BMUS News - Autumn 2020

View from my bike

A gloomy dark morning, remnants of storm Alex dripping down.  Spinning downhill to Swansea train station, for my weekly commute to Withybush Hospital. Check pockets, left pocket - phone with e-ticket; right pocket - mask and wallet containing key worker ID.  The joys of lockdown and travel in this mad world. The dreaded “new normal” (I can’t be alone in my dislike of the term).  The bike feels heavy this morning but it’s not an overloaded pannier, my legs are trashed after Sunday’s virtual London marathon.  Despite storm Alex’s best efforts, it was an enjoyable day.  Ok, my choice of route wasn’t the easiest option (from Worms Head in Rhoshilli at the westerly tip of the Gower, running along the coastal path back to Mumbles) but it was spectacular.  Yes, it was wet, alternating mud and soft sand with crashing surf and sea spray, but what a six hour yomp along the rugged delights of the Gower coastline.

A “virtual marathon”, a sign of the times.  But this then is our world – Teams / Zoom meetings, virtual clinics, tele-medicine, virtual conferences etc., etc. Virtual clinics …mmm…. Again, not my favorite concept/terminology.  “Virtual”, interesting term – look up the Cambridge Dictionary definition: “virtual: something that can be done or seen using computers or the internet instead of going to see a place or meeting people in person”.  Ok, the virtual London marathon, not running through the streets and crowds of London.  But running over welsh cliffs with my mates and family joining me for the last 12k – that was real, alive and probably better?  Nothing virtual in that.

Funny how some see their new normal as virtual medicine, but seem to have forgotten the essence of medicine i.e. our patients.  So, while angst and ire are induced by colleagues telling me they have “seen and assessed” patients in their virtual clinic; those of us who practice Ultrasound are seemingly a rare breed of medical practitioner?  We are the now the ultimate in ‘face to face’ (don’t you just love having to describe our practice as face to face !?) practitioners.

Isn’t it incredible how we have seen some Radiologists retreat to remote working, having to be coaxed back with the reminder that not everything can be done via a remotely reported CT or MRI?  Whilst others have shrugged the shoulders, gowned and masked up and got on with it.  What has been uplifting for me is seeing the renewed acknowledgement and realisation of that input by clinicians and patients alike. Patients now are sadly well aware that they have been unable to see their GP or hospital specialist, yet we will see them on a one to one basis, scan them and make the diagnosis.  Plus, increasingly now having to go the extra mile to guide them through their treatment options and follow up.  A recent patient in whom I had just diagnosed a rotator cuff tear said to me ‘So my GP wouldn’t see me, the physios won’t see me – but you are seeing me and scanning me?!’.  I won’t go into the rest of the conversation but I shared his pain on a professional level.

The train is now gently chugging past the hills of Narberth, I am tapping these words out on my laptop; earphones in, listening to the President of the Royal College of Surgeons on the Today programme (with mask on – a great look).  He talks of the “fragile recovery”, outlines the forthcoming expected winter pressures, adds in the fear and chaos factors associated with Covid – the perfect storm.  Preservation of capacity is key he says, if we are to get anywhere near a recovery for elective work.  He is not alone in pointing out that the current reality i.e. the NHS has been turned into a Covid only service, the knock-on effects of which are only now being belatedly acknowledged.  The tsunami of patients with chronic morbidity who have been unfairly penalised by the response to Covid deserve recognition and a realignment of capacity/resources.  All correct but let’s add it to the expanding list of pressure points for us as imagers: emergency work, USC, Cancer follow up, Primary care pathways, Obstetric services, etc., etc. Happy days!

Preservation/ring fencing/managing capacity and balancing demand is one of the biggest stresses we will undoubtedly face at multiple levels as we move forward.  Managers are slowly realising that we need to balance and preserve diagnostic and therapeutic capacity.  Some of our clinical colleagues are engaging in appropriate clinical triage but some still hide behind the excuse of Covid.  I will not be alone in having “difficult” conversations with colleagues regarding their referrals, outlining why it isn’t justified.  I accept it is easier for me - a gnarled, experienced (ok - old) Radiologist, not so easy for the young sonographer who may not have senior radiological support to hand.  (Remember the BMUS Guidelines – always a useful ally!)  But these are conversations we need to have and always remember that ultimately doing the right thing for all of our patients can always be justified.

