PURPOSE

The purpose of this document is to define the scope of practice and clinical standards for diagnostic medical sonographers and describe their role as members of the healthcare team. Above all else, diagnostic medical sonographers act in the best interest of the patient.

DEFINITION OF THE PROFESSION 

Diagnostic medical sonography is a multi-specialty profession comprised of abdominal sonography, breast sonography, cardiac sonography, obstetrics/gynecology sonography, pediatric sonography, vascular sonography, and other emerging clinical areas. These diverse areas all use ultrasound as a primary technology in their daily work.

The hierarchies of the profession include Medical Sonography Intern, Medical Sonographer, Registered Medical Sonographer, Senior Registered Medical Sonographer, and Consultant Registered Medical Sonographer.

Medical sonography intern is a student trainee who has completed both preclinical and clinical training in the field of sonography and works under supervision by a diagnostic medical sonographer or a radiologist, to gain work experience and also satisfy the requirements to write the professional exams by the Ghana Allied Health Professional Council (GAHPC) for licensure. The medical sonography intern has the credential MS (meaning Medical Sonographer) before his/her name on all written medical reports.

The Registered Medical sonographer is an individual who has passed the professional exam and is licensed/registered by the Ghana Allied Health Professional Council (GAHPC) to practice ultrasound. The diagnostic medical sonographer has the credential RMS (meaning registered medical sonographer) attached to his/her name on all written medical reports. He/she provides patient care services using ultrasound and related diagnostic procedures. The Registered Medical sonographer must be educationally prepared and clinically competent as a prerequisite to professional practice. Demonstration and maintenance of competency through clinical practice and certification by a nationally and internationally recognized sonography credentialing organization is the standard of practice of sonography.

The Senior Registered Medical sonographer is an individual who has passed the professional exam and is licensed/registered by the Ghana Allied Health Professional Council (GAHPC) to practice ultrasound and has been practicing for 3 years or more, and also has a minimum academic qualification of an MSc, MPhil, or its equivalent. The Senior Registered Medical sonographer has the credential SRMS (meaning Senior Registered Medical Sonographer) attached to his/her name on all written medical reports. He/she provides patient care services using ultrasound and related diagnostic procedures and plays an active role in the education of student sonographers.

The Consultant Registered Medical sonographer is an individual who is duly registered by the Allied Health Professional Council (GAHPC) to practice ultrasound and has been practicing for 10 years or more, and also has a minimum academic qualification of a PhD. The Consultant Registered Medical Sonographer has the credential CRMS (meaning Consultant Registered Medical Sonographer) attached to his/her name on all written medical reports. He/she provides patient care services using ultrasound and related diagnostic procedures when necessary. The main role of the consultant, however, will be in academia and policy development. He will play an active role in liaising with equipment manufacturers and institutional stakeholders, and play an active role in the education of student sonographers. He will also be the go-to person when the professional council needs advice on issues about the professional body.

The diagnostic medical sonographer:

• Functions as a delegate agent of the physician or specialist; and
• Reports all diagnostic information to the referring physician or specialist

Diagnostic medical sonographers are committed to enhanced patient care and continuous quality improvement that increases knowledge and technical competence. Diagnostic medical sonographers use independent, professional, ethical judgment and critical thinking to safely perform diagnostic sonographic procedures.

Fundamental approach to the safe use of diagnostic medical ultrasound is to apply the principles of As Low As Reasonably Achievable (ALARA), which includes the lowest output power and the shortest scan time consistent with acquiring the required diagnostic information. The diagnostic medical sonographer uses proper patient positioning, tools, devices, equipment adjustment, and ergonomically correct scanning techniques to promote patient comfort and prevent compromised data acquisition of musculoskeletal injury to the diagnostic medical sonographer.

DIAGNOSTIC MEDICAL SONOGRAPHER CERTIFICATION

A diagnostic medical sonographer must be competent in any sonographic procedure they perform. Certification by a sonography credentialing organization that is accredited by the Ghana Allied Health Professional Council (GAHPC) represents a “standard of practice” in diagnostic sonography.

