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What is Sonography? – Diagnostic medical sonography is the use of high-frequency sound waves via specialized equipment to create images of internal structures in the human body for medical treatment and diagnostic purposes. Sonographers are specialists in this technology and in interpreting the results of sonograms for other healthcare professionals.
Even without any real exploration into the science of ultrasonography, we all seem to have some innate understanding of how sound waves can help us better perceive the world around us. It’s even said that in heavy fog or darkness, ancient seafarers would let out a yell or clap their hands and listen carefully for the echoes to return as a way to get a mental picture of the land and rocks around them. Even as people were already using some rudimentary forms of this sort of sonic visualization, it wasn’t until research into the use of echolocation in bats and dolphins that the science of ultrasound sonography first emerged.
Today thousands of professional ultrasound technicians carefully manipulate sound-producing and receiving transducers, using waves above the frequency of human hearing to locate and produce stunningly realistic images of the internal structures of the human body.
Not only is sonography blowing up with new job opportunities, it’s a field that’s becoming a lot more interesting all the time, in terms of both the technology and its applications.
Today, broad-band, wide aperture transducers and digital phase data produce vivid Doppler color imaging so effective and useful that they are widely used in emergency medical diagnostics, during surgeries, and even to peer into the structures of the organs of vision in ophthalmological diagnostics. All using sound.
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Sonography uses sound waves and their reflections as they propagate through the soft tissues of the body to create images for a broad range of purposes, including everything from diagnosing medical conditions to simply assessing and observing perfectly healthy pregnancies. Though it’s commonly associated with obstetrics, the technology is useful for all kinds of internal imaging as a non-invasive alternative to, or even an improvement on, exploratory surgery. Sonographers are the allied health professionals who skillfully operate the transducer and imaging equipment, recording the results for physicians to interpret.
They may be technicians first and foremost, but sonographers also have a lot of contact with patients, starting even before the sonographic exam begins. It’s this dual role at the intersection of hard technical skills and a gentle bedside manner that makes the field so unique and interesting. A typical patient visit would start with the sonographer walking the patient through basic intake processes, taking background information and recording relevant medical histories. They then configure and set up the machine to get the best readings of the internal structures they’ll be looking at that day. During the exam, they gently move the transducer across the relevant areas of the patient’s body to create a visualization of the internal structures, which are displayed live on a monitor so that interesting findings can be identified and looked at more closely. Still images of those findings are then digitally recorded so doctors can later review them.
Sonographers have a strong understanding of the anatomical structures of the body, which allows them to capture the images that would be most useful to physicians. Although they are not qualified to make medical diagnoses themselves, their deep understanding of anatomy does allow them to get a sense of whether there is something abnormal or problematic.
Clinicians rely on the wealth of imaging experience diagnostic sonographers have and often consult with them prior to interpreting the findings and to make sure the images they select for the patient’s file are the ones that most clearly reveal the issues. You can’t overstate the importance of that first-line assurance of image quality since those very same images could serve as the basis for a patient’s diagnosis and end up being reviewed by a number of different specialists up the line.
Sonographers also take on other managerial or clerical roles that can include things like preparing work schedules, evaluating equipment purchases and scheduled maintenance, or, in executive roles, managing operations and other employees in a sonography department.
Sonography has become a highly specialized skill, with both the training and the certification processes reflecting the major categories of specialization in the field. Though there are certainly generalist roles for sonographers, broadly recognized specializations deal with particular organ systems or patient populations:
- Gynecological and Obstetric
As the field expands, bringing in newer sonographic techniques and equipment designed to image these and other organ systems and body structures, you’re likely to see other dedicated certification exams and credentials becoming available over time.
Becoming a medical sonographer follows a very logical sequence, from an education that includes an internship or other field experience to earning an exam-based certification from one of two national credentialing agencies that certify professionals in the field.
You would be right to imagine that understanding the internal structures of the body and mastering the technology used to effectively view it requires a very in-depth education. No one becomes a sonographer today without at least a two-year college degree, and more commonly a three-year associate’s by the time you complete practica and internships. And for the most ambitious, you’re looking at a full four-year bachelor’s in the field. A lot of people do, however, come into the field with a background in other allied health professions, and there are shorter sonography training programs designed specifically to build on their existing knowledge and healthcare experience.
