Standards and Guidelines for the Accreditation of Ultrasound Practices

PURPOSE

The American Institute of Ultrasound in Medicine (AIUM) strives to continuously improve the quality of diagnostic ultrasound services by offering a peer review process for providers to demonstrate that they meet nationally recognized standards and guidelines.

Diagnostic medical ultrasound makes important contributions to patient care and may be used in a variety of settings. Ultrasound practice accreditation is designed to set a standard of quality for the performance of basic ultrasound procedures. These Standards and Guidelines for the Accreditation of Ultrasound Practices specify minimum training, experience, credentialing, and continuing medical education (CME) requirements for medical staff and personnel who perform and interpret diagnostic ultrasound examinations. Furthermore, these standards specify the requirements for safety, maintenance and calibration of equipment, staff performance, reports, record keeping, and quality assurance (QA) for clinical practices where studies are performed.

Ultrasound practices that meet the standards and guidelines described below will be eligible for ultrasound practice accreditation.

Accreditation

Accreditation may be obtained in 1 or more of the following specialties:

  • Abdominal/General Ultrasound (may include thyroid/parathyroid, urologic, musculoskeletal, and head and neck ultrasound)
  • Breast Ultrasound (diagnostic only or diagnostic and interventional; a practice cannot be accredited in interventional only)
  • Dedicated Musculoskeletal Ultrasound (diagnostic and/or Ultrasound-guided interventional procedures)
  • Dedicated Thyroid/Parathyroid Ultrasound
  • Fetal Echocardiography
  • Gynecologic Ultrasound (with or without adjunctive 3-dimensional ultrasound)
  • Head and Neck Ultrasound
  • Obstetric or Trimester-Specific Obstetric Ultrasound (can be a combination of 2 trimesters or first, second, or third only)
  • Obstetric Ultrasound With Adjunctive Detailed Fetal Anatomic Ultrasound
  • Ultrasound-Guided Regional Anesthesia
  • Urologic Ultrasound
  • Additional Ultrasound-Guided Procedures (in development)

 

The completed application and supporting documents are reviewed by the AIUM’s Ultrasound Practice Accreditation Program's peer reviewers and/or staff reviewers. Reaccreditation is required every 3 years. In case of major changes in personnel or the practice, the AIUM’s Ultrasound Practice Accreditation Department must be notified as soon as possible.

ULTRASOUND PRACTICE PERSONNEL

Physician Director of Ultrasound

The practice must designate a physician director of ultrasound, who is responsible for all correspondence with the accreditation department and must sign all required accreditation correspondence. The physician director of ultrasound is responsible for overseeing the quality and appropriateness of ultrasound operations of the practice, including ensuring that appropriate clinical services are provided and that support services are sufficient, and for attesting that the practice continues to meet the Standards and Guidelines for the Accreditation of Ultrasound Practices. The physician director of ultrasound may supervise the entire operation of the facility or may delegate specific operations to associates and sonographers. The physician director of ultrasound must meet all requirements for physicians who perform and/or interpret ultrasound examinations.

Interpreting Physicians

Ultrasound studies must be supervised and interpreted by a physician or chiropractor with training and experience in the specific area of sonography and meet the following requirements:

  • Must have a current state license.
  • Must meet the AIUM Training Guidelines in the specific area of sonography for which they perform and/or interpret diagnostic ultrasound examinations (linked below).

· CME must be AMA PRA Category 1 Credits™ or American Osteopathic Association Category 1A Credits specific to ultrasound.

· Physicians with structured training in each of the specialty areas for which they interpret that occurred more than 36 months ago may provide a representative sample of clinical volume experience totaling 500 cases and a representative sample of CME for a total of 30 credits.

· Providers seeking accreditation in both obstetrics and gynecologic (female pelvis)ultrasound are required to have 500-case volume experience with a minimum of 200 in either specialty.

· For reaccreditation, physicians or chiropractors on the previous accreditation application will need to meet Maintenance of Competence and Continuing Medical Education requirements listed in each specific training guideline.