On my list yesterday was a young, 40 year old man with a buccal carcinoma.  Despite multiple attempts he failed in his attempt to see a GP, nor could he find a dentist who would see him.  So, he took himself to our overrun A&E dept where he was diagnosed with an advanced ulcerating cancer.  Head and neck cancer specialist nurses had successfully chased me to fit him in before my weeks leave. I fit him in for his neck Ultrasound, my MR and CT radiographer colleagues squeeze him in for scans for me to report.  Secretaries contact the MDT coordinators with reports, arrange follow up etc.  The patient stops on his way out of the US scan room, puts his hand out and says “Thanks for everything that you have all done for me today”.  I acknowledge his thanks and accept his handshake (Yes, I know the risk and yes, I washed my hands after!).  The best and worst of the NHS in one case - the dreaded “new normal”.

Modelling (admittedly, an inexact science if ever there was one) predicts that in the next five years the effects of the changes to health care instigated in response to Covid, will result in 4,000 avoidable cancer deaths.  Let’s hope that for this young man we have caught his cancer in time but unfortunately this is now the reality that many of our patients are now facing.  I hope that we can be allowed to manage and mitigate risk for all of our patients and maintain control of our limited capacity to allow us to provide functional services.

In the midst of service pressures, it is easy to forget what is happening to our trainees, in particular out trainee sonographers and radiologists.  Many junior Radiology trainees have been pulled back into general medical duties with a massive knock-on effect on their training.  The “second wave” may see this repeated in future. Senior trainees have seen their sub-specialty training decimated as services have been compromised by Covid. In addition, exams have been suspended, delayed and now rearranged in new VC format (final vivas done remotely – not an easy task).  The added stresses of all this on our young colleagues are obvious.  Trainee sonographers have seen their direct supervision and teaching being severely restricted.  These are our future and we need to swing the pendulum back and restore the balance.

Earlier this week one of our locum sonographers asked if she could do my list with me, it was the usual mix of MSK, head and neck, lumps and bumps plus a few biopsies.  We squeezed in some technique and anatomy teaching, off I went teaching the sweeps of the neck, with tips here and there.  An enjoyable and fun list, with the realisation for me was that this was the first time since lockdown that I had taught hands on Ultrasound. I have missed it!  As we head down the webinar tutorials and e-learning, lets hang onto the fact that ours is a practical profession which relies on excellent hands on technique and skills. Ultrasound isn’t virtual it’s real.  It is a skill that cannot be learnt entirely from a webinar and whilst we will undoubtedly face battles with the Covid police, risk can be mitigated and direct teaching will and must return.  So, a plea, when the radiology trainee comes calling let’s have no “this isn’t a teaching list”, find a way to teach and encourage that is safe for all.  Remember the enjoyment and fulfillment to be gained by trainee and teacher alike.

I lift my bike off the train, my quads are not happy, whilst a virtual marathon may not be the same as running through a crowded London, virtual meant that I set myself the challenge.  The damage to my quads is definitely real! Virtual is not a word that can or should be applied to Ultrasound or the practice of Ultrasound.  However, for me the real and tangible interaction between Ultrasound machine, probe, me and my patient is why I still enjoy being able to practice Ultrasound - despite “Covid”.  I hope that you are able to share that view. As, I come towards the end of my term as President of BMUS I look around and am immensely proud to be amongst colleagues who have provided and continue to provide an Ultrasound service for our patients.  The appreciation and number of clinicians who understand our essential role will continue to increase. In the current maelstrom of restricted access for consultation and the falsehood of virtual clinics, our patients are now increasingly aware of this.  We can and should be able to practice and teach Ultrasound safely.  As we move forward let’s bring along the next generation, despite “Covid” let’s enthuse them to practice Ultrasound.  They and our patients will thank us. I have no doubt that it will not be easy, but I am confident that we, as in the Ultrasound community and all those in BMUS, will do so.

So, as I tootle up the hill to the hospital, this is my last ‘View from my bike’ post to you. I wish you all good health and good luck for the future, from all of us at BMUS.  And from me, a last “Iechyd Dda!”

