ICUS Review Debunks Common Myth That “State Law” Bans Sonographer Administration of Ultrasound Contrast Agents

CHICAGO--(BUSINESS WIRE)--A comprehensive review of statutes and regulations across all 50 states and the District of Columbia challenges a common misconception that “state laws” prohibit trained and credentialed sonographers from placing intravenous (IV) lines and administering ultrasound contrast agents for contrast-enhanced ultrasound (CEUS) examinations, according to a new report released today by the International Contrast Ultrasound Society (ICUS).

The report examines state laws and regulations governing sonography and related healthcare professions in an effort to better understand the legal landscape surrounding administration of ultrasound contrast agents, also known as ultrasound enhancing agents.

The report notes that some healthcare institutions maintain internal policies that prevent trained and credentialled sonographers from starting IV lines or administering ultrasound contrast agents, possibly due to a misunderstanding of “state law.”

The ICUS review found that most states do not regulate the practice of sonography. Instead, states generally rely on national credentialing organizations and professional societies, such as the Society of Diagnostic Medical Sonography (SDMS), to establish educational standards, competency requirements and scopes of practice for sonographers.

The report notes that the current SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer authorizes trained sonographers to perform venipuncture and administer ultrasound contrast agents under appropriate supervision.

The report did not address state nursing board rulings and scopes of practice that authorize nurses to place IVs and administer contrast. The report said nursing boards generally do not have the expertise or authority to regulate the scope of practice of other professions.

The review concludes that the absence of sonography-specific laws in most states should not be interpreted as a legislative ban on the performance of tasks within a sonographer’s nationally recognized scope of practice.

"If legislative silence is interpreted as a prohibition, sonographers would not be able to perform their jobs in most states,” said Dr, Jordan Strom, an ICUS board member who helped facilitate the study. Dr. Strom is an Associate Professor of Medicine at Harvard Medical School, Director of the Echocardiography Laboratory at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and Co-Director of the Center for Clinical Outcomes Research at the Richard A. and Susan F. Smith Institute for Evidence, Innovation, and Policy.

ICUS undertook the review after hearing repeated concerns from sonographers, physicians and patients that CEUS examinations are sometimes delayed or denied when individual hospital policies do not allow trained, credentialled sonographers to place an IV or administer contrast, and nursing staff may be unavailable to do so in a timely manner.

"Our review challenges the widely repeated notion that ‘state law’ prohibits trained sonographers from administering ultrasound contrast agents," said Dr. Strom.

"In many cases, patients may be missing out on timely access to CEUS because of institutional policies rather than actual legal requirements," he added.

The study identified at least four states that affirmatively permit trained sonographers to place IV lines and administer contrast agents. Ohio authorizes the practice by statute while New Hampshire, New Mexico and North Dakota incorporate the national sonography scope of practice into state regulations.

Perhaps most significantly, investigators found no state statute expressly prohibiting trained, credentialed sonographers from placing IV lines or administering ultrasound contrast agents.

"This is an important finding for hospitals, imaging centers and physician practices that want to expand patient access to safe, reliable and affordable CEUS imaging,” said Dr. Richard Barr, an ICUS board member, professor of radiology at Northeast Ohio Medical University, and editor-in-chief of Journal of Ultrasound in Medicine.

Although states generally do not regulate the practice of sonography, many states have detailed regulations governing the scope of practice of radiologic technologists and radiologist assistants. According to the report, those regulations may reflect legislative concerns regarding exposure to ionizing radiation, issues that do not apply to ultrasound imaging or ultrasound contrast agents.

The report also notes that some states regulate contrast administration by certain healthcare professions.

"Healthcare organizations should review their policies carefully and ensure that they are aligned with current professional standards and the best interests of patients,” said Dr. Michael Main, an ICUS board member, professor of medicine at the University of Missouri-Kansas City, President of Saint Luke's Physician Group, and Chief Clinical Officer for BJC Health System (West Region).

Contrast-enhanced ultrasound uses intravenously-administered microbubble contrast agents to improve visualization of blood flow and tissue perfusion, helping physicians detect, characterize and monitor cardiovascular disease, liver disease, kidney disorders, cancer and other conditions. CEUS provides real-time imaging without exposing patients to ionizing radiation and can often be performed at lower cost than alternative imaging examinations.

The report was prepared by an interdisciplinary team including legal and medical professionals. Contributors included Linda Feinstein and Eugene Giudice of Dentons US; Norah Guenthner of New York University; and Dr. Strom.

ICUS emphasized that state laws and regulations may change over time and that healthcare providers should evaluate applicable requirements in their individual jurisdictions.

About ICUS

The International Contrast Ultrasound Society (ICUS) is a nonprofit medical society dedicated to advancing the safe and medically appropriate use of contrast-enhanced ultrasound (CEUS) worldwide. Through education, research and advocacy, ICUS works to improve patient access to CEUS and promote best practices in the use of ultrasound contrast agents.

For more information, visit www.ICUS-Society.org.