· If interpreting in multiple specialties, a representative sample of CME credits must be obtained in specialties for which they are applying.

 

Abdominal/General Ultrasound

Breast Ultrasound

Dedicated Musculoskeletal Ultrasound

Dedicated Thyroid/Parathyroid Ultrasound

Fetal Echocardiography

Gynecologic Ultrasound (with or without adjunctive3-dimensional ultrasound)

Head and Neck Ultrasound

Please note, as of March 1, 2016, initial CME credits will be required for head and neck ultrasound.

Obstetric or Trimester-Specific Obstetric Ultrasound

Obstetric Ultrasound With Adjunctive Detailed Fetal Anatomic Ultrasound

Ultrasound-Guided Regional Anesthesia

Urologic Ultrasound

 

Reaccreditation

At reaccreditation, all physicians who were on the previous application must have documentation of appropriate CME: CME must be in the area that physicians interpret and/or perform. Physicians who perform and/or interpret ultrasound examinations in multiple specialties must have a representative sample of CME credits from each area of specialty for the 3-year cycle.

Refer to the above links for AIUM Training Guidelines, which designate appropriate CME requirements.

Yearly Volume Requirements

Physicians must meet procedure volume requirements on the type(s) of accreditation for which the practice is applying.*

Refer to the above links for AIUM Training Guidelines, which designate appropriate yearly volume requirements.

*Physicians who do not meet the minimum volume of ultrasound procedures on an annual basis can participate in a QA program designed to increase their exposure to ultrasound examinations and ensure high-quality ultrasound care. Physicians who do not meet the minimum annual ultrasound volume requirements can meet the case study requirements in any 1 of the following ways:

  • They can double read ultrasound studies for QA purposes.

 

  • They can have their ultrasound studies reread by a physician who does meet the minimum volume requirements and compare their findings with those of the other physician.

 

  • They can participate in a monthly case study review seminar developed and conducted by physicians in the practice who do meet the minimum annual ultrasound volume requirements.

 

Sonographers and Other Nonphysicians Who Perform Ultrasound Examinations

Qualified sonographers and other nonphysicians who perform ultrasound examinations (here to referred to as sonographers) will be responsible for those tasks specified by the physician director of ultrasound. Sonographers must have appropriate training for the performance of the ultrasound examinations they perform. Requirements for sonographers and other nonphysicians who perform ultrasound examinations are as follows:

  • All sonographers must be certified in the specialty or specialties in which they perform ultrasound evaluations or must become certified before the next reaccreditation. If a sonographer is required to become certified in multiple specialties, the sonographer must obtain a minimum of 1 additional specialty certification per accreditation cycle.  FAQ

 

The following certifications are acceptable:

  • American Registry for Diagnostic Medical Sonography (ARDMS) certification in abdomen, breast, fetal echocardiography, musculoskeletal, obstetrics and gynecology, and others as applicable; and
  • American Registry of Radiologic Technologists (ARRT) "AIUM-recognized" certification in general sonography for abdomen and obstetrics and gynecology or the ARRT certification in breast sonography.

Although a sonographer may play a critical role in extracting the information essential to deriving a diagnosis, the rendering of a final diagnosis from ultrasound studies represents the practice of medicine and, therefore, is the responsibility of the supervising physician.

FINAL REPORTS

Final reports must meet the requirements specified in the AIUM Practice Parameter for Documentation of an UltrasoundExamination:

PRELIMINARY REPORTS

A preliminary report is a written or verbal report released before being signed by the physician responsible for giving the final interpretation. Refer to "Nonroutine Reporting" in the AIUM Practice Parameter for Documentation of an Ultrasound Examination:

If an interpreting physician is not immediately available at the time an ultrasound examination is being performed:

  • The sonographer performing the examination must be appropriately credentialed in the specialty area(s) of the examination.
  • A mechanism must be in place to address unexpected or emergency findings.
  • If the patient is not kept until the physician reviews the images, a call-back mechanism must be in place.
  • A final report of the sonogram must be available by the end of the next business day and must follow the AIUM Practice Parameter for Documentation of an Ultrasound Examination.

