Chapter 7: Clinical Assessments & Sonographic Procedures

Question 1

Competent SGs are expected to

Answer 1

have an excellent understanding of common diseases and to recognize any situation that calls for unusual views or patient preparations.

Question 2

SGs are to skillfully:

Answer 2

1. compile clinically relevant data through chart reviews
2. obtain addition history
3. communicate your observations in which u/s energy is penetrate and reflected back from the patient’s tissues.

Question 3

Describe the supine position.

Answer 3

Pt lies on his back with head and upper shoulders slightly elevated to provide comfort and maintain the natural curve of the spine at the neck. A. small pillow under his knees to relieve back pressure.For exams of the upper abdomen, the pt’s right arm is elevated to expand the rib spaces to their fullest.

Question 4

Describe the lateral decubitus position.

Answer 4

Pt lies on his side with arms position in front or dependent arm elevated. Dependent leg straight and other leg crossed over the knee resting on the table.

Question 5

Describe the prone position.

Answer 5

Pt lies on his abdomen, arms flexed at either side or elevated alongside the head to widen the intercostal spaces. A small pillow placed under the pt’s head, abdomen, and lower legs serves to relieve pressure. The pt’s feet should extend off the end of the table.

Question 6

Describe the upright position.

Answer 6

Pt sits on the edge of the scanning table, right arm elevated above the head, left arm and hand providing support. Helpful for scanning a high gallbladder or gassy pts.

Question 7

Describe the modified Fowler’s position.

Answer 7

The head and upper portion of the back is elevated 18-20”. Knees elevated for comfort. Useful in advanced pregnancies to avoid vena caval hypotension.

Question 8

Describe the Trendelenburg position.

Answer 8

The head of the pt’s table is tilted down 30-40 degrees and the table is anged to elevate the pelvis. Useful to visualize the lower uterine segment or low-lying fetal anatomy.

Question 9

Describe an anterior oblique position.

Answer 9

Pt is lying on their side with the torso angled forward.

Question 10

Describe a posterior oblique position.

Answer 10

Pt is lying on their side with torso angled back.

Question 11

Why do SGs change a pt’s position?

Answer 11

In order to visualize an area better for better imaging.

Question 12

What’s another name for the supine position?

Answer 12

Dorsal recumbent.

Question 13

The routine duties of a SG:

Answer 13

1. perform quality assurance test regularly
2. prepare and clean transducer
3. order supplies
4. check schedule daily to obtain prior u/s studies or other diagnostic test results for scheduled pts
5. record, generate, distribute and archive images
6. create and maintain a teaching file

Question 14

Routine Duties: Quality Assurance (QA)

Answer 14

Basic tests of the equipment should be performed on a regular basis and the results recorded in an equipment log. A set of periodic definitive measurements for each transducer can identify degradation in image quality before it affects pt scans.

Question 15

QA areas tested

Answer 15

1. instrument sensitivity evaluation
2. image photography uniformity
3. vertical & horitzontal measurement accuracy

Question 16

U/s accreditation program requirements include that quality control testing be done how often?

Answer 16

at least twice a year

Question 17

Routine Duties: Transducer prep and care

Answer 17

clean between pts with disinfectant or sterilization like T-spray, following the manufacturer’s instructions.

Question 18

Glutaraldehyde solutions are used to

Answer 18

dinfectant endocavitary transducers, like vaginal probes

Question 19

Routine Duties: Supplies

Answer 19

maintain an adequate supply of linens and coupling gels, as well as bedpans, urinals, emesis basins, IV stands, and sterile trays for use in procedures.

Question 20

Routine Duties: Schedule review

Answer 20

any charts or previous and pertinent diagnostic or lab test results should be available before initating the study.

Question 21

Routine Duties: Image generation, recording, and distribution

Answer 21

To perform and reproduce high-quality images, stay current on standards of care guidelines for new procedures, clinical applications and instrumentation. Check the AIUM and SDMS websites regularly.

