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Diagnostic ultrasound in B.C., 1979-1980 : provision and utilization University of British Columbia. Division of Health Services Research and Development Sep 30, 1980

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.. • \.-l~~ ~6·, 't Report S:8 Prepared by : DIAGNOSTIC ULTRASOUND IN B.C., 1979 - 1980 Provi sion and Util i zation Division of Health Servi ces Researc h and Development Health Sciences Cent re University of Bri t i sh Columbi a September, 1 980 .. .. -iii-HEAL TH MA!\POWER RESEARCH U!\IT ("IQ orFJCI: or THl C'OORDl~ATOR HLALTH SCl[SCES C[STRr PHOl'E: (6041 226-481 (I M~. Clair Buckley, Chairman, Health Manpower Working Group, Ministry of Health, Parliament Buildings, Victoria, B.C. Dear Mr. Buckley, 4th FLOOR l.R.C. BUILDl~G THE l'.Nl\'ERSITY OF BRITISH con:MBIA VANCOl.\"ER. B.C., CA:\ . .\D . .\ V6T IW.S September 22, 1980 Re: Diagnostic Ultrasound in B.C. It is with pleasure that I transmit to you and to the members of the Health Manpower Working Group, the completed report "DIAGNOSTIC ULTRASOUND IN B.C., 1979 - 1980, Provision and Utilization". This report is one of a series describing the distribution of health manpower and health care resources in this province. Discussion of the report and questions for further study are anticipated. MLB/slm Sincerely yours, Morris L. Barer, Ph.D., Associate Director, Division of Health Services Research and Development. A Research Unit for the Health Manpower Working Group, Ministry of Health, British Columbia -iv-ACKNOWLEDGEMENTS Generous assistance and invaluable information was provided by Dr. Peter Cooperberg, Section of Ultrasound, Department of Radiology at the Vancouver General Hospital. As a project of the Division of Health Services Research and Development, the research involved many staff members at various junctures. Particularly helpful were Sharon Jansen and Susan Moloney. A special thanks is due the respondents to the questionnaires -- heads of radiology, ultrasound and other departments, and all the ultrasound techni-cians. The extremely high response rates indicate a genuine interest in en-suring quality provision of ultrasound services in B.C. - v -DIAGNOSTIC ULTRASOUND Table of Contents Letter of Transmittal iii Acknowledgements Table of Contents iv v List of Tables vi List of Figures Survey Report vi l I II III IV v VI VII VIII IX Appendices A B c D E References Background and Introduction l Scope of Project 3 Methodology 3 Facilities and Services 5 Utilization 7 Staffing 10 Training Programs 24 Summary and Conclusions 26 Future Research 28 Ultrasound Techniques and Equipment 29 Hospital Questionnaire -- Ultrasound Services 35 Survey of Ultrasound Technicians 38 American Registry of Diagnostic Medical Sonographers Preliminary Brochure 42 ASUTS Update of Diagnostic Sonography Educational Programs 50 57 Tables la lb 2 3 4 5 6 7 8 9 10 11 12 13 14 Figure 1 -vi-LIST OF TABLES Ultrasound Facilities in B.C. Distribution of Ultrasound Rooms in B.C., 1978 and 1979 Ultrasound Procedures and Ratios, B.C., 1979 Ultrasound Technicians in B.C., January 1980 Number and Distribution of Ultrasound Technicians Responding to Survey, by Regional District of Residence, Summer, 1980 Age and Marital Status by Sex, Sunvner, 1980 Place of Birth and Year of Immigration to Canada (where applicable) Employment in Other Health Occupations Prior to Ultrasound Training Highest Level of Non-Health-Related Education Duration of Informal Training Programs Location of Respondents• Informal Training Programs Total Employment Time in Ultrasound by Current Employment Status Desired Employment Status by Current Employment Status Desired Employment Status by Total Employment Time in Ultrasound Length of Time with Current Employer by Total Employment Time in Ultrasound LIST OF FIGURES Regional Hospital Districts, HMRU Health Regions 4 6 8 11 13 15 16 17 17 18 19 20 21 21 22 14 I. BACKGROUND & INTRODUCTION Ultrasound is the term used to describe mechanical radiantenergy (sound) having a frequenc1 be,yond the yt>_per 1 imi t .Qf .per.ception w the- -human ea-r {-be;yeml-20, 000 cycles per second). The phenomenon of ultrasound is the same as that of normal audible sound. It occurs when mechanical vibrations in one region of a medium are transmitted to other regions by the mechanical interaction of the atoms and molecules of the medium. Diagnostic ultrasound involves the visual display of information derived from the reflection of transmitted ultrasound off tissue structures. This dis-played information is directly related to the acoustical properties of the tis-sues and is essentially different from that supplied by other diagnostic tools such as X-rays or isotope scanning. Ultrasound techniques are employed as a means of obtaining information about the structure of the organs of the body and are important tools for examin-ing the body internally by non-invasive methods. The distinguishing feature of this technique is the ability to provide an accurate cross-sectional view of soft tissue. A more detailed description of the process and some of the more corrrnon ultrasound machines/techniques appears in Appendix A. Ultrasound was first applied to diagnostic medicine in 1937, concurrently in Germany and the United States. The last decade has seen rapid increases in its use both in B.C. and elsewhere, and marked advances in the technologies used. The ultrasonic examination of a patient is basically different from most diagnostic procedures. In the X-ray department, a technician or radiologist prepares the patient, adjusts the equipment and a picture is produced automa-tically. In nuclear medicine, the technician sets up the scanner, positions the patient, injects the isotope and the machine does the rest. There is little interaction between operator, instrument and patient once the actual procedure starts. In contrast, the final result of all ultrasonic procedures, good or bad, depends on the knowledge and the ability of the operator to use the instrument in an interactive way on the subject. The operator must be able to interpret the echo patterns as the procedure progresses in order to control the direction of the ultrasonic beam and produce the desired result. The critical task is to locate abnormalities or to ensure that they do not exist, even when the structure for investigation cannot be specifically pinpointed (i.e. when the procedure is investigative). -2-This means that the operator of the equipment as well as the diagnostician must be experienced/trained to recognize both physiological and acoustical landmarks and must understand the complex elements of the interactive de-tection and measurement system of the instrument in use. Since the machine is not automatic, the results that it presents to the user depend on its design amt-now tt ts operatea. UTtrasouna is currentTy usea as a diagnostic tool primarily in the specialty areas of cardiology and obstetrics, and for examinations of the abdomen. Recent technological advances in the field of ultrasound suggest that the examination process will continue to rely on the skill and experience of the operator at least as much as has been the case to date. Accordingly, the rationale for this study was a desire to examine and document the provision of diagnostic ultrasound examinations in a province which currently provides no formal training program for ultrasound technicians. The provision of ultrasound services in B.C. takes place exclusively within the public sector. All ultrasound facilities are presently housed in public acute care hospitals. This is important for two reasons. First, although a significant proportion of ultrasound services are provided on a fee-for-service basis, 1 the possibility of physician self-referral is ex-tremely limited. This is due in part to the fact that many of the fee-for-service physicians involved have at best small private practices outside the hospital setting. In addition, most of those physicians are not generally involved in direct referrals even in private practice (e.g. a patient is referred to a radiologist, who in turn may recolTlllend further testing to the referring-physician but will not directly refer that patient). Second, and perhaps more important from the perspective of this particular project, the restricted settings permit relatively straightforward gathering of information on facilities, utilization and staffing. In most situations the multitude of paying agencies and providers would make a report of this type a prohibitive task. 1 For inpatients, the physician fee is paid by hospitals out of their global budgets. Hospitals usually bill the Medical Services Plan for reimbursement of fees paid for procedures for outpatients. -3-II. SCOPE OF PROJECT The general objectives of the project were: (i) to ascertain the extent, location and composition of ultrasound units in the province in 1979 - 1980. (ii) to develop a profile of persons currently providing ultrasound techni ~ cian services, with particular focus on education and ultrasound experience. (iii) to gather information on current formal training programs elsewhere in Canada; certification procedures, etc. (iv) to attempt to assess the need for a formal training program for ultrasound technicians in ·B.C. Of particular interest was the training of those technicians currently per-forming ultrasound examinations, the degree of difficulty encountered by employers in hiring or replacing technicians, and the estimated future require-ments for additional technicians. III. METHODOLOGY Data collection was undertaken in two stages. A hospital questionnaire (Appendix B} was mailed in mid-January, 1980, to 31 institutions (listed in Table la, page 4) known to be operating ultrasound facilities at that time or planning co11111encement of service provision in 1980. The survey was admini-stered by the Health Manpower Research Unit, in cooperation with Dr. Peter Cooperberg, Chairman of the Ultrasound Subcolllllittee of 8.C. Institutional Services' Radiological Advisory Committee. Follow-up telephone contact was necessary in a small number of cases, and by April 1980 a 94% response rate had been achieved. Of more importance, however, was the 100% response rate from hospitals with operatingultrasound facilities in 1979. -4-Table la: Ultrasound Facilities fn B.C • . . -HO. of ROOMS HOSPITAL CITY YEAR FIRST ROOM OPENED OPERATING, 1979 A. Maxwell Evans Clinic Vancouver 1979 1 Burnaby Genera 1 Burnaby 1978 1 Campbell River & District General Ca~bell Rh<er (proposed, 1980) -Chilliwack General Chillfwack April, 1980 -Dawson Creek & District General Dawson Creek 1979 1 G.R. Baker Memorial Quesnel (proposed, 1980) -Grace Vancouver 1978 1 Health Sciences Centre Hospital, U.B.C.* Vancouver August, 1980 1 Ke 1 own a Genera 1 Kelowna 1978 2 Kitimat General Kitimat (proposed, 1980) -Langley Memorial Langley (proposed, 1981) -Lions Gate North Vancouver 1977 1 Maple Ridge Maple Ridge (proposed, 19817) -Matsqui-Sumas-Abbotsford Genera 1 Abbotsford 1978 1 Nanaimo Regional General Nanaimo , 978 1 Penticton Regional Penticton 1979 2 Powell River General Powel 1 River 1974 1 Prince George Regional Prince George 1976 2 Richmond General Ricl¥nond 1979 1 Royal Columbian New Westminster 1977 3 Royal Inland Kamloops 1978 2 Royal Jubilee Victoria 1975 1 Shaughnessy Vancouver 1978 1 St. Joseph's Genera 1 Comox (proposed, 1 980) -St. Paul's Vancouver 1974 3 St. Vfncent's Vancoµver 1970 1 Surrey Memor1a1 Surrey 1979 1 Tra i 1 Regi ona 1 Trail 1979 1 Vancouver General Vancouver 1975 7 Vernon Jubilee Vernon March, 1980 -Victoria Genera 1 Victoria 1975 2 West Coast General Port Al berni April, 1980 -* Was not included fn January 1980 survey of fnstitutfons with ultrasound. -5-The purpose of this questionnaire was to solicit information regarding the number of ultrasound rooms and machines in use, and dates at which they commenced service provision; number of ultrasound examinations of various types provided during 1979; and infonnation on current staffing and supervision, and prospective- t&-AA-l-Eiil-ft -s-ta-ffi-n1J -needs. in addition, rather ltmiteel ana impres-sionistic information was gathered on difficulties with recruiting ultrasound technicians. The information on number of technicians on staff at each hospital was used as a basis for distribution of a second questionnaire, to the ultrasound technicians (see Appendix C). This questionnaire was mailed early in May 1980, using the head technician at each institution as a distributor. Two subsequent mailings and a number of telephone calls resulted in a total of 62 completed questionnaires. While it is impossible to establish a precise response-rate-equivalent, based on the data from the first questionnaire we estimate that these 62 responses represent at least 90% of the ultrasound technicians currently employed in the province. The technician questionnaire requested personal data, information on general educational background and on ultrasound-related education and train-ing. Additional questions addressed ultrasound employment experience and current employment status. Since registration/licensure is not compulsory in Canada (in fact there is no Canadian certification body), it is of course not possible to identify not-currently-employed ultrasound technicians. We were able to obtain a recent membership list from the American Society of Ultrasound Technical Specialists (ASUTS). Matching this list against our survey returns yielded many names not on their membership list, and identified a small number of persons who were members of ASUTS but from whom we had received no completed questionnaire. These members either had elected not to complete a questionnaire or were not employed as ultrasound technicians in any of the thirty-one institutions. Questionnaires sent to these additional potential ultrasound technicians produced two additional returns, for a total response of 64. Information on course/program offerings elsewhere in Canada and programs and certification in the United States was gathered from a number of sources -literature, correspondence and personal communication. IV. FACILITIES AND SERVICES The first ultrasound facility in B.C. opened in 1970 at St. Vincent's Hospital. By the end of 1975 there were still less than ten ultrasound rooms in the province serving a population of close to 2.5 million. Expansion since then has been dramatic. Eighteen new rooms appeared during the 1976 - 1978 period, and an additional eleven rooms came on stream in 1979. -6-By the end of 1979 there were 37 ultrasound examination rooms providing service capacity for a population which had grown to just under 2.6 million.2 Some-where between ten and fifteen additional rooms will begin operation during 1980 and 1981. Ten first-time facilities were proposed for 1980-1 in hospitals without previous ultrasound ca_paciti (see Table la~ page_ 41 And.