Training Guidelines for Licensed Medical Providers Who Perform and Interpret Ultrasound-Guided Procedures

In order to meet this training guideline, the individual must be a licensed medical provider and perform and report ultrasound-guided procedures. They must have a thorough understanding of the indications and guidelines for the relevant ultrasound procedure as well as familiarity with the basic physical principles and limitations of the technology of ultrasound imaging. They should be familiar with alternative and complementary imaging and diagnostic procedures and should be capable of correlating the results of these other procedures with the ultrasound findings. They should have an understanding of ultrasound technology and instrumentation, ultrasound power output, equipment calibration, and patient and operator safety. Practitioners responsible for ultrasound examinations and/or ultrasound-guided procedures should be able to demonstrate familiarity with the anatomy, physiology, and pathophysiology of those organs or anatomic areas that are being examined. Performance and reporting of most ultrasound-guided procedures require advanced skills and knowledge. The training should include methods of documentation and reporting of ultrasound studies. Only those that meet these training requirements can request to be part of an ultrasound practice accreditation application.

Practitioners performing ultrasound-guided (USG) procedures must meet ONE of the following:

1. Have met the Training Guidelines for Physicians Who Perform and/or Interpret Diagnostic Ultrasound Examinations as well as have been involved in a minimum of 50 ultrasound-guided procedures within the previous 36 months. If completion of training was more than 36 months ago, an additional 5 AMA PRA Category 1 Credits™ or AOA Category 1-A credits related to ultrasound guidance are required.

2. Completion of an ACGME-accredited residency and/or GME fellowship program (or international equivalent) that included training in ultrasound-guided procedures under the supervision of a physician(s) who meets this training guideline. If completion of competency was more than 36 months ago, an additional 50 ultrasound-guided interventional procedures AND an additional 5 AMA PRA Category 1 Credits™ or AOA Category 1-A credits related to ultrasound guidance are required. 

3. Completion of an ACGME residency and/or GME fellowship program (or international equivalent) without training in ultrasound-guided procedures but have been involved in the performance and reporting of a minimum of 50 ultrasound-guided procedures under the supervision of a physician(s)* within the previous 36 months AND deemed to be competent to perform ultrasound-guided procedures by the chair of the department or section chief (or equivalent) who meets this training guideline, by written attestation. If completion of this training was more than 36 months ago, evidence of at least 30 AMA PRA Category 1 Credits™ dedicated to the ultrasound examination specific to their specialty that they perform, including didactic education in diagnostic ultrasound, is required within the previous 36 months. 

4. Physician Associates and Nurse Practitioners must meet the Training Guidelines for Licensed Medical Providers (PA, NP, CNM/CM, DPT, and DC) Who Perform and/or Interpret Diagnostic Ultrasound Examinations as defined. They must show evidence of being involved in the performance and reporting of at least 50 ultrasound-guided interventional procedures within the previous 36 months, under the supervision of a physician(s)* AND be deemed to be competent to perform ultrasound-guided procedures by the chair of the department or section chief (or equivalent) who meets this training guideline, by written attestation. A physician who meets these training guidelines should be available for supervisory consultation in an appropriate clinical time frame (unless not required by local/regional standard). If completion of this training was more than 36 months ago, evidence of at least 30 AMA PRA Category 1 Credits™ dedicated to the ultrasound examination specific to their specialty that they perform, including didactic education in diagnostic ultrasound, is required. 

5. Radiologist Assistants (identified as either RRAs and/or RPAs) must be registered by the American Registry of Radiologic Technologists (ARRT) and any performed procedures are required to be supervised by a radiologist as part of a radiologist-led team. The entry-level clinical activities document by the ARRT states, RRAs do not perform interpretations (preliminary, final, or otherwise) of any radiological examination. The RRA may make and communicate initial observations only to the supervising radiologist.

*Methods of supervision when training in ultrasound.

When trainees are learning ultrasound, the supervising interpreting practitioner must review, discuss, and confirm the diagnosis of all examinations performed and/or interpreted. The supervisor does not have to be present at the time of the initial interpretation; however, the examinations must be under the supervision of or with support from (direct or via telemedicine) a practitioner who meets the AIUM training guidelines and the supervisor must review and, if necessary, correct the interpretation of the trainee.

Maintenance of Competence in Ultrasound is required once training is complete.