Sonography: "Unfortunately, hospitals are not being required to train well"

Interview with Prof. Christian Arning, Representative of Continuing Education, German Society for Ultrasound in Medicine (DEGUM)

Prenatal care, cancer check-up, vascular examinations - sonography is versatile, provides reliable imaging to physicians and does not tax patients with radiation. It is comprehensively available, from doctor’s office to university medical center. A sound continuing education of sonography users is essential for good diagnostics, also since different devices have different strong points.


Photo: Prof. Christian Arning

Prof. Christian Arning; ©Asklepios Kliniken Hamburg GmbH

Prof. Christian Arning is Representative of Continuing Education at the German Society for Ultrasound in Medicine (DEGUM). At he talks about the quality of diagnostic sonography and the possibility for physicians and hospital departments, who train physicians in the use sonography, to receive DEGUM certification.

Prof. Arning, in the past, the DEGUM criticized the quality of diagnostic sonography in medical facilities. How does poor quality reveal itself in this instance?

Prof. Christian Arning: Diagnostic sonography or ultrasonography is a particularly difficult examination. Physicians need to be very experienced and well trained in this area. Without it, diagnostic findings can easily turn out uncertain or even wrong. If a misdiagnosis is made, it can result in the wrong indications for surgery. The patient could then potentially have surgery for no reason whatsoever.

Ultrasonography is also the method that puts the least amount of strain on patients. Neurologists for instance use ultrasound to examine cervical arteries to prevent strokes. Arteriosclerosis, which causes strokes, can be seen perfectly by using ultrasound. This is why in an interdisciplinary guideline, ultrasound is suggested as the number one diagnostic method, but only when an experienced examiner is available. If this is not the case, you have to fall back on computed tomography for example, which exposes the patient to radiation however, or magnetic resonance imaging, which requires an extended stay in a tight tube. Some patients perceive this as very stressful.

How does DEGUM address this flaw?

Arning: We define quality standards, perform quality inspections and grant certificates for individuals as well as entire departments. DEGUM grants physicians certificates in three levels. Level I is awarded for the basic qualifications of examiners, Level II is for advanced qualifications for instructors and Level III is the highest qualification for colleagues, who also work in a scientific capacity in the ultrasound field.

For a hospital department to become certified, management as well as the junior doctors representative need to confirm that training takes place through a DEGUM certified instructor. This way we can ensure that the department has a certified expert available and responsible for the training.
Photo: Collage of ultrasound pictures; Copyright:

Sonography provides images with a good resolution and does not expose the pa-
tient to radiation. But only training and experience make a good diagnosis possible; © koi88

How exactly can a physician become certified?

Arning: Any doctor, who performed a specific number of examinations and takes an exam, can obtain the Level I Certificate. Level II requires that a person has worked or observed in the department of a highly qualified ultrasound expert. Level III also requires additional research experience in the ultrasound field. This includes proof of scientific research and lectures, which is then verified by a committee. A trial presentation is also a part of the qualification process.

Does a certified department carry a visible reputation for a hospital?

Arning: DEGUM's web page releases both certified physicians as well as departments in a list. In addition, departments offering certified training are more likely to obtain good employees. Young physicians today also choose positions based on the right quality of education.

DEGUM and the German Electrical and Electronic Manufacturers Association (ZVEI) created the "Ultrasound Quality Initiative", in which employees from equipment manufacturers participate in DEGUM classes. Why is that?

Arning: Good equipment is also necessary for qualified ultrasound examinations. However, not all equipment is equally well suited for every examination. The industry is committed to quality and suggested on its own accord that their application specialists, who ultimately sell these devices, should receive great training. They participate in the classes and observe in medical practices or hospital facilities, so they are well schooled in the practical applications and are able to recommend the right device to physicians. Within the scope of the Initiative, they learn which device is best suited for which doctor and which application.

How can ultrasound training be advanced in your opinion?

Arning: Unfortunately, hospitals are not being required to train well. This is the main problem in my opinion. Even though doctors in almost all clinical subjects need to be trained in ultrasonography according to the Regulation of Continuing Education in Medicine, there are many departments where training is done poorly or not at all, but is nevertheless being certified. There are many misnomers out there. It would be preferable that medical associations pay attention to this problem and check whether professional training has actually taken place. First, they would need to assert the instructor's qualifications and secondly, find out which qualifications the physician has obtained by the end of the advanced training. This is why ultrasound should also potentially be a part of the physician board certification.
Photo: Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.