1. Surgeon-Performed
Ultrasound
Privileges, Competency and
Practice
The Results of an ACS Survey
Grace S. Rozycki, MD, RDMS, FACS
Vice Chair, Technology/Research
ACS Executive Committee
National Ultrasound Faculty

2. Scanning the Future
As an extension of the
physical examination,
ultrasound is a diagnostic tool:
• Solve clinical problems
• Contribute to the
intraoperative
management of their patients

3. Scanning the Future
Introduction
Ultrasound is not a “conventional” part of
surgical practice
therefore
Questions are raised about the surgeon’s
education, training, privileges, and
competency in this modality

4. Scanning the Future
Introduction
Purpose of survey:
To ascertain information from surgeons
about ultrasound as it relates to
education (training), privileges,
competency, and practice

5. Scanning the Future
Methods
Survey: Mailed to 1,791 surgeons
Surgeons: Participated in an ACS
Ultrasound Course(s)
Period: 1998-2000

6. Scanning the Future
Methods
Questions 6-12:
# FOCUS OF QUESTION
6 Number of ultrasound examinations
performed before competent
7 Type and # of US-guided
procedures/month
8 Number of procedures performed before
competent

7. Scanning the Future
Methods
# FOCUS OF QUESTION
9 Which company manufactured your
ultrasound machine?
10 Where was the ultrasound machine
located?
11 In which areas were you restricted form
performing ultrasound?
12 If not performing ultrasound, why?

8. Scanning the Future
Methods
Competent:
Ability to perform an ultrasound
examination/procedure so that other
diagnostic tests were not needed to
confirm the result.
Clinical area (relative to ultrasound):
Abdominal, Acute Setting, Breast,
Endoluminal, Head/Neck,
Intraoperative/Laparoscopic, Vascular

9. Scanning the Future
Methods
Statistics:
Statistical analysis of categorical
data was performed using SAS
and
categorical variables were
analyzed using Chi Square test.

10. Scanning the Future
1,791 Surveys
873 Surgeons
576 did US 297 did not do US
(66%) (34%)
267 = 1 area 309 > 1 area

11. Scanning the Future
Results
Ultrasound in 1 clinical area
AREA # OF SURGEONS
Breast 142 (53.2%) Early
Acute 59 (10.4%) courses
Vascular 27 (4.8%) Later
Intraop/Lap 16 (2.8%) courses
Endoluminal 14 (2.5%)
Head/Neck 5 (0.9%)
Abdominal 4 (0.7%)
TOTAL = 267 (100%)

12. Scanning the Future
Results
Ultrasound in 1 clinical area
AREA # OF SURGEONS
Breast 142 (53.2%) Early
Acute 59 (10.4%) courses
Vascular 27 (4.8%) Later
Intraop/Lap 16 (2.8%) courses
Endoluminal 14 (2.5%)
Head/Neck 5 (0.9%)
Abdominal 4 (0.7%)
TOTAL = 267 (100%)

13. Scanning the Future
Results
Assessment of Competency:
576 Surgeons
267 = 1 area 309 > 1 area
Statistical comparison showed no difference (p >0.6)

14. Scanning the Future
Results
Clinical area
Breast
Acute Setting
Vascular
Intraop/Laparoscopic
Endoluminal
Head/Neck
Abdominal

15. Scanning the Future
Results
Competence by clinical area
AREA # EXAMINATIONS
MOST AREAS 1-20 (11-20)
*ACUTE 21-30
SETTING

16. Scanning the Future
Results
Competency:
Ultrasound-guided procedures
576 Surgeons
267 = 1 area 309 > 1 area
Statistical comparison showed no difference (p >0.6), except
for breast ultrasound-guided procedures (p <0.04),
competent after performing about 10 examinations

17. Scanning the Future
Results
Access of Equipment
580 Surgeons
576 do US 4 do not do US
Access to 1,175 ultrasound machines
(2 machines/surgeon)
78% owned similar machines as used in the ACS courses

18. Scanning the Future
Results
Locations of Ultrasound Machines
AREA # OF MACHINESS
Office 444 (38%) Breast
Operating Room 306 (26%)
Emergency Dept. 219 (19%) Acute
Radiology Dept. 108 ( 8.9%)
Laboratory 52 (4.3%)
Other 46 (3.8)
TOTAL = 1,175 (100%)

19. Scanning the Future
Results
576 surgeons
386 restricted (67%)
Where?
Radiology = 55.4%
Office = 4.7%

20. Scanning the Future
Conclusions
1. Surgeons successfully use
ultrasound and
more than half do so
in several clinical areas.
2. Many surgeons perform
ultrasound-guided procedures,
most commonly breast.

21. Scanning the Future
Conclusions
3. In general, surgeons report
competency with < 20
ultrasound examinations in
most clinical areas, except
Acute Setting
Note: No difference if they performed ultrasound
in >1 clinical area.

22. Scanning the Future
“Acute Setting” Ultrasound Changes
1997: Trauma-related examinations
Hemopericardium
Hemoperitoneum
Hemothorax

23. Scanning the Future
“Acute Setting” Ultrasound Changes
2000:
Trauma/Critical Care/Acute Gen. Surg.
Hemopericardium Sternal Fracture
Cholelithiasis
Hemoperitoneum + AAA
DVT
Hemothorax
Pneumothorax

25. Scanning the Future
Conclusions
4. Surgeons have access
to ultrasound machines in all
patient care areas but,
especially in the office and
the operating room.

26. Scanning the Future
Conclusions
5. There is widespread use of
ultrasound by surgeons
but, they are still restricted
from using it in some
patient care areas

27. Scanning the Future
Discussion
AIUM recommends:
interpretation of 300 abdominal/general
examinations
But!
Not applicable to surgeons because:
!Surgeon has direct clinical contact with the patient.
!Anatomy is enhanced by operative experience.
!Examinations are focused: ask question/get answer.
!Surgeons perform and interpret the examinations.

28. Scanning the Future
Discussion
Ownership of an ultrasound machine
+
the surgeon’s inquisitive mind:
“How can I use ultrasound to help my patient?”
!Encourages new uses of ultrasound
!Portability allows access to all areas
of patient care
No department or specialty has ownership
of this technology!

29. Scanning the Future
Discussion
The performance and
interpretation of the examination
with integration
into the patient’s clinical picture
underscore the need for the
ultrasound examination to be
performed by the surgeon who is
caring for the patient.

30. Scanning the Future
Recommendations
for scanning the future…
Expert surgeon-sonographers
develop guidelines
for competency in the each of
the clinical areas

31. Scanning the Future
Recommendations
for scanning the future…
The American College of
Surgeons
continue to be a major
educational resource for
surgeons interested in
learning ultrasound