Q: How can I become a sonographer?
A: We recommend a well-rounded cardiac sonography program that meets both didactic and clinical instruction and is accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), through the Joint Review Committee in Cardiovascular Technology (JRC-CVT) and the Joint Review Committee in Diagnostic Medical Sonography (JRC-DMS). Echocardiography or Cardiac Sonography is covered through two allied health care disciplines which are Diagnostic Medical Sonography and Cardiovascular Technology.
These programs can be found by visiting the education section of our Website where you can review programs that are accredited by CAAHEP or by visiting their site at www.caahep.org. There is also information on schools under the “Sonographers” link on our Website. By attending a program accredited by CAAHEP, you will be eligible to apply to take the national certification examinations offered by the ARDMS and/ or CCI upon graduation from the program. By successfully completing the certification exams, you will be awarded a credential of ‘registered’ in that field. Increasingly, employers require their sonographers to become registered or hire only registered sonographers.
Q: How do I become a registered sonographer?
A: There are several types of registry organizations and the type of training you choose can affect what you need to do to be able to take the certification examinations.
ARDMS (American Registry of Diagnostic Medical Sonographers) administers examinations and awards credentials including the areas of diagnostic ical sonography, diagnostic cardiac sonography and vascular technology. Contact the American Registry of Diagnostic Medical Sonographers (ARDMS) athttp://www.ardms.org or 1-800-541-9754. ARDMS offers four different credentials:
- RDMS® Registered Diagnostic Medical Sonographer®
- RDCS® Registered Diagnostic Cardiac Sonographer®
- RVT® Registered Vascular Technologist®
- RPVI® Registered Physicians Vascular Interpretation®
The Cardiovascular Credentialing International (CCI) administers examinations and awards credentials in the field of cardiovascular technology, including the areas of vascular technology and diagnostic cardiac sonography. Contact CCI at http://www.cci-online.org or (800) 326-0268. They offer the following credentials:
- RCIS: Registered Cardiovascular Invasive Specialist
- RCS: Registered Cardiac Sonographer
- RVS: Registered Vascular Specialist
- CCT: Certified Cardiographic Technician
Q. Have the duties of sonographers changed in recent years?
A: The duties of sonographers have evolved over the years as advances in echocardiography bring new tools to cardiovascular ultrasound. Three-dimensional echocardiography (3D) and cardiac mechanics (strain, torsion) continue to gain wider acceptance, requiring sonographers to learn new imaging modalities and gain a new understanding of cardiovascular ultrasound. Interventional procedures such as percutaneous valve replacement/repair and left atrial appendage occlusion have shifted the role of the sonographer from the traditional clinic or hospital inpatient floors to the catheterization laboratory and hybrid operating room suite.
Q: Will the education level needed to practice cardiovascular sonographers change in the near future?
A: The current infrastructure in terms of education for supplying technologists to the field seems to be adequate. There is an initiative underway that will create a new career ladder (the Advanced Cardiovascular Sonographer – ACS) for sonographers that will provide senior sonographers with an additional opportunity for advancement. The impact of the ACS program on the field of cardiovascular ultrasound has not yet been determined, as the program is in its infancy and no programs have begun to enroll students yet.
Q: How common is licensure or certification?
A: Only two states have passed legislation requiring licensure. They are New Mexico and Oregon. Oregon has implemented their legislation, and sonographers in that state are required to be licensed. New Mexico has passed the legislation, but has not yet implemented it.
In the cardiovascular ultrasound field “certification” is achieved through the passing of a credentialing examination administered by either Cardiovascular Credentialing International (CCI) or the American Registry of Diagnostic Medical Sonographers (ARDMS). Sonographers who pass these examinations are called “registered” technologists. We do not use the term certified. There is no requirement that a technologist be registered to be employed; however, almost every employer hiring a sonographer either includes being registered as a requirement for employment, or requires that newly graduated sonographers become registered within 12-24 months as a contingency of employment.
At the national level there has been an effort to develop national standards for education and credentialing in medical imaging. The CARE Bill (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy) has yet to be passed, despite enormous efforts by the medical imaging community. To date there are no legislated national standards for education and credentialing.
Q: What traits are important for a sonographer to be successful on the job?
A: Flexibility – a sonographer has to be able to work in any aspect of cardiovascular ultrasound;
Enthusiasm – the cardiovascular ultrasound field is constantly evolving, and sonographers have to be eager to learn new modalities and new uses of ultrasound;
Confidence – sonographers are often alone when acquiring images and have to be confident in what they are seeing and able to tailor their exams for the various pathologies they encounter.
Q: What impact will the ACA have on cardiovascular sonographers?
A: Nationwide there has been a drop in volumes or number of procedures being performed. This drop is due to many factors, and the Accountable Care Act is one. Other factors include an increased emphasis on Appropriate Use Criteria, the Choosing Wisely Program, and changes in reimbursement by insurance companies.
