Soundeffects News: Sonography Research Special Edition

OCTOBER 2022

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SONOGRAPHY RESEARCH SPECIAL EDITION

In this issue

03 05 08 14 15 17 18 20 22 24

Message from the CEO I nterview with Afrooz Najafzadeh, Research Special Interest Group Chair ASA Sonographers Employment and Salary Report The Impact of COVID-19 on Australasian Sonographers

Interview with Jessie Childs Sonographer Code of Conduct

Interview with Jacqueline Roots, ASA Research Grant Recipient 2021

Interview with Assema Lalzad, ASA Research Grant Co-Recipient 2020 I nterview with Bernadette Dellar, ASA Research Grant Co-Recipient 2020

Evaluation of sonographer administered ultrasoundguided musculoskeletal injections

ASK AN EXPERT Have a clinical question? Ask our Special Interest Groups!

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SONOGRAPHY RESEARCH SPECIAL EDITION

Message from the CEO

T

he ASA is committed to driving the quality and standards of sonography. As part of that commitment, we develop and publish guidelines, clinical statements and position statements with recommendations which can be accessed through our website. Our international peer reviewed journal Sonography publishes articles which may include original research, re-analyses of research, reviews of literature in a specific area, proposals of new but untested theories, or opinion pieces on a quarterly basis, and Making Waves, our concise resource, helps you keep up with what is going on in sonography research.

It is important for the standing of the profession that we continue to support and invest in research which assists in progressing and strengthening the profession, and this special edition of Sound Effects on sonography research demonstrates the important role of research and highlights the research areas the ASA has invested in.

I hope you enjoy reading the ASA Sonographers Employment and Salary Report, as well as the Impact of COVID-19 on Australasian Sonographers, and the updates on the amazing work our research grant recipients are undertaking.

The ASA will continue to invest in sonography research, and we are currently commissioning research on scan times, looking at whether ultrasound examination times correlate with quality outcomes. The first report of this research is expected by the end of 2023.

I also encourage you to consider writing an article for the journal, presenting an abstract at the conference, or undertaking case studies or research of your own to increase the visibility and credibility of the sonography profession.

The ASA has a variety of resources available on our website sonographers.org

Jodie Long CEO Australasian Sonographers Association

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CALL FOR ASA2023 BRISBANE

Do you have an original research project, case study, new or improved clinical technique, or educational presentation?

Submit an abstract for presentation at the ASA2023 Brisbane International Conference.

SUBMIT HERE

SONOGRAPHY RESEARCH SPECIAL EDITION

Research Afrooz Najafzadeh Research Special Interest Group Chair

In the first of many interviews with some of our members in sonography research, we started with the Chair of our Research Special Interest Group, Afrooz Najafzadeh. We asked Afrooz why research is so important to the sonography profession, how sonographers at any level can get involved in research, and what are some of the areas of interest in research right now for sonography.

career. The competency framework expects sonographers to know the correct steps in the research pathway, which include and are not limited to:

Why is research important in ultrasound?

n c ritical thinking: questioning, analysing, synthesising, interpreting

The Australian healthcare system prides itself on basing all their decision-making and policies on evidence-based best practice.

The evidence is based on the findings and recommendations of credible resources such as peer reviewed research output in Australia and overseas. The AIUM, ASUM, BMUS and ASA guidelines and mission statements would not have been credible and reliable if they weren’t based on critical evaluation of the available research literature.

Research brings about new discoveries and opens the world to new possibilities. Research is now an integral part of Australian education and is now taught as early as primary school. Research is encouraged from the early years of education and is embedded in the Australian secondary and tertiary teaching curricula.

Conducting higher degree research is strongly encouraged by all Australian universities and other tertiary education providers. There are financial incentives for both students and education providers in Australia to engage in higher degree research and increase the Australian universities’ research output.

Why would a sonographer choose to take on a research project?

As well as all the above reasons, the ‘Professional Competency Framework for Sonographers’ document(1), which was published in October 2021, has specifically stated research as an essential part of sonography education in Australia. A key component of competency frameworks is the idea of observable behaviours.

These describe behaviours that evidence the ability to effectively perform the tasks which are underpinned by knowledge, skills and attitudes. The document states ‘Lifelong learner’ as a desired attribute for sonographers.(2–3) Sonographers are encouraged to actively pursue new knowledge and continue their professional development throughout their

‘best available research evidence: information from valid and clinically relevant research conducted using sound quantitative or qualitative methodology, n c ritical appraisal: the assessment of information for its adequacy to address requirements

n c ognitive reasoning and critical appraisal of literature and evidence n r eflective thinking: self-reflection during and after a clinical challenge or experience n s tructured and informal reflection to review and integrate knowledge and findings into practice and identify any limitations or risks to practices.’

What would you say when people think research is too much to undertake?

Taking the first step is always the hardest. Conducting research should not be limited to a select few senior sonographers or be exclusively for those working in teaching hospitals with good resources and infrastructure for research. Sonographers at any level of experience have the potential to conduct research if they wish to. This does not have to be a huge undertaking such as enrolling in a higher degree course at a university or coordinating a large project.

Sonographers can take small steps towards a research activity by – for example, conducting an audit of one aspect of their practice or simply following up on an interesting clinical case. Holding in-house discussion of interesting clinical cases with colleagues is counted as a research activity. Reading up about any interesting findings and writing a paragraph or two about the case can be the first step towards writing a clinical case study. The topic of research need not be on a technical aspect of sonography. Writing can be a reflection on the day’s events, on an idea brought on after a conversation with a patient or expressing your feelings after a challenging communication or a thought-provoking discussion with a colleague.

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SONOGRAPHY RESEARCH SPECIAL EDITION

Afrooz Najafzadeh (continued)

Why do a PhD or Master by research? n T o add an academic qualification to one’s research activity n T o enable better collaboration, supervision and mentorship n T o improve on research resources n T o help work towards a goal n T o be guided by experts n T o share the research findings and have credible research output n T o benefit the wider community n T o increase sonographer-led research output n T o enable future employment as an academic.

