| Emergency-level TUS operator |
Completed an introductory thoracic ultrasound session and has a basic understanding of ultrasound machines and examinations. Logbook of five normal thoracic ultrasound and five large pleural effusions of more than 5 cm depth. Satisfactory summative DOPS* to identify thoracic and abdominal cavity structures (diaphragm, lung, heart, rib, liver, spleen and kidney). Satisfactory summative DOPS* to identify a large pleural effusion >5 cm depth and to guide intervention.
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| Basic-level TUS operator |
Completed a structured thoracic ultrasound course and has a basic understanding of ultrasound physics, modes of ultrasound, anatomy of thoracic cavity and simulated experience. Ability to identify small pleural effusions and complex/septated pleural effusions. Ability to identify gross malignant pleural nodularity, for example, diaphragmatic nodularity. Ability to identify consolidated and atelectatic lung. Ability to assess lung sliding. 2x satisfactory summative DOPS in a ‘challenging USS case’. Examples of this include: small pleural effusion on CXR, consolidation versus collapse versus effusion on CXR and loculated effusion on CXR/CT. Logbook of procedures including more than 60 ultrasound procedures including normal scans, pleural effusions and identification of sites for intervention. The logbook should include minimum of 10 thoracic ultrasounds of small effusions <5 cm, complex/septated effusions, pleural nodularity or consolidated/atelectatic lung.
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| Intermediate-level TUS operator |
Minimum of 2 years’ experience as a basic-level TUS operator. Ability to detect A-lines and B-Lines in lung ultrasound. Ability to identify and assess pleural thickening. Ability to assess diaphragm function on ultrasound. Ability to perform real-time pleural aspiration and chest drain insertion when required. Ability to use ultrasound help guide site for indwelling pleural catheter insertion (scanning patients in lateral decubitus position). Annual review and appraisal of practice including standardised outcome measures.
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| Advanced-level TUS operator |
Advanced thoracic ultrasound practitioners who performs minimum of 100 thoracic ultrasounds per year. Ability to perform real-time image-guided pleural biopsy. Ability to use M-Mode, colour and Doppler in appropriate setting. Annual review and appraisal of practice including standardised outcome measures.
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