The Brazilian College of Radiology and Diagnostic Imaging (CBR), a national entity that officially represents the Specialty of Radiology in Brazil, by bringing together doctors specializing in Radiology and Diagnostic Imaging and those who use ultrasound as an area of expertise, fulfilling their statutory commitments and obligations, makes public, before our associates, the medical profession, the entire Brazilian population and all national institutions, their REPUDIATION the decision issued in the judicial process that rejected the request for an injunction pleaded by the Regional Council of Medicine of the State of São Paulo (CREMESP), whose objective would be to revoke Resolution No. 627/2020 of the Federal Council of Nursing, to prevent professionals in this area perform ultrasound examinations, as well as issue reports.
We emphasize that this action was taken unilaterally by CREMESP, without having been consulted in order to give greater technical subsidies, and it is an initial judicial decision, handed down at First Instance. Thus, it is still in the appeal phase, which should be done soon.
The moment is critical and requires unity from all of us in favor of good medical practice and the care that the Brazilian population deserves. For this reason, CBR reaffirms that it will place all its legal efforts, alongside the Federal Council of Medicine (CFM), to reverse this first instance judicial decision, fulfilling its role within the scope of the Professional Defense of each doctor it represents in the country.
The National Ultrasound Commission of the Brazilian College of Radiology and Diagnostic Imaging (CNUS / CBR) and our entire Board REPUDIA The Ultrasound exams performed by non-medical professionalstherefore not qualified and / or enabled. Remember that the training of a professional to perform ultrasonography is time consuming and there are already several standards very well specified that guarantee the QUALITY of the training of this medical professional, encompassing knowledge that goes far beyond just learning the technique of how to perform an ultrasound examination.
This statement reinforces the position of the Technical Chamber of the Federal Council of Medicine (CFM) with the participation of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and CBR, published in 2017, in opinion 35/2017, which reiterates that: “The execution and interpretation of an ultrasound examination, as well as the issuing of the respective report, are the exclusive competence of the physician. It is forbidden for the doctor to delegate the performance of examinations to non-doctors and to assume responsibilities for an examination that he did not perform ”.
Ultrasonography is a dynamic examination, whose documented images represent a minimal fraction of the multiplanar scans viewed by the doctor during the examination and, therefore, are insufficient, in themselves, for the elaboration of a diagnostic report. Medical training enables knowledge of possible diagnoses and the proper direction of the exam. Therefore, CFM Resolution 2235/2019 ratifies CFM opinion 35/2017.
Timely, we reiterate that the production of image in real time can lead to the taking of immediate conduct and, not being performed by a doctor, can cause loss of time for the resolution of the case with good result, which may generate risk of irreversible damage to (the ) patient and increased maternal and perinatal morbidity and mortality.
It must be reported that the previous Resolution of CFM 1361/1992, dated December 9, 1992, already recognized the physician's exclusive competence in the execution and interpretation of the ultrasound examination in human beings, as well as the issuance of the respective report.
THE Law 12842 of the Medical Act, of July 10, 2013, is explicit in its Article 4 on what are the physician's private activities in the following items:
"III- indication of the execution and execution of invasive procedures, whether diagnostic, therapeutic or aesthetic, including deep vascular accesses, biopsies and endoscopies;"
"VII - issuing a report on endoscopic and imaging exams, invasive diagnostic procedures and anatomopathological exams".
Assessing the facts, the Brazilian College of Radiology reaffirms its position in the sense that:
- The indication, execution, interpretation and issuance of the ultrasound examination report are the exclusive competence of the physician and that this is performed by a trained professional and, preferably, with the proper certification of performance by CBR / FEBRASGO / AMB.
Despite the RESPECT that CBR has always had with the Nursing Councils (COFEN and CORENS), we reinforce that any type of news or content published by the Nursing Councils, stating that these professionals would be authorized to carry out ultrasound examinations and to issue reports and opinions on these images are about premature news, based on a legal decision at 1st instance, in order to disclose untrue material, as they are in total disagreement with the Current legislation and it totally disagrees with the rules of the Federal Council of Medicine, an organ that has constitutional powers of inspection and standardization of medical practice.
We also remember that any ultrasounds performed by a professional who is not duly qualified may give rise to a PROCESS in the civil and criminal spheres, and that, for sure, will be called "MEDICAL ERROR", and never "nursing error" or any other professional in the area of health!
Finally, CBR stresses that it will act legally to comply with Federal Law 12.842 / 2013, which clearly lists the activities that only doctors can perform, remembering that normative acts, such as resolutions and ordinances, issued by federal authorities, in this case in On the screen, Resolution No. 627/2020 of the Federal Nursing Council, cannot and should not override legal and constitutional provisions that deal with the matter. All the appropriate measures are being taken in this sense, preserving the best care for the population, aiming at the safety of the patient, and in the case of obstetric ultrasonography, of her concept.
The CBR is available to the entire medical and non-medical community, for any clarifications deemed necessary.
Dr. Wagner Iared
Coordinator of the National Ultrasound Commission / CBR
Dr. Cibele Alves de Carvalho
CBR Professional Defense Director
Dr. Alair Sarmet Santos
President of CBR (2019/2020)