Evaluation of the Competence of Sonographers in 3D/4D Ultrasound Imaging: The Case of Nairobi County

Background: There is variable utilization and in some cases non-utilization of 3D/4D ultrasound imaging, even when the application is available in equipment. The reasons of non-utilization of 3D ultrasound given the high amounts of money invested in purchase of equipment with such technology in Kenya remain largely unknown. 

Objectives: The aim of this study was to evaluate the competence of sonographers in 3D/4D ultrasound imaging in Nairobi County in Kenya. The main outcome measures were knowledge, skills, and attitudes of sonographers in the use of 3D/4D ultrasound imaging.

Methodology: This was a cross-sectional descriptive survey in which self-administered questionnaires were utilized to gather data regarding utilization of 3D/4D ultrasound imaging among practicing sonographers in both public and private imaging facilities within Nairobi County.

Results: The majority, 60% of the respondents worked in private healthcare facilities. In terms of gender distribution, 52% of the respondents were male. The professional inclination of the majority of the respondents, 60% had a radiography background. None of the participants had a radiology inclination while one respondent (4%) had an obstetrics inclination. However, it is noted that 24 %( n=6) of the respondents did not respond to the question on their professional inclination and it is probable that those respondents were uncomfortable with the question. The majority, 76 % ( n=19) of the respondents had an experience of between zero and four years in sonography. The highest professional qualification of the majority of the respondents was diploma level while only 8% (n=2) of the respondents had a bachelor’s degree and above. A significant number of the respondents, 68 %( n=17) did not have formal training in 3D/4D ultrasound imaging. The majority, 68 % of the respondents did not practice 3D/4D ultrasound imaging. The majority of the respondents, 52% had regular access to 3D/4D equipment. The majority of the respondents, 64% did not undergo continuing education in 3D/4D. Most respondents, 80% believe that 3D/4D ultrasound imaging is clinically useful in obstetrics. The majority, 48 % of the respondents thought that performing 3D/4D examinations was cumbersome  The majority, 68% of the respondents thought that 3D/4D ultrasound imaging was good for patient entertainment and as a commercial gimmick. The majority of the respondents, 64 % had never recommended 3D/4D ultrasound imaging to a clinician. The majority, 92 % held that 3D/4D added information in medical diagnosis. This correlates well with the participants’ majority opinion that 3D/4D was useful. The majority, 96 % of respondents was of the opinion that showing 3D/ 4D images to patients was re-assuring and it enhanced patient’s confidence in the sonographer. Some respondents also opined that 3D/4D gives detailed images, as one is able to project images in several dimensions.

Conclusion: There is a generally low level of knowledge and utilization of 3D/4D ultrasound imaging among sonographers in Nairobi County and much equipment with 3D/4D functionalities remain under-utilized despite the fact that use of 3D/4D options adds value in ultrasound imaging. A number of respondents thought that 3D/4D ultrasound imaging was for patient entertainment or simply a commercial gimmick. 

This suggests precedence of the push factors that vendors use to achieve a sale of new equipment while neglecting the clinical supremacy of the clinical application.

Recommendation: Purchase of ultrasound equipment should be strategic rather than passive so that equipment are  not purchased expensively with in-built state of art technology like 3D/4D that is left to lie idle while other priorities are denied funding. In case there is purchase of ultrasound equipment with 3D/4D capability, there should be regular continuing medical education workshops or seminars by the dealers on user application training in order to achieve optimal utilization of the functionalities. The curriculum for training of sonographers should incorporate aspects of 3D/4D imaging to harness the benefits of using this technology as an adjunct to the routine 2D ultrasound imaging.