelvic cysts and fluid collections (TA & TV)

Ultraschall 2005; 26

cysts, hydrosalpinx, para-ovarian cysts and benign solid adnexal masses

• Discriminate between endometrioma, dermoid cysts, peritoneal inclusion

______________

• Saline infusion sonography

________

• Passed theoretical examination

• Logbook of 2000 completed cases

• Ultrasound screening for cancer

• Abnormalities in primary & secondary amenorrhoea

adrenarche & virilisation

• Changes in children with precocious puberty, menarche, thelarche,

• Oocyte collection by TV ultrasound guided follicular aspiration

________

______________

________

______________

• Discriminate between fibroids & adenomyosis

• Features of endometrial cancer

Date Knowledge on:

Trainer Signature

______________

Trainer Signature

______________

• Illustrated logbook of 20 completed cases

______________

Trainer Signature

• Logbook of 300 completed cases

• Ultrasound in management of miscarriage & tubal pregnancy

• Fetal heart activity in embryo > 10mms CRL

• Intrauterine gestation sac of > 5mms in diameter

Competencies/Skills to be acquired Level 2

________

To be competent to perform/diagnose etc.:

organs in non-pregnant woman

______________

• Obtain accurate measurements of uterus, endometrium and ovaries

• Discriminate between normal and abnormal appearances of pelvic

______________

• Obtain optimal images of uterus and adnexae

• Uterine fibroids ? size, number and position

______________ ______________

• Systematic examination of pelvic organs (TA & TV)

________

Date To be competent to perform/diagnose:

Trainer Signature

Competencies/Skills to be acquired Level 1

To be competent to perform/diagnose:

Trainee

APPENDIX 3: GYNAECOLOGICAL ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

________

Date

________

Date

EFSUMB Newsletter

Ultraschall 2005; 26

____________ ____________ ____________ ____________

• Cavum septum pellucidum

• Cisterna Magna

• Cerebellum

• Cerebral Ventricles

____________ ____________ ____________

• Diagnose intrauterine growth restriction

• Diagnose complications in twin pregnancies

• Logbook of 800 completed cases ____________ ____________

completed literature search

• Passed theoretical examination

• Illustrated logbook of 10 cases including clinical information &

____________

• Diagnose common fetal malformations

To be competent to perform/diagnose etc the following: Trainer Signature

____________

• Midline echo in brain

Competencies/Skills to be acquired Level 2

____________

• Skull/Brain

Discriminate normal from abnormal in:

abdominal diameter & circumference

____________

• Obtain optimal images in a correct orientation

• Obtain accurate measurements of biparietal diameter, femur length,

____________

Trainer Signature

fluid & fetus

• Systematic examination of pregnant uterus, placenta amniotic

To be competent to perform/diagnose etc the following: • Neck

To be competent to perform/diagnose etc the following:

• Stomach

• Four chamber view of heart/outflow tracts

________

Date

________ • Ability to communicate findings to pregnant woman

________ • Arms, legs, hands & feet

________ • Spine in three planes (coronal, transverse & sagittal)

________ • Bladder

________ • Kidneys

________ • Umbilical Cord insertion

________

________ • Thorax

________

Date

Competencies/Skills to be acquired Level 1

A formal theoretical and practical examination should take place at the end of training

Trainer

Trainee

APPENDIX 4: OBSTETRIC ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

________ ________ ________

____________

________

____________ ____________

________

____________ ____________

________

____________

________

____________

________

____________

Date

Trainer Signature ____________

EFSUMB Newsletter 97

____________

• Abnormal texture

____________

• Gall bladder stones

• Duct dilatation

____________

________ ________

____________ ____________

• Pancreatic tumours

Ultraschall 2005; 26

• Pancreatitis

________ ________

____________ ____________

• Duct stones

____________

• Ovarian cysts and masses • Aortic aneurysm

• Normal pancreatic anatomy

________

PANCREAS ____________

____________ ____________

____________

• Uterine fibroids

________

____________

• Undertake biopsy of parenchymal liver disease

• Solid renal mass

• Renal cysts

• Hydronephrosis

• Aorta

• Ovaries

• Uterus

• Normal kidneys

OTHER STRUCTURES etc

• Splenic trauma

• Focal splenic lesions

• Splenomegaly

• Normal spleen

• Cavernous transformation

• Thrombosis

• Varices

____________

________

Trainer Signature Date

• Pregnancy

________ ________

____________

________

• Benign inflammatory conditions of gall bladder and gall bladder tumours ____________

