What is Sonography?


Sonography (or ultrasound) is a diagnostic medical procedure that uses high frequency sound waves to produce dynamic visual images of organs, tissues, or blood flow inside the body. This type of procedure is called a sonogram. There are several areas of specialization in the field of sonography:

Abdomen - evaluation of all the soft tissues, blood vessels and organs of the abdomen

Breast - frequently used to evaluate breast lumps and other abnormalities that are found with screening or mammography

Obstetrics/Gynecology - evaluation of the developing fetus and the female reproductive system

Cardiac/Echocardiography - evaluation of the anatomy and function of the heart and related blood vessels

Vascular - evaluation of the blood flow through blood vessels

Neurosonology - evaluation of the brain and spinal cord in infants

Sonography is increasingly being used in the detection and treatment of heart disease, heart attack, and vascular disease that can lead to stroke. It is also used to guide needles for tissue biopsies taken for testing under a microscope

The professionals who perform these procedures are known as sonographers.




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Sonographer Career & Salary Overview


The following statistical information is from Bureau of Labor Statistics. Wages vary drastically from location, place of business (doctor office/hospital) and whether or not you are Registered with ARDMS (American Registry of Diagnostic Medical Sonographers), ARRT (American Registry of Radiologic Technologists), or CCI (Cardiovascular Credentialing International). Also check out these great sources for salary info:

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Diagnostic Medical Sonographer

Earnings
Median annual earnings of diagnostic medical sonographers were $57,160 in May 2006. The middle 50 percent earned between $48,890 and $67,670 a year. The lowest 10 percent earned less than $40,960, and the highest 10 percent earned more than $77,520. Median annual earnings of diagnostic medical sonographers in May 2006 were $56,970 in offices of physicians and $56,850 in general medical and surgical hospitals.


Employment
Diagnostic medical sonographers held about 46,000 jobs in 2006. More than half of all sonographer jobs were in public and private hospitals. The rest were typically in offices of physicians, medical and diagnostic laboratories, and mobile imaging services.


Job Outlook
Faster-than-average employment growth is expected. Job opportunities should be favorable.

Employment change. Employment of diagnostic medical sonographers is expected to increase by about 19 percent through 2016—faster than the average for all occupations—as the population ages, increasing the demand for diagnostic imaging and therapeutic technology.

Additional job growth is expected as sonography becomes an increasingly attractive alternative to radiologic procedures, as patients seek safer treatment methods. Unlike most diagnostic imaging methods, sonography does not involve radiation, so harmful side effects and complications from repeated use are less likely for both the patient and the sonographer. Sonographic technology is expected to evolve rapidly and to spawn many new sonography procedures, such as 3D- and 4D-sonography for use in obstetric and ophthalmologic diagnosis. However, high costs and approval by the Federal Government may limit the rate at which some promising new technologies are adopted.

Hospitals will remain the principal employer of diagnostic medical sonographers. However, employment is expected to grow more rapidly in offices of physicians and in medical and diagnostic laboratories, including diagnostic imaging centers. Healthcare facilities such as these are expected to grow very rapidly through 2016 because of the strong shift toward outpatient care, encouraged by third-party payers and made possible by technological advances that permit more procedures to be performed outside the hospital.


Job prospects
Job opportunities should be favorable. In addition to job openings from growth, some openings will arise from the need to replace sonographers who retire or leave the occupation permanently for some other reason. Pain caused by musculoskeletal disorders has made it difficult for sonographers to perform well. Some are forced to leave the occupation early because of this disorder.





Cardiovascular Ultrasound Technician/Echocardiographer


Earnings
Median annual earnings of cardiovascular technologists and technicians were $42,300 in May 2006. The middle 50 percent earned between $29,900 and $55,670. The lowest 10 percent earned less than $23,670, and the highest 10 percent earned more than $67,410. Median annual earnings of cardiovascular technologists and technicians in 2006 were $41,960 in offices of physicians and $41,950 in general medical and surgical hospitals.


Significant Points
Employment is expected to grow much faster than average; technologists and technicians trained to perform certain procedures will be in particular demand.
About 3 out of 4 jobs are in hospitals.
The vast majority of workers complete a 2-year junior or community college program.


Nature of the Work
Cardiovascular technologists and technicians assist physicians in diagnosing and treating cardiac (heart) and peripheral vascular (blood vessel) ailments.

