Fall, 2017

 


Has the sonographer done everything possible on behalf of this patient at the time of imaging? 

Sonographers are tasked with not only imaging the abdominal organs in this setting, but also to employ a diagnostic approach to their patient to find the answers that the patient and ordering physician need. It is imperative to approach studies with an inquisitive mind, trying to answer diagnostic questions, not just being an organ imager. 


Diagnostic Medical Sonographer

This is the diagnostic approach to imaging this same patient.

38 year old female goes to the doctor because she has abdomen pain. She tells the doctor about her abdominal pain and other symptoms that include nausea, vomiting, loss of appetite, bloat, etc.

The ordering physician orders an abdominal ultrasound to see if the gallbladder is the culprit. The order reads, “US Abdomen”, Diagnosis “Abdomen Pain.”

She comes to the imaging facility at the scheduled morning appointment time npo as instructed.  The sonographer has the patient get into a gown and into position on the scanning table for the ultrasound.

The sonographer, performs 76700 Abdominal ultrasound which includes imaging of the liver, gallbladder, pancreas, spleen, aorta, kidneys, common bile duct, and ivc. 

The sonographer completes the protocol as required by the facility. 

Now, the diagnostic sonographer asks the patient to direct the diagnostic imaging. 

There are several ways of asking the same thing, 

“Have I imaged your site of pain?”

“Can you show me where your pain is?” 

“I would like to image your site of pain now. Show me where it hurts.”

The patient directs imaging which leads to imaging over the bowel. As transducer pressure is applied the patient yelps, and the sonographer can feel a sort of mass resistance sliding side to side under the pressure. 

The sonographer Impression Worksheet now includes the following ;

“Patient directed imaging over site of pain which is in the Right Lumbar Region. There appears to be a complex solid irregular mass in area of the ascending colon, with adjacent inflamed fat.”

The ordering physician ordered a contrasted CT on this patient which confirmed a large solid colon mass with abdominal lymphadenopathy.

Two ways of approaching the same study. 

Do you want to be a photographer or diagnostic medical sonographer?

There are many scenarios we encounter that require us to be diligent in our commitment to answering diagnostic questions.

It is important to answer;

  • The question of the order, and
  • The concern of the patient. 

Whether it is an area of pain or lump, whatever the concern that is what we will focus on, EVEN if it is outside of the standard imaging protocol of the facility. Imaging bowel is not standard protocol, but giving your patient a moment with diagnostic suspicion looking for answers will always be in a good diagnostic sonographer’s protocol.