Rhodri Evans
President

President Elect Update

As we near the close of play for 2020 I, for one, am finding it hard to reconcile the massive changes we have all experienced, and continue to experience, in our personal and professional lives. Just 12 months ago I was in a packed stadium in Japan cheering on England in the 2019 Rugby World Cup. How times have changed, but with resilience and team working we can ensure there are small wins that emerge from those changes. The wonders of modern technology and IT links have made working from home a realistic possibility for those in non-patient facing roles but, given for many in our profession, our primary clinical role is direct patient contact we remain a point of contact for our patients. Indeed, in many cases, we are the only direct point of contact patients have had as we are now in a world of telephone or virtual consultations. I have noticed a difference in my face to face contacts with patients. There is an increasing demand for me to share results and discuss patient pathways due to the patient’s awareness that we are the only face they may see. The advent of the rapid diagnostic centers and services throughout 2020 and into 2021 is placing a reliance on swifter diagnostics with a heavy reliance on imaging (¹). Ultrasound should be considered as a key core test for patients on such pathway. Given that we are likely to be the first health care professional that these patients see we are well placed to provide more than a diagnostic scan. We are in a good position to take history, provide advice and guidance and to ensure patients are directed on to the correct onward pathway. 

Whilst it is hard to see the benefits of the Covid-19 pandemic, perhaps one to be considered is the recognition of the need and role of sonographers and imaging within diagnostic pathways. As you are aware there has been an ongoing project, since 2015 with Health Education England, to increase the sonographer workforce, however there has also been a recent recognition of the need for increased number of diagnostic imaging staff. Recent figures from data collected by HEE indicate the known vacancy rate of diagnostic radiographers and sonographers has not abated and the demand for imaging continues to rise. An additional pressure that is heading our way is the very recent launch of community diagnostic hubs (CDH). NHS England News of 1^st October 2020 headlines:

NHS to introduce ‘one stop shops’ in the community for life saving checks

The NHS is set to radically overhaul the way MRI, CT and other diagnostic services are delivered for patients, a major report to NHS England recommends today.

Community diagnostic hubs or ‘one stop shops’ should be created across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. (²)

This plan acknowledges: “The pandemic has brought into sharper focus the need to overhaul the way our diagnostic services are delivered” and recommendations include:

• Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients
• The imaging workforce needs to be expanded as soon as possible with 2,000 additional radiologists and 4,000 radiographers as well as other support staff

The aim is that one CDH will be established per 1,000,000 population; the reality is that these need staffing. The CDH may take some demand from current acute sites but it is highly likely that the development of CDH’s alongside the emerging rapid diagnostic pathways will increase demand.  Saving Babies Lives Care Bundle V2 continues to be embedded into practice with an anecdotal evidence of variation across England. Coupled with the concerns regarding social distancing, PPE supplies and birth partner engagement, practitioners working within obstetric ultrasound have had a whole different range of issues to deal with during the pandemic. Clearly capacity has reduced as we all attempt to provide a service and also fulfill patient safety measures during a time of increasing demand. With the likely lockdown spike in pregnancies, (which we are definitely experiencing locally) the rise in demand is likely to continue for some time to come. It is safe to say that challenges to the sonographer and radiologist workforce are significant and relentless. However, BMUS, in collaboration with the RCR and SCoR, continue to work with HEE and CASE to support and develop new models and pathways of education.  BMUS continues to work on guidance for career transition, preceptorship and capability development and it is expected that this guidance will be produced for consultation towards the end of 2020.

The absence of an Annual Scientific Meeting this year sadly means that the forum where BMUS has traditionally launched new and updated guidance is not available. However, BMUS aims to hold a virtual ASM with a selection of speakers and presentations during December. Whilst the traditional networking is on hold until 2021 I do hope you will join BMUS in this virtual event. The ASM is time for the traditional hand over of Presidency and a time to thank the BMUS office staff for their input and hard work into making BMUS the success it is. Despite the lack of a face to face meeting the BMUS office team have worked continuously, and socially distanced, to keep BMUS producing education, guidance and the journal throughout 2020. Working from home may have some benefits but it is lonely and not without frustrations; the BMUS office team have done so without complaint. I am sure they are looking forward to being back in the office face to face when safety allows but for the time being continue to support BMUS from a safe distance. I would like to take this opportunity to thank Joy, Emma, Tracey and Mandy for their continued hard work and support for the BMUS officers, council, committees, BMUS members and wider profession. We couldn’t have got through without you.