Cardiovascular technologists and technicians schedule appointments perform ultrasound or cardiovascular procedures, review doctors’ interpretations and patient files, and monitor patients’ heart rates. They also operate and care for testing equipment, explain test procedures, and compare findings to a standard to identify problems. Other day-to-day activities vary significantly between specialties.

Cardiovascular technologists may specialize in any of three areas of practice: invasive cardiology, echocardiography, or vascular technology.

Invasive cardiology. Cardiovascular technologists specializing in invasive procedures are called cardiology technologists. They assist physicians with cardiac catheterization procedures in which a small tube, or catheter, is threaded through a patient’s artery from a spot on the patient’s groin to the heart. The procedure can determine whether a blockage exists in the blood vessels that supply the heart muscle. The procedure also can help to diagnose other problems. Part of the procedure may involve balloon angioplasty, which can be used to treat blockages of blood vessels or heart valves without the need for heart surgery. Cardiology technologists assist physicians as they insert a catheter with a balloon on the end to the point of the obstruction. Another procedure using the catheter is electrophysiology test, which help locate the specific areas of heart tissue that give rise to the abnormal electrical impulses that cause arrhythmias.

Technologists prepare patients for cardiac catheterization by first positioning them on an examining table and then shaving, cleaning, and administering anesthesia to the top of their leg near the groin. During the procedures, they monitor patients’ blood pressure and heart rate with EKG equipment and notify the physician if something appears to be wrong. Technologists also may prepare and monitor patients during open-heart surgery and during the insertion of pacemakers and stents that open up blockages in arteries to the heart and major blood vessels.

Noninvasive technology. Technologists who specialize in vascular technology or echocardiography perform noninvasive tests using. Tests are called “noninvasive” if they do not require the insertion of probes or other instruments into the patient’s body. For example, procedures such as Doppler ultrasound transmit high-frequency sound waves into areas of the patient’s body and then processes reflected echoes of the sound waves to form an image. Technologists view the ultrasound image on a screen and may record the image on videotape or photograph it for interpretation and diagnosis by a physician. As the technologist uses the instrument to perform scans and record images, technologists check the image on the screen for subtle differences between healthy and diseased areas, decide which images to include in the report to the physician, and judge whether the images are satisfactory for diagnostic purposes. They also explain the procedure to patients, record any additional medical history the patient relates, select appropriate equipment settings, and change the patient’s position as necessary. (See the statement on diagnostic medical sonographers elsewhere in the Handbook to learn more about other sonographers.)

Vascular technology. Technicians who assist physicians in the diagnosis of disorders affecting the circulation are known as vascular technologists or vascular sonographers. Vascular technologists complete patients’ medical history, evaluate pulses and assess blood flow in arteries and veins by listening to the vascular flow sounds for abnormalities, and assure the appropriate vascular test has been ordered. Then they perform a noninvasive procedure using ultrasound instruments to record vascular information such as vascular blood flow, blood pressure, oxygen saturation, cerebral circulation, peripheral circulation, and abdominal circulation. Many of these tests are performed during or immediately after surgery. Vascular technologists then provide a summary of findings to the physician to aid in patient diagnosis and management.

Echocardiography. This area of practice includes giving electrocardiograms (EKGs) and sonograms of the heart. Cardiovascular technicians who specialize in EKGs, stress testing, and those who perform Holter monitor procedures are known as cardiographic or electrocardiograph (or EKG) technicians.

To take a basic EKG, which traces electrical impulses transmitted by the heart, technicians attach electrodes to the patient’s chest, arms, and legs, and then manipulate switches on an EKG machine to obtain a reading. An EKG is printed out for interpretation by the physician. This test is done before most kinds of surgery or as part of a routine physical examination, especially on persons who have reached middle age or who have a history of cardiovascular problems.

EKG technicians with advanced training perform Holter monitor and stress testing. For Holter monitoring, technicians place electrodes on the patient’s chest and attach a portable EKG monitor to the patient’s belt. Following 24 or more hours of normal activity by the patient, the technician removes a tape from the monitor and places it in a scanner. After checking the quality of the recorded impulses on an electronic screen, the technician usually prints the information from the tape for analysis by a physician. Physicians use the output from the scanner to diagnose heart ailments, such as heart rhythm abnormalities or problems with pacemakers.

