In a quiet regional clinic three hours north of Brisbane, Luke Kipping is leading a quiet revolution in sonography. While many sonographers across Australia remain confined to traditional diagnostic roles, Luke has successfully secured approval from Queensland Health to perform ultrasound-guided musculoskeletal injections—without the direct supervision of a radiologist.
This milestone is significant, not only for Luke but for the broader sonography profession, raising important questions about scope of practice, professional autonomy, and access to healthcare in regional Australia.
A Unique Career Path
Luke’s journey to becoming an interventional sonographer was anything but straightforward. Despite obtaining a postgraduate qualification in musculoskeletal interventions from the University of Essex—an education pathway endorsed at the time by the Australasian Sonographers Association—he entered a professional landscape rife with regulatory and institutional barriers.
Historically, musculoskeletal injections were performed exclusively by radiologists. However, increasing demand for these procedures, coupled with radiologist shortages in regional areas, has forced the system to adapt. Queensland Health’s approval for Luke to practice independently recognises this evolving landscape, yet raises an uncomfortable question: why are some sonographers allowed to perform these procedures while others are not?
The Supervision Paradox
One of the most striking inequities in Luke’s story is the variation in supervision requirements. While he operates independently, two other sonographers in Queensland performing similar procedures are required to have direct supervision from a radiologist.
“If I were based in Brisbane, I would probably be required to have direct supervision,” Luke notes. “But in a regional setting, where the demand for these services far exceeds the available radiologists, I’ve been allowed to practise with greater autonomy.”
This contradiction highlights a broader systemic issue: should geography determine the level of professional independence granted to health practitioners? If a sonographer is trained and competent to perform musculoskeletal injections in a regional setting, why should the same not apply in metropolitan areas?
Unpacking the Barriers
Despite clear workforce needs and cost efficiencies, few sonographers are performing musculoskeletal injections in Australia. Why?
Several key barriers have contributed to this reality:
- Regulatory Resistance: The Royal Australian and New Zealand College of Radiologists has historically opposed sonographers performing injections. Their 2015 position statement discouraged the practice, effectively stalling momentum and deterring potential candidates.
- Training Pathway Closure: The University of Essex course that provided formal training for musculoskeletal injections was abandoned after a single cohort, leaving no clear pathway for future sonographers to gain the necessary qualifications.
- Institutional Constraints: Many large radiology providers adhere strictly to radiologist-driven models of care. Even sonographers with the right training struggle to find workplaces that support them to practise their skills.
- Cultural Barriers: The prevailing medical hierarchy remains a challenge. “If you’re not a doctor, there’s an assumption you shouldn’t be performing injections,” Luke says. Yet, in practice, many referring doctors—including orthopaedic surgeons and rheumatologists—are highly supportive of sonographers taking on this role, particularly in regions with long wait times.
A Case for Change
Beyond professional autonomy, the case for expanding sonographers’ roles is a pragmatic one. Allowing trained sonographers to perform musculoskeletal injections:
- Improves Access: In regional areas, where patients are waiting up to six months for injections, this change could significantly reduce wait times.
- Reduces Costs: Sonographers earn significantly less than radiologists, making the service more affordable while freeing radiologists to focus on higher-complexity procedures.
- Enhances Efficiency: Radiologists can redirect their time to advanced imaging, CT-guided interventions, and complex diagnostics, improving workflow across radiology practices.
Yet, without a renewed push for accredited training programs and regulatory clarity, the profession remains in limbo.
The Path Forward
For musculoskeletal injections by sonographers to become a mainstream service, several key steps are needed:
- Reinstating Training Programs: Universities and professional bodies must reintroduce accredited training pathways to ensure consistent education and competency assessment.
- Regulatory Reform: Clear, consistent guidelines need to be established so that scope of practice is determined by skills and competency, not geography or arbitrary supervision rules.
- Cultural Shift: Greater collaboration between radiologists and sonographers is essential. Professional organisations must take a leadership role in breaking down outdated barriers.
- Advocacy and Awareness: As demand for musculoskeletal injections continues to grow, the case for expanding sonographers’ roles must be made louder—within the profession, among referrers, and at the policy level.
A Profession at a Crossroads
Luke Kipping’s experience underscores both the potential and the frustrations of working in an evolving healthcare landscape. His role as an interventional sonographer is a model for the future—but whether others will be able to follow in his footsteps remains uncertain.
“The demand is there, the need is clear,” he says. “But without systemic changes, we risk losing an opportunity to improve access to care and make better use of our workforce.”
For now, Luke continues to break new ground, one injection at a time. But the question remains: will the system catch up?
Read Luke’s article in the Australian Health Review Australian Sonographers – Sound Policy for Progress?
