European Federation of Societies for Ultrasound in...

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Ultraschall 2005; 26

79European Federation of Societies for Ultrasound in Medicine and Biology

Dear members of EFSUMB

You are probably all aware of the document “Minimum training

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

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

After a few years of work EFSUMB Education and Professional

Standards Committee has developed guidelines for how the mi-

nimum training requirements can be achieved at each level of

practice. Structured theoretical and practical training should be

followed by competency assessment. In the document that fol-

lows you will find a description – for some medical specialties –

of the theoretical and practical training that the committee re-

commends and also competency assessment sheets. We hope

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

fessional Standards Committee will be helpful.

We would welcome general comments on these recommendati-

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

future and suggestions for additional syllabuses. Comments

should be submitted by email to: [email protected]

Lil Valentin

Chairman of the EFSUMB Education

and Professional Standards Committee

Minimum training recommendations for the practice of medical ultrasound

1. Introduction1.1 Many medical specialists are increasingly wishing to un-

dertake ultrasound examinations on patients referred to

them for their clinical opinion as a direct extension of

their clinical examination. This may take place in the

outpatient department, on the wards and in the assess-

ment of emergency patients. Additionally there is a de-

mand by some European Training Boards to incorporate

ultrasound experience into clinical training and accredi-

tation where appropriate.

1.2 This document makes recommendations for minimum

ultrasound training requirements in the following areas:

– gynaecological ultrasound

– obstetric ultrasound

– gastroenterological ultrasound

– nephro-urological ultrasound

– breast ultrasound

– vascular ultrasound

2. Aims and Principles2.1 The medical use of ultrasound remains highly operator

dependent in spite of advances in technology and the in-

terests of the patient are best served by the provision of

an ultrasound service which offers the maximum clinical

benefit and optimal use of resources i.e. with appropria-

tely trained personnel using equipment of appropriate

quality

2.2 All who provide an ultrasound service are ethically and

legally vulnerable if they have not been adequately trai-

ned. A defence against a claim for negligence is unlikely

to be successful should an error of diagnosis be made by

an untrained practitioner of ultrasound.

2.3 An appropriate level of training in ultrasound is one that

allows for the provision of a safe and effective ultra-

sound service. This may be a purely diagnostic, predomi-

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 ultra-

sound in Europe (Appendix 1). These identify three le-

vels of training and expertise. The boundaries between

the three levels are difficult to define precisely and

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

petence and experience. In the detailed syllabuses ap-

pended an attempt is made to indicate more specifically

the type of experience required for each level of training

2.5 A system for recording the results of any ultrasound exa-

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

manent recording of images, where appropriate, is desi-

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rable for the purposes of correlative imaging, future

comparison and audit.

2.6 Knowledge of the appropriate use and integration of

other imaging techniques should be required

2.7 The requirement to deliver training must acknowledge

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

vision of funding, the content and practicability of the

curriculum and the availability of trainers and training

courses. It must be recognised that training requires ad-

ditional time, space and equipment. Training should be

properly costed and funded.

2.8 Training should be related to the specialist requirements

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

one level of training it may be appropriate for a trainee

to become proficient in some but not all of the individual

modules and only undertake ultrasound practice in

this/these areas.

2.9 Training should be given in departments which have a

multidisciplinary (medical, surgical, radiological etc)

philosophy, an adequate throughput of work, a trainer

with experience and an interest in training in the modu-

le required, appropriate equipment and an active audit

process.

2.10 Regular appraisal should take place during the training

period. At the end of a period of training a “competency assessment“ form should be completed for each trainee,

which will determine the area or areas in which they can

practice independently. The responsibility to be adequa-

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

dividual practising ultrasound. An assessment of compe-

tence is a reflection on the position at that moment in

time and no more.

2.11 Following training, regular and relevant continued me-

dical education (CME)/continued professional develop-

ment (CPD) should be undertaken and documented. It is

the responsibility of the trainee to ensure that their

practical skills are maintained by ensuring regular ultra-

sound clinics are undertaken and that there is an ade-

quate range of pathology seen in their ultrasound

practice.

3. Training Recommendations3.1 Training should consist of a theoretical module (Appen-

dix 2) and practical modules of training (Appendices 3–

8)

4. Theoretical Training4.1 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.

5. Practical Training5.1 A curriculum for each module for the three levels of trai-

ning has been developed incorporating theoretical trai-

ning on anatomy and pathology and a practical syllabus

listing conditions which should be included in the expe-

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

mited anatomical or modular approach may also be ac-

ceptable if full competence in that area is demonstrated

and future clinical practice is confined to that area alone.

Practical experience should be gained under the

guidance of a named trainer.

5.2 The requirements for the different levels of training are

as follows:

Level 15.2.1 Different trainees will acquire the necessary skills at dif-

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

me should be judged by an assessment of practical com-

petence.

5.2.2 Examinations should encompass the full range of patho-

logical conditions listed in the modules.

5.2.3 A log book listing the number and type of examinations

undertaken by the trainee themselves should be kept.

5.2.4 An illustrated log book of specific normal and abnormal

findings may be appropriate for some modules.

5.2.5 Training should usually be supervised by a level 2 practi-

tioner. In certain circumstances it may be appropriate to

delegate some of this supervision to an experienced le-

vel 1 practitioner with at least two years of regular

practice.

Level 25.2.6 This requires at least one year of experience at level 1,

with regular ultrasound clinics.

5.2.7 A significant further number of examinations should

have been undertaken in order to encompass the full

range of conditions and procedures encountered in each

module.

5.2.8 A log book listing the numbers and types of examinati-

ons undertaken by the trainee should be maintained.

5.2.9 An illustrated log book of specific normal and abnormal

findings may be appropriate for some modules.

5.2.10 Supervision of training should be undertaken by someo-

ne who has achieved at least level 2 competence and has

had at least two years experience at that level.

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Level 35.2.11 This requires a practitioner to spend a significant part of

their time undertaking ultrasound examinations or tea-

ching, research and development in the field of ultra-

sound.

5.3 The syllabus for each practical module is outlined in Ap-

pendix 3–8

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

6.1 The minimum amount of on-going experience in ultra-

sound as outlined in each syllabus should be maintained.

6.2 CME/CPD should be undertaken which incorporates ele-

ments of ultrasound practice.

6.3 Regular audit of the individual’s ultrasound practice

should be undertaken to demonstrate that the indicati-

ons, performance and diagnostic quality of the service is

satisfactory.

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

United Kingdom Royal College of Radiologists, its committees

and members and Fellows, which resulted in the Publication of

‘Ultrasound Training Recommendations for Medical and Surgical

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

contribution of the Royal College of Radiologists and its Fellows

Appendix 1

Minimum Training Requirements for the Practice of

Medical Ultrasound in Europe

1. Introduction1.1 The increasing applications of ultrasound imaging

throughout medical practice, together with the increa-

sing availability of cheaper and smaller ultrasound scan-

ners, mean that more medical personnel are using ultra-

sound equipment to perform and interpret ultrasound

scans.

1.2 Ultrasound has an enviable safety record to date. Various

bodies, including scientific societies and manufacturers

associations have made recommendations concerning

the safe and prudent operation of ultrasound equip-

ment, but, unlike imaging equipment, which makes use

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

or international regulation of ultrasound usage.

1.3 More than with any other imaging modality, the medical

use of ultrasound is highly operator dependent and is

fraught with scope for diagnostic error, the potential for

which is magnified by the on-going development of

more sophisticated equipment with extended applicati-

ons.

1.4 In order to gain maximum clinical benefit, as well as to

achieve optimal use of resources, there is a need for ope-

rators of ultrasound equipment to have the appropriate

skills for the performance and interpretation of ultra-

sound examinations.

1.5 EFSUMB, (which is a federation of national ultrasound

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

re is no standardisation of training requirements for ul-

trasound practitioners, either between different coun-

tries or between different medical disciplines [3].

This document is an attempt to stimulate national and pan-Eu-

ropean speciality groups to consider training in ultrasound and to

work towards the setting of minimum Europe-wide standards for

such training.

2. Levels of Practice2.1 Most national associations and speciality groups will re-

cognise that ultrasound can be practised at different le-

vels.

2.2 However, because of variations in medical systems bet-

ween countries and variations in the organisation of the

different specialities in those countries, it is difficult to

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-

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

Group have indicated that ultrasound training needs

may be defined according to equipment availability, and

suggest three levels of training requirement.

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

vel concept of ultrasound practice, based on clinical ex-

perience, ultrasound experience, practical competencies,

research record and ability to teach, and are introducing

regulated training requirements for each level.

2.5 Whilst it would be unrealistic to expect every speciality

group in every European country to agree upon the pre-

cise definitions of the levels of practice, abilities for each

level may be accepted. Recommendations for the mini-

mum training requirements for each level of practice can

then be based on these principles

Level 1Practice at this level would usually require the following abilities:

a. to perform common examinations safely and accura-

tely

b. to recognise and differentiate normal anatomy and

pathology

c. to diagnose common abnormalities within certain or-

gan systems

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

dicated

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

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

ate specialist training programmes.

Level 2Practice at this level would usually require the following abilities:

a. to accept and manage referrals from Level 1 practitio-

ners

b. to recognise and correctly diagnose almost all patho-

logy within the relevant organ system

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

vasive procedures

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

oners

e. to conduct some research in ultrasound

The training requisite to this level of practice would be gained du-

ring a period of sub-speciality training, which may either be

within or after the completion of a specialist training programme.

Level 3This is an advanced level of practice, which involves the following

abilities:

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

oners

b. to perform specialised ultrasound examinations

c. to perform advanced ultrasound-guided invasive pro-

cedures

d. to conduct substantial research in ultrasound

e. to teach ultrasound at all levels

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

sound

3. Minimum Training Requirements 3.1 For each level of ultrasound practice, national and/or Eu-

ropean speciality groups should formulate a detailed

syllabus with comprehensive recommendations for ne-

cessary amounts of practical experience (target num-

bers).

