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Ultraschall Med 2022; 43(05): e36-e48
DOI: 10.1055/a-1857-4435
Guidelines & Recommendations

Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Long Version) – General Aspects

Professionelle Standards im medizinischen Ultraschall – EFSUMB Positionspapier – Allgemeine Aspekte
Matthias Wüstner 
1   Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder, Trier, Germany
,
Maija Radzina 
2   Radiology Research laboratory, Riga Stradins University, Riga, Latvia
3   Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia
,
Fabrizio Calliada
4   Department of Radiology, Policlinico San Matteo, Pavia, Italy
,
Vito Cantisani
5   Department of Radiology, “Sapienza” University of Rome, ROME, Italy
,
Roald Flesland Havre 
6   Department of Medicine, Haukeland University Hospital, Bergen, Norway
7   National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
,
Klaus-Vitold Jenderka
8   FB INW, Hochschule Merseburg, Germany
,
Adnan Kabaalioğlu
9   Radiology Department, Koç University Hospital, Istanbul, Turkey
,
Milan Kocian
10   Anästhesie und Intensiv, Asklepios Klinik, Burglengenfeld, Germany
11   Visual Medicine s. r. o., Olomouc, Czech Republic
,
Christian Kollmann
12   Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
,
Julian Künzel
13   Otorhinolaryngology, University of Regensburg, Germany
,
Adrian Lim
14   Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
,
Giovanni Maconi 
15   Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L. Sacco” University Hospital, “L. Sacco” University Hospital, Milan, Italy
,
Vladimir Mitkov
16   Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
,
Alina Popescu
17   Gastroenterology, University of Medicine and Pharmacy, Timisoara, Romania
,
Adrian Saftoiu
18   Res Ctr Gastroenterol Hepatol, University of Medicine and Pharmacy of Craiova, Romania
,
Paul S. Sidhu 
19   Radiology, King’s College London, United Kingdom of Great Britain and Northern Ireland
,
Christian Jenssen
20   Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
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Abstract

This first position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards presents a common position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of ultrasound examinations by any professional ultrasound operator. It describes general aspects of professionality that ensure procedure quality, effectiveness, efficiency, and sustainability in virtually all application fields of medical ultrasound. Recommendations are given related to safety and indication of ultrasound examinations, requirements for examination rooms, structured examination, systematic reporting of results, and management, communication and archiving of ultrasound data. The print version of this article is a short version. The long version is published online.

Zusammenfassung

Dieses erste Positionspapier der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) zu professionellen Standards beschreibt eine gemeinsame Position der verschiedenen medizinischen Berufe innerhalb der EFSUMB zu optimalen Standards, wie Ultraschall-Untersuchungen von jedem professionellen Untersucher durchgeführt und befundet werden sollten. Beschrieben werden allgemeine Aspekte der Professionalität, die die Qualität, Effektivität, Effizienz und Nachhaltigkeit in praktisch allen Anwendungsbereichen des medizinischen Ultraschalls gewährleisten. Empfehlungen werden gegeben zur Sicherheit und Indikationsstellung von Ultraschall-Untersuchungen, zu Anforderungen an Untersuchungsräume, zur strukturierten Untersuchung und systematischen Befundung sowie zur Verarbeitung, Kommunikation und Archivierung von Ultraschalldaten. Die gedruckte Version dieses Artikels ist eine kurze Version. Die lange Version wird online veröffentlicht.