• Complications of Acute Cholecystitis

____________

• Level of obstruction ____________

____________

• Duct dilatation

____________

• Intra and extra-hepatic ducts and variants

• Acute Cholecystitis

____________

• Normal gall bladder

• Chronic Cholecystitis

____________

• Hepatic Veins, dilatation, thrombosis

________

____________ ____________

• Cysts, Haemangioma, Metastases

________ ________

____________

________

____________

• Focal lesions

• Cirrhosis

• Fatty liver

________

____________

• Atrophy and hypertrophy of lobes and segments

• Dilated portal vein

• Normal portal vein

• Common variants of anatomy

________

____________ ____________

• Normal liver segmental anatomy

________

To be competent to perform/diagnose etc. the following: PORTAL VENOUS SYSTEM/SPLEEN

Trainer Signature Date

Competencies/Skills to be acquired Level 1

Trainer

LIVER AND BILIARY SYSTEM

To be competent to perform/diagnose etc. the following:

Trainee

APPENDIX 5: GASTROENTEROLOGICAL ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

EFSUMB Newsletter

Ultraschall 2005; 26

____________ ____________ ____________ ____________

• Diverticular disease and abscess

• Colonic Tumours

• Small bowel obstruction

• Inflammatory bowel disease

• Inflammatory masses

________

• Undertake microwave ablation of tumours

• Undertake laser ablation of tumours

• Undertake PEI

• Undertake RFA

• Undertake ultrasound contrast examinations

• Undertake endoscopic ultrasound

• Undertake biopsy of focal lesions

• Spectral and colour flow Doppler of portal and hepatic venous system

• Undertake drainage of fluid collections/abscesses

OTHER

• Omental Disease

• Mesenteric masses

• Peritoneal fluid collections

____________ ____________

• Normal stomach, small and large bowel

________

To be competent to perform/diagnose etc. the following: PERITONEAL CAVITY, MESENTERY & OMENTUM

Trainer Signature Date

Competencies/Skills to be acquired Level 2

Trainer

HOLLOW DIGESTIVE TUBE

To be competent to perform/diagnose etc. the following:

Trainee

APPENDIX 5: GASTROENTEROLOGICAL ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

________ ________ ________

____________ ____________ ____________

________ ________ ________ ________ ________

____________ ____________ ____________ ____________ ____________

________

____________

________ ________

____________ ____________

Trainer Signature Date

EFSUMB Newsletter 99

____________

• Ultrasound techniques

________

• Pathology in relation to ultrasound

• Sectional and ultrasonic anatomy

• Administration

Trainer

____________

• renal length and variation from normality

• collecting system dilatation

________ ________ ________

____________ ____________ ____________ ____________

• stones

• renal parenchymal disease

• ultrasonic anatomy and common normal variants

____________

• use colour Doppler to assess ureteric jets

____________ ____________ ____________ ____________

• prostatic volume

• abnormal focal lesion

• trans-rectal prostatic biopsy (optional/depending on national guidelines)

Ultraschall 2005; 26

• trans-rectal ultrasound

________

• know when to refer to a more expert ultrasonologist

• normal uterus and ovaries and gynaecological masses

• normal aorta and aortic aneurysm • normal liver and liver masses

________

____________

• ultrasonic anatomy and common normal variants

• scrotal pain

• palpable scrotal masses

• supra-pubic mas

• recurrent urinary tract infection

• lower urinary tract symptoms

• renal failure

Prostate (for Urologists)

________

________ ________

____________

________

____________ ____________

________ ________

____________ ____________

________

• calculi

• tumours

• diverticula

• bladder volume

• loin pain/renal colic • loin mass

____________

• haematuria

• Use ultrasound in the assessment of patients presenting with:

• ultrasound examination in different planes

General

Bladder

________

____________ ____________

• peri-renal abnormalities

________

• use Doppler to help differentiate torsion/inflammatory problems

• inflammatory changes in testes and epididymides

• tumours

• intra-scrotal and intra-testicular calcifications

• varicocoeles

• epididymal cysts

• reno-vascular hypertension

• tumours

• complex cysts

________

________ ________

____________

• simple cysts

____________

________

• ultrasonic anatomy and common normal variants

• ultrasound examination in different planes

____________

• ultrasonic anatomy and common normal variants

________

____________

• ultrasound examination in different planes

________

Scrotum (for Urologists)

Trainer Signature Date

Kidneys

To be competent to perform/diagnose the following:

Competencies/skills to be acquired Level 1

____________

• Practical instrumentation/use of ultrasound controls

To be competent to perform/diagnose the following:

____________

Trainer Signature Date

Core knowledge base - Level 1

• Physics and technology

Trainee

APPENDIX 6: NEPHRO-UROLOGICAL ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

________

____________

Trainer Signature Date

________

____________

Trainer Signature Date

EFSUMB Newsletter

100

Ultraschall 2005; 26

• recognise abnormalities elsewhere in the abdomen/pelvis

• perform Doppler studies

• trans-rectal prostate biopsy

• suprapubic bladder catheter insertion

• nephrostomy

• renal biopsy

• abscess drainage

• cyst aspiration

Perform

Recognise all urinary tract pathology

To be competent to perform/diagnose the following:

Trainee

____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________

____________ ________ ________ ________ ________ ________ ________ ________ ________

________

Trainer Signature Date

Competencies/skills to be acquired Level 2

Trainer

APPENDIX 6: NEPHRO-UROLOGICAL ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

EFSUMB Newsletter

101

____________ ____________ ____________

• Administration

• Sectional and Ultrasound anatomy

• Normal Anatomy of female and male breast.

____________

• Pathology in relation to ultrasound

Ultraschall 2005; 26

radiotherapy changes, fat necrosis, scarring

early and late post-operative appearances, seromas, haematomas,

• Iatrogenic changes in the breast , including breast implants,

abscess formation

____________

• Normal and abnormal appearances of axillary lymph nodes.

• Inflammatory conditions in the breast including infection and

____________ ____________

carcinomas

• Breast malignancy including ductal, lobular, inflammatory and other

____________ ____________

lipomas, lipomas, haematomas, fat necrosis, hamartomas

• Indeterminate abnormalities including duct papillomas, radial scar

• Benign breast conditions including cysts,f ibroadenomas, fibroadeno-

____________

pregnancy and lactation, hormonal status, medication

• The changes in ultrasound appearances associated with age,

with the breast.

____________

• Anatomical, physiological and developmental anomalies associated

____________

• Physics and Instrumentation

• Ultrasound techniques

• Be able to confidently exclude the presence of a sonographic lesion

• Be competent in recognising the criteria for lesion characterisation.

________

required

________ • Recognise personal limitations and ask for more expert advice if

________ to breast imaging

• Understand the principle of Doppler ultrasound and its relevance

further management

grading, differential diagnosis, conclusion and recommendation for

________ • Be able to write a detailed report of the ultrasound findings with

________ within the breast

________

and ultrasound appearances

________ • Be aware of the interdependency and significance of mammographic

ultrasound

________ • Understand the strengths, weaknesses and limitations of breast

in the triple assessment process

________ • Understand the indications for and the importance of ultrasound

________ • Be able to recognise normal anatomy of breast and axilla

________ • Perform a thorough ultrasound examination of the breast and axilla

Competencies/skills to be acquired: Date

Core Knowledge Base Level 1 Trainer Signature

Trainer

Trainee

APPENDIX 7: BREAST ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

____________

Trainer Signature

________

Date

EFSUMB Newsletter

102

Ultraschall 2005; 26

Trainer

_____________ _____________ _____________

• To understand and be familiar with vacuum assisted breast biopsy

• To conduct research.

• To teach U/S at all levels.

Doppler and the use of intravascular contrast agents.

