USG for non radiologists-a controversial topic

Radiologists lead campaign to change ultrasound practice

Ultrasound is an ugly word in India because of the immediate connection it provokes with female foeticide. And sadly so, because there’s a lot more to ultrasound than pre-natal sex determination. Apart from being more affordable and accessible than other imaging techniques, ultrasound is extremely useful in the diagnosis of pregnancy abnormalities and diseases of the gall bladder and pancreas.
The Indian Radiological and Imaging Association (IRIA), which is campaigning to remove the stigma and restrict the practice of ultrasound only to doctors who have studied ultrasound as part of their postgraduate syllabus, will take up the issue of ultrasound practice once again with the Central Supervisory Board.
The Central Supervisory Board, constituted under the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT Act), is scheduled to meet on September 23 for the first time since the new government was formed. The meeting will be chaired by the Union Minister for Health and Family Welfare, Dr Anbumani Ramdass.
The board is responsible for reviewing the implementation of the act, and also for recommending any changes, if required, by the government.
The IRIA will be represented on the board by Dr C.S. Pant, past president of the association. Speaking to AuntMinnieIndia.com, Pant was emphatic that only doctors who have studied US in their postgraduate syllabus should be permitted to perform ultrasonography, which means only those with a two- or three-year postgraduate specialisation in gynaecology or radiology.
"On one hand, the government wants to prevent misuse of ultrasound. On the other hand, it is practically allowing everybody to do it," he said. The IRIA's stand is that restricting the practice of ultrasound to those who are either radiologists or gynaecologists will also reduce the misuse of the modality for sex determination.
For instance, the IRIA, as an association of radiologists, can take action against members who are misusing US. But with more than just radiologists performing US, the association has no control over the misuse of US.
"We are not claiming to curb it. But what we are saying is that we can control it," said Pant, admitting that merely restricting US practice to radiologists or gynaecologists will not eliminate the problem of female foeticide.
Backbone of radiology
But the larger reason why the IRIA is pushing for US to be restricted to those with a postgraduate specialisation is because it believes that US is not a skill that can be learnt in six months or one year.
"If that's the case, then why have ultrasound as a postgraduate course in medicine?" Pant asked. It is the most widely taught subject in radiology in India and makes up close to 70% of the content of a radiology course in US, he said.
He likens the status of US today to the x-ray machine of yesteryear because of its availability. Unlike the more expensive CT and MRI units, ultrasound machines are affordable for nearly every medical university, making ultrasound a very widely taught modality.
"We are (contending) in the Supreme Court that only a radiologist who takes two years or three years to get trained, and then undergoes specialised training in US is qualified to perform US," said Col M.N. Sree Ram, central council member of the IRIA representing the armed forces. The matter is yet to come up for hearing.
Currently, anyone with a basic degree in medicine (MBBS) and even those with a degree from the Indian System of Medicine (including homeopathy, ayurveda, and unani) can practice US.
Harassment under PNDT Act
The IRIA has received complaints that its members are being harassed when they approach the district and state health authorities to register their facilities. Under the PNDT Act, hospitals, clinics, laboratories, and nursing homes that provide genetic counselling, conduct pre-natal diagnostic tests, and analyse test samples need to obtain a certificate of registration.
The act also states, "All records, charts, forms, reports, consent letters, and all other documents are required to be maintained under this Act, and the rules shall be preserved for a period of two years or for such period as may be prescribed."
According to Pant, there is scope for considerable ambiguity in the interpretation of the act, leading to harassment of radiologists. "There is no clear stipulation on the records that need to be maintained. There are no clear guidelines," he told AuntMinnieIndia.com. Harassment is one of the issues that the IRIA will take up at the upcoming Central Supervisory Board meeting.
Strangely, Pant also points out that the board does not have any radiologists among its members although US is performed by radiologists. He himself is a special invitee and not part of the board as envisaged under the PNDT Act. The board consists of geneticists, gynaecologists, paediatricians, social scientists, and representatives of women’s welfare organisations, among others