Confusion about whether to use "ultrasound" or "sonography," "sonographer" or
"ultrasound tech," has done the profession a disservice.The following is the
unedited version of the manuscript submitted, including references. The version
referenced above was edited.
Sonography what is it? Words are golden.
Diagnostic sonography exploded into public consciousness in the early 1970s with
the amazing ability to look into the world of prenatal development. Even with
an ever growing work force of diagnostic sonographers, however, as an
occupation the profession continues to lack cohesion.
Sonography has continued to move into every area of the hospital and clinic.
Sonography was quickly adapted by many specialties: cardiology, vascular
medicine, ophthalmology, obstetrics and gynecology, as well as radiology. Even
psychiatry has used sonography to distinguish neurological perfusion problems
from other brain maladies.
Historically, ultrasound was the word used to identify the modality.
Originally the word ultrasound was used as a noun to identify acoustic
energy with a frequency above the average human’s hearing. Later the use of ultrasound
as a noun was expanded to include the images and procedures, as in “I am
going to perform your ultrasound.” Ultrasound also became a verb, as in
“please ultrasound Ms. Jones’s gallbladder”.
In early weeks in 1976 when we received the first sonographic machine in the
hospital, there was some confusion over the term ultrasound . The
Radiology Department was getting patients who were supposed to go to physical
Therapy for therapeutic ultrasound; and the physical Therapy Department was
getting obstetrical patients who were supposed to be coming to Radiology for
diagnostic examinations. In 1969 a small group of sonographers-to-be gathered
at an american Institute of Ultrasound in Medicine (AIUM) meeting and decided
to form the american Society of Ultrasound Technical Specialists (ASUTS)…
pronounced by some as “ASS-UTS”. In 1976 the name was changed to the Society of
Diagnostic Medical Sonography (SDMS), and the term sonography was
coined, resulting in the birth of sonographer, sonologist, sonographic, and
sonogram. Joan p.Baker, the “Mother of american Sonography”, states
that she had suggested the term sonography out of the term SONaR and a
term used in Great Britain, radiographer.
“Because the occupation was so new, Baker, Nuss, and Staiano were determined to
establish higher standards than those of most other allied health professions.
as they discussed the mutual difficulty they were experiencing in establishing
the term ‘technical specialist’, they agreed that the lack of success stemmed
from the inability to prevent the use of the terms technician and technologist.
Because the Registry was still in an embryonic stage, they seized the
opportunity to adopt a new title. as a result of this, the Registry became the
american Registry of Diagnostic Medical Sonographers (ARDMS). This action sent
another message to the AMA – that we were indeed what we claimed and that we
were serious about setting and maintaining high educational standards.”1
The noun, sonogram, is more grammatically correct, in my opinion, than ultrasound
for describing an image made using ultrasonic energy. To call such an image
an ultrasound is analogous to calling a photograph a light because it is
made using reflected light. It also follows that “Sonographer” is
better than “ultrasonographer”, or, heaven forbid, “ultrasound tech”.
Sonography is the most operator dependant diagnostic modality in modern
medicine, and that difference has not received the attention that it deserves.
Sonographers are really sonographic anatomists. The sonographer
must be able to recognize normal anatomy, or they will never recognize
abnormal; thus providing relevant, focused images used for diagnosis. The
american Labor Relations Board defines a professional as one who has advanced
education, has had specialized internship, and uses their judgment to perform
tasks that cannot be performed in a specified time frame.
“NLRB Rules and Regulations [page 251-290] NATIONAL LABOR RELATIONS ACT also
cited NLRA or the act; 29 U.S.C. Sec. Sec. 151-169 [Title 29, Chapter 7,
Subchapter II, United States Code] findings and policies Section 1.
