ULTRASOUND Messages for December, 1997: Jimbaun <Jimbaun@aol.com>: Re: ob protocols

Jimbaun <Jimbaun@aol.com>: Re: ob protocols

From: Terry J. DuBose

tjdubose@juno.com

Mon Dec 29 11:55:19 1997

Jimbaun@aol.com

sonographers-connection@Lists.UCHSC.edu

<< This is a BIG change for us.. we are used to taking several images and then taking them to the radiologist for review. The radiologist will come back to see the patient only if he feels a strong need to do so >>

<<Our concern is that we will not have any documentation of the exam other than the six images he wants us to take. I've talked to him about the ACR's accreditation process and the documentation that they looked for on our studies when we went through our review before he was hired.>>

---------------------------- Your situation draws attention to a major disparity in approach to ---------------------------- sonographic

-- ---------------------------- practice between radiologists and OB/GYNs. Just as a gynecologist is not going to spend the time and the resources to extensively "document" his/her findings on colposcopy or hysteroscopy, they don't necessarily see the need to do so with sonography either. The concept of "hard copy" and doumentation for medico-legal reasons orginated in the imaging sciences, for the most part because the radiologist did not see the patient. To this day, most radiologists don't examine patients personally and must rely on the images provided by an allied health care practitioner. Of necessity then, the radiologist must be assured that every important structure has been imaged and that is achieved by taking 40-60 still images during the course of a routine, normal OB sonogram.

It is quite possible for an experienced sonographer to conduct a first trimester or 20 week screening OB sonogram in a normal pregnancy within 15 minutes if he\she is not required to provide unequivocal, high-quality single images of 30 different anatomical structures and 12 biometric measurements on every patient. Normal is normal. Having worked with private practice OBs for some 15 years, my typical schedule is one patient every 15 minutes. No need for hospital gowns or undressing, no need for full bladders (now that trans- labial US is de rigeur to r/o previa), no need to print page upon page of hard copy. I examine all the same fetal and maternal structures as I have when I've worked in radiology practices taking 30-40 minutes to conduct an exam. If they're normal, what else can you say? If a question arises, however, or an abnormality is detected, the patient is scheduled for a return visit usually within 24 hours with a sonologist and/or a perinatalogist.

If the supervising physician is comfortable with this approach and does not require extensive hard copy "documentation", it is his/her call. Afterall, he/she is directing care of the patient and will ultimately be held accountable for outcome of the pregnancy. Actually, this approach can make your job easier. The only caveat that I would offer is that the examining sonographer be experienced enough to confidently call a pregnancy normal.

Jim Baun

--------- End forwarded message ----------

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