Thoracic Ultrasound Training: 2024 Update

In 2020, the BTS published new training standards for thoracic ultrasound¹. These minimum training standards have been adopted by respiratory physicians and should be followed by all clinicians performing pleural procedures.

The key messages from the document are as follows:

1. There are four grades of thoracic ultrasound ‘operators’: emergency, primary, advanced and expert.
2. The primary operator criteria broadly align with the historic Royal College or Radiology ‘Level 1’ standards and are the minimum expected of a respiratory registrar in training. Some trainees may gain competence aligned with the advanced operator criteria later in training.
3. In order to become independent as a primary thoracic ultrasound operator, you need to meet the following criteria:
   • A locally delivered introductory thoracic ultrasound course (see below)
   • Logbook of 10 directly observed thoracic ultrasounds demonstrating normal structures and pleural fluid
   • Logbook of at least 50 further scans including at least 10 with pleural fluid and 5 normal scans (images saved and reviewed by supervisor, if not directly supervised)
   • DOPS confirming you can identify a safe site for pleural intervention
   • A summative DOPS confirming you meet all criteria at ‘Level 4 Primary Pathway’
4. Supervisors for pleural procedures for those being trained at primary thoracic ultrasound level should be ‘Level 5 Primary Pathway’ meaning they have completed the primary pathway and have a logbook of at least 100 further procedures over at least a 2 year period. In reality, this translates to most senior registrars ST5/6+ and consultants who regularly perform pleural ultrasound.