For a treadmill stress test, EKG technicians document the patient’s medical history, explain the procedure, connect the patient to an EKG monitor, and obtain a baseline reading and resting blood pressure. Next, they monitor the heart’s performance while the patient is walking on a treadmill, gradually increasing the treadmill’s speed to observe the effect of increased exertion. Like vascular technologists and cardiac sonographers, cardiographic technicians who perform EKG, Holter monitor, and stress tests are known as “noninvasive” technicians.

Technologists who use ultrasound to examine the heart chambers, valves, and vessels are referred to as cardiac sonographers, or echocardiographers. They use ultrasound instrumentation to create images called echocardiograms. An echocardiogram may be performed while the patient is either resting or physically active. Technologists may administer medication to physically active patients to assess their heart function. Cardiac sonographers also may assist physicians who perform transesophageal echocardiography, which involves placing a tube in the patient’s esophagus to obtain ultrasound images.

Work environment. Cardiovascular technologists and technicians spend a lot of time walking and standing. Heavy lifting may be involved to move equipment or transfer patients. These workers wear heavy protective aprons while conducting some procedures. Those who work in catheterization laboratories may face stressful working conditions because they are in close contact with patients with serious heart ailments. For example, some patients may encounter complications that have life-or-death implications.

Some cardiovascular technologists and technicians may have the potential for radiation exposure, which is kept to a minimum by strict adherence to radiation safety guidelines. In addition, those who use sonography can be at an increased risk for musculoskeletal disorders such as carpel tunnel syndrome, neck and back strain, and eye strain. However, greater use of ergonomic equipment and an increasing awareness will continue to minimize such risks.

Technologists and technicians generally work a 5-day, 40-hour week that may include weekends. Those in catheterization laboratories tend to work longer hours and may work evenings. They also may be on call during the night and on weekends.


Training, Other Qualifications, and Advancement
The most common level of education completed by cardiovascular technologists and technicians is an associate degree. Certification, although not required in all cases, is available.


Education and Training
Although a few cardiovascular technologists, vascular technologists, and cardiac sonographers are currently trained on the job, most receive training in 2- to 4-year programs. The majority of technologists complete a 2-year junior or community college program, but 4-year programs are increasingly available. The first year is dedicated to core courses and is followed by a year of specialized instruction in either invasive, noninvasive cardiovascular, or noninvasive vascular technology. Those who are qualified in an allied health profession need to complete only the year of specialized instruction.

The Joint Review Committee on Education in Cardiovascular Technology reviews education programs seeking accreditation. The Commission on Accreditation of Allied Health Professionals (CAAHEP) accredits these education programs; as of 2006, there were 31 programs accredited in cardiovascular technology in the United States. Similarly, those who want to study echocardiography or vascular sonography may also attend CAAHEP accredited programs in diagnostic medical sonography. In 2006, there were 147 diagnostic medical sonography programs accredited by CAAHEP. Those who attend these accredited programs are eligible to obtain professional certification.

Unlike most other cardiovascular technologists and technicians, most EKG technicians are trained on the job by an EKG supervisor or a cardiologist. On-the-job training usually lasts about 8 to 16 weeks. Most employers prefer to train people already in the health care field—nursing aides, for example. Some EKG technicians are students enrolled in 2-year programs to become technologists, working part time to gain experience and make contact with employers. One-year certification programs exist for basic EKGs, Holter monitoring, and stress testing.


Licensure and Certification
Some States require workers in this occupation to be licensed. For information on a particular State, contact that State’s medical board. Certification is available from two organizations: Cardiovascular Credentialing International (CCI) and the American Registry of Diagnostic Medical Sonographers (ARDMS). The CCI offers four certifications—Certified Cardiographic Technician (CCT), Registered Cardiac Sonographer (RCS), Registered Vascular Specialist (RVS), and Registered Cardiovascular Invasive Specialist (RCIS). The ARDMS offers Registered Diagnostic Cardiac Sonographer (RDCS) and Registered Vascular Technologist (RVT) credentials. Some States require certification as part of licensure. In other States, certification is not required but many employers prefer it.


Other Qualifications
Cardiovascular technologists and technicians must be reliable, have mechanical aptitude, and be able to follow detailed instructions. A pleasant, relaxed manner for putting patients at ease is an asset. They must be articulate as they must communicate technically with physicians and also explain procedures simply to patients.


Advancement
Technologists and technicians can advance to higher levels of the profession as many institutions structure the occupation with multiple levels, each having an increasing amount of responsibility. Technologists and technicians also can advance into supervisory or management positions. Other common possibilities include working in an educational setting or conducting laboratory work.


