1. Professional Practice in Patient Care Lesson 10 April 4th, 2013

2. Supine Position
Patient on back with head and upper shoulders slightly elevated
Used for examinations of the upper abdomen
Elevating the patient’s right arm opens up intercostal spaces

3. Lateral Position
Place a pillow between the legs at knee level for pregnant or elderly patients.

4. Prone Position Patient on his or her abdomen
Arms flexed at either side or elevated alongside the head to widen the intercostal spaces
Small pillows under the patient’s head, abdomen, and lower legs to relieve pressure

5. Upright/Erect Position
Patient sits on the edge of the scanning table, right arm elevated above the head, left arm and hand providing support.
Used to scan a gallbladder in an extremely high position under the rib cage
For vascular studies, the patient may have to stand erect for portions of the study.

6. Modified Fowler Position
Head elevated 25 degrees; knees slightly flexed
Used in advanced pregnancy to avoid vena caval hypotension

7. Trendelenburg Position
The patient’s pelvis is higher than her head.
Used when fetal parts obscure the LUS or when fetal lie prevents imaging of the fetal head

8. Scanning Planes Sagittal plane—longitudinal
Midsagittal plane divides the body into equal right and left sides
Transverse plane—horizontal
Coronal plane—vertical
Divides the body into anterior and posterior portions
Oblique—any plane not parallel to sagittal, transverse, or coronal

9. Ultrasound Specialties
1. Abdominal
2. Breast
3. Cardiac
4. Gynecologic
5. Obstetric
6. High-resolution
7. Neurosonography
8. Ophthalmologic
9. Vascular
10. Musculoskeletal

10. Study-Related Duties
Get copies of any pertinent diagnostic or lab reports.
Confirm that the patient’s preparation has been carried out.
Get brief patient history; list present medications.
Document laboratory data.
Review prior ultrasound or other diagnostic tests.
Record and archive examination images.
Prepare sonographer’s technical report. 

11. Laboratory-Related Duties
Quality assurance testing
Transducer preparation and care
Cleaning ultrasound equipment and preparing area for the next patient
Maintaining supplies

12. Sonographer’s Report Location of the scan plane
Normal or abnormal echogenicity, or both, of the organs studied
Measurements and their locations
Presence of shadowing or acoustic enhancement
Presence and location of any masses
Presence and location of abnormal fluid collections
Any technical difficulties encountered during the study

13. Computer-Assisted Programs
PACS—electronically store, manage, distribute, and allow viewing of images
RIS—streamline scheduling and ordering of appointments, patient registration, work lists, billing, and medical and management reporting
EMR

14. Transducer Preparation and Care
Clean transducers mechanically with an enzymatic cleanser after every patient study.
Whenever a chance of contamination exists, clean the transducer using either a disinfectant or a sterilization process.
Guidelines for cleaning and preparing endocavitary ultrasound transducers may be found at

15. Maintaining Supplies Linens Coupling gels Bedpan, urinal, emesis basin
IV stand
Sterile trays

16. Abdominal and Retroperitoneal Sonography
Used to examine:
The abdominal cavity for fluid, abscesses, or lymph adenopathy
The liver, spleen, pancreas, gallbladder, biliary tract, kidneys, and urinary tract
Major abdominal vessels by using 2D, 3D, and Doppler ultrasound techniques.
Abdominal sonography should be done before any diagnostic imaging tests that require contrast material.

17. Interventional Procedures
Ultrasound guidance may be requested for various procedures or to help place tubes and drains.
“Freehand” technique—transducer and the needle are not connected
Used to drain ascites, pleural fluid, and in superficial lesions.
Needle guide attached to the transducer
Used for small lesions, deep lesions, and lesions near major vessels or structures.

18. Vascular Sonography
Performed to determine the absence or presence of stenosis, aneurysm, thrombosis
Used to evaluate patients with grafts or stents
Duplex imaging used to determine hemodynamic status of the vascular system and to detect the presence of pathology

19. Obstetric and Gynecologic Sonography
Used to evaluate pregnancy and the female reproductive organs
Standard protocols for first, second, and third trimester examinations
Limited study—used in emergencies or as a follow-up to a prior complete examination
Specialized examination—done when an abnormality is suspected or found
Biophysical profiles, fetal Doppler examination, or fetal echocardiography

20. Obstetric and Gynecologic Sonography
Transabdominal probes
Placed on the anterior abdominal wall or perineum
3.5 MHz or higher
Transvaginal probes
Closer to the area of interest
5.0 MHz or higher
Intracavitary—requires the insertion of this specialized transducer into the vagina.

21. Transrectal/Transperineal Sonography
Optional techniques for patients who are not candidates for a transvaginal exam
Young, virginal patients
Postmenopausal patients with a stenotic introitus

22. Doppler
Color, power, and spectral Doppler used to evaluate the vascular characteristics of ovarian and uterine masses
Color Doppler can be used to identify and differentiate vascular structures from nonvascular entities.

23. Interventional Procedures
Biopsy or aspiration procedures
Patients with masses or free fluid in the pelvis
Paracentesis
Patients with severe abdominal/pelvic ascites
Thoracenthesis
Patients with fluid in the pleural cavity

24. Adult Echocardiography
Transthoracic echocardiography (TTE)
Noninvasive
2D, real-time
Used to evaluate cardiac structure and function
Transesophageal echocardiography (TEE)
Invasive
Places a specialized transducer within the esophagus

25. Adult Echocardiography
Sonographic modalities most commonly used in echocardiography:
2D and 3D imaging
M-mode tracings
Doppler flow studies
Tissue Doppler-imaging techniques
Interventional procedures
Injected contrast agents

26. Additional Applications of Echocardiography
Serial echocardiography
Intraoperative echocardiography
Intracardiac-echocardiography (ICE)
Intravascular echocardiography (IVUS)
Stress echocardiography
Pharmacologic echocardiography
Pre- and post-ablation
Pre- and post-cardioversion

27. Exercise Healthcare Trends!! Where are we going?
With an older population and more Diagnostic tools at our disposal, what seems to be happening in terms of patient referrals?