Diagnostic ultrasound (US) is a medical imaging technique which, since its introduction in clinical practice at the end of the 1960s, has seen continuous improvement in image quality and constant growth in number of examinations perfromed and variety of clinical applications. It is now considered to be the second most frequently performed imaging examination, following the chest X-ray.
Although radiologists are deeply involved in this field, US is also used extensively by many specialists of other disciplines. It is considered that, nowadays, more than 50% of US examinations worldwide are performed by clinical specialists rather than radiologists or technicians working in a department of radiology. There are important fields of application of diagnostic US, for instance cardiology, obstetrics, and gynaecology, which are almost exclusively performed by non-radiology specialists.
Turf battles about the use of US continue to grow as more and more specialists are claiming US as part of their everyday’s work, and the position of radiologists is progressively further undermined.
It is well know that, in clinical medicine, a strong position in any examination technique belongs to those who are most active in research and new developments. On the radiologists’ side, there is a decrease in dedication and involvement in US research. Radiologists probably do most of the “routine” work in US, but seem to pay relatively little attention to the new advances in this field. The most important of them, the use of US contrast media, is growing very slowly and seems more frequently employed by non radiology physicians.
Furthermore, there seems to be lower attention to US also in clinical practice. Young radiologists often regard US as less attractive than CT and MR. Many consider it as a “mature” technique, with few possibilities of advancement and as a physically and mentally stressful activity (high number of requests, continuous “clinical” attention while performing the studies, direct contact with patients). Clinical Directors of Radiology Departments have organization and budget concerns about US: it is an examination technique which is difficult to standardise and consumes considerable human resources (even when performed by a sonographer the physician must be nearby, and “medical time” is costly); CTs and MRs are requested also after US performed by clinicians, and these examinations ensure higher income to the Department. CT and MR often have higher sensitivity and always have wider capabilities: it is commonly thought that the examination technique which, in theory, provides the best results “in one stop” is the best choice.
In addition, the shift to a practice and academic model in which radiologists are focused on organ systems has, in some ways, highly enhanced the capabilities of radiologists to correlate with referring specialists but, on the other hand, has lowered the visibility of technique based specialities (e.g. US) This has led to decreased emphasis on the technical aspects of US during residency programmes and increased requests for specific ultrasound skills to be obtained towards the end of training.