-5..0llle. .of the. twenty-two hospitals with ultrasound facilities in 1979 will more than likely expand their operations over this period. Table lb groups the hospitals listed in Table la by size, and shows the distribution of ultrasound rooms according to acute care rated bed capacity. Every acute care hospital with 301 or more beds was supplying ultrasound services by 1978. By 1979, only one such hospital with 201 or more beds did not have ultrasound, and that hospital was at close proximity to a hospital with three ultrasound rooms. At the end of 1979, only four of 68 'small' hospitals (less than 101 beds) were providing ultrasound. Two more were planning operations for 1980, although as of .June 1980 neither had yet provided an ultrasound examination. Table lb: Distribution of Ultrasound Rooms 1n B.C., 1978 and 1979 1978 1979 Size of II of Hospitals II of Ultrasound II of Hospitals II of Ultrasound Hospital with rooms with rooms Ultrasound* Ultrasound* >500 beds 3 10 3 11 401 - 500 beds 5 8 5 g 301 - 400 beds 2 2 2 4 201 - 300 beds 2 3 3 4 101 - 200 beds 2 2 5 6 slOO beds 2 2 4 4 Total 16 27 22 38 * Does not include rehab111tat1on or psychiatric hospitals, extended c~rc units or Red Cross outposts. 2 Doppler facilities, utilization and personnel are not included in these or subsequent figures. -7-The ratio of population to examining rooms has fallen precipitously since 1970. In 1971 it stood at 2,184,621:1, dropping to 224,237:1 in 1976, and further to 69,918:1 in 1979.3 Each examining room held, on average, close to two machines in 1979. Hospital responses indicated a total of 1£ mactrines ln piace ana an aadit1onal six to eight approved and on order in the 22 institutions with ultrasound facilities as of 1979. The returned question-naires from hospitals planning first-time capacity for 1980 suggested at least an additional eight machines on order at that time. Of course the technical capability of these machines is variable due to differences in manufacturers' design, the complement of machines in any given facility, and the range of procedures to be performed (Appendix A). V. UTILIZATION Table 2, pages, sununarizes ultrasound utilization in the province during 1979. Close to 70,000 ~onographic examinations were provided to a population of approximately 2.6 million, a rate of one procedure for every 37 persons in the province.4 This represents a sharp increase from the 1978 rate of approxi-mately one procedure for every 49 persons. Of the total procedures, 61.7%, or 42,931 procedures were provided by facilities based in GVRHD hospitals. It is interesting to note that GVRHD hospitals provided proportionately fewer obstetrical procedures than were provided in non-GVRHD hospitals. Relatively more abdominal, pelvic, thyroid and other examinations were done in this group of hospitals. In fact, while aggregate obstetrical procedures under-taken in the province increased by about 15% from 1978 to 1979, the absolute number provided in GVRHD hospitals fell slightly. Obstetrics is the only area which allows linkage of number of ultrasound procedures with a specific patient/condition. We have attempted to link 'com-pleted' pregnancies (i.e. live and still births, one per pregnancy, plus abor-tions and ectopic pregnancies) with obstetrical ultrasound procedures. Because of the disease classification system (ICD-9) this was not entirely possible. The births include all single live and still births plus additional live births from multiple newborns (e.g. ten sets of twins in which all 20 newborns were live births would add 10 births to the estimate of completed pregnancies). Still births in multiple birth situations where at least one newborn was a live birth, were not counted. 3 Population estimates are from Statistics Canada (1978) and ROLLCALL 79. 4 Of course this ignores ultrasound examinations of B.C. residents at non-B.C. facilities, but at the same time undoubtedly includes some procedures provided at B.C. facilities to non-residents. I 1 I I I -8-Table 2: Ultrasound Procedures 1nd Ratios, British Columbia, 1979 ! Ultrasound Procedures: ! Obstetrical Ophthalmic Cardiac Other {abdominal, pelvic, thyroid, etc.) 21..ZM-1 8362 9,873 30,9941 .40...D-1.2 14.2 44.6 Total 69,487 100.0 Deliveries and Abortions: Live and Still Births3 Abortions 4 Obstetrical Ultrasound Procedures Per recorded Pregnancy 38,669 17 I 181 0.50 Bed Capacity: Rated Acute Care Bed Capacity, December 31, Public Acute Care Hospitals Ultrasound Procedures Per Acute Care Bed Rated Acute Care Bed Capacity of Public Acute Care Hospitals with Ultrasound Facilities Ultrasound Procedures Per Acute Care Bed for Hospitals with Ultrasound Facilities i of Ultrasound Procedures Done on InpatientsS Inpatient Ultrasound Procedures Per Acute Care Bed Inpatient Ultrasound Procedures Per Acute Care Bed for Hospitals with Ultrasound Facilities 11, 792 5.89 7,598 9.15 41% 2.42 3.75 Population: 2 3 5 Provincial population (est.) Ultrasound Procedures per capita 2,586,965 0.027 One hospital indicated 1,849 procedures for the 'Other' plu$ 'Obstetrical' categorie$ in 1979. Based on its 1978 distribution of procedures and the fact that the hospital has no obstetrical beds, 300 procedures were allocated to 'Obstetrical' and the remainder to 'Other'. One hospital with ophthalmic capacity did not provide this infonnation. Thus the procedures figure may be slightly low. As recorded by acute care and day care facilities in the province. While the desired figure was number of recorded pregnancies, the figure reported is upward biased by the aggregate number of multiple live births. 'Abortions' includes spontaneous and therapeutic abortions and ectopic pregnancies as recorded by acute care and day care facilities. Infonnation on number of outpatient procedures for which hospitals billed the Medical Services Plan were unavailable for the 1979 calendar year. The 411 was calculated by comparing outpatient procedures for the 1978-79 fiscal year with total 1978 ultrasound procedures. -9-Our estimate of abortions underrepresents total abortions in the province, as it was beyond the scope of this project to attempt linkage of ultrasound services with ultimate pregnancy outcomes. Only those abortions recorded by acute and day care facilities are reported here. Current rates suggest, then, one examination for every two pregnancies, a slight increase over 1978 rates. Interpretations of relationships between number of procedures and bed availability are not straightforward and, in fact, are relatively unhelpful for planning or information purposes because a high proportion of ultra-sound examinations are provided on an outpatient basis. There may remain, however, a temptation to combine provision rates with estimates of ultrasound room, technician or machine throughput to determine the size of hospital gen-erally able to support an ultrasound capability. For example, the average annual workload of ultrasound technicians seems to have been in the neighbour-hood of 1,550 examinations in 1979.s Combining this with the 9.15 procedures per bed in hospitals with ultrasound facilities yields a ratio of approximately 170 beds per technician. Does this indicate that any hospital with at least 170 beds should have an ultrasound room? Unfortunately the issue is not that straightforward. Hospitals vary widely in their facilities and the mix of patients they treat, and thus in the appropriateness of diagnostic ultrasound for their respective patient loads. In fact, one could envisage a ten bed hospital with a booming ultrasound facility for outpatients, or a 250 bed hospital with no ultrasound due to an alternative source of that service in the same area. Furthermore, the 1,550 procedure rate does not necessarily represent an optimal level of technician activity. It may represent a combination of excess capacity, student supervision time, on-the-job training, etc., particularly in light of the absence of any formal training program in the province, and the rela-tive novelty of this service to many of the institutions providing it. Seven hospitals of less than 170 beds had ultrasound facilities in B.C. in 1979. Their average procedure throughput per full-time equivalent techni-cian, at just over 1,500 examinations, was not significantly different from the rate for all other hospitals. Thus, the procedure rates per bed in Table 2 are of little more than curiosity value, with the possible exception of the last grouping. Here we have estimated the share of ultrasound 'con-sumed' by inpatients, and related that usage to inpatient beds. As noted in the table, the inpatient/outpatient ratio applied is not that of the 1979 calendar year, but is likely a close approximation. Hospitals with ultrasound facilities were, on average in 1979, doing 3.75 inpatient examinations per bed-year. This was up from just over 3 examinations in 1978. 5 A precise calculation of average technician procedure rates is hindered by two factors. First, information was generally received only on month of opening for rooms which commenced operation during 1979. All such rooms were assumed to have been rendering services for the entire open-ing month. Second, some uncertainty exists regarding the reliability of respondents' estimates of FTE technicians. • -10-While gaps remain in the data for 1979, and the only other year for which data are currently available is 1978, indications are that the provi-.s.inn .of -Ultrasound .will -G-00-tl-oo-e- ta- -be- -a- -growth- tndustry for trre- near future. Technological advances have become corrmon in recent years, and in 1980 alone between eight and ten hospitals in the province will be providing ultrasound for the first time. Since it is unlikely that these new settings will be providing exclusively substitute services, and given relatively stable bed supply and population, it seems safe to presume that 1980 will show continued increases in the ratios of Table 2. By the end of 1980, however, every hospital of 100 beds or more will have ultrasound facilities in-house or conveniently close. The only likely justification for new site expansion will then be one of access, as the existing facilities will be conspicuously concentrated in the south-western part of the province. Expansion within existing facilities will be dependent on the technology (new uses and/or improved uses for sonography) and on hospi-tal budgets. This suggests an area of future research - the scope for expan-sion in use of ultrasound and for substitution of ultrasound for other diag-nostic techniques. VI. STAFF! NG There are two strands to this topic, the first of which we will dispense with rapidly. Due to the nature of diagnostic ultrasound, a physician and a technician are usually jointly involved in an examination. This does not mean that two persons. are continuously present throughout the duration of an exami-nation, but rather that a physician is generally on hand if assistance is re-quired and to read sonograms. The bulk of this section will report on the ultrasound technicians. Most of the ultrasound rooms operate under the direction of one or more radiologists with training in ultrasound. Responses to the questionnaire (Appendix B) indicated a total of 45 radiologists devoting anywhere from less than five per cent to one hundred per cent of their working time to the ultra-sound rooms (approximately 20 full-time equivalents [FTE's]). In addition, thirteen cardiologists (1.5 FTE's estimated and less than two other specialty FTE's were involved in a similar capacity. Information on those providing ultrasound technician services was collected in two phases, as noted earlier in the methodology section. The data in Table 3, page 11 are based on the hospital (employer) questionnaire and represent responses of the medical directors of ultrasound facilities as of January - February 1980. Since the questionnaire to the technicians them-selves (Appendix C) was administered three to four months later, and since a few hospitals conrnenced provision of ultrasound services in that period, it is not possible to create a precise matching of the two sets of data. -ll-Table 3: Ultrasound Technicians in B.C., January 1980 Full-time technicians Part-time technicians Student technicians Estimated full-time-equivalent {FTE) technicians* Estimated average procedures per FTE technicians Estimated FTE technicians per Ultrasound room** 39 14 7 44.7 1,555 1.41 * Some respondents did not provide this information. In such cases, estimates based on number of procedures were used. In the extreme, this would make any estimate of procedures per FTE technician completely circular. However, the incidence of incomplete responses was low enough that we have included this calculation for information. The FTE figure is much lower than the aggregate number of technicians (60) because some rooms operated for only part of 1979. ** There were 31.7 FTE ultrasound rooms in operation during 1979. All subsequent tables providing detailed infonnation on the technicians are derived from technicians' responses to the questionnaire in Appendix C. Data of comparable detail to that in Table 3 were not available for pre-vious years. However, the number of FTE technicians increased between 1978 and 1979 by over 40%, so that the number of examinations per technician dropped in response to the rapid expansion of facilities. This may have been due to increased teaching and supervision time for existing technicians as new techni-cians came on staff or were trained on-the-job. In addition, or alternatively, it may reflect a (temporary?) phenomenon of facilities getting ahead of 'demand'. Sixty-five responses to the technician questionnaire were received. As noted earlier, this includes (conservatively) at least 90% of those working as ultrasound technicians as of June - August 1980. Because no Canadian certifi-cation body exists and no specific question was included in the survey regarding American certification, this status of the respondents is uncertain. -12-Certification (.registration) in the U.S. is administered by the hnerican Regi-stry of Diagnostic Medical Sonographers (ARDMS). Prerequisites for those wishing to sit the registration examinations vary according to extent of health-related and ultrasound back_groynd~ but int.liule. in .all cases a mini-mum of 12 months ful1-time clinical ultrasound experience. Details may be found in Appendix D. The examination process leading to ARDMS registration is comprised of three parts - a written examination of "ultrasonic Physics/Instrumentation and Emergency Medical Situations 11 , and a written and oral exam in a chosen specialty. Specialty areas include abdomen, echocardiography, neurosonology, obstetrics and gynecology and ophthalmology, Again, Appendix D provides more detail. Area of Residence In Table 4, page 13, respondents have been grouped into nine geographic areas, based on their place of residence. Figure 1, page 14, maps regional hospital districts into these nine areas. Sixty-two per cent of respondent technicians resided in urban areas (Capital and Greater Vancouver). In com-parison, these urban areas contain approximately 52.5% of the provincial popu-lation (U.B.C., 1979) and 54.3% of the province's acute care hospital beds. While it may seem, then, that there is a relatively high concentration of ultra-sound technicians in the urban regions of the province, in fact the urban/ rural differences in technicians/bed and technicians/population ratios turn out not to be statistically significant (p>.2). While the overall urban ratios were higher than their rural counterparts, the statistical insignificance re-sults from wide inter-regional variation in these ratios among the non-urban districts. For example the NORTH district has 0.8 technicians per 10,000 population (far exceeding the ratio for Greater Vancouver), whereas the CENTRAL district has 0.06 technicians. A similar pattern characterizes the cross-regional distribution of technician/bed ratios. Personal Data Table 5, page 15, presents some of the personal characteristics of the respondents and is self-explanatory. The ultrasound technicians in B.C. are predominantly female (.83%) and 35 years of age or younger (71%). While a majority are married (55%)., female technicians seem more likely to be single than their male counterparts. Table 4: -13-Number and Distrtbutton of Ultrasound Technicians Responding to Survey, by Regional District of Residence, Sunrner, 1980 HMRU Health Region* N % Capital 4 6.2 Central 1 1.5 Fraser Valley 5 7.7 Greater Vancouver 36 55.4 Island Coast 5 7.7 North 4 6.2 North Central 3 4.6 Okanagan 5 7.7 South-East 2 3 .1 Total 65 100. 