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AJR mlockhart{at}uabmc.edu
"Improved emphasis on sonography-related issues will likely help radiology turn the tide and maintain its role in sonography for the foreseeable future. I hope that we are riding the wave at that time and not standing on the beach watching."
In this issue, there are two interesting articles addressing the diagnostic usefulness of sono graphy techniques within the abdomen and pelvis. Kim et al. [1] show the value of sonography to detect hepatic con gestion after living donor modified right lobe hepatic transplantation. In this prospective evaluation, sonography was able to non invasively identify hepatic venous congestion by identification of abnormal Doppler flow in middle hepatic vein tributaries. In another study, Ghate et al. [2] compare 2D and 3D findings in sono hystero graphy. In this retrospective evaluation, the addition of 3D did not add value to the detection of en dometrial abnormalities but improved visual ization of the contour of the uterine fundus. Each of these studies highlights the continued research and innovation that is occurring within sonography. However, I am concerned that future research in sonography may not take place within our specialty.
For more than 30 years, radiologists have played a central role in advancing the art and science of diagnostic sonography. As the medical community's acceptance of sonography services grew during the 1970s and 1980s, new clinical sonography laboratories were often sited in radiology departments, where they were in proximity to radiographic, fluoroscopic, and CT suites and the radiologists who used them. Pioneering radiologists were prominent in innovation and expansion of the rapidly developing field, performing basic and clinical research, writing sonography textbooks, and educating residents and fellows.
During subsequent decades, however, radiology began to shift to a practice model in which radiologists focused on organ systems rather than imaging techniques. CT and sonography fellowships, which had enjoyed considerable popularity, were subsumed by fellowships in which sonography was but one of many components. Nevertheless, sonography remained a distinct entity in most academic radiology departments, and sonography facilities were typically staffed by a small cadre of radiologists who were recognized as experts in clinical sonography. Sonography also continued to have its own section on the American Board of Radiology's oral examinations.
Unfortunately, recent developments have begun to seriously erode sonography's place in radiology. The restructuring of conference sessions toward an organ-based focus has led to a decrease in visibility of radiologic sonographic research, with potentially a decline in interest from fledgling researchers. The pro gressive deemphasis of sonography in resi dency and fellowship training has resulted in fewer practicing radiologists who truly em brace sonography and are willing to push its limits clinically and teach the next generation of sonographic radiologists.
At a time when other specialties are focusing efforts to improve their presence in sonography, many in radiology do not seem to perceive the need. On a personal note, as other specialties require additional training of their residents in sonography, the time spent in sonography in my own department has decreased by nearly 50%. A few years ago, the residents would have resisted such a change as their anxiety when preparing to perform sonographic procedures during the night increased before those first fearful nights of imaging call. This is yet another motivation that we have removed to ease the workload of the residents (who truly are worked very hard) with implementation of 24-hour non-physician sonographer coverage.
The rapid pace of technological advances has further contributed to the trend by making high-resolution sonographic equipment widely available to a range of medical specialists and generalists who compete with radiology. Often, nonradiologists who incorporate sonography into their workflow perform sonography them selves, compared with radi ology practices, in which sonographers are the norm. Sadly, the number of radiologists who know how to scan well and frequently routinely rescan to check the sonographer's findings when needed continues to fall. In fact, this has been used as ammunition for further erosion of the traditional radiologist's sonographic services. Despite the probable lessening of scanning skills in the typical radiology resident with respect to the past, they are still exposed to thousands of sonograms during their residency. Residents scan many more organ systems, vessels, and areas of the body than most if not all of the other disciplines during their training. This breadth of scanning and exposure still provides a vastly more comprehensive exposure to the discipline than any other.
The erosion of radiology's leadership in sonography also has had adverse consequences for patients. Although other clinicians often claim that they are better able to compare sonographic findings with a patient's physical examination and laboratory values, radiologists are more adept at correlating sonograms with other imaging tests, which is often critical in arriving at a correct diagnosis.
Subspecialty radiologic sonography organizations have strived to enhance the visibility of radiologists in clinical sonography and sonographic research. At these meetings, it is good to hear discussions about encour agement of young radiologists in the practice of sonography and maintenance of high standards in sono graphic practice. The future of sono graphy will be in the training of young investigators and the development of junior faculty who have a love of the practice of sonography. However, they will not be successful unless the radiology community makes a concerted effort to maintain our specialty's preeminent role in sonography through several initiatives:
Improved emphasis on sonography-related issues will likely help radiology turn the tide and maintain its role in sonography for the foreseeable future. I hope that we are riding the wave at that time and not standing on the beach watching.
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  P. M. Huisman Radiology and the Future of Sonography Am. J. Roentgenol., October 1, 2008; 191(4): W195 - W195. [Full Text] [PDF]
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 P S SIDHU The EFSUMB guidelines for contrast-enhanced ultrasound are comprehensive and informative for good clinical practice: will radiologists take the lead? Br. J. Radiol., July 1, 2008; 81(967): 524 - 525. [Full Text] [PDF]
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