Employment
Cardiovascular technologists and technicians held about 45,000 jobs in 2006. About 3 out of 4 jobs were in hospitals (public and private), primarily in cardiology departments. The remaining jobs were mostly in offices of physicians, including cardiologists, or in medical and diagnostic laboratories, including diagnostic imaging centers.


Job Outlook
Employment is expected to grow much faster than average; technologists and technicians trained to perform certain procedures will be in particular demand.


Employment Change
Employment of cardiovascular technologists and technicians is expected to increase by 26 percent through the year 2016, much faster than the average for all occupations. Growth will occur as the population ages, because older people have a higher incidence of heart disease and other complications of the heart and vascular system. Procedures such as ultrasound are being performed more often as a replacement for more expensive and more invasive procedures. Due to advances in medicine and greater public awareness, signs of vascular disease can be detected earlier, creating demand for cardiovascular technologists and technicians to perform various procedures.

Employment of vascular technologists and echocardiographers will grow as advances in vascular technology and sonography reduce the need for more costly and invasive procedures. Electrophysiology is also becoming a rapidly growing specialty. However, fewer EKG technicians will be needed, as hospitals train nursing aides and others to perform basic EKG procedures. Individuals trained in Holter monitoring and stress testing are expected to have more favorable job prospects than those who can perform only a basic EKG.

Medicaid has relaxed some of the rules governing reimbursement for vascular exams, which is resulting in vascular studies becoming a more routine practice. As a result of increased use of these procedures, individuals with training in vascular studies should have more favorable employment opportunities.


Job Prospects
Some additional job openings for cardiovascular technologists and technicians will arise from replacement needs as individuals transfer to other jobs or leave the labor force. Although growing awareness of musculoskeletal disorders has made prevention easier, some cardiovascular technologists and technicians have been forced to leave the occupation early because of this disorder.

It is not uncommon for cardiovascular technologists and technicians to move between the specialties within the occupation by obtaining certification in more than one specialty.


PayScale, Inc. Salary Guide

History of Sonography


Evolution of Sonography (Ultrasound)
by Dr Sonali Maniar
Chief of Conventional Radiology & Ultrasound
Wockhardt Hospital, Mumbai


Ultrasound is the most widely used imaging modality. The technology has evolved considerably over time and so have its applications. The foundation of ultrasound can be traced back to 1880 when Pierre Curie introduced simple echo sounding methods, leading to discovery of Sound Navigating and Ranging or SONAR. SONAR was used to detect submarines during the world war. This inspired the early ultrasound investigations in various centres across the world.

The first published work on medical ultrasound was by Dr Karl Theodore Dussik in Austria in 1942. He used ultrasound waves to detect brain tumors. His method consisted of an ultrasound emitter at one end and ultrasound receiver at the other, while the patient stayed between the two devices. By measuring the sound beams transmitted through the patient, he was able to detect any tumors in the brain.

Professor Ian Donald from Glasgow, Scotland along with his colleagues in 1950's did much to facilitate the development of the technology and applications leading to wider use of ultrasound in medical practice. He was an obstetrician with interest in machines and electronics. Along with Tom Brown he invented and constructed the prototype of the first Compound B Mode Contact Scanner. Professor Donald introduced several diagnostic techniques in obstetrics and gynaecology which are till today in use such as the measurement of foetal Biparietal Diameter.

Flashback

Early machines in the 1960s were primitive, where a single image took several seconds to build up. These images depicted only the structure but not the movement. The scanning equipment was very large and probes had a large scan head with heavy cables. The first real time scanner was developed in 1965 by Walter Klause and Richard Soldner. The ultrasound beam from a hand-held probe was swept quickly and repetitively through the body by mechanised or electronic means. Thus, large volumes of tissues could be scanned in a short time.

The application of ultrasound extended to scan abdominal organs to help in detection of gall stones and tumors. Breast evaluation with ultrasound also began to develop. Studies were also made to use ultrasound for musculoskeletal imaging. The first B Scan image of a human joint was published in 1972 by Daniel G McDonald and George R Leopold in the British Journal of Radiology.

In early 1980s, computer software was merged to ultrasound technology. Digital technology helped in making smaller, more portable and relatively low-cost machines. The convex and curvilinear abdominal transducers were introduced and probes were smaller, lighter and easy to operate. Spectral and Colour Doppler were introduced which led to the extension of ultrasound applications to evaluate blood vessels and also cardiac imaging. Tumour vascularity could also be studied with color doppler.