0 * Regional Hospital Districts were aggregated into nine larger Health Regions, as illustrated in Figure 1. l!lt ... 1 llDspttll Dtstr\cts 1 [•St JaotetWIJ Z C:.tr1l ICooteftlJ a laoteMJ lclund1r1 J OlM1191n-St•tlk1111111 4 Collllbt1-Shus .. p S llDrth otiane91n 6 t ... trll OllANCJlft 1 Tl9allpSOl9-Rtcol• I Cllrtboo I 5qiMlltslt-Lt11009t 10 Freser-C,... 11 t.Rtr•l Fr•ser Y•11•J 12 o..dne1-Alouett• 1J lir'Mter V•ncouwr 14 Sunshtne Coast 15 ,.._.11 Rtver 16 ...,_t Wdtft!ltaft 11A c:.ttral Coast 17 SkeeN-Queen CMrlottt 11 lttt .. t-Sttktne lt .,lkle1-Nechlko ZO f'rHer-Fort Ceof'9I 21 PHc:e Rtver-lt1nl l2 Sttkfne n C11ptt11 24 Cawtchln 1111•1 ZS llnatm 21 Albernt-Cl•yoquot l1 C-•-Strathc:Oftll 22 I . . . .. \ .. I ... \.·· . . .. . -......... NORTH ,._;....,. , . .\ , . .. • . \ Vv4-~ '· •,, \,,. .... ,·-.. -. Port Nelaon 21 . .. , Baaeltoa • '•, I r·.-r·····' 19 Terrece: ..._lthere \ . - NORTH CENTRAL ,• ..., : ~--'l Venderhoof • \ 8 \. I r .. ...,., ~U HEALTH REGhJNS • ..... '° c 1 GYRO ., tD z CAPITAL ..... J FMSER YAll~ • OWAliAll 5 SOUTlf-EAST I ISLAND COAS11 1 CENTRAL I IMIRTM C~ ' !MIRTH • Retfo1111 MDsptlhl Dtstrtcts ._. .._ 1rbftr1rtly "'9•'9d by the flelilt~ Manpower ReH1rch Ulltt tn order te prowtde sufftdfent bl'e.for ana111t1 of smaller .. ..., .. r groups. CENTRAL .... _J .. J~ .~ --·--.-'ullooet' ,' 1 , 9 FRASER VALLEY I ..... ,,,,. I -15-Table 5: Age and Marital Status by Sex, Sunmer 1980 Male Female Total Age/Marital Status N % N s N % -Age: ~ 25 years - - 4 7.4 4 6.2 26 - 30 years 4 36.4 23 42.6 27 41.5 31 - 35 years 3 27.3 12 22.2 15 23 .1 36 - 45 years 3 27.3 9 16. 7 12 18.5 ~ 45 years - - 5 9.3 5 7.7 Unknown l 9. l l 1. 9 2 3 .1 -----------------·----------- --------------- -------------------------------Marital Status: Single 2 18.2 20 37.0 22 33.8 Married 8 72.7 28 51. 9 36 55.4 Other/Unknown 1 9. 1 6 11.1 7 l 0.8 Total 11 100.0 54 100·.o 65 100.0 (16. 9%) (83 .1 %) 100.0%) • • -16-The vast majority (83%) of respondents were born in Canada (Table 6), with non-Canadian-born technicians scattered widely as to place of birth. In turn, the Canadians-by-birth were largely born in British Columbia. It ts lnterestfng to note tne complete absence of tecnnic1ans De>rn in Quebec. Table 6: Place of Birth and Year of l11111igration to Canada (where applicable) YEAR OF l...,IGRATION TO CANADA TOTAL Place of Birth Not Applicable 1951-60 1961-70 1971-80 N ! Canada: 54 83 .1 Alberta 5 7.7 British Columbia 25 38.5 Manitoba 6 9.2 New Brunswick 3 4.6 Nova Scotia 1 1.5 Ontario 7 10.8 Saskatchewan 6 9.2 Yukon 1 1.5 United States 1 1 1.5 United Kingdom 3 3 4.6 Australia and New Zealand 1 1 2 3.1 Other l l l 3 4.6 Unknown 2 3 .1 TOTAL 56 1 5 3 65 100.0 • -17-Pre-Ultrasound Health-Related Occupations Virtually all respondents (98%) received basic training in a health occupa-tion prior to specializing in ultrasound. The vast majority held diplomas and/ or registration in medical radiation technology (Table 7), with the second-most-frequent field being nuclear medicine. Other health related occupational "backgrouncts tncl uaecf mecttcal lat>oratory, nurslng, l>lomeatca1 electronics, tCT1 and EEG. In addition, seven of the respondents held formal non-health related qualifications in management, teaching, biology, etc. The highest level of non-health-related education for the remaining 58 respondents is shown in Table 8. For over 88% of those providing this information, high school gradua-tion was the pre-health-training base. Table 7: Employment in Other Health Occupations Prior to Ultrasound Training Employment Prior to Ultrasound Training N % -Medical Radiation Technology 48 73.9 Nuclear Medicine Technology 6 9.2 Other Health-Related Field 10 15.4 No Previous Health-Related Occupation 1 l. 5 Total 65 1 oo. a Table 8: Highest Level of Non-Health-Related Education Highest Level of General Education N % -Degree, diploma or certificate 7 10.8 2 - 3 years university 6 9.2 Grade 13 23 35.4 Grade 12 24 36.9 ------------------------------------------· -----------.,.. ____________ No Answer 5 7.7 Total 65 100.0 • II -18-Ultrasound Technician Training The scarcity of formal ultrasound technician training programs in Canada ana tlie wfde variat ion 1n lengtn of on-the-job training made somewhat diffi-cult the task of separating formal from non-fonnal ultrasound education. Respondents in some instances classified 2 week courses at educational institu-tions as 1 forma1 1 , and 12 month' hos pi ta 1-based training as 'not forma 11 • For the sake of consistency, a formal training program in ultrasound is defined in this project as a program of at least 3 months duration offered at an educa-tional institution. Thus all hospital-based training is classified here as 'not formal' without intending to imply anything about relative quality or experience gained. Under this definition, only ten of sixty-five respondents had completed a formal program. Program length ranged from three months to five years (a B.Sc. in ultrasound from a U.S. university}, with over half being of twelve months' duration. All but one of the ten respondents completed this training in the last six years. Four of the ~espondents' programs were based in the United States, with the remainder from the University of Manitoba's program. Those respondents without 'fonnal' training gained their ultrasound experience through on-the-job training or in-service programs. Table 9 shows the distribution of training period duration. Most training periods were either six months or one year and again, most of those trained in this manner completed their training in the last six years (85%). Table 9: Duration of lnfonnal Training Programs Duration of Informal Training Programs N % < 1 month 7 10.8 2 - 3 months 5 7.7 4 - 6 months 21 32.3 7 - 12 months 15 23. l 13 - 18 months l 1.5 > 18 months 1 1.5 --------------------------------------------- --------· -----------· Indeterminate, No Answer or Not Applicable , 5 . 23., Total 65 100.0 .. -19-Table 10 provides information on the locations of the informal programs. Vancouver General Hospital has been the major source of ultrasound technicians for the province, as w~ll as the major employer. Close to 54% of the pertinent respondents received their informal training solely in a GVRHD hospital, and almost all received the bulk of their training in Canadian institutions. Table 10: Location of Respondents' Infonnal Training Programs Location of lnfonnal Training Programs Vancouver General Hospital St. Paul's Hospital Other GVRHD Hospitals Other B.C. Hospitals Multiple Institutions including B.C. Other Canadian Setting Multiple Institutions outside B.C. Non-Canadian Institutions No Answer or Not Applicable Total N -15 4 10 7 5 10 l 2 ----------11 65 % 23 .1 6.2 15.4 l 0.8 7.7 15 .4 1.5 3.1 ----------16.9 l 00.0 Respondents were queried regarding their involvement in ultrasound-related continuing education activities over the past two years. A total of 41 (63%) indicated some such involvement, with over half of these reporting less than 60 hours of continuing education time. Seven respondents reported more than 100 hours over the two year period, while twelve indicated less than 20 hours • -20-Employment Profiles In Table 11, two pieces of information are provided and related to each other -- length -of experience ancl current empioyment status. Table 11: Total E!Jllo,Y!l!ent Time in Ultrasound by Current En!>lO,Y!l!ent Status Total Length of Current Employment Status Total time Employed in Ultrasound F.T. P.T. CAS Student Other li ! < 1 year 6 5 3 3 0 17 26 .2 1 year to under 3 years 18 11 1 0 0 30 46.2 3 years to under 5 years 10 0 1 0 0 11 16 .9 5 years to under 15 years 4 1 1 0 1 7 1 O.B 15 yea rs or more 0 0 0 0 0 0 0.0 ! 38 17 6 3 1 65 ! 58.S 26.2 9.2 4.6 1.5 100 .0 F.T. •employed full-time as an ultrasound technician P.T. ~employed part-time as an ultrasound technician but may or may not have full-time employment. (e.g. part-time ultrasound and part-time X-Ray) CAS •employed on a casual, back up basis as an ultrasound technician; may or may not hold another full-time job. Close to 60% of respondents were employed as full-time ultrasound technicians as of summer 1980, with an additional 37% employed on a part-time or casual basis. Over 70% of the respondents had spent a total of less than three years in ultrasound-related employment, with 26% of them in their first year as ultra-sound technicians. The share of full-time technicians was 35% for those employed less than one year, rose to 60% among the one to three year employed group, peaked at 91% for those who have spent three to five years in ultrasound, and declined to 57% for those who have been employed for five or more years. This may reflect a shortage of full-time positions, an inclination on the part of employers to break-in new technicians on a part-time basis, or a desire by younger technicians to work only part-time. -21-While we have insufficient information to provide an unequivocal explanation, Tables 12 and 13 provide some assistance. In the former we see that of the twenty-three respondents currently in casual or part-time positions, only eight (35%) were seeking full-time employment. Those working part-time were 1-es-s likely to--wtsn Ml-ttme employment Utah tliose working on a casual basis. Table 12: Desired El!>lo.)'ll!!!nt Status by Current En!>lo,pent Status Current ~loyment Status Desired Employment Status Total F.T. P.T. CAS STUDENT OTHER Seeking Full-time position as Ultrasound technician 0 5 3 0 0 8 Not Seeking Full-time position as Ultrasound technician 0 12 3 0 0 15 Not Applicable 38 0 0 3 1 42 Total 38 17 6 3 1 65 Table 13: Desired Employment Status by Total El!!>lo,Y!l!ent T1me 1n Ultrasound Total Length of Time Employed in Ultrasound Total Desired Employment Status 1 yr. to 3 yrs. to 5 yrs. to cl yr. under under under 3 Yrs. 5 yrs. 15 yrs. Seeking Full-time positions as Ultrasound Technician 2 5 1 0 8 Not Seeking Full-time positions as Ultrasound Technician 6 7 0 2 15 Not Applicable 9 18 10 5 42 Total 17 JO 11 7 65 • -22-A shortage of full-time positions might be reflected in the desired employment status of the newest technicians. But as Table 13 shows, a higher proportion of those with one to t~ree years' experience are interested in full-time wor.k than those. -With- le-s-s- t-haf\- -&tte- yea-r- -of- ultrasound exper1 ence. Two other related pieces of information may be garnered from age/sex data. Of those not employed as full-time technicians, respondents in the 26 - 30 age bracket were more likely to be interested in full-time positions than respon-dents from all other age groups, and all but one of the eight wishing a full-time position were female. Finally, of those eight persons. six currently reside in Greater Vancouver or on Vancouver Island. What seems evident, then, is that those few wishing to work as full-time technicians and not doing so presently, are predominantly under 30 1 and have most often worked in the field for between one and three years. Table 14 relates total ultrasound employment time to time employed by current employer. This table cannot provide definitive turnover/attrition information because the length of time within categories is sufficient to allow within-category employment changes. Table 14 : Length of Time with Current Employer by Total Employment Time in Ultrasound Length of Time Total Length of Time Employed in Ultrasound with Total Current Employer <1 yr. 1 yr. to <3 yrs. 3 yrs. to <5 yrs. 5 yrs . to <15 yrs. < 1 year 7 7 2 1 17 1 yr. to under 3 yrs. 2 13 2 2 19 3 yrs . to under 5 yrs . 