By Landi Milano (Archivio Albertomos) [Public domain], via Wikimedia Commons

An expert-level, practical program requiring 725 scans, 5 case studies, and 3 exams, equipping doctors to practice ultrasound independently and educate others.

n.b. My study notes from the DDU are here. This article is a brief overview of what’s involved with the DDU.


ASUM has for over 30 years offered the DMU program as training for sonographers. The Diploma of Diagnostic Ultrasound (DDU), aimed at clinicians, has provided advanced training in ultrasound to radiologists, cardiologists and obstetricians for two decades. In 2010 a DDU program in Critical Care was established.

Practically focused

The core of the DDU is hands-on scanning with formal, supervised reporting. Recognising their importance in ICU, 100 of the 450 TTE studies must be haemodynamic, and 50 TOEs must be performed (i.e. at least 500 echoes). The remaining 225 scans include rapid abdominal scans, lung ultrasound, vascular scans, line insertion and other ultrasound guided procedures.


The exam components include a

  • physics exam (closed book MCQ)
  • written exam (ten 15-minute SAQs)
  • viva (live loop interpretation in front of a panel)

The other requirements include:

  • 5 case studies, combining the clinical scenario with the ultrasound images obtained, interpretation and commentary
  • logbook as noted above
  • assessment of competence by your supervisor
  • at least 2 years of ultrasound experience

Compared with the various university courses, the DDU is structured more like a college fellowship. ASUM sets a syllabus and recommended texts, examines candidates and marks the case studies, and provides some non-mandatory courses, for example for the physics module. However, the majority of the training comes from local supervisors and sonographers, and your own study.

Significant and ongoing commitment

At least 2 years of ultrasound experience is required to complete the DDU. There are also time limits on how long the scans can be obtained over. Once completed, CPD is required to maintain the qualification.

Supervising trainees

The DDU (Critical Care) is recognized as a suitable qualification for supervising trainees in critical care ultrasound – specifically, for

  • Focused Cardiac Ultrasound (FCU) – the new CICM requirement for trainees. Under the new syllabus, trainees cannot complete FCICM without FCU.
  • the Certificate in Clinical Performed Ultrasound (CCPU). This ASUM qualification is available in a variety of units, including
    • rapid cardiac echocardiography (RCE, which aligns with the FCU)
    • basic echocardiography in life support (BELS)
    • pleural effusion
    • above knee DVT
    • lung ultrasound

My thoughts

  • It’s very hard to accumulate all the scans you need without taking dedicated time out to devote to echo and ultrasound, even if you are scanning regularly in the course of your work. I did an echo / ultrasound fellowship full-time for a year to get the scans I needed for the DDU. For many intensivists who don’t intend to make echo a focus of their work, other qualifications such as the CCPU will likely meet their needs with a lesser investment of time.
  • The self-directed nature of the study required suited me – your mileage may vary. I mainly used authoritative textbooks, the ASE guidelines, and selected journal articles to tease out the evidence in critical areas (e.g. volume responsiveness).
  • Unlike the university qualifications, there is a significant ongoing CPD requirement. Depending on how much echo and ultrasound you will be doing, this may or may not be suitable.

Cover image: By Landi Milano (Archivio Albertomos) [Public domain], via Wikimedia Commons


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