Satisfying NICE (quickly) - A sonographer’s experience of a streamlined approach to becoming proficient in ultrasound guided biopsy in the neck,

Michelle Davies, Chris Greenall, Rhodri Evans, Radiology, ABMU Health Board

In February 2016 NICE published ‘Cancer of the upper aerodigestive tract: Assessment and management in people aged 16 and over’. This recommended the use of ultrasound guided biopsy for the assessment of neck lumps. While the role of the neck lump clinic or alternative referral pathways are a source of much debate there is certainly increased demand for ultrasound guided neck biopsy.

Ultrasound guided biopsy has been traditionally undertaken by radiologists, but due to increasing demand, availability and portability of ultrasound, and a national shortage of radiologists, this has resulted in other healthcare practitioners increasingly undertaking these procedures.

Successful sonographer led neck lump clinics have been established throughout the United Kingdom based on training schemes adapted to the resources available locally. To date there is no nationally recognised training pathway for sonographers wishing to perform ultrasound guided neck biopsy.

The poster details how an ‘in house’ sonographer training programme was established for head and neck ultrasound guided FNA in Morriston Hospital, Swansea. Unlike other training schemes in the UK our program was streamlined, requiring completion of fewer biopsies, focusing instead on multiple work based assessments performed at regular intervals throughout the training.

The assessments, performed by different radiologists, were based on the ‘mini-DOPS’ tools used by the Royal College of Radiologists and are an essential part of the Radiology Trainee’s curriculum. These Direct Observation of Procedural Skills are used as a summative measurement of progress in a particular technique, taking into account not only practical skills, but also communication and cross infection.

The poster describes the program, its advantages and pitfalls, and highlights the multiple assessments that had to be successfully completed prior to moving onto the next.

The assessment tools encourage reflective practice. The trainee was also required to keep a separate log book of biopsies performed with periodical reflection on positive and negative experiences. The trainee attended the Head and Neck Oncology MDT and also regularly audited their biopsy success against local and national standards.

Through regular assessment, reflection and audit of the trainee’s progress this training pathway offers a reproducible, transparent, efficient and ultimately safe training pathway with the goal of becoming proficient in a much sought after procedure.

View the Poster here