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Re: Focused emergency ultrasound

Dear Editor,

As a radiologist, I read with interest the recently published paper by R McLaughlin et al concerning emergency department ultrasound.[1] At the time the article was written, there has been an absence of agreed UK accreditation guidelines. However, recently the Royal College of Radiologist has published ultrasound training recommendations for medical non radiologists.[2] This included Focused Emergency Ultrasound (FEU). Recommendations of training included both theoretical (physics, techniques, anatomy and pathology in relation to ultrasound) as well as practical aspects, which lead to three levels of competency.

There are certainly benefits of FEU but it is important to be aware of the limitations. It is primarily used to answer specific questions. For example, to look for pericardial/pleural effusions, abdominal aortic aneurysms, abdominal free fluid and deep vein thromboses.

There is also the risk of misdiagnosis. Would the practitioner recognise other causes for abdominal pain when scanning for abdominal aortic aneurysm or other causes of leg swelling (for instance Baker’s cyst or a soft tissue sarcoma) when scanning for DVT?

Therefore, education by an experienced radiologist is essential. Training should be adequately funded so that this does not adversely affect the service provision to patients and the training of radiologists and sonographers. Finally, it is important to audit this type of service to ensure and maintain high clinical standards.

References

1. R McLaughlin, N Collum, S McGovern, C Martyn and J Bowra Emergency department ultrasound (EDU): clinical adjunct or plaything? Emerg Med J 2005; 22:333-335.