How can we, as a profession, encourage more research undertakings? n C ontinue the ASA Research Grant for funding sonographer-led research n F acilitate research and writing workshops at national and international conferences n E ncourage sonographers to connect with the ASA Education Advisory Committee (EAC) and the ASA Special Interest Groups (SIGs) via the new ‘ask the expert’ platform to seek guidance with their research ideas n E ncourage employers to provide support for their employees seeking further education and research n F acilitate various platforms (online and face to face), such as seminars, webinars, study days, workshops, etc., to enable sonographers to share research ideas and activities and communicate any preliminary research findings n S upport sonographers to disseminate their research activities via the ASA or the ASAR online platforms by allowing them to reach the wider membership (post their surveys to membership, promote and advertise their research, contact potential volunteers for study, invite collaboration, etc.).

What are the current challenges in the research field?

Sonographers are highly skilled and hard-working allied health professionals who often work under challenging conditions imposed by chronic workforce shortages. This, as well as a lack of funding and absence of direction and research leadership at the workplace, have discouraged many capable sonographers from taking on further education and research. Inflexible working conditions, increased workload, and the recent challenges brought by a worldwide pandemic have worsened sonographers working conditions and further impeded sonographers seeking further studies and conducting research.

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What are some of the interesting areas of ultrasound research right now?

This depends on the researcher’s interests and their area of expertise. Any area that they feel there’s a gap in knowledge or that requires improvement can be used to develop a research question.

All subspecialties of medical ultrasound, being MSK or paediatric sonography, can benefit from further research. The professional aspect of sonography, such as sonography regulation in Australia, sonographers’ autonomy or their working conditions can make good topics for research. Machine learning and artificial intelligence (AI) are rapidly finding their place in various modalities of medical imaging, including ultrasound. I believe AI can vastly improve sonographers’ future work practices and will no doubt aid in the diagnosis of disease. This is still in its infancy and has great potential for being a subject for ongoing research.

If there is a sonographer out there now who has an interest in research, what steps should they take to start on their journey?

They must ensure that they’re adequately supported both at home and work before they embark on their research journey. Having the right work and homelife balance is essential before sonographers can take on any extra education or conduct any research.

Research is not possible without collaboration. Sonographers must talk to as many people as possible about their research ideas or enquire about the research ideas of others. This conversation can start from home and continue into the workplace. Sonographers must find out if there is any support available from their employers or if there is an existing research team that they can collaborate with. Conducting research does not have to start at a university.

There are many research projects currently underway with various radiology service providers (public and private). Interested sonographers should actively seek out these opportunities and start the conversation. This will help them to develop their research ideas and formulate their research question(s).

Interested sonographers are advised to seek guidance from the EAC or SIGs by using the new ‘Ask the Expert’ platform on the ASA website.

(1) https://eprints.qut.edu.au/227162/1/Professional_Competency_Framework_ for_Sonographers.pdf (2) Edwards C, Thoirs K, Osborne B, Slade D, McDonald S, Lombardo P, et al.

Australian sonographer competency – A new framework. Sonography.

2022;9(3): 108 – 115. https://doi.org/10.1002/sono.12309 (3) Childs J, Thoirs K, Quinton A, Osborne B, Edwards C, Stoodley P, Lombardo P, Mcdonald S, Slade D, Chandler A, Taylor L, Long J, Pollard K, Halligan T. Development of a professional competency framework for Australian sonographers – perspectives for developing competencies using a Delphi methodology. Int J Qual Health Care. 2022 Apr 12;34(2).

SONOGRAPHY RESEARCH SPECIAL EDITION

POSTERS + WORKSHEETS LATEST POSTERS A vital part of the ASA’s dedication Paediatric Bowel Pathology Stretching in the workplace

to promoting best practice in medical sonography involves producing and providing resources to guide sonographers in their work.

Endovascular Aortic Repair (EVAR)

View the latest posters

LATEST WORKSHEETS Paediatric renal ultrasound

Paediatric spine ultrasound

Paediatric pylorus ultrasound

Paediatric cranial worksheet

View the latest worksheets soundeffects news

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ASA Sonographers Employment and Salary Report

I

n November 2021, 1,153 sonographers from Australia and New Zealand took part in the ASA Sonographers Employment and Salary Survey. The survey was the biggest inquiry of its kind for sonographers, and is important as it provides valuable benchmark data on Australasian sonographer workforce conditions, as well as a snapshot of what is currently happening in our profession. The findings below were compiled by Survey Matters on behalf of the ASA from the responses to the survey.

Overall, the trend of increasing employment of sonographers in private practice continued in 2021, with 76% working in private practice in Australia and 70% in NZ.

SONOGRAPHERS’ AREA OF PRACTICE AND WORK ROLES Area of Practice, 2021 GENERAL

RESPONDENT PROFILE

% 66% 69

79%

21%

FEMALE

OBSTETRICS & GYNAECOLOGY

12% 12%

11% 11%

OTHER

VASCULAR

6%

%

4

6%

4%

2019

2021

2019

2021

66%

34% RURAL & REMOTE

Most respondents work in general ultrasound, with a small proportion working in specialist fields.

60%

8%

Locations sonographers work across

METROPOLITAN

HAVE PRIOR EXPERIENCE AS A RADIOGRAPHER

MASTER’S OR PHD

SONOGRAPHERS’ PRIMARY PLACE OF EMPLOYMENT

PRIVATE PRACTICE

PRIVATE PRACTICE IN A PRIVATE HOSPITAL

12 2021

2021

2019

2021

2019

2021

WORK LOCATION

AUSTRALIA

NEW ZEALAND

2019

2021

2019

2021

In multiple locations for the same employer

45%

41%

49%

46%

In one specific location for the same employer

39%

43%

37%

37%

In different locations for different employers

15%

16%

14%

15%

WORKFORCE COMPOSITION

60% 56%

2019

Fewer sonographers are moving across workplaces for their employer, with more working from a single location than in 2019.

