Pros and Cons of Ultrasound Worksheets

I don’t remember exactly when during my training I first encountered an ultrasound worksheet, but I do recall being unclear as to its purpose. In x-ray, CT, and MR, techs performed their imaging-studies and left it to the radiologists to interpret them; why were the sono techs writing up their findings?

Each attending I asked about it gave me a different answer. Some liked the sheets; they helped organize the sonographers’ work, streamlined dictations, served as prelims, etc. Others felt that the sheets served no useful function, or were even detrimental. Subsequent work in other facilities showed me that some places didn’t use them at all.

As a result, I’ve developed a mixed attitude towards the worksheets. Sometimes, it feels like I’ve got a little angel on one shoulder and a little devil on the other, whispering bits of advice into each ear as demonstrated in numerous cartoons (or National Lampoon’s Animal House, if you prefer).

I’ve never been a fan of using the sheets to speed through dictations. The thought of diverting even 10% of my attention from the actual images to the tech’s writeup inspires anxiety that I’m going to miss something the tech imaged but didn’t write down. (I’d like to believe that nobody dictates entirely from the worksheet without looking at the pictures.)

Some folks use the worksheets to quickly dictate measurements, rather than sifting through the images for numbers; even this gives me pause when I consider that the tech might accidentally transcribe a wrong value. Incorporating such a mistake into a report could turn a normal study into an abnormal one, or vice versa; at the very least, it could look like sloppy work if anyone notices.

Medicolegal issues also come to mind; suppose the radiologist disagrees with the tech’s note and thus reports differently. Down the line, might a lawsuit discover the discrepancy and put the radiologist in a bad spot? Rather than saving time, the worksheets can actually cost me a little more.

On the other hand, I’ve found the sheets useful in certain ways. For instance, suppose the tech who did a study is unavailable, and I’ve got a question about the images. Sometimes, notes on the worksheet can provide answers, and I can sign off a report that would otherwise sit in Limbo for hours or days. How about when the images are temporarily or permanently MIA? The worksheet may permit me to tell the clinician what the tech saw while we’re waiting for PACS to come back online or for the patient to be rescanned. Finally, I hate to say it but all sonographers were not created equal. Some just can’t (or won’t) remember to capture sufficient images for a complete study: Three-dimensional measurements, for instance, or resistive indices on Doppler. Some occasionally forget to image the pancreas. For them, having a sheet that they MUST fill out before the patient leaves is a necessary crutch to prevent callbacks.

In describing to non-imagers how operator-dependent ultrasound can be, I’ve used the metaphor of walking into a dark room, with a tech as a guide. With most modalities, the tech flips a switch on the wall, turning on a ceiling-light that illuminates the entire room. Everything that can be seen is on display for the radiologist to view. But with ultrasound, there is no light on the ceiling. Instead, the tech has a flashlight, and the radiologist can only see what’s painted by the tech’s beam. Worksheets can help ensure that the dark room is fully explored…but they can also create and hide some significant blind-spots.