Q: How does the supply of sonographers compare with the demand for them?
A: Five to seven years ago there was a sonographer shortage, and sonographers could pick and choose the jobs they wanted. In response to the shortage, schools opened new training programs and began bringing so many techs into the field that the pendulum has now shifted the other way. These days there may be 15-20 applicants for a job posting. Changes in health care have also decreased the number of sonographers needed to meet the demand. These factors have combined to make it very challenging for sonographers, especially new sonographers, to find employment.
Q: Need Career Presentation Materials for Students?
A: If you are asked to talk about your Sonography career at a school, college or club, ASE can provide you with free “Careers in Non-Invasive Cardiovascular Sonography” guides to hand out to your audience. These informative flyers contain information on the profession, nature of the work, opportunities for jobs, training and salary ranges. Contact ASE’s Marketing Manager at firstname.lastname@example.org for more information or to order.
Q: What is the Scope of Practice for Sonographers?
A: Click here to view the Scope of Practice for Sonographers
The following organizations participated in the development of this document. Those organizations that have formally endorsed the document are identified with the “†” symbol. Supporting organizations are identified with the “*” symbol.
• American College of Radiology (ACR)
• American Congress of Obstetricians and Gynecologists (ACOG)*
• American Institute of Ultrasound in Medicine (AIUM)
• American Registry for Diagnostic Medical Sonography (ARDMS)
• American Registry of Radiologic Technologists (ARRT)
• American Society of Echocardiography(ASE)†
• American Society of Radiologic Technologists(ASRT)
• Cardiovascular Credentialing International (CCI)
• Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-‐DMS)
• Joint Review Committee on Education in Cardiovascular Technology (JRC-‐CVT)
• Society of Diagnostic Medical Sonography (SDMS)†
• Society of Radiologists in Ultrasound (SRU)
• Society for Maternal-‐Fetal Medicine (SMFM)
• Society for Vascular Surgery (SVS)†
• Society for Vascular Ultrasound (SVU)†
• Sonography Canada (formerly the Canadian Society of Diagnostic Medical Sonography)
Q: What is ASE’s position on preliminary reporting by sonographers?
A: A cardiac sonographer must be skilled in interacting with patients, which involves explaining the procedure to the patient but not discussing the clinical findings of the examination. We have two documents that address this issue: “Guidelines for Cardiac Sonographer Education” and “Interpretation of Echocardiographic Data: Are Physicians and Sonographers Violating the Law?“.
Q: Can you give me information on sonographer salaries?
A: The ASE 2010 Salary Survey indicates the average hourly wage is $34.05. The field is also seeing an increase in signing bonuses. Many employers are also offering tuition assistance and loan forgiveness to graduating students in exchange for employment agreements with those students. Beyond the financial rewards, there are many other attractions of this dynamic field. Flexibility and mobility are key benefits of this career. So are hands-on patient interactions and opportunities to work with leading-edge technologies. Sonographers also have the opportunity to specialize — to migrate to the area of ultrasound that most intrigues them. Sonographers can work with all stages of life- fetal, children, adults and the elderly. Opportunities to cross-train, to advance into supervisory or management roles, and to teach or do research are also within reach in this exciting field.
Q: Are there licensure requirements for sonographers?
A: Regulation of echocardiography is coming. Two states, Oregon and New Mexico, now require licensure for sonographers and more states are expected to follow their lead. In general, credentialing by CCI or ARDMS is a requirement for sonographers wishing to be licensed. Medicare requires that studies be perfor by a registered technologist or under direct supervision of a registered technologist in vascular labs. Echocardiography registry requirements are also needed in several states for performing stress echoes. Visit ASE’s Advocacy page for more details.
Q: Is there Liability Insurance available for sonographers?
A: ASE recognizes that as the field of cardiovascular ultrasound continues to advance, new diagnostic tools and treatment options have the potential to create liability challenges for practitioners. The reality is that healthcare professionals, cardiovascular sonographers and nurses are as susceptible to being sued as any other healthcare provider. Therefore, ASE believes it is important for our members to have adequate protection against the cost and consequences of a potential negligence claim with individual professional liability insurance. That’s why we are pleased to inform our members about the opportunity to secure an ASE-Endorsed Professional Liability Insurance Program.
Q: Where can I find employment?
A: Visit ASE’s Marketplace to post jobs and resumes and find employments.
Q: Are there standards of case loads for cardiac sonographers?