Despite the commonality of ultrasound technology across the field of sonography, the bodies of knowledge, technical skills, and competencies of sonographers in different areas of sonography specialization are markedly different. In performing procedures in and of the following primary areas of sonography specialization, a diagnostic medical sonographer must demonstrate competence in the specialty areas(s) through appropriate education, training, and clinical practice.

1. Abdominal/General Medical Sonography
2. Obstetrical/ Gynecological sonography
3. Vascular sonography
4. Urological sonography
5. Small parts sonography
6. Musculoskeletal sonography

If the diagnostic medical sonographer specializes or regularly performs procedures in areas such as pediatric or neonatal sonography, breast sonography, musculoskeletal sonography, cardiac sonography, etc, the diagnostic medical sonographer should demonstrate competence through certification or proof of training from a recognized institution or by a qualified sonographer or radiologist. Employers and accrediting organizations should require maintenance of diagnostic medical sonographer certification in all areas of practice.

DIAGNOSTIC MEDICAL SONOGRAPHY CLINICAL STANDARDS

Standards are designed to reflect behavior and performance levels expected in clinical practice for diagnostic medical sonographers. These clinical standards set forth the principles that are common to all of the specialties within the larger category of the diagnostic sonography profession. Individual specialties or clinical areas may extend or refine but not limit these general principles according to their specific practice requirements.

SECTION 1

STANDARD – PATIENT INFORMATION ASSESSMENT AND EVALUATION

1. Information regarding the patient’s past and present health status is essential in providing appropriate diagnostic information. Therefore, pertinent data related to the diagnostic sonographic procedure should be collected and evaluated to determine its relevance to the examination. The diagnostic medical sonographer:
2. Verifies patient identification and that the requested examination correlates with the patient’s clinical history and presentation. If the requested examination does not correlate, the referring physician will be notified.
3. In compliance with privacy and confidentiality standards, interviews the patient or their representative and or reviews their medical records to gather relevant information regarding the patient’s medical history and current presenting indications for the study.
4. Evaluates any contraindications, insufficient patient preparation, and the patient’s inability or unwillingness to tolerate the examination and associated procedures. 

STANDARD – PATIENT EDUCATION AND COMMUNICATION

1. Effective communication and education are necessary to establish a positive relationship with the patient or the patient’s representative and to elicit patient cooperation and understanding of expectations. The diagnostic medical sonographer:
2. Communicates with the patient in a manner appropriate to the patient’s ability to understand. Presents explanation and instructions in a manner that can be easily understood by the patient and other healthcare providers.
3. Explains the examination and associated procedures to the patient and responds to patient questions and concerns.
4. Refers specific diagnostic, treatment, of prognosis questions to the appropriate physician or healthcare professional

STANDARD – ANALYSIS AND DETERMINATION OF PROTOCOL FOR THE DIAGNOSTIC EXAMINATION

3. The most appropriate protocol seeks to optimize patient safety and comfort, diagnostic quality, and efficient use of resources while achieving the diagnostic objective of the examination. The diagnostic medical sonographer:
4. Integrates medical history, previous studies, and current symptoms in determining the appropriate diagnostic protocol and tailoring the examination to the needs of the patient.
5. Performs the examinations using appropriate maneuvers as deemed fit for the examination.
6. Uses professional judgment to adapt the protocol and consult appropriate medical personnel when necessary, to optimize examination results.

STANDARD – IMPLEMENTATION OF THE PROTOCOL:

1. Quality patient care is provided through the safe and accurate implementation of the deliberate protocol. The diagnostic medical sonographer:
2. Implements a protocol that falls within established procedures.
3. Elicits the cooperation of the patient to carry out the procedures.
4. Adapts the protocol according to the patient’s disease process or condition.
5. Adapts the protocol as required, according to the physical circumstances under which the examination must be performed (e.g., operating room, diagnostic sonography laboratories, patient’s bedside, emergency room, etc.).
6. Monitors the patient’s physical and mental status
7. Adapts the protocol according to the changes in the patient’s clinical status during the examination.
8. Administers first aid or provides life support in emergencies.
9. Performs basic patient care tasks as needed.
10. Recognizes sonographic characteristics of normal and abnormal tissues, structures, and blood flow; adapts protocol as appropriate to further assess findings; adjusts scanning technique to optimize image quality and diagnostic information.
11. Analyzes sonographic findings throughout the examination so that a comprehensive examination is completed and sufficient data is provided to the referring physician for patient management.
12. Performs measurements and calculations according to facility protocol.

