Tag: breast ultrasound

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The Sharp Breast Ultrasound Technologist: The Key To A Well Run Practice!

technologist

In a thriving radiology practice, all technologists contribute to the functioning of the whole. However, one sort of technologist, in particular, can tip the balance between a smoothly run practice and disaster. Which one would that be? Well, if you read the title, you would know immediately!

Why does a breast ultrasound technologist wield so much power over a successful radiology practice? Unlike other technologists, I came up with three reasons why we rely on them so much. First, these technologists are the most “independent” of all other technologists. Second, they require a good eye, more so than other technologists. And finally, they must have excellent hand-eye coordination. We will examine all three characteristics and what happens when your practice uses a suboptimal technologist.

Independence

Sure, most technologists have some autonomy. I mean, CT techs must set the parameters for the scans independently. And mammography techs must ensure they perform all the QI before beginning a study. But breast ultrasound technologists are unique in this regard. When breast sonographers leave the room to create their images, you cannot check the quality of their work directly. What do I mean by that? Sure, there are required images. However, the ultrasonographer can choose to show you whatever they deem crucial. Alternatively, this same tech can leave out what they think is “unnecessary.”

I can’t think of any other technologists with such independence of action. You can almost always check the work of a CT, mammography, MRI, or fluoro technologist. The body part is complete, or it isn’t. The breast tissue is all on the film, or it’s not. On the other hand, with ultrasound techs, you can never know if they have completed what they were supposed to. You must rely on their word and their word alone.

What happens when the ultrasound technologist does not act independently? These technologists come reeling in and out of the reading room incessantly, asking questions and interrupting the day’s workflow. Furthermore, the radiologist’s stomach churns when unsure if the technologist knows the morphology and location of what they are searching for. That means they must check and recheck everything the breast ultrasound technologist completes. It wastes so much time that the radiologist cannot attend to his other duties.

The “Good Eye”

Radiologists rely on the ability of breast ultrasound technologists to pinpoint a specific lesion on mammography. Or, they need to find the proverbial needle in a haystack on screening ultrasound. In other words, they must keep constant awareness of their search. In addition, they need to identify the shapes and abnormalities they see on the mammogram. This task becomes challenging when you have a 350-pound patient with a large amount of breast tissue! A “good eye” varies widely among technologists, similar to radiologists. But, good technologists will reliably find what is needed and discard the impertinent findings in the breast.

I can’t tell you how often a technologist without a “good eye” will search and search for something, only to have you, the radiologist, come in and find the lesion first. Imagine the hours over a lifetime that a radiologist must waste to compensate for the ultrasound technologist without a “good eye”!

Hand-eye Coordination

Finally, an ultrasound technologist’s ability to scan patients relies upon a baseline level of coordination. This baseline becomes vital for two main reasons. First, the ultrasound technologist needs to find and rediscover a lesion. For instance, some lesions are tiny or roll off the transducer very easily. Good ultrasound technologists need a steady hand to create images of these abnormalities.

Furthermore, breast ultrasound technologists, in particular, play an essential role in performing procedures to assist radiologists with cyst aspirations and biopsies. They need to be able to keep the transducer on a specific plane at the time of a biopsy.

Frustrating is the singular word for performing procedures with a breast ultrasound technologist with two left hands! Imaging studies and techniques can take triple the amount of time with a technologist with poor coordination. That does not include contamination of the sterile field!

The Sharp Breast Ultrasound Technologist- The Key To A Well-Run Practice

As you can see, a breast ultrasound technologist is much more than just another member of the imaging center team. Without a quality breast ultrasound technologist, the center becomes much less efficient and can fall apart at the seams. If you find a great one, this team member becomes the glue holding the imaging center together. Keep the tech even if at a higher-than-average cost. Why? Because the costs to a practice pale compared to the damage if they leave!

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The Uncomfortable “Screenostic” Breast Ultrasound Imaging Dilemma

ultrasound

For those of you who have completed a mammography rotation or are beginning to practice mammography, you may notice ordering physicians prescribe a diagnostic mammogram along with a diagnostic and screening ultrasound. One example would be the doctor who orders a mammogram for a unilateral breast asymmetry with an accompanying bilateral diagnostic ultrasound. Or other times, the ordering doctor will specify to perform an ultrasound for pain on one breast. Yet they order a bilateral breast ultrasound that the patient expects to get done. One of my former excellent mammographers had called these sorts of situations “screenostic studies.” And I think that is a great descriptive name since these breast ultrasounds encompass both a “diagnostic” and a “screening” component. So, I kind of took to the title, “screenostic.” Now, I use it all the time.

Issues Behind The “Screenostic” Ultrasound

For me, I always find this situation very frustrating. You are never quite sure if the ordering physician means to order the study as a screening ultrasound. Or, did they mean for the case to be diagnostic and accidentally request a bilateral breast ultrasound? Perhaps, they were not thinking about it or did not understand the purpose of the ultrasound. Unfortunately, frequently, you will never know the answer.

So, let me give you an example of what happens when you confront the issue head-on. You call the physician to learn their ordering intentions, taking away precious minutes of your valuable time. Then, when you ask the ordering physician what they wanted, the physician often becomes indignant because it “wastes their time.” On top of this, the patient expects that they will receive a bilateral ultrasound because it is “better” than a one-sided diagnostic ultrasound. Now, they have to wait longer. And if you decide to change the order, you now have to waste additional time to persuade the patient that they need a unilateral breast ultrasound.

Bottom line. All hell breaks loose. It’s ugly. You have a mixture of undecipherable physician expectations. And the patient has unfounded expectations to complete the study. The radiologist is unhappy; the patient is angry, and the ordering physician is upset. It is a lose, lose, lose situation.

So what finally happens? Regardless of the study indication and the true intentions of the ordering physician, the technologist completes the study. It’s just a heck of a lot easier. But, it is all a waste of time and money.

Call To Arms!

I only see two potential ways out of this daily breast imaging mess. First, we need intense education for ordering physicians. In most practices, however, this road is a difficult one. It can be next to impossible to get through to all the referring physicians in a bustling business. And, referrers just want to order and write their scripts without dealing with the implications. It takes too much time to “listen” to the meager radiologist or set up an educational outreach program.

Second (and I may get a lot of backlash for this one), enter clinical decision support systems. If only a system could force the ordering physician to make a clear prescription that makes sense. Clinical decision support systems would do just that.

You may think that I am just whining and complaining. But this issue has real implications for patient well-being and daily workflow. Oh well, in the end, it is just another dilemma that occurs when the clinician controls the ordering of imaging studies instead of the true imaging expert, the radiologist. Let’s take it back!!!