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.. OVERVIEW Diagnostic medical sonographers, or sonographers, use advanced technology in the form of high-frequency sound waves similar to sonar to produce two- dimensional, gray-scale images of the internal body for analysis by radiologists and other physicians. There are about 33,000 diagnostic medical sonographers employed in the United States. HISTORY Pierre Curie discovered a procedure to produce ultrasonic vibrations in 1890. It was not until World War II, however, that ultrasound gained a practical application in the form of SONAR, an ultrasonic device used to detect sub marines beneath water. In the 1960s, ultrasound gained a medical use. The medical industry sought a safer and more effective way of imaging fetuses. Ultrasound provided the answer: the echoes created by ultrasonic sound waves gave physicians and obstetricians a safe way to monitor the development of the fetus. Ultrasound technology has since been adapted for other medical uses, including the heating of deep tissue to treat such ailments as arthritis and bursitis, and in bloodless brain surgery. Dentists also use ultrasound to remove calcium deposits from the surface of teeth. In addition to its medical uses, ultrasound is used in the plastics, precious metal and gemstone, electronic, textile, and welding industries. Diagnostic medical sonographers must strike a balance between professionalism and empathy while conducting procedures. THE JOB Sonographers work on the orders of a physician or radiologist. They are responsible for the proper set up and selection of the ultrasound equipment for each specific exam. They explain the procedure to patients, recording any additional information that may be of later use to the physician. Sonographers instruct patients and assist them into the proper physical position so that the test may begin. When the patient is properly aligned, the sonographer applies a gel to the skin that improves the diagnostic image. The sonographer selects the transducer, a microphone-shaped device that directs high- frequency sound waves into the area to be imaged, and adjusts equipment controls according to the proper depth of field and specific organ or structure to be examined. The transducer is moved as the sonographer monitors the sound-wave display screen in order to ensure that a quality ultrasonic image is being produced. Sonographers must master the location and visualization of human anatomy to be able to differentiate clearly between healthy and pathological areas. When a clear image is obtained, the sonographer activates equipment that records individual photographic views or sequences as real-time images of the affected area. These images are recorded on computer disk, magnetic tape, strip printout, film, or videotape. The sonographer removes the film after recording and prepares it for analysis by the physician. In order to be able to discuss the procedure with the physician, if asked, the sonographer may also record any further data or observations that occurred during the exam. Other duties include updating patient records, monitoring and adjusting sonographic equipment to maintain accuracy, and, after considerable experience, preparing work schedules and evaluating potential equipment purchases. REQUIREMENTS High School If you are interested in a career in sonography, in high school you should take courses in mathematics, biology, physics, anatomy and physiology, and, especially, chemistry. Also, take English and speech classes to improve your communication skills. In this career you will be working with both patients and other medical professionals, and it will be important for you to be able to follow directions as well as explain procedures. Finally, take computer courses to familiarize yourself with using technology. Postsecondary Training Instruction in diagnostic medical sonography is offered by hospitals, colleges, universities, technical schools, and the armed forces in the form of hospital certificates, and two-year associate’s and four-year bachelor’s degree programs. Most sonographers enter the field after completing an associate’s degree. The Joint Review Committee on Education in Diagnostic Medical Sonography (a division of the Commission on Accreditation of Allied Health Education Programs) has accredited more than 70 programs in the United States. Education consists of classroom and laboratory instruction, as well as hands-on experience in the form of internships in a hospital ultrasound department. Areas of study include patient care and medical ethics, general and cross-sectional anatomy, physiology and patho-physiology, applications and limitations of ultrasound, and image evaluation. Certification or Licensing After completing their degrees, sonographers may register with the American Registry of Diagnostic Medical Sonographers (ARDMS). Registration allows qualified sonographers to take the National Boards to gain certification, which, although optional, is frequently required by employers. Other licensing requirements may exist at the state level hut vary greatly. Students should also be aware of continuing education requirements that exist to keep sonographers at the forefront of current technology and diagnostic theory. They are required to maintain certification through continuing education classes, which vary from state to state. This continuing education, offered by hospitals and ultrasound equipment companies, is usually offered after regular work hours have ended. Other Requirements On a personal level, prospective sonographers need to be technically adept, detail-oriented, and precision minded. You need to enjoy helping others and working with a variety of professionals as part of a team. You must be able to follow physician instructions, while maintaining a creative approach to imaging as you complete each procedure. Sonographers need to cultivate a professional demeanor, while still expressing empathy, patience, and understanding in order to reassure patients. This professionalism is also necessary because tragedies such as cancer, untreatable disease, or fetal death are revealed during imaging procedures. As a result, sonographers must be able to skillfully deflect questions better left to the radiologist or the attending physician. Clear communication, both verbal and writ ten, is a plus for those who are part of a health care team. EXPLORING Although you can only gain direct experience in sonography through proper education and certification, you can gain insight into duties and