3.2 Syllabuses should include, at the appropriate level, theo-

retical knowledge of:

– 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

– indications for ultrasound and inter-relationship with

other imaging modalities

– ultrasound-guided procedures

3.3 Recommendations should include an indication of the

minimum numbers of scans, which should be performed

(at the appropriate level) as:

– supervised scanning

– independent scanning, with review by a designated

trainer

3.4 Training programmes should include recommendations

and/or regulations for evaluinterpretive skills. In each

country and/or speciality there should be a recognised

competent authority with responsibility for the evaluati-

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

propriate in that country and/or speciality. Similarly,

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

dividuals who have completed training programmes will

vary, and it is essential that there should be recognition

of the necessity for limiting the use of ultrasound to sui-

tably trained individuals.

3.5 Continuing professional education and development is

essential for any individual practising ultrasound. Trai-

ning recommendations and/or regulations should inclu-

de consideration of minimum scanning practice in order

to maintain skills and minimum levels of educational ac-

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

the rapidly developing field of medical ultrasound.

4. Sonographers4.1 Sonographers are healthcare professionals without a

medical degree who use ultrasound for medical purpo-

ses in some specialities in some European countries.

4.2 In virtually all countries and medical specialities in Euro-

pe where sonographers currently practice, there are

comprehensive training programmes for sonographers

which require high standards of knowledge and practical

scanning skills, and they are strictly regulated with well

developed schemes for the evaluation and accreditation

of the trainees.

4.3 It is possible that the practice of ultrasound by sonogra-

phers will increase and will be introduced into more

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

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

table training programmes in order to ensure that the

sonographers are properly trained for their job.

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5. Conclusions5.1 The medical use of ultrasound can be practised at diffe-

rent levels

5.2 Those physicians and sonographers practising ultra-

sound should be properly trained for the appropriate le-

vel 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

supervise the theoretical and practical training that is re-

quisite for the various levels of ultrasound practice.

References1. Council Directive 97 / 43 / Euratom of 30 June 1997. The Medical Ex-

posures 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 Stan-

dards: Report of WHO Study Group 1998. WHO technical report se-

ries: 875

Footnote This document has been prepared by the EFSUMB Education and Pro-

fessional Standards Committee, and has been approved by the EFS-

UMB Executive Bureau. As part of the consultation process, this com-

mittee 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.

Members of EFSUMB Education and Professional StandardsCommitteeDr Lil Valentin (Sweden) – Chairman

Dr Henry Irving (UK) – Secretary

Prof David H Evans (UK)

Prof Jochen Hackeloer (Germany)

Prof Kurt Jäger (Switzerland)

Dr Pentii Lohela (Finland)

Dr Ioan Sporea (Romania)

Contributors to Edinburgh WorkshopProf. Dr. med. Uli Hoffmann, Representative of the International

Union of Angiology

Dr George R Sutherland, Chairman of the Echocardiography wor-

king group 7 of the European Society of Cardiology

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

ternational Society of Ultrasound in Obstetrics and Gynecology

Prof. Rolf W. Günther, President of the European Association of

Radiology

Prof. Carlo Trombetta, President of the Italian Society of Urologi-

cal Imaging and the coordinator of the European Society of Uro-

logical Imaging

Dr Ioan Sporea, replaced Prof. Rapaccini as representative of Eu-

ropean Gastroenterologists

Prof. Michel Claudon, President of EFSUMB

Appendix 2

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

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 ultra-

sound and the effect on image quality and penetration.

• The interaction of ultrasound with tissue including biological

effects.

• The safety of ultrasound and of ultrasound contrast agents.

• The basic principles of real time and Doppler ultrasound in-

cluding colour flow and power Doppler.

• The recognition and explanation of common artefacts

• Image recording systems.

Ultrasound Techniques• Patient information and preparation.

• Indications for examinations.

• Relevance of ultrasound to other imaging modalities.

• The influence of ultrasound results on the need for other

imaging.

• Scanning techniques including the use of spectral Doppler

and colour Doppler.

Administration• Image recording.

• Image storing and filing.

• Reporting.

• Medico-legal aspects – outlining the responsibility to

practice within specific levels of competence and the re-

quirements for training

• Consent

• The value and role of departmental protocols in determining

the appropriate use of ultrasound

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Gynaecological Ultrasound

This curriculum is intended for clinicians who perform diagnostic

gynecological ultrasound scans. It includes standards for theore-

tical knowledge and practical skills. It is recommended that all

gynaecologists obtain Level 1 competence, preferably during

their specialist training.

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

of 300 examinations under supervision. However different

trainees will acquire the necessary skills at different rates

and the end point of the training programme should be jud-

ged by an assessment of competencies

• Examinations should encompass the full range of pathologi-

cal 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 practitio-

ner. In certain circumstances it may be appropriate to delega-

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

oner with at least two years of regular practical experience.

• The training should include 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 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

Level 1 Knowledge Base and Recommended Contents of Level1 Theoretical CourseA minimum of 20 hours theoretical teaching is required prefe-

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

• Physics and Technology, Ultrasound Techniques and Admi-

nistration (see Appendix 2)

• Normal gynaecological ultrasound findings in non-pregnant

women

• Normal ultrasound findings in early pregnancy (4–12 gestati-

onal weeks)

• Ultrasound based management of early pregnancy complica-

tions

• Common abnormal ultrasound findings in the uterus, e.g. fib-

roids 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 in-

fusion sonography, etc)

• Common abnormal ultrasound findings in the adnexae, e.g.

corpus luteum cysts, endometriomas, dermoid cysts, hydro-

salpinges, para-ovarian cysts, peritoneal inclusion cysts, ab-

scesses.

• Ultrasound characteristics of benign and malignant pelvic

masses.

• Management of incidentally detected ovarian cysts in post-

menopausal women.

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

• Perform a systematic examination of the pelvic organs, both

transvaginally and transabdominally

• Obtain optimal images of the uterus and adnexa

• Obtain accurate measurements of the uterus, endometrium

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 fin-

dings 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 compli-

cations (miscarriage and tubal pregnancy)

Level 2• The training requisite to this level of practice would be gai-

ned during a period of sub-speciality training, which may eit-

her be within or after the completion of a specialist training

programme.

• Competencies will have been acquired during training for le-

vel 1 practice which will then be refined by performing a mi-

nimum of 30 clinic sessions at a centre where supervision by

someone with level 2 competence is available.

• 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

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• To maintain competence at level 2 practitioners should per-

form 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-

graphy

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

mensional (3D) imaging

a. Fibroids, sarcoma

b. Adenomyosis/adenomyomas

c. Uterine malformations

• Endometrial pathology: ultrasound based management of

bleeding disturbances

• Cervical pathology including cancer

• Screening for ovarian and endometrial cancer

• Gynaecological oncology – Staging, recurrence, response to

treatment

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

• Pelvic inflammatory disease (PID)

• Infertility – HysteroContrastSalpingography (HyCoSy), Saline

Infusion Sonography (SIS), Follicle aspiration, Hyperstimula-

tion Syndrome

• Early pregnancy complications – molar pregnancy and chori-

ocarcinoma, all types of ectopic pregnancy (including both

diagnosis and management)

• Use of ultrasound in the evaluation of women with pelvic

pain including adnexal torsion, pelvic inflammatory disease,

endometriosis and extragenital causes (eg appendicitis, di-

verticulitis)

• Paediatric and adolescent gynaecology

– Assessment of normal development of the genital or-

gans

– Common findings in precocious puberty, adrenarche,

thelarche, virilisation and primary amenorrhoea

– diagnosis and management of adnexal masses in

children

• Invasive procedures

• puncture of ovarian cysts

• drainage of pelvic abscesses

– fine needle and larger bore needle biopsy of pelvic

masses

Level 2 Competencies to be acquired• Uterus

– reliably discriminate between fibroids and adenomy-

osis

– recognize the features of endometrial cancer

– use ultrasound correctly in the management of blee-

ding disturbances including postmenopausal bleeding

• Adnexa

– reliably discriminate between benign and malignant

adnexal masses

– reliably diagnose endometrioma, dermoid cyst, hy-

drosalpinx, peritoneal pseudocysts, paraovarian cysts,

and benign solid adnexal masses

– recognise acute and chronic pelvic inflammatory di-

sease

– assess by ultrasound the status of ectopic pregnan-

cies of all kinds and plan treatment

– assess the likelihood of torsion of normal adnexal

structures and adnexal masses

– use ultrasound in infertility workup (for trainees wor-

king in this area)

– use ultrasound to monitor ovulation induction

• Interventional ultrasound

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

ections, abscesses etc under transabdominal and

transvaginal ultrasound guidance

– perform saline infusion Hysterosonography (SIH)

– assess tubal patency with HysteroContrastSalpingo-

graphy (HyCoSy) – not obligatory

• Have knowledge of

– the common findings in children with precocious pu-

berty, menarche

– thelarche, adrenarche and virilisation

– possible findings in primary and secondary amenor-

rhoea

– the role of ovarian and endometrial cancer screening

– the principles of oocyte collection by transvaginal ul-

trasound guided follicular aspiration

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

undertaking gynaecological ultrasound and/or teaching, research

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

Maintenance of SkillsRecommended numbers of examinations to be performed annu-

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

Practitioners should:

• include ultrasound in their ongoing continued medical edu-

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.

