ULTRASOUND

Estimate caseload, procure cheap/free practice US scanner and identify friendly and accessible MSKUS mentor. 2-3 months.

Business plan and pilot study – simultaneously

Indentify clinical need. 0-3 months, or inadequate local MSKUS service or desire to develop personal practice.

Enroll of intro and post graduate MSKUS course(s) and keep logbook. Use other learning resources such as MSKYUS DVD’s and e-learning packages. Video conferencing is another option. 12-18 months.

Initial idea for MSKU

Attain post graduate PGC or diploma and develop more advanced MSKUS skills (possibly interventional techniques). 6-18 months.

Figure 5: Sample strategy for developing a MSKUS service (with appropriate achieveable timelines)

much of this has changed in the last 3-4 years. The cost of equipment has reduced and now good quality MSKUS scan images are possible with machines that retail for under £20,000 new. £5000 can buy you a re-conditioned ex-hospital department machine; the main drawback here is that future software upgrades are usually not possible.

Whatever equipment is used, it must be up to the job, and satisfy the demands of clinical governance.

In any event, clini-

cians will always reflect on the whole clinical picture, not just the scan image, when making complicated management decisions and considering the need for onward consultant referral.

TRAINING ISSUES AND RESOURCES A suggested strategy is summarised in figure 5. The whole issue of 'training for non-radiologists in performing ultrasound' has triggered much published debate over the last 10-12 years.

In the recent past,

training in ultrasound almost exclusively relied on the direct involvement of consul- tant radiologists (13-16). However, the practice of ultrasound (and specifically MSKUS) has increasingly spread into the clinical (or 'office') environment).

this, there has been a realisation that expe- rienced 'clinician US scanners' and e-learn- ing will have an important role to play in the future training and mentoring of non- radiologist clinician sonographers (17, 18).

24

Short 2-3 day MSKUS courses, often sponsored by the main ultrasound equipment manufacturers, can provide use- ful introductions to the subject. These are supported by internet resources and DVD products (19-22). More formal training is increasingly becoming available on University post-graduate courses and these can lead to PGC, diploma and masters degree qualifications (see the box on train- ing at the end of the article).

It is now

generally accepted that around 300-500 shared and supervised scans over approxi- mately 40-50 clinical sessions by a suitably experienced MSKUS teacher are required to achieve competence in a common range of MSKUS applications (23). In many instances progress on to interventional MSKUS will only take place over a longer

TRAINING

■ Currently there is an established MSKUS course based at Lancaster University (School of Radiography, n.jones@ucsm.ac.uk), a similar course has been successfully piloted is near completion at Portsmouth University (School of Radiography, budgie.hussein@port.ac.uk); this is due to be repeated in 2007-2008.

■ Teeside University is in the planning stage of offering an MSKUS PGC and Diploma starting in the Autumn 2007.

With

■ Sonosite 2-3 day courses on MskUS ñ contact michelle.hannon@sonosite.com ■ Musculoskeletal Ultrasound Society. Annual International Meeting/Congress with both 2-day introductory and advanced courses. Palais de Congres in Paris. www.musoc.com

Next courses 25-28 Aug 2007,

■ Nuffield Orthopaedic Centre courses: http://www.noc.nhs.uk/ourservices/ training/british_musculoskeletal_ultrasound.aspx

■ Further information on courses can be found at www.bmus.org (British Medical Ultrasound Society) and www.underoak.co.uk

sportex medicine 2007:33(Jul):20-26

period. If non-radiologists fail to engage in such a recognised and comprehensive training programme and a long term post- training maintenance plan there is the real danger that their MSKUS practice will not stand up to appraisal of clinical com- petency (24).

In practical terms much diagnostic sonography in Europe passed over from radiologists to clinicians in the 1990s; this is reflected in a letter considering German practice in 1996: '...most German radiologists who I have talked to admit they do not perform ultrasound, and that the clinicians do it all.

As a result

ultrasound machines have proliferated in clinical areas...' (15).

Therefore, it is not

surprising that increasing cohorts of enthusiastic non-radiologist clinicians in

Long term maintenance of MSKUS skills +/- teaching research and mentoring and further degree