Becoming an ultrasound technician follows a very standard process that’s no different from what you find in many allied health fields and other skilled professions: 1) Complete a relevant degree or post-degree certificate program including an internship or other field experience, and 2) then go on to take a certification exam to demonstrate you mastered the knowledge and skills necessary to begin professional practice.
1. Degree and Certificate Options
Your education and training options are determined by the background you already have:
If you’re just getting started with your healthcare career and education and you haven’t gained any clinical experience yet, then you’ll be going into an associate or bachelor’s degree program in general diagnostic medical sonography or one with a specialized curriculum in an area like cardiac or vascular sonography.
- Associate Degree– Two and three-year AS and AAS programs are the most common degree option in the field.
- Bachelor’s Degree– With about 90 accredited four-year sonography programs across the country, bachelor’s degrees are becoming a popular option.
If you already have a healthcare related degree and some clinical experience under your belt, you can add to that with a post-degree certificate in diagnostic medical sonography or a specialized area like cardiac or vascular sonography. If you’re a healthcare professional who already has an associate’s or bachelor’s in another allied health field, then a post-degree certificate or diploma is what you’re after.
All of these options would include a significant field training or practicum component that puts out in the clinical environment using the skills and knowledge you developed in the classrooms and labs of your training program, but while still getting all the benefits and learning that come from supervision and guidance from people who have been working in the field for years. For a lot of students, that field experience turns into a full-time position with the clinic.
2. Professional Credentialing: State Licensure and National Certification
Licensing in the healthcare professions typically comes into play only with roles in which there is some potential for harm to come to patients if procedures aren’t carried out correctly. But because the gentle and noninvasive nature of diagnostic medical sonography makes that extremely unlikely, most states don’t feel the need to have any licensing requirements in place for ultrasound techs.
That is something that could change over time as the scope of the field expands and more and more technical and diagnostic expertise is expected of them, but to date only these states require ultrasound techs to hold a state-issued license:
- New Hampshire
- New Mexico
- North Dakota
Employers still need to know they are hiring technicians with the right kind of know-how to be a strong addition to their teams. In the absence of state licensing, that means almost every position will require an exam-based professional certification from either the American Registry for Diagnostic Medical Sonography (ARDMS) or Cardiovascular Credentialing International (CCI). Even states that do require licenses base their requirements on the same training standards and exams these certification agencies use.
Certifications like these play much the same role as a license in that they signify proof that the certified professional has the technical and ethical training, as well as the knowledge of anatomy and medical terminology they need to be able to perform the job correctly and safely. The one primary difference is that these types of credentials are nationally-recognized by employers from coast to coast.
Not to be confused with an academic certificate training program, professional certifications require you to have the right education behind you just to be eligible to take the exams required to become certified. These exams include a general technological knowledge test on sonographic principles and equipment, but also rigorous specialty exams that are specific to the current practices and procedures in your chosen area of expertise. There is more than one way to meet the requirements, with options that include combining education and experience in related professions.
Despite the rigorous nature of earning ARDMS and CCI certifications, you’ll find yourself to be a better prepared and better paid ultrasound tech after you’ve earned one.
Choosing the right medical sonography program doesn’t have to be complicated, and it shouldn’t be.
Start by 1) simply getting familiar with the three primary education options and determining which one fits your situation, then 2) move on to learning how to verify the quality of the programs available to you by making sure they’re accredited, and finally 3) give some consideration to the extras that might be important to you, like whether or not the program is offered online.
Which level of training is right for me?
An associate’s is a solid option for career-focused high school grads just getting started and looking to get into the field quickly and with minimal expense. Associate’s degrees in sonography are designed as associate of science (AS) or associate of applied science (AAS) programs. The AAS is more career-oriented and includes fewer general education classes that are typically required for the degree to be considered transferable to a four-year degree. That means that an AS is what you want if you hope to continue your education and earn a bachelor’s degree at a later point.
If you’re just out of high school and you’ve already budgeted for the time and expense of a college education, then a bachelor’s degree is the perfect option for you. Four-year degree programs in sonography are becoming more and more common as the field becomes more complex, and as employers place more responsibilities in the hands of sonographers. As a public-facing role, and one that involves working side-by-side with MDs and specialists, a bachelor’s is also a great way to tune up communication skills and professionalism with an education that includes all the math and science courses you’ll ever need, along with a dose of liberal arts curriculum.
If you already have a degree and some experience in an allied health field, a certificate will provide a quick and efficient way to tack on some sonography skills. Alternatively, if you already have a bachelor’s in diagnostic medical sonography, certificate programs are a great option for specialization. Some hospitals even offer this kind of training to employees in-house, so if you’re an existing ultrasound tech looking to specialize or a respiratory therapist, surgical tech, or other allied health clinician looking to add skills or change careers, it’s worth checking with your employer to see what options are available to you. Even if no employer-sponsored in-house programs are available, you’ll have no problem finding one online or at your local community college. These programs are mostly one to two years in length, and in some cases run parallel to the school’s associate’s degree in sonography, with the only difference being that you won’t be retaking the basic college courses that are part of the AS.
Does the program hold CAAHEP accreditation?
The number one consideration right behind figuring out the degree level and educational path that’s right for you, is finding a program you can feel confident will give you the depth of knowledge, hands-on training and experience you need to pass your certification exams and perform the job. That means going with a program that has been accredited by CAAHEP, the Commission on Accreditation of Allied Health Education Programs.
CAAHEP is the same organization that grants accreditation to top-quality degrees and other training programs for dozens of other healthcare professions, from anesthesiology techs to surgical assistants, and is one of the preeminent standards bearers for quality in healthcare education.
CAAHEP accreditation helps ensure you will get the right kind of curriculum, practical training and classes in medical ethics you need to become certified. In fact, the primary route to qualifying for ARDMS and CCI exams is to complete a CAAHEP-accredited program.
Even beyond that, though, accreditation is the stamp of quality that tells you you’ll be learning under experienced and caring instructors and getting access to the best clinical practicum placements in your area, along with career counseling and support when it comes time to transition into the work force.
Is the program offered in the specialty area I’m interested in?
You’re always going to need a program that comprehensively covers the latest technologies and techniques, but you also need one that aligns perfectly with your career goals. If your plans include going into a particular specialty, that means your next consideration will be to make sure the school you’re interested in offers it as an option. Although you can specialize in other areas through experience, self-study and passing the right certification exam, you’ll find virtually all degree and certificate programs offered in these categories:
- Diagnostic medical sonography
- Gynecological and Obstetric
- Pediatric cardiac
You can expect any accredited program to offer basic courses in all of the different applications of ultrasound, giving you a good overview of the subject with courses in diagnostic critique and pathology, sectional anatomy, physics of ultrasound, and advanced sonographic principles, even as you concentrate on a particular specialty. Many sonographers appreciate the ability to switch or add specialties through additional certifications later in the career, whether as a way to ride the wave of the latest trends in demand or just for a change of scenery.
Hands-on education is important in sonography, so you want to consider what kind of practicum placements you can expect based on the types of specialty clinics in your area the school partners with. The idea is to make sure you will be exposed to a good representative sample of the right kinds of cases to get a good depth and breadth of real-world experience in your specialty.
Is the program available partially or entirely online?
For years, the trend has been toward offering any curriculum that doesn’t actually involve hands on training and lab work online. That trend dramatically accelerated in 2020 as a result of the COVID-19 pandemic.
Online programs have always been an excellent choice for anyone who would have difficulty relocating for school or who is busy holding down a regular full-time job, and these days it that’s not only a convenient option, but in some states a necessary one too.
The asynchronous coursework makes it easy to complete classes on your own timeline, but naturally some in-person attendance will always be necessary for the hands-on training, and of course, the practicum.
