Why do you have to know ultrasound physics?

American Medical Associations Resolution H-230.960, Privileging for Ultrasound Imaging, recommends that “the criteria for granting ultrasound privileges should be in accordance with recommended training and education standards developed by each physician's respective specialty”.

And all specialty societies that have published recommendations on training and education standards for those performing point-of-care ultrasound (POCUS). Those recommendations include training in ultrasound physics as a requirement to ensure accurate image acquisition, interpretation, and patient safety.

So if you're going to seek privileges for POCUS, then yes, you should know, at minimum, the basics of US physics.

Why is it specifically necessary for those who perform Point-of-Care Ultrasound to know ultrasound physics?

Take the opportunity to visit with any of your institutions ultrasound labs and connect with an experienced sonographer. If you watch how they scan, what you’ll notice is that they use their knowledge of anatomy, pathology, and ultrasound physics to carefully search, change angles, and masterfully massage every control on the ultrasound machine in an effort to craft the optimal, most accurate image. They can be very artistic.

They complete their examination and present it to a sonologist for diagnosis. Every aspect of what’s presented is judged and scrutinized.

As a provider who practices Point-of-Care Ultrasound,
I am assuming the responsibility of both sonographer and sonologist.

To paraphrase a quote from Medical Physicist, Crispian P Oates: In the last several years, ultrasound has transformed into the only imaging modality in that anyone, given a probe and some gel, can produce an image. That is both its utility and its danger. The danger is not from a factor like ionizing radiation, but in not producing optimum images and interpreting them correctly.

Personally, I want my knowledge of ultrasound to be unimpeachable.