By Dr Owen Doran – FACEM, AED lead for ultrasound
Credentialing for bedside ultrasound is essential for the safe and trusted use of ultrasound by Emergency doctors. The ACEM provides guidance for credentialing a practitioner to become an Emergency Medicine Sonologist, and policies can be found on the college website:
This involves attending a course and performing a minimum number of proctored, documented and acceptable exams in that module, of which at least 50% are indicated and 5 are positive for pathology.
- 15 for AAA
- 25 for other modules
- Basic echo module also requires you to view 25 echocardiograms on ‘file’, some with demonstrated pathology.
You also have to pass an ‘exit exam’ per ACEM & ASUM guidelines, which consists of performing a focused scan on a patient/volunteer while observed by an examiner (radiologist, ultrasonographer or previously accredited EM sonologist).
Each individual department is responsible for adopting and implementing this process.
In practical terms, this usually means a member of the specialist team is identified as the ultrasound champion for the department, and they help to coordinate this process.
Scans can be reviewed realtime, with direct supervision, or more commonly with a review of images. To have reviewed images accepted, they have to be of good quality, with labelling and patient information complete, and a confirmatory imaging or treatment modality must be available. This can be departmental ultrasound, CT or operative findings. The fact that a patient went home and did not come to further harm is not enough.
The easiest way is to keep a log of your scans- I have given an example of this below. This can be done as paper copy, or computer file. I have given an example of a file that might be compiled for review of a FAST scan below:
FAST images and correlating CT report: