Fundamentals Final

Sonographer responsibilities

• Quality patient care

• Obtain & record diagnostic images for doc

• Know how to use ultrasound equipment & optimize images

• Assist w ultrasound guided procedures

Echogenicity

Ability to produce an echo

Echogenic

Tissue producing echoes

Echo identity

Expected Echogenicity in normal conditions

Boundary

Distinct boundaries for normal organs

Disease can alter boundaries

Penetration

Machine defaults to normal penetration

Causes of changes in penetration

Due to pathology or body habitus

Acoustic window

Directing sound through a structure for better imaging

Hyperechoic

Bright white, structure has brighter echoes than reference area

Hypoechoic

Dark gray, lower in Echogenicity when compared w/ another

Anechoic

Completely black, doesn’t produce echos

Ex: fluid filled structures

Homogenous

Even texture throughout structure

Heterogenous

Uneven patchy mixed texture

Isoechoic

Structures similar or close in Echogenicity

WNL

Within normal limits

NPO

Nothing by mouth

Localized

Within a specific area

Diffuse

Located within many areas (multiple within an area)

Wet Read

Unofficial report

For STAT (emergency/critical findings) exams

Referring Physician

Refers pt to a specialist

Orders specific diagnostic tests

Interpreting Physician

Reviews & analyzes test images to write formal diagnostic report

Observations to make during an exam

Size/shape of organ

Position

Relationship to other structures

How do observations help w/ diagnosis?

• SHAPE/CONTOUR COMPROMISED BY DISEASE MAY BECOME IRREGULAR (ex: fluid pushing on outer capsule)

• Comparing relative sizes of organs may show abnormality

• Knowing normal locations of organs can help identify conditions that alter location

Quality image depends on

Abilities/experience of sonographer

Condition of machine / patient

Capabilities of system

What’s the most operator dependent of all imaging methods?

Ultrasound

Cineloops

Motion clips to scan in “real time”

When are cineloops typically used

Cardiology

Obstetrics

Valsava

What can be used to evaluate organ function

Ultrasound

What is color Doppler used to evaluate

Vascularity

Stenosis

Perfusion

Sonographer should evaluate an organ’s Echogenicity in comparison to?

The adjacent organ (interface)

Sonographer tasks PRIOR to exam

Review request

Confirm pt identity

Check lab values

Check for proper test prep (NPO, etc)

Sonographer tasks DURING exam

Clear instructions

Correct presets & transducer

ADJUST PARAMETERS FOR EACH IMAGE

Follow protocol

Sonographer tasks AFTER exam

DOUBLE CHECK IMAGES

Complete tech worksheet

Submit images & report to reading physician

Reading physician responsibilities

Review & analyze ultrasound images

Match sonography findings w/ other reports (labs)

Provide final diagnostic report

If emergency, contact referring physician

In STAT results, sonographers are responsible for

Sending images to reading physician ASAP

CONTACT READING PHYSICAN W/ FINDINGS

PROVIDE RESULTS TO OTHER DRS W/ READING PHYSICIAN PERMISSION

Provide wet read (unofficial report)

Examples of critical findings exams

Fetal demise/abnormalities

Ectopic pregnancy

Mass w suspicion for cancer

Testicular/ovarian torsion

Ruptured aneurysm

DVT

Proper prep for exams

Abdominal scans: NP for 8 hrs prior exam

Pelvic exam: full bladder 32 oz before scan

Cardiac: no prep

Vascular: no prep except NPO for abdominal vascular scan

What to do if pt isn’t properly prepared for exam?

Stop exam immediately

Notify doctor or care team

Reschedule exam w/ patient

Review prep steps w pt again

Document what happened in pt chart

Terms to describe pathology

Mass = large distinct lump

Lesion = damaged tissue

Nodule = small solid clump of tissue

Abnormality

Avoid using specific terms such as?

Tumor

How to investigate an abnormality

Image in two planes (SAG & TRV)

Check for distinguished borders

See if it’s reproducible

To demonstrate true pathology, must provide

Always image with & without calipers

Look for vascularity & complexity

Look for compressibility

Measure volume (SAGxAPxTRV)

Degeneration of mass

Additional images of pathology

Solid and/or cystic components

How to identify mass

Show sonographic features of benign vs malignant

Image mass w high & low gain

Show difference in Echogenicity from nearby structures

Varying appearances of solid masses

Slightly denser tissue can appear isoechoic

More dense tissue shows shadowing

Complex has cystic & solid components

Can be hyper or hypoechoic

Can be homo or heterogenous

How to image location of mass

Establish location

Image mess in relation to nearby structures

Compare echo textures, size/shape, Echogenicity

Document location on worksheet

Document mass measurements using

Cm or mm measurements

Multiple dimensions (height, wider)

Specify orientations (TRV or sag)

Characteristics of simple cysts

No internal echos

Anechoic or sonolucent

Well defined walls

Acoustic enhancement

Complex mass has

Solid & cystic components

Internal echos

Calcifications, septations, fluid level

Irregular or well defined walls

Tech worksheet includes

Pt info (name, MRN, history/prior exams)

Lab data

Assessment of exam (organ appearance, measurements)

Comments (abnormal or limited exam)

Provide your initials

Differences between benign vs malignant mass

Shape (irregular vs round)

Borders (ill defined vs well defined)

Should you use words benign or malignant in your worksheet

No! Don’t diagnose

Solid mass pathology (photos)

Solid tissue mass. No fluid

Echogenic, varying borders, no posterior enhancement

Cystic mass pathology (photos)

Fluid filled

Anechoic (black vessel)

Defined borders

Has posterior enhancement

Malignant mass pathology (photos)

Tumor

Heterogenous

Irregular borders

No posterior shadowing

Well circumscribed pathology (photos)

Distinct lesion

Clear boundaries

Echogenicity varies

Often shows posterior enhancement