(12) The term ``professional employee'' means-- (a) any employee engaged in work
(i) predominantly intellectual and varied in character as opposed to routine
mental, manual, mechanical, or physical work; (ii) involving the consistent
exercise of discretion and judgment in its performance; (iii) of such a
character that the output produced or the result accomplished cannot be
standardized in relation to a given period of time; (iv) requiring knowledge of
an advanced type in a field of science or learning customarily acquired by a
prolonged course of specialized intellectual instruction and study in an
institution of higher learning or a hospital, as distinguished from a general
academic education or from an apprenticeship or from training in the
performance of routine mental, manual, or physical processes; or (b) any
employee, who (i) has completed the courses of specialized intellectual
instruction and study described in clause (iv) of paragraph (a), and (ii) is
performing related work under the supervision of a professional”2
The confusion for the public about whether it is ultrasound or sonography,
sonographer or ultrasound tech has done the profession a
disservice. The lay-person, and even many medical professionals, do not
understand the sophisticated process that is sonography. It is different from
simple “eye-hand coordination”. When a couple has an obstetrical sonographic
study, they see the sonographer simply slide the “plastic thing on a cable”
over the abdomen and these recognizable images appear on the monitor. There are
even nurses and physicians who watch this process in the hands of a skilled
sonographer and think, “I know anatomy, I can do this”, but they do not realize
the complex cognitive and psychomotor skills that the sonographer must have to
make it look simple. This problem is compounded by the fetal studios springing
up in malls, often operated by the uneducated and unwashed that do not know
anatomy and do not care because they are “nonmedical”.
Many often do not understand that there is a cybernetic process in which the
sonographic instrument enters into the sonographer’s eye-hand neural loop,
extending the sonographer’s vision and hearing beyond the skin surface. as the
operator observes the image on the monitor, the brain directs the hand’s
motions, the direction, angle, rotation, and how subtle to make the movements
of the transducer. a complex graphic workstation is actually between the eye
and the hand, and requires an accomplished knowledge of the three-dimensional
anatomy and the physics of how sound interacts with human tissue to be
successful as a sonographer. as students learn the anatomy, and their
psychomotor skills are developed they quit looking at their hand and focus
their total attention on the monitor in order to analyze the anatomy and
mentally direct their scanning hand. Sonographers are highly skilled
anatomists. This fact has been recognized since the earliest days of sonography
as pointed out in 1982 by the late Dr. Kenneth Taylor of Yale University.
“".... There is a very important difference between sonographers and other
imaging technologists. Other technologists may reject an image because of
sub-optimal technical quality, but the sonographer usually rejects over 95% of
the scans because they do not provide the diagnosis. The sonographer must make
the diagnosis and be able to interpret the scan to document the presence of any
abnormalities. This is the unique responsibility of the sonographer." Ken
Taylor, Yale University, in the Nov/Dec., 1982, issue of the SDMS Newsletter.”3
The sonographer’s role and the requirement that they exercise independent
judgment and have a responsibility in diagnosis have continued to be
acknowledged by many medical luminaries. For the following and additional
quotations from medical experts about the sonographic profession see:
"Many ultrasound examinations are performed by technologist [sic] when a
physician is not present, and a report is issued by a physician at a later
time. The legal responsibilities are extraordinary because a necessary part of
care may involve rendering an interpretation at the time the study is
performed, especially if real-time instrumentation is used. This differs from
the relative roles of technologists and physicians in other imaging
“Diane, I have studied all of the major imaging technologies over the last 25
years -- CAT scanning, magnetic resonance imaging, angiography, and nuclear
medicine. all of these technologies are very complicated in their own right.
But among those, there is no question in my mind that ultrasound is the most
difficult to learn.” Roy Filly on ABC Primetime Live; January 14, 1998.5
The required focus on the image and anatomy while scanning becomes a problem in
large institutions with many different models of sonographic machines. The fact
that an intimate knowledge of the machine is required in order to adjust the
many controls and optimize the image, WHILE SCANNING, means that
fumbling with the controls makes the machine a barrier between the operator and
patient. For this reason the best sonographers are intimate with the
sonographic equipment they operate. When an individual tries to scan on the
various models with which they are not familiar, the machine is a barrier even
if she/he is skilled with a different model. If a physician skilled with the
sonographic machine in their office tries to scan in a large hospital, with
many different pieces of sonographic equipment, they often end up fumbling with
the controls and losing their focus. The fact that physicians generally do not
like to appear as though they do not know what they are doing means the process
can affect their judgment. This means that the most skilled sonologist will ask
a sonographer to operate unfamiliar machines while watching and discussing the
case as the sonographer scans.
