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Since the first surgeon-performed ultrasound examinations in the 1980s, the field has matured and expanded to include many surgical, and indeed other medical, specialties. In fact, in 1999 the American Medical Association passed a resolution (Res. 802, I-99; Reaffirmed: Sub. Res. 108, A-00) acknowledging the extensive application of the technology in medical practice and its use was within the scope of practice of “appropriately trained physicians.” The resolution states that hospitals should be responsible for granting privileges to individuals within their scope of ultrasound practice. Furthermore, the AMA resolution recommends that specialties using ultrasound develop specialty-specific recommendations for its use. As the ranks of physicians comfortable with the performance and interpretation of ultrasound grow, guidelines for verification of competency and standardization of practice are essential. This chapter provides a historical context for current standards, justification for those standards, and a practical guide for those seeking credentialing in ultrasound in many interventional specialties.


Clearly the field of medicine, like many other advanced and highly technical disciplines, has and will continue to experience an exponential growth in the adoption of new technologies. With this evolution comes the need for practitioner training, credentialing, and continuing education. There are several notable precedents, or at least contemporaries, to the use of ultrasound by nonradiologists. Perhaps the most apparent is laparoscopy. Dismissed by many in the early years as too difficult, too expensive, and too time-consuming, it has now become the standard approach for many surgical procedures, relegating “open” approaches in many cases to the barbaric. Although ultrasound cannot be compared directly to laparoscopy, as it represents an adjunct to current techniques, rather than a whole new approach, the history of training and credentialing can be paralleled.


In the late 1980s and early 1990s practicing surgeons struggled to find venues in which to learn the emerging technique of laparoscopy. Courses using simulators, cadavers, and animal models were created to introduce the instrumentation and methods of the procedures. Proctors were dispatched from the ranks of early adopters to assist in the acquisition of laparoscopic skills and to ensure safe practices. Junior partners graduating from large academic programs were recruited in some cases to propel a group practice forward into the era of laparoscopy. Hospitals and surgical departments were called upon to credential their staff on these new privileges, based on tangible criteria, tradition, or even wisdom from the more seasoned staff. Gradually, training programs together with the ACGME (Accreditation Council of Graduate Medical Education) and the American Board of Surgery developed minimum training standards and objective criteria as a condition for successful completion of a residency in general surgery that includes laparoscopic skills. In other words, completion of a residency in general surgery now qualifies a graduate as competent in laparoscopy, pending successful examination by the ABS.


Thus, the lesson learned from laparoscopy may be simplified as follows. An emerging technique is identified and verified independently by the surgical innovators. Through peer-reviewed communications at conferences ...

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