Finally, however, I want to reserve the greatest thanks to our outgoing President Prof. Rhodri Evans. The only benefit of not being able to hold an ASM gala dinner is that Joy will know the President’s medal is safe. Other than that, it is a shame that we cannot thank Rhodri in person for his support to BMUS over the many years he has been involved. He has worked tirelessly on several committees, Council and, latterly, as a BMUS officer raising awareness of the need for the highest standards of medical ultrasound in the UK. He has represented BMUS and its inclusive membership to the benefit of the profession. Rhodri will still be an active member of the ultrasound scene, hopefully, for many years and will represent BMUS in EFSUMB for the next two years but we will miss him dearly as he leaves his current very active role. Big shoes to fill for sure. 

1. https://www.england.nhs.uk/cancer/early-diagnosis/
2. https://www.england.nhs.uk/2020/10/nhs-to-introduce-one-stop-shops-in-the-community-for-life-saving-checks/

Pamela Parker
BMUS President Elect

Development Officer Update

Despite all the challenges of 2020 the old adage ‘the show must go on’ still applies to us all including BMUS. Which means that behind the scenes in 2020, BMUS, RCR and SCoR have continued to lobby for progress on obtaining statutory regulation for sonographers.

Recently the Department for Health/Department for Business, Energy & Industrial Strategy have launched a consultation: ‘The Recognition of Professional Qualifications and Regulation of Professions: Call for Evidence’; regarding the need for professional regulation and is asking for input from individuals, institutions, employers and organisations.  BMUS have been working on a response for submission, working alongside the Member Organisations of CASE (Consortium for the Accreditation of Sonographic Education) and the CASE Chair, Heather Venables, to provide evidence from an educational accreditation stance. It feels as if we have reached a pivotal moment in the journey for recognition of sonographers. We must remain resolute in our determination and continue to provide all the evidence required.

Changing the subject….. New Guidance ALERT!

Managing incidental findings. All ultrasound practitioners are faced with quandaries in our daily scanning lists and some of these diagnostic dilemmas will often include what to recommend/do with regards to incidental findings. The Professional Standards Group and associated experts in their field have put together a document in order to aid in the development of local protocols which could advise recommendations for the patient pathway in cases of incidental findings. We hope you find it useful and informative. This document is available now online to BMUS members in the Professional Guidance section of the BMUS website.

Medical Ultrasound Awareness Month. MUAM! It has become a fixed occasion during October to recognise the contribution of ultrasound practitioners across the world. To promote and celebrate our passion for ultrasound. I hope you all have had a chance to do this. I’ve seen some interesting items across our profession during MUAM – including some fabulous cake baking!

Well I’d personally like to take the opportunity on behalf of BMUS to say a big THANK YOU to you all, especially for this year for your continuing passion for whichever field of ultrasound you represent and work in.

Catherine Kirkpatrick
BMUS Development Officer

Ultrasound in small animal veterinary care; is there a place for ‘sonographers’ in the multidisciplinary team?

An article written by David Woodmansey and featuring on the front page of the June 10th 2018 edition of Veterinary Times got me thinking about the role of Sonographers in animal care. The article discussed the ‘hub and spoke’ model of allied professionals and their clearly defined, close working relationship with vets across all sectors. Although Radiographers were not in the list of allied professionals mentioned in the article, there are quite a few working in CT, MRI and plain film imaging but I’m aware of only a handful of sonographers.

As it isn’t a protected title and to avoid any confusion, what I mean when I say sonographer is a registered healthcare professional (usually a radiographer) who has undertaken competency based, post graduate training in diagnostic ultrasound scanning in human medicine.

It’s true to say that I stumbled into small animal veterinary ultrasound at a time in my career when I was searching for greater professional challenges. An opportunity arose to extend my scope of practice to include small animal abdominal ultrasound in a busy veterinary specialist referral hospital and I jumped at the chance. I left my managerial role as Head of Ultrasound for a successful UK wide private imaging company and went swiftly over to the furry side of medicine.

Some of my former colleagues thought I had ‘lost the plot’ but most were thrilled for me and some even expressed a hint of jealousy!

Veterinary co-colleagues acknowledged my existing professional qualifications, skills and abilities but were surprised by the level of clinical knowledge and autonomous responsibility a sonographer in human medicine has. The specialist vets and, in particular, our Imaging Specialist (the NHS equivalent is a Consultant Radiologist) supported and guided me in to my new role.

