The Multidisciplinary Sonographer

Being a multidisciplinary sonographer in today’s workforce is a challenging yet rewarding profession. That being said, one also must acknowledge the frustration that a multidisciplinary sonographer may endure when being compared to a sonographer who specializes in a single recognized area of sonography such as breast, peripheral vascular, or obstetrics. As a multidisciplinary sonographer working in a large tertiary care hospital, there is a wide variety of examinations to be done within a week, sometimes even within 1 day. These scans may include any combination of pediatrics, neurosonography, vascular, breast, abdomen, small parts, musculoskeletal, first trimester obstetrics, emergency second and third trimester obstetrics, and gynecologic exams, as well as assisting during various ultrasound-guided and intraoperative procedures. In such a department, the sonographer wears many hats and each one comes with its own protocols and challenges.

The multidisciplinary sonographer is likely to be required to be registered by the American Registry for Diagnostic Medical Sonographers (ARDMS) in more than one specialty. There is a broad spectrum of ultrasound certification available in diverse areas that encompass abdomen (which includes small parts, such as thyroid and scrotal), breast, neurosonology, obstetrics, and gynecology, as well as a new pediatric specialty coming in 2015. ARDMS also offers examinations and certification in the areas of vascular, musculoskeletal, and the cardiac specialties, including adult, fetal, and pediatric. Each examination requires an abundance of preparation; you must obtain clinical verification under the guidance of a registered sonographer and spend innumerable hours studying and preparing to take the examination.

Since every registered sonographer has had to go through the same rigorous requirements, one might assume that our positions and status within the workplace are equal, but many times that is not the case. Most multidisciplinary sonographers have had to, at one point or another, listen to explanations and arguments from a specialty/subspecialty sonographer as to why his or her position is more important, stressful, or worthy of a higher salary, though there is no valid justification for this opinion. To compound this faulty impression, multidisciplinary sonographers are oftentimes labeled or categorized merely as general sonographers, whose scans and patient interactions are not as challenging and sometimes even less important than those in departments such as maternal fetal medicine, breast care centers, and vascular departments. These sonographers are frequently considered as sonographer specialists, and they are given this title because that one specific area is their only area of expertise and that is all they do. Please do not take that in the wrong sense; these sonographers/vascular technologists deserve a great deal of respect and recognition for what they do. However, not everyone is well suited to do the same type of examinations all day, every day. What needs to be brought into focus is that multidisciplinary sonographers are specialists as well, and their job is equally challenging (and on any given day may be more so, depending on the patient) to that of a sonographer who must perform only studies that fall under the scope of one ARDMS certification.

All sonographers need to remember that no matter what the specialty or certification, each patient is unique, each patient is anxious, and each patient is coming to find answers. “Every patient deserves your undivided attention, consideration, and care. All patients feel vulnerable.” ¹ In every specialty, patients are seen with a variety of disorders and ailments—many of which may be treatable and curable, and many are not. According to Arnall ² in the Society of Breast Imaging Newsletter, a unique aspect of breast imaging is the high level of anxiety that each patient exhibits. However, the anxiety of a young adult male facing the unknown outcome of a testicular ultrasound for a palpable lump is likely no less than that of a woman with a palpable lump in her breast. Both lumps could be cancer, both could have devastating consequences, and both are just as serious and life threatening.

Pediatric sonography is another area where anxiety levels are characteristically high, and in these instances it usually involves both the patient and the parents. de Bruyn ³ pointed out emphatically that diagnostic examinations in children can be very stressful for both the child and the parents. Anxiety about whether the child will be cooperative, the findings of the test, and the experience of being in a strange clinical environment are all factors that must not be underestimated; part of the role of the sonographer becomes one of making the experience a positive one. An examination of a newborn premature baby in the neonatal intensive care unit to evaluate the brain for an intraventricular hemorrhage is as equally nerve wracking for the parents as the follow-up on a 20-week fetal anatomy scan for an abnormality seen within the ventricles. At the completion of a pediatric abdominal scan, when the radiologist has asked the sonographer to relay information or results to the child’s mother or father waiting anxiously in the examination room, it should be recognized that this news will usually be harder to wait for and hear than if the parent were waiting to hear results about his or her own scan or biopsy. It always needs to be taken into consideration that each patient and each examination is equally important.

The Merriam-Webster Dictionary defines a specialist as a person who has special knowledge and skill relating to a particular job, area of study, and so on. As Hagen-Ansert ⁴ pointed out, a sonographer is someone who carries out studies and gathers diagnostic data under the direct or indirect supervision of a physician. To produce quality sonographic images, the sonographer must possess an in-depth understanding of anatomy and pathophysiology and must be able to clinically evaluate a patient’s problem. For a multidisciplinary sonographer to function within this framework, this requires knowledge and understanding of not just one organ or organ system and its associated pathologies, but knowledge of the associated pathologies found within multiple systems throughout the body. This required knowledge and understanding do not come easily but are obtained through a great deal of rigorous preparation, clinical understanding, and dedicated hard work.

It is safe to say that working in just one single department is not the only thing that makes a sonographer multidisciplinary or a specialist. As with any professional position, a sonographer’s level of expertise and confidence will be elevated by the number of years in the field, the number and variety of completed scans, and, equally important, the level of desire the sonographer has to actively develop knowledge and skills. Producing diagnostic images for a physician to read and determine a diagnosis, caring for and treating patients with respect and compassion, going the extra step and evaluating patients to see what it is they really need, and determining with the reading physician what information may be shared with the patient in each distinctly different situation—these are the things that make a sonographer a specialist as well as special.

On a strictly personal note, I am proud to say that in sonography, I am an abdominal specialist, an obstetric and gynecologic specialist, a breast specialist, and a vascular specialist. I am also fortunate enough to be working and developing skills in the areas of musculoskeletal sonography, neurosonology, and pediatric sonography, but I will not say that I am a specialist in those fields just yet. There are three more registry examinations to get through before I will grant myself those titles.