Primary Place of Employment 2019 & 2021

2019

CARDIAC

MALE

%

2019

12

%

2021

PRIVATE RADIOLOGY PRACTICE IN A PUBLIC HOSPITAL

4%

4%

2019

2021

Overall Workforce Composition, 2010 to 2021

PUBLIC HOSPITAL/ DEPARTMENT

60%

25%

22%

2019

2021

OTHER

47%

50%

3%

2%

40%

2019

2021

30%

46%

53% 40%

20%

WORK LOCATION

AUSTRALIA

NEW ZEALAND

2019

2021

2019

2021

Private practice

55%

60%

66%

60%

Private practice in a private hospital

12%

12%

8%

9%

Private Radiology practice in a public hospital Public hospital/department Other

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5%

4%

1%

1%

25%

22%

24%

30%

3%

2%

2%

0%

10% 0% 2010

2011

2012

2014

2017

7%

2019

7%

2021

n Full-time n Part-time n Casual/Locum

The shift towards part-time employment gathered momentum in 2021, with the proportion of sonographers that work part time eclipsing those working full time for the first time.

SONOGRAPHY RESEARCH SPECIAL EDITION

The shift towards part-time employment gathered momentum in 2021, with the proportion of sonographers that work part time eclipsing those working full-time for the first time.

In 2021, more than half (53%) of sonographers indicated they worked part time, with similar percentages across Australia (53%) and New Zealand (54%). The total proportion was up from 47% in 2019, with a continual upward trend since 2010.

Reflecting the trend towards part-time employment, sonographers worked an average of 29.9 hours per week in 2021, down from 31 hours in 2019.

In contrast, the proportion of sonographers working full time declined from 46% in 2019, and over 50% in 2010, to 40% in 2021.

In Australia, this 2021 figure was 40%, while the New Zealand figure was higher at 45%.

Sonographers working in public hospitals reported the biggest decline in working hours, down from 31.8 hours in 2019 to 30.2 hours in 2021. This remains higher than private practice-based sonographers who worked an average of 29.8 hours per week in 2021, down from 31.1 hours in 2019.

The proportion of sonographers working on a casual basis, or as a locum, remained stable across these years at almost 7% in both 2021 and 2019, although there has been a general downward trend over the past decade. This percentage for New Zealand was only 1.1% in 2021 (7% for Australia).

Non-cardiac sonographers worked longer hours on average than cardiac sonographers. This group reported an average weekly workload of 30.1 hours per week, compared to 28.6 hours for cardiac sonographers.

There was no significant difference across Australia, with the proportion of sonographers employed on a part-time basis increasing in all states of Australia.

While more non-cardiac sonographers reported working on a part-time basis in 2021, there was a big jump in casual work among cardiac sonographers.

The proportion of cardiac sonographers working part time remained relatively stable in 2021 at 43%, while casual positions increased to 19% in 2021, up from 15% in 2019.

On average, sonographers in New Zealand worked longer hours than their Australian counterparts, at 31.1 hours on average per week. Australian-based sonographers worked an average of 29.8 hours per week. Sonographers in New South Wales (28.8) worked significantly fewer hours on average per week than those based in Queensland (31.1) or Victoria (30.1).

Secondary Roles One in five (21%) respondent sonographers have a secondary sonographer role in 2021, almost unchanged from 24% in 2019.

Average Hours Worked per Week PUBLIC HOSPITAL Average Hours Worked per Week

PRIVATE PRACTICE

NON-CARDIAC

CARDIAC

2019

2021

2019

2021

2019

2021

2019

2021

31.8

30.2

31.1

29.8

31.1

30.1

-

28.6

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SONOGRAPHY RESEARCH SPECIAL EDITION

ASA Sonographers Employment and Salary Report (continued)

SONOGRAPHER PRODUCTIVITY

‘Seven out of ten sonographers are satisfied with the amount of time they are allocated to perform each scan.’

Average Number of Scans per Day 15.7

11.9

PRIVATE HOSPITAL

PUBLIC HOSPITAL

7.3

PUBLIC HOSPITAL

Non-Cardiac Sonographers

10.1

PRIVATE HOSPITAL

Cardiac Sonographers

NON-CARDIAC

The average number of scans performed per day by a non-cardiac sonographer in a private practice was 15.7 in 2021 (up from 15.3 in 2019), with an allocated scan time of approximately 28 minutes.

This compares with a public hospital, where the average was 11.9 scans per day (down from 12.8 in 2019), with an average allocated scan time of 31 minutes.

For cardiac sonographers, the average number of scans per day in a private practice was 10.1 in 2021 (down from 10.3 in 2019), with an average time allocated per scan at about 40 minutes. This compares with public hospitals where the average number of patients scanned per day was 7.3 in 2021 (7.7 in 2019), with an average allocated scan time of around 47 minutes.

It should be noted that public hospitals generally have more complex scans to perform.

Average Time Allocated per Scan (Minutes) 47.4

PUBLIC HOSPITAL

31.3

PUBLIC HOSPITAL

28

% Satisfied with Time per Scan

PRIVATE PRACTICE

PUBLIC HOSPITAL

PRIVATE PRACTICE

2019

2021

2019

2021

2019

2021

2019

2021

82%

82%

70%

66%

84%

69%

61%

75%

WORK DUTIES DISTRIBUTION Percentage of Time Spent on Work Duties, 2010 to 2021 78%

77%

80% 70% 60% 50% 40% 30%

40.2

PRIVATE HOSPITAL

20%

2010

Cardiac Sonographers

9%

10%

10% 0%

PRIVATE HOSPITAL

Non-Cardiac Sonographers

PUBLIC HOSPITAL

CARDIAC

2011

2012

2014

2017

4%

4%

2019

2021

n Sonographic services, including administration n Clinical supervision & training n Management or administrative tasks

SONOGRAPHER SATISFACTION WITH SCAN TIME

More time has been allocated to core sonographic services over the last decade, at the expense of time dedicated to supervision and training.

Overall, seven out of 10 (70%) respondent sonographers indicated that they were satisfied with their time allocation per scan in 2021, unchanged from 2019. In Australia, 69% of sonographers were satisfied, compared with 80% in New Zealand.