A: There have been a few surveys over the past few years which gathered data on the average number of cases sonographers would perform in a day. The data from the 2010 ASE survey showed that the number of scans varied per day, though the majority of sonographers perfor more than 6 scans per day. The most frequently reported number of scans was 8 per day. The average per day in a hospital setting was 6. Please note that the number of pediatric studies is lower. Other surveys we have come across also validate the ASE survey results. The only true “standard” which exists is the IAC lab accreditation standards. The ASE, as a sponsoring organization, supports those standards as good practice to maintain quality. These standards suggest allowing a minimum of 45-60 minutes for an uncomplicated transthoracic case, and possibly another 15 – 30 minutes for a complicated case. This standard would fall into line with the benchmark data survey results of the most common number of studies per day at 8-10. The other issue to not leave out of any discussion of number of cases per day is the physical effects of scanning too many patients per day. Many well known speakers on the subject of musculoskeletal injury in scanning recently quote statistics of a dramatic increase in the incidence of injury when sonographers perform more than 10 studies per day. One other suggestion to make in comparing case volumes, is to look to other neighboring or regional labs to see what they are doing. This benchmark data can offer a lot of relevant information.
Q: Is there a state specific scope of practice or by-laws for Cardiac Sonographers?
A: The ACC/AHA have scope of practice for physicians involved in echo. The ASE has written documents on scope of practice for sonographers over the years. ASE has just published a minimum standards document for the cardiac sonographer which addresses many of these issues (click here to download a pdf of this document). Historically, sonographers were once designated as technicians or “one who is a specialist in the practical knowledge and technical details of ultrasound” and often received only on-the-job training. This traditional career pathway for sonographers has now evolved today into a requirement of training through a formal cardiac ultrasound program, obtaining a recognized credential through a certification examination, association with professional societies, and continued ical education by attendance at local/regional or national meetings. There are also legal restraints on the practice of icine without a license and the practice of cardiac sonography must take these in consideration.
Q: Does ASE have a policy regarding degradation of echo images and the possible conversion of echo video images?
A: The ASE does not have an official policy on videotape enhancement, or have any specific vendors that it would recommend for either of these 2 processes. Unfortunately, videotape images degrade over a number of years and often very quickly the more the image has been played. It may be legally dangerous to use methods to enhance those images. Check with your own medical records department before changing anything about the image. Often in legal cases the attorneys for both parties want the “original” video, so a copy or a reproduced enhanced copy which has been enhanced may not be appropriate. Certainly there are vendors and solutions that will improve the quality of older videotape. The legal and law enforcement industries perform video enhancement so there is a possibility that healthcare may do the same. As for taking your previously recorded videotaped echo images and converting them to a digital storage file, there are echo labs that looked for help in this from the ultrasound manufacturers and the digital echo reporting vendors. Many labs work with digital echo vendors (i.e. GE, Philips, Siemens, Heartlab, Digisonics, etc) to work on retrospective image conversion. This is a very labor intensive task and consequently has some significant costs. Again it may be legally dangerous to take originally captured medical images and converting them. There aren’t a lot of vendors that recommend this because labs still need to maintain the original copy, and the possibility of being able to simultaneously display a converted image within a new digital storage system is often not possible.
Q: How long should an echocardiographic study take ?
A: The CQI document from 1995 recommends 45 to 60 minutes from patient encounter to departure for a good-quality, uncomplicated exam. The only true “standard” which exists is the IAC lab accreditation standards. The ASE, as a sponsoring organization, supports those standards as good practice to maintain quality. These standards suggest allowing a minimum of 45-60 minutes for an uncomplicated transthoracic case, and possibly another 15 – 30 minutes for a complicated case. This standard would fall into line with the benchmark data survey results of the most common number of studies per day at 8-10. The other issue to not leave out of any discussion of number of cases per day is the physical effects of scanning too many patients per day. Many well known speakers on the subject of musculoskeletal injury in scanning recently quote statistics of a dramatic increase in the incidence of injury when sonographers perform more than 10 studies per day. One other suggestion to make in comparing case volumes, is to look to other neighboring or regional labs to see what they are doing. This benchmark data can offer a lot of relevant information.
Q: At my office we had a patient who came in with left chest pain. Performed the echo, did not complain of any pain during the exam except for when the tech was starting the apical view and she said it hurts right around that area. Everything was fine during and after the exam. 8 days later she calls our office and states that the tech ruptured her breast implant. Have you ever heard of this?
A: I was just involved with an ASE project with many sonographers from across the country and this issue was discussed. First question – was the integrity of the implant compromised from something other than the echo? We agreed that everyone does not apply the same pressure, some more than others, but what type of force does it take to rupture an implant? I spoke with a plastic surgeon. The plastic surgeon stated that the encasement is thick “plastic” that needs a great amount of force to rupture. He stated force such as blunt force trauma or air bag deployment. He asked about the age of the implant, date of insertion, etc. of which I had no idea. He stated that if a rupture occurred, the noticeable difference in formation would be noted immediately. Deformation of breast, i.e. would be smaller, lopsided, sagging, is quite apparent.