Ultrasound in radiology —state of the art

The practice of ultrasound in radiology has continued to develop and shows no signs of slowing down. The changes affect the systems themselves, with important technical developments, as well as the ways they are used, and to some extent these are interlinked. The earliest static scanners were so difficult to use that only dedicated personnel could find the time and make the effort required to use them. This led to a small cohort of enthusiasts offering a limited and expensive service. Strangely, they were a mixture of doctors (many of whom were not radiologists) and physicists, perhaps reflecting the complexity of the scanners. with the development of real-time systems and increasingly as they have become easier to operate, ultrasound found its place within radiology departments and, in parallel, in cardiology and obstetric units as well as in vascular labs. Here the role of physicists faded and most of the people performing the scans were medical, a situation that still obtains in many parts of the world, notably in the Far East (in China, the doctors are ultrasound specialists) and in many European countries. In others, especially in the United States, technologists or radiographers took over the actual scanning, leaving radiologists or their equivalent (cardiologists, obstetricians) to read and report the studies by analogy with other scanning modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). The driver for this major change has mainly been financial: medics are expensive and sharing the workload with technologists is cost-effective. However, this shift comes with a penalty: as ultrasound is a real-time method and the techniques required to make the studies are very interactive, simply reading a set of images on a PACS (picture archiving and communication system) workstation deprives the radiologist of dynamic information that can be critical to making the diagnosis. In some places the response to this has been to train the technicians or radiographers to interpret and report their own cases. Though often disapproved of by the regulatory authorities and exposing practitioners to risks of litigation, this approach has been popular amongst radiographers only partly because their extended role is rewarded by additional pay.