_____________

• To be able to mentor and supervise practitioners at level 1 and 2.

• To be aware of and pursue developments in breast U/S including

_____________

more complex ultrasound examinations.

• To accept referrals from level 1 and level 2 practitioners and undertake

Essential principles

Trainer Signature

_____________

• Accept referrals from level 1 practitioners

Level 3

_____________

neo-adjuvant chemotherapy.

• Perform ultrasound guided marker or coil insertion prior to

skin marking and wire insertion techniques.

_____________

• Perform ultrasound guided localisations pre-operatively, using both

_____________

• Perform ultrasound guided breast abscess aspiration.

_____________

Trainer Signature

results to imaging and pathology.

• Successfully perform ultrasound guided core biopsy with correlation of

technique and be aware of its uses and limitations.

procedure within the unit then the student should be familiar with the

correlation of results to imaging and pathology. If FNA is not standard

• Perform fine needle aspiration cytology on abnormalities with

Essential principles

Competencies/skills to be acquired:

_______

Date

_______

Date

This involves a minimum of 1 scanning clinic session per week (at least 10 cases per week) for at least 3 months.

After reaching competency at Level 1 practitioners may progress to Level 2.

Level 2

Trainee

APPENDIX 7: BREAST ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

EFSUMB Newsletter

103

____________ ____________ ____________ ____________

• Ultrasound techniques

• Administration

• Sectional and ultrasonic anatomy

• Pathology in relation to ultrasound

________

• know when to refer to a more expert ultrasonologist

____________ ____________ ____________

• perform compression and augmentation

• recognise acute femoro-popliteal DVT

• diagnose and locate reflux

________

____________

• other competencies acquired

• Scan external iliac to popliteal veins

________

• recognise patency, occlusion, plaque and stenosis General

• recognise common interventions

________

Extracranial vessels • recognise normal anatomy and common variants

____________

• recognise and differentiate 50% stenosis

________

• recognise normal anatomy and common variants

____________

• recognise patency, occlusion and aneurysm

Ultraschall 2005; 26

Peripheral deep veins

____________ ____________

• scan external iliac to popliteal arteries

• recognise patency and occlusion of aorta • recognise and size aortic aneurysm

____________

Peripheral arteries and grafts

• diagnose reflux, incompetence, perforators Abdominal ultrasound

• recognise normal anatomy and common variants

________ ________

____________ ____________

• identify sapheno-femoral and sapheno-popliteal junctions

• velocity measurement and Doppler angle

________

• colour flow and spectral analysis

• caliper measurements of distance and size

• recognise normal anatomy and common variants

____________ ____________

• CW hand-held Doppler and segmental pressures

Peripheral superficial veins

Essential Principles

To be competent to perform/diagnose the following:

Competencies/skills to be acquired - Level 1

________

Trainer Signature Date

____________

To be competent to perform/diagnose the following:

____________

• Practical instrumentation/use of ultrasound controls

Trainer Core Knowledge Base Level 1 Trainer Signature Date

• Physics and technology

Trainee

APPENDIX 8: VASCULAR ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

____________

________

Trainer Signature Date

EFSUMB Newsletter

104

Ultraschall 2005; 26

____________ ____________ ____________

• Peripheral arteries and grafts

• Peripheral deep and superficial veins

• Transcranial Doppler

________

and occlusion of major abdominal and iliac vessels

• normal variants, aneurysmal dilatation, patency, stenosis

• grade degrees of carotid stenosis and plaque type

and vertebral vessels

• patency, occlusion, stenosis reverse flow and steal in the carotid

• assessment from subclavian to radial and ulnar arteries and veins

• assessment from iliac to pedal arteries and veins

To be competent to perform/diagnose the following:

Competencies/skills to be acquired - Level 2

Core Knowledge Base Level 2 Trainer Signature Date

Trainer

Trainee

APPENDIX 8: VASCULAR ULTRASOUND TRAINING COMPETENCY ASSESSMENT SHEET

________ ________ ________ ________ ________

____________ ____________ ____________ ____________ ____________

Trainer Signature Date

EFSUMB Newsletter

105