Australian sonographers – sound policy for progress?

Sonographers are ‘Experts in Ultrasound’, highly skilled health professionals essential to the Australian healthcare system.¹ Traditionally focused on diagnostic services, some Australian sonographers have expanded their roles to include ultrasound-guided injections (UGIs), following evidence that this practice is safe, cost-effective, and yields high patient satisfaction.^2,3 Given the high prevalence of chronic pain and musculoskeletal conditions in Australia, the demand for UGIs has significantly increased. Typically, UGIs are low-risk procedures involving the injection of local anaesthetic and corticosteroids using real-time ultrasound guidance to reduce inflammation and pain.

Access and efficiency

The lack of radiologists in rural and remote areas necessitates exploring alternative delivery models for UGIs. Patients in these areas often face long travel distances, extended wait times and additional expense for pain relief. Sonographer-performed injections could provide a dual diagnostic and interventional service in one visit, improving resource utilisation and patient care. Allowing suitable sonographers to have independent provider numbers under Medicare could expand these services in underserved regions.

Professional barriers

The expansion of sonographers’ scope of practice has been a long-standing discussion. The Australasian Sonographers Association has advocated for this since 2007, and a 2014 report suggested training sonographers for low-risk injections could reduce wait times and improve access.⁴ In 2015 the Australasian Sonographers Association announced a training pathway for appropriately experienced sonographers to perform UGIs through a Post Graduate Certificate in Musculoskeletal Interventions, in conjunction with the University of Essex. Despite this, the Royal Australian and New Zealand College of Radiologists (RANZCR) opposed the initiative via a position statement in 2015.⁵ This resulted in limiting the utilisation of the trained sonographers and the course has not been offered since. Evidence from pilot studies shows high levels of safety and patient satisfaction with sonographer-performed injections, but the opposition from RANZCR has greatly stymied progress.

Industry ramifications

Many major radiology providers, influenced by RANZCR and the Australian Diagnostic Imaging Association, have limited support for sonographer-performed UGIs. This has resulted in growing demand and long waiting times for these procedures in areas with few or no radiologists. Rescinding or revising RANZCR’s position would open opportunities for sonographers to perform UGIs, supported by appropriate training and certification pathways.

Inconsistent regulation

State regulations on the administration of corticosteroids vary, complicating the delegation of these procedures to sonographers. While some states allow it, others do not, creating a regulatory patchwork that hampers uniform practice. Streamlining legislation could reduce bureaucratic barriers and increase access to these procedures, particularly in areas of need.

Time to move forward?

Despite decades of advocacy and evidence supporting the expanded role of sonographers in performing UGIs, progress has been limited. Highly skilled sonographers remain underutilised, and important training pathways have been abandoned. To maximise the benefits of these professionals, regulatory reform and the reintroduction of comprehensive and suitable education pathways are necessary. Value-based healthcare requires top-level support and system-wide alignment to ensure that patients can access the full potential of sonographer services.⁶

Conclusion

Unlocking the potential of interventional sonographers through regulatory reform and continuous education could significantly enhance healthcare access, reduce wait times, and improve patient outcomes. The healthcare system must align to support these changes, ensuring that highly qualified sonographers can perform UGIs safely and effectively, ultimately benefiting patients across Australia.