1 3 4 0 8 5 yrs. to under 15 yrs. 5 4 2 3 14 15 yrs. and over 0 1 0 1 2 Not Applicable or No Answer 2 2 1 0 5 Total 17 30 11 7 65 However, it is interesting to note that out of 60 respondents for whom ·both pieces of data were relevant and provided, fourteen have been employed as ultrasound technicians with at least two different employers. In contrast at least nineteen of the 60 respondents have moved into ultrasound from other areas of the same hospital, reflecting the pervasive nature of on-the-job training in B.C.'s ultrasound technician complement. • -23-Twenty-six per cent of respondents have been with their current employer for less than a year. Yet of that 26 per cent, fifty-nine per cent have been ultrasound technicians for one year or more. This suggests considerable mobi-lity during the early stages of this particular type of career. Again this may reflect the type of training -- persons trained on-the-job may move to new employers once they have completed their 'apprenticeship'. Vacancies and Recruiting In the previous section it was reported that out of 65 technicians, 23 are not currently employed full-time, and eight of those are currently seeking full-time positions as ultrasound technicians. From the employer questionnaire, information was gathered on the difficulty of filling vacancies for ultrasound technicians. Of the twenty-two hospitals with ultrasound capacity in 1979, eleven had encountered recruiting difficulties at some time, ten had not, and one did not answer the question. However, two of the 'no' responses indicated that a vac-ancy situation had never arisen, and there were 'yes' and 'no' responses from institutions which have trained their own technicians. In some cases this latter phenomenon reflected a preferential choice, while for others it was not obvious whether they would have preferred to hire ready-made graduates from a . formal education program. Most 'yes' respondents circumvented vacancy problems by utilizing back-up internally-trained staff, by training existing staff speci-fically to fill a vacancy, or by attempting to hire students from other institu-tions. One respondent indicated that the radiologist took over the reins, while others reported temporary closure of the ultrasound facility. The value of this information is critically dependent on the policy questions being asked. If one is interested in the extent of vacancies/ recruiting difficulties, responses are inconclusive -- there was no strong sense of desperate ultrasound rooms scrambling to steal technicians from neighbouring hospitals. Many hospitals train their own technicians and, at least in some explicit cases, seem to prefer to do so. If, instead, one is interested in the availability of formally trained technicians and the unstandardized quality of those trained on-the-job, then one should find revealing the fact that most hospitals must rely on training their own technicians or on hiring on-the-job trained staff from other hospitals. • -24-Future Staffing Requirements An attempt was made to ascertain additional technician requirements over the two years, 1980-81, over and above replacement staff. Twenty responses from hospitals with ultrasound rooms indicated an anticipated need for 23 new FTE technicians. The seven responses from hospitals planning the commencement of ultrasound services during those two years suggested requirements for an additional 10 FTE technicians. Assuming the four non-respondents could each reasonably require one addition to staff of this type, this totals 37 new ultrasound technicians. In Table 3, we saw that in 1979 there were approximately 1.4 FTE techni-cians per ultrasound room. If we assume that by the end of 1980 there will be fifty fully operational rooms~ 6 and count current part-time and student techni-cians as .5 FTE's, then these responses suggest approximately 85 technicians for fifty rooms -- 1.7 FTE technicians per room. Without more information on reason-able throughput capacity of technicians by type of ultrasound procedure, and future increases in utilization it is difficult.to assess this projected increase in technician requirements. However, these figures do imply that institutions currently providing ultrasound services see a need for approximately a 50% increase in technician staff by the end of 1981, keeping in mind the possible wish-bias of responses to this type of question. VII. TRAINING PROGRAMS Canadian Until recently the Health Sciences Centre at the University of Manitoba was the only Canadian educational institution providing any 'for~al' ultrasound training. As of this fall (1980), this program will have been joined by programs offered in two Ontario settings, and a program at the British Columbia Institute of Technology. The University of Manitoba currently offers a variety of programs. These include a 'formal' one year program in diagnostic medical sonography, a two-week introductory course, individually tailored preceptorships of from two weeks to six months' duration, and residency programs for physicians of from 3 - 12 months' dura-tion. 6 The thirty-eight rooms in operation at the end of 1979, plus one room in each of the nine hospitals starting ultrasound in 1980-81, plus three unassigned additions in existing locations. • -25-The one year program started in 1974 and currently accepts five students per year. The prerequisite is certification in another allied health field. The two week program is offered four or five times a year, with a maximum 15 students _per .co.urse.,. and seems- geared -no-t- -OJH-y -towa-FG -tec-flfl-kta-ns -but -a-m toward radio-logi sts who are interested in exposure to, or upgrading their skills in ultrasound. Commencing this September, Mohawk College in Hamilton, Ontario will offer a one year program and will be accepting up to ten students. The program will be comprised of three semesters. In the first semester, 40% of student time will be spent in clinical settings, a ratio which will increase to 60% for the final two semesters. Applicants must have registration in some health profession, and some prior ultrasound experience is preferred. In January 1979 the Toronto Institute of Medical Technology (TIMT) began a one year program. The first class was composed of 15 persons, all medical radiation technologists. The program gears its clinical portion to each stu-dent's past ultrasound experience, and a certificate is awarde~ to graduates. Infr~mation on this year's program is sketchy since no responses to our queries were received directly from TIMT. It would appear that the Institute planned to offer three separate programs: (i) an introductory course through Continuing Education, graduates of which would be candidates for the advanced ultrasound programs. (ii) a part-time advanced program of six months' duration, plus up to twelve weeks clinical training (depending on previous experience). (iii) a full-time program for non-Toronto-area residents, comprised of an introductory course followed by 6 months of concurrent didactic and clinical training. Those admitted to the 1979 program were all employed at the time in ultrasound, and most had already taken an introductory course. In short, the TIMT program seems geared at present to those with some ultrasound expertise already in hand, although it is eventually anticipated that less experienced candidates will gain admission as the program changes. With increased enrol-lment of this latter type of person, greater emphasis will likely be placed on the full-time segment of the program. In addition, short, advanced courses are offered by Mohawk College. Finally, a one year course is being offered for the first time this year at the British Columbia Institute of Technology. Enrollment for 1980-1 is eight students. This course is an add-on option to the existing two-year medical radiation technology program. • -26-United States Appendix E is a list of ultrasound educational training programs in the United States, obtained from the American Society of Ultrasound Technical Specialists. VIII. SUMMARY AND CONCLUSIONS Ultrasound services are currently provided in B.C. through twenty-five to thirty acute care hospitals. The use of diagnostic ultrasound has in-creased dramatically over the last decade and particularly during the last few years. Approved provision of service in new sites and anticipated additional personnel needs suggest continued rapid growth for at least the next two years. Growth thereafter may be critically dependent on access considerations and on technological advances uncovering new and improved uses for sonography. By the end of 1981 there should be few hospitals without ultrasound capacity which could justify having that capacity. Thus, our data suggest that geographic expansion of this service may be limited in the future, but tell us very little about future demands on existing facilities. Corresponding to the rapid growth in utilization has been the increase in the number of persons providing ultrasound technician services. Since there was only one formal training program in Canada for these technicians prior to 1979, the majority of those employed in B.C. have medical technology backgrounds and have received ultrasound training on-the-job. This continues to be the major source of technicians in B.C. today. While the data gathered for this report provide information on those technicians currently employed, a potentially important piece of information is missing. We were able to identify and collect data from only one person who was not currently employed in ultrasound but had been in the past. Un-doubtedly there are others, although the numbers involved may not be significant. Whether this group represents a potential pool of future returnees, depends on their numbers and on any future training standardization requirements for ultra-sound technicians in B.C. Highlights l. There are presently at least 64 and perhaps as many as 70 technicians doing ultrasound examinations on a full or part-time basis in B.C. hospitals. 2. Most of those employed as ultrasound technicians are certified medical radiation technologists, and a few have American ultrasound certifica-tion through A.R.D.M.S. 3. Approximately 60 per cent of respondents resided in GVRHD or the Capital hospital district. Almost all were Canadian-born, over 80 per cent were female, and around 70 per cent were less than 35 years of age. • -27-Highlights (continued) 4. Almost 60 per cent of respondents were employed full-time as ultrasound technicians. Those with three to five years ultrasound experience were -mes-t 1--i-ke-ly- to- ire -emp-luye-tt fu'tt-rtme. Almost naTf tne responcfents had been employed in ultrasound for between one and three years, reflecting the relative novelty of the profession. 5. Of 65 respondents, 23 were employed on a part-time or casual basis, and eight of those 23 were seeking full-time positions as ultrasound technicians. As noted earlier there may be additional persons, not identified through current affiliation with a hospital or membership in A.S.U.T.S., who are also seeking such employment. The numbers involved, however, will likely be very small. 6. Employing hospitals were mixed in their responses to queries regarding vac-ancies and the difficulty of filling them, with slightly more than half the hospitals indicating past recruiting difficulties. 7. Respondents to the hospital questionnaire indicated an aggregate require-ment for close to 40 new FTE (i.e. non-replacement) technicians by the end of 1981. 8. There are currently four Canadian educational institutions offering formal programs in ultrasound technology - University of Manitoba, Mohawk College (Hamilton), the Toronto Institute of Medical Technology, and the British Columbia lRstitute of Technology. The Ontario sites have only offered their programs since 1979 and the B.C.I.T. course was first offered in September, 1980. From a policy perspective there seem to be two separate but related ques-tions requiring attention. First, are there and will there be sufficient ultra-sound technicians to meet the Ministry of Health needs in the future and, second, is some standardization of training desirable? Unfortunately the data compiled and reported here allow no answer to the second question and only an impression-istic answer to the first. There is no doubt that some hospitals do, and did, have difficulty're-crui'ting ultrasound technicians. Others expressed a preference to train their own. Some have attracted graduates from the Winnipeg program, and there is no reason to believe that B.C. will not attract graduates of the two new Ontario programs. Vancouver General Hospital has a more-or-less formal one-year program training two students per year, with funding from the Ministry of Health. Other hospitals make provision for stw:tents out of their global funding. • -28-If, however, the requirement for new and replacement technicians over the next two years is going to be close to 40, it is unlikely that the current act troc -collection uf training 1 programs-1-wi'li be able to saUsfy tLC. -.-s re-quirements. A formal program would only partially solve that problem, as gradu-ates would not appear before the summer of 1981, and current enrolment is only eight students. Some type of standardization of training does seem desirable. However, it raises two immediate questions; the status of technicians without a certi-ficate from a formal program, and class size. Whether those now practising as ultrasound technicians without formal training should be required to up-grade their training where necessary and to sit exams equivalent to those required of graduates from a formal program, is a question which must be addressed by the Ministry of Health and others. Funding implications of up-grading would also require attention. In addition, since the demand for techni-cians may be largely a catch-up phenomenon, provision should be made in the planning of a formal program for a phase-down in class size if future demand, attrition and turnover rates seem tp indicate that is an appropriate policy. In addition, the termination of such a program should be held as an option, should subsequent monitoring and evaluation indicate that on-the-job training is a more effective and efficient method of ensuring quality provision of ultrasound examinations to B.C. patients. IX. FUTURE RESEARCH Much will depend on the policy decisions taken in this area. At the very least, the intent of the Health Manpower Research Unit is to develop an ongoing capacity for monitoring staffing and requirements which would permit an assessment of turnover, attrition and demand. Since a formal program has now been adopted in B.C., the capacity is in place for monitor-ing graduates and assessing employer satisfaction with them relative to on-the-job trained personnel. A separate, more involved project requiring different expertise also seems desirable. This would attempt to document the areas in which ultrasound serves to complement, and to substitute for, other diagnostic tools. In this way, better estimates of future expansion in ultrasound may be forthcoming and guidelines for the future funding of new or expanded ultrasound capacity may be established. , -29-APPENDIX A Ultrasound Techniques and Equipment -30-APPENDIX A ULTRASOUND TECHNIQUES AND EQUIPMENT Ultrasound occurs when mechanical vibrations in one region of a medium are transmitted to other regions through the interaction of the atoms and molecules of that medium. Ultrasound vibrations are orderly rather than random and are generated by an external source. Typically, this source is the elec-trically induced vibration of a crystal. The interaction that occurs