chapter  11
6 Pages

Ultrasound training and accreditation Introduction

The use of thoracic ultrasound by non-radiologytrained clinicians is increasing ac ross the world, both in the diagnostic workup for pleural pathologies and for guiding invasive pleural procedures. In order for ultrasound to be performed safely and accurately, robust training and accreditation need to be available in order to maintain standards and ensure patient safety. There is evidence that the use of ultrasound in guiding pleural procedures may help to minimize procedure-related complications1-3 (see Chapter 1). With adequate training, respiratory physician-delivered thoracic ultrasound has been shown to be accurate and safe for the identification of pleural effusion and in choosing a site for intervention.4 This, along with concerns about drain misplacement using a “blind” approach,5 has led to current best practice guidelines advocating the use of thoracic ultrasound to guide pleural interventions involving fluid.6 In addition, the decreasing cost of portable ultrasound machines has led to better availability of this technology, and hence more clinicians are eager to acquire this skill. Audit data would suggest that the majority of UK respiratory departments have access to at least one ultrasound machine.7 However, simply having access to a machine is not sufficient, and adequate staff training is imperative to ensure the equipment is used correctly. Clinicians from a variety of different fields may benefit from skills in thoracic ultrasound, and recommendations about training are included in guidelines for critical care physicians,8 surgeons,9 emergency medicine clinicians,10 and respiratory physicians.11,12

Ultrasound is operator dependent and requires both psychomotor and cognitive skills in order to obtain high-quality images and interpret them. Adequate training and hands-on experience are therefore required in order for operators to be sufficiently skilled in all of these areas. The traditional “see one, do one, teach one” approach to teaching is increasingly being replaced by a multimodality method, to include theory sessions, simulation, direct observation, and observed practice.13 Many of the established introductory courses in thoracic ultrasound include all of these methods.14-16 One study in the United States, which evaluated a simulationbased ultrasound training module for interns, found it improved trainees’ confidence in identifying specific structures using ultrasound, and hence it is felt to be useful preparation for supervised clinical practice.17