Key words

ultrasound - education - training - quality assurance - imaging


Publication History

Received: 28 July 2021

Accepted: 09 May 2022

Article published online:
18 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Education and Professional Standards Committee, European Federation of Societies for Ultrasound in Medicine and Biology. Minimum training recommendations for the practice of medical ultrasound. Ultraschall in Med 2006; 27 (01) 79-105
    PubMedGoogle Scholar
  • 2 Jenssen C, Gilja OH, Serra AL. et al. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Policy Document Development Strategy – Clinical Practice Guidelines, Position Statements and Technological Reviews. Ultrasound Int Open 2019; 5 (01) E2-E10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Edwards HM, Sidhu PS. Whoʼs doing your scan? A European perspective on ultrasound services. Ultraschall in Med 2017; 38 (05) 479-482
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC (Consolidated version): EUR-Lex – 32017R0745 – EN – EUR-Lex (europa.eu) (accessed April 17, 2021).
    PubMedGoogle Scholar
  • 5 Gesetz über Medizinprodukte (Medizinproduktegesetz – MPG, BGBl. I p. 1133) 7.8.2002, adopted 18.7.2017; Germany. https://www.gesetze-im-internet.de/mpg/MPG.pdf (accessed April 17, 2021)
    PubMedGoogle Scholar
  • 6 Bundesgesetz betreffend Medizinprodukte (Medizinproduktegesetz – MPG, Fassung v. 12.9.2018, BGBl. No. 657/1996), Austria. RIS – Medizinproduktegesetz – Bundesrecht konsolidiert, Fassung vom 22.05.2021 (bka.gv.at) (accessed April 17, 2021).
    PubMedGoogle Scholar
  • 7 European Commission, Single Market and Standards, Notified Bodies, Brussels. https://ec.europa.eu/growth/singlemarket/goods/building-blocks/notified-bodies_en
    PubMedGoogle Scholar
  • 8 FDA. FDA Basics. https://www.fda.gov/aboutFDA/transparency/fda-basics/ (accessed April 17, 2021)
    PubMedGoogle Scholar
  • 9 International Electrotechnical Commission (IEC). IEC 60601-1-2. Medical electrical equipment – Part 1-2: General requirements for basic safety and essential performance – Collateral Standard: Electro-magnetic disturbances – Requirements and tests. International Standard, Geneva.
    PubMedGoogle Scholar
  • 10 International Electrotechnical Commission (IEC). IEC 60601-2-37. Medical electrical equipment – Part 2-37: Particular requirements for the safety of ultrasonic medical diagnostic and monitoring equipment. International Standard, Geneva.
    PubMedGoogle Scholar
  • 11 International Electrotechnical Commission (IEC). IEC/TR 80002-1:2009 Medical device software – Part 1: Guidance on the application of ISO 14971 to medical device software, Geneva.
    PubMedGoogle Scholar
  • 12 Kollmann C, Jenderka KV, Moran C. et al. EFSUMB clinical safety statement for diagnostic ultrasound – (2019 revision). Ultraschall in Med 2020; 41 (04) 387-389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 EFSUMB – ECMUS Safety Statements. https://www.efsumb.org/safety-statements (accessed April 17, 2021)
    PubMedGoogle Scholar
  • 14 Schiavone C, Grassi R, Bertolotto M. et al. The sonographic medical act. J Ultrasound 2020; 23 (04) 445-447
    CrossrefPubMedGoogle Scholar
  • 15 Livingston CJ, Freeman RJ, Mohammad A. et al. Choosing Wisely® in preventive medicine: The American College of Preventive Medicine’s top 5 list of recommendations. Am J Prev Med 2016; 51 (01) 141-149
    CrossrefPubMedGoogle Scholar
  • 16 Dietrich CF, Westerway S, Nolsoe C. et al. Commentary on the World Federation for Ultrasound in Medicine and Biology project “incidental findings”. Ultrasound Med Biol 2020; 46 (07) 1815-1820
    CrossrefPubMedGoogle Scholar
  • 17 Hayward C. Sizing Imaging and Procedure Rooms, January 2, 2021. https://blog.spacemed.com/sizing-imaging-and-procedure-rooms/ (accessed march 26, 2022)
    PubMedGoogle Scholar
  • 18 Facility Guidelines Institute with assistance from the U.S. Department of Health and Human Services. 2.2-3.4.5 Ultrasound, in: 2010 Guidelines for Design and Construction of Health Care Facilities. https://www.aapm.org/meetings/amos2/pdf/49-14367-84348-888.pdf (accessed march 26, 2022)
    PubMedGoogle Scholar
  • 19 EFSUMB. Best Practice recommendation for cleaning and disinfection of ultrasound transducers whilst maintaining transducer integrity. 2019 Available at (accessed April 17, 2021): https://www.efsumb.org/wp-content/uploads/2020/12/2019-probe_cleaning_recommendation.pdf
