- Review prior related studies and comment about your findings relative to the previous studies.
- Document if you cannot reproduce prior findings
- Measurements: Choose the longest axis and measure the AP in the same image (except the kidney and spleen), the transverse should be measured 90 degrees from this plane.
Image Checklist:
- Have I taken an appropriate history on behalf of the radiologist?
- Correct Preset?
- Correct Transducer and frequency for application?
- Proper use of technology? (Harmonics, Compounding, RTAF's, etc.)
- Does pathology display diagnostic markers? (shadow, posterior enhancement, etc.)
- Is the image balanced from top to bottom? (TGC)
- Is the image zoomed usefully? (Not too small and not too "pixelated")
- Is there something odd in my image that is not associated with the structure of interest?
- Have I created something in my image that is not real? ("Imaginoma")
- Do my images tell the story?
Fetal Heart - What Do I Image?
- 4 Chamber - Always
- LVOT, RVOT and 3 Vessel View - A good attempt made
- Image of Stomach must follow or immediately precede the image of the 4 chamber heart
- Stomach must be included in cine clip of Situs - also including the 4 chamber
- Cine clip of beating heart is not required (except in Seattle) but is helpful to identify valve insertion and VSD/ASD. For still images of these remember to modify settings for best frame rate.
- Do NOT use spectral Doppler for fetal heart rate.
- Proper algorithm for fetal demise:
- 2D M-Mode (I like to use color M-Mode but the use of color will increase the MI)
- 2D cine clip usually in 4 chamber
- Color Doppler cine clip if 2D is ambiguous
- If you still can't get it, call the radiologist.
- Zoom to a useful size
Take Home Message:
Communicate what you know and what you have seen or couldn't demonstrate so the radiologist knows what you were thinking. If it is not on the online form it is assumed you didn't ask, didn't know or didn't try.