Ultrasound Technician Training Options
When it all boils down, there are two paths to getting training in diagnostic medical sonography or another specialized area of ultrasound: one for people brand new to healthcare without a college degree who have the option of earning an associate or bachelor’s degree in ultrasound technology, and another for current healthcare professionals interested in adding a certificate in ultrasound technology on to an existing healthcare related degree.
Associate Degree – Two and three-year AS and AAS programs are offered at private schools and community colleges. As the most common degree option in the field, associate’s programs make up a significant majority of all accredited diagnostic medical sonography programs nationwide. It’s noteworthy that many are designed as transfer degrees (AS), which points to the inclination in the field to design programs with a curriculum that is easily transferrable to a bachelor’s degree later on. There are also lots of Associate of Applied Science (AAS) options, which are designed as technical career preparation programs that typically involve less in the way of general education courses. This means they can often be completed in less time. Applied programs don’t usually allow you to transfer your credits to a bachelor’s, so this is something you definitely want to be aware of when making your selection and considering your long-term education plans.
Bachelor’s Degree – With about 90 accredited four-year sonography programs across the country, bachelor’s degrees are making up a growing segment of career preparation programs in diagnostic medical sonography. And there’s a good reason for that; as the technology advances and the applications get broader, it’s only natural that a lengthier course of training would be required to cover it all. When you consider that many associate’s degrees in the field actually run three years rather than the two years typical of an associate’s, it’s not a huge leap to choose a bachelor’s instead. Offered at both traditional colleges and some of the most esteemed university hospital medical centers in the country, you don’t have to look far anymore to find a topflight bachelor’s in general, vascular or cardiac sonography.
Post-Degree Certificate – Any training program that runs less than a couple of years would be insufficient to prepare for a career in diagnostic medical sonography – unless that program is designed to build on preexisting education and experience in healthcare. That’s exactly what ultrasound certificate and diploma programs are designed to do. The more highly focused curriculum found in these types of programs assumes some basic knowledge of medical science and terminology and a working understanding of the clinical environment, making them ideally suited for nurses and allied health professionals like respiratory therapists, and surgical techs and assistants. If you already have an associate’s or bachelor’s in another allied health field and you’re looking to add diagnostic sonography skills to your repertoire, or change directions in your career entirely, then a post-degree certificate or diploma is your ticket.
Areas of Focus for Medical Imaging Training
All of these training options in diagnostic medical sonography will include some coverage of all the major organ systems and soft tissues of the body. Some programs even offer a focus that gives you a chance to hone your skills in a specific area of the body or with a particular patient population group. Stepping into a generalist role in diagnostic medical sonography is definitely an option, but you’ll also find lots of opportunities to become certified and find work in the exact niche that interests you:
- Abdominal – Many of the most important organs in the body are found in the abdominal cavity, and specialists in this area of ultrasound are experts in capturing images and detecting anomalies for all the organs located here, with a typical focus onthe gallbladder, bile ducts, kidneys, liver, pancreas, spleen and the male reproductive system.
- Breast – Dealing strictly with mammary tissue and underlying vascular structures, breast sonography is used to track tumors, monitor blood supply conditions, and perform general exploratory diagnostics before and after the biopsy of breast tissue, however, it is not effective in identifying or diagnosing breast cancer.
- Vascular – The circulatory system has unique characteristics in different parts of the body, and vascular sonographers specialize in capturing the images that help cardiologists identify blockages by capturing images of the peripheral veins and arteries exclusively, but not the heart.
- Cardiac – Properly understanding the mechanisms and anatomy of the heart and surrounding ventricles, let alone capturing useful sonographic images is such a complex matter that it warrants its own specialty area separate from the rest of the vascular system. With heart disease being the number one cause of disease related death in the U.S., echocardiographers who deal primarily with imaging of the heart, hold a very important place in the American healthcare system.
- Gynecological and Obstetric – The popular understanding of the profession lands squarely on its long-standing use in obstetrics and other gynecological diagnostics. This is the type of work that comes to mind for most people when they think of sonography, and is the one area of practice where ultrasound isn’t necessarily used just to diagnose a problem, but instead is just a normal part of routine prenatal care and observation. Many in this area of practice specialize further in fetal echocardiology.