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Obstetric Ultrasound

This curriculum is intended for clinicians who perform obstetric

ultrasound scans. It includes standards for theoretical knowledge

and practical skills. Level 1 competence should be obtained by

anyone performing routine unsupervised scans in pregnancy

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

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

vision. However trainees will acquire the necessary skills at

different rates and the end point of training should be judged

by an assessment of competencies

• Examinations should encompass the full range of conditions

listed below


should be kept





• Trainees should attend an appropriate theoretical course (see

below) followed by a theoretical examination and the trainee

should read appropriate textbooks and literature


least 500 examinations each year



area or areas the trainee can practise independently

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

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

• Physics and Technology, Ultrasound Techniques and Admi-

nistration (see Appendix 2)

• Dating of pregnancy

• Weight estimation and fetal growth

• Normal fetal anatomy

• Common fetal anomalies

• Multiple pregnancy

• Placenta, amniotic fluid

• Screening for fetal chromosomal anomalies: soft markers,

nuchal translucency

• Invasive procedures: amniocentesis, chorionic villus biopsy

• Psychological aspects

• Ethical aspects

• Quality control

Level 1 Competencies to be acquiredAt 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

• Optimize and correctly orientate the ultrasound image

• Obtain accurate measurements of the fetal biparietal diame-

ter, femur length and abdominal diameter or circumference

for dating and/or weight estimation

• Evaluate fetal anatomy, rerognizing the following structures

and discriminating normal from abnormal findings in these

structures:

– Skull/brain

– Midline echo in brain

– Cavum septum pellucidum

– Cerebellum

– Cisterna magna

– Cerebral ventricles

– Neck

– Thorax

– Four chamber view of heart plus outflow tracts

– Stomach

– Umbilical cord insertion

– Kidneys

– Urinary bladder

– Spine

– Extremities (arms, legs, hands and feet)

– The ability to communicate both normal and abnor-

mal findings to the pregnant woman

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 practitio-

ner

• A minimum of 800 examinations will have been undertaken

• A log book of 10 well documented cases (eg fetal malformati-

ons, intrauterine growth restriction, twin complications etc)

should be kept. This should include ultrasound images, clini-

cal data and literature research

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

ned by a period of subspecialty training which may either be

within or after the completion of a specialist training pro-

gramme.

• During the couse of training the competency assessment

sheet should be completed

• Training should include a theoretical course of at least 30

hours (see below) followed by a theoretical examination


least 400 obstetric examinations per year

Level 2 Knowledge Base and Recommended Contents of Level2 Theoretical Course

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

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• 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

• Psychology, counselling

• Ethics

Level 2 Competencies to be acquiredBe able to:

• Diagnose common fetal malformations and have knowledge

of their management

• Diagnose intrauterine growth restriction and have know-

ledge of its management

• Diagnose complications in twin pregnancies and have know-

ledge of their management


undertaking obstetric ultrasound and/or teaching, research and

development and will be an ‘expert’ in this area

Maintenance of SkillsRecommended numbers of examinations to be performed annu-

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

Practitioners should:

• Include ultrasound in their ongoing continued medical edu-

cation (CME) and continued professional development (CPD)

• Audit their practice

• Participate in multidisciplinary meetings

• Keep up to date with relevant literature

Appendix 5

Gastroenterological Ultrasound

This curriculum is intended for clinicians who perform gastroen-

terological ultrasound scans. It includes standards for theoretical

knowledge and practical skills. At least Level 1 competence

should be obtained by anyone performing gastroenterological ul-

trasound unsupervised

Level 1• It is recommended that at least 5–10 examinations are per-

formed by the trainee (under supervision) per week and that

a minimum of 300 examinations in total are undertaken. Ho-

wever different trainees will acquire the necessary skills at

different rates and the end point of the training programme

should be judged by an assessment of competencies


cal conditions listed below


should be kept





• Trainees should attend an appropriate theoretical course and

should read appropriate textbooks and literature

• It is recommended that a medical practitioner performing le-

vel 1 ultrasound should continue to perform at least 300 exa-

minations each year on a regular basis and attend regular ul-

trasound meetings



area(s) the trainee can practice independently

Knowledge Base

Physics and Technology, Ultrasound Techniques and Adminis-tration: see Appendix 2

Sectional and Ultrasonic Anatomy • Liver

• Gallbladder

• Bile ducts

• Pancreas

• Spleen

• Kidneys, Bladder and Adrenal Glands

• Other structures (uterus, ovaries, lymph nodes, vessels, hol-

low digestive tube)

Pathology in relation to ultrasound• Liver: Cysts, benign and malignant tumours, metastatic di-

sease, fatty change, cirrhosis.

• Biliary system: Gallbladder stones, acute and chronic chole-

cystitis, gallbladder tumours, bile duct obstruction including

level of obstruction, intra hepatic duct gas and stones.

• Pancreas: Pancreatitis (acute and chronic), duct stones, duct

dilatation, pancreatic tumours.

• Portal venous system and spleen: Splenic enlargement, por-

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

ted fluid collections

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

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• Kidneys: Size, hydronephrosis and masses

• Other structures: Gastrointestinal masses and masses of gy-

naecological origin including cysts, tumours, fibroids and un-

expected pregnancy.

Competencies to be acquired

LiverTo be able to: • 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 requi-

ring further investigation.

• Recognize normal hepatic and portal venous anatomy within

the liver.

• Perform ultrasound controlled biopsy for the evaluation of

parenchymal liver disease.

Biliary SystemTo be able to:• Perform a thorough evaluation of the biliary system

• Recognize normal ultrasonic anatomy of the biliary system

and its frequent normal variants.

• Recognize abnormalities of the gallbladder wall

• Recognize gallbladder stones

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

tra hepatic levels

PancreasTo 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 chro-

nic)

• Recognize pancreatic duct dilatation and pancreatic duct

stones

Portal Venous System and SpleenTo 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

BowelTo be able to:• Recognize normal stomach, small and large bowel

• Recognize focal intestinal abnormalities and understand the

principles of further investigation.

• Recognize intestinal obstruction.

OtherTo be able to:• Recognize abdominal aortic aneurysm

• Recognize hydronephrosis and other renal abnormalities

• Recognize free and loculated fluid collections

• Recognize lymphadenopathy

• Recognize gynaecological and other pelvic abnormalities

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 procedu-

res listed below.

• Supervision of training should be undertaken by someone

who has achieved level 2 competence in gastrointestinal ul-

trasound and has had at least 2 years experience at that level.

• The trainee should be competent to accept referrals from le-

vel 1 practitioners

Knowledge Base

Sectional and Ultrasonic Anatomy:• Detailed understanding of gastrointestinal, mesenteric, peri-

toneal, omental, vascular and retroperitoneal anatomy.

Pathology in relationship to Ultrasound:• An understanding of disease processes which affect the peri-

toneal cavity, its mesenteries, ligaments and compartments.

• An understanding of the pathways of spread of intraperitone-

al 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 di-

sease.

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89

• Be able to evaluate the large bowel for the presence of diver-

ticular disease and its complications, tumours and obstruc-

tion.

• Be able to evaluate the peritoneal cavity, its mesenteries,

compartments and the omentum for the presence of infecti-

ve or malignant disease.

• Be able to undertake ultrasound guided drainage of peritone-

al 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

lesions.

• Be able to undertake endoscopic ultrasound

• Be able to undertake an ultrasound contrast examination of

the liver

• Be able to undertake some percutaneous ultrasound guided

therapeutic procedures such as radiofrequency ablation

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

wave tumour ablation.


undertaking gastrointestinal ultrasound or teaching, research

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

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

need for continued professional development (CPD) and mainte-

nance of practical skills.

Practitioners should:-

• include ultrasound in their ongoing continued medical edu-

cation (CME)




Appendix 6

Nephro-Urological Ultrasound

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 ne-

phro-urological scans unsupervised

Level 1 • Practical training should involve at least one ultrasound cli-

nic per week over a period of 3–6 months, with approxima-

tely 5–10 examinations performed by the trainee (under su-

pervision) per clinic session.

• A minimum of 250 examinations should be undertaken. Ho-

wever, different trainees will acquire the necessary skills at

different rates, and the end point of the training programme

should be judged by an assessment of competencies.


cal conditions listed below.


should be kept.

• Training should usually be supervised by a practitioner who

has obtained at least level 2 competence in nephro-urologi-

cal ultrasound. In certain circumstances it may be appropria-

te to delegate some of this supervision to an experienced le-

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

• Trainees should attend an appropriate theoretical course and

should read appropriate textbooks and literature.



area or areas the trainee can practise independently.

Level 1 Knowledge Base• Physics and technology, ultrasound techniques and adminis-

tration (see Appendix 2)

• Sectional and ultrasonic anatomy

– kidneys

– ureters

– other retro-peritoneal structures (adrenals, aorta,

i.v.c.)

– bladder

– seminal vesicles

– prostate

– scrotal contents

– other pelvic structures (uterus, ovaries, lymph nodes,

vessels, bowel)

• Pathology in relation to ultrasound

– kidneys: congenital anomalies, cysts, tumours (beni-

gn and malignant), stones, collecting system dilatati-

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

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on, renal and peri-renal abscesses, trauma, diffuse re-

nal diseases, acute and chronic renal failure

– ureters: dilatation, obstruction

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

volume estimation

– prostate: zonal anatomy, infection, hyperplasia, tu-

mours

– scrotal contents: testicular tumours, cysts, torsion,

hydrocele, inflammatory problems, trauma

Level 1 Competencies to be Acquired• Kidneys

To be able to:

– perform a thorough ultrasound examination of the

kidneys in different planes

– recognise normal renal ultrasonic anatomy and com-

mon normal variants

– measure renal length and assess variation from nor-

mality

– recognise and assess the degree of collecting system

dilatation

– recognise and diagnose simple cysts

– recognise complex cysts and refer for appropriate

further investigation

– recognise renal tumours and refer for appropriate


– recognise diffuse renal medical diseases associated

with renal dysfunction

– recognise and diagnose renal stones

– recognise peri-renal abnormalities and refer for ap-

propriate further investigation

– recognise abnormalities which need referral for scan-

ning by a more experienced ultrasonologist and/or


• Bladder

To be able to:


bladder in different planes

– recognise normal ultrasonic anatomy of the bladder

and common normal variants

– measure bladder volume

– 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:


scrotal contents in different planes

– recognise normal ultrasonic anatomy of the testes

and epididymi and common normal variants

– recognise and diagnose epididymal cysts

– recognise and diagnose varicoceles

– use doppler to help differentiate torsion/inflammato-

ry problems

– recognise and assess intra-scrotal and intra-testicular

calcifications

– recognise and assess testicular tumours

– recognise inflammatory changes in testes and epidi-

dymes



investigation

• Prostate (for Urologists)

To be able to:

– recognise normal ultrasonic anatomy and common

normal variants

– perform trans-rectal ultrasound

– measure prostatic volume

– identify abnormal focal lesions

– perform a standardised technique of trans-rectal pro-

static biopsy (optional depending on clinical

practice/national guidelines)



investigation

• 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

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– 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 procedu-

res referred to below.

