Filly's First Law
Placing electronic calipers at the margins of a “structure” does not make it “real” or pathologic.
If you are responsible for the interpretation of sonograms, then you are fully aware of the important contribution of your sonographers. These highly trained individuals have saved me from making diagnostic errors on more occasions than I can count. My policy was always to check a completed sonogram before releasing a patient and I never failed to ask my sonographer his or her opinion of the normalcy of the case.
Sonographers are different than, for example, a radiologic technologist taking four views of the knee. We allow our sonographers to actually choose the images that we will interpret. Yes, we require them to provide sufficient images to fulfill the requirements of our protocols, but other than that they have relatively free reign to select the images we see. One study may have 70 images and the next might have 100 images – same sonographer; same day; consecutive patients; same clinical history.
For example, my protocol for an abdominal sonogram required longitudinal and transverse images of both kidneys (whether or not the requisition said “right upper quadrant pain” or “left upper quadrant pain” or whatever). But after that, I didn’t try to count up whether there were six images of the right kidney and ten images of the left kidney. The sonographer made that decision.
While sonographers have diagnostic skills, they are not the responsible individual to interpret the sonogram. The physician is the responsible agent. However, the sonographer feels the responsibility to ensure that the physician sees those potentially pathologic structures that caused them concern. They largely accomplish this by taking multiple images and placing calipers on the area of the image that concerned them. (As I often quipped, they want to be certain that even “their doctor” won’t miss it.)
However, as well intentioned as this might be, it can also lead to significant misinterpretations. Now reread the Filly’s Law #1, and always keep it in mind.
If you are responsible for the interpretation of sonograms, then you are fully aware of the important contribution of your sonographers. These highly trained individuals have saved me from making diagnostic errors on more occasions than I can count. My policy was always to check a completed sonogram before releasing a patient and I never failed to ask my sonographer his or her opinion of the normalcy of the case.
Sonographers are different than, for example, a radiologic technologist taking four views of the knee. We allow our sonographers to actually choose the images that we will interpret. Yes, we require them to provide sufficient images to fulfill the requirements of our protocols, but other than that they have relatively free reign to select the images we see. One study may have 70 images and the next might have 100 images – same sonographer; same day; consecutive patients; same clinical history.
For example, my protocol for an abdominal sonogram required longitudinal and transverse images of both kidneys (whether or not the requisition said “right upper quadrant pain” or “left upper quadrant pain” or whatever). But after that, I didn’t try to count up whether there were six images of the right kidney and ten images of the left kidney. The sonographer made that decision.
While sonographers have diagnostic skills, they are not the responsible individual to interpret the sonogram. The physician is the responsible agent. However, the sonographer feels the responsibility to ensure that the physician sees those potentially pathologic structures that caused them concern. They largely accomplish this by taking multiple images and placing calipers on the area of the image that concerned them. (As I often quipped, they want to be certain that even “their doctor” won’t miss it.)
However, as well intentioned as this might be, it can also lead to significant misinterpretations. Now reread the Filly’s Law #1, and always keep it in mind.