From recommendations to accreditation: Implementing neurological point-of-care ultrasound training in the UK

We read with great interest the recent review by Wong et al., ¹ which highlights the current gaps in training and competency frameworks for Neurological Point-of-care-ultrasound (NeuroPOCUS). We concur that there is a pressing need for structured, standardised education in this evolving field and welcome the opportunity to contribute to this important conversation.

In October 2023, the Intensive Care Society (ICS) appointed national leads for each established Focused Ultrasound in Intensive Care (FUSIC^®) module, as well as national leads for new module development. ² The FUSIC^® Brain workstream prioritised developing a robust, comprehensive and evidence-based accreditation pathway aligned with the FUSIC^® ethos. As Wong et al. noted in their review, one of the main challenges remains the limited availability of experienced instructors.

Transcranial Doppler has been used for over 50 years in clinical practice to assess cerebral haemodynamics, particularly in neonatal and paediatric patients.^3,4 The ability to visualise brain parenchyma and intracranial vessels, facilitated by favourable acoustic windows, enabled broader dissemination of brain POCUS skills in neonatal and paediatric intensive care units. Given this established expertise among paediatric intensivists, the collaboration between FUSIC^® Brain and Children’s Acute Ultrasound (CACTUS^®) was a natural step in developing the accreditation pathway.

The curriculum encompasses key theoretical content including neuroanatomy, Doppler principles, standard insonation techniques and interpretation of flow velocities and indices (e.g. pulsatility index (PI) and Lindegaard Ratio). Candidates are required to complete a logbook of 50 cases, supported by a remote supervision platform, and must pass a formal in-person assessment conducted by accredited supervisors. The accreditation pathway also includes monthly webinars, encouraging clinical case discussions to supplement candidates’ learning, in addition to hands-on scanning.

In November 2024, we launched the ‘train the trainer’ NeuroPOCUS course days. Expressions of interest were invited from UK adult and paediatric intensivists using transcranial colour coded Duplex (TCCD) in routine practice to both gauge interest in the new accreditation module and build a network of experienced trainers. These well-received sessions provided an opportunity to standardise scanning techniques and curriculum delivery across the trainer cohort. We were encouraged by the enthusiasm for NeuroPOCUS and the lively discussions between experts highlighted areas for future development of the accreditation pathway.

We fully agree with Wong et al. on the importance of ongoing competency maintenance. As such, the FUSIC^® Neuro module incorporates annual ‘train the trainer’ days to support continued professional development and progression from accreditation to mentorship.

The FUSIC^® and CACTUS^® Neuro leads and trainers are committed to expanding the evidence base for NeuroPOCUS through engagement with national initiatives such as TBI Reporter ⁵ and collaboration with local and international acute brain injury research groups.

We hope this update provides reassurance that a structured NeuroPOCUS accreditation pathway is now a reality, following the recent sign-off of the neuro module by the FUSIC^® committee. We welcome ongoing dialogue and collaboration with colleagues across the POCUS community, as we anticipate the continued growth of NeuroPOCUS as a valuable tool beyond neurocritical care. ⁶