Spring, 2017

This is a compiled list of 100 best scanning advice with some contributions from other experienced ultrasound technologists and ultrasound students.

1. Know when to move on. Struggling for 20 minutes isn’t going to make that pancreas become text book beautiful.

2. Don't look at your hand, look at the screen.

3. It's not always about landmark images, it's about scanning through the entire organ looking for pathology.

4. Treat your last scan of the day like it was your first. This is hard to do at times when you have had enough. The last patient very often has an abnormal finding.

5. When scanning the breast, don’t look away from the screen while your hand is moving, you could miss something.

6. Slather on tons of gel. Stop just short of the patient sliding off the table.

7. When scanning an early OB with a barely visible fetal pole and a slower than normal fetal heart rate, use spectral Doppler on the maternal iliacs to ensure you are not picking up maternal heart rate.

8. Always review your study before sending it over to PACS. Cut out redundant and misleading images. Your name is on your study and you want to represent yourself well.

9. Scan what you can and don't scan what you can't.

10. If you ever think "I wonder if I should look at or do a.....fill in the blank, do it, you will never forgive yourself for an "I should have...." When you find out later you missed something because you cut a corner.

 

11. Grab it when you see it and try and get a better picture later. Digital film is cheap.

12. If you cannot see the aorta anteriorly, then put the patient on his/her side and approach the aorta from the coronal window.

13. After getting images of the organ in its setting, don’t be afraid to zoom up on it to show close-up detail.

14. Keep your focal zone moving! Your left hand is as busy as your right.

15. Pumping out too many normal studies could indicate that you are likely rushing and missing pathology.

16. When you freeze the screen make sure that you are not creating inadvertent pathology. You must be able to explain the image to the radiologist if there is a question. For example a normal liver image may be shown with an "abnormal mass," but it's just artifact. Avoid sending these misrepresenting images.

17. Be confident in your knowledge when dealing with a radiologist. Don’t hem and haw.

18. When you aren’t sure of something, be confident enough in yourself to ask for help. Everyone needs it at some point, no one is perfect. 19. Know when to keep trying and when that's all you can get. It's not worth damaging yourself.

20. Treat every person that goes on your table like they are your family. You would only want the best for those you love.

21. Use a linear probe on OB 1st and 2nd when possible.

22. Use annotations such as, “Site as indicated by patient”. “Patient’s area of lump/pain.”

23. Use Color Doppler with proper settings, correct box size and scale.

24. Always scan where the patient hurts, you never know what you will find.

25. Treat patient information with the strictest confidentiality.

26. As a student I would spend 20 minutes trying to get a perfect image, my lab instructor said, "Is it a diagnostic image or is it hanging in the Louvre?"

27. Do not forget you can use Cini-loop clips for ambiguous or even definitive pathology.

28. Sweep all the way out of the organ you are interrogating. An exophytic mass or pedunculated fibroid could be hanging out there.

29. Be sure to always answer the questions of the physician’s order. If its pain, abnormal lab work, abnormal prior imaging finding, whatever it is that’s your purpose is to answer to that.

30. Include in your report any patient pertinent negatives. For example, “Patient denies pain.” “Patient denies any lump, pain, or discharge of the breast.”

31. Don't stop looking after you find something. Just because you see an explanation for their symptoms, it doesn't mean there's not more going on. There may be a second or third finding. Keep looking for more.

32. Create images that have diagnostic clarity as these images will go to a specialist without your tech impression worksheet to explain.

33. Do not allow cell phone use during an exam.

34. When in doubt always ask another tech or Rad for their opinion.

35. When imaging masses, include some images of surrounding organs to better show the radiologist the location of the mass.

36. Never forget how important you are to your job and your patients.

37. When looking at priors for a lower extr venous exams, include CT angio for PE results.

38. Learn the poker face.

39. Love what you do, and you'll never work a day in your life.

40. A radiologist said to me, "If you are not humbled by this profession, at least every now and then and always learning, then maybe you should be doing something else." Even he admits to not knowing everything and still learning new things after more than 30 years as a radiologist. That in of itself is humbling to me! The most valuable thing I have learned is that we must keep an open mind to always be learning. Don't ever think you know it all.

41. Go window shopping. Shop till you find a window. Rolling them and raising their arms will help clarify windows.

42. Be thorough. Perform the exam like you are doing it on your family and like every picture will be published with your name.

43. Graduation from your ultrasound program doesn't mean that you are a master sonographer. It just means that you know enough to do your job well. This is the beginning of a career where skill over time will continue to get better and better.