Percentage of Time Spent on Work Duties, by Employer

At 82%, non-cardiac sonographers in public hospitals have the highest satisfaction with the time allocated for their scans. This percentage was unchanged from 2019.

However, non-cardiac sonographers in private practice have seen a drop in satisfaction from 70% to 66%.

Down from 84% in 2019, only 69% of cardiac sonographers working in public hospitals were satisfied with time allocated per scan in 2021. This follows a fall in the average time allocated from 49.1 minutes per scan in 2019 to 47.4 minutes per scan in 2021.

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Public Hospitals

70%

12% 5% 2% 8% 3%

Private Practices

81%

9% 3% 1

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

4% 1%

100%

n Sonographic services, including administration n Clinical supervision & training n Management or administrative tasks n Delivery of sonographic education n Non-ultrasound imaging n Other non-scanning duties

SONOGRAPHY RESEARCH SPECIAL EDITION

Sonographers in private practice tend to spend more time on sonographic services and related administrative tasks than those in public hospitals.

‘Overtime hours fell in 2021, down to an average of 2.9 hours per week.’

OVERTIME Proportion of Sonographers Working Overtime, 2017-2021

PAY ARRANGEMENTS Pay Arrangements, 2010 to 2021

100%

100%

80%

80%

58%

60%

50%

2019

13%

12%

40%

20% 2017

85%

60%

47%

40%

84%

20%

2021

0%

The trend of fewer sonographers working overtime each week continued in 2021, with the exception of cardiac sonographers who reported working more overtime hours than in 2019.

Australian sonographers are more likely to work overtime than those in New Zealand.

Public Hospitals

48%

19%

10%

n Hourly Rate

2011

2012

n Annual Salary

2014

2017

3%

3%

2019

2021

n Per Scan

The practice of sonographers being remunerated by the hour continued in 2021, with over four in five sonographers paid on an hourly rate basis.

Overtime Payment Method 10%

2010

12% 1%

The numbers of those paid per scan was consistent at 3% in 2021. The percentage paid per scan is 4% in Australia, and 1% in New Zealand.

Private Practices

23%

38% 6%

12%

19% 3

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n Standard hourly rate n Time and a half n Double time n Time in lieu n Other n Not compensated for overtime

SONOGRAPHER WAGES Average Hourly Rate, 2010 to 2021 $70 $ $

Almost one in five sonographers in private practice are still not compensated for working overtime.

$60

In New Zealand, 43% of respondents indicated they were paid their standard hourly rate for working overtime in 2021, compared with only 18% in Australia. Further, 34% of New Zealand sonographers were paid time and a half for overtime, with Australia-based sonographers at 40%.

$50

58.40

$ $

50.80

$

While 18% of sonographers in Australia were not compensated for working overtime, this figure was 9% in New Zealand.

62.80

62.00

2010

50.50

$

2011

56.70

52.50

$

2012

2014

2017

2019

2021

Sonographers hourly rate increased 2.3% in 2021, continuing the upward growth.

This hourly pay rate rise continued a steady growth trend from 2012, with a $14.30 an hour increase seen since 2011. This rise represented an overall increase of 28.3%, or an annualised growth rate of 2.3% to an average of $64.80.

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SONOGRAPHY RESEARCH SPECIAL EDITION

ASA Sonographers Employment and Salary Report (continued)

AUSTRALIA

Rate per hour

CPD SUPPORT

NEW ZEALAND

2019

2021

2019

2021

$62.00

$65.10

$61.60

$61.10

NON-CARDIAC SONOGRAPHERS PUBLIC HOSPITALS

While sonographer pay rates increased in Australia, those working in New Zealand saw their hourly rate fall.

NON-CARDIAC SONOGRAPHERS Average Payment Rate per Hour

CARDIAC SONOGRAPHERS

Private Practice

Public Hospitals

All Employers

Minimum

$39.00

$24.00

$30.00

Mean

$63.40

$65.70

$59.20

$130.00

$140.00

$86.00

Maximum

There is a clear correlation between experience as a sonographer and remuneration, with an upward trend in sonographer hourly rates as experience rises to 15 years.

Paid in full

Partially paid

PRIVATE PRACTICE

Taken in 2021

Paid in full

Partially paid

Taken in 2021

Conference leave

61%

20%

25%

26%

23%

18%

Support to present at conferences

27%

20%

5%

14%

17%

8%

National conference registration fee

24%

32%

30%

22%

38%

29%

Attendance at a local professional development

20%

22%

19%

16%

28%

30%

National conference travel & accommodation

19%

25%

7%

11%

31%

11%

Attendance at international professional development

11%

21%

10%

8%

26%

9%

PERFORMANCE BONUS One in five sonographers receive a performance-based bonus; however, it is much more common in Australia than in New Zealand.

Sonographer Bonus Amount, 2021

‘COVID-19 impacted sonographers’ ability to use CPD supports provided by employers.’

25% 17%

17% 11%

10%

CARDIAC SONOGRAPHERS PUBLIC HOSPITALS

13% 8%

Paid in full

Partially paid

PRIVATE PRACTICE

Taken in 2021

Paid in full

Partially paid

Taken in 2021

Conference leave

57%

14%

12%

24%

14%

11%

Support to present at conferences

20%

23%

0%

14%

4%

18%

The average bonus amount among sonographers that received a bonus in 2021 was $9,475, with nearly all of those receiving a bonus working in private practice.

National conference registration fee

20%

26%

13%

14%

21%

21%

Attendance at a local professional development

17%

17%

0%

11%

14%

29%

How performance bonuses are calculated

National conference travel & accommodation

6%

26%

18%

10%

15%

8%

Attendance at international professional development

3%

23%

11%

5%

9%

8%

None

Less than $1,000

$1,000 to $2,000

$2,000 to $5,000

$5,000 to $10,000

$10,000 to $20,000

73%

10%

20%

30%

40%

50%

60%

70%

Over $20,000

12% 6%

80%

90%

3%

6%

100%

n Set number of scans personally n Overall business/department performance n Overall personal performance n Set number of scans per department n Other

Performance bonuses are largely based on sonographers achieving a set number of scans personally. For sonographers that received a performance-based bonus in 2021, more than seven out of 10 (73%) were based on achieving over a set number of scans personally. This is up significantly, from 63% in 2021.

