Dangers in the dark: Calling for a safer practice of transvaginal ultrasonography

Abstract

Background The intimate examination is an important component of the assessment of a patient presenting with obstetric or gynaecological concerns. Ultrasound practitioners, like any other medical practitioner, are in a unique and privileged position. During the examination, the sonographers engage in a very close and personal interaction with an individual whom they have likely never met. They are also most likely unfamiliar with their social situation, cultural background, previous experiences with the healthcare profession and more importantly, any history of sexual trauma. It is an extremely sensitive area of practice which places a great deal of responsibility on the clinician to ensure that they not only protect their patient from psychological distress, but also themselves, from the threat of litigation arising from such distress. Aims This paper highlights the current governance requirements for sonographers and makes suggestions to support them in safeguarding their patients and themselves from allegations of unprofessional conduct, until such a regulatory body exists. Materials and Methods A wide‐ranging review of the literature exploring the perceptions of female patients regarding intimate sonographic examination was performed using standard search engines. Additionally, grey literature was searched for policy statements and government regulatory documents for guidance on the topic. Results Although much research has been undertaken in this field across diverse cultures and knowledge in this area is ever increasing; however, the guidelines for sonographers appear to be site specific and variable. At present, there is no overarching governance for sonographers, as there is with practitioners registered with the Australian Health Practitioner Regulation Agency. Discussion While there are practice standards for the purposes of Medicare set out by the Diagnostic Imaging Accreditation Scheme, there is no regulatory professional standard that sonographers are held accountable to. This is problematic and has the potential for inadvertent boundary transgression by the practitioner, as there is also no existing framework for management of such incidents in an equitable manner. Conclusion The intimate examination is generally well tolerated; however, there is a subset of the population who are vulnerable to psychological distress arising from the examination. The sonographer must be astute to signs of distress and act in accordance with the intimate examination guidelines set out by AHPRA, for the dual purpose of protecting their patients against harm and also themselves from the threat of litigation.

Australian sonographers’ perceptions of patient safety in ultrasound imaging: Part 1 – identifying the main safety concerns, a qualitative study

“…Sonographers in Australia are subject to the National Code of Conduct for Health Care Workers but unlike practitioners registered with the Australian Health Practitioner Regulation Agency (AHPRA), no overarching governance specifically for sonographers exists. 8…”

“…Sonographers in Australia are subject to the National Code of Conduct for Health Care Workers but unlike practitioners registered with the Australian Health Practitioner Regulation Agency (AHPRA), no overarching governance specifically for sonographers exists. 8 ASAR approves courses of study in sonography, maintaining a register of accredited sonographers in Australia. To be eligible for Medicare, ultrasound examinations must be carried out by accredited sonographers.…”

“…Ultrasound examinations often involve scans of sensitive regions such as the vagina, testes and breast, at close proximity and with prolonged contact with patients. 8 Thirteen (41%) respondents appreciated that intimate examinations place patients in a vulnerable position, 'there's a feeling of vulnerability for them because they have to remove the clothing off the top half of the body' (PS13). However, even these sonographers mostly had a low perception of the risk to the patient, with sonographers placing a lot of trust in the mechanisms of informed consent and the use of chaperones in ensuring patient safety.…”

“…Intimate examinations such as testicular and transvaginal (TV) examinations pose physical and psychological risk to patients. 8 Ultrasound imaging poses infection risks for patients. 9 Furthermore, sonography practice is highly operator-dependent and the quality of the ultrasound examination is related to the operators' skill, training and experience, and there is a risk of incorrect or missed diagnoses when ultrasound imaging is sub-optimal, putting patients' safety at risk.…”

Perceptions and Willingness to Undertake Transvaginal Sonography by Women at the Sally Mugabe Central Hospital, Zimbabwe

“…A structured self-administered questionnaire with three sections and 20 questions was used to solicit information. The questionnaire was adapted from 2,6,10,11 previous studies found in the literature. Two lecturers in The Department of Radiography at the Harare Institute of Technology were asked to evaluate the questionnaire and offer suggestions for improvement.…”