THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week 619.6

Guest Ann Jones, RN, RVT, RDMS, past chair - American Registry of Diagnostic Medical Sonographers

Topic Certification of medical sonographers

Host/Producer Steve Girard

NEMA A recent segment of ABC's Primetime Live focused on the importance of sonography...or taking an image of an internal physiologic activity by bouncing sound waves...and the lack of certification for many health care workers responsible for getting these essential diagnostic indicators. Today, we have Ann Jones, a nurse and past chair of the American Registry of of Diagnostic Medical Sonographers...to talk with us about the importance of having qualified, certified people in these jobs....

JONES Well, there are several different pathways that someone who becomes a medical sonographer can actually originate from. Many of our sonographers are from nursing backgrounds, many of our sonographers are from radiologic technology backgrounds. Others have just completed a four year college degree, in some allied health related area, and sort of migrate into ultrasound, based on interest or a work setting that requires them to learn how to do ultrasound studies.

NEMA How long has this discipline been available to people interested in medical work...?

JONES We actually started the ARDMS in 1975. So, we initiated the exam then, and so we've been in business for quite some time and have actually registered over 30 thousand individuals.

NEMA What is the range of jobs that someone certified in diagnostic medical sonography would perform?

JONES There are actually three major specialty areas that people in ultrasound sort of fit into as far as a category of certification You would have a registered diagnostic medical sonographer, who would be the individual who would be performing your obstetrical ultrasound study. If you were in an obstetrician's office, or in a hospital or a clinic setting. We also have the registered diagnostic medical sonographer, who may be looking at your gallbladder in a radiology department or an internist's office. We have the diagnostic medical sonographer who may be performing an ultrasound on your baby's head, when they were in the intensive care setting. Or if you went to see you opthamologist, and needed to have an ultrasound done on your eye, we would have registered sonographers in opthamology. Then, if you want to move through the body systems, if you have a problem, or an evaluation needs to be done of your heart, we actually have two specialty areas here...where we divide it into adult echocardiography or pediatric echocardiography....so we have specialist who evaluate adults or children, or possibly both. And then, when we move out of the realm of the cardiac, and into the realm of the blood vessels of the body...we have the registered vascular technologist, who would evaluate an individual who you're screening that may have disease in their arteries in their neck that supply the brain. So they would do a carotid ultrasound. If someone develops a blood clot in their leg or their arm, a vascular technologist would evaluate that area as well.

NEMA I didn't realize that we could get pictures of so many parts of the body by bouncing sound waves...

JONES Exactly, and interestingly enough, although we're not currently offering an exam in this area...there are new areas that are being developed everyday...one of the most recent areas is evaluating the blood flow in the brain, using trans-cranial Doppler. And that would probably fit in the realm of the vascular technologist. So, we have to keep moving forward everyday because of new areas of development.

NEMA We all know about sound in our everyday life...some people, like me, work in it...but it's interesting to know how it works to take internal pictures, and help make diagnoses...

JONES We all see Doppler in the weather reports, so we actually can apply that technology to evaluating blood flow, looking at the direction of flow, looking how fast it's moving...and this type of thing as well, so it really is emerging. And you really have to be very specialized in a very specific area in order to do a good study.

NEMA That's one of the reasons I wanted to speak with you...when we go into a doctor's office, and undergo some type of diagnostic procedure...we assume that the person conducting the test or procedure is somehow ready and able to do the best possible job...and that there's a certain standard that tech person has to meet to do the job....

JONES That's right. You assume when someone is using a piece of very specialized equipment and has on a white lab coat...that they're automatically ready and qualified to perform the study, and to be able to evaluate and quantify anything that they happen to fall into as far as pathology, that they may find in this patient. And because of the fact that the ultrasound instrumentation is relatively inexpensive, compared to other major capital equipment in hospitals...and because it's portable, and because the actual knobs and buttons can actually be learned over a period, not a very long period of time...the impression has been left that a person could actually go to a course over a weekend and learn how to use the machine...and therefore are absolutely qualified to perform a study. And nothing can be farther from the truth.

