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Re: TECHNICAL IMPRESSIONS;From: Terry J DuBose (tjdubose@juno.com)Sun Jul 13 21:53:44 2003
This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ----__JNP_000_1e77.7f03.07b7 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Dear Teresa, I agree that sonograms don't come with little tags that say "fibroid" or "myoma", etc. But what would be the difference in a RDMS describing a uterine mass with the sonographic appearance of a fibroid? The ARDMS exams do ask about pathologic appearances, so it does seem to be in the sonographer's purview to describe what they see. I understand that you are suggesting describing a constellation of sonographic characteristics. Is there that much difference in describing it as "fibroidal in appearance" and enumerating all the different characteristics that you list? The ARDMS exams requires the sonographer to pick the correct pathology from a list of differential diagnoses in multiple choice questions. The reality is that sonographers have always functioned as something of a "physician's assistant", often scanning patients and communicating findings to physicians who are managing the case. It is even more prevalent in the vascular and cardiac areas of sonography for physicians to go to surgery based upon scans of the sonographer, the physician having never scanned the patient. To quote Dr. Ken Taylor, Yale University, from the early 1980's: "".... There is a very important difference between sonographers and other imaging technologists. Other technologists may reject an image because of sub-optimal technical quality, but the sonographer usually rejects over 95% of the scans because they do not provide the diagnosis. The sonographer must make the diagnosis and be able to interpret the scan to document the presence of any abnormalities. This is the unique responsibility of the sonographer." Ken Taylor, Yale University, addressed this question in the Nov/Dec., 1982, issue of the SDMS Newsletter. Also, "Many ultrasound examinations are performed by technologist [sic] when a physician is not present, and a report is issued by a physician at a later time. The legal responsibilities are extraordinary because a necessary part of care may involve rendering an interpretation at the time the study is performed, especially if real-time instrumentation is used. This differs from the relative roles of technologists and physicians in other imaging disciplines." James A E, Bundy A L, Fleischer A C, et al; "Legal Aspects of Diagnostic Sonography" in SEMINARS in ULTRASOUND, CT and MR; Grune & Stratton, Inc., 6:209; June, 1985. Sonographers do have a good bit of responsibility in the sonographic diagnosis... and it is done realizing that sonography simply does not always give a definitive diagnosis.... but it is always a game of "name the possible differentials". Peace, Terry J DuBose, M.S., RDMS Little Rock, Arkansas USA
On Sun, 13 Jul 2003 10:24:26 -0500 XRAYSONO1@ADELPHIA.NET (TERESA
WINSTEAD) writes:
> THIS IS A THOUGHT AND A QUESTION FOR ALL OF THOSE INDEPENDENT <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> Dear Teresa, I agree that sonograms don't come with little tags that say
"fibroid" or "myoma", etc. But what would be the difference in a
RDMS describing a uterine mass with the sonographic appearance of a
fibroid? The ARDMS exams do ask about pathologic appearances,
so it does seem to be in the sonographer's purview to describe what they
see. I understand that you are suggesting describing a constellation of
sonographic characteristics. Is there that much difference in
describing it as "fibroidal in appearance" and enumerating all the
different characteristics that you list? The ARDMS exams
requires the sonographer to pick the correct pathology from a list of
differential diagnoses in multiple choice questions.
The reality is that sonographers have always functioned as something of a
"physician's assistant", often scanning patients and communicating findings to
physicians who are managing the case. It is even more prevalent in
the vascular and cardiac areas of sonography for physicians to go to surgery
based upon scans of the sonographer, the physician having never scanned the
patient.
To quote Dr. Ken Taylor, Yale University, from the early 1980's:
"".... There is a very important difference between sonographers and other
imaging technologists. Other technologists may reject an image because of
sub-optimal technical quality, but the sonographer usually rejects over
95% of the scans because they do not provide the diagnosis. The
sonographer must make the diagnosis and be able to interpret the scan to
document the presence of any abnormalities. This is the unique
responsibility of the sonographer." Ken Taylor, Yale University, addressed this
question in the Nov/Dec., 1982, issue of the SDMS Newsletter.
Also, "Many ultrasound examinations are performed by technologist [sic]
when a physician is not present, and a report is issued by a physician at a
later time. The legal responsibilities are extraordinary because a
necessary part of care may involve rendering an interpretation at the time the
study is performed, especially if real-time instrumentation is used. This
differs from the relative roles of technologists and physicians in other imaging
disciplines." James A E, Bundy A L, Fleischer A C, et al; "Legal Aspects
of Diagnostic Sonography" in SEMINARS in ULTRASOUND, CT and MR; Grune &
Stratton, Inc., 6:209; June, 1985.
Sonographers do have a good bit of responsibility in the sonographic
diagnosis... and it is done realizing that sonography simply does not
always give a definitive diagnosis.... but it is always a game of "name
the possible differentials".
Peace, Terry J DuBose, M.S., RDMS
Little Rock, Arkansas USA
On Sun, 13 Jul 2003 10:24:26 -0500 XRAYSONO1@ADELPHIA.NET (TERESA
WINSTEAD) writes:
> THIS IS A THOUGHT AND A QUESTION FOR ALL OF THOSE INDEPENDENT > REGISTERED > SONOGRAPHERS IN PRIVATE OB/GYN OFFICES AND ALSO IN RADIOLOGY > DEPARTMENTS > . I THINK THAT THERE SHOULD BE A SEMINAR ON( HOW TO) WRITE A > TECHNICAL > IMPRESSION ON REPORTS PRIOR TO THE RADIOLOGISTS SEEING THE EXAM. > ALSO > IN A PRIVATE DOCTORS OFFICE THESE REPORTS REMAINE ON FILE IN THE > PATIENTS CHART. IN CASE OF A POTENTIAL LAW SUITE, WE AS > SONOGRAPHERS > ARE NOT TO WRITE A DIAGNOSIS OR ANY TYPE OF DIFFERENTIAL DIAGNOSIS, > BECAUSE WE DO NOT HOLD A MD LICENSE AND THAT WOULD BE PRACTICING > MEDICINE. SO WHEN YOU SEE FOR EXAMPLE A FIBROID AND YOU FEEL > PRETTY > SURE THAT IT IS A BEGIN FIBROID, LEI,,EX. YOU SHOULD WRITE AN > ECHOGENIC > FOCI, ACOUSTIC SHADOWING, CYSTIC DEGENERATION. ETC. THE TYPE OF > ECHOGENICITY AND SO FORTH. I HAVE SEEN SO MANY REPORTS COME > THROUGH > WHERE SONOGRAPHERS WERE WRITING THEIR INTERPERATION AND THEY DO NOT > KNOW > THE DANGERS LURKING OUT SIDE WAITING FOR THEM(AS FAR AS LAW SUITS). > PLEASE BE CAREFUL IN THE TECHNICAL IMPRESSIONS. MAYBE IN THE > FUTURE > SOMEONE AT A SEMINAR WILL ADDRESS THIS ISSUE. > > >
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