responsibilities by speaking directly to an experienced sonographer. You can visit a hospital, health maintenance organization, or other locations to view the equipment and facilities used and to watch professionals at work. You may also consider contacting teachers at schools of diagnostic medical sonography or touring their educational facilities. Guidance counselors or science teachers may also be able to arrange a presentation by a sonographer. EMPLOYERS While hospitals are the main employers of sonographers, increasing employment opportunities exist in nursing homes, HMOs, imaging centers, private physicians’ offices, research laboratories, education al institutions, and industry. STARTING OUT Those interested in becoming diagnostic medical sonographers must complete a sonographic educational program such as one offered by teaching hospitals, colleges and universities, technical schools, and the armed forces. You should be sure to enroll in an accredited educational program, as those who complete such a program stand the best chances for employment. Voluntary registration with the American Registry of Diagnostic Medical Sonographers (ARDMS) is key to gaining employment. Most employers require registration with ARDMS. Other methods of entering the field include responding to job listings in sonography publications, registering with employment agencies specializing in the health care field, contacting headhunters, or applying to the personnel offices of health care employers. ADVANCEMENT Many advancement areas are open to sonographers who have considerable experience and, more importantly, advanced education. Sonographers with a bachelor’s degree stand the best chance to gain additional duties or responsibilities. Technical programs, teaching hospitals, colleges, universities, and, sometimes, in-house training programs can provide this further training. Highly trained and experienced sonographers can rise to the position of chief technologist, administrator, clinical supervisor, overseeing sonography departments, choosing new equipment, and creating work schedules. Others may become sonography instructors, teaching ultrasound technology in hospitals, universities, and other educational settings. Other sonographers may gravitate toward marketing, working as ultra sound equipment sales representatives and selling ultrasound technology to medical clients. Sonographers involved in sales may market ultrasound technology for nonmedical uses to the plastics, steel, or other industries. Sonographers may also work as machinery demonstrators, traveling at the behest of manufacturers to train others in the use of new or updated equipment. Sonographers may pursue advanced education in conjunction with or in addition to their sonography training. Sonographers may become certified in computer tomography, magnetic resonance imaging, nuclear medicine technology, radiation therapy, and cardiac catheterization. Others may become diagnostic cardiac sonographers or focus on specialty areas such as obstetrics/gynecology, neuro-sonography, peripheral vascular Doppler, and ophthalmology. EARNINGS According to the U.S. Department of Labor, diagnostic medical sonographers earned a median annual income of $44,820 in 2000. The lowest paid 10 percent of this group, which included those just begin- fling in the field, made approximately $32,470. The highest paid 10 percent, which included those with experience and managerial duties, earned more than $59,310 annually. Median earnings for those who worked in hospitals were $43,950 and for those employed in offices and clinics of medical doctors, $46,190. Pay scales vary based on experience, educational level, and type and location of employer, with urban employers offering higher compensation than rural areas and small towns. Beyond base salaries, sonographers can expect to enjoy many fringe benefits, including paid vacation, sick and personal days, and health and dental insurance. WORK ENVIRONMENT A variety of work settings exist for sonographers, from health maintenance organizations to mobile imaging centers to clinical research labs or industry. In health care settings, diagnostic medical sonographers may work in departments of obstetrics/gynecology, cardiology, neurology, and others. Sonographers enjoy an indoor workplace that is clean, well lighted, quiet, and professional. Most sonographers work at one location, although mobile imaging sonographers and sales representatives can expect a considerable amount of travel. The typical sonographer is constantly busy, seeing as many as 25 patients in the course of an eight-hour day. Some employers may also require overtime. The types of examinations vary by institution, but common areas include fetal ultrasounds, gynecological (i.e., uterus, ovaries), and abdominal (i.e., gallbladder liver; and kidney) tests. Prospective sonographers should be aware of the occasionally repetitive nature of the job and the long hours usually spent standing. Daily duties may be both physically and mentally taxing. Although they are not exposed to harmful radiation, sonographers may nevertheless be exposed to communicable diseases and hazardous materials from invasive procedures. Universal safety standards exist to ensure sonographers’ safety. OUTLOOK According to the U.S. Department of Labor, employment of diagnostic medical sonographers should grow faster than the average through 2010. One reason for this growth is that sonography is a safe, nonradioactive imaging process. In addition, sonography has proved successful in detecting life-threatening diseases and in analyzing previously non-imageable internal organs. Sonography will play an increasing role in the fields of obstetrics/gynecology and cardiology. Furthermore, the aging population will create high demand for qualified technologists to operate diagnostic machinery. Demand for qualified diagnostic medical sonographers exceeds the current supply in some areas of the country, especially rural communities, small towns, and some retirement areas. Being flexible about location and compensation will lead to the best opportunities in current and future job markets. A few important factors may slow growth. The health care industry is currently in a state of transition because of public and government debate concerning Medicare, universal health care, and the role of third-party payers in the system. Also, some procedures may prove too costly for insurance companies or government programs to cover. Hospital sonography departments will also be affected by this debate and continue to