At the start of this training I was faced with both expected and unexpected or rather, unforeseen challenges and some presented me with both positive and negative aspects which I had to reconcile and accept into my working practice. I have been working with ultrasound for 30 years and having to adapt and change my practice although never easy, is an essential aspect of working in a healthcare environment. I am living proof that you can teach an old dog new tricks!

The small animal abdominal ultrasound survey is more inclusive than a general abdominal scan performed in human diagnostics, where the assessment of upper abdominal and pelvic organs are considered, (in the main) to be separate examinations and are given a 20 minute appointment slot. Companion animal abdominal scans can take up to 45 minutes to perform and as well as the abdominal and pelvic organs it is normal practice to assess the gastrointestinal tract, the lympho-centres and the adrenal glands.

After scanning and reporting in much the same way for 30 years, the different terminology and anatomical variations took time to learn and it was no longer ‘second nature’.  Being patient with myself as I learned became a skill in itself and although I thought I would struggle with being a ‘student’ again, it was not nearly as difficult as I thought it would be.

Probably the most challenging ‘technical’ aspect I faced in human ultrasound is patient adiposity (the same breed, but oh so many different shapes and sizes). In my new role, this was replaced by a myriad of patient breeds and conformations.

Navigating the tiny organs of kittens and puppies with what seems like a giant-sized microconvex or linear probe or trying to assess a cranially sited liver and spleens in deep-chested dogs became the new norm.

A skill I didn’t expect to learn (but am so grateful I did) was clipping the abdomen – fast forward to my rather impressive attempt at my son’s lockdown hairdo! I cannot lie, there were occasions in my previous working life when grabbing a pair of hair clippers would have considerably reduced the volume of gel I needed to use, but I’m not sure I would have got away with it without a rather drastic alteration of NHS departmental protocols and consent process!

Another thing which would never get through clinical governance in the NHS is sedation for the majority of patients, but it makes for a much more compliant subject which in itself lends itself to an increase in sensitivity and specificity when scanning and reporting.

Knowing that obtaining informed consent was no longer my responsibility and not having to hide my expressions and wear my ‘poker face’ so as not to cause anxiety or face difficult questions from my patients have been definite advantages to working within the veterinary field.

My normal transducer ‘pencil grip’ had to be adapted to a ‘racquet grip’ on occasions, meaning my fine motor skills needed significant refining, particularly with the patient in a right lateral recumbency position and lying on my scanning arm, not something I had ever faced when scanning humans

To enhance and support my learning, I bought books and looked on line for tutorials. I found some very useful videos on the practical applications of scanning, but was surprised that there were no competency-based post-graduate veterinary ultrasound courses available, and I wondered how vets who wanted to become truly proficient in ultrasound training managed.  There are a multitude of expensive (in comparison to human ultrasound CPD/training) non-competency based on-line and day courses which convey very basic ultrasound system skills and technique tips to the non-expert operator but they didn’t meet my specific needs.

I attended an ‘advanced’ ultrasound course – but I came away concerned that after a day of scanning a compliant pet, attendees would leave feeling that they were now competent to take ultrasound back to their practice.  I am sure most of the attendees will have felt they had improved their skills by attending the course but without having a competency assessment using their own ultrasound machine, would they actually be able to translate what they learned into their own practice?

Ultrasound is the most operator dependent imaging modality and so, what is standard across all formal ultrasound training in the UK is the requirement for clinical competency assessments in every aspect of practice with regular audit for all grades of staff irrespective of their background or years of experience. Lectures and theory modules cannot teach the hand/eye/brain coordination which is vital in ultrasound.

It is inconceivable that someone could practice ultrasound without having undergone comprehensive assessment in their actual ability to scan, and it is standard practice when employing a sonographer that they be assessed very early in their probation period (and certainly prior to scanning autonomously), irrespective of where they have trained or worked previously. This helps to ensure that their standards and competencies match the role requirements.

Those involved in diagnostic medical ultrasound understand and acknowledge that UK-trained sonographers are highly skilled advanced practitioners with an autonomy that could not have been predicted 30 years ago. We are clinically, legally and personally responsible for our ultrasound interpretation and written reports. Some sonographers have become consultant practitioners, performing biopsies and FNAs, doing joint injections or undertaking amniocentesis.