• A log book listing all examinations undertaken should be

kept.


who has achieved at least Level 2 competence in urological

ultrasound and has had at least 2 years experience at that Le-

vel.

• A Level 2 practitioner will be able to accept referrals from Le-

vel 1 practitioners.

Level 2 Knowledge Base• Physics and technology

– in-depth knowledge and understanding of the physics

of ultrasound

– in-depth knowledge and understanding of the tech-

nology of ultrasound equipment

• Ultrasound techniques

– the advanced use of Doppler ultrasound, including

spectral, colour and power Doppler

– the use of ultrasound for guiding interventional pro-

cedures

– further applications of trans-abdominal ultrasound

– further application of endo-cavity ultrasound (e.g.,

trans-vaginal ultrasound

– 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).

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:

– recognise all pathology affecting the urinary tract and

provide an accurate diagnosis in almost all cases

– recognise abnormalities which are outside his/her ex-

perience and refer on appropriately to a more experi-

enced ultrasound professional

– perform ultrasound-guided invasive procedures, in-

cluding cyst aspiration, abscess drainage, renal bio-

psy, percutaneous nephrostomy, supra-pubic bladder

catheter insertion and trans rectal prostate biopsy

– perform Doppler ultrasound studies relevant to the

urinary tract

– recognise abnormalities elsewhere in the abdomen

and pelvis which need referral for scanning by ano-

ther ultrasonologist and/or further investigation

Level 3 Training and Practice• A Level 3 practitioner is likely to spend the majority of their

time undertaking nephro-urological ultrasound, teaching, re-

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

• He/she will have spent a continuous period of specialist trai-

ning 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 pos-

sible malignancy) as well as performing advanced 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 (CME) and continued

professional development (CPD) and maintenance of practi-

cal 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-

trasound skills, and at least 100 examinations should be per-

formed 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




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Breast Ultrasound

Level 1• Trainees should initially attend an appropriate theoretical

course to acquire the core knowledge base as itemised in Ap-

pendix 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-

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

and no more than 1 year.

• A minimum of 100 examinations should be undertaken and a

record of these kept. However different trainees will acquire

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

training programme should be judged by an assessment of

competencies.

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

details of the indications for the procedure, the interpretati-

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

correlation with clinical examination and other imaging fin-

dings and needle biopsy results and surgical histology where

appropriate.

• 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 impal-

pable 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 Oc-

cupational Standards. The practical experience should ideally

be undertaken in conjunction with attendance on a recognis-

ed postgraduate course, such as that provided by some uni-

versities and trainees should read appropriate textbooks and

literature

Knowledge Base

Physics and Technology, Ultrasound Techniques and Adminis-tration:-

see Appendix 2.

Sectional and Ultrasound Anatomy• Normal Anatomy of female and male breast.

• Anatomical, physiological and developmental anomalies as-

sociated with the breast.

• The changes in ultrasound appearances associated with age,

pregnancy and lactation, hormonal status, medication.

Pathology in relation to ultrasound• Benign conditions including cysts, fibroadenomas, fibroade-

no-lipomas, lipomas, haematomas, fat necrosis, hamartomas.

• Indeterminate abnormalities including duct papillomas, radi-

al scar.

• Malignancy including ductal, lobular, inflammatory and

other carcinomas.

• Normal and abnormal appearances of axillary lymph nodes.

• Inflammatory breast conditions including infection and ab-

scess formation.

• Iatrogenic appearances including breast implants, early and

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

therapy changes, fat necrosis, scarring.

Competencies to be acquiredTo be able to:• Perform a thorough ultrasound examination of the breast

and axilla

• To recognise normal anatomy

• Understand the indications for and the importance of ultra-

sound in the triple assessment process.

• Understand the strengths, weaknesses and limitations of bre-

ast ultrasound.

• Be aware of the interdependency and significance of mam-

mographic and ultrasound appearances.

• Be competent in recognising the criteria for lesion characteri-

sation

• Confidently exclude the presence of a sonographic lesion

within the breast.

• Write a detailed report of the ultrasound findings with gra-

ding, differential diagnosis, conclusion and recommendation

for further management.

• Understand the principle of Doppler ultrasound and its rele-

vance to breast imaging.

• Recognise personal limitations and ask for more expert ad-

vice if required

Level 2Interventional Techniques• After reaching competency at Level 1 practitioners may pro-

gress to Level 2. This should involve a minimum of 1 scan-

ning 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.

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• Training for interventional techniques should include obser-

vation initially followed by performance of the examination

and/or procedure under close supervision. When compe-

tence has been acquired then procedures may be undertaken

alone but with support close to hand

• A logbook of diagnostic and interventional procedures per-

formed 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

• Aspirate cysts of less than 1cm diameter

• Guided fine needle aspiration biopsy (FNAB): Perform a mini-

mum of 10* FNABs of solid lesions, with pathological correla-

tion of cytology result and final pathology (if available)

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

the uses and limitations of the technique

• Guided core biopsies: Perform a minimum of 10* guided core

biopsies with pathological correlation of core biopsy histolo-

gy and final pathology (if available)

• Perform guided abscess aspiration and drainage

• Perform pre-operative guided localisations using skin mar-

king and wire insertion techniques

• Perform guided marker or coil insertion prior to neo-adju-

vant chemotherapy

• Ability to accept referrals from level 1 practitioners

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

vidual breast units

Level 3Competencies to be Acquired• To be able to accept referrals from level 1 and level 2 practiti-

oners 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.

• To conduct research

• To teach breast ultrasound at all levels

• To be aware of and pursue developments in breast ultra-

sound including Doppler and the use of intravascular cont-

rast agents

Maintainance of Skills In order to maintain competence the practitioner should perform

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

minations per year.

There should be continuing professional updating with atten-

dance at multidisciplinary breast meetings and relevant and ap-

propriate courses with a component relating to breast ultrasound

scanning together with regular reviews of the current literature.

Regular audit of the individual’s ultrasound practice should be

undertaken.

Appendix 8

Vascular Ultrasound

Level 1 Training and Practice

• Practical training should involve at least two half day ultra-

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

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

tions performed by the trainee under supervision per clinic.

• A minimum of 100 imaging examinations of each type (eg ca-

rotid, lower limb venous etc) should be undertaken if this is

the first practical training module undertaken.


cal conditions listed below.


should be kept.

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

ner in vascular ultrasound. In certain circumstances it may be

appropriate to delegate some of this supervision to an expe-

rienced level 1 practitioner with at least two years of regular

practical experience. This will usually mean that training is

carried out in dedicated vascular duplex sessions supervised

by an accredited vascular physician/scientist/technologist,

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.



area or areas the trainee can practise independently.

Level 1 Knowledge Base• Physics and technology, ultrasound techniques and administ-

ration (see Appendix 2).

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

instrumentation and practical working knowledge of real-ti-

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

cludes colour flow and power Doppler, colour and pulsed

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

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

city measurement, spectral changes and all other parameters

required to perform a complete diagnostic vascular duplex

study.

• Sectional and ultrasonic anatomy including common normal

variants

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

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– peripheral extremity arteries

– peripheral extremity veins

– abdominal aorta

– extracranial vessels

• Pathology and results of treatment in relation to ultrasound

– peripheral extremity arteries: patency, stenosis, oc-

clusion, aneurysmal dilatation

– peripheral extremity veins: patency, occlusion, deep

venous thrombosis, reflux and incompetence

– abdominal vessels: patency, occlusion, aneurysmal

dilatation of aorta

– extracranial vessels: patency, occlusion, stenosis

– appearances and sequelae of common surgical or per-

cutaneous interventions including angioplasty,

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

ointimal hyperplasia

Level 1 Competencies to be Acquired• To be able to perform continuous wave hand-held Doppler

and segmental pressures (ABPI)

• 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 ex-

tent of abnormality

– diagnose > 50% stenosis

– recognise common surgical interventions, arterio-ve-

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:

– identify the saphenofemoral and saphenopopliteal

junctions

– recognise and locate clinically relevant venous reflux,

incompetence and perforators

– perform vein mapping and marking

• Abdominal vessels

To be able to:

– recognise and locate patency and occlusion of the ab-

dominal aorta

– recognise and size aneurysmal dilatation of the abdo-

minal aorta

• Extracranial vessels

To be able to:

– recognise and locate patency, occlusion, plaque and

stenoses in the carotid vessels

Level 2 Training and Practice• Practical training should include at least one year of experi-

ence at Level 1 with continuous ongoing weekly ultrasound

clinics.

• A log book of all examinations undertaken should be kept.


who has achieved at least Level 2 competence in vascular ul-

trasound and has had at least 2 years’ experience at that le-

vel.

Level 2 Knowledge Base• Peripheral arteries and grafts

• Peripheral deep and superficial veins

• Abdominal Aorta branches

• Transcranial Doppler ultrasound:

– ultrasonic anatomy, common normal variants and

principles and practice of the technique

– clinical indications and ultrasonic findings in common

clinically relevant abnormalities

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-

per and lower extremities, from common iliac to pe-

dal vessels and subclavian to radial and ulnar arteries

and veins

• Extracranial vessels

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 dila-

tation, patency, stenosis and occlusion of the major

abdominal and iliac vessels, including the mesenteric

and renal vessels

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Level 3 Training and Practice• 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 prac-

titioners.

• He/she should have the capability to utilise developing tech-

nologies and ultrasound techniques, develop research and

teaching skills and the performance of specialised examinati-

ons 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 du-

ring 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 trai-

ning 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 medi-

cal education (CME) and continued professional deve-

lopment(CPD)

– audit their practice

– participate in multidisciplinary meetings

– keep up to date with relevant literature

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__

__

__

__

__

__

__

__

• F

eta

l he

art

acti

vity

in e

mb

ryo

> 1

0m

ms

CR

L_

__

__

__

__

__

__

__

__

__

__

_

• P

hys

iolo

gic

al c

han

ge

s in

ute

rus

& o

vari

es

du

rin

g m

en

stru

al c

ycle

__

__

__

__

__

__

__

__

__

__

__

• U

ltra

sou

nd

in m

an

age

me

nt

of

mis

carr

iag

e &

tu

bal

pre

gn

ancy

__

__

__

__

__

__

__

__

__

__

__

• L

oca

lize

po

siti

on

of

an in

trau

teri

ne

co

ntr

ace

pti

ve d

evi

ce_

__

__

__

__

__

__

__

__

__

__

_

• D

iscr

imin

ate

be

twe

en

no

rmal

an

d a

bn

orm

al a

pp

ear

ance

s o

f p

elv

ic

org

ans

in n

on

-pre

gn

ant

wo

ma

n_

__

__

__

__

__

__

__

__

__

__

_•

Lo

gb

oo

k o

f 3

00

co

mp

lete

d c

ase

s_

__

__

__

__

__

__

__

__

__

__

_

• Il

lust

rate

d lo

gb

oo

k o

f 2

0 c

om

ple

ted

ca

ses

__

__

__

__

__

__

__

__

__

__

__

• P

ass

ed

th

eo

reti

cal e

xa

min

ati

on

__

__

__

__

__

__

__

__

__

__

__

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 2

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc.:

Kn

ow

led

ge

on

:

• D

iscr

imin

ate

be

twe

en

fib

roid

s &

ad

en

om

yosi

s_

__

__

__

__

__

__

__

__

__

__

_•

Oo

cyte

co

llect

ion

by

TV

ult

raso

un

d g

uid

ed

fo

llicu

lar

asp

irat

ion

__

__

__

__

__

__

__

__

__

__

__

• F

eat

ure

s o

f e

nd

om

etr

ial c

ance

r_

__

__

__

__

__

__

__

__

__

__

_•

Ch

ang

es

in c

hild

ren

wit

h p

reco

cio

us

pu

be

rty,

me

na

rch

e, t

he

larc

he,

adre

nar

che

& v

irili

sati

on

__

__

__

__

__

__

__

__

__

__

__

• S

alin

e in

fusi

on

so

no

gra

ph

y_

__

__

__

__

__

__

__

__

__

__

_•

Ab

no

rmal

itie

s in

pri

mar

y &

se

con

dar

y am

en

orr

ho

ea

__

__

__

__

__

__

__

__

__

__

__

• U

ltra

sou

nd

in b

lee

din

g d

istu

rban

ces

be

fore

me

no

pau

se_

__

__

__

__

__

__

__

__

__

__

_•

Ult

raso

un

d s

cre

en

ing

fo

r ca

nce

r_

__

__

__

__

__

__

__

__

__

__

_

• D

iscr

imin

ate

be

twe

en

be

nig

n &

ma

lign

ant

adn

exa

l mas

ses

__

__

__

__

__

__

__

__

__

__

__

• D

iscr

imin

ate

be

twe

en

en

do

me

trio

ma,

de

rmo

id c

ysts

, pe

rito

ne

al in

clu

sio

n

cyst

s, h

ydro

salp

inx,

par

a-o

vari

an c

ysts

an

d b

en

ign

so

lid a

dn

exa

l mas

ses

__

__

__

__

__

__

__

__

__

__

__

• R

eco

gn

ise

pe

lvic

infl

amm

ato

ry d

ise

ase

__

__

__

__

__

__

__

__

__

__

__

• L

og

bo

ok

of

20

00

co

mp

lete

d c

ase

s_

__

__

__

__

__

__

__

__

__

__

_

• E

cto

pic

pre

gn

ancy

an

d p

lan

tre

atm

en

t_

__

__

__

__

__

__

__

__

__

__

_•

Pa

sse

d t

he

ore

tica

l ex

am

ina

tio

n_

__

__

__

__

__

__

__

__

__

__

_

• T

ors

ion

of

no

rmal

ad

ne

xae

& a

dn

exa

l mas

ses

__

__

__

__

__

__

__

__

__

__

__

• P

ost

me

no

pau

sal b

lee

din

g a

sse

ssm

en

t_

__

__

__

__

__

__

__

__

__

__

_

• In

fert

ility

wo

rku

p —

no

t o

blig

ato

ry_

__

__

__

__

__

__

__

__

__

__

_

• T

ub

al p

ate

ncy

usi

ng

HyC

oS

y —

no

t o

blig

ato

ry_

__

__

__

__

__

__

__

__

__

__

_

• A

spir

ate

/dra

in p

elv

ic c

ysts

an

d f

luid

co

llect

ion

s (T

A &

TV

)_

__

__

__

__

__

__

__

__

__

__

_

EFSUM

B N

ewsletter


97

AP

PE

ND

IX 4

: OB

ST

ET

RIC

ULT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 1

A f

orm

al t

he

ore

tica

l an

d p

ract

ica

l ex

am

ina

tio

n s

ho

uld

ta

ke

pla

ce a

t th

e e

nd

of

tra

inin

g

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 1

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc t

he

fo

llo

win

g:

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

• S

yste

mat

ic e

xam

inat

ion

of

pre

gn

an

t u

teru

s, p

lace

nta

am

nio

tic

flu

id &

fetu

s_

__

__

__

__

__

__

__

__

__

_

• N

eck

__

__

__

__

__

__

__

__

__

__

• O

bta

in o

pti

mal

imag

es

in a

co

rre

ct o

rie

nta

tio

n_

__

__

__

__

__

__

__

__

__

_•

Th

ora

x_

__

__

__

__

__

__

__

__

__

_

• O

bta

in a

ccu

rate

me

asu

rem

en

ts o

f b

ipar

ieta

l dia

me

ter,

fem

ur

len

gth

,

abd

om

inal

dia

me

ter

& c

ircu

mfe

ren

ce_

__

__

__

__

__

__

__

__

__

_

• F

ou

r ch

amb

er

vie

w o

f h

ear

t/o

utf

low

tra

cts

__

__

__

__

__

__

__

__

__

__

Dis

crim

inat

e n

orm

al f

rom

ab

no

rmal

in:

• S

tom

ach

__

__

__

__

__

__

__

__

__

__

• S

ku

ll/B

rain

__

__

__

__

__

__

__

__

__

__

• U

mb

ilica

l Co

rd in

sert

ion

__

__

__

__

__

__

__

__

__

__

• M

idlin

e e

cho

in b

rain

__

__

__

__

__

__

__

__

__

__

• K

idn

eys

__

__

__

__

__

__

__

__

__

__

• C

avu

m s

ep

tum

pe

lluci

du

m_

__

__

__

__

__

__

__

__

__

_•

Bla

dd

er

__

__

__

__

__

__

__

__

__

__

• C

iste

rna

Mag

na

__

__

__

__

__

__

__

__

__

__

• S

pin

e in

th

ree

pla

ne

s (c

oro

nal

, tra

nsv

ers

e &

sag

itta

l)_

__

__

__

__

__

__

__

__

__

_

• C

ere

be

llum

__

__

__

__

__

__

__

__

__

__

• A

rms,

leg

s, h

and

s &

fe

et

__

__

__

__

__

__

__

__

__

__

• C

ere

bra

l Ve

ntr

icle

s_

__

__

__

__

__

__

__

__

__

_•

Ab

ility

to

co

mm

un

icat

e f

ind

ing

s to

pre

gn

ant

wo

man

__

__

__

__

__

__

__

__

__

__

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 2

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

• D

iag

no

se c

om

mo

n f

eta

l ma

lfo

rmat

ion

s_

__

__

__

__

__

__

__

__

__

_

• D

iag

no

se in

trau

teri

ne

gro

wth

re

stri

ctio

n_

__

__

__

__

__

__

__

__

__

_

• D

iag

no

se c

om

plic

atio

ns

in t

win

pre

gn

anci

es

__

__

__

__

__

__

__

__

__

__

• L

og

bo

ok

of

80

0 c

om

ple

ted

ca

ses

__

__

__

__

__

__

__

__

__

__

• Il

lust

rate

d lo

gb

oo

k o

f 1

0 c

ase

s in

clu

din

g c

lin

ica

l in

form

ati

on

&

com

ple

ted

lite

ratu

re s

ea

rch

__

__

__

__

__

__

__

__

__

__

• P

ass

ed

th

eo

reti

cal e

xa

min

ati

on

__

__

__

__

__

__

__

__

__

__

EFSUM

B N

ewsletter


98

AP

PE

ND

IX 5

: G

AS

TR

OE

NT

ER

OL

OG

ICA

L U

LT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 1

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc. t

he

fo

llo

win

g:

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc. t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

