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 Table of Contents  
Year : 2018  |  Volume : 2  |  Issue : 3  |  Page : 193-196

Novel demographic capture employing electronic and social media: Preliminary report from the national cardiac sonographer survey

1 Department of Cardiology, Teleradiology Solutions and RxDx Clinics Whitefield, Bengaluru, Karnataka, India
2 Department of Cardiology, Narayana Health City, Bengaluru, Karnataka, India
3 Department of Cardiology, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
4 Department of Cardiology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
5 Department of Cardiology, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
6 Department of Cardiology, Ramesh Hospitals Vijayawada, Andhra Pradesh, India
7 Department of Cardiology, Bon Secours Health System, Ireland
8 Department of Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
9 Department of Cardiology, Baroda Heart Institute and Research Centre, Vadodara, Gujarat, India
10 Department of Medicine, Karolinska Institute, Stockholm, Sweden

Date of Web Publication10-Dec-2018

Correspondence Address:
Mr. K Praveen Kumar
Department of Cardiology, Teleradiology Solutions and RxDx Clinics, Plot No 7G, Opposite Graphite India, Whitefield, Bengaluru - 560 048, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiae.jiae_30_18

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Background: While cardiac sonography is recognized as a skilled allied health profession in the developed world, sonographers are relatively unorganized in India. This survey aimed to capture basic demographic data of this organically growing community employing electronic and social media platforms. Materials and Methods: A predominantly multiple-choice-based questionnaire was created using a free, open-access survey platform and circulated on available sonographer social media forums, messenger groups, and E-mail lists. Information distribution, data collection, and response analysis were entirely paperless. Results: Between July 2017 and April 2018, 290 sonographers from 19 states participated in this survey. Forty-six allied health courses offering echocardiography were identified across India. A majority of respondents and identified courses were based in the South and West India. About 62% of the sonographers were women, and approximately 60% were <30 years old. Multiple training pathways were displayed, and >30% held university-level degrees in echocardiography. More than 50% were early to mid-career sonographers and scanned more than 20 patients a day. All sonographer scanned under authorized supervision. A minority were credentialed after training. Less than 1 in 3 were members of the National Indian Academy of Echocardiography. Conclusions: Preliminary analysis in this ongoing survey suggests that the Indian sonographer community is young, predominantly female, and generally work in hospital-based clinical environments. Sonographer credentialing, enhanced society engagement and continuous medical education may support career development and contribute to the society's goals to promote echocardiography practice and education in India.

Keywords: Cardiac sonographer, demographics, echo, survey

How to cite this article:
Kumar K P, Rambothu R, Shah R, Thakur AS, Nandakumar S, Kumarvel P S, Meesala VR, Umashankar A, Gunasekar P, Venkateshvaran A. Novel demographic capture employing electronic and social media: Preliminary report from the national cardiac sonographer survey. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:193-6

How to cite this URL:
Kumar K P, Rambothu R, Shah R, Thakur AS, Nandakumar S, Kumarvel P S, Meesala VR, Umashankar A, Gunasekar P, Venkateshvaran A. Novel demographic capture employing electronic and social media: Preliminary report from the national cardiac sonographer survey. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2018 [cited 2019 Jun 18];2:193-6. Available from: http://www.jiaecho.org/text.asp?2018/2/3/193/247030

  Introduction Top

Cardiac sonographers are allied health professionals with requisite training, competency, and skills to perform echocardiograms. They support cardiologists with image acquisition, analysis, and preliminary interpretation of echo studies. Cardiac sonography is a recognized skilled profession in the USA, UK, and Australia but is a relatively recent development in India. Early sonographers in our country were trained under the supervision of cardiologists and were provided hospital-based certifications to perform routine studies. However, in recent times, formal university-level diplomas, undergraduate and postgraduate programs have also been introduced. Despite informal efforts to organize this group and a growing number of individuals embracing this profession, no data regarding the demographic distribution is currently available. The objective of this pilot was to acquire preliminary demographic information of the Indian cardiac sonographer community employing electronic and social media. Online questionnaires, E-mail lists, and messenger platforms were employed for this purpose.