In some ways, moving from human to animal ultrasound could be seen as a backward step because, in line with the Veterinary Act 1966¹ I can no longer write diagnostic reports but actually, not having that pressure and the ‘what if I was wrong’ thoughts that diagnostic sonographers constantly carry with them is actually quite nice.

Is there a place for sonographers in the veterinary world?

I can only speak from my own experiences in small animal care but I believe that there is a place for sonographers to move into veterinary ultrasound and the benefits go both ways:

Sonographers:

The UK has a national shortage of sonographers with many having to leave the profession early due to work related injuries, the number of patients on a daily list and the ever-increasing prevalence of obesity take their toll on our bodies, particularly the upper limb and spine.

It isn’t just physical injury that causes sonographers to leave, the increased risk of litigation, particularly in obstetric scanning and the psychological impact of having to deliver bad news all have a part to play (autonomy has its downsides) in a sonographer’s professional decisions.

Whilst I would not want to take a sonographer from the NHS, surely it is better that their skills are not lost completely? Perhaps having the ability to spend a day or two a week in veterinary ultrasound might mean they are able to continue with the physical and mental demands of the rest of their working week in the NHS?

Veterinary Practice:

Having a competent sonographer in a practice or hospital means that ultrasound can be the first line of imaging for many cases which might otherwise be referred on to a specialist hospital for imaging modalities which are not available in first opinion practice. This may result in a considerable financial saving for pet owners but there is also the time saving aspect for the practice and indeed where timing is critical e.g. in AFAST or TFAST scanning a focussed ‘yes/no’ scan can be the difference between a much-loved pet living or dying.  

Sonographers can help veterinary colleagues get the best out of the ultrasound machine controls and can provide training and support to those vets who wish to provide a more comprehensive service but who do not have access to Imaging Specialists with the time to teach them. This leads to an increased confidence in scanning and more confidence when making a diagnosis.

Given that there is no competency-based stand-alone post graduate ultrasound qualification and the teaching of ultrasound in undergraduate vet schools is very limited, it would seem that there is not only scope for sonographers working in both first opinion and specialist centres but that there is also a need for a training programme for vets.

Veterinary specialist imaging training is robust and well executed but there is a shortage of Imaging Specialists. Their workload is intense and with the ever-increasing need for multi-modality imaging, there is the risk that those Specialists in practice could become overburdened.

Ultrasound is not only used in supporting diagnoses but is also extremely useful in the assessment of treatment regimes and disease progression. Having clear scanning protocols and standardised reporting formats means that processes can be benchmarked, monitored and audited.

There are currently no veterinary ultrasound scanning and report writing standards or guidelines. However, these have been developed in human ultrasound and they support any professional who has been appropriately trained to follow nationally recognised, evidence-based protocols and work within their scope of practice.

The documents listed are examples of seminal works and their use has contributed significantly to the safety of both patients and users.

• The British Medical Ultrasound Society and Society and College of Radiographers Guidelines for Professional Ultrasound Practice²
• Public Health England; ‘Fetal anomaly screening: ultrasound practitioner’s handbook’³
• The Royal College of Radiologists; ‘Standards for the Provision of an Ultrasound Service’⁴

In 2008, The National Ultrasound Steering Group⁵, a sub-group of the National Imaging Board recommended the establishment of Clinical Governance Boards for all providers of ultrasound services because the proliferation of equipment outside traditional imaging departments saw non radiology clinicians scanning patients without training or governance and this in turn saw in an increase in untoward incidents. It became mandatory for clinicians such as those working in Obstetrics and Gynaecology, Urology and Anaesthetics to undergo a period of formalised ultrasound training as part of their studies.

The availability of inexpensive ultrasound machines means that many, if not all, first opinion surgeries will have one in the corner of a room somewhere. Some will be used regularly, some not so often but the lack of any competency-based training means that many users will not be getting the best out of their machine. As happened in medicine, perhaps there is a need to move towards including ultrasound competency as part of undergraduate training.

Recently a small cohort of first opinion vets participated in a five day focussed course in abdominal ultrasound scanning with lectures, hands on clinical training and a competency assessment. On returning to their own practice, they were supported remotely by the lecturers in optimising their own equipment and sonographers then went out to the clinics to support and assess the ‘students’ ensuring that the objectives of the training course had been met and the vets felt confident in their new found skills.