- Musculoskeletal – Augmenting and supplanting traditional x-ray technology, these sonographers work primarily in orthopedic and sports injury clinics using sonographic imaging to visualize muscles, nerves, and joint structures, including connective tissues like ligaments, tendons, and cartilage to better understand injuries that aren’t visible to the eye.
- Pediatric – Dealing with both fetal imaging and patients in early childhood, the pediatric area of practice can involve any of the other types of sonographic specialties, with the additional challenge of having to visual very tiny organs and systems. Some in this area specialize further in pediatric echocardiography.
- Neurosonography – Using frequencies, beam shapes, and specially designed Transcranial Doppler (TCD) transducers and other equipment different from what you’d find in any other area of sonography, neurosonography involves capturing images of the brain and nervous system. ARDMS offered certification in this area at one time, and allows anybody grandfathered in to keep it active until 2021, but at this time no national certification options are available for anybody entering the field.
You get a pretty clear picture of how you’ll fit your career goals and the area of practice you’re most interested into these general categories of specialization by looking at the specialty certifications available through ARDMS. Specialty certification builds on existing sonographic knowledge, skills and experience, so only sonographers who are already either RDMS or RDCS certified can achieve these specialized credentials:
- Registered Diagnostic Medical Sonographer (RDMS)
- Fetal Echocardiography
- Obstetrics & Gynecology
- Pediatric Sonography
- Registered Diagnostic Cardiac Sonographer (RDCS)
- Adult Echocardiography
- Fetal Echocardiography
- Pediatric Echocardiography
Aside from the specialty credentials available to RDMS and RDCS holders, ARDMS also offers separate certifications for vascular technologists as well as sonographers whose primary focus is the musculoskeletal system:
- Registered Vascular Technologist (RVT)
- Registered Musculoskeletal Sonographer (RMSKS)
Job Growth for Diagnostic Medical Sonographers
The latest data coming out of the Bureau of Labor Statistics in 2019 shows that a full 60% of sonographers work in hospitals, 21% staff clinics and physicians’ offices, and 11% work in medical and diagnostic laboratories. For cardiovascular technicians, almost 80% work in hospitals while 12% are found in clinics or physician’s offices.
Healthcare jobs in the United States in any setting are going through an unprecedented boom that isn’t likely to end anytime soon. An aging population, new healthcare treatment options and technologies, and a wave of retirement from Baby Boomers transitioning out of the healthcare workforce all feed into the wave. According to the Bureau of Labor Statistics, during the period from 2018 to 2028, healthcare occupations overall will experience a 14% growth rate.
The BLS predicts that diagnostic medical sonographers, a category that includes related ultrasound positions like vascular and cardiovascular technologists, will mirror that growth exactly, adding 14% more jobs between 2018 and 2028, a lightning-fast rate of growth not seen in many other fields.
Ultrasound Technician Salary Potential
And not only can you expect a lot more sonography jobs to open up in the future, but these are positions that pay well too. For 2019, the median pay for the segment according to BLS was $68,750 per year, or $33.05 per hour. But those in the top ten percent of the profession, with the highest level of education, experience, and training, brought in six figures, at more than $102,060!
Salary offers are not pinned to one scale in every location or specialty. For example, outpatient care centers have relatively fewer sonography positions available, but offer a median salary of $90,000 per year, near the top end of the profession. Diagnostic laboratories, on the other hand, pay a median closer to $70,000, consistent with the pay typical of the profession overall.
Geographic differences are also big in the industry, and often to your advantage. California, for example, has the highest level of employment for sonographers in the nation, so there are many job openings, but it also delivers as the second highest paying state, with an average annual salary just over $100,000.
Working one-on-one with patients while commanding a high salary level and engaging in extremely technical and interesting work keeps medical sonography interesting. At the same time, the field is accessible, with education requirements that are strict, but not overwhelming. That magic combination of accessibility, big paydays, and tremendous variety in practice options, all in a job that is critically important and that plays a role in really improving peoples’ lives, makes ultrasound technology one of the hottest professions in healthcare today.