CC BY-NC-ND 4.0 · Ultrasound Int Open 2022; 08(01): E29-E34
DOI: 10.1055/a-1922-6778
Original Article

Head and Neck Ultrasound – EFSUMB Training Recommendations for the Practice of Medical Ultrasound in Europe

1   Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Denmark
2   Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, and The Capital Region of Denmark, Copenhagen, Denmark
3   Department of Clinical Medicine, University of Copenhagen, Denmark
Caroline Ewertsen
3   Department of Clinical Medicine, University of Copenhagen, Denmark
4   Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
5   Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
6   Brandenburg Institute for Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany
Rhodri Evans
7   Department of Radiology, Withybush General Hospital, Swansea, United Kingdom of Great Britain and Northern Ireland
Julian Kuenzel
8   Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
› Author Affiliations


Different surgical and medical specialists increasingly use head and neck ultrasound and ultrasound-guided interventions as part of their clinical practice. We need to ensure high quality and standardized practice across specialties, and this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes the training requirements for head and neck ultrasound. Traditionally, a minimum number of ultrasound examinations indicates competence, but this is unreliable, and a general shift towards competence-based training is ongoing. For each EFSUMB level, we will outline the theoretical knowledge and skills needed for clinical practice. The recommendations follow the three EFSUMB competency levels for medical ultrasound practice. Level 1 describes the skills required to perform essential head and neck ultrasound examinations independently, level 2 includes ultrasound-guided interventions, while level 3 involves the practice of high-level neck ultrasound and use of advanced technologies. Our goal is to ensure high quality and standardized head and neck ultrasound practice performed by different clinical specialists with these recommendations.

