Ultrasound has been in clinical use to image the human body for over half a century [1, 2]. It is a portable, safe, effective, accessible and real-time imaging modality that is capable of providing clinically relevant information about most parts of the human body in a rapid and cost-effective fashion [1,2,3]. Ultrasound imaging investigations can assist in the diagnosis and monitoring of disease conditions [4]. In many cardiovascular diseases, it has replaced invasive methods as the primary means of evaluation [3]. Furthermore, it is the most applicable imaging technique for guiding biopsies and fine needle aspirations that are performed percutaneously provided the lesion can be visualized sonographically [5].
Ultrasound practitioners come from a wide range of professional backgrounds which include radiologists, radiographers, sonographers, nurses, midwives, physiotherapists, obstetricians and clinical scientists [4, 6, 7]. Sonography is a profession to some practitioners while to others is a diagnostic or therapeutic tool used to support their main professional role [8]. It is a primary imaging modality in the daily work of sonographers and sonologists [8]. Ultrasonography requires a practice of hand-eye coordination skills and the use of intelligence, medical knowledge and experience [9]. Training for diagnostic ultrasound examinations and procedures is varied; the level, duration and intensity depend on the desired use [4]. Medical doctors undergoes radiology residency programme that lasts for an average duration of 5 years in African countries before being certified to practise radiological procedures including ultrasonography [10, 11]. Residency is defined as the constellation of learning activities carried out to enable doctors to develop relevant competencies and deeper knowledge in specific subject areas after completion of basic medical education [11]. In Nigeria, radiographers shall additionally possess a postgraduate diploma in Ultrasonography of the Nigerian Institute of Radiography or any other qualifications recognized by the Board before being certified to practise general ultrasonography; otherwise, they are restricted to obstetric and gynaecology scan [12]. The largest group of professionals working in ultrasound has come from a radiography background via accredited programmes of education, delivered by higher education establishments and accredited by the Consortium for the Accreditation of Sonographic Education (CASE) in the UK [8]. Some medical specialities perform specialized ultrasound scans as part of their training, like gynaecologists and cardiologists [4]. A high level of diagnostic accuracy of sonographers/radiographers has been shown in a number of studies across all subspecialties [7, 13,14,15]. The imaging modality is an operator dependent, and the usefulness of an ultrasound examination depends on the experience and the capability of the ultrasound examiner [4]. In the hands of an untrained or poorly trained person, ultrasound may be misleading and even dangerous because misinterpretation will lead to an erroneous diagnosis [4].
Ultrasound is among the most rapidly advancing imaging techniques; advances in equipment technology allow users to discover a wide range of pathologic conditions with minimal image noise and improve resolution [16]. Functional methods such as elastography have been clinically introduced, and tissue characterization is improved by contrast-enhanced scans [16]. The recent advances that have produced the most significant impact on the general public and ultrasound community have been the ability to view three-dimensional (3D) images in real time [17]. Doppler ultrasound is also an added advantage that provides vital information on the haemodynamics of the cardiovascular system [17].
Quality assurance (QA) of ultrasound systems is necessary to ensure the reliability of results and to check for deterioration in performance [18]. It is a highly recommended procedure intended to test the performance of clinical instrumentation and monitor its deterioration periodically over time, which may be responsible for a slight but progressive degradation of image quality [19]. Equipment performance testing has been seen as the domain of the Medical Physics Department, involving extensive use of tissue-mimicking phantoms (TMPs) and other test devices. Over time, it has been recognized that sonographers have an essential role in the QA of ultrasound scanners. There are three levels of QA: level 1 (infection control and scanner damage), level 2 (basic scanner and transducer testing) and level 3 (further scanner and transducer testing). These tests are performed daily and weekly for level 1, daily for level 2 and monthly for level 3 [18, 19].
An audit should be performed on every professional practice aimed at taking corrective measures where errors are identified and improvement in the practice where errors are not identified. However, an empirical study shows that an audit of ultrasound practice has not been performed in some centres in Kano metropolis, and a literature review showed no documented published work in the study area. This may lead to an uncertainty about the reliability of diagnosis and patient care. The findings of the study will serve as a baseline for making recommendations to the relevant authorities or professional bodies to improve on regulations regarding ultrasound practices so as to enhance proper diagnosis and patient care. It will also serve as a guide for practitioners to improve on their technical skills and expertise. The study aims at evaluating the current status of ultrasound practice in Kano metropolis, Nigeria.
