Thoracic ultrasound (TUS) competency levels

Emergency-level TUS operator
  • Completed an introductory TUS session and has a basic understanding of ultrasound machines and examinations

  • Logbook of five normal TUS and live large pleural effusions of >5 cm depth

  • Satisfactory summative DOPS to identify thoracic and abdominal cavity structures (diaphragm, lung, heart, rib, liver, spleen and kidney)

  • Satisfactory summative DOPS to identify a large pleural effusion >5 cm depth and to guide intervention

Basic-level TUS operator
  • Completed a structured TUS course and has a basic understanding of ultrasound physics, modes of ultrasound, anatomy of thoracic cavity and simulated experience

  • Ability to identify small pleural effusions and complex/septated pleural effusions

  • Ability to identify gross malignant pleural nodularity; for example, diaphragmatic nodularity

  • Ability to identify consolidated and atelectatic lung

  • Ability to assess lung sliding

  • 2x satisfactory summative DOPS in a “challenging USS case”. Examples of this include: small pleural effusion on CXR, consolidation versus collapse versus effusion on CXR and loculated effusion on CXR/CT

  • Logbook of procedures including >60 ultrasound procedures including normal scans, pleural effusions and identification of sites for intervention

  • The logbook should include minimum of 10 thoracic ultrasounds of small effusions <5 cm, complex/septated effusions, pleural nodularity or consolidated/atelectatic lung

Intermediate-level TUS operator
  • Minimum of 2 years' experience as a basic-level TUS operator

  • Ability to detect A-lines and B-lines in lung ultrasound

  • Ability to identify and assess pleural thickening

  • Ability to assess diaphragm function on ultrasound

  • Ability to perform real-time pleural aspiration and chest drain insertion when required

  • Ability to use ultrasound help guide site for indwelling pleural catheter insertion (scanning patients in lateral decubitus position)

  • Annual review and appraisal of practice including standardised outcome measures

Advanced-level TUS operator
  • Advanced TUS practitioners who performs minimum of 100 TUS per year

  • Ability to perform real-time image-guided pleural biopsy

  • Ability to use M-Mode, colour and Doppler in appropriate setting

  • Annual review and appraisal of practice including standardised outcome measures

CXR: chest radiograph; CT: computed tomography; DOPS: direct observation of procedural skills.