  Materials and Methods Top

This pilot was conducted during the period from July 2017 to April 2018. Sonographer volunteers connected by an informal, messenger-based social media group (Cardiac Sonographers Club on Telegram®) were recruited from different regions of India.

An online questionnaire was created by the volunteer core-group country employing Google Forms® (https://www.google.com/forms/about/), a free, online platform to create, distribute, and analyze surveys. The ongoing survey can be accessed by the link: https://goo.gl/forms/ki1BbcKBimy8PzpA3. It comprises 21 questions in a multiple-choice or free-field-entry format and takes <5 min to complete. In addition to capturing basic demographic information, the online questionnaire also captures training pathways, current roles, engagement with local societies, and educational interests of sonographers. The form was shared employing messenger portals such as Whatsapp® and Telegram®, over E-mail lists and via social media forums such as Facebook® and Twitter®. Responses were collected, analyzed, and expressed in absolute numbers and percentages employing the analysis function on Google Forms®. A completely paperless approach was adopted in performing this exercise. In addition, sonographers were also invited to share details of current institutions offering echocardiography programs, in addition to the type of course, duration, and contact information.

  Results Top

Forty-six allied health programs that offered Cardiovascular Technology (that included echocardiography) was identified, predominantly from Karnataka (n = 13; 28%), Maharashtra (n = 11; 23%), Tamil Nadu (n = 7; 15%), and Kerala (n = 7; 15%). Twenty-eight courses (60%) were conducted for a minimum of 3 years at the university level. Ten courses (21%) were postgraduate courses of which 7 (15%) were conducted exclusive in echocardiography.

Preliminary results of the sonographer survey are presented in [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]. Two hundred and ninety cardiac sonographers across 19 states participated in this exercise during a 10-month period. Their state-wise distribution is provided in [Figure 1]. The regional spread of the community was skewed, with the majority of sonographers based in South and West India. Women comprised 62% of the total group [Figure 2]a. Approximately 6 in 10 sonographers were <30 years old [Figure 2]b. More than half of the participants had been actively scanning for <5 years [Figure 3]. All sonographers scan under the supervision of cardiologists or cardiac physicians. Fifty-six percent of the respondents performed over 20 echo studies a day, suggesting active participation in routine clinics [Figure 4]. A majority (85%) scan in large, hospital-based environments [Figure 5]. Multiple pathways have been employed to acquire echo certification, which includes hospital-based training, diplomas, and university-level training programs. More than 1 in 3 of the respondents had undergone a formal bachelors-level program, and approximately 1 in 4 had undergone postgraduate training in echocardiography [Figure 6]. Less than half of the respondents were members of the state echo society, and only 27% of the respondents were members of the National Indian Academy of Echocardiography (IAE) [Figure 7]a and [Figure 7]b. Majority (around 70%) of sonographers were not credentialed after their training. A small number had national and internationally recognized credentials [Figure 8]. Sonographers revealed a strong interest in continuous medical education with >70% of them attending echo meetings held by their respective departments, institutions or regional or national echo society [Figure 9].
Figure 1: Regional sonographer distribution (n = 290) across 19 states in India

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Figure 2: (a) Gender distribution of sonographer community. (b) Age distribution of sonographer community

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Figure 3: Work experience (years) of sonographer community

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Figure 4: Number of echocardiograms performed per day

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Figure 5: Training pathways of sonographer participants. BSc: Bachelor of Science, MSc: Master of Science

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Figure 6: Institutional affiliation of sonographer participants

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Figure 7: (a) Membership acquired at the National Indian Academy of Echocardiography state chapter. (b) Membership acquired at the National Indian Academy of Echocardiography (IAE)

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Figure 8: Echo credentialing after completion of echo program

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Figure 9: Number of echo-related educational meetings attended in the last 2 years

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  Discussion Top

To the best of our knowledge, this is the first study to capture and present preliminary demographic data of cardiac sonographers across India. Our data suggest that the sonographer community in India is young, predominantly women and that distribution of the sonographer community is geographically skewed. Although sonographers pursue multiple training pathways, a growing number have formal, university-level degrees. A minority, however, have recognized credentials after training. A significant percentage of sonographers are professionally active, academically inclined and demonstrate rising engagement with the IAE. This exercise is an important step forward in gaining insight into the hitherto relatively unorganized sonographer community.

