Chapter 1: Before, During, After Exam

Responsibilities of Sonographer

1. Obtain and record patient data pertinent to ultrasound study (nam, DOB, Hx/symptoms)

2. Proper use of ultrasound system (beginning/ending an exam, knobology)

3. Provide quality patient care (compassion, listening skills, patience)

4. Knowledge of standard precaution (gloves, gowns, hand hygiene)

5. Acquire, analyze, modify, and select images to store and present to interpreting physician for diagnosis

6. Use ultrasound terminology to document the technical summary of ultrasound findings which are presented or sent to the interpreting physician

7. Assist with ultrasound-guided invasive procedures

OSHA

Occupational Safety and Health Administration; standards designed to protect health care workers from transmission of diseases

Before an Exam

Need an ultrasound request form, patient clinical history and ICD-10-CM (code that indicates need for the scan); request form will also have name and address of referring physician, essential clinical facts explaining the reason for exam, patient history, physician signature, and area for barcode; need verbal identification of name and DOB, and examination priority and location plus patients precautions on request form

During an Exam

Need documentation of ultrasound images using universal or facility protocols/images including location of anatomy and sonographic appearance of normal body structures and terms to describe their appearance

After an Exam

Write final interpretive report/exam worksheet to include patient clinical history, symptoms, pertinent lab results, and ultrasound findings; provide a written technical observation summary of ultrasound findings using sonographic terms (include limitations and never provide diagnosis)

Imaging Criteria

Use the correct transducer for the type of scan; use coupling agent (gel) between transducer and skin; apply pressure which could vary depending on type of scan, body habitus, or patient tolerance; perform scan survey (scan over the entire organ/region for an overview but no images taken); optimize image quality with keyboard and touchscreen

Sagittal Plane

Anterior on top, posterior on bottom, superior/above on left of screen, inferior/below on right side of screen; can be termed as long axis

Coronal Plane (not really used in real world)

Lateral on top, medial on bottom, superior on left of screen, inferior on right of screen

Transverse Plane

Anterior on top, posterior on bottom, right side of patient on left side of screen, left side of patient on right side of screen; can be termed as short axis (axial)

Descriptive terminology

Soft tissue and usually solids are described by size, shape, and contour (edge texture), position within the body, or parenchymal (tissue) texture; bone is white (with a shadow underneath), fluid is black, soft tissue is shades of gray

Homogeneous Echotexture

uniform in texture/all one shade of gray

Heterogeneous Echotexture

Irregular in texture/different shades of gray; diffuse disease (infiltrative: spreads throughout an organ) or localized (a mass or masses circumscribed to a specific area), intraorgan is usually a solid mass inside the organ or extraorgan which hangs beside the organ

Echogenicity

The quantity of echoes

Hyperechoic

Abundant echoes - bright/white

Hypoechoic

fewer echos - gray

Anechoic

No echoes - black (liquids)

Isoechoic

Echoes are the same (used to compare tissues)

Criteria of a Simple Cyst

Anechoic, defined walls, and posterior through transmission aka posterior enhancement (white shadow posterior to structure)

Complex Masses

Both fluid and tissue components with varying percentages of each; walls vary from well defined and smooth to poorly defined and irregular