Ultrasound is often perceived as a simple procedure for imaging a developing baby, but in practice, it’s a sophisticated diagnostic discipline performed by clinicians who combine technical precision with deep knowledge of anatomy, physiology, and pathology.
In recognition of Ultrasound Awareness Month, the communications team spoke with Niki Marsh, OB/GYN imaging manager for UAB’s Division of Maternal-Fetal Medicine, about her career, the evolution of the technology, and the future of the field.
From exploration to expertise
Marsh did not initially set out to pursue sonography. She considered several healthcare disciplines before discovering the profession while researching non-nursing career paths.
Early in her training, maternal-fetal medicine emerged as her professional focus, and her first position was within that specialty. It is an area of practice defined by both clinical complexity and emotional significance, where a sonographer’s responsibilities extend well beyond image acquisition.
“We have the opportunity to provide compassionate support, answer questions within our scope, facilitate bonding between parents and their baby, and obtain the high-quality images that help MFM specialists deliver the best possible care,” said Marsh.
Ultrasound expertise at UAB
Marsh is part of a larger ultrasound team within UAB’s Department of Obstetrics and Gynecology, which provides imaging support for obstetrics, gynecology, and reproductive endocrinology and infertility (REI). Over the past year, the team performed approximately 36,000 scans.
The department has 30 sonographer positions, 28 of which are currently filled. Every sonographer on staff is trained in nuchal translucency and cervical length imaging, and 80% are registered in fetal echocardiography, with the department working toward 100%.
The practice is accredited by the American Institute of Ultrasound in Medicine (AIUM) in four specialties: gynecology with 3D, standard obstetrics, detailed obstetrics, and REI with 3D. It is the only practice in Alabama to hold AIUM accreditation in REI.
Physicians across the department see the impact of that expertise firsthand. Akila Subramaniam, M.D., a tenured professor and division director in UAB’s Division of Maternal-Fetal Medicine, works alongside the sonography team and says their role touches nearly every part of patient care.
“Ultrasound is such a pivotal aspect of all facets of women’s health care, especially in reproductive health,” said Subramaniam. “From providing real-time insight into fertility treatment to diagnosis of complex anomalies, sonographers play a key role as part of our clinical OB/GYN team.”
“Their expertise is second to none and allows us to provide early diagnosis and treatment, ultimately enhancing how we care for our patients and providing our patients the best information in their care journey,” said Subramaniam. “It just wouldn’t be possible without the amazing sonographers who work alongside us.”
The evolution of ultrasound technology
Marsh has practiced as a sonographer since 2009, a period marked by substantial technological advancement in the field.
“Think about the difference between the phone or laptop you used in the early 2000s and the technology available today,” said Marsh. “Ultrasound systems have seen similar improvements in size, speed, processing power, image quality, AI, and data-sharing functionality.”
She recalled one instance that directly illustrated this progress. Following an equipment upgrade in her department, a colleague identified what initially appeared to be an abnormal finding. Later, it was subsequently determined to be normal anatomy that earlier-generation equipment had lacked the resolution to display accurately.
“These advancements continue to improve our ability to evaluate anatomy and support patient care,” said Marsh.
A window into early intervention
Among ultrasound's most significant contributions is its capacity for early detection. Marsh cited conditions such as twin-twin transfusion syndrome (TTTS) and spina bifida, for which timely diagnosis can enable fetal intervention associated with improved outcomes.
Ultrasound also plays a central role in identifying structural anomalies and findings associated with genetic conditions.
“Early detection allows care teams and families more time for evaluation, care planning, delivery coordination, and access to appropriate resources,” said Marsh. “It can also help families better understand and process complex information before delivery, allowing them to make informed decisions alongside their healthcare team.”
The cost of the craft
Marsh emphasized that sonographers are clinicians rather than technicians whose role is limited to image capture. Sonographers bring specialized training in anatomy, physiology, and physics to each examination and collaborate closely with physicians and advanced practice providers across subspecialties, including maternal-fetal medicine, reproductive endocrinology and infertility, and gynecology, to acquire and evaluate imaging that informs diagnosis and treatment.
She also pointed to an underrecognized occupational concern: the physical demands of the profession. Sonographers experience elevated rates of work-related musculoskeletal injury due to the repetitive, physically intensive nature of scanning.
“Increased awareness can help support investments in ergonomic equipment, safe workplace practices, and staffing models that promote long-term career health and sustainability for sonographers,” said Marsh.
Closing the gap in maternity care
Marsh expressed particular interest in technologies aimed at expanding access to obstetric ultrasound in underserved areas. Citing data from the March of Dimes, she noted that numerous counties in Alabama are designated as “maternity care deserts,” where access to maternity care is limited or unavailable.
Emerging technologies, including real-time remote physician review, AI-assisted imaging, and robotic ultrasound systems, are being developed to support telemedicine and remote care models that could extend specialized MFM expertise to these communities.
“These innovations have the potential to bring specialized expertise to communities that may not otherwise have ready access to maternal-fetal medicine services, helping improve equity in healthcare access while maintaining high standards of care,” said Marsh.
Ultrasound Awareness Month is a chance to honor the skill, dedication, and quiet compassion that define the sonography profession. As Marsh's story shows, behind every scan is a clinician devoted to caring for patients at some of the most meaningful moments of their lives. Continued investment in both technology and the people who bring it to life will be essential to carrying that care forward, for every family, everywhere.