1. Image Quality Review 3rd Quarter Wednesday October 19 th 2011 IIBC 5:30-7:30

2. Agenda Review from 2 nd Quarter General announcements Image review for 3 rd quarter 2011. Questions and wrap up..

3. 2 nd Quarter review 2011 Presentation posted on SharePoint Proper measurements for cervix, lateral ventricle and aorta Imaging tips for finding ovaries, proper vascular technique, and imaging large patients on the E9

4. ddddddd Bad Cervix

5. Good Cervix Good Cervix Good Cervix

6. Bad Ventricle

7. Good Ventricle

8. General Announcements Scheduling ultrasound and vascular exams If we do a venous exam, we use the code WITHOUT THE DASH. If we do a Carotid or upper extremity venous, we USE THE DASH. VVDVT LOWER EXTREMITY VENOUS FOR DVT (NO DASH FOR ULTRASOUND) -UCARDU CAROTID DUPLEX EXAM ( WITH DASH FOR ULTRASOUND) -UUEVEN UPPER EXTREMITY VENOUS UNILATERAL (on call) CPT 93971 ( WITH A DASH FOR ULTRASOUND) -UUEVEB UPPER EXTREMITY VENOUS BILATERAL (on call) CPT 93970 ( WITH A DASH FOR ULTRASOUND)

9. Announcements Cont.….. Limited versus follow- up 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses This code is used for a selected, limited purpose such as evaluation of fetal viability, fetal position, or amniotic fluid check. It includes gray scale real time images with written interpretation and, if possible, image documentation. Code 76815 is used only once per exam and not per element or per fetus. 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus. This examination is designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously identified on an ultrasound. This code should be used once for each fetus requiring reevaluation using modifier ‘59’ for each fetus after the first.

10. More Announcements MULTIPLE GESTATIONS : When evaluating a pregnancy with multiple gestations, the following criteria must be met in addition to the established obstetrical ultrasound protocols: Attempt to establish chorionicity and amnionicity if it has not previously been established. Documenting separate placentas and/or differing fetal genders can confirm dichorionicity. Documentation of a membrane separating the fetuses confirms diamnionicity. Fetal positions should be documented in longitudinal and transverse planes with the fetuses labeled “A” and “B” in these images. The fetus that is presenting is designated as “Baby A”. This must remain consistant. The fetus designated as “Baby A” on the first ultrasound remains “Baby A” regardless of presentation changes. If necessary, simply specify that “Baby B is now the presenting fetus”. It is also mandatory to draw the fetal positions on the online form. Note: In Viewpoint, “Baby A” is “Fetus 1” and “Baby B” is “Fetus 2”.

11. Twins Continued… When evaluating biometry in Viewpoint, the fetal growth must be anchored to one fetus. On the first ultrasound, the larger fetus should be selected. On all subsequent ultrasounds, the gestational age is always anchored to the fetus that was selected on the first examination (the selection should not change regardless of whether or not the relative sizes of the fetuses change). A four quadrant AFI is performed without regard to the membrane(25 wks +). A subjective evaluation should be made of the amount of amniotic fluid in each sac, and a maximum vertical pocket measurement should be obtained in each sac.( 18 wks +) The placental cord insertion site(s) should be evaluated and imaged. The incidence of velamentous cord and vasa previa is increased in twins.

12. Other Stuff Ovarian cysts should be measured to include the cyst wall. The GB section on the online form is for comments, not a routine GB measurement. Cervices less than 3 cm are not routine unless otherwise specified by Radiologist.

13. RadWorkFlow Feedback 3 RD Quarter 2011

14. Show Placental Edge

15. Need Placental edge with this picture Need placental edge picture with this image as well

16. “Images of fetal heart need to be magnified”

17. 

19. 

20. Much better magnification of heart

21. Only image of Fetal Heart…..but good cine documented

22. Poor image of fetal kidneys

24. Better image of fetal kidneys

25. Poor measurement of HC

27. Better results using point to point HC

28. “Unacceptable images of posterior fossa”

32. Long and short axis cine images must be oriented to the uterus,not the patient

35. No color Doppler of thickened endometrium

37. Coronal Images of IUD’s Do we begin again?

38. How would you measure?

39. Include uterine mass in measurement.

40. Transverse measurement

41. Geez (crap) did I really just do that? Spine and kidneys not imaged, but checked off as normal on Viewpoint. Follow up recommended due to poor visualization of the spine. Spine not imaged on current exam. Oops! (read prior OB reports) Incorrect Uterine volumes, no uterine volumes. Right and left ovarian measurements transposed. Fibroids well documented but not drawn on on-line form. No Doppler of left testicle. No cine sweeps of the thyroid, uterus, ovaries, pathology.

42. Sick gallbladders need to be addressed

45. Take Home Message 1. Look at prior report. 2. Document that you looked and couldn’t find it.

47. Thyroid Nodules

51. How should we label? A B C OR 1 2

52. How to measure Sagittal Transverse

53. What about nodules less than 1 CM?

54. Uterine Masses

56. A B A B

57. The End