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One-third (33%) of sonographers receive support for their CPD in the form of a direct monetary allowance in 2021, although on average, monetary CPD allowances were lower than in 2019.

Nearly two-thirds of sonographers say that stress levels have gone up at their workplace.

SONOGRAPHY RESEARCH SPECIAL EDITION

CLINICAL GUIDANCE GUIDELINES A vital part of the ASA’s dedication to promoting best

Intimate examinations, consent and chaperones ASA and ASUM joint Guidelines for

practice in medical

Reducing Injuries to all Ultrasound

sonography involves

Users

producing and

Vasa praevia diagnosis in the mid

providing clinical

trimester ultrasound

guidance and

A sonographer's guide to clinical

standards.

supervision

CLINICAL STATEMENTS Disinfection of intracavity ultrasound transducers Early Pregnancy Loss

READ HERE

Infection Prevention and Control Guidelines for Sonographers Safe use and storage of ultrasound gel Veins of the lower limb

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SONOGRAPHY RESEARCH SPECIAL EDITION

COVID-19 RESEARCH

‘What is the impact of COVID-19 on the Australasian sonographic community captured at three time points during the pandemic?’

Jessie Childs, Kathryn Lamb, Brooke Osborne, Sandhya Maranna, Adrian Esterman

T

he ASA is financially supporting the research project from the University of South Australia on the impact of COVID-19 on Australasian sonographers.

COVID-19 has significantly affected sonographers in a variety of ways. It is important for the sonography profession to capture how the pandemic influenced work hours, diversification of duties, incidences of cessation of certain scans, protocol changes and wellbeing. The findings could assist in the formation of future sonography guidelines and protocols.

Australasian sonographers and the ASA’s Sonography journal were recognised by the World Health Organisation (WHO) on the COVID-19 Global Literature on Coronavirus Disease Database.

The initial findings of this research are now available from the WHO website.

SURVEY ONE Survey One sought to capture data from the early months of the COVID-19 outbreak. Data was collected during May 2020, and the initial findings were presented at the ASA Virtual Conference 2020 and published in the Sonography journal on 28 May 2021.

Survey One found that scan numbers and sonographers’ work hours were affected by COVID-19. View the three publications produced from Survey One below: The initial impact of COVID-19 on Australasian Sonographers Part 1: Changes in scan numbers and sonographer work hours The initial impact of COVID-19 on Australasian sonographers Part 2: Changes to sonographic examination protocols and access to personal protective equipment The initial impact of COVID-19 on Australasian sonographers Part 3: Sonographer professional, personal, and social wellbeing

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SURVEY TWO Survey Two captured the interim impact of COVID-19 and found that there was a lull during this period. The research found workers’ hours returned to normal in most instances, personal protective equipment (PPE) supplies increased and most protocols returned to normal. Jessie Childs provided an update of findings from Survey Two in a webinar featured on the ASA website.

Watch the Webinar by Jessie Childs here

SURVEY THREE Survey Three captured the Delta outbreak and saw sonographers’ work hours largely unaffected, with PPE supplies staying at high levels. Sonographers reported that they felt safer overall, with the impact on practice being less severe than the initial COVID-19 outbreak. Significant changes were documented in sonographer wellbeing across the first three surveys. Findings suggest decreasing sonographer wellbeing levels, which prompted researchers to include additional questions to address sonographer wellbeing in the final survey.

SURVEY FOUR A fourth survey was added to the research project to capture the Omicron outbreak. This study aims to capture the protocol changes, impact on examinations, wellbeing of sonographers, and the status of ultrasound in Australasia at the time of the Omicron outbreak.

The results of Survey Three and Survey Four are yet to be published. •

SONOGRAPHY RESEARCH SPECIAL EDITION

RESEARCH Jessie Childs Research project: What is the impact of COVID-19 on the Australasian sonographic community captured at three time points during the pandemic?

J

essie Childs is no stranger to ASA members. Many sonographers in Australia and New Zealand participated in her research project on how sonographers have been impacted by COVID-19. This research was also recognised globally when the World Health Organisation (WHO) included it on the COVID-19 Global Literature on Coronavirus Disease Database.

So, it was no surprise when Jessie received the honour of ASA Researcher of the Year 2022, earlier this year. We interviewed Jessie about her current research project, the challenges she faced, and what she hopes to achieve through her research.

What has surprised you the most throughout this project?

What is your research project about? What methods are you using?

The amazing number of sonographers who have taken the time to respond to the surveys in what was/is such a tumultuous time. We are extremely thankful to every one of them.

The project was designed to capture the impact of COVID on Australasian sonographers via survey methodology. It was originally intended to capture the initial impact of COVID, the interim impact of COVID 3 months later, and the aftermath of COVID 6 months after that. COVID, however, hung around a little longer than we anticipated, so we ended up adding another survey and capturing the initial impact of COVID, the interim impact 3 months later, the impact of the Delta variant, and then the impact of the Omicron variant combined with a return to the new normal.

The methodology was surveys eliciting both qualitative and quantitative responses. Questions were around changes to work hours and protocol, access to PPE, wellbeing and vaccination.

What prompted you to undertake this research?

When COVID struck we thought it was important to capture its impact on Australasian sonographers to inform future policy and to document the journey of our profession through what was a unique event in history.

Can you explain some initial findings?

There are so many. The initial findings are written into three journal articles published in the Sonography journal. There were many who suffered a reduction in work hours and many protocol changes.

PPE access was varied, and the wellbeing of sonographers appeared to suffer.

Your research project is in multiple parts?

Why is that?

The project is in multiple parts to capture different time points throughout the pandemic and to document changes over time with respect to the impact the pandemic is having on sonographers.