between the source and the particles of the outer surface of the medium cause the part-icles to vibrate. These particles in turn cause neighbouring particles to vibrate (oscillate) and the mechanical vibrations pass very quickly through the material. The motion of the particles can be likened to a weight on the end of a pendulum, although the distances moved in ultrasound are micro-scopic. The frequency of sound determines the number of complete oscillations per second, and has a great influence on the final displayed result. Common frequ-encies for diagnostic ultrasound range from 0.5 - 25 MHz but are generally with-in the range of l - 15 MHz. l MHz or megahertz is equal to 1,000,000 complete oscillations per second. (Note: Ultrasound does not occur extensively in na-ture except at lower frequencies. No natural sources of ultrasound in the MHz region are known and this complicates the investigation of potential hazards of this technique. Available evidence suggests diagnostic ultrasound is a safe procedure but the question of possible genetic effect, immediate or delayed, remains unanswered and will be difficult to document in any case). An essential feature of most ultrasonic instruments is the ability to pro-duce narrow ultrasound beams which are highly directional - the acoustical equiva-lent of a miniature searchlight. Ultrasound can be transmitted continuously along the beam or may be in the form of short regular pulses. In general, the type of display or scan distinguishes different ultrasound instruments and the uses made of them. For the most part, machines for multi-uses would be the conventional B-scan, the Real-time B-scan or CT scanner. These multi-use machines vary in their display ability (e.g. A-scan, linear array, sector scan, M-scan) or their flexibility of use and speed with which procedures can be completed. Dedicated machines are developed around techniques best suited for single purpose diagnostic procedures (e.g. eye, head) and would be selected only when warranted by an adequate number of patients requiring such procedures. Machines developed with the smaller hospital in mind usua1ly offer all display options in a single instrument. Since machines are less standardized than the techniques they incorporate, it is most useful to review the typical range of techniques. A-scan The A-scan was the original and the simplest scanning technique but has now been replaced by Grey Scale Echography. -31-However, some machines still provide A-scan displays as an adjunct to other display abilities. The technique provides a one dimensional scan that records echoes detected from surfaces that lie along the length of and intersect with the ultrasound beam. The display re~ngle line movement in both verti-cal and horizontal directions {e.g. ). The vertical height of the display measures degree of deflection of the sound {size of echo received) and the horizontal distance between vertical deflections is a measure of the depth of the reflecting surface. Prior to the advent of Grey Scale Echography, the A-scan was used to examine anatomical structures that were not complex ones, to provide accurate dimensions of structures and as an aid to interpreting more complex scanning techniques. Grey-Scale Echography In the past, most echograms displayed only a portion of the information derived from a magnitude of echoes, and had a characteristic black and white contrast appearance. This was adequate in applications where diagnosis could be made on shape, position and size of structure but could not provide differ-entiation between tissues that lay in acoustically similar surroundings. Grey scale echography introduces techniques that are sensitive to slight variations in echo strength (as per variations between soft tissues) and displays these variations as shades of grey. B-Scan The B-scan technique was developed to overcome the ambiguity that can arise from a one-dimensional scan and provides a pictorial representation of tissues. The ultrasound beam is made to sweep in a plane section through the body, the point of interface with structures is recorded (echo spots of bright light) and from this, a two-dimensional picture or image of the structures de-tected can be displayed. The B-scan technique allows a more detailed study of the dimensions of a structure, assessment of volume, localization of tissue position {e.g. tumour, placenta) and provides information about the physical nature of the tissue by its ability to reflect sound. The more complete the scanning action, the more likely that tissue boundaries will present at suitable angles to the beam and be recorded, and thus the more complete the image displayed. With a conventional B-scan instrument the ultrasound beam is positioned at a predetermined angle suitable for the desired scanning motion {e.g. a trans-verse section). -32-The beam is repositioned for each new angle or section to be scanned. For each position, the appropriate echo pattern is displayed within a lapsed time of about one to two seconds per image. A number of such section images are usually required to build a complete tissue image and a typical procedure can take from 30 to 45 minutes to complete. The photographic record of these images covers a large field (one of the advantages of the conventional B-scan instrument) and provides good support for post-procedural interpretation and diagnosis. The rapid or real-time B-scan instrument introduces a technique where scan-ning action is performed and repeated very rapidly, allowing the motion of struc-tures within the body to be observed. Results are displayed innnediately and the complete image is viewed continuously during the examination. Ideally, scanning is performed so rapidly (providing about 30 images per second) that echoes from all parts of the structure in the scan plane appear simultaneously on the dis-play screen. This instrument is a most flexible one - the ultrasound 'beam' is hand held and can be rotated o~ moved in any direction for whatever scanning action desired. The time required for a complete procedure is around five minutes and thus is very much shorter than for a conventional B-scan procedure. The field of vision, however, is smaller and this makes the recorded images more difficult to interpret in a post-procedural review. This problem is offset by a combination of operating skill and 'on the spot' interpretation. The range of scanning action (the angle and direction in which the ultrasound beam is moved) is critical to the result of an ultrasound procedure. This action may be manually induced and is typically classified as simple linear, simple sector, simple radial, simple contact, compound linear or compound contact, (see attached). Machine technology has incorporated a number of the different scanning actions within the instrument for more precise and rapid action. For example, a simple linear scan uses a linear array of transducers which generate a number of parallel ultrasonic beams. This is used for scanning large struc-tures and displays a simple linear image. A simple sector scan displays a more complete/detailed image of a small sector or structure by rotating the trans-ducer in a rapid, complex scanning action over the restricted area . . The flexibility of the real-time B-scan instrument stems from its potential to combine instrument-initiated with manually-initiated scanning actions. M-mode Time-Motion scan (M-scan) This is a technique that uses pulsed ultrasonic scanning to observe motion within the body. Movement of a surface is detected by noting changes in echo amplitude. The resulting display (similar in appearance to an electrocardiogram} is a trace of time versus position for each interface detected. The facility for time-motion scanning is now found on most multi-use instruments. .. • -33-Doppler scan Motion can also be detected by an application of the Doppler effect where ultrasound of a well-defined frequency is reflected from moving tissue, and the shift in frequency provides a measure of the speed of movement. Doppler is a technique involving the reflection of continuous wave rather than pulsed wave ultrasound. Ultrasonic Doppler instruments are highly sensitive, inexpen-sive and widely used - particularly for foetal heart monitoring and for blood measure/flow determination. Nowadays the Doppler instruments are more likely to be used for their audial reporting (e.g. like a stethoscope) rather than for a visual display and as such, the technique is regarded as part of routine practice in obstetrics and surgery and not regarded as a lab procedure (no fee is paid for a Doppler procedure). This type of procedure is not included in the data of this report. Common Procedures "Some of the studies performed by the sonographer are: 1. Echoencephalography - examination of the contour and inner structures of the brain with sound waves. 2. Echocardiography - examination of the heart and its structures such as the valves. 3. Abdominal - examination of all the soft tissue structures in the abdomen and retroperitoneal space. {liver, spleen, kidneys, pancreas, aorta, vena cava) 4. Obstetrics/Gynecology - examination of female anatomy and pregnant females. 11 ("Diagnostic Medical Sonographers Program", University of Manitoba, mimeo, page 2) -34-CLASSIFICATION OF SCA:mING ACTION ~ -I I ' (a) I I I I I I I I I I I I I I I I I ' f t • • Simple Linear B - Scan -~-..... \ ~ I ' 4 ' , ~/ & \ I I I' ', \ 1 '/ ~ .. ( c) Simple Radial B - Scan \),7'-~ • ~ > l ''\"''''"' ,,, I I ~ I ( I \ I ,I I \ I 11\1/\11\1/\1 \ I I/ \~ \JI \1/ \I \ I JAAl\\ , II /I\ lh II\ I\ ~ {e) Compound Linear B - Scan B-scan instruments <..t~7; ,,, ,, /I I \ ', I I I \ ' ' I I \ • • • ~ (b) Simf le Sector - Scan ~ \ I 1 \ \ I \I I \ \I ,( I \ t ,.\ ' \" ( d) Simple Contact B - Scan _,~l-~\ ,',·, ) f''t, I \ \ I I \I \ \I ~' \ \ I : 11 / t I ,\ ~ ,. ,,,,,I °t' ( f) Compound Contact B - Scan source: McOicken (1976), page 103 -35-APPENDIX B Hospital Questionnaire -- Ultrasound Services • APPENDIX B 1. ~neral Infonnation: -36-llOSPJTAL QUESTJONNAIRt 11.TRASOUND SERVJCES 1. lame of Hospft.al --------------------------2. lame of Respondent -------------------------3. Posftfon of Respondent-------------------II. Ultrasound Fac1lit1es: 4. Does 1our hos pf t.a l have one or .,re ul trHound l"OClll5 7 lf NO, please proceed to Questfon 10b. YES D Phone: -----Wj D lf YES: How •ny, tn ..tiat departlllents ire they located, 1nd ..tien were they opened? Nlll!'ber of Rooms lame of Depa rtlllent Year Opened 5. Please indicate the nunt>er of each of the following ty~ of .. chines utflfzed fn 10ur hospft.11 fn 1979; and on order: (a) Conventional B-scan (b) Real-time (lfnear Array) (cl Real-tfme (Sector Fonnat) (d) M-mode (Dedicated) (el M-mode with Sector Scan (f) Dedicated eye units (g) CT head scanner (h) CT total body scanner III. Ultrasound Utilf11tion Utflfzed fn 1979 On Order 6. (a) Please fndicate the Nld>er of procedures undertlten durfng 1979 tn etch of the followfng areas: (f) obstetrfcal · (f 1) lb~n. pelvfc and •fscellaneous ('111) eye (fv) cal'dfac (v) doppler TOTAL. (b) Pl1ase tndfcate the tot.Al nunt>er of delfverfes perfonned tn 1our hospf~l durfng 1979: -37-JV. Current St1ffin for Ultrasound: 7. Pl11se tnditlte tht IUC>er of physicfans llfho .orted (p1rt-tf• .. full-ti•) tn your ultrasound room(s) during 1979: Rad1ologtsts Cardiologists Obs tetri ci1ns Other (Specffy) Ave,... I of their .orkfng tf111e g!!l tft Ultrasound• •Total tiine spent fn ultrasound by 111 physftfans tn each ca"'9rJ (t.e. lldiologfsts), divided by total ~orking time of the same physicfans. 8. How •ny of Hth of the following types of personnel curnnt11 ,rovfde 'ultrasound technfcfan' servfces fn your hospital: Ultrasound technfcfans Student technitf ens •ull'ber of Ful 1-tflne .-er of Part-tf• AYerage I of time spent in Ultrasound by part-tfme technfcians• • T1111e spent fn ultrasound dt..Wed by tote\ .orltfng tf1te. If you are utilizing student technicfans, whit ts the duratfa.ef thefr trafnfng perfod? 9. (a) When technicfan vacancies arfse in your ultrasound rooin{s), do you hllff dfffftulty recruitfng experienced ultrasound technicfans? YES D 10 D (b) If yes, how do you generally resolve thfs difficulty? V. Future Steffin Re uf~nts for Ultrasound: 10. (a) IF YOUR HOSPITAL CURRENTLY HAS ONE OR P'ORE ULTRASOUND llDIS: How Nny technfcfans do you foresee a need to add to your ultrasound room(s) staff llfilllin the neat lllO years? (count pert-tiine technicf ans as ~) (b) IF YOUR HOSPITAL PLANS TO START AN ULTRASOUND lt()()I WITHJI 1HE EXT 'NO YEARS: How 1111\Y technfcians do you antfcfpate needfng to adequately staff lbe roam? (count pert-tfme · technfcfans as ~) TMnlt you for lfNr cooperatfon tn c_,1ett• lltts Questfonnafre -38-APPENDIX C Survey of Ultrasound Technicians APPENDIX C -39-SURVEY OF ULTRASOUND TECHNICIANS Personal Identification: 1. Name: (SURNAME) (FIRST NAME) (SECOND NAME) 2. Address: (APT. or BOX NO.} (S'J'REET NO. and NAME) (CITY) (PROVINCE/STATE} (POSTAL/ZIP CODE) 3. Sex: Male D Female D 4. Marital Status: Single D Married 0 Other 0 5. Date of Birth: (MONTH) (DAY) (YEAR) 6. Place of Brith: (CITfJ (PROVINCE/STATE) (POSTAL/ZIP CODE) 7. IF NOT BORN IN CANADA : What year did you inmigrate to Canada? Education - General: 8. Did you receive basic training in any other health occupation before entering the field of Ultrasound Technology? YES D If YES: What was this occupation? Medical Radiation Technology 0 Medical Laboratory Technology 0 Nuclear Medical Technology 0 Other Health Ffeld (please specUy) ----------------Did you receive a degree, diploma or certificate? YES D If YES: Please specify nature of degree, diploma or certificate. ---------------( ..•• continued) Education - General continued -40-9. Other than any health occupation training (as described in question 8) and your training in Ultra-sound, do you have additional degrees, diplomas or certificates? YES D If YES: In what di sci pl ine? -----------------------------Please specify nature of degree, diploma or certificate; (i.e., B.A., Psychology). If NO: What is the highest level of fonnal non-health education attained, (i.e., Grade 12, etc.)? Education & Training - Ultrasound 10. Have you completed a formal training progra~ in Ultrasound Technology? YES D (If ~ Please answer Ouestion ll ) If YES: Name of diploma or certificate? -----------------------Duration of program: ------------Year completed: Name of School /Hospital: --------------------------Location of School/Hospital: (CITl') (PROVINCE/STATE) (COUNTRY) (If YES: Please omit Ouestion ll) 11. If you have NOT completed a formal training program in Diagnostic Ultrasound, what type of training in Ultrasoundtlave you received (e.g., on-the-job training, in-service education, etc.)