Chapter 1 Notes: The Sonography Profession

Key Terms

  • Accreditation
  • Credential
  • Certification
  • Licensure
  • Scope of Practice
  • Profession
  • Professional
  • Professionalism

The Sonography Profession: Overview

  • The profession includes two groups: sonographers and sonologists.
    • Sonographers: health care professionals educated to use imaging equipment, soundwaves, and echoes to acquire and evaluate sonograms; decide when sufficient imaging data is recorded.
    • Sonologists: physicians who interpret the sonograms.
  • Sonograms: the recorded images of the sonography examination.
  • Objective of this chapter: define profession, track the profession’s evolution, understand accreditation/credentialing/licensure, explore scopes of practice, and recognize the role of the sonographer in health care.

Important Definitions and Distinctions

  • Profession vs Occupation:
    • Profession: a group of disciplined individuals who adhere to ethical standards.
    • Occupation: a limited definition referring to the activity the professional performs for compensation; not synonymous with profession.
    • A profession comprises individuals who have completed specialized academic courses and clinical scanning competencies in educational, clinical, or research environments; graduates must be competent to meet profession criteria.
  • Professional: a member of a profession who follows codes of conduct, ethics, standards, and guidelines; accountable to those served and to society; recognized for specialized knowledge, ongoing currency of knowledge, and perceived competence.
  • Professional behavior depends on aptitudes, attributes, and attitudes; professionals should evaluate how these affect behavior and competency; professional standards can be enhanced through routine evaluation of these elements.
  • Professionalism is rooted in the profession and its standards; it is about how an exam is completed, not just the completion of the exam.
  • Professionalism involves aligning aptitudes, attributes, and attitudes to enhance behavior and practice; practice methods reflect professionalism and uphold the profession’s principles.

The Sonography Legacy: Evolution of a Profession

  • ASUTS origins and early leadership:
    • In 1969, Joan Baker, Marilyn Ball, Margaret Byme, James Dennon, Raylene Husak, and L. E. Schnitzer proposed forming the American Society of Ultrasound Technical Specialists (ASUTS) to reach those performing ultrasound procedures.
    • AIUM board initially skeptical; ASUTS debuted in 1970 at AIUM’s Annual Conference in Cleveland with 187 registrants (plus 12 exhibitors and 13 technical specialists).
  • Governance and expansion:
    • After constitution/bylaws, ASUTS elected an 11-member Board of Directors for 2-year terms; Baker became the first president; 6 regional directors represented the six North American regions.
    • From 1969 to 1974, ASUTS pursued collaboration with other organizations to set goals and pathways.
  • Naming and acceptance:
    • ASUTS leadership recognized that the term “technical specialist” was not well received; Baker proposed “sonography” to align with the British term for imaging with sound.
    • ASUTS was formed in 1969, created in 1970, incorporated in 1972.
    • Official name changed to the Society of Diagnostic Medical Sonographers (SDMS) on September 16, 1980.
  • Name change to reflect profession (2016):
    • To be more inclusive of changes in the field, the name changed to the Society of Diagnostic Medical Sonography (SDMS) in 2016 to emphasize the profession’s scope beyond individual sonographers.
  • Creating the occupation (to protect the field):
    • Leaders concluded that a separate occupation in diagnostic medical sonography was essential to prevent the field from fragmenting or being subsumed by other occupations.
    • Rationale: avoid the loss of diagnostic ultrasound to other occupations and ensure proper prerequisites education in ultrasound.
  • Early external challenges to creating the occupation:
    • AMA’s Manpower Division contemplated disbanding, risking delay in establishing a new occupation.
    • US Office of Education (USOE) discouraged proliferation of allied health occupations, preferring ultrasound to be incorporated under existing occupations.
    • Dr. Gil Baum (AIUM President) helped persuade the Manpower Division to engage ASUTS, leading to the creation of the occupation in 1973.
  • Essentials for accreditation and credentialing foundations:
    • The AMA’s Allied Health collaboration to develop a Document of Essentials for programmatic accreditation and written/practice examinations.
    • Nine tasks established to lay the groundwork for programmatic accreditation and credentialing examinations.
  • Key takeaway: the profession matured through organized professional societies, standard-setting, and education/accreditation frameworks that supported a distinct diagnostic imaging occupation.