LIV

ER

AN

D B

ILIA

RY

SY

ST

EM

PO

RTA

L V

EN

OU

S S

YS

TE

M/S

PLE

EN

• N

orm

al li

ver

seg

me

nta

l an

ato

my

__

__

__

__

__

__

__

__

__

__

• N

orm

al p

ort

al v

ein

__

__

__

__

__

__

__

__

__

__

• C

om

mo

n v

ari

ants

of

anat

om

y_

__

__

__

__

__

__

__

__

__

_•

Dila

ted

po

rtal

ve

in_

__

__

__

__

__

__

__

__

__

_

• A

tro

ph

y an

d h

ype

rtro

ph

y o

f lo

be

s an

d s

eg

me

nts

__

__

__

__

__

__

__

__

__

__

• V

aric

es

__

__

__

__

__

__

__

__

__

__

• A

bn

orm

al t

ext

ure

__

__

__

__

__

__

__

__

__

__

• T

hro

mb

osi

s_

__

__

__

__

__

__

__

__

__

_

• F

atty

live

r_

__

__

__

__

__

__

__

__

__

_•

Cav

ern

ou

s tr

ansf

orm

atio

n_

__

__

__

__

__

__

__

__

__

_

• C

irrh

osi

s_

__

__

__

__

__

__

__

__

__

_•

No

rmal

sp

lee

n_

__

__

__

__

__

__

__

__

__

_

• F

oca

l le

sio

ns

__

__

__

__

__

__

__

__

__

__

• S

ple

no

me

gal

y_

__

__

__

__

__

__

__

__

__

_

• C

ysts

, Hae

man

gio

ma,

Me

tast

ase

s_

__

__

__

__

__

__

__

__

__

_•

Fo

cal s

ple

nic

lesi

on

s_

__

__

__

__

__

__

__

__

__

_

• H

ep

atic

Ve

ins,

dila

tati

on

, th

rom

bo

sis

__

__

__

__

__

__

__

__

__

__

• S

ple

nic

tra

um

a_

__

__

__

__

__

__

__

__

__

_

• N

orm

al g

all

bla

dd

er

__

__

__

__

__

__

__

__

__

__

• In

tra

and

ext

ra-h

ep

atic

du

cts

and

va

rian

ts_

__

__

__

__

__

__

__

__

__

_O

TH

ER

ST

RU

CT

UR

ES

etc

• D

uct

dila

tati

on

__

__

__

__

__

__

__

__

__

__

• N

orm

al k

idn

eys

__

__

__

__

__

__

__

__

__

__

• L

eve

l of

ob

stru

ctio

n_

__

__

__

__

__

__

__

__

__

_•

Ute

rus

__

__

__

__

__

__

__

__

__

__

• G

all

bla

dd

er

sto

ne

s_

__

__

__

__

__

__

__

__

__

_•

Ova

rie

s_

__

__

__

__

__

__

__

__

__

_

• C

hro

nic

Ch

ole

cyst

itis

__

__

__

__

__

__

__

__

__

__

• A

ort

a_

__

__

__

__

__

__

__

__

__

_

• A

cute

Ch

ole

cyst

itis

__

__

__

__

__

__

__

__

__

__

• H

ydro

ne

ph

rosi

s_

__

__

__

__

__

__

__

__

__

_

• C

om

plic

atio

ns

of

Acu

te C

ho

lecy

stit

is_

__

__

__

__

__

__

__

__

__

_•

Re

na

l cys

ts_

__

__

__

__

__

__

__

__

__

_

• B

en

ign

infl

amm

ato

ry c

on

dit

ion

s o

f g

all b

lad

de

r an

d g

all b

lad

de

r tu

mo

urs

__

__

__

__

__

__

__

__

__

__

• S

olid

re

nal

mas

s_

__

__

__

__

__

__

__

__

__

_

• U

nd

ert

ake

bio

psy

of

par

en

chym

al li

ver

dis

eas

e_

__

__

__

__

__

__

__

__

__

_•

Ute

rin

e f

ibro

ids

__

__

__

__

__

__

__

__

__

__

• P

reg

nan

cy_

__

__

__

__

__

__

__

__

__

_

PA

NC

RE

AS

• O

vari

an

cys

ts a

nd

mas

ses

__

__

__

__

__

__

__

__

__

__

• N

orm

al p

ancr

eat

ic a

nat

om

y_

__

__

__

__

__

__

__

__

__

_•

Ao

rtic

an

eu

rysm

__

__

__

__

__

__

__

__

__

__

• D

uct

dila

tati

on

__

__

__

__

__

__

__

__

__

__

• D

uct

sto

ne

s_

__

__

__

__

__

__

__

__

__

_

• P

ancr

eat

ic t

um

ou

rs_

__

__

__

__

__

__

__

__

__

_

• P

ancr

eat

itis

__

__

__

__

__

__

__

__

__

__

EFSUM

B N

ewsletter


99

AP

PE

ND

IX 5

: G

AS

TR

OE

NT

ER

OL

OG

ICA

L U

LT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

mp

ete

nci

es/

Sk

ills

to

be

acq

uir

ed

Le

ve

l 2

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc. t

he

fo

llo

win

g:

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se e

tc. t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

HO

LLO

W D

IGE

ST

IVE

TU

BE

PE

RIT

ON

EA

L C

AV

ITY

, ME

SE

NT

ER

Y &

OM

EN

TU

M

• N

orm

al s

tom

ach

, sm

all a

nd

larg

e b

ow

el

__

__

__

__

__

__

__

__

__

__

• P

eri

ton

eal

flu

id c

olle

ctio

ns

__

__

__

__

__

__

__

__

__

__

• D

ive

rtic

ula

r d

ise

ase

an

d a

bsc

ess

__

__

__

__

__

__

__

__

__

__

• M

ese

nte

ric

mas

ses

__

__

__

__

__

__

__

__

__

__

• C

olo

nic

Tu

mo

urs

__

__

__

__

__

__

__

__

__

__

• O

me

nta

l Dis

eas

e_

__

__

__

__

__

__

__

__

__

_

• S

mal

l bo

we

l ob

stru

ctio

n_

__

__

__

__

__

__

__

__

__

_

• In

flam

mat

ory

bo

we

l dis

eas

e_

__

__

__

__

__

__

__

__

__

_O

TH

ER

• In

flam

mat

ory

mas

ses

__

__

__

__

__

__

__

__

__

__

• U

nd

ert

ake

dra

inag

e o

f fl

uid

co

llect

ion

s/ab

sce

sse

s_

__

__

__

__

__

__

__

__

__

_

• S

pe

ctra

l an

d c

olo

ur

flo

w D

op

ple

r o

f p

ort

al a

nd

he

pat

ic v

en

ou

s sy

ste

m_

__

__

__

__

__

__

__

__

__

_

• U

nd

ert

ake

bio

psy

of

foca

l le

sio

ns

__

__

__

__

__

__

__

__

__

__

• U

nd

ert

ake

en

do

sco

pic

ult

raso

un

d_

__

__

__

__

__

__

__

__

__

_

• U

nd

ert

ake

ult

raso

un

d c

on

tras

t e

xam

inat

ion

s_

__

__

__

__

__

__

__

__

__

_

• U

nd

ert

ake

RFA

__

__

__

__

__

__

__

__

__

__

• U

nd

ert

ake

PEI

__

__

__

__

__

__

__

__

__

__

• U

nd

ert

ake

lase

r ab

lati

on

of

tum

ou

rs_

__

__

__

__

__

__

__

__

__

_

• U

nd

ert

ake

mic

row

ave

ab

lati

on

of

tum

ou

rs_

__

__

__

__

__

__

__

__

__

_

EFSUM

B N

ewsletter


100

AP

PE

ND

IX 6

: NE

PH

RO

-UR

OLO

GIC

AL

ULT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

re k

no

wle

dg

e b

ase

- L

ev

el 1

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

• P

hys

ics

an

d t

ech

no

log

y_

__

__

__

__

__

__

__

__

__

_•

Ad

min

istr

atio

n_

__

__

__

__

__

__

__

__

__

_

• P

ract

ical

inst

rum

en

tati

on

/use

of

ult

raso

un

d c

on

tro

ls_

__

__

__

__

__

__

__

__

__

_•

Se

ctio

nal

an

d u

ltra

son

ic a

nat

om

y_

__

__

__

__

__

__

__

__

__

_

• U

ltra

sou

nd

te

chn

iqu

es

__

__

__

__

__

__

__

__

__

__

• P

ath

olo

gy

in r

ela

tio

n t

o u

ltra

sou

nd

Co

mp

ete

nci

es/

skil

ls t

o b

e a

cqu

ire

d L

ev

el 1

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

Kid

ne

ys

Scr

otu

m (

for

Uro

log

ists

)

• u

ltra

sou

nd

exa

min

atio

n in

dif

fere

nt

pla

ne

s_

__

__

__

__

__

__

__

__

__

_•

ult

raso

un

d e

xam

inat

ion

in d

iffe

ren

t p

lan

es

• u

ltra

son

ic a

nat

om

y an

d c

om

mo

n n

orm

al v

aria

nts

__

__

__

__

__

__

__

__

__

__

• u

ltra

son

ic a

nat

om

y an

d c

om

mo

n n

orm

al v

aria

nts

• r

en

al le

ng

th a

nd

var

iati

on

fro

m n

orm

alit

y_

__

__

__

__

__

__

__

__

__

_•

ep

idid

ymal

cys

ts

• c

olle

ctin

g s

yste

m d

ilata

tio

n_

__

__

__

__

__

__

__

__

__

_•

var

ico

coe

les

• s

imp

le c

ysts

__

__

__

__

__

__

__

__

__

__

• in

tra

-scr

ota

l an

d in

tra

-te

stic

ula

r ca

lcif

icat

ion

s

• c

om

ple

x cy

sts

__

__

__

__

__

__

__

__

__

__

• t

um

ou

rs

• t

um

ou

rs_

__

__

__

__

__

__

__

__

__

_•

infl

amm

ato

ry c

han

ge

s in

te

ste

s an

d e

pid

idym

ide

s

• s

ton

es

__

__

__

__

__

__

__

__

__

__

• u

se D

op

ple

r to

he

lp d

iffe

ren

tiat

e t

ors

ion

/in

flam

mat

ory

pro

ble

ms

• r

en

al p

are

nch

ymal

dis

eas

e_

__

__

__

__

__

__

__

__

__

_

• r

en

o-v

ascu

lar

hyp

ert

en

sio

n_

__

__

__

__

__

__

__

__

__

_General

• p

eri

-re

nal

ab

no

rmal

itie

s_

__

__

__

__

__

__

__

__

__

_•

Use

ult

raso

un

d in

th

e a

sse

ssm

en

t o

f p

atie

nts

pre

sen

tin

g w

ith

:

• h

aem

atu

ria

Bladder

• lo

in p

ain

/re

nal

co

lic

• u

ltra

sou

nd

exa

min

atio

n in

dif

fere

nt

pla

ne

s_

__

__

__

__

__

__

__

__

__

_•

loin

mas

s

• u

ltra

son

ic a

nat

om

y an

d c

om

mo

n n

orm

al v

aria

nts

__

__

__

__

__

__

__

__

__

__

• r

en

al f

ailu

re

• b

lad

de

r vo

lum

e_

__

__

__

__

__

__

__

__

__

_•

low

er

uri

nar

y tr

act

sym

pto

ms

• d

ive

rtic

ula

__

__

__

__

__

__

__

__

__

__

• r

ecu

rre

nt

uri

nar

y tr

act

infe

ctio

n

• t

um

ou

rs_

__

__

__

__

__

__

__

__

__

_•

su

pra

-pu

bic

mas

• c

alc

uli

__

__

__

__

__

__

__

__

__

__

• p

alp

able

scr

ota

l mas

ses

• u

se c

olo

ur

Do

pp

ler

to a

sse

ss u

rete

ric

jets

__

__

__

__

__

__

__

__

__

__

• s

cro

tal p

ain

Prostate

(fo

r U

rolo

gis

ts)

• n

orm

al a

ort

a an

d a

ort

ic a

ne

ury

sm

• u

ltra

son

ic a

nat

om

y an

d c

om

mo

n n

orm

al v

aria

nts

__

__

__

__

__

__

__

__

__

__

• n

orm

al li

ver

and

live

r m

asse

s

• t

ran

s-re

ctal

ult

raso

un

d_

__

__

__

__

__

__

__

__

__

_•

no

rmal

ute

rus

and

ova

rie

s an

d g

yna

eco

log

ical

mas

ses

• p

rost

atic

vo

lum

e_

__

__

__

__

__

__

__

__

__

_

• a

bn

orm

al fo

cal l

esi

on

__

__

__

__

__

__

__

__

__

__

• k

no

w w

he

n t

o r

efe

r to

a m

ore

exp

ert

ult

raso

no

log

ist

• t

ran

s-re

ctal

pro

stat

ic b

iop

sy (

op

tio

nal

/de

pe

nd

ing

on

nat

ion

al g

uid

elin

es)

__

__

__

__

__

__

__

__

__

__

EFSUM

B N

ewsletter


101

AP

PE

ND

IX 6

: NE

PH

RO

-UR

OLO

GIC

AL

ULT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

mp

ete

nci

es/

skil

ls t

o b

e a

cqu

ire

d L

ev

el 2

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Re

cog

nis

e a

ll u

rin

ary

trac

t p

ath

olo

gy

__

__

__

__

__

__

__

__

__

__

Pe

rfo

rm

• c

yst

asp

irat

ion

__

__

__

__

__

__

__

__

__

__

• a

bsc

ess

dra

inag

e_

__

__

__

__

__

__

__

__

__

_

• r

en

al b

iop

sy_

__

__

__

__

__

__

__

__

__

_

• n

ep

hro

sto

my

__

__

__

__

__

__

__

__

__

__

• s

up

rap

ub

ic b

lad

de

r ca

the

ter

inse

rtio

n_

__

__

__

__

__

__

__

__

__

_

• t

ran

s-re

ctal

pro

stat

e b

iop

sy_

__

__

__

__

__

__

__

__

__

_

• p

erf

orm

Do

pp

ler

stu

die

s _

__

__

__

__

__

__

__

__

__

_

• r

eco

gn

ise

ab

no

rmal

itie

s e

lse

wh

ere

in t

he

ab

do

me

n/p

elv

is_

__

__

__

__

__

__

__

__

__

_

EFSUM

B N

ewsletter


102

AP

PE

ND

IX 7

: B

RE

AS

T U

LT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TE

NC

Y A

SS

ES

SM

EN

T S

HE

ET

Trai

ne

eTr

ain

er

Co

re K

no

wle

dg

e B

ase

Le

ve

l 1C

om

pe

ten

cie

s/sk

ills

to

be

acq

uir

ed

:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

• P

hys

ics

and

Inst

rum

en

tati

on

__

__

__

__

__

__

__

__

__

__

• P

erf

orm

a t

ho

rou

gh

ult

raso

un

d e

xam

inat

ion

of

the

bre

ast

and

axi

lla_

__

__

__

__

__

__

__

__

__

_

• U

ltra

sou

nd

te

chn

iqu

es

__

__

__

__

__

__

__

__

__

__

• B

e a

ble

to

re

cog

nis

e n

orm

al a

nat

om

y o

f b

reas

t an

d a

xilla

__

__

__

__

__

__

__

__

__

__

• A

dm

inis

trat

ion

__

__

__

__

__

__

__

__

__

__

• U

nd

ers

tan

d t

he

ind

icat

ion

s fo

r a

nd

th

e im

po

rtan

ce o

f u

ltra

sou

nd

in t

he

tri

ple

ass

ess

me

nt

pro

cess

__

__

__

__

__

__

__

__

__

__

• S

ect

ion

al a

nd

Ult

raso

un

d a

nat

om

y_

__

__

__

__

__

__

__

__

__

_•

Un

de

rsta

nd

th

e s

tre

ng

ths,

we

akn

ess

es

and

lim

itat

ion

s o

f b

reas

t

ult

raso

un

d_

__

__

__

__

__

__

__

__

__

_

• N

orm

al A

nat

om

y o

f fe

mal

e a

nd

mal

e b

reas

t._

__

__

__

__

__

__

__

__

__

_•

Be

aw

are

of

the

inte

rde

pe

nd

en

cy a

nd

sig

nif

ican

ce o

f m

amm

og

rap

hic

and

ult

raso

un

d a

pp

ear

ance

s_

__

__

__

__

__

__

__

__

__

_

• A

nat

om

ical

, ph

ysio

log

ica

l an

d d

eve

lop

me

nta

l an

om

alie

s as

soci

ate

d

wit

h t

he

bre

ast.

__

__

__

__

__

__

__

__

__

__

• B

e c

om

pe

ten

t in

re

cog

nis

ing

th

e c

rite

ria

for

lesi

on

ch

arac

teri

sati

on

._

__

__

__

__

__

__

__

__

__

_

• T

he

ch

ang

es

in u

ltra

sou

nd

ap

pe

aran

ces

asso

ciat

ed

wit

h a

ge,

pre

gn

ancy

an

d la

ctat

ion

, ho

rmo

nal

sta

tus,

me

dic

atio

n_

__

__

__

__

__

__

__

__

__

_

• B

e a

ble

to

co

nfi

de

ntl

y e

xclu

de

th

e p

rese

nce

of

a so

no

gra

ph

ic le

sio

n

wit

hin

th

e b

reas

t_

__

__

__

__

__

__

__

__

__

_

• P

ath

olo

gy

in r

ela

tio

n t

o u

ltra

sou

nd

__

__

__

__

__

__

__

__

__

__

• B

e a

ble

to

wri

te a

de

taile

d r

ep

ort

of

the

ult

raso

un

d f

ind

ing

s w

ith

gra

din

g, d

iffe

ren

tial

dia

gn

osi

s, c

on

clu

sio

n a

nd

re

com

me

nd

atio

n fo

r

furt

he

r m

an

age

me

nt

__

__

__

__

__

__

__

__

__

__

• B

en

ign

bre

ast

con

dit

ion

s in

clu

din

g c

ysts

,f ib

road

en

om

as, f

ibro

ade

no

-

lipo

mas

, lip

om

as, h

ae

mat

om

as, f

at n

ecr

osi

s, h

amar

tom

as_

__

__

__

__

__

__

__

__

__

_

• U

nd

ers

tan

d t

he

pri

nci

ple

of

Do

pp

ler

ult

raso

un

d a

nd

its

rele

van

ce

to b

reas

t im

agin

g_

__

__

__

__

__

__

__

__

__

_

• In

de

term

inat

e a

bn

orm

alit

ies

incl

ud

ing

du

ct p

apill

om

as, r

adia

l sca

r_

__

__

__

__

__

__

__

__

__

_•

Re

cog

nis

e p

ers

on

al li

mit

atio

ns

and

ask

for

mo

re e

xpe

rt a

dvi

ce if

req

uir

ed

__

__

__

__

__

__

__

__

__

__

• B

reas

t m

alig

nan

cy in

clu

din

g d

uct

al, l

ob

ula

r, in

flam

mat

ory

an

d o

the

r

carc

ino

mas

__

__

__

__

__

__

__

__

__

__

• N

orm

al a

nd

ab

no

rmal

ap

pe

aran

ces

of

axill

ary

lym

ph

no

de

s._

__

__

__

__

__

__

__

__

__

_

• In

flam

mat

ory

co

nd

itio

ns

in t

he

bre

ast

incl

ud

ing

infe

ctio

n a

nd

absc

ess

fo

rmat

ion

__

__

__

__

__

__

__

__

__

__

• Ia

tro

ge

nic

ch

ang

es

in t

he

bre

ast

, in

clu

din

g b

reas

t im

pla

nts

,

ear

ly a

nd

late

po

st-o

pe

rati

ve a

pp

ear

ance

s, s

ero

mas

, hae

mat

om

as,

rad

ioth

era

py

chan

ge

s, f

at n

ecr

osi

s, s

carr

ing

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EFSUM

B N

ewsletter


103

AP

PEN

DIX

7: B

RE

AS

T U

LTR

AS

OU

ND

TR

AIN

ING

CO

MP

ET

ENC

Y A

SSE

SSM

ENT

SH

EET

Trai

ne

eTr

ain

er

Lev

el 2

Aft

er

rea

chin

g c

om

pe

ten

cy a

t Le

ve

l 1 p

ract

itio

ne

rs m

ay

pro

gre

ss t

o L

ev

el 2

.

Th

is in

vo

lve

s a

min

imu

m o

f 1

sca

nn

ing

cli

nic

se

ssio

n p

er

we

ek

(a

t le

ast

10

ca

ses

pe

r w

ee

k)

for

at

lea

st 3

mo

nth

s.

Co

mp

ete

nci

es/

skil

ls t

o b

e a

cqu

ire

d:

Tra

ine

r S

ign

atu

reD

ate

Ess

en

tia

l pri

nci

ple

s

• P

erf

orm

fin

e n

ee

dle

asp

irat

ion

cy

tolo

gy

on

ab

no

rmal

itie

s w

ith

corr

ela

tio

n o

f re

sult

s to

imag

ing

an

d p

ath

olo

gy.