There are two issues here. One is the knowledge and skills that are required for
successful sonography, and the other issue is, "Does it matter what the process
and those who perform it are called?" Some would propose that, “Sticks and
stones may break my bones, but words will never hurt me.” Others will quote
Shakespeare, “"What’s in a name? That which we call a rose by any other word
would smell as sweet". There is some truth in both of these quotations.
However, if you call a florist and order chrysthanthemums, I’ll wager that you
will not get sweet smelling roses.
The issue of whether words can harm a sonographer is more complex because it
requires some discussion of linguistics. Basically words are used as symbols by
people to organize and communicate thoughts about concepts, things, and
feelings. If we are not precise with the words that we use, then those
listening to us will interpret our meaning with what they believe we told them.
as one of my mentors used to say, “You may think you understand what I said,
but what you don’t understand is that I did not say what I meant.”
We think with words, words have meaning, and what we think will eventually
become our reality. “Linguistic Determinism refers to the idea that the
language we use to some extent determines the way in which we view and think
about the world around us.”6 When administrators, legislators, and the public
think about sonography, they need a specific term and definition in order to
understand the object of the thought. If they do not understand the operator
dependency of sonography, they tend to think of it as simple technology. This
will effect how they set pay scales, write laws, and communicate about the
profession of sonography.
If sonographers do not use these terms correctly, then its likely that no one
else will either. We need to insist that publications, employers, and the
public use the proper terms when referring to our profession. Hospital and
clinic signage should say “Sonography (Ultrasound)” as so many currently
have signs that say “Radiology (X-Ray).” The accurate use of these words
does make a difference in how people will think about our profession. It is
this specific linguistic use of terms that makes doctors want to be called
“Doctor”, and nurses want to be called “Nurse”, and the reason corporations
trademark their product names. It is a matter of “branding” so that the public
knows specifically what a name means.
The term ultrasound has a place in history and physics; but ultrasonographer
is a mouthful, and ultrasound tech or just tech become the less
difficult, yet inadequate terms for describing our complex profession. While sonographer
is not as simple as tech, it is unique and specific to our profession
and communicates clearly that sonographers are not “techs”. Sonography and
sonographer are in all modern dictionaries, even though the terminology
is often currently given second place to ultrasound, and ultrasonographer.
It is the task of those in the sonographic profession to exploit every
opportunity to communicate clearly and educate the public and medical community
about who we really are… it will make a difference to our profession in the
Author: Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
Terry is Director, Division Diagnostic Medical Sonography & DMS program and
Associate Professor in the College of Health Related Professions, University of
Arkansas for Medical Sciences. Terry's on-line CV can be accessed
- Joan Baker; Society of Diagnostic Medical Sonographers: Focus on the Future –
A History of SDMS’ First 25 Years; SDMS/Lippincott-Raven 1995, p. 2-17.
NLRB Rules and Regulations [page 251-290] NATIONAL LABOR RELATIONS ACT
also cited NLRa or the act; 29 U.S.C. Sec. Sec. 151-169 [Title 29, Chapter 7,
Subchapter II, United States Code] findings and policies Section 1. [Sec.
http://www.nlrb.gov/nlrb/legal/manuals/rules/act.asp, accessed June
- Kenneth Taylor; Yale University, SDMS Newsletter, Nov/Dec., 1982.
James A E, Bundy A L, Fleischer A C, et al; "Legal Aspects of Diagnostic
Sonography" in SEMINARS in ULTRASOUND, CT and MR; Grune & Stratton, Inc.,
6:209; June, 1985.
PrimeTime Live, “Sound Advice” National Headliner Awards: Investigative
Reporting First Place: ABC News - Prime Time Live; Diane Sawyer and Dr. Roy
Filly of the University of California in San Francisco.
http://www.uams.edu/chrp/sonography/DMSQuotations.asp accessed May 15, 2006.
Linguistic Determinism: A Definition;
http://venus.va.com.au/suggestion/sapir.html accessed May 14, 2006.