Abstract
I became familiar with the world of sonography at the very beginning of my career in medicine while participating in research projects focused on musculoskeletal sonography, as an undergraduate research assistant. The mentorship and experience I gained while working with sonographers was instrumental in guiding my path into medical school and beginning a career in radiology.
After completing my radiology residency and beginning a fellowship in musculoskeletal radiology, I have had the opportunity to reflect on the collaboration which takes place every day between radiologists and sonographers. Like many other radiologists, ultrasound was a part of my training; however, the majority of the time I spent scanning was while performing image-guided procedures. On diagnostic rotations, my interaction with sonographers was primarily on the breast imaging service, where all diagnostic mammography and breast sonograms were reviewed collaboratively by the sonographer, resident or fellow, and attending radiologist, prior to the patient leaving their appointment. This collaboration ensured that all necessary images were obtained in a single visit for the patient. Looking back, I see a lot of untapped potential for similar collaboration and shared learning elsewhere in the training and practice of radiology.
During my fellowship, I have had the privilege to work more closely with many of the talented sonographers at our institution. Within our department, musculoskeletal sonography is growing and expanding. Some of our sonographers are quite experienced in musculoskeletal imaging, and others are working to develop this skill set. I have had the opportunity to observe them at work and to practice my own scanning skills, with the benefit of their feedback and advice. During this time, we have been able to share knowledge. They have shared techniques for scanning, positioning the patient, and optimizing the parameters of the ultrasound equipment system, to obtain the best possible evaluation. I have answered questions regarding anatomy, pathology, and treatment. These moments exemplify the spirit of an academic medical center, where it is possible for a sonographer, sonography student, medical student, resident, fellow, and attending radiologist to all be involved in the acquisition and interpretation of images for a single patient.
The unique utility and challenges of sonography, as an imaging technique, further exemplify the importance of collaboration. Images are obtained in real time, allowing more rapid diagnosis. Sonography is also dynamic, allowing us to guide procedures and view pathology in action, such as when maneuvering the shoulder to assess for rotator cuff impingement. However, given the narrow field of view of a single sonographic image compared to other imaging techniques, it can sometimes be unclear what part of the body is even being examined in the absence of anatomical landmarks. Because of this extra complexity and operator dependence, communication between the sonographer and interpreting radiologist can be essential to fully realize the benefits of sonography, particularly with complex cases. While this can be as simple as exam notes left by the sonographer, communication face-to-face or over the phone is often necessary to interpret more challenging cases. Every communication is an opportunity for learning and to improve patient care. I have seen patient care expedited many times when a sonographer has called to notify me of a potentially critical finding that they identified while scanning a patient.
In the face of constantly increasing case volume and complexity in a growing health care system, I hope that we do not discard a spirit of collaboration in the pursuit of greater efficiency. By working together, we can further develop our knowledge and skills and develop a sense of community and belonging, which I hope will ensure that this work is exciting and rewarding for both sonographers and radiologists, no matter what challenges we may face in this rapidly evolving field of health care. So, my request is that if you ever find yourself wondering if you should pick up the phone or step into the reading room to discuss an interesting or challenging case, please do not hesitate. I am excited to see what we can learn together.
