Breast Ultrasound Certification FAQ | ASBrS

No, you do not need to submit documentation of the required 100 breast ultrasound exams; however, keep in mind that you should maintain records for your own reference. In the application, you will be required to attest to the fact that you independently perform no fewer than 100 breast ultrasound exams per year, with review of a minimum of 100 mammography exams annually.

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Fellows applying for candidate certification must submit a signed log of a minimum of 30 diagnostic and 10 interventional breast ultrasound procedures performed over the last 12 months. Fellows may utilize the ASBrS procedure log, the ACGME rotation report, or similar tracking document that has been validated by their program director.

Applicants are required to submit 3 diagnostic ultrasound procedures and 3 interventional ultrasound procedures. Please see the Breast Ultrasound Clinical Case Requirement Chart for further details regarding case submission criteria.

Fellows applying for candidate certification are required to submit one diagnostic and one interventional procedure, personally performed and documented or be co-signed by attending.

A minimum of 15 AMA-PRA category 1 CME credits in breast ultrasound is required for certification. Of these, a minimum of 7 AMA-PRA category 1 CME credits in breast ultrasound must be obtained during the 18 months prior to submission of the application. You must document successful completion of no less than 1 full-day course, including a didactic portion on the principles of ultrasound as well as a "hands-on" portion demonstrating ultrasound-guided procedures.

Fellows may utilize attendance at the ASBrS fellows breast ultrasound course to meet the all-day with hands-on element of the CME requirement.

Yes, you must submit documentation of your required CME credit hours with your completed application.

Fellows applying for candidate certification are not required to meet the CME requirement. The CME criteria will be required with the second and full certification step of the process.

The Society offers pre-meeting breast ultrasound courses at our Annual Meeting and occasionally offers regional courses during the year. Our Annual Meeting's General Session offers approximately 2-3 hours of breast ultrasound CME as well.

The American College of Surgeons and several other organizations offer breast ultrasound CME that also meet the requirements. Some online category I CME in breast ultrasound is also acceptable as part of the total 15 credit hours.

Fellows may utilize attendance at the ASBrS fellows breast ultrasound course to meet the all-day with hands-on element of the CME requirement.

Cases may be submitted from fellowship training only if the images were personally acquired and independently interpreted by the applicant. In addition, the applicant must have made the final independent disposition for the patient based on the imaging findings.

Current Fellows or those out of fellowship within 12 months may elect to pursue the Fellows certification track for additional flexibility as they await board certification.

Surgeons can easily accumulate diagnostic ultrasound experience even if they have not performed the initial ultrasound on the patient. Diagnostic images obtained at the time of an interventional procedure as well as images obtained by the surgeon to confirm the finding of an outside ultrasound can be counted in the total. The surgeon is encouraged to document his or her independent interpretation of the findings, impression and recommendation based on his or her own images obtained. The surgeon's diagnostic ultrasound does not need to be the initial ultrasound for the patient nor does the patient need to be billed for the additional study for it to count as one of the 80 annual diagnostic ultrasounds.

Two orthogonal images of the lesion, either radial/anti-radial or transverse/sagittal (longitudinal) are required. Each image must have annotation either in text or on icon regarding the side, location (clock position), and transducer orientation. Distance from the nipple must be in text. The lesion should be measured in at least 2 dimensions.

At some point, our Sterile Processing (SP) Departments must say goodbye to the old and hello to new and updated capital equipment. We see this quite often when it comes to ultrasonic washer-disinfectors. Facilities are limping by on outdated ones that don’t have the necessary capacity. It is likely no longer meeting the demands of your growing case volumes and complex instrumentation.

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In this write-up, we’ll walk through the types of ultrasonics available, examine your asset-to-need ratio, and outline steps to help you secure capital equipment approval from decision-makers.

Types of Ultrasonics to Consider

According to AAMI ST79/ 7.6.4.3.3 on selecting mechanical and disinfection equipment, there are various types of ultrasonic cleaners, each suited to different reprocessing needs:

1. Ultrasonic Cleaning Equipment: Standard units that use ultrasonic waves to clean instruments.
2. Ultrasonic Irrigators: Specialized for flushing narrow lumens and complex devices.
3. Ultrasonic Irrigator Washers: Combine cleaning and irrigation functions.
4. Ultrasonic Irrigator Washer-Disinfector: Adds disinfection capabilities, offering a more complete cleaning process.

The right ultrasonic washer-disinfector depends on your facility’s needs. A high-volume surgical center with orthopedic and robotic procedures will have different requirements than an outpatient surgery center with lighter caseloads.

