In discussion with interventional sonographer Luke Kipping
When I first spoke with interventional sonographer Luke Kipping in 2025, I was interested in what seemed to be an unusual example of scope of practice reform. Luke was working in a regional Queensland clinic, performing ultrasound-guided musculoskeletal injections without the direct supervision of a radiologist. He had the training, he had demonstrated his competence, Queensland Health had approved the arrangement, and the service met a clear local need.
Yet remarkably few sonographers in Australia were able to do the same work.
At first glance, Luke’s story looks like an example of successful advanced practice. Look more closely, though, and it reveals something else: how difficult it is for an innovative model of practice to move from an individual practitioner or service into the wider health system. That question has become even more important as governments seek to expand health professional scopes of practice.
A different career path
Luke’s journey to becoming an interventional sonographer was anything but straightforward. He completed postgraduate training in musculoskeletal interventions through the University of Essex, through an education pathway endorsed at the time by the Australasian Sonographers Association.
Historically, musculoskeletal injections were performed almost exclusively by radiologists. But growing demand for these procedures, together with shortages of radiologists in regional areas, created pressure for services to work differently. Luke eventually secured approval from Queensland Health to perform ultrasound-guided musculoskeletal injections independently.
That is significant, but it also raises an obvious question. If a sonographer has the education, competence and clinical governance arrangements required to undertake this work safely, why is the role so difficult to reproduce elsewhere?
The supervision paradox
One of the most striking features of Luke’s story is the variation in supervision requirements. While Luke has been able to practise independently, other sonographers undertaking similar procedures in Queensland have been required to work under the direct supervision of a radiologist.
“If I were based in Brisbane, I would probably be required to have direct supervision,” Luke told me. “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.”
There is an uncomfortable contradiction here. Geography has effectively influenced the level of professional autonomy available to practitioners. Regional workforce shortages created sufficient pressure for the system to permit a different model of care, but the underlying question is not really whether regional services should have special rules. It is whether scope of practice should be determined by demonstrated competence and appropriate clinical governance, rather than by the availability of another profession to supervise the work.
So why hasn’t the model spread?
Despite the apparent benefits, very few Australian sonographers perform musculoskeletal injections. There are several reasons.
One is that the training pathway disappeared. The University of Essex program that allowed Luke to undertake formal postgraduate training in musculoskeletal interventions was discontinued after a single cohort. That immediately creates a problem for scale. An innovative role cannot become a workforce model if there is no reliable pathway through which the next practitioner can acquire the required capability.
Professional and regulatory boundaries also remain contested. Radiology has historically been cautious about sonographers performing interventions traditionally undertaken by radiologists. Those concerns include legitimate questions about training, patient selection, complications, clinical responsibility and governance. But there is a difference between specifying the conditions required for safe practice and assuming that the work must always belong to a particular occupational group. That distinction matters as health systems increasingly ask practitioners to work to their full scope of practice.
Employers also need systems that can authorise the work. Even where practitioners have advanced skills, organisations need mechanisms for determining who is competent to undertake particular procedures, under what conditions and with what accountability. Without those systems, advanced practice depends heavily on local champions willing to negotiate an exception. That makes innovation possible, but it does not make it scalable.
Existing service models create another constraint. Large radiology services have been designed around a radiologist-led model of care. Training, supervision, workflow, funding and professional responsibilities have developed around that model. Introducing an advanced sonography role therefore involves more than teaching a sonographer a new clinical skill. It changes how work is distributed across the service, and systems are generally much better at absorbing an individual innovation than redesigning themselves around it.
There is a strong service argument
The case for exploring these models is not simply about professional autonomy. It is about access to care and the best use of scarce workforce capacity.
In regional areas, patients may face lengthy waits for musculoskeletal injections because of limited access to radiologists. A suitably trained sonographer can potentially provide the intervention while the radiologist concentrates on work requiring their particular expertise, including more complex diagnostic and interventional procedures. That creates the possibility of better access, different use of specialist capacity and a more flexible workforce.
But those benefits will not be realised simply by identifying a handful of exceptional practitioners. The pathway has to be reproducible.
From individual innovation to workforce reform
When I originally wrote about Luke’s work, the obvious questions were about training, credentialling, regulation and professional culture. I now think his story illustrates an even larger problem.
Health systems are very good at producing examples of advanced practice. They are much less successful at creating the conditions that allow those examples to become normal practice.
Luke had acquired the capability. A health service had found a way to authorise the work. Patient need provided a compelling reason to change the model. But the surrounding workforce architecture had not moved with it.
There was no enduring Australian education pathway through which other sonographers could readily follow him. Recognition of the role varied between organisations and locations. Supervision expectations remained inconsistent. And the broader system had no obvious mechanism for turning a successful local model into an established workforce pathway.
This is the distinction between innovation and institutionalisation. The first can be achieved by determined clinicians and supportive services. The second requires the systems around them to change.
The real question
Luke’s experience demonstrates what is possible when a health service is prepared to reconsider who can safely undertake particular work. But it also exposes the limitations of relying on pioneers to reform the workforce one service at a time.
“The demand is there, the need is clear,” Luke said. “But without systemic changes, we risk losing an opportunity to improve access to care and make better use of our workforce.”
That remains the central issue. The question is no longer simply whether sonographers can perform musculoskeletal interventions. Some clearly can.
The more useful question is: what has to change around them for an effective advanced practice model to become part of the system rather than an exception to it?
I explore that question more fully in Why Advanced Practice Won’t Scale Without Top-Down Strategy, where I argue that sustainable advanced practice requires alignment between education, authorisation and regulation, industrial structures, and funding.
Luke’s experience is a very good example of what happens when those things do not move together.
Read Luke Kipping’s 2024 article in the Australian Health Review: “Australian Sonographers — Sound Policy for Progress?”
This article was originally published on The Allied Health Academy on 20 February 2025. It has been revised and republished on HealthWorX Futures in October 2026.