    PubMedGoogle Scholar
  • 20 Nyhsen CM, Humphreys H, Koerner RJ. et al. Infection prevention and control in ultrasound – best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights Imaging 2017; 8 (06) 523-535
    CrossrefPubMedGoogle Scholar
  • 21 American Institute of Ultrasound in Medicine. Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as well as Safe Handling and Use of Ultrasound Coupling Gel. https://www.aium.org/officialStatements/57 (accessed April 17, 2021)
    PubMedGoogle Scholar
  • 22 Müller T, Martiny H, Merz E. et al. DEGUM recommendations on infection prevention in ultrasound and endoscopic ultrasound. Ultraschall in Med 2018; 39 (03) 284-303
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Basseal M, Westerway SC, Juraja M. et al. Guidelines for reprocessing ultrasound transducers. Australas J Ultrasound Med 2017; 20: 30-40
    CrossrefPubMedGoogle Scholar
  • 24 American College of Emergency Physicians. Guideline for Ultrasound Transducer Cleaning and Disinfection. Ann Emerg Med 2018; 72: e45-e47
    CrossrefPubMedGoogle Scholar
  • 25 Westerway SC, Basseal JM, Abramovicz JS. Medical ultrasound disinfection and hygiene practices: WFUMB global survey results. Ultrasound Med Biol 2019; 45: 344-352
    CrossrefPubMedGoogle Scholar
  • 26 Dietrich CF, Bamber J, Berzigotti A. et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall in Med 2017; 38 (04) e16-e47
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Săftoiu A, Gilja OH, Sidhu PS. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall in Med 2019; 40 (04) 425-453
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39 (02) e2-e44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Dietrich CF, Nolsøe CP, Barr RG. et al. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall in Med 2020; 41 (05) 562-585
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Atkinson NSS, Bryant RV, Dong Y. et al. How to perform gastrointestinal ultrasound: Anatomy and normal findings. World J Gastroenterol 2017; 23 (38) 6931-6941
    CrossrefPubMedGoogle Scholar
  • 31 American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum. J Ultrasound Med 2012; 31 (08) 1301-1312
    CrossrefPubMedGoogle Scholar
  • 32 Walas MK, Skoczylas K, Gierbliński I. Standards of the Polish Ultrasound Society – update. The liver, gallbladder and bile ducts examinations. J Ultrason 2012; 12 (51) 428-445
    PubMedGoogle Scholar
  • 33 Ćwik G. Standards of the Polish Ultrasound Society – update. Pancreas examination. J Ultrason 2013; 13 (53) 167-177
    CrossrefPubMedGoogle Scholar
  • 34 Tyloch JF, Woźniak MM, Wieczorek AP. Standards of the Polish Ultrasound Society – update. Ultrasound examination of the kidneys, ureters and urinary bladder. J Ultrason 2013; 13 (54) 293-307
    PubMedGoogle Scholar
  • 35 Laursen CB, Clive A, Hallifax R. et al. European Respiratory Society Statement on Thoracic Ultrasound. Eur Respir J 2020; 2001519
    PubMedGoogle Scholar
  • 36 Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound 2014; 12: 25
    CrossrefPubMedGoogle Scholar
  • 37 Möller I, Janta I, Backhaus M. et al. The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 2017; 76 (12) 1974-1979
    CrossrefPubMedGoogle Scholar
  • 38 Kwak JY, Han KH, Yoon JH. et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260 (03) 892-899
    CrossrefPubMedGoogle Scholar
  • 39 Trzebińska A, Dobruch-Sobczak K, Jakubowski W. et al. Standards of the Polish Ultrasound Society – update. Ultrasound examination of thyroid gland and ultrasound-guided thyroid biopsy. J Ultrason 2014; 14 (56) 49-60
    PubMedGoogle Scholar
  • 40 Mitchell C, Rahko PS, Blauwet LA. et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019; 32 (01) 1-64
    CrossrefPubMedGoogle Scholar
  • 41 Santos SND, Alcantara ML, Freire CMV. et al. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology – 2019. Arq Bras Cardiol 2019; 112 (06) 809-849
    PubMedGoogle Scholar
  • 42 Małek G, Nowicki A. Standards of the Polish Ultrasound Society – update. Sonography of the lower extremity veins. J Ultrason 2014; 14 (58) 287-296
    PubMedGoogle Scholar
  • 43 Małek G, Elwertowski M, Nowicki A. Standards of the Polish Ultrasound Society – update. Ultrasound examination of the aorta and arteries of the lower extremities. J Ultrason 2014; 14 (57) 192-202
