From Air Force training to Maui’s serene waves: a sonographer’s journey to promote recognition and respect
Medical imaging has consumed all of my adult career—I don’t count the first three and a half years languishing on a dairy farm in upstate New York. Never did I imagine myself, in the twilight of my career, being in an exotic locale like Maui, where I’ve resided, more on than off, for the last nine years.
My initial introduction to medical imaging was as an Air Force radiologic specialist (1984). Air Force training was excellent, and I gained hands-on experience due to the high volume of opportunities. In 1988, I had the opportunity to cross-train on-the-job in ultrasonography. Ultrasound technology has made significant improvements since the late 80’s when the technology relied on oil-immersed mechanical scan heads alongside the emerging linear array technologies with digital utilization, modifications, and expanding applications closing fast in the subsequent decades.
The primary purpose of medical sonographic technology is to provide diagnostic information to the practitioner that makes the clinical decisions. That’s all it is, nothing more nothing less. I believe the expansion of this field was a result of the ever-evolving applications of the basic technology.
Sonographers provide a technical service to answer a specific clinical question or indication. What makes an especially good sonographer is each person’s unique skill set in recognising the application of a variety of knowledge areas; physics, anatomy, physiology, pathophysiology, chemistry, biology, genetics, heamodynamics, and the never-ending application of the technology. In addition, applying this knowledge in the challenging three dimensions we must mentally process is what creates the sonographer-artisan.
The basic techniques used in working with patients are fundamentally the same as in other imaging modalities. Once behind closed doors, expressing concern for why the patient is having the procedure and asking clarifying questions that will aid in maximising the exam outcome is critical for the patient’s level of understanding and comfort during the procedure.
Regardless of setting (eg, hospital, medical centre, outpatient clinics), the fundamental patient care doesn’t change much. Sonographers must possess many attributes that most may not be born with such as: patience, creativity, resilience, adaptability, flexibility, empathy, and tolerance. The challenges inherent within a particular setting may require additional time and creativity. Patients come in all shapes and sizes, with varying cognitive, emotional, and physical conditions that pose minor but manageable challenges.
Sonographers often find themselves caught in the middle of quality patient care. On one hand, while the patients are in our room, we are as hands on with them as beloved nurses, providing comfort and wiping tears. On the other hand, we are seen as ‘just techs’ operating a machine, expected to keep any medical opinions to ourselves. This is one of the biggest challenges, particularly for well-trained and experienced sonographers who have to balance the knowledge we have about the images on our screen with our proper place in the medical hierarchy.
To enter this field, fundamental education is a certificate. Like many other vocational occupations, no broad or far-reaching educational preparation is necessary. Training in the technical aspects seems to be enough for a fraction of the programs that do not include general academic rigor within the certificate curriculum. Sonographers have been seeking professional status for over 30 years. Unfortunately, the process has been mired in opinions, anecdotes, and the perpetual subordinate role sonographers play in the healthcare environment. I don’t have the answers for what might be the best approach in establishing minimum educational standards, supported by academic rigor, that leads to a recognised professional degree, but all one must do is look at the professions duly recognised and see what minimums they meet. Certainly, a degree may not be needed for this occupation, however, the knowledge expected of the sonographer doesn’t ring true given the minimal experiential opportunities required to qualify for work.
My perception of this occupation has always been viewed as vocational. No more, no less. The pursuit of education and advanced degrees had always been a personal goal, which if it worked out, may have benefitted me in making an academic career a possibility. It didn’t work out that way. So, here I am on an island, in the middle of the Pacific, watching the sun set, and for this life that has made all the difference.
About Dale Collins
Dale Collins currently works as a staff sonographer with Maui Health Systems, Wailuku HI. He has been a full-time and contracted sonographer with Maui Memorial Medical Center, Maui Health Systems, and Hilo Medical Center.
Dale received initial radiography training in the United States Air Force beginning in 1984, obtaining certification from ARRT in 1986. Since 1984, Collins has worked in clinical radiography, undergraduate and graduate education, and various sonography clinical environments. He has served in a number of organizational governance and on several committees with the Alaska Society of Radiologic Technologists (AKSRT), the American Society of Radiologic Technologists (ASRT), and most recently an eight-year appointment (2013-2021) to the Joint Committee on Education in Diagnostic Medical Sonography (JRC-DMS) serving in the capacity of chair-elect, chair, and past chair, and the Hawaii Society of Radiologic Technologists (HSRT). He has served as vice president, president, immediate past president, board chair, and delegate with the AKSRT. Currently, he is serving as president of the HSRT.
Collins has earned Associate, Bachelor’s, and Master’s degrees, and a post-graduate certificate (e-Learning). He also holds seven credentials: three from ARRT and four from ARDMS. He resides in Kula, Hawaii.
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