DMU 3212 Unit 1

Before, during, and after the exam; Sonography & Anatomy

Other names for ultrasound (5)

Sonography, sonogram, echocardiogram (echo), doppler, ultrasonography

Example of an ordering practitioner

Physician (doctor), Physician’s Assistant (PA), Nurse Practitioner (NP)

What does an ordering practitioner do?

They see the patient and order the exam .

What does the sonographer do?

Performs and records ultrasound study

What does the Reading Physician do?

They provide final legal interpretation of ultrasound findings. Creates final report (interpretative report).

Examples of a Reading Physician (5)

Radiologist, OB/GYN Physician, Cardiologist, Vascular Surgeon, Sonologist

What is on the Exam Order (US Request Form)? 4 things

Patient ID (Name and DOB), Symptoms/ Reason for exam (ICD 10 code), Type of exam requested, Physician Signature (Physical/ written or electronic)

What can you find on a Patient Chart (Medical Record)?

Patient information (ID and contact info), medical history, physical exam results, symptoms, previous imaging results, lab results

What is an Electronic Medical Record (EMR)?

Digital (computerized) medical record

Meaning of Standard Precautions

Treat every patient as though they may have a bloodborne or infectious disease.

3 Acts of Standard Precautions

Clean/ disinfect ultrasound system between patients, wear appropriate PPE (gloves and masks), handwashing for 30 seconds before and after an exam

Curved Transducer

Abdominal exams, trans abdominal pelvic

Deeper images over a wider area

Curvilinear, curved array

Linear transducer

Vascular and small parts (thyroid, breast, scrotum)

Shallower images

Linear array

Sector Transducer

Cardiac

Deeper with a smaller “footprint”

Phased, phased array

Endocavity Transducer

Transvaginal

In what direction do linear beams travel?

Straight

In what direction do curved beams travel?

Diverge from curve of transducer

In what direction do phased/ sector beams travel?

Diverge significantly from transducer

Steps for beginning the exam

1. Verify patient identity

2. Interview the patient

3. Explain the exam to the patient

Steps for during the exam

1. Choose appropriate machine presets for your exam

2. Know your protocol

3. Know your anatomy and normal sonographic appearance

4. Obtain images in appropriate scanning planes and label correctly

Protocol

Anatomic images and measurements required for the ordered exam.

Steps for after the exam (Sonographer)

1. Clean up the ultrasound room

2. organize your machine

3. Review images and write up preliminary findings

4. Submit images to the PACS system

PACS

A computerized method of storing, transmitting, and displaying medical images

DICOM

The international; standard to communicate and manage medical images and data

Steps for after the exam (Reading Physician)

1. Review preliminary findings and images

2. Create final report

What may a Final Report include?

Recommend clinical correlation, recommend further imaging, recommend biopsy, potential differential diagnosis

Differential Diagnosis

Other possible cause of finding

Echo Texture

Sonographic appearance of tissue within the body

Anechoic

Echo-free appearance, structure will be black, fluid-filled

Isoechoic

The same echogenicity, same shade as another structure

Hypoechoic

Less echogenic, darker than another structure

Hyperechoic

More echogenic, brighter than another structure

Gray Scale

Black and white image

Color Doppler

Presence and direction of blood flow

Pulsed Wave Doppler (Spectral)

Speed and direction of blood flow

Continuous Wave (CW) Doppler

Direction and speed of flow, but not location

Cystic

Fluid-filled

Solid

Composed of tissue

Homogenous

Similar or uniform echo pattern

Heterogenous

Irregular or mixed echo pattern

Simple

Uncomplicated, usually referring to cysts

Anechoic, unilocular, thin smooth wall, no blood flow

Complex

Composed of both tissue and fluid

Septations

Thin membranes within a mass

Ipsilateral

On the same side

Contralateral

On the opposite side

NPO

Nothing by mouth

Neoplasm

Any abnormal growth

Benign

Non-cancerous

Malignant

Cancerous

Diffuse Disease

Disease throughout an organ

Superior/ Cephalic

Towards the head

Inferior/ Caudal

Towards the feet

Anterior/ Ventral

Front of body

Posterior/ Dorsal

Back of body

Medial

Towards middle of body

Lateral

Towards edge of body

Proximal

Towards the heart

Distal

Further from the heart

Subcostal

Beneath or below the ribs

Intercostal

Between the ribs

Midline

Vertical line- center of body

Midclavicular

Vertical line- middle of clavicles

Xiphoid Process

Lower end of sternum (breastbone)

Umbilicus

Belly button

Sternal Notch

Top of sternum

Iliac Crest

Top of hip bone

Symphysis Pubis

Joint of left and right pubic bones

Sagittal Plane

Longitudal, long

Divides body into left and right

Transducer indicator notch towards patient’s head

Transverse Plane

Divides body into superior and inferior

Transducer indicator notch towards US machine

Coronal Plane

Divides body anterior to posterior

Transducer Indicator

Indicator points towards patient’s head in sagittal or towards the machine in transverse

The indicator will correspond with the left side of your screen

If indicator is to patient’s anatomic right, right side anatomy is seen on the left of the screen in transverse

Supine

Laying on back

Indicator towards machine (patient’s right)

Prone

Laying on belly (not frequently used for US)

Indicator towards machine (patient’s left)

Left Lateral Decubitus (LLD)

Patient lays on left side

Enables scanning of right lateral surface

Right Lateral Decubitus (RLD)

Patient lays on right side

Enables scanning of left lateral surface