If you are new to the research world, finding a good, experienced mentor would be a fabulous start.

Without pre-empting the results, what are you hoping to achieve?

A really good picture of the effect the pandemic has had on sonographers in terms of impact on work hours, impact on PPE access and safety, impact on wellbeing and changes to department protocols.

What (if any) challenges did you face, and how did you overcome them?

The pandemic continued for longer than we anticipated. We had to make some changes to our initial plan of only three surveys. We also had to face the huge amounts of data generated. The answer was to divide and conquer.

What did you gain from doing the research?

We have and will gain a great understanding of the impact of COVID on Australasian sonographers. Not only an understanding of how individuals were affected but also an understanding of the effects on different states, practice locations (that is, rural, metropolitan), types of practice (big, small, public, private) and different genders.

What advice would you give to a sonographer looking to undertake a research project?

If you are new to the research world, finding a good, experienced mentor would be a fabulous start. Often the best way to do this is to undertake an honour’s or master’s qualification so that you have an experienced supervisory team and access to an ethics committee. Make sure you plan well and trial any instrument (that is, survey) that you are going to use to ensure that the data you are getting answers your research questions. •

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POSITION STATEMENTS 2022 POSITION STATEMENTS Sex determination by ultrasound in the first trimester

ASA Position Statements provide the association's view on topics and issues relevant to sonographers,

Student sonographers paying

sonography practice, and members

for clinical training

of the public undergoing ultrasound

placements

scans. They are all available to view

Mitigating

from our website.

sonographer distractions in obstetric ultrasounds

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CODE OF CONDUCT

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arlier this year, the ASA proudly released a new Sonographer Code of Conduct, which underpins the practice of all sonographers and sets the benchmark for our professional standards.

The Code was commissioned by the ASA and reviewed and updated

by Uni SA, in consultation with the ASA Sonographer Policy and Advisory Committee, to reflect the current governance and regulatory settings that apply to sonographers in Australia and New Zealand.

The Sonographer Code of Conduct sets out the required standards of professional conduct, ethics and other principles for safe and effective practice by sonographers. It also outlines the standards of sonographer professional conduct to inform the community about what to expect from sonographers.

The ASA also distributed the new Sonographer Code of Conduct to health departments across Australia and New Zealand to ensure wide-reaching recognition of the standards of the sonography profession.

Creating a benchmark Sonographer Code of Conduct is another way the ASA is working towards driving the quality and standards of sonography practice. •

All sonographers should take the time to read the

Sonographer Code of Conduct to acknowledge the new professional standard, and recognise your professional responsibilities.

READ HERE

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SONOGRAPHY RESEARCH SPECIAL EDITION

ASA RESEARCH GRANTS The ASA is committed to supporting sonographers who are striving to make improvements and develop new applications for the sonography profession by offering annual grant funding. The ASA Research Grants support sonographers undertaking important research, which leads to publications and contributes to the evidence base of sonography. Each year, a total funding pool of AUD$30,000 is available to support one or more research projects to facilitate new research.

We asked three previous recipients of the ASA Research Grant about their research projects, how the grant assisted their work, and what they hope to achieve with their research.

Jacqueline Roots

ASA Research Grant Recipient 2021 Research Project: Shear Wave Elastography to assess the change in stiffness of muscles in the acute stage post-stroke. Host Organisation: Queensland University of Technology

What is your research project about?

What methods are you using?

This project is using an advanced ultrasound technology called shear wave elastography to assess the stiffness of muscles after a person has had a stroke. Stroke survivors can develop an increased muscle stiffness, leading to pain and decreased range of motion. Their occupational therapists and physiotherapists can try to target rehabilitation to the affected muscles to reduce the likelihood of the increased stiffness occurring; however, the current tests are subjective and unreliable. Shear wave elastography will be able to quantitatively determine the stiffness of the muscles and detect changes earlier which will lead to improve rehabilitation and quality of life for survivors.

This is a longitudinal, prospective, observational study where scans are completed bedside at a hospital. We will evaluate the stiffness of the biceps muscle twice a week for the first four weeks after a person has had a stroke.

What is the current status of your research project?

We have completed two sets of data collection on healthy volunteers and analysed the data ready for publication. We have obtained ethics approval and are currently collaborating with the neurology departments to finish the site-specific assessment. We are about to start scanning the stroke survivors at the hospital and will recruit participants for 40 weeks. The project is QCAT approved and registered on the Clinical Trials Registry. Our team has become GCP and MoCA certified.

Why did you want to undertake this research?

I wanted to undertake this research because I love knowing that I’m making an impact. I enjoy learning, but when there is a question that has never been answered, that means you’ve got to figure out the answer yourself, and that’s research to me.

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This particular research is fascinating because shear wave elastography has so many potential applications and there are countless unanswered questions yet to be investigated. I believe that eventually shear wave elastography will be another tool in the sonographer’s toolkit like Doppler, dynamic assessment, 3D or SMI.

You were the recipient of the 2021 ASA Research Grant; why did you apply and how has the grant assisted your research?

I applied to the ASA Research Grant because I’d seen the excellent work of the previous recipients and wanted to do the same. My research project was limited by a budget and without the ASA grant I would have had to scale back the project immensely. It has assisted me in guaranteeing I can collaborate with the hospital easily, cover the materials, and purchase software for the data collection. I also love the idea that I’ll be able to disseminate my research findings with ASA, because it will reach Australian sonographers who will be some of the first in the world to be utilising this technology.

What are you hoping to achieve with your research?

This research is hopefully the start of something much bigger. This research will help occupational therapists to target their patient’s therapy to exactly where it is needed, without spending time on muscles that don’t need it. Ideally, shear wave elastography of the muscles will become a new diagnostic test to help stroke survivors initially before moving outwards to include other neuromuscular disorders and musculoskeletal pathologies such as cerebral palsy, Duchenne muscular dystrophy, myositis and Parkinson’s disease.

What did you gain by doing the research?