? (Please specify) ---------------------------------Duration of Training: _____________________ _ What year did you ~omplete this training: __________________ _ Name of School/Hospital where training was received: Location of School/Hospital: (CITY) (PROVINCE/STATE) (COON:'RY) ( ••.. continued) • I I . I . I -41-Continuing Education: 12. In the past two years have you participated fn Continuing Education activities which were related to your occupation? (Do not include llllY of the education activities described above) mO ~o If YES: What is the approximate number of hours spent durfng the past two years in these activities? hours ~~~~~-Employment: 13. How long have you been employed in the field of Ultrasound? (Please check one only) ~ Under one year D One year to under three years c=J Three years to under five years [::J Five years to under fifteen years D Fifteen years and over 14. What is your current employment status? (Please check one only) c=J Employed full-time as an Ultrasound Technician i=J Employed part-time as an Ultrasound Technician c=J Employed casually as an Ultrasound Technician c:J Employed, but NOT employed as an Ultrasound Technician 15. a) Please give name of present employing institution: (INSTITUTION/AGENCY) b) How long have you been employed by this employer? ~~~~~-months c) If employed as an Ultrasound Technician, either part-time or casually, please check one of the following: c:J Currently seeking full-time position as an Ultrasound Technician 0 Currently not seeking full-time position as an Ultrasound Technician Other Information and Co111T1ents (THANK YOV 'FOR YOUR COOPERATION IN COllPLETING THIS QUESTIONNAIRE) • -42-APPENDIX D American Registry of Diagnostic Medical Sonographers Preliminary Brochure • -43-The ~rican Registry Of Diaqnosttc Medical Sonogrophers Central Off ice 2810 Burnet Avenue - Suite N Cincinnati, Ohio 45219 Telephone: <513> 281~8860 -44-HISI'ORY The American Registry of Diagnostic Medical Sonographers (A.R.D.M.S.) is a non-profit organization that was incorporated in JlD'le, 1975 for the sole purpose of acmunistering examinations in diagnostic medical sonography. The ARl}.5 has the recognition of the American Institute of Ultrasotmd in Medicine and the American Society of Ultrasound Technical Specialists and is involved with the National Conmission of Health c.ertifying Agencies. The c.entral Office was established in October, 1978. Since October, 1975 through October, 1979 the total nurber of candidates registered in each specialty is as follows: Specialty Abdomen Adult Echocardiography Neurosonology Obstetrics & Gynecology OphthalJOOlogy Pediatric Echocarcliography Peripheral Vascular Ik>ppler Nunber of· Applicants 3169 1412 621 3389 29 149 61 Number R~gistered 1917 770 316 2054 17 87 33 'lbe conposition of the ARIMS Executive Board includes 8 physicians, 1 acoustical engineer, 13 sonographers (4 of whom serve as officers) and 1 consuner rep-resentative. The Executive Board develops policies for planning and illJ'le-menting the examinations. Each specialty is represented by a physician and registered sonographer actively engaged in the practice of clinical or academic ultrasotmd. Board members from each specialty serve as co-chairpersons of a coltl11ittee comprised of additional qualified individuals in the specialty who are responsible for developing the written and oral/practical examinations for that specialty. This is acconplished in conjlD'lction with a professional testing agency, 'lbe American C.Ollege Testing Program (ACT). to insure standardization, content validity, reliability, quality of test materials and administration of examinations. f.ertification in the following specialties is offered: Abdomen, Adult Echocardiography, Neurosonology, Cl>stetrics 6 Gynecology, Ophthalmology, Pediatric Echocardiography and Peripheral Vascular Ik>ppler. REGISI'RY RFgJIRF.MENI'S 'lbe following are prerequisites for individuals desiring to take ARIM5 registry examinations. These prerequisites have been revised as of May 3, 1980 and super-cede all previous prerequisites. In order to be eligible, individuals must have COJ11Jleted their prerequisites by October 1. 1981. 1. Individuals trained in a 2 year, recognized NQ\ allied heal th occupation rust have in addition a mininllln of 12 full-time ronths clinical ultrasound: experience. -45-{prerequisites continued) Exa11J>les of NI.ft. allied health occ\4)ations are: registered nurse, radiologic technologist, respiratory therapist, physicial therapist, occupational therapist, medical tech-nolo&,ist, etc. 2. Individuals with two years of fonnal education past high school must have in addition a lllininun of 24 mnths full -time clinical ultrasol.Dld experience. 3. Individuals enrolled in a Bachelors degree program in ultra-sol.Dld or radiology with a minor in ultraso\.lld nust have 12 m:>nths full-time clinical ult!BSOllld experi~nce. This indi-vidual is eligible to take the registry one year prior to the completion of their Bachelors degree provided that the 12 lll>nths clinical ultrasound experience has been coapleted. 'I Individuals with a Bachelor degree must have 12 m:>nths full-time clinical ultrasound experience. (However, the Registry Executive Board reconnends 24 m:>nths clinical ultrasound experience.) 4. A high school graduate who attends an ultrasound program (two or mre years) in a Junior college must have an additional 12 mnths full-time clinical ultrasol.Dld experience. 5. Equi valency - An individual who does not qualify mder the above categories may be eligible to take the registry examinations mder the equi valency clause. This clause includes any person having 24 m:>nths of on-job-training in a recognited >11,A, allied health occupa-tion e.g., EKG, EEG, Non-invasive testing etc., with or without some fonnal education, plus 24 m:>nths full-time clinical ultrasound experience, totaling 48 mnths. All 48 mnths may be in ul trasol.Dld. •• CUM.CAl. uUJr.a.6owid e.xpe!Lle.nc.e. 11~ .tha.t 4ll .i.ndlv..ldual. a.ppty..lng 'olL ARVMS e.xamlna.tum1i llLL6t be pe.Jt'o.ltmlng u.Ulut6owid e.xamina..ti.o~ .ln a. cUn.iCAl. 1ie.t.Ung 1iu.c.h 46 a. ho6plta.t, cU.n.lc., pll...lua.te p!U1.C.Uc.e olL a.6 a. 6tude.nt wtdeJL the 6upe.Jr.v..ilt..lon 06 a phy11..lcian olf. 1te.g.Ute1te.d 6ono-gJLa.pheJL on a. ~uU-.tUne ba.6..llt. •• fuU.-t.bne ba.6.U ..llt de.fined 46 35 hoWL6 pe.Jt wee~ - a.t lealit 48 wee.k.6 pe.JL ye/VI.. I 6 wo.ILIU.ng pvr.t-.time., the JLe.qu..iJwne.nt.6 4Jte. pJr.OJLa.:ted ovelL a. peJLiod 06 .tUne to equal 'uU-.tUne.. Example: 20 hoWL6 pVL wed would t.a.ke .two ye.a.JL6 PREPARATICN RlR EXAMINATION It is the responsibility of each candidate to prepare for the registry examinations. Assistance in preparing for the examinations should be obtained from the phsyician or registered sonographer to whom the candidate is responsible. -46-Educational guidelines for each of the specialties with a comprehensive bibli-ography may be obtained from the .American Society of Ultrasollld Technical Specialists (ASlITS) c.entral Office. 1bere is a prepaid fee of $15.00 for ment>ers or $25. 00 for non-meni>ers. Send to: ASLrrS - c.entral Off ice P.O. Box 35008 Dallas, Texas 75235 (Zl4) 521-1841 For a nominal fee of $3.00 an additional bibliography of available ultrasollld pub-lications may also be obtained from the American Institute of Ultrasound in Medicine (AILM) c.entral Office. Send to: AllN, Inc. Executive Office 6161 N. May, Suite 278 Oklahoma City, Oklahoma 73ll2 (405) 840-3721 The JTDSt appropriate preparation is achieved by the continuous education process with a thorough review of the subject/specialty. "Cranuning" for likely or anticipated questions may not be advantageous and is not reconmended. The examinations are de-signed to measure corrprehensive knowledge and the ability to apply that knowledge intelligently. The registry does not endorse any specific source of infonnation or educational programs. GENERAL INFORMA.TION The registry examinations are comprised of a written portion and an oral/practical portion. The written and oral/practical examinations are given on separate dates. All candidates nust pass a written examination on Ultrasonic Physics/InstT\Jllentation and Emergency Medical Situations as we~l as a written examination in a specialty be-fore taking an oral/practical examination in that specialty. Candidates are only required to pass the Ultrasonic Physics/Instl'\.11lentation and Emergency Medical Situ-ations examination once. 1. A candidate who fails a specialty examination two consecutive years will not be eligible to apply the following year, for that specialty. 2. A candidate who fails the Ultrasonic Physics/lnstn.inentation and Emergency Medical Situations examination two consecutive years but passes the specialty-(ies) examination will not be eligible to apply the following year. 3. A candidate who passes the Ultrasonic Physics/lnstrunentation and Flnergency Medical Situations and written specialty(ies) but fails the oral and/or practical portion(s) is not required to repeat the examinations that were passed, however, rust repeat the portion failed the following year. A candidate who fails an dral/_practical examination two consecutive years will not be eligible to apply the following year, for that specialty. • • -47-4. Candidates "10 have passed previous specialty examinations lDlder the Grandfather Clause status will no~ be required to take a written specialty examination be-fore being eligible for oral/practical examination(s) when applying for future specialty examinations. DEADLINES Applications for 1981 examinations will be available in November of 1980 The dead-line for receipt of all correctly ft'e¥1eted applications is Wednesday, June 24 1981 . No application will be processed a ter this date. It is strongl~ reconmended that you allow at least ten dats for domestic mail and two weeks for foreign air mail to reach the ARIM5 r.eiitra Office. Written examinations will be administered on Saturday, October 3, 1981; Oral and/or practical examinations on Saturday and SlDlday March 27 and 28, 1982. WRIITEN EXAMINATIOOS 1he written examinations are of the objective type (multiple-choice, tJLJe/false or matching fonn of test). 1he duration of each examination isl~ to 2 hours. NO CANDIDATE MAY TAKE M:>RE THA.\J FOUR EXAMJNATIONS. All examination answer sheets will be scored by con;>uter. The Ultrasonic Physics/InstTllT!entation and Emergency Medical Situations written examination will include basic ultrasonic principles coJTUTOn to all disciplines (in-cluding Real Time) as well as emergency medical situations. For the specialty examinations: The areas in which candidates will be tested include fundamentals of teclmique, nonnal anatomy, pathology and physiology that are charac-teristic of each specialty. 1he following are S81Jt>le questions: Abdomen 1. Which of the following vessels drain directly into the inferior vena cava? 1. Portal vein. 2. Renal veins. 3. Inferior mesenteric vein. 4. Hepatic veins. a. 1 and 3 b. 2 and 4 c. 1, 2 and 3 d. 4 only e. 1, 2, 3 and 4 -48-Adult Echocardiographr 2. The A-C interval of the mitral valve echocardiogram is increased in: a. elevated left ventricular end-diastolic pressure b. elevated left ventricular end-systolic pressure c. elevated left atrial pressure d. none of the above Neurosonology 3. Serial follow up of shunted patients is essential to detect: a. collapsed lateral ventricles b. obstruction of foranen of t.k>nroe c. obstruction of the aqueduct of Sylvius d. malfunctioning shunt Obstetrics .§. Gynecology 4. The chorionic plate is: a. the annion and chorion b. the mass of chorionic villi c. the maternal surface of the placenta d. the fetal surface of the placenta e. all of the above 5. To prove the location of a lost lUCJ) once you have visualized it within the uterus you should: 1. take at least three pictures 2. visualize it both longitudinally and transversely 3. scan the patient in Trendelenburg position 4. lower the gain and see whether .the strong echoes remain a. 1 and 3 b. 2 and 4 c. all of the above except 3 d. all of the above Ophthalloology 6. Sub-retinal hemorrhages are characterized mst often by: a. spontaneous internal mvements observed on A-scan b. thickness of S - 10 nm. c. thin leading edge echo on A-scan with low amplitude internal echoes. d. diffuse mid-vitreous echoes. e. a and c. s I D E , • ,I I I, I I I I I I I I I I I I I I I I I I I I I I I I I l I I I I I I I I I I I I I I I I I I I I I I I I I • I I I I I I. I 11 11 ' ' I I II II ltt I r.~- NAllE (UM a Soft LHd '9nc:U Onlf) ,,,..._,,. Ml I ....... '""1811 THT CENTER LOCATION T•c.n...C.., ... Z,.Codl I.Tl NAiii! Lall N8rr'9 FiratName 0 0 0 0 0 0 D D 0 0 0 0 a a D 0 c; c; e ~ (1 © ~ t) © ® 6 6 ~ I~ e s 0 0 0 e e ~ r; G ~ ~ ~ e 0 ~ ~ et e © ~ c; @ e e e e 0 0 0 e e ® e e e 0 0 c; 13 8 0 0 ® 0 @ 6 a a a 6 c; e e e e e e 8 e e e e e e e (g (9 © ~ © e © (g © © ~ @ © a @ e e e 8 e e e @ e e e 8 e ® © © © © © © © © © © © © ~ ('.) ('.) 6 ~ ('.) 6 ~ e ('.) el el t!) ('.) ~ ~ " e (g e e @ e ® e e e e e e ~ a a e a e 0 0 e e 0 0 a 0 c 0 0 0 0 0 0 0 0 0 0 0 0 G G GJ @ ~ G 0 0 0 0 0 0 0 0 e e 6 e 6 6 e e e e s e el e 9 0 0 Q 0 e © G @ @ © l9 © © e 1111 e e 8 8 8 8 8 e s 8 e 8 e e s 13 6 6 e e 8 e 8 e e s ~ (j (3 @ @ @ @ @ @ @ @ @ @ ~ e ~ e ~ e e 6 6 e 6 e e 6 e ~ e ~ e & ~ @ e @) @) e @) e @ 0 6 0 c; 0 0 0 e e 0 e e s e " @ @ e e @ @ @ @ @ ® @ @ ® 0 0 0 e e 0 e ~ 0 e e (!) (!) (!) e e g g e e e e e 9 9 e e 9 e e e 000000 0 0 e e e a e 0 0 9 9 9 9 9 e e 9 9 e 0 0 0 000000 0 0 0 0 0 e e 0 eeeeee e 0 (i) 0 0 0 0 0 0 0 © 0 © © 0 0 0 © 0 IDENTIFICATION NUllBER • DATE OF DAlllNATION , ....... ,, Numb9r) 0 0 0 0 0 @ @ @ ® ® (iJ ~ @ @ (!) 0 13 e s e c;; r:> ® ® e ~ rs s ® € 00000 ~J~1'!)@€ [.., (..~ t;, 111 Pi I I "'°""' 0., "-0 0 0 D D 0 0 0 0 c; c; 8 8 a c; e 6 6 e e e e e e @) e e ~ ~ e © ~ ~ @ © @ e e e e e ~ @) @) e @) ® @) @) @) © @) @) ~ f) ~ ~ ~ el ~ e> ('.) e @ " ® ® ~ e ® ~ @) e 0 0 e e e e El e 0 0 0 e 0 0 0 0 (1 15 0 0 0 G G e 0 0 6 e 6 e e s ei ,;\ \.' 6 @ © c 0 €) €i 8 '!) 0 8 e e e e e e e e a e 6 e e e e ~ a @ @ @ @ @ ~ ® @ e " e 6 6 el e 6 ~ 6 © e @ @) e ® fl ~ e c; e 6 e e e ® e El @ @ ® ® 8 @ @ ® ® © e © © e e e e e e e e e e e 9 e e 0 0 0000000 9 8 e e e e e e e (i) 0 00(i)000(i) 0 0 0 © 0 (i) (i) 0 0 © 0 0 © © © @ © © P-Pront Ml 0 6 @) © e ~ f.' © e 0 G 8 0 e e ~ 6 e 6 ® © e 0 8 (i) 0 © I I AMERICAN REGISTRY OF DIAGNOSTIC MEDICAL SONOGRAPHERS IN•TRUCTIONS: ..... the inatruc:tiona below IMlfore completing Block• A-F. u ... aofl (No. 2) lud pencil. 