STANDARD – EVALUATION OF THE DIAGNOSTIC EXAMINATION RESULTS:

1. Careful evaluation of the examination results in the context of the protocol is important to determine whether the goals have been met. The diagnostic medical sonographer:
2. Establishes that the examination as performed complies with applicable protocols and guidelines.
3. Identifies and documents limitations to the examination.
4. Notifies the referring physician when immediate medical attention is necessary, based on examination findings and patient condition.

STANDARD – DOCUMENTATION:

1. Clear and precise documentation is necessary for continuity of care, accuracy of care, and quality assurance. The diagnostic medical sonographer:
2. Provides timely, accurate, concise, and complete documentation.
3. Provides an oral or written report of findings to the referring physician.

SECTION 2

STANDARD – IMPLEMENT QUALITY IMPROVEMENT PROGRAMS:

1. Participation in quality improvement programs is necessary. The diagnostic medical sonographer:
2. Maintains a safe environment for patients and staff.
3. Performs quality improvement procedures to determine that equipment operates at optimal levels and to promote patient safety.
4. Participates in quality improvement programs that evaluate the technical quality of images, completeness of examination, and adherence to protocols.
5. Compares facility quality improvement standards to external metrics such as accreditation criteriaevidence-baseded literature, or accepted guidelines.

STANDARD – QUALITY OF CARE:

1. All patients expect and deserve optimal care. The diagnostic medical sonographer:
2. Works in partnership with other healthcare professionals.
3. Report adverse events.

SECTION 3

STANDARD – SELF ASSESSMENT:

1. Self–assessment is an essential component in professional growth and development. Self–assessment involves evaluation of personal performance, knowledge, and skills.
2. Recognizes strengths and uses them to benefit patients, coworkers, and the profession.
3. Recognizes weakness and limitations and performs procedures only after receiving appropriate education and supervised clinical experience in any deficient areas.

STANDARD – EDUCATION:

1. Advances in medical science and technology occur rapidly, requiring an ongoing commitment to professional education. The diagnostic medical sonographer:
2. Obtains and maintains appropriate professional certification/ credential in areas of clinical practice.
3. Recognizes and takes advantage of opportunities for educational and professional growth.

STANDARD – COLLABORATION:

1. Quality patient care is provided when all members of the healthcare team communicate and collaborate efficiently. The diagnostic medical sonographer:
2. Promotes a positive and collaborative atmosphere with members of the healthcare team.
3. Communicates effectively with members of the healthcare team regarding the welfare of the patient.
4. Shares knowledge and expertise with colleagues, patients, students, and members of the healthcare team.

SECTION 4

STANDARD – ETHICS:

1. All decisions made and actions taken on behalf of the patient adhere to ethical standards. The diagnostic medical sonographer:
2. Adheres to accepted professional ethical standards.
3. Is accountable for professional judgments and decisions.
4. Provides patient care with equal respect for all.
5. Respects and promotes patient rights, provides patient care with respect for patient dignity and needs, and acts as a patient advocate.
6. Does not perform sonographic procedures without a medical indication, except in educational activities.
7. Adheres to this scope of practice and other related professional documents.

SECTION 5

STANDARD-OTHER DOCUMENTS

Documents already prepared by sister organizations across the globe, which the association deems fit for adoption, will be adopted and included in our practice locally to ensure that members wishing to practice outside the boundaries of our country can do so without encountering any problems.

These documents include:

1. American Institute of Ultrasound in Medicine Guidelines.
2. United Kingdom Association of Sonographers guidelines
3. Society of Radiographers guidelines
4. International Society of Ultrasound in Obstetrics and Gynecology guidelines
5. British Medical Ultrasound Society guidelines
6. Canadian Society of Diagnostic Medical Sonographers