This research is part of my PhD with Queensland University of Technology. I have gained so much knowledge from undertaking

SONOGRAPHY RESEARCH SPECIAL EDITION

‘When there is a question that has never been answered, that means you’ve got to figure out the answer yourself, and that’s research to me.’ this research. I’ve learnt about the physics behind the different types of elastography, the best data collection methods and ways to analyse the data. I’ve improved my academic writing style and my ability to communicate complex ideas. I’ve been able to publish papers as a first author and collaborate with researchers and sonographers from all over Australia.

Would you undertake it again?

Yes, absolutely. There are always going to be ‘highs and lows’ with research, but overall I’ve definitely enjoyed the process. I have met so many new people and been able to learn so much, not only about my own topic but about the projects from other researchers.

I had no idea there were so many sonographers involved in research until I started this project.

What (if any) challenges did you face, and how did you overcome them?

The main challenge has been learning about the statistical analysis.

I have a wonderful statistician to help analyse the data, but you must make sure you’re collecting the right data that will answer the question. Other minor challenges have been the amount of time spent in administration-related work, such as paperwork and emails, therefore it’s a good idea to have multiple tasks on the go in case anything takes longer than anticipated.

I think it’s really important to have a good support network when it comes to research, in both supervisors and friends. You need to have someone to chat to or vent with about the trivial little problems so that they don’t become big problems. •

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ASA RESEARCH GRANTS Assema Lalzad

ASA Research Grant Co-Recipient 2020 Research Project: Bioeffects of Doppler ultrasound on the newborn brain: A pilot study to investigate structural effects in an in vivo rat model. Host Organisation: Monash University

What is your research project about? What methods are you using?

evolving present-day technology. It is hoped that this research will draw attention to the often disregarded field of ultrasound biosafety.

Given that ultrasound carries thermal and mechanical energy, of which 99% is absorbed by the brain tissue, it is reasonable to speculate that the energy dissipated may trigger a reactive response in the exposed region. Such a response could theoretically invoke an inflammatory and injurious process. In this study, we focus on the inflammatory processes of the central nervous system (CNS), which is the hallmark of the brain’s initial reaction to any external stimuli, stress, injury or disease process. Based on the established association between acute injury and neuroinflammation through the activation of the immune cells of the CNS, we developed a study with the aim to investigate the bioeffects of B-mode ultrasound on the mammalian brain using an in vivo rat model to observe histological changes associated with potential neuroinflammation in the insonated brain region. Specifically, we aimed to explore activation of microglia and increased density of astrocyte. We hypothesise that clinical diagnostic levels of B-mode ultrasound (a 10-minute continuous exposure) can induce neuroinflammation in the exposed regions.

What did you gain from doing the research?

What is the current status of your research project?

This research has been completed and a manuscript has been prepared for publication and is awaiting approval.

Why did you want to undertake this research?

Despite the absence of ionising radiation, the potential for ultrasound to interact with biological tissue has been established, albeit in very limited studies. All of these studies relate to the use of Doppler mode ultrasound exposure, due to the fact that traditionally the highest ultrasound intensities have been associated with Doppler mode. No consideration has been given for B-mode exposure, despite the exponential rise in B-mode intensities relative to Doppler mode in the 20 years from 1990 to 2010. No research in the field of ultrasound bioeffects has explored the postnatal scan of the human neonatal brain. Therefore, we have no clinically relevant information on the possible biological effects that may occur when the preterm brain is exposed to ultrasound directly via the fontanelle.

What are you hoping to achieve with your research?

The clinical safety of cranial ultrasound was insinuated three decades ago as a result of the undisputed absence of ionising radiation and any associated obvious short- or long-term deleterious effects, as well as no empirical evidence of adverse outcomes arising from ultrasound exposure during pregnancy. Ultrasound is, however, not as risk free as once thought, conceding to the intensities associated with ever20

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This research provides breakthrough evidence on the presence of neuroinflammation in the mammalian brain after exposure to B-mode ultrasound via the transcranial window.

Would you undertake it again?

It is not known if the observed neuroinflammatory changes in response to ultrasound exposure are transient and carry risk for cognitive and/or functional deficits and if these changes observed in the rat are also occurring in the human preterm brain. This necessitates further research into the safety profile of neonatal cranial scans using larger observational longitudinal studies. It would be a privilege for me to be part of a research team that would conduct such a study in the future.

What (if any) challenges did you face, and how did you overcome them?

One of the aims of our study was to examine bioeffects of neonatal cranial ultrasound under clinically relevant conditions. Ideally, to simulate the neonatal cranial scan of the preterm human infant requires the use of a rodent model with a postnatal age of less than 10 days. Although this research used 9-week-old rats as study models, the small size of the brains proved very difficult to interrogate with ultrasound. However, the research was not concerned with pathological or structural changes visible with ultrasound. Therefore, the small size of the brains and reduced resolution did not impact the outcome of the research.

You were one of the recipients of the 2020 ASA Research Grant; why did you apply and how has the grant assisted in your research?

I had anticipated to utilise an NHMRC grant (awarded in 2016) on the proposed animal study which was the final phase of my PhD. However, with the impact of COVID-19, the university froze all research funds. This prevented the conduct of the animal study. The university suggested I change the direction of my PhD or limit the scope of the research originally planned. At this time, many other funding bodies were reluctant to provide research funding under the same circumstances, especially given the limited timelines.

However, I remained fully committed to pursuing the completion of my original work. After a lengthy time spent sourcing scholarships and grant opportunities, I applied for and was awarded a research grant by the Australasian Sonographers Association to complete my original rat study. •

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‘Ultrasound is, however, not as risk free as once thought, conceding to the intensities associated with ever-evolving present-day technology. It is hoped that this research will draw attention to the often disregarded field of ultrasound biosafety.’

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ASA RESEARCH GRANTS Bernadette Dellar

ASA Research Grant Co-Recipient 2020 Research Project: Is transpubic sonography a reliable assessment of functional voiding in asymptomatic females? Host Organisation: Absolute Ultrasound Services

What is your research project about? What methods are you using?

hence I am now collecting that data. I am very thankful and appreciative to be a recipient of this grant.

