Chapter 6: Clinical Assessments and Sonographic Procedures Flashcards
What are the 12 Ultrasound Specialties?
Abdominal, Breast, Adult Cardiac, Pediatric Cardiac, Fetal Echocardiography, Gynecologic, Obstetrics, Opthalmologics, Pediatrics, Urologic, Vascular, and Muskoskeletal.
What are the four most widely practiced diagnostic ultrasound specialties?
Abdominal, Obstetric and Gynecologic, Cardiac, and Vascular.
What does SCAN stand for?
Sonography Clinical Assessment Notebook
Who developed SCAN?
International Foundation for Sonography Education and Research or IFSER
What was developed collaboratively and endorsed by many sonography-related organizations?
the National Education Curriculum
Who offers NEC?
The Joint Review Committee on Education in Diagnostic Medical Sonograpy or JRC-DMS
What is a major goal of sonographers when it comes to sonographic techniques?
To master them to produce high-quality diagnostic sonograms with minimal patient discomfort.
What skills are sonographers required to have?
To compile relevant data by reviewing charts: obtaining additional history and physical data, evaluating lab values, and communicate in written and verbal forms.
What is Supine Position?
Also known as the dorsal recumbent position.
Patient is on their back with head and shoulders slightly elevated.
Used to examine the upper abdomen
Elevating patients right arm helps to open up intercoastal spaces in the ribs.
What is the Lateral Position?
Patient is lying on his side with arms positioned in front of them.
What is a right lateral decubitus position?
Patient will be laying on right side with leg crossed over in front of the other one. Helpful in seeing left kidney.
What is a left later decubitus position?
Patient lays on left side with leg crossed in front of other. Helpful in viewing gallbladder and right kidney. Used in echocaridography.
What is the prone position?
Patient lies on their abdomen with arms at either side or elevated alongside the head. Used to evaluate the kidneys and neonatal spine
What is the upright/erect position?
Patient sits on edge of scanning table, right arm elevated above head, left arm supporting.
Used to scan the gallbladder and pancreas.
What is the modified fowler position?
Head elevated 25 degrees, knees slightly bent.
Used during advanced pregnancy.
What is the Trendelenburg position?
The pelvis is elevated higher than the patients head.
What are the 4 scanning planes?
Sagittal, Transverse, Coronal, and Oblique.
What is the sagittal scanning plane?
Longitudinal, lengthwise, divides the patient into left and right sides.
What is the transverse scanning plane?
Horizontal across the patients body, 90 degrees to the sagittal plane. Divides body into superior and inferior positions. (Top and Bottom)
What is the coronal scanning plane?
Vertical plane - right angles to the sagittal plane. Divides the body into anterior and posterior positions.
What is the oblique plane?
any plane not parallel to the three other planes (sagittal, transverse, and coronal)
What are routine duties a sonographer should know?
Patient preparation, scheduling, image generation, recording, distribution, and archiving, technical reports, procedural and diagnostic coding, quality assurance testing, and supplies.
What is patient preparation?
- review the order to see if an ultrasound is the appropriate course of action.
- Check results of any prior diagnostic tests
- Mentally review sonographic protocols.
- Inform patient the reason for the ultrasound procedure
- Ensure the patient has followed any required pre-exam requirements
- Conduct a brief patient history.
- Instruct the patient on how to disrobe if needed
- Perform a brief physical examination
- Position patient on scanning table
- Select appropriate transducers for exam.
What is a schedule review?
Check schedule to pull prevous ultrasound examinations from the PACS system.
What is Image Generation, Recording, Distributuion, and Archiving?
Check accredited websites to ensure protocols and guidelines are up to date.
DICOM is the standard used with PACS for handling, storing, printing, and transmitting information in medical imaging.
What is DICOM?
Digital Imaging and Communications in Medicine
What was used before DICOM with PACS?
RIS or Radiology Information System
What are technical reports?
Also known as the preliminary report.
Report of finding and observations
What is included in a technical report?
- Scanning planes and position used
- Normal or abnormal echogenicity (or both) of organs studied.
- Measurements and locations
- Presence of Shadowing or acoustic enhancement.
- Presence and location of masses.
- Presence and location of abnormal fluid collection
- Any technical difficulties encountered during study.
What are Procedural and Diagnostic Coding?
CPT codes or current procedural terminology codes.
Accounting and billing staff will keep CPT codes up to date.
You are responsible for keeping them current in your department.
Who publishes CPT codes?
The American Medical Association
What is quality assurance testing?
Testing of all ultrasound equipment and transducers, this is required.
What is a PM?
Preventive Maintenance
What is OEM?
Original Equipment Manufacturer
What are some supplies a sonographer would use?
Linens
Gels
Bedpan, urinals, emesis basin
Tissues
Wipes
IV Stand
Sterile Trays
Disinfectant Solutions
What is Abdominal and Retroperitoneal Sonography?
Used to examine the abdominal cavity for fluid, abscesses, or lymph adenopathy: liver, spleen, pancreas, gallbladder, biliary tract, kidneys, and urinary tract. Also used to examine Major abdominal vessels using 2D, 3D, and dopper ultrasound techniques
When should Abdominal Sonography be done?
Before any diagnostic images that require contrast material.
What does NPO stand for?
Nothing by Mouth
Whats the difference between adult NPO and
Adults are NPO 6-8 hours before exam
Children are NPO 4-6 hours before exam.
Who do abdominal sonographers work under?
A Radiologist
What are the preliminary steps for Abdominal and Retroperitoneal Exams?
- Verify Order
- Identify patient according to NSPG’s guidelines
- Confirm patient is prepared for abdominal sonographic exam.
- Take patient’s history
- Review medical history and history of infectious diseases
- Obtain list of current medications
- Document any normal or abnormal findings
- Review any prior results
What type of exposure should you use on children and infants?
