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The Sonographer Practitioner and Advanced Practice Sonographer

To the Editor: The Journal of Ultrasound in Medicine recently published 2 editorials about the responsibilities of diagnostic medical sonographers.1,2 It is unfortunate that neither editorial listed references to prior publications in this area (despite the disclaimer, “We are unaware of prior articles that have discussed physician extenders in sonography”1), particularly because sonographers took the lead in this area years ago; in fact, the Society of Diagnostic Medical Sonography (SDMS) has established the Advanced Practice Sonographer (APS), has rigorous criteria, and has a trademark on the title. A simple search of the SDMS Web pages (http://www.SDMS.org) for “APS” or “practitioner” will bring up several such references, and even a Google search will bring them up (see http://www.sdms.org/membership/aps.asp, http://www.sdms.org/career/upinfo.asp, http://www.sdms.org/pdf/jdmsup.pdf, and http://www.sdms.org/pdf/UP2001.pdf). Regardless of the history, it is gratifying to see editorials in such a prestigious journal as the Journal of Ultrasound in Medicine recognizing the responsibility of experienced sonographers. It was even more gratifying that the sonographic luminary Beryl Benacerraf, MD, had the good breeding to include her APS as a coauthor. These editorials recognize what has been stated by others since the early 1980s, such as a letter by Kenneth Taylor, MD, PhD, of Yale University School of Medicine, which appeared in the November/December 1982 issue of the SDMS newsletter: “There is a very important difference between sonographers and other imaging technologists. Other technologists may reject an image because of suboptimal technical quality, but the sonographer usually rejects over 95% of the scans because they do not provide the diagnosis. The sonographer must make the diagnosis and be able to interpret the scan to document the presence of any abnormalities. This is the unique responsibility of the sonographer.” Another such statement that recognized the responsibility of sonographers was this one by earlier luminaries: “Many ultrasound examinations are performed by technologist [sic] when a physician is not present, and a report is issued by a physician at a later time. The legal responsibilities are extraordinary because a necessary part of care may involve rendering an interpretation at the time the study is performed, especially if real-time instrumentation is used. This differs from the relative roles of technologists and physicians in other imaging disciplines.”3 Still another expert stated, “It is embarrassing to me as a sonologist and greatly to the credit of sonographers that they have taken the lead on qualifying examinations. The American Registry of Diagnostic Medical Sonographers conducts a comprehensive examination that, in my opinion, would be failed dismally by many physicians who ‘practice’ sonology.”4 So it must be acknowledged that sonographers have had these extraordinary responsibilities for well over 25 years—indeed, since the inception of diagnostic sonography. It is great that we are finally being recognized as the professionals that we have always been. All of this brings up several questions for sonographic professionals and educators: 1. Does the APS or sonographer practitioner (SP) designation need to be formalized? One of the editorials mentioned that, “There is now a clear pathway for professional advancement by senior sonographers.”1 How do sonographers decide to follow this career ladder or advancement pathway? Must they wait for a physician (any physician?) to bestow it on them? It is obvious to many experienced sonographers that having a multitude of degrees does not necessarily mean that one understands or has the psychomotor skills to scan well; it is a very experiential, operator-dependent modality. This is particularly true in large institutions in which there is a plethora of various types of sonographic machines. One must be intimately familiar with the equipment, or it becomes a barrier between the operator and the patient; an operator who has the skills and is most familiar with the machine will elicit the best diagnostic images from it most efficiently. Letters to the Editor