Regulating Ultrasound and Increasing Radiography Training Capacity: Opinion Piece by Warren Foster

Regulating Ultrasound and Increasing Radiography Training Capacity: Opinion Piece by Warren Foster

In the past couple of weeks, ultrasound and radiography have been in the news for very different reasons. The BBC recently revealed that some private clinics offering baby scans to pregnant women showed ‘incredibly poor practice’.

These private clinics offer a range of services. Some do diagnose medical problems, but many simply offer souvenir images or video of the baby. This is often known as ‘social scanning’. Many clinics sell ‘reassurance scan’ packages, giving women the chance to see their baby if they are feeling anxious.

However, the BBC investigation has highlighted that serious medical problems are being missed by these clinics and women are being given false reassurance. 

Last week, the Government’s Spending Review promised £325m to upgrade aging imaging equipment in the NHS.

We asked Head of the School of Radiology at AECC University College, Warren Foster, to share his thoughts on these news items:

Call to regulate ultrasound

“I believe that the time has come to regulate ultrasound. A number of clinics offering private scans to pregnant women have realised that you don’t actually need to be qualified to perform scans.

“There’s a big range across the country. Some clinics still employ qualified sonographers to perform scans, whilst others have started using unqualified people as there currently isn’t any regulation. The latter are considerably less expensive.

“When clinics don’t use qualified sonographers to perform scans, the quality assessments that would normally take place don’t happen.”

A way forward

“In terms of solving this issue, I believe there are two ways to go. One way is to regulate ultrasound, which is really what we should be doing.

“This would mean clinics have to use fully-qualified sonographers and this would protect the patient and the industry. I strongly feel that this needs to happen.

“Ultrasound practitioners can come from a variety of backgrounds: radiography, physiotherapy, medicine, or midwifery. The most common route is from radiography and in the past, all sonographers were radiographers and therefore regulated by the Healthcare Professional Council (HCPC). But the title of sonographer was never formally regulated: performing ultrasound was never made a regulated profession.

“Organisations like the British Medical Ultrasound Society and the Society of Radiographers recognise that ultrasound has now come so far, and has such wide-reaching effects on patient care, that it really is time to regulate. People are calling for that now.

“It protects people like me who have spent nine years in education to do this role but more importantly the patients.”

Short term solution

“Establishing regulation takes time, so in the short term, another solution could be developing training that is adequate for social scanning. Women would need to have their NHS scan first and then they could have a social scan later.

“At the moment, there is only one level of sonography training and this takes three to six years. We don’t currently have training to a standard that is required for social scanning.

“This new training qualification could qualify you to produce pictures of a baby and also train you in the big developmental issues to watch out for. The training would make it clear when you would need to refer a woman to the NHS for further investigation.  

“This training qualification would need to be accredited by a body like CASE, one of the main accreditors for ultrasound training in the UK.

“Private clinics who opt to employ these professionals would then be able to offer these ‘baby bonding’ scans only, rather than offering 20-week anomaly scans or reassurance scans. These would be scans for bonding, rather than diagnostic purposes.

“At the moment, nobody offers that.”

Dual system of regulation

“I strongly believe we also need to go one step further than regulating ultrasound. In my opinion, we should have a two-tiered system of regulation.

“The first tier would be regulation for technical technicians, who are working to a defined scope of practice. For example, a sonographer who performs aortic screening or a sonographer who performs rheumatology ultrasounds. These professionals would be regulated as technician-grade sonographers.

“Then you could have a professional-grade regulation for people who work outside of a single scope, across specialties in ultrasound. They can do obstetrics, vascular, musculoskeletal, head and neck, women’s health: they have a wider scope of practice to do ultrasound in general, rather than within a specific practice.

“That immediately defines professionals who do ultrasound as an adjunctive to their main role (e.g. a Physiotherapist who performs musculoskeletal ultrasound of the shoulder) and those who sit in the top tier that do any area of ultrasound within their specialty.”

Government investment in imaging equipment

“It’s brilliant that the Government is investing in imaging equipment, but my main concern is the staff shortages that we are seeing. We have a shortage of radiographers in general and in imaging specialties: we basically need to train more people. There needs to be investment into increasing training intake and a rethink on clinical training models.

“I believe that as a profession, we also need to review our training process. At the moment, we have a training system that relies on one-on-one clinical placements. This just isn’t the case with medicine, midwifery, or nursing. In these training programmes, we have two or three students working with one person.

“Really, I think we should have two or three radiography students working together with a radiographer in a day – they will each get hands-on experience and learn from each other.

“We need to look at increasing training numbers and look at different ways of doing the training itself.”

Read more about the radiology and medical imaging courses that we offer at AECC University College.