The lowest exposure as possible
What planes are used in abdominal and retroperitoneal exams?
Longitudinal, transverse, coronal, and oblique
What organs are covered under abdominal and retroperitoneal exams?
Liver, Gallbladder, Common Duct, Kidneys, Pancreas, Spleen, Diaphragm, Aorta, and IVC.
What organs would you use the color dopper on in abdominal and retroperitoneal exams?
Liver, Kidney, Aorta, and IVC
What are Midquadrants?
Transverse image at the level of the umbilicus
What are lower quadrants?
Transverse images at the level of the iliac crests
What is the pelvis?
Sagittal midline image
Exams of what organs are not typically in abdominal scans?
Gastrointestinal tract, adrenal glands, and urinary bladder.
What are Interventional Procedures?
These are minimally invasive procedures guided by real-time ultrasound imaging.
What is the “freehand” technique?
This is where the tranducer and needle are not connected.
used to drain ascites, pleural fluid, and in superficial lesions.
What is another interventional procedure?
The Needle Guide attached to the transducer.
Used for small lesions, deep lesions, and lesions near major vessels/structures.
What is the main thing to watch out for when it comes to CPT codes?
Difference between complete and limited examinations
What is Vascular Sonography?
used to evaluate the body’s circulatory system.
What is Duplex imaging?
An ultrasound machine that incorporates both 2D image and all doppler information on the same screen.
What is vascular sonography used to determine?
The absence or presence of stenosis, aneurysms, thrombosis, or other pathologic conditions without ionizing radiation or nephrotoxic contrast agents.
Used to also evaluate patients with grafts or stents
How do you prep a vascular sonography patient?
- Must be NPO for at least 6 hours before exam.
- Verify that the appropriate exam has been ordered that fit patients symptoms and diagnosis.
- Get a brief medical history
- Get a list of medications
- Brief the patient on the procedure.
Does Extracranial and extremity duplex require preperation?
No preperation required.
What are some clinical indications that vascular sonography is needed?
Extracranial - aphasia, dysphasia, etc.
Peripheral Arterial - Extremity pain, asymmetric bood pressure, etc.
Peripheral Venous - Extremity swelling, palpable cord, etc.
Abdominal - Acute or severe abdominal pain, history of cirrhosis.
What is extracranial positioning?
Patient lies supine with the neck slightly extended and turned contralateral side.
What is the Peripheral Arterial position?
Patient lies supine with ipsilateral knee slightly bent.
What is peripheral venous position?
patient lies supine with table placed in a slight reverse (Trendelenburg position)
What is the abdominal position?
Placed originally in the supine position - upright, right, and left lateral decubitus positions.
Standard protocol for an extracranial duplex exam should include what?
grayscale and color doppler imaging in longitudinal and transverse pleanes.
What is spectral analysis?
A method to display the blood flow velocities by representing graphically on the Y-axis time and on the X-axis the doppler information.
What is popliteal?
Anatomical structure located in the back of the knee.
What is Peroneal?
The outer side of the calf of the leg near the fibula
What are the upper extremities for peripheral venous duplex?
Subclavian, axillary, brachial, radial, and ulnar arteries
What are the lower extremities for peripheral venous duplex?
Femoral, profunda, common femoral, popliteal, posterior tibial, and peroneal veins.
What is Obstetric and Gynecologic Sonography?
Used to evaluate pregnancy and the female reproductive organs.
How many segments is pregnancy divided into?
3 semesters
How many weeks is the first trimester of a pregnancy?
13 weeks
How many weeks is the second trimester?
begins the 14th week and ends the 26th week.
How many weeks is the 3rd trimester?
Begins the 27th week and ends at birth. (usually around week 40)
What is chorionic Villus sampling?
A form of prenatal diagnosis to determine genetic abnormalities in the fetus in which a sample of chorionic villi is obtained and tested.
Who is AIUM?
American Institue of Ultrasound in Medicine
What two ways can you perform a first trimester ultrasound examination?
Transabdominally (TA) or Transvaginally (TV)
What is the alternative approach if TV and TA are not definitive?
Transvaginal Sonography or TVS
What is Transvaginal Sonography?
Also known as Endovaginal Sonography.
A specialized transducer that is inserted into the vagina to obtain high resolution images of the female pelvic organs and area.
What 3 types of sonography help to visualize the cervix?
Transvaginal, Transperineal, or transabdominal.
What is the most common invasive obstetric procedure performed under ultrasound guidance?
Amniocentesis
What does MFM stand for?
Maternal-fetal Medicine Specialist
What is Ultrasound-guided Percutaneous Umbilical Blood Sampling (PUBS)?
A diagnostic test which examines blood from the umbilical cord to detect some fetal - abnormalities. Usually performed after 17-18 gestational weeks.
What is paracentesis?
procedure to take out fluid (called ascites) that has collected in the peritoneal cavity.
What is a transabdominal probe?
Placed on the anterior wall of the abdomen or perineum. 3.5 MHz or Higher
What is a transvaginal probe?
Place inside the vagina. 5.0 MHz or higher
When is a transrectal or Transperineal Sonography usually done?
When the female patient is not a candidate for transvaginal, Typically a virgin or postmenopausal patient.
What are the two major cardiac ultrasound procedures?
Transthoracic Echocardiography and Transesophageal Echocardiography
What is the major difference between Transthoracic and Transesophageal?
Transthoracic is non-invasive and Transesophageal is invasive since it places a specialized transducer within the esophagus.
What modes are commonly used in echocardiography?
2D and 3D imaging, M-Mode Tracing, Doppler Flow Studies, and Tissue Doppler-imaging techniques.
What is EMR?
Electronic Medical Records