Question 22

PACS stands for…

Answer 22

Picture Archiving and Communicating System.

Question 23

PACS is…

Answer 23

a computer-assisted program that electronically stores, manages, distributes and allows viewing of images.

Question 24

RIS stands for…

Answer 24

Radiology Information Systems

Question 25

RIS is…

Answer 25

a computer-assisted program designed to streamline scheduling, pt registration, work lists, billing and medical reporting.

Question 26

The benefits of PACS/RIS:

Answer 26

1. saves time
2. saves the cost of film
3. tracks pt data better
4. improves turnaround time for dictation and sending of reports to the referring MD

Question 27

If PACS/RIS are not available, …

Answer 27

produce diagnostic hard copy images to submit with your impressions for interpretation.

Question 28

SG’s technical reports should include the following info:

Answer 28

1. location of the scan plane
2. normal or abnormal echogenicity of the organs studied
3. measurements and their locations
4. presence of shadowing or acoustic enhancement
5. presence and location of any masses
6. presence of mass vasularity
7. presence and location of abnormal fluid collections
8. any technical difficulties encountered during the study

Question 29

Before the exam, the SG should…

Answer 29

1. review the pt’s chart to verify MD’s order
2. make sure the appropriate test is being ordered per symptoms
3. get prior diagnostic test results
4. inform the pt of the purpose of the exam
5. inquire about pt prep
6. get pt history (allergies, etc)
7. disrobe and position pt
8. select appropriate instrumentation based on pt body habitus

Question 30

Abdominal/Retroperitoneal ultrasound examines:

Answer 30

1. abdominal cavity
2. liver
3. spleen
4. pancreas
5. gallbladder and bilary tree
6. kidneys
7. great vessels (aorta & IVC)

Question 31

Clinical Indications for abdominal exam:

Answer 31

1. ab, flank, or back pain
2. referred pain from the abdominal/retroperitoneal regions
3. presence of palpable masses or organomegaly
4. abnormal lab findings suggestive of pathology
5. evaluation of known or suspected abnormalities
6. exploration for the site of primary or metastatic disease
7. trauma
8. evaluation of know/suspected congenital abnormalities
9. evaluation of pretransplant or posttransplant surgery
10. identification of calculi in the digestive or urinary tracts
11. assesment and evaluation of tumors, cysts, abscesses, or free fluid within the abdomen
12. evaluation of the major abdominal arteries of the presence of an aneurysm
13. evaluation of narrowing of the abdominal arteries
14. guidance during aspiation or biopsy procedures
15. location of a foreign object within the abdominal/retroperitoneal organs/cavities

Question 32

Name four things that can hinder the ultrasonic viewing of internal organs.

Answer 32

bowel gas, barium (and other contrast materials), obesity and dehydration

Question 33

Describe the patient prep for an exam of the digestive tract

Answer 33

Pts should eat a fat-free meal the evening before the test and then be NPO 8-12 hours prior. May also be asked to drink 8 oz of water.

Question 34

Describe the patient prep for an exam of the abdominal vessels.

Answer 34

Pts should avoid eating for 8-12 prior to the test.

Question 35

Describe the patient prep for an exam of the urinary tract.

Answer 35

Pts should drink 4-6 glasses of liquid an hour before the test to fill the urinary bladder.

Question 36

SG’s exam steps:

Answer 36

1. confirm pt’s ID & prep
2. question the pt’s history (pain, what sort, for how long, personal history)
3. present meds
4. lab test results
5. position pt
6. select transducer
7. gel
8. document images of liver, GB, kidneys, pancreas, spleen, diaphragm, aorta, IVC, CBD, fluid collections (check all quadrants)

Question 37

What three things are not usually including in an abdominal exam, unless specifically requested?

Answer 37

bowel, adrenal glands, and bladder

Question 38

Use of ultrasound in interventional procedures may be requested for:

Answer 38

1. localizing a lesion to be punctured
2. needle-guided lesion puncture
3. paracentesis: ascites
4. thoracentesis: pleural fluid