SOS Syndrome

Lest you wonder, this is not about to be a discussion of sinusoidal obstruction. No, it’s something far more commonly encountered in the medical imaging universe: the phenomenon of receiving ultrasounds from Some Other Sonographer, as opposed to your known and trusted technologist who always gives you quality work.

Some Other Sonographer can be expected - for instance, if you are doing locums work or providing coverage at a facility other than your usual. Go somewhere other than your usual stomping ground, and chances are you won’t be bringing your favorite sono tech with you.

Sometimes, fortune will smile and you’ll have a nearly seamless transition or a minimum of acclimatization as you get familiar with the local tech’s way of doing things. If you’re really lucky, you might get a tech even better than your usual.

Generally, though, if you’ve got SOS, it’s a harsher reality. Three-dimensional organs (or lesions) are only depicted in one or two - assuming they get measured at all. Healthy 20-somethings inexplicably have peak-systolic carotid velocities measured in the range of 30 cm/s. Routine portions of the anatomy are missing - for instance, the entire length of a femoral vein during an evaluation for DVT - and your reassurance is in the form of a handwritten note from the tech that the study was “WNL.”

Forgetting about the potential impact of SOS on your patients, you as the reader of these studies, have a cascade of potential harm coming your way. Anxiety, aggravation, and anger, to name a few. Chronic exposure to SOS could well hike up your blood pressure, derange the balance of lipids in your circulation, and have lasting effects on your cerebral function. To say nothing of the potential harms awaiting you when legal misadventures are pursued against you for having been involved, as the poor slob who was on duty when SOS left its mark.

Radiologists who recognize that they’re suffering from SOS often do not have the means to institute actual cures, and are limited to damage control. Bringing patients back for rescanning is the mainstay of treatment, and often this requires some fancy logistical footwork to make sure the additional imaging occurs when a more trustworthy tech is on duty.

This can also result in some unpleasant feedback from the Powers That Be if it’s perceived that the radiologist’s callbacks are occupying the sono-area too frequently. (In some facilities, displacing even one ultrasound study on a new patient is too much.)

Complete removal of SOS is the only surefire cure, and unfortunately the ones with the power to perform this extraction are rarely motivated to do so - since they, themselves, are pretty much never in the uncomfortable position of reading the ultrasounds and agonizing over whether the provided images are diagnostic (and/or defensible). From their perspective, the potential benefits of SOS-removal are counterbalanced by the nuisance value of finding a replacement, who, if equipped with better skills, could cost more to retain. Besides, there’s only one radiologist complaining of SOS - and he doesn’t usually work there.