POLICIES AND PROCEDURES SAFEGUARDING PATIENTS, ULTRASOUND PERSONNEL, AND EQUIPMENT

Patient Identification

Patients must be identified by 2 separate identifiers before a study is performed: for example, name, date of birth, address, or medical record number.

Precautions for Invasive Procedures

Time-outs

  • Before beginning an ultrasound-guided invasive procedure, the practice must take steps to verify patient identification, the type of procedure planned, and the appropriate procedure site(s).

Specimens

  • The practice must take steps to ensure that specimens are correctly labeled.
  • The practice must clearly define the personnel responsible and the steps required to hand off each specimen.

 

INCIDENT REPORTING

A policy/procedure must exist for responding to and reporting any accidents or complications that occur in the facility.

PATIENT CONFIDENTIALITY

All practice personnel must adhere to Health Insurance Portability and Accountability Act regulations and professional ethics and behavior to ensure patient confidentiality.

POLICIES ON PREVENTION OF INFECTIOUS DISEASES

The practice must have procedures and policies on the protection of patients and practice personnel from the transmission of infectious disease as well as the cleaning and disinfection of ultrasound equipment and transducers:

ALARA PRINCIPLE

Personnel must be familiar with and show evidence of practicing the ALARA (as low as reasonably achievable) principle. Medical Ultrasound Safety can be purchased at the AIUM Online Store. Refer to the official statement; and the Journal of Ultrasound in Medicine article on biosafety:

QUALITY ASSURANCE

The practice must show ongoing monitoring of the clinical practice's ultrasound personnel performance, including all physicians and sonographers through regular, retrospective review.

  • To assess diagnostic accuracy, the practice must obtain correlation of ultrasound diagnoses of normal and abnormal studies with clinical, radiographic, laboratory, surgical, and pathologic findings.
  • The review must include normal and abnormal case studies to evaluate the following:

· Content, completeness, and technical quality of the images; and

· Accuracy and timeliness of final reports.

  • When deficiencies are identified, the causes should be investigated, and corrective action should be planned and implemented.
  • Information obtained should be disseminated to both physician and sonographer personnel of the ultrasound practice in a timely fashion.
  • A record of QA activities must be maintained and kept current.

DOCUMENT STORAGE AND RECORD-KEEPING GUIDELINES AND REQUIREMENTS

  • There must be provisions for the retrieval and storage of examination records of all studies performed.
  • Appropriate documentation of every study must include permanent ultrasound images stored on suitable recording media, as well as a report that indicates the findings obtained by the examination and adheres to the AIUM Practice Parameter for Documentation of an Ultrasound Examination.
  • Ultrasound images and a report from the interpreting physician must be maintained in a readily accessible fashion for comparison and consultation.
  • Recording media must have a shelf life compatible with the minimum number of years, required by law, for the maintenance of patient records. In most states, this will be for at least 7 years after the patient's last examination was performed; however, these requirements vary from state to state.

POLICIES PROTECTING PRACTICE PERSONNEL

The practice must be in compliance with all US Occupational Safety and Health Administration regulations.

ULTRASOUND EQUIPMENT AND QUALITY ASSURANCE

  • The ultrasound equipment must meet all state and federal guidelines.
  • Studies must be conducted with real-time equipment, and transducers must be available with a frequency range that will optimize beam penetration and resolution.
  • The equipment used for diagnostic testing must be maintained in good operating condition and undergo routine quality assurance at least once a year or more frequently if problems arise. Routine quality assurance on ultrasound equipment must meet or exceed the recommendations specified in Routine Quality Assurance “Cookbook”.
  • Records of routine quality assurance must be kept for 3 years or longer depending on state and federal guidelines.

 


Approved: 03/13/2002; Reapproved: 11/10/2002, 11/13/2005, 11/14/2009, 03/27/2010, 12/17/2010, 11/05/2011, 04/02/2014, 11/02/2014, 10/31/2015

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