Table 2

Thoracic ultrasound competency levels

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.

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.

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.

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.

  • CXR, chest X-ray; DOPS, direct observation of procedural skills; TUS, thoracic ultrasound.