NEMA What are the variables...things that someone with the certification and the training would be able to know and understand that would make a difference in the way a patient is evaluated and diagnosed?

JONES For instance, like in the Prime Time Live study, a patient supposedly had vascular disease. If a person was doing a study who did not understand, not only the disease processes that are going on in the vascular system, but also the capabilities of the machine to evaluate them...you could bring a patient in and you could start a study, and you could have the gain settings on the machine set so low, that you may actually miss that there is blood flow in an artery. And if you didn't recognize that you didn't have your settings right, or you didn't use the full capabilities of the machine, you may actually give information to the physician to make an interpretation that is incorrect. If you didn't understand that the blood flow in a particular artery needed to be in one direction, and that if it was reversed, then that told you that there was a problem with that patient, then you wouldn't recognize the pathology...you would just notice that there was blood flow, and the assumption would be that it was normal. But if you didn't understand the pathology that the blood flow was in the wrong direction, then you would completely miss something. So, we're talking about serious diagnoses...when you talk about obstruction of blood flow to the brain, or a blood clot in a vessel that, because of the fact that you have not used the instruments properly, or did not understand the anatomy, that you may actually miss very critical information for the patients management.

NEMA it's a matter of depth of knowledge and experience...?

JONES And that's why, with the ARDMS, that we have created an exam process...where you're not just evaluated on the one specialty area that you're actually sitting for. You have to take a separate physics exam...where you have to show that you understand the physics of ultrasound, the physics of Doppler, and how to actually run one of these ultrasound machines. And it's a difficult exam, and if you get through it, are able to sit for the next exam...which would then, once they passed that, give them certification.

NEMA So...the main point is to make sure there's an consistent aspect of quality in the image taking process, so the physician can do his or her job properly...?

JONES Because clearly there are physicians involved in the process, but if the registered sonographer goes in and does the initial evaluation...develops the film, takes them to the physician, but has not done a complete study, or has not focused in on a particular area that was important, and gives the physician that information, and then he comes in a maybe does a quick evaluation or looks at the study and says everything looks good, or this looks bad. You know, he can make a misdiagnosis based on inadequate information that was provided by a sonographer that is not qualified.

NEMA And I would imagine it would be in the physician's best interest to have the best qualified person at the sonography level, so that he would not make a mistake, which as we know can have serious repercussions...

JONES I couldn't have said it better myself....

NEMA Now, how many people are performing sonography who are not certified?

JONES You know, that's a very good question...we actually do not know what the universe of unregistered sonographers would be, but we're making an assumption that it's probably about at least twice what we know is already registered...and maybe even larger than that. We know that the field of ultrasound instrumentation has been growing significantly over the past years. Clearly, wherever there is an ultrasound machine, there is someone who is operating that machine. And at this point in time, we are making efforts to find out what the universe of the non-registered sonographer is.

NEMA I'm sure that most people don't know that doing sonography is not part of usual nurse training...I didn't realize the depth of experience needed...

JONES And that brings up an interesting point, that to be able to sit for our exam, you don't just have to have fulfilled the prerequisites when it comes to education or background, you also have to have fulfilled a specific clinical requirement....usually it's 12 months of clinical requirement, where you've performed probably 700-800 cases in your specialty area, and then have a physician or a sonographer document that you've done this before they'll even let you sit for the exam.

NEMA Our thanks to Ann Jones, a nurse and past chair of the American Registry of Diagnostic Medical Sonographers. Of the many thousands of people performing ultrasound procedures, it's estimated that less than half of them have certification in OB/GYN, cardiac or vascular ultrasound. It feels strange to go to the lab or clinic where your ultrasound is scheduled, and ask for the operators certifications...but in this every changing world of health care, we all have to learn to be more in control. Your looking for ARDMS certificates. If you are an ultrasound technologist, it would make sense to start the certification process...because if you're well trained and experienced, you should have no problem getting certified. You can call the ARDMS at 800-541-9754, or find them on the web at www.ardms.org.

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...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.