Q3 2011 Image Quality Update

• Limited versus Follow Up on OB - Limited (76815) is used to look specifically at things like viability, fluid volume or fetal position and is usually done from the ED.  Follow Up (78616) is used for following  biometry and anomalies.  
• Chorionicity and Amnionicity of Multiples - Be sure to document # of placentas, membranes and fetuses especially if not previously documented.  Labeling fetuses begins at the first presenting fetus at the cervix and increases to the fundus starting with "A".  Draw the fetuses on the online form.
• When dating multiples choose the largest on the first ultrasound.  
• Take the general AFI of the uterus and the largest pocket in each sac.  
• Document the placental cord insertion with and without color Doppler
• Ovarian cyst measurements should include the wall or rind.  
• The gallbladder box on the online form is intended for a comment not a measurement.  Use "wnl" or "stones" and put further comments in the Findings portion.  
• If a cervix is less than 3 cm please don't leave as routine and check with the reading radiologist.  
• Document lower tip of placenta in relation to the internal cervical OS.  

• I suggest taking a cine clip if it cannot be documented with one image and at least comment that the placenta is not near the cervix.

Zoom and frame fetal heart images appropriately

Good

Poor

Fetal Kidneys

Clearly demonstrated and appropriate size.

Good

Poor

Head Measurements  
Keep anatomy symmetrical

Poor

Good

Posterior Fossa 

Good Posterior Fossa.  Clean images and clear anatomy.  Don't push the transducer beyond it's limits

Orientation of Uterus

Line up the long axis of the structure not necessarily on the patient.

Color Doppler 

Color Doppler should have been done on thickened endometrium.

3D Uterus for IUD placement???

Should we or should we not?  That is the question!

Measurements:

Compare the sonographer's measurements to the radiologist's measurements.  Include the fibroids in the overall measurement.









Did I really just do that???

Spine and kidneys not imaged, but checked off as normal.

Follow up recommended due to poor visualization of the spine. Spine not imaged on current exam. Oops! (read prior OB reports)

Incorrect Uterine volumes, no uterine volumes.

Right and left ovarian measurements transposed.

Fibroids well documented but not drawn on on-line form.

No Doppler of left testicle.

No cine sweeps of the thyroid, uterus, ovaries, pathology.

Look at previous studies and be sure to reproduce and or comment on previously seen pathology.

Sick Gallbladders

These need to be addressed!  Don't let them sit over the weekend.