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The usage of diagnostic ultrasound equipment has expanded into physiotherapy. The aim of this paper is to deliver to both the ultrasound and physiotherapy professions an understanding of the use of diagnostic ultrasound for biofeedback in physiotherapy of the female pelvic floor and the issues related to competent and safe practice, including accessing suitable training. This has been evaluated using a qualitative research paradigm with data gathered via focus groups of Australian physiotherapists. The target group were pelvic floor physiotherapists as this is one of the main uses of diagnostic ultrasound within physiotherapy and the main area physiotherapists would like to be trained in. Two focus groups were run with a total of sixteen physiotherapists. Focus group participants reported their training in diagnostic ultrasound to be largely self directed. They also reported they were learning on their patients. Despite very limited training, participants demonstrated some familiarity with images and equipment settings. Participants felt the modality had a role within physiotherapy as an adjunct to their current practices. The main need raised by participants during the focus groups was related to patient expectations and the fact that the physiotherapist may miss evidence of pathology.

Diagnostic ultrasound has expanded into physiotherapy though training in the modality appears to be and is reported by physiotherapists as limited. To address this, a training package was specifically developed for physiotherapists within Australia. The aim of this study was to evaluate the training package for improved educational outcome and to ascertain if there was a difference in outcome between two forms of delivery. The training package was delivered either during a workshop, where the training package was delivered face to face, or via a self paced DVD, which was mailed to participants. Both participant groups completed a web based assessment prior to and at the completion of the training. The assessment assessed their knowledge in ultrasound physics, scanning technique and anatomy. Pre and post training assessment scores were available for 84 participants who attended a workshop and 96 participants who received the DVD. Important and statistically significant ( p On comparison, no statistically significant difference between the two methods of training; workshop and DVD, was found so both can be seen to be beneficial to the professional development of the physiotherapist in the use of diagnostic ultrasound within their profession.

Aim To investigate the changes in rabbit foetal body composition in terms of bone mineral density (BMD) after ultrasound exposure (insonation) was given during different stages of gestation at different lengths of exposure time. Methods Three groups of pregnant rabbits; A, B, and C were given an ultrasound exposure of 30, 60 and 90min, respectively; during "Trimester 1", "Trimester 2", and "Trimester 3", using a 2-D B-mode Philips HD3 ultrasound system with a 9MHz 50mm broadband high-resolution linear array transducer. A fourth group of pregnant rabbits, O, was used as control. Each full-term newborn rabbits were scanned using a Lunar DPX-IQ dual energy X-ray absorptiometry (DEXA) scanner for whole-body BMD measurement in grams per centimetre square (g/cm 2 ). Results The results suggested that insonation for 90min in the 1st and 2nd trimester produced significant increase in BMD of rabbit foetus. Conclusion This in-vivo study revealed that a 90min B-mode diagnostic ultrasound exposure during the 1st and the 2nd trimesters caused significant increase in foetal BMD. A further study should be instituted to determine whether this finding in rabbit may also occur in human by means of clinical trials.

The expansion of diagnostic ultrasound outside of the traditional radiology profession into the physiotherapy profession is occurring. The purpose of this study was to determine if physiotherapists are purchasing diagnostic ultrasound machines, receiving training in the modality and what imaging procedures they are performing. For the design of future training tools, also investigated were the methods of training that physiotherapists might find most beneficial and what content they deem necessary to be covered during such training for the use of diagnostic ultrasound for their profession. An e-mail invitation was sent to physiotherapists throughout Australian who were registered on two databases, asking them to complete a web based survey. The survey was comprised of 18 questions including open and closed items. The data was then categorised into themes in accordance with the purpose of the study. Of the respondents, 39% did not own a diagnostic ultrasound machine, 33% had access to a machine that was owned by their employer and 18% actually owned a machine themselves. Training in diagnostic ultrasound had been received by 61% of the respondents however for 67% of those who had been trained, this training had only lasted for several hours, not days or weeks. For future training in ultrasound the majority of respondents would prefer either a workshop or DVD to cover imaging anatomy, the use of machine controls and scanning the pelvic floor, abdominal muscles and shoulder. From this survey it can be concluded that physiotherapists have an interest in or are using diagnostic ultrasound in their practice. While some form of training is being provided, further training is considered necessary and wanted by the physiotherapists so training tools need to be developed.

Background Diagnostic ultrasound is traditionally and extensively used within the radiology department. However in recent years its use has expanded outside this traditional area into health professions such as physiotherapy, emergency medicine and anaesthesiology. Purpose The radiology community needs to be aware of the expansion of use of diagnostic ultrasound. This article starts this exploration in the health professions mentioned, however it is acknowledged that diagnostic ultrasound use goes beyond what is covered in this article. As diagnostic ultrasound is a user dependant modality and the outcome of an examination is largely influenced by the skill and experience of the operator,1 the radiology community should take a guiding role in its use, training and protocol development for health professionals. Method This article explores the literature on the use of diagnostic ultrasound within physiotherapy, emergency medicine and anaesthesiology. Literature was searched for on the databases Medline, Cinahl and Embase. Results Diagnostic ultrasound is being used in health professions such as physiotherapy, where it is being used to provide biofeedback to patients on contraction of abdominal and pelvic floor muscles; emergency medicine, for the investigation of free fluid within the abdomen of a trauma patient and anaesthesiology, for the placement of catheters and nerve blocks. Conclusion As members of the radiology community are considered experts in the field, they need to take the lead to guide and mentor the other health professionals who are now using the modality. To be able to achieve this they must have an understanding of what these professions are using the modality for.