00 NOT uae ball-point pen, tount81n pen. cotor9d pencil, nylon-tip '*'· or t.n-t1p pen. It you make an error 1n marking an oval. erme your ,,,., ma1'I compl9'ely and then blecken the c:onect oval. K.OCK A-Print your name end the loc:atlon of ,.._ ._. .,...., on 1"9 liW DfOWlded. lll.OCK 9-Printyour narneinthelargeboa•atthetap labeled LAat Heme. Firwl Name, Ml(......_ lmt1al) Then in the column below each boll, blacken the appropr1.te oval Be sure to blac:llan ttla bl9nk rectangle below NCh boa left empty. BLOCll C-Print your Identification Number (provided on your admiulon card) in the i...ge boa• Then 1n the column below each boa, blacken the appropr .. te oval. • LOCll II-Print the month, day, and year or tftl9 eumination on tlW line prowldad. BLOCK I-Print the name of the Specialty EMminalion you •• taking on tlW Hne -fRlimd .SLOCIC ,_aYour proc:torn ....... 1 you,--~;;;,-~_ 0 e : Examination Score Sheet NAllE OF THIS SPECIAL TY EUlllNATION 8"CIALT\' CODE CM' l!XAlllNATION 010 @ @ s @ @ e @ e @I© I -"' l.C I -50-APPENDIX E ASUTS Update of Diagnostic Sonography Educational Programs 0 -51-DIAGNOSTIC &ONOGRAPHY EDUCATIONAL Pk>GRAMS (JUNE 1980) In each iasue of the Newsletter ve publi•h all 94ditional educational program inforwuation that has been received. In this manner a continuous update b available to ahowcaae •erginv pr09r11111S and to keep t.he ultrasound eo111-munity abreast of •i~nificant change• in mri•tinca pl'OCJreas. A complete li•t i• publi•hed annually in the first Newsletter issue of each calendar year and ia therefore available to our •embers at no cost. Copies of the list and all updates are available to non-embers and duplicate copies of the list requested by members upon re-quest and the submission of $1. DO to help defray the cost of JIO•uge and printi119. All information contained in this list has been provided to the ASU'l'S/SDMS -.oluntarily and does not signify or .iinply approval or rec011111endation by the Society of the pl'09rams. !'his project i• offered for general information purposes only to aeet the numerous requests received daily by the Society. MIDDLE ATLANTIC (Se111inars/short texm courses) Ultrasound Review Courfe: Barbizon Plaza Hotel, New York City. Dates: September 5 5 6, 1980. • This course is designed to aid candidates prepare for the written examinations this Fall. The faculty includes ultrasonographers and ultrason-ologists prominent in ultrasound training.First ·.-.orning offerings: Physics and machine operation, followed by two half-day sessions devoted to obstetrics and abdomen. Echocardiography vill be covered in a separate half-day period following physics for those who wish review in that area. Course will consist of pre and post tests, lec-tures and discussion periods. Course sponsors: Royal J. Bartrum, Jr., M.D. and Barte C. Crowe, MD. Course coordinator: Marcia Lavery, JU>MS. For in-formation contact: Jean Marchewka, Dept. of Jtadiology, Mary Hitchcock Memorial Hospital, Hanover, NH 03755. J«>RTHWEST Salem Hospital - Memorial Unit, 665 Winter It.SE, Salem , OR 97303. Program Director: William ~­ford, ROMS. Course Le119th1 one year. Specialties covered: agdominal, obstetrical and gynecological ultrasound. Mo. of students: 2 students/year. Starting dates: Jan 1 - Dec 311 July 1 - June 30. 'J'Uition: None. Hospital j,ays stipend of $150 first 6 110nths1 $250.00 second 6 months. Equipment available: 2 B-mode1 2 Real-time. Exams/111Dnth: 300. Direct inquiries to William Medford, JtDHS, Dept. of Radiology; Division of Ultrasound. llIOWEST University of Wisconsin-Madison. Program Di-rectors: William Zweibel, MD1 Howard ~yinond, MD Sandra Hagen-Ansert, BA, ROMS. Course Length: 12 110nths. No. of students: 3-4. Tuition: $1200. Equipment: A-mode; II-mode 1 B-scan: Real Time; Doppler )continuous wave). Specialties: Abd0111en, GYN, OB (limited), adult and pediatric echocardio-9raphy, doppler and breast. Certificate Awarded: Yes. Contact:: Sandra Hagen-Ansert, Clinical Science Center, University of Wisconsin-Madison 600 Highland Avenue, Madison, WI 53792 (608) 263-8300. Short-ter'll/~eminar Courses: University of Wisconsin-Madison: Course Title: Introduction to Diagnostic Ultrasound Technology. Presented by: Section of Ultrasound, Dept of Ra-diology. Admission Requirements: Limited to para medical personnel wishing to learn basic ultra-80und skills Which vill be applied in a clinical •etting. Lenqth of course: 4 weeks. Tuition:$600 Objectives: Course designed to provide basic instruction in general abdominal and obstetrical ultrasound. Emphasis on scanning technique, anatom-ic landmarks and technical aatisf action of Oiagnos-tic criteria. 'l'hree additional courses are offered: Basic Con-cepts of Abdominal Son09raphy1Basic Concepts of Ob-GYN Sonoqraphy; Basic Concepts of Echocardio-traphy. Admission requirements: Limited to para-medical personnel currently working in the med-ical feild whose department has or is considering purchase of equipnent. Length of course: 12 weeks. 'l'Uition: $1800. Objectives: to provide basic in-•truction in the 9eneral application of ultrasound to the specialty being studied to provide a foun-dation of knowledge for the beginning sonographer · .to build on upon return to bis own environment. For further infoXWltion contact: Sandra Ragen-Ansert at the acSdreaa listed 8hove. -52-e DJAGNOSTJC IONOGRAPHY EDUCATIONll PllOGRMS ln each issue of the Nevaletter, ..,. will publish all additional edu~ational progra• infonnation we receive. Jn this Update will be available. Once each year. a1 in the .,_,t the entire list will be published. vay a continuous NORTHEAST Maine Medical Center: Specialties: abdotaen, echocardiolc;,gy, ob-gyn, Doppler. 1.ength of prograM: 1 yr. No. of students: 2. Tllition: SlSOO. Equipnent: A-1110de, M-llOde, a-scan, real ti~e, Doppler. Certificate awarded. ·Prograr.i directors: Donald Bittel'lllan, MD and .Jaaies Priola, RT, JUlKS. Address: Radiology Dept. - Ultrasound, Maine MPdical Canter, Portland, Me. 04102. Northeastern University: Suburban Campus, South. Bedford Road, Burlington, Massachusetts 01803. Program Director: 111omas R. Kirkham. Course Lengtla: lS-18 Months. Specialties covered: Ab-domen, OB-CYN, tchocardiography, Neuro. Number of students: 20/yeax. Tuition: $1800/ year. Equipment available: Various B-scanners and Real Time. Exams/month: 2SO/aionth(average per hospital). Awards: Certificate of Completion. NORTHWEST Seattle University, School of Science ' Engineering: Length of Program: 4 years. upon co~pletion of high school. College transfer credit available. current enroll-111ent: 50. Tllition: yes. Classes begin at the beginning of every quarter. College credit awarded: this is a 1.5. degree pro-gram with internship of 1 calendar year as t.he senior year of the degree. Direct-or: .Joan Baker, MSR, RDHS. Address: Dept. of Allied Health. Seattle University, Seattle, WA. 98122 MIDDLE ATLANTIC Ultrasound Technical Services: 80 Fifth Avenue 1402, New York, N.Y. 10011. Program Directors: ·Philip M. Vald, MD; Donna Seusa, ltDMS; Douglas Brashears, RnMS. Echocardiography Program Di-rectors: I Kronzen, MD and Shirley Staiano,JtDMS. MIDWEST University of Jowa Ultrasono;raphy Progra111: Special-t.ies: Abdomen, Ob-Cy11 Equipinent: 2 Picker BOL Digital Scanners, 1 ADR Real Ti•e. Lengt~ of .Pro-9r8111: 1 year.case Load: J00-350 exa111S/1110nth. Tuition': Sil5/year. Pr09ru Directors Victor Wedel. RT, RD.~S. Me•ical Director: Le• Oaiv, MD. Certifi-cate •warded. Ro. 'of atudenta: 2. ltartin9 d•teaa .January and .July. address: Dliversity of Iowa. Hospitals •nd ~linics,.Dept. of lt.adi6logy, ~ectio: of Diagnost~c Ultrasonography; Iowa City, IA. S22 2 SOU111EAST lroward Co11111unity College: I Lisa Shuke, R:, ltDMS 6701 West Sunrise loulevard, Plantation, Florida )3313. Proaraa Directors: Dr. Robert Steinborg 11nd Lisa Shuke. frogram length: 1 year. Student capacity: 8-10. Specialties covered: abdomen, Ob-Cyn, echocardiography. Tuition: $300 111atri-culation. Equipment available: A-110de, I-scan, leal time. Exa11111/110nth: 400/institution vith aix affiliate hospitals participating • .Avards: Certificate of completion. SOUTH\.'EST Stanford University Medical Center: Department of Ul-trasound "Cll8B'', 300 Pasteur Dr., Stanford, CA 94305. Program Director: Kathleen Murphy-Irwin. Course Length: 1 year. Specialties covered: Abdomen, Ob-Gyn, Ophthalmic; aome Cardiac; Doppler; researeh. Number of students: 1 per year. Tuition: $300/yr. Equipment available: Research scanners, B-&canners, Real time scanners, Doppler. Exams/month: 300. Awards: Certificate of Completion. The Penrose Hospital: Diagnostic Medical Sonography Pro-aram, 2215 North Cascade, Colorado Springs, CO 80907. Program Director: Anna Worley, ltDMS. Course Length: 1 year; classes start each July. Specialties covered: Ob-Cyn, Abdominal, Echocardiography. Number of Students: 1-2/ year. Tuition: None. Stipends: $300/month. Equip-•ent available: Picker 80L Analog, Toshiba Real Time, ATL Sector and M-Hode. Exams/month: approx. 250. Awards: Cer-tificate of completion. Southern Nevada Memorial Mospital: 1800 W Charleston Blvd. Las Vegas, Nevada. Program Director: Harold W. Poehlmann, M.S., ltDMS. Course Length: 4 1110nths • Also short re-fresher courses of 1-2 weeks. Specialties covered: Echo-cardiography (M-11ode - 2D Scanning). Number of Students: 6 maximum. Tuition: $2000/4 month course; $500/wk for abort course. Equipment available: Smith Kline. Exams pe iaonth: 180. Awards: Certificate of completion. DISCONTlNUED COURSES OR CORRECTIONS TO CURRENT COURSES: MIDWEST Methodist Hospital of Cary: 600 Grant Street, .Cary, IN 4640 "Please be advised that Cary Hethodis,t Hospita::. presently i llOT offering an Ultrasound training program. A program is planned aoaetilBe in the future." Mila Vuckovich, Director of Affiliatin& Educational Programs • souTHtAST Florida Medical Center: Lauderdale Lakes. Florida. ' -53-DIACNOSTIC SONOClAPHY tDUCAUONAL fllOCRAKS The following is an updated liat of educational pro1ra .. co•plled by the ASUTS/SDMS. Jt is divided into several categories: Full ti•e programs; Seminars; Local Study Groups; and evening, part-time classes. The listing is 1rovped aeoaraph1cally: llortheaatt llorthwest; Middle Atlantic; Mldveat; Southeaat; Southwest USA and Canada. llOllTIIEAST Kaine Medical Center Specialtiea' ·"\•en, echocardlology, ob-gyn, Dop~,- of program: 1 yr. •o. ~· ion: $1500. EquiP"'" l)~'tY- -..m, real Uae '"' t;t.'t ~ -•rded. Progr-' ..... cteraann, HD, James p .-.:i . Address: ladiology Depart--. ~ltraaound, Portland, ME 04102. Middlesex Ct-11111unity College: Specialties: ab-domen, echocardiology, ob-gyn, echoencephalog-raphy. Length of program: 2 yrs. No. of atu-dents: lS. Exams/mo.: 100/hospital. Tuition: $300/yr. Equipment: A-mode, M-1110de, B-acan, real time. A.S. degree awarded. Program di-recors: Jeffrey Rudnick, HD, Linda Selland, RT JtDMS. Address: Springs lld., Bedford, MA 01750. Tale-New Haven Hospital: Specialties: abdomen, ob-gyn, cardiology. Length of program: 1 yr. •o. of studenta: 3/course, 6 total. Exa111s per month: 800. Equipment: A-mode, M-1110de, I-scan, real time, Doppler. Certificate awarded. Pro-1ram directors: Ken Taylor, MD, A. Rosenfield, HD, Carol Talmont. Address: Dept of Ultrasound • ladiology, Nev Haven, CT 06510. NORTil\IEST Seattle University, School of Scie~· t:· Length of program: S years•. -city: variable. ·Tuit•· -gin each Septeml-• ti...'tf. ..,arded: •this h ,. • ~1)~ • 111th an intern-ahi~ t;'t't .... a. Director: Joan l Address: Seattle Univ-e. .~£ of Science • Engineering, Se -Ae, VA 98122, Swedish Hospital and Medical Center: Length of program: 1 yr. Student capacity: 2. Tuition: none. Classes begin: variable. Equipment: 1-acan. Director: John Denney, Kl> • Mary ~ufleger, RDHS. Address: Dept of Ultrasound, 1211 Marion Street, Seattle,Waahington 98104 MIDDLE ATLANTIC Maryland Jnatitute of Ultrasound Technology: Specialties: abdomen, cardiology, ophthal-90logy; Doppler, ob-&111, pediatric cardiolo&J, neurolo1y. Lenath of progra•: 1 'fr• Student capacity: 6-7. Esama per 90nth: 217S. Tui-tion: $1500. Equipment: A-110de, M-.ode, 1-aca~. real ti•e, Doppler. C.rttficate 8Vard-ed. Pro1ra• directors: loger C. Sanders, MD, Roy Soares, IA, IDHS, l~1sell Clark, llDMS. Address: P 0 lox 161, lidervood, MD 21139. State University of Nev York, School of Ultrasound: Specialties: abdo .. n, neurology, ophthAl1DOlogy, ob-ayn, echocardiology. Program length: 1-2 yrs . Student capacity: 14-18. Exams per •onth: 650. Tu· ition: $900/year(in state) $1500/year (out of state : l.S. degree awarded for 2 yr program and certificat• for 1 yr proiram. Equipment: A-mode, M-1110de, B-acan, real time, Ophthal-A, Ophthal-B. Program di-rector: Horton Schneider, HD. Address: 450 Clarksor Avenue, Brooklyn, NY 11203. Thomas Jefferson University Hospital: Srecialties: abdomen, echocardiology, Doppler, ob-11n, ophthal-mology, neurology. Program len~th: 1 yr. Student capacity: 12. Exams per 110nth: 700-800. Tuition: $1200. Equipment: A-mode, M-110de, I-scan, real ti•e, Ophthal-A, Ophthal-~. Doppler. Certificate awarded. Program director: Barry r.oldberg, KD. Address: Dept of Ultrasound, 1015 Walnut St., Phil-•delphio, PA 19107. University of Pennsylvania: Specialties: abdomen, echocardiology, neurology, ob-gyn, "ophthalmology. Program length: l yr. Student capacity: 3. Exams per aionth: 7SO. Tuition: $300. Equipment: A-mode, K-aiode, I-scan, real time, Ophthsl-A, Ophthal-B . Certificate awarded. Program directors: Peter Ar-aer, MD, Marilyn Slutsky, RT, llD~S. Address: De-part•ent of ladiology, 3400 Spruce St., Philadel-phia, PA 19128 Vest1110reland Hospital: Length of program: 1 yr. Student capacity: 2. Tuition: yes. Classes begin Jan •nd July. Equipment: I-scan. Directors: V. Daniel Foster, MD and Jocelyn Champagne, RDHS. Address: Dept of Ultrasound, 532 W. Pittsburgh St., Greensburg, PA 1S601. The Nev York Hospital: Program length: 1 yr. Stu-dent capacity: 3. Tuition: yes. Classes begin: September. Equipment: I-scan. Director: Robert T. lagler, RT. Address: Cornell Medical Center, De-partment of ladiolosy, 52S E 68 St, Nev York, NY. 10021. MIDWEST: Benry Ford Hospital: Specialties: abdomen, ophthal-' 90Jo1y, ob-&Jn, •chocardiology. Program length: 1 yr. Student capacity: 2. Exams per 111>nth: 600 Tuition: $200. Equipment: A-'lllC>de, H-mode, I-scan, real ti••• .Ophth~l-A, · Ophthd-B._ Certificate MIIM:ST (cont.) Renry Ford Ho1pital (cont.): evarded. Pro1ram director1: Beatrice Madraso. HD. M. Sandler. HD, John Parks, aDMS. Ad-dres1: 2799 Veit Crand llvd. 1 Detroit. MI 48202. lorthwe1t Co11DUnity Ro1pital: Spec-S.ltie1: abdomen. echocardiology. ob-ayn. echoeacephalo1raphy. Pro1ram length: 1 Jr. Student capacitJ: 2. lx-aa• per 110nth: 2SO. Tuition: aone, ... u atipend. lqufpaient: A-.ode, ,._.,de, J-acan, Doppler. Certificate awarded. rrograa directora: Jerome loy, HD. M. Vln-ters. E. Leonard. P. lughe1. Addreas: 100 Vest Central Id., Arlington Bta., IL 6000.S. Providence Hospital: Specialtiea: abd01ten, echocardiolo17. ob-17n. Pro1raa lan&th: • 110nth1 per apecialty area. Student .:.