Cardiac sonographers are integral to echocardiography laboratories across the developed world. As allied health professionals with the necessary competence to perform noninvasive examinations of the heart, this community has contributed to increased productivity, reduced patient waiting time and a significant reduction in examination unit costs in many countries.[1]

In India, however, the profession is less recognized for a number of reasons. Echocardiography is considered an operator-dependent diagnostic, demanding a requisite level of skill, knowledge, and clinical competence. Clear recommendations for sonographer training and a standardized core curriculum are currently unavailable and regulatory legislation such as the Preconception and Prenatal Diagnostics Techniques Act, also applicable to echocardiography, blur the identity of this community.

The preliminary results of this survey suggest that a growing body of sonographers exist in the country, and can support physicians in addressing the growing unmet need to provide rapid access to care. Engagement with the IAE is an important step in the evolution of this community. As early as 1992, the American Society of Echocardiography published a formal report for sonographer training.[2] A dialogue on necessary credentialing, registration, licensure, and accreditation requirements was then initiated to raise cardiac sonographers to a recognized profession.[3] Subsequently, the recommendations for sonographer education were updated in 2001.[4] Today, the American sonographers have grown into a vibrant community, contributing actively to society advocacy, education, and humanitarian initiatives.

Over the past few years, the IAE has contributed to sonographer identity and educational development in numerous ways. An exclusive sonographer membership, Level 1 and 2 echo examinations, sonographer-focused sessions during the sonographer track in annual meetings, opportunities to contribute to scientific publications, and travel grants that provide support to attend national and international echo meetings have boosted sonographer engagement. With the rising number of students graduating from sonographer schools and the expected increase of sonographers in the years to come, it may also be strategic to reflect on how this group can be better equipped to support cardiologists in promoting health access across India. Formal recognition and representation, establishing standards for sonographer training, discussions on universally-recognized accreditation, and sonographer student mentorship can potentially contribute to both society initiatives and to non-invasive cardiology teams across the country.


Limitations of this survey include: (a) the utilization of electronic media to capture data, hence excluding those sonographers less comfortable with these means of data collection. Less than 1% of our survey participants were over 50 years and only 14% between 40 and 50, suggesting that older sonographer may not have actively participated in this exercise. Further, (b) the survey does not include sonographer students in training. Given the rising number of institutions in the South and West India that offer university-level programs in echocardiography, this number can be expected to rise significantly in future. Another survey may be necessary to capture details of the sonographer student community. Finally, (c) our data may not accurately reflect sonographer distribution in certain regions, eg. North India, where survey participation was low. With greater awareness of this ongoing exercise, this information may be captured in time.

  Conclusions Top

The preliminary results of the national sonographer survey provide valuable demographic insights into the young, growing sonographer community in India. Multiple training pathways have been employed toward certification, including formal university-level training. Discussions on formal representation, standardization of sonographer training, and career development, in addition to universally recognized credentialing and continuous medical education may better equip this community to contribute to noninvasive cardiac health teams in India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Nicastro I, Barletta V, Conte L, Fabiani I, Morgantini A, Lastrucci G, et al. Professional education, training and role of the cardiac sonographer in different countries. J Cardiovasc Echogr 2013;23:18-23.  Back to cited text no. 1
Gardner CJ, Brown S, Hagen-Ansert S, Harrigan P, Kisslo J, Kisslo K, et al. Guidelines for cardiac sonographer education: Report of the American Society of Echocardiography Sonographer Education and Training Committee. J Am Soc Echocardiogr 1992;5:635-9.  Back to cited text no. 2
Waggoner AD, Skelly AC. The profession of cardiac sonography and the status of professionalization of cardiac sonographers. J Am Soc Echocardiogr 1999;12:335-42.  Back to cited text no. 3
Ehler D, Carney DK, Dempsey AL, Rigling R, Kraft C, Witt SA, et al. Guidelines for cardiac sonographer education: Recommendations of the American Society of Echocardiography Sonographer Training and Education Committee. J Am Soc Echocardiogr 2001;14:77-84.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]


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