44. Tell the patient to be still and not talk until you are done to get the best study possible for the doctor.

45. Explain each step to the patient so they know what you are doing. No surprises.

46. Know human anatomy inside out and backwards, then you can recognize pathology.

47. Look for fetal heart tones first before anything else.

48. A cocky, know-it-all sonographer, is a dangerous sonographer.

49. Some patients, some studies make it necessary to have a chaperone in the room.

50. Don’t let the gel tip touch the patient or a dirty transducer as this could contaminate it.

51. Use high frequency transducer on kidney transplant for better velocity measurements. Then finish scan with low frequency transducer.

52. Try to be an ambidextrous sonographer in case you have one sided joint pain.

53. Use an assistant with large patients.

54. Move your machine and patient around YOU! Save yourself! You won't be able to scan anyone if you're constantly injuring yourself.

55. Take the picture. You can always get a better one later.

56. Always read the final radiology reports on your studies.

57. If a patient is at all verbally abusive or inappropriate, you should end the study.

58. Learn how to say "take a deep breath and hold it" in many languages.

59. You are not a miracle worker. You are only as good as the experience of the tech, the quality of the machine, and the habitus of the person you are scanning.

60. You can only do one patient at a time. Don't stress about how many are waiting for you.

61. Keep your elbow as close to your body as possible.

62. Never take on the bad attitude of the sonographers that choose to be miserable.

63. When ruling out a pseudo/AVF, always look with the curved, after looking with the linear.

64. Always look at prior studies done and get an excellent patient history.

65. Stand behind your scan, that being said, make sure your scan is something you would stand behind.

66. Rotate the patient in any position you need to better visualize, supine, LLD, RLD, erect, etc

67. Get more CME credits then you need. The more you get, the more you have learned. You can never learn too much.

68. Try for publishable quality images, if you are not proud of it, don't print it.

69. Don't get tunnel vision.

70. When I am having trouble keeping my transducer steady, I use my pinky to anchor my hand. Pinkie is key to holding views. Also use the pinkie as the “hydraulic lift” to elevate and hold over superficial findings.

71. We all work in small dynamic ultrasound world. A sonographer at a different hospital may one day be your manager, or an instructor may one day be your coworker, etc. Be a good sonographer and a team player. Your reputation goes everywhere with and without you.

72. Have reference books available to you in your ultrasound room.

73. Be curious. My best finds come from stepping out of protocol.

74. Use warm gel. They love it!

75. Create very thorough documentation so there is no question or doubt.

76. Take an image of blank screen first to document the time when you started a patient’s exam. That way if the study is ever reviewed they will know you spent time surveying before imaging. This is especially good habit in breast imaging.

77. Color Doppler is your friend, EKG is your friend, no question is stupid, never be afraid to admit you don't know something, and never be afraid to ask for help.

78. “Today’s study is tomorrow’s prior.” Make reproducible studies with good imaging habits and thorough documentation.

79. Stay positive and supportive on social media. Future employers will read your posts

80. Never believe you know it all or you will never learn more. There is always going to be something out there that you have never seen and there will always be a trick to make something easier that you have never been taught. Listen to your peers, doctors and even students. There is always room to learn more.

81. Pick the exam you hate to do the most and volunteer to do them all for a while. You will gain confidence. You will get good at the exams that no one else wants to do, and that makes you a hot commodity!

82. Good Ergonomics for a long career.

83. Orient yourself to the organ, not which way the transducer is facing. If you get mixed up and lose orientation during a scan, find your home base for every study. Go back to what you know for sure. When scanning testicles, my home base is transverse midline with both testicles in the image. It is easy to see the opposite testicle if you are angled a certain way and get the right or left confused.

84. Don't hesitate to use a different transducer in addition to what you would normally use. The curvilinear can be tremendous help on testicles or large patient DVT studies.

85. Follow your instinct. If something just isn't right, find out why, and prove it to your reading physician.

86. Breast sonographers must be able to correlate with the mammogram on every patient.

87. Just keep scanning. If you struggle with it and keep trying, you will eventually conquer it.

88. Remember you are the eyes of the physician. If you don’t see it they won’t see it.

89. Remember JCAHO rules. All of them.

90. Don't forget your bedside manner.

91. Whether it's your patient, the patient's family, your staff, or the stranger in the hallway, everyone deserves a smile. Smiles are contagious.

92. Never take things personally and never emotionally carry your last exam into your next.

93. If you see something in sagittal but you're not sure if it's real, always turn on it in a transverse plane to confirm that it is real.

94. Share what you learn with others. We are all in this together.

95. Always keep patient confidentiality. Be careful when sharing patient case studies for educational purposes by removing any patient identifiers first.

96. Get registered in every exam type that you work in.

97. Don't tell gender when the patient doesn't want to know it, and when the patient wants to know wait until the end of the study.

98. When doing lower extremity arterials make sure the room is comfortably warm so the arteries don’t constrict making the signals suboptimal.

99. Go to ultrasound conferences so you can network with like-minded people. It can make a huge difference in your career.

100. When following a mass seen on another modality, review thoroughly its mass location, size, and shape.