This is an inter-rater and intra-rater assessment of a dynamic ultrasound technique where two sonographers scan the same volunteer. This research might be unusual to most sonographers because we are assessing micturition. Yes, voiding is urination and, no, we don’t get urinated on at all. My research requires a volunteer to void in a seated position with the transducer held by the sonographer.

Each volunteer attends 2 sessions each lasting about 3 hours. A total of 4 voids are performed by the volunteer to complete the study.

Simultaneous ultrasound and uroflowmetry devices are used to visualise the urethra, pelvic floor, and flow pattern.

This ultrasound research will change the way functional voiding is assessed. When I present my work internationally at ICS 2023, I will be proud to say that ASA made it possible. Because research is very time consuming and costly, I needed money to pay normal volunteers (4 hours of their time) to wee for me, rental of the ultrasound equipment, Tristel wipes, rental of a uroflowmetry and the sonographers time to collect the data.

What is the current status of your research project?

I hope to see this research in clinical settings where simultaneous ultrasound with urodynamics adds value to women’s health imaging and diagnosis.

Data collection is finished and the statistician and I are currently analysing 34 data sets.

What did you gain from doing the research?

Why did you want to undertake this research?

When I was working as a radiographer in a women’s hospital some years ago, women with voiding issues had to go through fluoroscopic micturating cystograms, while currently the gold standard test is urodynamics. Then, those techniques had limitations, like radiation and invasive catheterisation. Those tests were not even able to visualise soft tissue during voiding. It occurred to me that ultrasound was great at visualising soft tissue, a dynamic study was distinctly possible, and so began my research in this area. I found an article by GN Schaer, published in 1995, where he used ultrasound simultaneously with urodynamics assessment. I messaged Dr Schaer because he lives in Switzerland, and we had a good chat thanks to modern technology. He supported my research by writing a recommendation letter to help my grant application.

You were one of the recipients of the 2020 ASA Research Grant; why did you apply and how has the grant assisted your research?

In the past, I did an ethics approved research. The project took 6 months of my weekends. Fifty-five volunteers answered my local newspaper advertisement titled ‘Solving a wee problem’. I gave the volunteers a can of Coke and a Mars bar as a token of my appreciation for participating. I was using the hospital’s ultrasound machine and hours of my time spent to investigate if it was possible to ultrasound micturition. I could observe what was happening, but I couldn’t quantify what I saw. After more research, I became aware of the International Continence Society (ICS) and its ultrasound section with recommendations on what to measure. I looked further and realised that there is currently no data on normal measurements,

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What are you hoping to achieve with your research?

Research starts with a question; you find some answers and you have more questions. This topic has been an interest to me for a long time. Now that I am doing the research, I am in my happy place! I would like to share my knowledge about the processes of research and data presentation.

Would you undertake it again?

Research? Yes, definitely. Another grant would enable clinically relevant volunteers to participate. I would encourage sonographers who have a yearning question they want answered to apply for the grant and undertake their own research. The upcoming ASA2023 Conference will have sessions on research, so stay tuned.

What (if any) challenges did you face, and how did you overcome them?

COVID-19 presented challenges and delays. I discovered that people don’t read flyers and paper prints. I was encouraged when some volunteers answered my Facebook advertisements. My initial plan required volunteers to attend 4 sessions, and when I did not get any takers at all after a month of advertising, I panicked! After conferring with my supervisors and discovering that UQ had a website just for recruiting research volunteers, I applied to have my research advertised through UQ. I learnt when volunteering for another researcher’s project that participants don’t mind attending 2 sessions if they know for how long those sessions go. So, back to the drawing board. After submitting an ethics amendment and completing my data collection a little late because of COVID-19 and other delays, I did it! My next steps will be presenting the findings, writing, and publishing. •

ASA’s biannual publication Making Waves, provides a review of the most current sonography research in one place. The research is analysed by a member of our Special Interest Group Committees, and the findings and clinical applications are presented in a more accessible, easy-to-read format for busy sonographers.

View the latest issue

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RESEARCH Evaluation of sonographer administered ultrasound-guided musculoskeletal injections

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ince 2019, the ASA has funded the research project ‘Evaluation of sonographer administered ultrasoundguided musculoskeletal injections’ with the International Centre for Allied Health Evidence, University of South Australia, who conducted the research.

This study, published in Sonography journal, indicates that appropriately trained sonographers can provide ultrasoundguided musculoskeletal injections at a level of safety that is comparable to similar injection procedures explored in the literature. The high level of satisfaction of the patients suggests that this service should be extended and expanded to address patient concerns regarding long waiting times.

View the article: Patient satisfaction and incidence of adverse events during a trial of sonographer administered musculoskeletal injections

The medications used in cortisone injections are classified as Schedule 4 restricted drugs. Who can prescribe, administer and hold restricted drugs is determined separately by state legislation and subordinate regulation. Each state or territory has its own ‘drugs and poisons’ legislation, which is overseen by the jurisdictional Department of Health. As such, the legislation on who can prescribe, administer, and hold restricted drugs varies between Australian states and territories.

Even for those in a state that allows sonographers to administer restricted drugs at the direction of a medical practitioner, it still requires a supervising medical practitioner (for example, radiologist) to consider this as an appropriate model of healthcare. It also requires the support of the workplace for this service delivery model.

For more information, read the FAQs on Sonographer administered ultrasound-guided MSK injections •

UPCOMING RESEARCH Scan Times Research Project

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n the last member survey, the majority of members asked for advice and guidance on scan times and scheduling. Many of you spoke of the number of scans you are expected to perform in a day, with scan times shortening, and the impact this has not only on the quality of your work, but also the potential for mistakes, burnout, and sonographer injury.

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The ASA is in the process of commissioning research to be undertaken to answer the question ‘Do ultrasound examination times correlate with quality outcomes?’ by identifying the relationship between current scheduled ultrasound examination times and transducer times and determine if there is any correlation with quality outcomes.

This work is expected to commence in 2023 with an initial report by the end of 2023. •

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