Publication History

Received: 23 March 2022

Accepted: 27 July 2022

Article published online:
07 October 2022

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  • References

  • 1 McQueen AS, Bhatia KS. Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin Radiol 2018; 73: 81-93
  • 2 Kunzel J, Strieth S, Wirth G, Bozzato A. Ultrasound in the Re-Staging of Cervical Metastases after Chemoradiotherapy for Head and Neck Cancer. Ultraschall Med 2018; 39: 659-666
  • 3 Ahn D, Sohn JH, Yeo CK, Jeon JH. Feasibility of surgeon-performed ultrasound-guided core needle biopsy in the thyroid and lymph nodes. Head & neck 2016; 38: E1413-E1418
  • 4 Todsen T, Bennedbaek FN, Kiss K, Hegedus L. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Head Neck 2021; 43: 1009-1013
  • 5 Sidhu PS. Multiparametric Ultrasound (MPUS) Imaging: Terminology Describing the Many Aspects of Ultrasonography. Ultraschall Med 2015; 36: 315-317
  • 6 Todsen T. Surgeon-performed ultrasonography. Dan Med J. 2017; 64
  • 7 Hegedus L. Thyroid ultrasound. Endocrinology and metabolism clinics of North America 2001; 30: 339-360 viii-ix.
  • 8 Jakowski JD. Pictorial Essay on How to Perform an Ultrasound-Guided Fine-Needle Aspiration Biopsy. AJSP: Reviews & Reports 2013; 18: 18
  • 9 Lokkegaard T, Todsen T, Nayahangan LJ, Andersen CA, Jensen MB, Konge L. Point-of-care ultrasound for general practitioners: a systematic needs assessment. Scand J Prim Health Care 2020; 38: 3-11
  • 10 Moore CL, Copel JA. Point-of-care ultrasonography. The New England journal of medicine 2011; 364: 749-757
  • 11 Nielsen M, Cantisani V, Sidhu P, Badea R, Batko T, Carlsen J. et al. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper. Ultraschall in der Medizin - European Journal of Ultrasound. 2019; 40: 30-39
  • 12 Todsen T, Melchiors J, Charabi B, Henriksen B, Ringsted C, Konge L. et al. Competency-based assessment in surgeon-performed head and neck ultrasonography: A validity study. The Laryngoscope 2018; 128: 1346-1352
  • 13 Nicholls D, Sweet L, Hyett J. Psychomotor skills in medical ultrasound imaging: an analysis of the core skill set. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2014; 33: 1349-1352
  • 14 Lorentzen T, Nolsøe C, Ewertsen C, Nielsen M, Leen E, Havre R. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. Ultraschall in der Medizin - European Journal of Ultrasound. 2015; 36: E3-E16
  • 15 Wüstner M, Radzina M, Calliada F, Cantisani V, Havre RF, Jenderka KV. et al. Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Long Version) – General Aspects. Ultraschall Med. 2022 Jul 18. doi: 10.1055/a-1857-4435. Online ahead of print.
  • 16 Ernst BP, Katzer F, Kunzel J, Hodeib M, Strieth S, Eckrich J. et al. Impact of structured reporting on developing head and neck ultrasound skills. BMC Med Educ 2019; 19: 102
  • 17 Ernst BP, Hodeib M, Strieth S, Kunzel J, Bischof F, Hackenberg B. et al. Structured reporting of head and neck ultrasound examinations. BMC Med Imaging 2019; 19: 25
  • 18 Ernst BP, Strieth S, Katzer F, Hodeib M, Eckrich J, Bahr K. et al. The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency. Eur Arch Otorhinolaryngol 2020; 277: 269-276
  • 19 Trzebinska A, Dobruch-Sobczak K, Jakubowski W, Jedrzejowski M. Standards of the Polish Ultrasound Society – update. Ultrasound examination of thyroid gland and ultrasound-guided thyroid biopsy. J Ultrason 2014; 14: 49-60
  • 20 The Royal College of Radiologists.. Ultrasound training recommendations for medical and surgical specialties. Third Edition. London, 2017
  • 21 Education and Practical Standards Committee. European Federation of Societies for Ultrasound in Medicine and Biology. Minimum training recommendations for the practice of medical ultrasound. Ultraschall in der Medizin 2006; 27: 79-105
  • 22 Jang TB, Ruggeri W, Dyne P, Kaji AH. The Learning Curve of Resident Physicians Using Emergency Ultrasonography for Cholelithiasis and Cholecystitis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2010; 17: 1247-1252
  • 23 Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Medical Teacher 2010; 32: 676-682
  • 24 Tolsgaard MG, Todsen T, Sorensen JL, Ringsted C, Lorentzen T, Ottesen B. et al. International multispecialty consensus on how to evaluate ultrasound competence: a delphi consensus survey. PloS one 2013; 8: e57687
  • 25 Kunzel J, Bozzato A, Ernst BP, Fuhrmann T, Ugele I, Scherl C. et al. [Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. HNO.. 2021
  • 26 Todsen T, Jensen ML, Tolsgaard MG, Olsen BH, Henriksen BM, Hillingsø JG. et al. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients-a randomized controlled trial. American journal of surgery 2016; 211: 40-45
  • 27 Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. European thyroid journal 2017; 6: 225-237
  • 28 Weller A, Sharif B, Qarib MH, St Leger D, De Silva HS, Lingam RK. British Thyroid Association 2014 classification ultrasound scoring of thyroid nodules in predicting malignancy: Diagnostic performance and inter-observer agreement. Ultrasound. 2020; 28: 4-13
  • 29 Som PM, Curtin HD, Mancuso AA. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 2000; 174: 837-844
  • 30 van den Brekel MW, Castelijns JA. What the clinician wants to know: surgical perspective and ultrasound for lymph node imaging of the neck. Cancer Imaging 2005; 5 Spec No A S41-S49
  • 31 Foss KT, Subhi Y, Aagaard R, Bessmann EL, Botker MT, Graumann O. et al. Developing an emergency ultrasound app - a collaborative project between clinicians from different universities. Scand J Trauma Resusc Emerg Med 2015; 23: 47
  • 32 Subhi Y, Todsen T, Konge L. An integrable, web-based solution for easy assessment of video-recorded performances. Advances in medical education and practice 2014; 5: 103-105
  • 33 Sidhu PS, Brabrand K, Cantisani V, Correas JM, Cui XW, D’Onofrio M. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Short Version). Ultraschall Med 2015; 36: 566-580
  • 34 Kahr Rasmussen N, Nayahangan LJ, Carlsen J, Ekberg O, Brabrand K, Albrecht-Beste E. et al. Evaluation of competence in ultrasound-guided procedures-a generic assessment tool developed through the Delphi method. Eur Radiol 2021; 31: 4203-4211
  • 35 Sidhu P, Cantisani V, Dietrich C, Gilja O, Saftoiu A, Bartels E. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in der Medizin - European Journal of Ultrasound 2018; 39: e2-e44
  • 36 Saftoiu A, Gilja OH, Sidhu PS, Dietrich CF, Cantisani V, Amy D. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall Med 2019; 40: 425-453