If F

NA

is n

ot

stan

da

rd

pro

ced

ure

wit

hin

th

e u

nit

th

en

th

e s

tud

en

t sh

ou

ld b

e f

amili

ar w

ith

th

e

tech

niq

ue

an

d b

e a

war

e o

f it

s u

ses

and

lim

itat

ion

s.

__

__

__

__

__

__

__

__

__

__

• S

ucc

ess

fully

pe

rfo

rm u

ltra

sou

nd

gu

ide

d c

ore

bio

psy

wit

h c

orr

ela

tio

n o

f

resu

lts

to im

agin

g a

nd

pat

ho

log

y._

__

__

__

__

__

__

__

__

__

_

• P

erf

orm

ult

raso

un

d g

uid

ed

bre

ast

absc

ess

asp

irat

ion

._

__

__

__

__

__

__

__

__

__

_

• P

erf

orm

ult

raso

un

d g

uid

ed

loca

lisat

ion

s p

re-o

pe

rati

vely

, usi

ng

bo

th

skin

mar

kin

g a

nd

wir

e in

sert

ion

te

chn

iqu

es.

__

__

__

__

__

__

__

__

__

__

• P

erf

orm

ult

raso

un

d g

uid

ed

ma

rke

r o

r co

il in

sert

ion

pri

or

to

ne

o-a

dju

van

t ch

em

oth

era

py.

__

__

__

__

__

__

__

__

__

__

• A

cce

pt

refe

rral

s fr

om

leve

l 1 p

ract

itio

ne

rs_

__

__

__

__

__

__

__

__

__

_

Lev

el

3

Tra

ine

r S

ign

atu

reD

ate

Ess

en

tia

l pri

nci

ple

s

• T

o a

cce

pt

refe

rral

s fr

om

leve

l 1 a

nd

leve

l 2 p

ract

itio

ne

rs a

nd

un

de

rtak

e

mo

re c

om

ple

x u

ltra

sou

nd

exa

min

atio

ns.

__

__

__

__

__

__

__

__

__

__

• T

o b

e a

ble

to

me

nto

r an

d s

up

erv

ise

pra

ctit

ion

ers

at

leve

l 1 a

nd

2.

__

__

__

__

__

__

__

__

__

__

• T

o u

nd

ers

tan

d a

nd

be

fam

iliar

wit

h v

acu

um

ass

iste

d b

reas

t b

iop

sy_

__

__

__

__

__

__

__

__

__

_

• T

o c

on

du

ct r

ese

arch

._

__

__

__

__

__

__

__

__

__

_

• T

o t

eac

h U

/S a

t al

l le

vels

._

__

__

__

__

__

__

__

__

__

_

• T

o b

e a

war

e o

f an

d p

urs

ue

de

velo

pm

en

ts in

bre

ast

U/S

incl

ud

ing

Do

pp

ler

and

th

e u

se o

f in

trav

ascu

lar

con

tras

t ag

en

ts.

__

__

__

__

__

__

__

__

__

__

EFSUM

B N

ewsletter


104

AP

PEN

DIX

8: V

AS

CU

LAR

ULT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TEN

CY

ASS

ESS

MEN

T S

HEE

T

Trai

ne

eTr

ain

er

Co

re K

no

wle

dg

e B

ase

Le

ve

l 1

Tra

ine

r S

ign

atu

reD

ate

• P

hys

ics

and

te

chn

olo

gy

__

__

__

__

__

__

__

__

__

__

• P

ract

ical

inst

rum

en

tati

on

/use

of

ult

raso

un

d c

on

tro

ls_

__

__

__

__

__

__

__

__

__

_

• U

ltra

sou

nd

te

chn

iqu

es

__

__

__

__

__

__

__

__

__

__

• A

dm

inis

trat

ion

__

__

__

__

__

__

__

__

__

__

• S

ect

ion

al a

nd

ult

raso

nic

an

ato

my

__

__

__

__

__

__

__

__

__

__

• P

ath

olo

gy

in r

ela

tio

n t

o u

ltra

sou

nd

__

__

__

__

__

__

__

__

__

__

Co

mp

ete

nci

es/

skil

ls t

o b

e a

cqu

ire

d -

Le

ve

l 1

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

Ess

en

tia

l Pri

nci

ple

sP

eri

ph

era

l su

pe

rfic

ial v

ein

s

• C

W h

and

-he

ld D

op

ple

r an

d s

eg

me

nta

l pre

ssu

res

__

__

__

__

__

__

__

__

__

__

• r

eco

gn

ise

no

rmal

an

ato

my

and

co

mm

on

var

ian

ts_

__

__

__

__

__

__

__

__

__

_

• c

alip

er

me

asu

rem

en

ts o

f d

ista

nce

an

d s

ize

__

__

__

__

__

__

__

__

__

__

• id

en

tify

sap

he

no

-fe

mo

ral a

nd

sap

he

no

-po

plit

eal

jun

ctio

ns

__

__

__

__

__

__

__

__

__

__

• c

olo

ur

flo

w a

nd

sp

ect

ral a

nal

ysis

__

__

__

__

__

__

__

__

__

__

• d

iag

no

se r

efl

ux,

inco

mp

ete

nce

, pe

rfo

rato

rs_

__

__

__

__

__

__

__

__

__

_

• v

elo

city

me

asu

rem

en

t an

d D

op

ple

r an

gle

__

__

__

__

__

__

__

__

__

__

Ab

do

min

al u

ltra

sou

nd

Pe

rip

he

ral a

rte

rie

s a

nd

gra

fts

• r

eco

gn

ise

pat

en

cy a

nd

occ

lusi

on

of

aort

a_

__

__

__

__

__

__

__

__

__

_

• r

eco

gn

ise

no

rmal

an

ato

my

and

co

mm

on

var

ian

ts_

__

__

__

__

__

__

__

__

__

_•

re

cog

nis

e a

nd

siz

e a

ort

ic a

ne

ury

sm_

__

__

__

__

__

__

__

__

__

_

• s

can

ext

ern

al il

iac

to p

op

lite

al a

rte

rie

s_

__

__

__

__

__

__

__

__

__

_E

xtr

acr

an

ial v

ess

els

• r

eco

gn

ise

pat

en

cy, o

cclu

sio

n a

nd

an

eu

rysm

__

__

__

__

__

__

__

__

__

__

• r

eco

gn

ise

no

rmal

an

ato

my

and

co

mm

on

var

ian

ts_

__

__

__

__

__

__

__

__

__

_

• r

eco

gn

ise

an

d d

iffe

ren

tiat

e 5

0%

ste

no

sis

__

__

__

__

__

__

__

__

__

__

• r

eco

gn

ise

pat

en

cy, o

cclu

sio

n, p

laq

ue

an

d s

ten

osi

s_

__

__

__

__

__

__

__

__

__

_

• r

eco

gn

ise

co

mm

on

inte

rve

nti

on

s_

__

__

__

__

__

__

__

__

__

_•

oth

er

com

pe

ten

cie

s ac

qu

ire

d_

__

__

__

__

__

__

__

__

__

_

Pe

rip

he

ral d

ee

p v

ein

sG

en

era

l

• r

eco

gn

ise

no

rmal

an

ato

my

and

co

mm

on

var

ian

ts_

__

__

__

__

__

__

__

__

__

_•

kn

ow

wh

en

to

re

fer

to a

mo

re e

xpe

rt u

ltra

son

olo

gis

t_

__

__

__

__

__

__

__

__

__

_

• S

can

ext

ern

al il

iac

to p

op

lite

al v

ein

s_

__

__

__

__

__

__

__

__

__

_

• p

erf

orm

co

mp

ress

ion

an

d a

ug

me

nta

tio

n_

__

__

__

__

__

__

__

__

__

_

• r

eco

gn

ise

acu

te fe

mo

ro-p

op

lite

al D

VT

__

__

__

__

__

__

__

__

__

__

• d

iag

no

se a

nd

loca

te r

efl

ux

__

__

__

__

__

__

__

__

__

__

EFSUM

B N

ewsletter


105

AP

PEN

DIX

8: V

AS

CU

LAR

ULT

RA

SO

UN

D T

RA

ININ

G C

OM

PE

TEN

CY

ASS

ESS

MEN

T S

HEE

T

Trai

ne

eTr

ain

er

Co

re K

no

wle

dg

e B

ase

Le

ve

l 2C

om

pe

ten

cie

s/sk

ills

to

be

acq

uir

ed

- L

ev

el 2

Tra

ine

r S

ign

atu

reD

ate

Tra

ine

r S

ign

atu

reD

ate

• P

eri

ph

era

l art

eri

es

and

gra

fts

__

__

__

__

__

__

__

__

__

__

To b

e c

om

pe

ten

t to

pe

rfo

rm/d

iag

no

se t

he

fo

llo

win

g:

• P

eri

ph

era

l de

ep

an

d s

up

erf

icia

l ve

ins

__

__

__

__

__

__

__

__

__

__

• a

sse

ssm

en

t fr

om

ilia

c to

pe

dal

ar

teri

es

and

ve

ins

__

__

__

__

__

__

__

__

__

__

• T

ran

scra

nia

l Do

pp

ler

__

__

__

__

__

__

__

__

__

__

• a

sse

ssm

en

t fr

om

su

bcl

avia

n t

o r

adia

l an

d u

lnar

art

eri

es

and

ve

ins

__

__

__

__

__

__

__

__

__

__

• p

ate

ncy

, occ

lusi

on

, ste

no

sis

reve

rse

flo

w a

nd

ste

al i

n t

he

car

oti

d

and

ve

rte

bra

l ve

sse

ls_

__

__

__

__

__

__

__

__

__

_

• g

rad

e d

eg

ree

s o

f ca

roti

d s

ten

osi

s an

d p

laq

ue

typ

e_

__

__

__

__

__

__

__

__

__

_

• n

orm

al v

ari

ants

, an

eu

rysm

al d

ilata

tio

n, p

ate

ncy

, ste

no

sis

and

occ

lusi

on

of

maj

or

abd

om

inal

an

d il

iac

vess

els

__

__

__

__

__

__

__

__

__

__

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