The course was very well received and all vets reported using ultrasound more in their practice and with much improved confidence in their ability to scan and diagnose.

In addition to the vet course, I have recently trained a number of veterinary nurses to undertake AFAST and TFAST scans – a very precise protocol is in place in our specialist hospital with these nurses completing their FAST scan report in a YES/NO, present/absent format. The nurses are not diagnosing but they are using ultrasound to identify any free fluid to help with the management of critical or clinically urgent cases. If urgent intervention is required, there is no time wasted in treating the animal.  Nurses from other surgeries have reported that on returning to their place of work, they were able to improve the optimisation of their own equipment and had become the ‘go to’ person for ultrasound related issues, with one nurse reporting how she had helped the vet to confidently confirm the presence of a gallbladder mucocoele in one urgent case.

What next??

I am about to start training another diagnostic sonographer in companion animal ultrasound. She has extensive ultrasound experience but has had to move away from human scanning because of upper limb and spine issues. We are hoping that the move from the heavy workload of scanning 24 patients in a day will not see an exacerbation of her symptoms so we can prove to other sonographers that veterinary work is a way for them to continue working in the modality they love. She knows she is a ‘project’ but is excited at the prospect of a new challenge!

Once she is ‘up and running’ and has passed all the required competencies, she will then be in a position to support vets in their own places of work and perhaps we can also create a cohort of sonographers UK wide who can help to take some pressure off services where there is difficulty in recruiting Imaging Specialists.

Perhaps my dreams of sonographers becoming part of the multidisciplinary workforce in veterinary care is moving closer.

Further Reading;

1. The Veterinary Act 1966 can be found at http://www.legislation.gov.uk/
2. The Royal College of Radiologists, Standards for the Provision of an Ultrasound Service (2014). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/443865/FASP_ultrasound_handbook_July_2015_090715.pdf
3. The British Medical Ultrasound Society and Society and College of Radiographers Guidelines for Professional Ultrasound Practice (December 2019). https://www.bmus.org/policies-statements-guidelines/professional-guidance/guidelines-for-professional-ultrasound-practice/
4. Public Health England, Fetal anomaly screening: ultrasound practitioner’s handbook, (April 2015). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/443865/FASP_ultrasound_handbook_July_2015_090715.pdf
5. The National Ultrasound Steering Group, Ultrasound Clinical Governance (October 2008). Can be found at; https://www.bmus.org/static/uploads/resources/ClinicalGovernanceInUltrasound-061108.pdf
6. The Consortium for the Accreditation of Sonographic Education (CASE) can be found at http://www.case-uk.org/handbook/

Angie Lloyd-Jones DCR DMU
Diagnostic Medical and Small Animal Veterinary Sonographer
Currently working at Northwest Veterinary Specialists, Sutton Weaver, Cheshire

2020 Annual General Meeting

In the Summer edition of the Newsletter, we advised on the plans to hold the Annual General Meeting (AGM) during a meeting of the S&E Committee, with the AGM being live streamed to allow as many members to attend as possible.

Unfortunately, due to the increase in COVID-19 cases, and restrictions being set down by government, the November S&E Committee meeting has been cancelled and will now be held virtually.

This change presented us with a difficulty in respect of the AGM as BMUS’s governing document states both ‘place’ and ‘present’ which are legally taken to mean, a physical meeting at a predefined place with physical attendees in place.

Fortunately, despite the restrictions in BMUS’s governing document, it has been made possible by a government amendment to the ‘Corporate Insolvency and Governance Act 2020’, which enables Charitable companies and Charitable Incorporated Organisations (CIOs) to hold their AGMs and other members’ meetings online during the Coronavirus pandemic.  At present this extension has been put in place until 30 December 2020, with the possibility of being extended further.

As such BMUS now plan to hold the AGM virtually before the end of 2020, and you will receive written details on how you can join the meeting in due course.  Please note that during the meeting we will be asking for permission from members to change how our AGM is held in the future, so that if there are further reasons why the AGM cannot be held as a Face to Face meeting that the meeting can still go ahead within the correct timescale.

We do hope that you will be able to join us online.

Joy Whyte
Executive Officer