Accreditation and Professional Organizations

  • Professional organizations purpose and scope:
    • Provide continuing education, support professional advancement, serve members’ interests, and serve the public good.
    • Organizations may operate at state, regional, national, or international levels.
    • They influence education requirements, clinical experiences, credentialing, program accreditation, scope of practice, and CME requirements.
  • Membership and value:
    • Member benefits include journals, conferences, webinars, practice parameters, research grants, ethics codes, and more.
    • Many offer CME credits and tracking, opportunities to contribute as authors/editors/presenters, scholarships, and awards.
    • Student members often receive discounted dues, scholarships, and grants.
  • Key organizations (examples):
    • American Institute of Ultrasound in Medicine (AIUM)
    • American Society of Echocardiography (ASE)
    • American Society of Radiologic Technologists (ASRT)
    • Society for Vascular Ultrasound (SVU)
    • Society of Diagnostic Medical Sonography (SDMS)
    • Society for Maternal-Fetal Medicine (SMFM)
    • Society of Vascular Surgeons (SVS)
    • World Federation for Ultrasound in Medicine and Biology (WFUMB)
    • Sonography Canada (national body)
  • Professional organizations and the profession’s history:
    • Formation of multiple organizations followed the legacy of ASUTS/SDMS and the need for broad-based representation to support education, research, and credentialing.
  • Table reference (Table 1-2): a list of major sonography professional organizations (e.g., AIUM, ASE, ASRT, SVU, SDMS, SOPE, SVS, SVU, WFUMB).

Accreditation: Postsecondary and Laboratory

  • Postsecondary accreditation (overview):
    • Accreditation is voluntary and evaluates educational quality and standards.
    • Two basic types: institutional accreditation (for the whole institution) and programmatic accreditation (for designated programs).
    • Goals: foster excellence, set standards, and ensure public accountability; involves self-review and peer-review.
    • Accrediting recognition enables eligibility for federal student aid programs.
  • Institutional accreditation specifics:
    • Usually government-involved in the global context; in the U.S., it is voluntary and overseen by agencies recognized by the USDE and CHEA.
    • USDE oversees the list of nationally recognized accrediting agencies; CHEA is a non-government organization overseeing accreditation.
    • Accreditation ensures performance integrity, meets standards, and equitable application of standards.
    • There are two broad zones: regional and national (regional accredits about 15 o% of institutions; national about 85 o%).
  • Programmatic accreditation specifics:
    • Represents a professional area (e.g., sonography) and is managed by specialized accrediting bodies.
    • In sonography, key programmatic accreditors include JRC-DMS and JRC-CVT within the umbrella of CAAHEP.
    • Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS) issued the first program accreditation in January 1982; subsequently, AMA proposed the CAHEA successor, leading to CAAHEP by mid-1994.
    • CAAHEP aims to simplify processes, be inclusive of allied health, and serve as a steppingstone for broader developments.
    • JRC-CVT and JRC-DMS are part of CAAHEP; CAAHEP oversees accreditation with input from JRCs.
  • Laboratory accreditation (overview):
    • Voluntary but supports uniform standards of practice and quality control; helps facilities meet government and payer criteria.
    • Accredits diagnostic sonography services to evaluate strengths/weaknesses and improve imaging outcomes.
  • Laboratory accreditation bodies:
    • American College of Radiology (ACR)
    • American Institute of Ultrasound in Medicine (AIUM)
    • Intersocietal Accreditation Commission (IAC) with divisions: IAC Vascular Testing, IAC Echocardiography, IAC Pediatric Echocardiography.
  • Key points on evaluation and standards:
    • Programmatic accreditation involves extensive onsite evaluation of course materials, curricula, and facilities.
    • JRC reports are reviewed by CAAHEP; CAAHEP board approves accreditation decisions.
  • Table references:
    • Table 1-3 lists programmatic accreditation bodies (CAAHEP, JRC-CVT, JRC-DMS).
    • Table 1-4 lists laboratory accreditation bodies (ACR, AIUM, IAC).