-pacity: 2-4. lxau per 110nth: 700. Tu-ition: $1000/yr •• atipend 1iven. lquip-aent: A-mode, H-110de 1 1-acan, real time. Program director: J. ltaro, MD. Address: P 0 lox 2043, Southfield. KI 48037. Oakwood Hospital School of Diagnostic Ultrasound: Prograv length: l yr. Tui-tion:no • atipend $100. Prerequisites: IT, ltN or IS in Science. Clinical ln-atructor: Denise Skowron. Address: 18101 Oa'kvood Blvd., Dearboni, KI 48124. Program director: Allen Hennessey, HD. Student capacity: 2. Classes begin: Jan 'July. Equipment: I-scan. Ht. Sinai Hospital: Length of Pro-1ram: 1 yr. Student capacity: 2. Tuition: no. Cla11es begin: variable. Equipment: b-acan. Director: Kichael J. Flynn, HD. Address: Dept. of Ul-trasound, Univer1ity Circle, Cleve-land. Ohio 44106. Aultman Hospital: Progr1m length: l yr. Student capacity: 2. Tui-tion: no. Classes begin Jan • July. Euipment: I-scan. Directors: Sam-uel Hissong, MD ind Su11n Hunter, RT. llDHS. Addre11: Dept of Ultrasound. 2600 6th St. sw. Canton. Ohio 44710. Methodist Hospital: Progralll ' \ 1 yr. Student .:.o• .. 6 ' \: JCS. CJ• .. - '3t't>?.'r$ _ .. cge 5$$ . -,.-ent: 1-acan. _..cie Siner, RT. Ad-•OO Crant St •• Cary. IR 46402 Unfver1fty of l1nsa1 Medical Center: Specialties: abdomen. echocardiology. ob-&yn. Pro1ram length: 1 yr. Stu-dent capacity: l. Exams per 110nth: 3SO Tuition: none. Equipment: A-.ode, M-aode, I-scan. real tiae. Certificate awarded. Program directora: Rabil Maklad. HD; laren Templeton. at, lobin lucholt1. IT, Linda Pirtle 1 IT. Ad-dres1: 39th ' ltainbov llvd, Jtanaas City, lS 66103. -54-Dniveraity of Oklahoma: Specialties: abdomen, echocardiology, ob-ayn. Pro1ram length: 1 and 2 Jrs. Student capacity: 20. Tuition: yea. lquipent: A-.ode, H-mode, I-scan. real time. Certificate and J.S. degree awarded. Program director: Jean tea, BA, lllHS. Addre11: College of Health. P 0 lox 26901. Oklaho .. City. OK 73190. ~fversity of Wisconsin: Specialtfe1: abdomen, ec:hocardiology, neurolo1y 1 ob-l)'n. Program length: 1 Jr. Student capacit7: 2. Exams per llOnth: 200. Tuition: $7SO. !qufpmeut: A-tDDde, 11-aode. 1-acan, real time, Doppler. Certificate ..,.rded. Program director: Dr. Rietz. Address: It. Mar7 1a Ho1pital. r It lox S03, IUlvaukee. VI 53201. It. Agne• Bo1pit1l: Program director: Cary Shaf-fer. IT. Program length: 1 Jr. Address: 430 E. Division St., Fond Du Lac. VI S493S. Atta: Diagnoatic Ultrasound Program. SOUTHEAST Bowman-Cray School of Medicine: Specialties: ab-domen. echocardiology, Doppler. ob-gyn, Ophthal-aology, neurology. Program length: 8 weeks. Stu-dent capacity: 30/wk. Tuition: $2500. Equip-aent: A-IDC>de, M-1DC>de, I-scan, real time. Ophthal-A. Ophthal-1. Certificate awarded. Program director: James Hartin, HD Address: lox 71, Vinston-Salem. MC 27103. lollyvood Center, Broward Community College: Spec-ialties: abdomen, echocardiology, ob-gyn, ophthal-110logy. Program length: 1 7r. Student capacity: 6. Exaas per 110nth: 400/ institution. tuition: $300 .. triculation. Equipment: A-mode, M-1DC>de, B-acan real time, Ophthal-A, Ophthal-B. Certificate awarded. Program directors: lobert Steinborg, HD Diane lhode Paulson, lTJl. llDHS. Address: 3601 Johnaoo Street, Hollywood. FL 33021. Ht. Sinai Hospital: . Proaram length: 1 7r. Stu-dent capacity: 2 Tuition: 7es. Classea begin: June. Equipment: B-acan. Director: K. Vfamonte, HD. Address: 4300 AltoD load. Miami, FL 32.504. Florida Medical Center: Length of Pr~ .. - · : 1 yr. Student capacity: 4. tuft• .. -· ia be-&ln: August. • .... • 'ft>lt.'r'E : Mi-chael - 5$$ '3 ._, 11.1. Address: Depar -·•"• SOOO V. Oakland Park llvd. _ ... croale Lakes, Fl 33313-Florida Institute of Ultrasound, Inc.: Program length: variable. Exams per 110nth: 300, Tuition: flSOO. Equipment: A-mode, l-1DC>de, real time. Program Director: J. J. Crittenden. HD. Address: r 0 lox 1S13S, Pensacola FL 32504. Vest Virginia University Hospital: Specialties: abdomen, echocardiology, ob-gyn. ophthalmology. Program length: 1 yr. Student capacity: l. Ex-ams per month: 15. Tuition: none. Equipment: A-110de, M-mode, 1-acan, real time. C•rtificate awarded. Progra• directors: Michael Hogan, MD, ltephaoie Fala••• lilt, JU>HS. Address: ltadiology Depart11ent 1 llor1antovn, VV 26SOS. ,. SOUTHEAST (cont.) Ochsner Medical Foundation: Specialties: ab-domen, ob-,yn. Program length: 1 7r. Stu-dent cap1city: 3. Exams per 110nth: 400. Tu-ition: none, $200/lllOnth stipend. Equipment: B-•ode, real time. Certificate awarded. Pro-aram directors: Christopher l.I. Herritt, MD, Heliaa1 Reiman, JU>HS. Address: Schooi of Allied Health Sciences, 1516 Jefferson Rwy., New Orleans, LA 70121. Charity Hospital: Progr .. length: 1 7r. Classes bein': September. Specialties: ab-domen, ob-gyn. Equipment: 1-acan. Program director: John Ceshner, JU>HS. Address: 1532 Tulane Avenue, New Orleans, LA 70140. Attn: School of Diagnostic Ultrasound. Richland Memorial Hospital: Sepcialties: abdomen, echocardiology, neurology, ob-1)'11, ophthal110logy. Program len1th: 1 ~· Stu-dent capacity: 2. Exams per 110nth: 150. Tuition: none. Equipment: A-mode, H-mode, I-scan, real time, Ophthal-A, Ophthal-B. Certificate awarded, Program director: David Adcock, HD. Address: 3301 Harden St. Ext. Columbia, SC 29203. SOUTH\lEST Memorial Hospital of Cardena: abdomen, Dop-pler, ob-cyn, echocardiology. Program length: 1 yr. Student capacity: 1. Exams per month: 170. Tuition: none. Equipment: A-1110de, H-mode, I-scan, real time, Doppler. Certificate awarded . Program director: Jonathan Po, MD. Address: 1145 West Redondo Blvd., Cardena, CA 90247. Santa Barbara Cottage Hospital: Program length: 1 yr. Student capacity: 1. Tu-ition: none. Classes begin: January. Equipment: I-scan. Director: Hector Rod-requez, HD. Address: Department of Ul-trasound, Pueblo @ Bath Streets, Santa Barbara, CA 93105. University of California @ Los Anceles C~nter for Health Sciences: Program length: 1 yr. -Student capacity: 2 • Exams per month: 900. Tuition: none. Equipment: A-mode, I-mode, M-lllDde, real time. Program director: Bob Clark, JUlHS. Address: Department of Radiology, Ultrasound/CAT, Los Angeles, Ca 90024. Veteran's Administration Hospital, ~adsworth: Specialties: abdomen, eye gynecology, minimal echocardiology. Program length: 2 110nths/specialty. Student capacity:2. Exams per DDnth: 80-120. Tuition: none. Equipment: A-mode, M-mode, I-scan, real time, Ophthal-A, Ophthal-B. Certificate awarded. Program directors: K. A. ~inston, HD, Betsy James, RT. Ad-dress: Department of Nuclear Med-icine, Los Angeles, CA 90073. -55-Veteran'• Administration Hospit1l, La Jolla: Specialties: ob-1yn 1 abdoninal cardiology. Pro-1ra, length: 6 110nths. Student capacity: 1/3 110nths. Exams per 110nth: 350. Tuition: none Equipment: A-110de 1 M-111Dde, I-scan, re.al time. Certificate awarded. Program directors: Barbara Coaink, MD, Ceorge Leopold, MD, Villa• Schieble, llD, John Fora7the, ltD!iS, H. Diane Reed, RT. Addre11: Department of Ultrasound, 3350 La Jolla Village Drive, San Diego, CA 92161. Martin Luther lin&. Jr. Hospital: Program 1 Jr. Student c•pacit7: 2 tuition: none. aes •e&in: Jan ' Jul7. Equip11tent: 1-acan Director: Caroline Yeager. Address: 2021 •ingtoD Avenue, Loa An1eles, CA 90059. lengtt-Clas-S. WU-Huntington Memorial Rospital: Program length: 1 Jr. Student capacit7: 1 Tuition: no Classes •eria: July. Equipment: 1-acan. Director: T. ~llen, MD Address: 100 Congress St •• Pasa-dena California. International Ultrasound Institute: Program length: 2 and 4 weeks. Student capacity: 8/ two-week classroom sesaionsi 6/clinical sessions Tuition: $550/2 vk course; $1000/' vk course. Equipment: A-mode, I-scan and Real Tine. Certif-icate awarded. Approved for ASRT ECE points: 10/2 vk programi 160/4 vk program. Director: Karveen Craig, JU>MS. Address: 5200 Maple Ave-30'. Dallas, Texas 75235. CANADA University of Manitoba: Specialties: abdomen, eel cardiology, ophthalmology, ob-gyn, neurology. Program length: l'yr. Student capacity: 4. Ex-ams per month: 800. Tuition:stipend $100/mo. Equipment: A-111Dde, M-mode, I-scan, real time Opthal-Ai Opthal-1. Certificate awarded. Pro-1ram directors: £. A. Lyons, MD, Kathleen Hc-Diarmid, RT, JU>MS. Address: Ultrasound Departme: Health Sciences Centre, 700 Willi1m Avenue, Win-nipeg, Manitoba, Canada R3E OZ3. P•squa Hospital: Program length: 1 yr. Student capacity: 1. Program director: Bruce Coalen Address: Department of Ultrasound, 4101 Dewdney Avenue. Regina, Saskatchewan, Canada J4T 1A5. V•ncouver Ceneral Hospital: Program length: 1 y Pro,ram director: Peter Cooperberg, MD. Address 855 12th Avenue V. Vancouver, British Columbia, Canada V52 lHI. Attn: Department of Ultrasound. SDUNAJlS: LOCAL STUDY CROUPS: PART-TIKE CLASSES NOR111EAST Veter•n's Administration Hospital: One hour sec-inars ever7 Wednesday. Providence, Rhode Island HlDDLE ATLUl'TIC Maryland •nd VashSngton Ultrasound Societies an~ Unirad Corporation: "lade Ultr•sound". Sep-• MIDDLE ATLANTIC (cont.) teaber - April 1980. Hol7 Cross Bo•-pi tal. Fore•t Glen Jt.oad. Silver Sprina, Kary land. Maryland Ultrasound Society: 1 hour each 90nth. Contact: Susan Mobley, Johns Hopkins Hospital Dept. of Ultrasound, SOl N. Wolfe Street, lalti110re, Kar')'land, 2120.s. Johns Hopkins Hospital: •aasic and Ad-vanced Practicum". Contact: Jt.oger San-ders, MD. Dept. of Jladiolo11, Bal-timore, Maryland 21205. Johns Hopkins Hospital: ·~ale Echo• July. three days. Contact: Sue Li-vengood. Baltimore, Maryland 21205 Johns Hopkins Hospital: •seminar in OB-GYN" Septed>er, lat veekend, Thursday - Saturday. lalti1110re, tlar')'-land 21205. Maryland Institute of Ultrasound Tech-nology: "Basic Ultrasound". October -April. every Tuesday evening from 7:00 to 9:00 PK, for one semester. P 0 Box 161, Riderwood, MD 21139. Maryland Institute of Ultrasound Tech-nology and North Charles Cenerel Hos-pital: "Advanced Echo" Last week of February, for three days. 2724 North Charles Street. laltiniore, Maryland 21218. • MIDWEST Michigan Sonographer'• Society: Local .eetin;s and registry reviews. Ex-ecutive Office, 24200 Renssaleer, Oak Park, Michigan 48237. Villiam Beaumont Hospital: Vinter Imaging Seminar. Contact: Hrs. Eager, Diasnostic kadiology, Royal Oak, Mi chigan. February 25 - 28, 1980. Oklahome Teleconference Series: 3 - 4 ultrasound seminars •cheduled yearly. Contact: lnservice Office, University Hospital and Clinics, Health Science Center, P. O. lox 26901, Oklahoma City, Oklahoma 73190. SOUTHEAST lobe Scientific Company: Sheraton Inn, Mobile, Alabama. January 15 - 18, 1980. Oschner Foundation and Unirad: Seminar, February 1980, Nev Orleans, Louisiana. Nev Orleans Ultrasound Society (MOUSA): Monthly 11eetings held 2nd or 3rd Wed-nesday of each.90nth, in the Radioloay Classroom, Ochsner Foundation Hospital, 1516 Jefferson HV)'~, Mev Orlean•~ 'IA. -56-Mi•sissippi Ultrasound Society: Meetings usuall held in Jackson, MS. Contact: Xathy Owens, RD~ Dept. of Radiology, 1225 N. State Street, Jacks KS 39201. Mississippi Ultrasound Society: Regional Se~ina in Abdo~en and OB-~. Karch 29 - 30, 1980 at Downtown Moliday Inn, Jackson, HS. Contact: ~e neth C. Carter, HD, Dept. of Radiology, 1225 N. State Street. Jackson. MS 39201. SOUTlfWEST Phoenix Ultrasound Society: Monthly meetings h1 at Cood Saraaritan Hospital, 1033 E. McDowell Rd. P. O. lox 2989, Phoenix, Arizona. University of California, San Diego: -Ultrasono1 raphy Update". February 11-Uth, 1980 at llotel del Coronado, San Diego, California. Contact: Continuing Educations -005, Universit7 of Califc aia, San Diego, La Jolla, California 92093. ASUTS/SDHS Regional Seminar: Co-sponsored 'by CSl Sheraton Denver Airport :nn, 3535 Quebec Street, Denver. Colorado 80207. Hay 2 and 3. 1980. Colorado Society of Ultrasound Technical Specia· lats (CSUTS): Heets 1st ~ednesday of every ~o r: Contact: CSUTS, P. O. Box 18422, Denver, CO ~02 : locky Mountain Regional Ultrasound and CT Croup · Physician and Sonographer meetings held 1st ~ed­nesday of every month. "ladiology-Aspen": Sponsored 'by Beth Ian el Ho! pital, Diagnostic Radiology, Nuclear Jladiolo&y, Diagnostic Ultrasound and CT Scanning. Febru•r) 24 - 29. 1980 at Aspen Institute for Humanistic Studies. Aspen, Colorado. "Ultrasound at Vail": Co-sponsored 'by AlUM . P. O. lox 6093, Cherry Creek Station, Denver, Cc orado 80206. March 22 - 29, 1980. To be held f The Lodae at Vail, P 0 lox 1168, Vail, Colorado 11657. (303)476-5011. ASUTS/SDHS Region I Continuing Education Course : Plans pending. To be given in ~os Angeles. Contact: Nanette Crandjean, 1653 Hott Smith Dr. Apt A, Honolulu, HI 96822, for aore information. Honolulu Hedical Croup Research and Education Fe ~ 4th Annual Echocardiography in Hawaii. Hauna Kea Beach Hotel, Xamuela. Hawaii. Januar~ 13, 1980. Contact Vincent Friedewald, MD, 550 South leretania Street, Honolulu, Hawaii 96813. University of Nev Hexico School of Medicine: C-: Ultrasound, Nuclear Medicine. February 8 - 10, 1980. Four Season•a Hotor Inn, 2500 Carlisle Nl Albuquerque, NH 87110. (505)265-1211. Dallas Ultrasound Society: Local meeting held each lllDnth, usually at Southwestern Hedical School. Contact: Julie Leonard, 2510 ComrDunity 1222 0 Dallas, TX 75220. Rouston Society of Ultrasound: Local meetings usually held the 1st Honday of each month at Jesse Jones Library, Texas Medical Center. Con-tact: Priscilla Jl7land, 2600 Veenstra, Houston, ........ 'I'll\.,"\ • -57-REFERENCES Donald, Ian and Levi, Salvator, ed. Present and Future of Diagnostic Ultra-sound. New York: John Wiley & Sons, 1976. King, Donald L., ed. Diagnostic Ultrasound. St. Louis: The C.V. Mosby Company, 1974. Lunt, R.M. Handbook of Ultrasonic B-scanning in Medicine. Cambridge, London: Cambridge University Press, 1978. McDicken, W.N. Diagnostic Ultrasonics: Principles and Use of Instruments. New York, Toronto: John Wiley & Sons, 1976. Statistics Canada. Provincial Census Tracts: Population and Housing Characteristics, Western Provinces and the Territories. Ottawa: 1978. Tuddenham, W.J., ed. Planning Guide for Radiologic Installations. Fascicle 3: Computerized Tomographic Facilities. Chicago, Illinois: American College of Radiology, 1976. University of British Columbia. ROLLCALL 79. Report R:l2, Division of Health Services Research and Development, 1979. de Vlieger, M.; White, D.N.; and Mccready, V.R., ed. Ultrasonics in Medicine. Proceedings of the Second World Congress, Rotterdam, 4 - 8, June, 1973, Excerpta Medica, Amsterdam, 1974. Wells, P.N.T., ed. Ultrasonics in Clinical Diagnosis. Edition II, Churchill, Livingstone, 1977. 

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