1. Understanding Your Asset-to-Need Ratio

Determining the best ultrasonic washer for your department means assessing your current and future needs. A few factors to consider:

• Surgical Volume and Case Types: How many cases do you handle daily? A facility with ten or more ORs and 50+ daily cases may need a larger unit with higher load capacities. Conversely, lower-volume facilities might find a compact model sufficient.

A term often used in our industry is throughput, which is defined as " the amount of material or items passing through a system or process.”  Larger units with higher throughput need more room. Some are wider to accommodate more or longer instruments, while others extend further from the wall. Height is also crucial for lid openings, elevators, and any vertical attachments like sprayers or backsplashes.

A compact tabletop model may be ideal for smaller SPDs with lighter reprocessing loads.

• Instrumentation: Facilities that reprocess complex or delicate instruments (like da Vinci robotic arms) will benefit from an ultrasonic unit that can handle mixed loads (cannulated, non-cannulated, orthopedic, and general surgery instruments) without causing damage or delays.
• Cycle Specifications and Water Standards: Does the ultrasonic provide thermal disinfection and use critical water in the final rinse? Meeting standards like AAMI TIR34 (5.2.1.3 on rinsing) ensures patient safety and minimizes contamination risks. Some units allow tap water rinsing, but final rinsing with critical water is crucial for instruments contacting sterile body areas to avoid endotoxins and microbial contaminants. To learn more about water quality standards, visit our recent blog https://www.skytron.com/articles/water-safety-in-device-reprocessing-understanding-ansi-aami-st/

2. Building a Case for Approval: Justifying Your Ultrasonic Washer-Disinfector

Once you’ve identified the right ultrasonic washer-disinfector, it’s time to build a compelling case for approval. Remember, leadership is focused on outcomes, so your proposal should highlight how the new equipment addresses their priorities.

1. Identify Patient Safety Risks: Describe the potential risks associated with using your current outdated equipment. For instance, bioburden could remain on instruments without a high-quality washer, posing a safety hazard and increasing liability. If you’re requesting a borescope (a video scope for inspecting lumened devices), explain how it will verify cleanliness, reduce risks, and meet manufacturers’ instructions for use (IFUs).
2. Outline the Benefits: Detail how a new ultrasonic washer-disinfector will improve department efficiency, elevate patient safety, and reduce regulatory citations. Mention specifics like reduced reprocessing times, enhanced load capacity, and improved cleaning for complex devices. These benefits align with the facility’s patient safety goals and contribute to operational efficiency.
3. Connect to Organizational Mission and Values: Frame your request within your mission. For instance, if your facility values quality patient care and innovation, explain how this upgrade supports those principles. It demonstrates that SP is dedicated to upholding these values through improved equipment that ensures sterile instruments are consistently available and compliant.

3. Partnering with Vendors to Build Your Financial Case

Your vendors are valuable allies in this process. They understand the technical details and can provide data, case studies, and success stories to support your proposal. Here’s how you can partner effectively with them:

• Safety and Differentiation: Ask vendors how their products enhance patient safety. Look for features that set their ultrasonic washers apart, such as shorter cycles, energy efficiency, or enhanced water filtration systems.
• Financial Case Support: Vendors often have experience in crafting financial arguments that appeal to decision-makers. Request specific metrics or cost-benefit analyses. A well-presented financial case, grounded in data, can turn the tide in your favor when justifying capital expenses.
• Supporting Documentation: Collect photos, IFUs, and case studies that illustrate the effectiveness of the washer-disinfector. These materials offer tangible evidence to stakeholders, showing the real-world impact on similar facilities.

 Key Questions to Guide Your Proposal

As you gather information, consider questions like:

• How does this washer-disinfector align with our patient safety goals?
• Can the washer handle our specific instrument types and case volumes without delays?
• What are the maintenance and operational costs, and how do these compare to our current unit?

Selecting and justifying an ultrasonic washer-disinfector upgrade can be complex, but approaching it methodically helps. By understanding the types of equipment, assessing your needs, and building a detailed, evidence-backed proposal, you increase the likelihood of securing approval.

The right ultrasonic washer-disinfector ultimately improves operational efficiency, supports regulatory compliance, and elevates patient safety. With a carefully crafted proposal and the right support from vendors, you’re well on your way to retiring that “dinosaur” and bringing in a unit that meets today’s demands.

Resources

1. https://www.merriam-webster.com/dictionary/throughput
2. All AAMI Standards & Guidelines should be readily available in your facility, and if you do not have a copy, the direct regulations can be found/purchased here

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