Credentials, Certification, and Licensure

  • Core definitions:
    • Credential: recognizes baseline knowledge and competence; demonstrates a minimum professional standard.
    • Certification: formal process recognizing qualifications after completing specified education and clinical practice; often elicits ongoing validity via CE.
    • Licensure: legal right to practice in a jurisdiction, established by government legislation.
  • Credentialing organizations (overview):
    • American Registry for Diagnostic Medical Sonography (ARDMS)
    • American Registry of Radiologic Technologists (ARRT)
    • Cardiovascular Credentialing International (CCI)
    • Sonography Canada
  • ARDMS (origin and role):
    • Began as the credentialing pathway following ASUTS’s groundwork; early members were grandfathered, not required to take written exams but may have completed proficiency assessments.
    • Since the 1970s, ARDMS has offered certification examinations across sonography specialties; expansion accommodated new technology and broader practice areas.
    • The first credentialing title chosen was the American Registry for Diagnostic Medical Sonography (ARDMS) after evolving terminology from “technical” designations.
    • By the late 1970s, ARDMS provided pathways for sonographers, midwives, and physicians to earn credentials.
  • ARDMS credential structure and prerequisites (Table 1-6):
    • Credentials include RDCS (Registered Diagnostic Cardiac Sonographer), RDMS (Registered Diagnostic Medical Sonographer), RVT (Registered Vascular Technologist), RMSKS (Registered Musculoskeletal Sonographer).
    • Each credential requires meeting eligibility prerequisites, passing the Sonography Principles and Instrumentation (SPI) exam, and passing one or more specialty examinations (e.g., AE for Adult Echocardiography, FE for Fetal Echocardiography, OB/GYN-related exams, AB, BR, etc.).
    • SPI must be passed within five years of the specialty examination.
  • ARRT (American Registry of Radiologic Technologists):
    • Offers credentialing exams for sonographers; has Primary and Postprimary eligibility pathways.
    • Primary eligibility requires completion of an ARRT-approved educational program.
    • When passing the sonography exam, credential is RT(S); when passing the vascular sonography exam, credential is RT(VS).
  • CCI (Cardiovascular Credentialing International):
    • Provides credentialing exams for cardiac and vascular specialties; as of the chapter, offers nine exams to validate knowledge and competence.
    • ACS (Advanced Cardiac Sonography) credential represents an advanced career track; credentialed sonographers focus on quality, advanced echocardiography, preliminary assessments, educational planning, QC, and research coordination.
  • Sonography Canada:
    • Launched on January 1, 2014 from the merger of the Canadian Society of Diagnostic Medical Sonographers (CSDMS) and Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP).
    • Provides a unified credential, with benefits including professional liability insurance, national continuing education, a national conference, and a professional journal.
    • Current credentials include CRGS (Canadian Registered Generalist Sonographer), CRCS (Canadian Registered Cardiac Sonographer), and CRVS (Canadian Registered Vascular Sonography).
    • Credentialing signifies meeting national educational and competency requirements; credential maintenance requires adhering to professional guidelines and member policies.
  • Maintaining credentials (CE/CME/CPD):
    • Credentials require ongoing maintenance through continuing education hours, renewal fees, and ongoing professional development.
    • Rationale: keep pace with rapidly changing health care and demonstrate ongoing knowledge/skill updates.
    • Resources for CE/CPD include medical journals with quizzes, conferences (national/state/local), virtual courses, webinars, and scholarly writing.
  • Licensure (state-level):
    • Licensure is the legal right to practice in a specific sonography role as determined by government legislation.
    • States with licensure requirements (as of the chapter): New Hampshire, New Mexico, North Dakota, and Oregon.
    • Requirements vary by state; professionals should verify state licensure rules before employment.

Scope of Practice and Clinical Standards (Preparing for the Profession)

  • History and endorsements:
    • The first edition of the Scope of Practice for the Diagnostic Sonographer was endorsed in December 1993 by the ACR, ASE, and SDMS.
    • May 2013: 16 organizations began revising and updating a new document.
    • April 15, 2015: a finalized Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer was endorsed by seven organizations: ASE, CCI, JRC-DMS, SDMS, SMFM, SVS, SVU.
  • Endorsing organizations and purpose:
    • The endorsed document serves as the sole reference for scope of practice and clinical standards in diagnostic medical sonography.
    • It emphasizes the sonographer’s role as a health care team member who must act in the patient’s best interest and uphold patient safety and quality care.
  • Scope of practice content:
    • Limited to what the law allows based on education, experience, and demonstrated competency.
    • Sonographers function as delegated agents of physicians; they do not practice independently but have autonomy and responsibility within their scope.
    • Emphasis on patient care, continuous quality improvement, enhanced knowledge, and technical competency.
    • Sonographers must use independent, professional, ethical judgment and critical thinking.
  • Clinical standards content (12 elements):
    1. Patient information assessment and evaluation
    2. Patient education and communication
    3. Analysis and determination of the protocol for the diagnostic examination
    4. Implementation of the protocol
    5. Evaluation of the diagnostic examination results
    6. Documentation
    7. Implementation of quality improvement programs
    8. Quality of care
    9. Self-assessment
    10. Education
    11. Collaboration
    12. Ethics
  • General principles:
    • Clinical standards reflect expected behavior and performance across specialties; individual specialties may extend or enhance these standards to fit practice requirements.
  • Recommended Professional Terminology:
    • Consistent professional terminology improves communication.
    • Historical terminology varied: imaging modality, equipment, imaging examination, acquired images, technical specialist.
    • In the Steven M. McLaughlin Memorial Lecture (2007), Terry DuBose discussed the preference for the term sonography over ultrasound, arguing that “sonography” is a more precise descriptor than referring to the image as an “ultrasound image.”
    • Example language adjustments to improve patient communication: refer to an upcoming study as an echocardiogram if appropriate, rather than an “echo” procedure; refer to a fetus as a fetus or a baby in patient discussions to avoid confusion; patient questions and scheduling language should reflect accurate terminology.