downsize. Some procedures will be done only on weekends, weeknights, or on an outpatient basis, possibly affecting employment opportunities, hours, and salaries of future sonographers. Conversely, nursing homes, HMOs, mobile imaging centers, and private physicians’ groups will offer new employment opportunities to highly skilled sonographers. Anyone considering a career in sonography should be aware that there is considerable competition for the most lucrative jobs. Those flexible in regard to hours, salary, and location and who possess advanced education stand to prosper in future job markets. Those complementing their sonographic skills with training in other imaging areas, such as magnetic resonance imaging, computer tomography, nuclear medicine technology, or other specialties, will best be able to meet the changing requirements and rising competition of future job markets. FOR MORE INFORMATION For information about available jobs and credentials, contact: American Registry of Diagnostic Medical Sonographers 51 Monroe Street, Plaza East One Rockville, MD 20850-2400 Tel: 800-541-9754 For information regarding accredited programs of sonography, contact Commission on Accreditation of Allied Health Education Programs 35 East Wacker Drive, Suite 1970 Chicago, Il. 60601-2208 Tel: 312-553-9355 Email: caahep@caahep.org http://www.caahep.org For information regarding a career in sonography or to subscribe to the Journal of Diagnostic Medical Sonography, contact Society of Diagnostic Medical Sonography 2745 Dallas Parkway, Suite 350 Piano, TX 75093-4706 Tel: 800-229-9506 Interview Anne Conner-Day has been working in diagnostic medical sonography for more than 25 years. She is a co-owner of the Sonography Education Academy in North Carolina and serves as an educational consultant for sonography programs at several institutions. She spoke with the editors of Careers in Focus: Medical Technicians about her career and the field of diagnostic medical sonography. Q. Please describe the responsibilities of your job. A. I provide distance education opportunities to underserved populations to help them enter the profession of diagnostic medical sonography. This is a new area and a new company, which is just now getting off the ground. I also consult with several universities and medical centers in curriculum development and online education. I currently work out of my home, although clinical site visitation will occur in the future. When I am consulting, I attend various meetings both online and in person. I also serve as a regional director for the Society of Diagnostic Medical Sonography and spend part of my day in this voluntary activity promoting medical sonography to the public and assisting our membership. Q. What were your expectations entering this field? Are they much different from the realities? A. In the mid-1970s, when I entered this field, I was fascinated by the prospects in diagnostic medical sonography. I enjoyed the personal contact with patients and the eye-hand coordination required of a sonographer. I also enjoyed the correlation of anatomy to pathological conditions and the responsibility placed on the sonographer to help in the final diagnosis. In the past 25 years I have seen the profession grow tremendously with imaging capabilities far surpassing early expectations of equipment and diagnostic abilities. One negative result of years of scanning patients is the high rate of musculoskeletal disorders that occur in sonographers due to their scanning techniques and equipment. These issues are currently being dealt with by hospitals and medical centers, which are purchasing the proper equipment needed for sonographers to avoid muscular strain injuries. Current education of student sonographers involves learning methods and techniques that will help prevent musculoskeletal injuries in people entering the profession. Q. What kind of education and training did you pursue for this position? A. I began my health career as a radiologic technologist. In the 1970s these were the typical people who entered the profession of sonography. However, sonographers now can be successfully educated without this background; people from many different professions are entering the field, as well as graduates of associate degree programs in community colleges and bachelor degree programs in universities. It is important for someone wishing to enter this profession to look for a CAAHEP-accredited program, which will ensure minimum standards are being met. When I chose to enter the field of education I received a bachelor’s degree in medical imaging and a master’s degree in health care administration. Q. Did you complete any internships or clinical practice to help you prepare for your career? A. I was required to scan for one year prior to taking certification examinations in the late I 970s and early I 980s. However, a minimum of 18 months of scanning is now suggested to become minimally proficient. This is, of course, along with quality didactic education. Q. What is the best way to find a job in this field? A. Sonographers are in need just about anywhere. Hospitals, medical centers, doctors’ offices, and commercial manufacturers are looking for sonographers at this time. Commercial employment usually requires experience prior to entrance into this area of employment. Applicants need to be certified by the American Registry of Diagnostic Medical Sonographers to be considered by most employers. Q. What would you say are the most important skills and personal qualities for someone in your field? A. The roles and qualities needed in a sonographer are best described by Marveen Craig in her book Introduction to Ultrasonography and Patient Care (WB. Saunders, 1993).To summarize these qualities: intellectual curiosity, eagerness and per severance, quick-thinking and analytic capabilities, good technical orientation, good physical health, self-direction, emotional stability, good communication skills, and dedication. Q. What advice would you give to someone who is interested in pursuing this type of career? A. Be sure to check to see if the program you wish to enter is CAAHEP accredited. Lists of these programs can be found at http://www.caahep.org.There are many non-accredited programs that are very expensive, and the graduate may not even be able to sit for American Registry of Diagnostic Medical Sonographers certification examinations. Checking for prerequisites for certification examinations is important and can be found at http://www.ardms.org. 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