Sasfying NICE – A Sonographer’s Experience of a Streamlined Approach to Becoming Proficient in Ultrasound Guided Biopsy of the Head and Neck Davies, M.J., Greenall, C., Evans, R.M., Morriston Hospital, Swansea ABMU Health Board The presentaon of a neck lump is a diagnosc conundrum. While the majority of the differenal diagnoses are benign, the overriding concern of paents and clinicians is to exclude malignancy. NICE guidelines1 recommend the consideraon of ultrasound guided fine needle aspiraon (FNA) cytology or core biopsy for paents with a neck lump suspected of being cancer of the upper aerodigesve tract. Successful sonographer led neck lump clinics are being established throughout the UK but to date, there is no UK training criteria aimed specifically at sonographers wishing to undertake intervenonal procedures. However, recent recommendaons3 published by the Royal College of Radiologists (RCR) included guidance primarily aimed at medical and surgical speciales in the training of ultrasound guided head and neck intervenonal procedures. This poster details an ‘in house’ training programme established in Morriston Hospital, Swansea, for a sonographer with experience in head and neck ultrasound, wishing to undertake fine needle aspiraon (FNA) in the head and neck. The programme was streamlined, focusing on reflecve pracce and mulple work based assessments performed at regular intervals.

Audit of FNA diagnosc success rate This demonstrated improvement during the direct supervision stage of however, targeted DOPS at specific areas training inially revealed an overall have so far, been limited due to low 68% success rate. numbers. Further analysis of results revealed Future Consideraons and Learning high inadequate rates in Points submandibular glands (SMG) and •This is a reproducible, realisc thyroid as demonstrated in the bar training programme based on chart below: mulple regular assessments with FNA Inadequate Rate According to Site emphasis on reflecve pracce and 100% audit as a way to ensure 90% •Sonographer aended the Morriston 80% competency. Head and Neck Ultrasound Workshop2 70% •Our ‘in house’ training programme 60% Adequate prior to commencement of training. 50% Inadequate was established prior to the •A clinical workbook was used to 40% publicaon of the third edion of record all training. 30% 20% the Royal College of Radiologists •Relevant previous experience in head 10% (RCR)document ‘Ultrasound 0% and neck ultrasound was documented SMG 4 THYROID 5 PAROTID 17 LYMPH NODE 26 training recommendaons for in the workbook. Our explanaon for this finding is that: medical and surgical specialies’3, •Sonographer regularly aends the •Low numbers of SMG and thyroid head and neck cancer mul- but included many aspects of the FNA’s may have skewed results. disciplinary team meeng. recommended training. •SMG biopsies are technically more •Pathway was based on mulple •Future accepted inadequacy rate difficult, parcularly superior and assessments similar to the ‘mini- may need to be reduced to <15% to anterior SMG space. DOPS’ tool4 used by the RCR. •We have previously found our be in line with the RCR •Expected FNA success rate was set at cytologists frequently report thyroid recommendaons. 70% and audited throughout the FNA as inadequate. (46% in previous •Training commenced in February training.(success = adequate and radiological pracce) 2016, ancipated independent diagnosc sample) pracce will commence in January •Assessments were performed by two Reflecon of pracce idenfied 2018. radiologists. possible ways of improving FNA •A stac image of the needle located success rate as demonstrated •This is the first training programme within the mass was always captured below: of its kind in Swansea, and possibly and recorded. Wales. •Open and ongoing communicaon Below: The RCR Mini-Dops Tool Used as with pathologists, radiologists and a Template in our Regular Assessments surgeons is essenal when establishing a sonographer led service of this kind.

References 1. NICE Guideline (NG36),’Cancer of the upper aerodigestive tract: assessment and management in people of 16 years and over’, Feb 16

2. The Morriston Head and Neck Ultrasound Workshop www.headandneckultrasound.co.uk FNA success rate was re- 3. The Royal College of Radiologists, ‘Ultrasound training audited aer mulple DOPS recommendations for medical and surgical specialities’, BFCR(17)3

which showed an overall 4. The Royal College of Radiologists, Workplace Based Assessment, www.rcr.ac.uk increase to 75%.