    PubMedGoogle Scholar
  • 44 Elwertowski M, Małek G. Standards of the Polish Ultrasound Society – update. Examination of the extracranial carotid and vertebral arteries. J Ultrason 2014; 14 (57) 179-191
    PubMedGoogle Scholar
  • 45 Millington SJ, Colvin MO, Shiloh AL. et al. How I Do It: Ultrasound-Guided Internal Jugular and Femoral Central Venous Catheter Insertion. Chest 2020; 158 (06) 2425-2430
    CrossrefPubMedGoogle Scholar
  • 46 Troianos CA, Hartman GS, Glas KE. et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2011; 24 (12) 1291-1318
    CrossrefPubMedGoogle Scholar
  • 47 Armas RR. Qualities of a good radiology report. Am J Roentgenol 1998; 170 (04) 1110
    CrossrefPubMedGoogle Scholar
  • 48 Brady AP. Radiology reporting – from Hemingway to HAL?. Insights Imaging 2018; 9 (02) 237-246
    CrossrefPubMedGoogle Scholar
  • 49 Weiss DL, Langlotz CP. Structured Reporting: Patient Care Enhancement or Productivity Nightmare?. Radiology 2008; 249 (03) 739-747
    CrossrefPubMedGoogle Scholar
  • 50 European Society of Radiology. ESR paper on structured reporting in radiology. Insights Imaging 2018; 9 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 51 Kuhn K, Zemmler T, Reichert M. et al. Structured data collection and knowledge-based user guidance for abdominal ultrasound reporting. Proc Annu Symp Comput Appl Med Care 1993; 311-315
    PubMedGoogle Scholar
  • 52 O’Connor SD, Kulkarni NM, Griffin MO Jr. et al. Structured reporting in ultrasound. Ultrasound Q 2020; 36 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 53 An JY, Unsdorfer KML, Weinreb JC. BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS, O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems. Radiographics 2019; 39 (05) 1435-1436
    CrossrefPubMedGoogle Scholar
  • 54 Ernst BP, Hodeib M, Strieth S. et al. Structured reporting of head and neck ultrasound examinations. BMC Med Imaging 2015; 19: 25
    CrossrefPubMedGoogle Scholar
  • 55 Russ G, Bonnema SJ, Erdogan MF. et al. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6 (05) 225-237
    CrossrefPubMedGoogle Scholar
  • 56 Chernyak V, Fowler KJ, Kamaya A. et al. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology 2018; 289 (03) 816-830
    CrossrefPubMedGoogle Scholar
  • 57 Kono Y, Lyshchik A, Cosgrove D. et al. Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®): the official version by the American College of Radiology (ACR). Ultraschall in Med 2017; 38 (01) 85-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Geyer T, Rübenthaler J, Marschner C. et al. Structured Reporting Using CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma (HCC)-Impact and Advantages on Report Integrity, Quality and Interdisciplinary Communication. Cancers (Basel) 2021; 13 (03) 534
    CrossrefPubMedGoogle Scholar
  • 59 Schwartz LH, Panicek DM, Berk AR. et al. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260 (01) 174-181
    CrossrefPubMedGoogle Scholar
  • 60 Ernst BP, Katzer F, Kunzel J. et al. Impact of structured reporting on developing head and neck ultrasound skills. BMC Med Educ 2019; 19: 102
    CrossrefPubMedGoogle Scholar
  • 61 Ernst BP, Strieth S, Katzer F. et al. The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency. Eur Arch Otorhinolaryngol 2020; 277: 269-276
    CrossrefPubMedGoogle Scholar
  • 62 Cantisani V, Grani G, Tovoli F. et al. Artificial Intelligence: What is it and how can it expand the ultrasound potential in the future?. Ultraschall in Med 2020; 41 (04) 356-360
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 Bidgood WD Jr, Horii SC, Prior FW. et al. Understanding and using DICOM, the data interchange standard for biomedical imaging. J Am Med Inform Assoc 1997; 4 (03) 199-212
    CrossrefPubMedGoogle Scholar
  • 64 Graham RN, Perriss RW, Scarsbrook AF. DICOM demystified: a review of digital file formats and their use in radiological practice. Clin Radiol 2005; 60 (11) 1133-1140
    CrossrefPubMedGoogle Scholar
  • 65 Foord K. Year 2000: status of picture archiving and digital imaging in European hospitals. Eur Radiol 2001; 11 (03) 513-524
    CrossrefPubMedGoogle Scholar
  • 66 Busch HP. (Ed.). Management-Handbuch für Radiologen (German). Stuttgart: Thieme; 2008
    Google Scholar