1990s saw further improvements in image quality. The new transducer materials and engineering techniques allowed the use of much wider frequency band widths and higher sensitivity. With improved contrast and spatial resolution and availability of multi-frequency probes, the applications of ultrasound increased. Small parts like thyroid, scrotum and eye could be scanned. With high frequency transducers, the skin and subcutaneous tissue can also be studied.

Endoluminal Devices

Endoluminal devices were introduced to provide images of the vessel wall structures. Endoscopic ultrasound developed with the use of high frequency ultrasound probes which are introduced into the upper or lower part of the gastrointestinal tract to visualised gastrointestinal wall and adjacent structures. This is very useful in diagnosis and staging of benign and malignant lesions of the gut wall and surrounding structures of the mediastinum, abdomen and pelvis. It is also useful to evaluate submucosal masses of the upper gastrointestinal tract and the rectosigmoid for locating pancreatic tumor and assessment of vascular disease. Guided interventions like FNA or drainage are also possible.

As the machines became smaller and portable their use in trauma units, emergency departments and critical care units has increased. Amongst the recent advances in ultrasound harmonic imaging, real time spatial compound imaging, adaptive image processing, power doppler imaging and contrast enhanced gray scale harmonic ultrasound improved the image quality significantly.

Harmonic imaging is a modality that produces artifact free images with high resolution. Real time spatial compounding sonography uses electronic beam steering of a transducer array and as many as nine scans of an object, which are acquired from different view angles, are merged in overlapping fashion and averaged to form a compound real time image. This reduces artifacts and noise, thereby enhancing image contrast.

Contrasts

The earliest use of ultrasound contrast agents was in 1968, but subsequently better agents were developed in the 1990s.These are gas filled microbubbles that are administered intravenously. Microbubbles have a high degree of echogenicity, which is the ability of an object to reflect the ultrasound waves. Contrast enhanced ultrasound can be used to image blood perfusion in organs and measure blood flow rate in the heart and other organs. It has also been useful to evaluate hepatic masses.

3D World

3D ultrasound was first developed by Olaf von Ramm and Stephen Smith at Duke University in 1987. But later 4D came into existence which adds the element of time to the process. It renders live images of the foetus, much to the delight of expecting mothers and radiologists. It is currently widely used in obstetrics to show live images of the foetal face and also helps in diagnosing anomalies like cleft-lip and spinal dysraphism. Improvements and advances in technology led to several newer applications.

In gynaecology, it helps to evaluate uterine cavity anomalies, ovarian volumes, volumes of fibroids and other masses. In the abdominal study, it helps to determine the volumes of masses, gallstones, congenital renal anomalies, bladder masses and diverticuli. It can also be used in breast imaging to evaluate the tumor margins and its relation to ductal structures. The spatio-temporal image correlation technology is particularly useful in imaging the foetal heart.

Other Innovations

Ultrasound elasticity imaging is another new innovation useful for imaging nearly every tissue. Studies have shown that in breast imaging this can enhance the specificity for cancer detection. Elastography can also be used to image lesions in the thyroid, prostate, pancreas and lymph nodes.

The introduction of intra-operative transducers has led to the use of ultrasound in diagnosing liver metastases or pancreatic masses during surgery. It also provides valuable information of the relationship of the tumour to the portal and hepatic veins, thus being helpful in planning the surgery. It is also used in liver transplant to map the hepatic veins in the donor and to evaluate the hepatic artery graft in the recipient.

Ultrasound guided interventions like guidance for drainage, FNA, biopsy and pigtail catheter insertions can be performed. Recently, ultrasound has also been used to assist radiofrequency ablation of tumors. The therapeutic effects of ultrasound have been used to treat an injured joint or muscle tissue. High-intensity focused ultrasound is now used to heat and destroy pathogenic tissue. It is being used to treat uterine fibroids and prostate cancers.

Today, ultrasound is a sophisticated computer integrated tool. Its use has extended from obstetrics, as in the early days, to image almost every organ system of the body resolving structures down to couple of millimeters in size. Additionally, it has the advantages of involving no ionising radiation, has no known side effects, is readily available, relatively cheap, non invasive and portable.

With the ongoing improvements in ultrasound technology and software development, the applications of ultrasound will keep expanding.