Purpose: This work was carried out to estimate the extent to which radiographers perform general diagnostic ultrasound (excluding obstetric and cardiac ultrasound), in England and Scotland; to determine work practices within departments where radiographers undertake ultrasound investigations; and to establish the education and qualifications of radiographers. Methods: During 1996, 150 hospitals were surveyed including 110 English hospitals randomly selected from The Hospital Year Book, and a purposive sample of Scottish hospitals. Separate questionnaires were designed for radiographers and consultant radiologists, with a common core of questions to facilitate inter-group comparison. The main topics investigated were: anatomical areas examined; use of procedural guidelines; methods of image reporting; clinical audit; radiographers' selection for training, and continuing educational needs. Results: Radiographers carried out general diagnostic ultrasound in 72.2% ( n =104) of hospitals surveyed, and in 57% of cases this had commenced within the previous 5 years. Both professions identified similar anatomical areas that could be appropriately imaged by radiographers, including more complex cases, as the radiographer gained experience. Procedural guidelines existed in approximately half of all the departments. Methods of reporting varied considerably, but 55.1% ( n =38) of radiologists reported images in conjunction with the radiographer. Radiographer enthusiasm was cited as the main reason for selecting radiographers to train. The majority of radiographers (84%, n =326) held the Diploma in Medical Ultrasound (DMU). Radiographer performed ultrasound was audited in 44% of hospitals in the United Kingdom. Conclusions: Adequately trained radiographers are performing general diagnostic ultrasound in close collaboration with radiologists.

This paper outlines the processes and outcomes of the project set up to develop occupational standards for the practice of diagnostic ultrasound. The background to this development was reported in the last issue. Occupational Standards are descriptions of what a practioner is expected to be able to achieve in a particular work role. Outcomes are viewed from the service user's perspective. Occupational standards are quality specifications which describe what should happen and their aim is to improve standards of current practice. The interactive process of functional analysis was utilized to develop occupational standards for diagnostic ultrasound. An overall picture of the main aspects of diagnostic ultrasound was obtained from acknowledged experts in the field and draft standards were developed. A nationwide consultation process followed, prior to the standards being completed and finalized. Because of the benefits that occupational standards may bring to work roles and job design, it is important that ultrasound practitioners and imaging managers understand the process which guided these developments and the outcomes. An insight into the debates surrounding the developments may facilitate the integration of the standards into practice.

This, the first of two papers considers the development of occupational standards in the practice of diagnostic ultrasound, giving an overview of the background to the project which was commissioned by the NHS Executive South and West and the College of Radiographers. The paper provides a review of the literature related to occupational standards with key themes, such as the role of professional bodies in monitoring practice and practitioners and the derivation and definition of occupational standards. Other models and projects which have developed methods of standards design in areas of radiography and diagnostic ultrasound (such as the development of competency based standards for medical radiation science professions) are also considered. The paper concludes with a reflection on the need for continual evaluation of occupational standards and their use in practice.

Purpose To determine the accuracy of ultrasound localisation of the tumour bed versus clinical mark-up of the lumpectomy scar to define the electron boost field in carcinoma of the breast. Methods Twenty-eight patients were recruited to the pilot study and underwent diagnostic ultrasound to localise the tumour bed. The boost field was prescribed utilising the ultrasound measurements and a form was completed outlining the effect (if any) of ultrasound on the positioning of the electron field. Results Ultrasound affected the management of approximately 72% of patients in the pilot study. Conclusion Ultrasound appears to be more accurate in localising the tumour bed compared with the ‘standard' technique of using the lumpectomy scar in this pilot study.

Purpose: To describe the sonographic appearance of the Achilles tendon following surgery. The images presented are from a selection of patients screened for inclusion in a wider study undertaken to evaluate the efficacy of a micro-current treatment regime, contrasted with current conservative management, for the Achilles tendon presenting witj chronic pathology. Twenty per cent of the patients studied reported no change or a worsening of their original symptoms following surgical intervention. All subjects underwent an initial clinical and imaging assessment to ascertain their level of functional ability and the degree of deviation from normal sonographic appearance. Methods: Sixteen of the 60 subjects required for the research programme had previously undergone surgical intervention. Failure to respond to conservative management was the consistent reason for surgery. Patients were scanned in the prone position, employing a standard technique, using real-time sonography with a 10 MHz transducer. Longitudinal and transverse scans were performed. Scans were undertaken at inital assessment, 6 months and 1 year post-presentation. Results: Surgical intervention can significantly affect the ultrasound appearance of the Achilles tendon. The disturbed tendon can present as enlarged, with a lesser or greater degree of anatomical variation, with residual or new pathology resulting in pain and/or functional disability. Conclusions: Real-time sonography of the Achilles tendon can make a contribution to a post-surgical assessment. It can evaluate accurately the success of a procedure and reduce the ‘sit and wait' time, when patients are often subjected to further bouts of conservative treatment in an attempt to relieve post-surgical symptoms.