Entering the Profession and Professional Practice

  • Entering the profession:
    • Essential prerequisite: complete a sonography program with specialized coursework and supervised clinical experience.
    • Graduates must be educationally prepared and clinically competent; develop psychomotor skills during training.
  • Transition to practice:
    • Sonographers may work independently or in collaboration with physicians; must recognize their role within health care.
    • Critical ability to differentiate normal vs abnormal anatomy and to reject sub-optimal images.
    • Correlating clinical history with imaging enhances targeted investigation.
    • Sonologists interpret findings and provide diagnostic context (correlation of imaging with clinical data).
    • After formal education, career progression typically includes earning additional credentials and maintaining CME/CE records.

Connecting Concepts: How It All Fits

  • The profession’s evolution from ASUTS to SDMS reflects a commitment to professional standards, education, and credentialing to safeguard patient care.
  • Accreditation, credentialing, and licensure form a continuum: they ensure educational quality (programmatic and institutional accreditation), validate practitioner competence (credentials and certifications), and confirm legal authority to practice (licensure where required).
  • The Scope of Practice and Clinical Standards document integrates professional expectations across organizations, guiding practitioners to uphold ethics, patient safety, continuous improvement, and collaborative care.
  • Terminology and communication are foundational to professional identity and patient understanding, influencing how care is described, explained, and delivered.

Connections to Real-World Practice and Ethics

  • Ethical implications include maintaining patient welfare, confidentiality, informed consent, and accurate communication; professional behavior should reflect empathy, honesty, integrity, and accountability.
  • Practical implications involve staying current with evolving technology, continuing education requirements, and adherence to changing standards across organizations and jurisdictions.
  • Philosophical implications touch on the professional duty to advance the field responsibly, balance autonomy with collaboration, and prioritize public health over individual practitioner preferences.

Summary of Key Points ( distilled )

  • The sonography profession combines distinct roles (sonographers vs sonologists) and relies on standardized education, accreditation, and credentialing to ensure high-quality patient care.
  • The field’s history shows deliberate moves to establish a recognized occupation with defined standards (ASUTS → SDMS) and to create robust credentialing pathways (ARDMS, ARRT, CCI, Sonography Canada).
  • Accreditation (institutional/programmatic) and laboratory accreditation (ACR/AIUM/IAC) provide quality assurance for education and practice, enabling federal funding and public trust.
  • Credentialing and licensure frameworks (ARDMS, ARRT, CCI, Sonography Canada; optional licensure in some states) establish professional qualifications and legal authority to practice in specific jurisdictions.
  • Scope of Practice and Clinical Standards unify expectations across the profession, stressing patient-centered care, ethical practice, and continuous improvement; clear terminology supports effective communication.
  • Entering the profession requires formal education, supervised clinical experience, and ongoing professional development to maintain credentialed status.

Key Dates and Numbers (for quick reference)

  • ASUTS formed: 1969; debut: 1970; incorporated: 1972; renamed to SDMS: 1980; occupation established: 1973.
  • First JRC-DMS accreditation: January 1982; CAHEA evolution to CAAHEP: mid-1994; CAAHEP operational: 1994; JRC-CVT and JRC-DMS under CAAHEP: ongoing since then.
  • Endorsing scope document: 1993 (initial endorsement by ACR, ASE, SDMS); updated: 2015 endorsement by seven organizations.
  • SPI exam timing rule: SPI must be passed within 5 years of specialty exam.
  • Licensure states (U.S.): NH, NM, ND, OR as of the chapter.
  • Key organizations in programmatic and lab accreditation: JRC-DMS, JRC-CVT, CAAHEP; ACR; AIUM; IAC (Vascular Testing, Echocardiography, Pediatric Echocardiography).
  • Credentialing organizations referenced: ARDMS, ARRT, CCI, Sonography Canada.