Quality sonographer and speed

A sonographer asked the question about how to be fast in her job ? and she said

"It is the scanning part itself; it takes me too long to produce an image of good diagnostic quality (in my opinion)".

This also can be true about many other technologists. Well it is have everything to do with all the points that you mentioned, the machine, the color and the scale you use, the cine lobe and the zoom, the annotation and the physics itself , that why I hate the word sonographer , we are not sono GRAPHER , WE ARE NOT PICTURE TAKER , like radiographer , mamographer, etc The word TECHNOLOGIST is more fit like MRI,CT technologist. Or we must use the word IST, like PHYSIOTHERAPIST, pharmacist, so we are SONOIST.

Forget the word SONOLOGIST as this is taken by the radiologists who have half of our skills as we are the true sonologists .So it is all about the machine and the speed of your critical thinking, don’t be panic sonographer. Do the best by doing the basic.

• Quality work in good timing and not fast (quantity), to be great sonographer you must have, Compassion and Interpersonal Skills. Try to keep a note beside you to write short notes about the pathology part so when you done with the exam you don’t have to go back and check the images and write your technical notes. Make sure to add or ask the application specialist to add annotation to make the typing part shorter. Reduce talking to patients as some tell you life stories and you are trying to be polite so don’t ask any open ended questions.
• Try to prepare the history of the case day before, I usually spend some time to come early so I can retrieve all the cases history on a small note for each case, sometimes they change or the patient will not show but I try to get the majority of the history beforehand like the previous ultrasound finding, CT, MRI and other modality reports if they have any,so you can be prepared ahead of time about the case .
• If a part is difficult to get and covered by gas don’t be panic sonographer just put it as gassed out pancreas or difficult to scan due to patient size, food, not full bladder etc. The note book beside you it seem for you is delaying you at the start but trust me I save about one hour because of this notes so I don’t retrieve the images again.
• Make sure to ask the clerk (THE CLERKS) - makes or breaks the clinic and the sonographers, 50% of the problems come from the clerks as majority of them don’t know how to book, not clear about filling the bladder, they give wrong or unclear direction to the clinics and makes the patient late or barley come on time.
• Coming exactly on time is not good for us because he or she have to wait for the paper work and the insurance then they have to change and sometimes they have to go to the washroom for 10 minutes. So make sure your boss have clear communication with the clerk and hope h get rid of those who don’t learn and cause so much delay to the sonographers even if she is related to the boss or someone in the company.
• Try to prepare and adjust the bed, the chair, the machine to fit your arm and back position and make sure to get a good chair, it is so hard to find the perfect chair.
• Technical Skills and Eye-Hand Coordination between the knobs, the image and the pathology you are trying to get, cover the basic in sag, trv and color, if not sure do fast cine lobe for the radiologist so he can see himself that you tried.
• Be a Keen Learner not just from books but from you tube and Google search about hernias, MSK, and other topics that might find yourself in delay when you do them.
• They always try to telling us to be Detail-Oriented, sure is good idea, but don’t overdo it a gallbladder stone is a stone so you don’t need 16 images in different direction to show how beautiful the stone is. Try to use split screen to 2 or 4.
• You also need Physical Strength to be a good sonographer because if you work fast you will injured yourself and if you have neck, back ,wrist and shoulder pain that will delay your work.
• You also need a good Mental Strength, try to leave your personnel problem at the door and don’t day dream while doing the case or remember your pet and trying to cover your smile or thinking what you will do this weekend or what you will cook tonight. Stress and depression can reduce the speed .Make sure you drink lots of water and for some of us we are able to take mini breaks between.
• I do about 16 cases a day and about 20 on Friday and Monday. From 8.30 to 4.30 and I usually have at least 7 minutes extra time with each case as I done them already.
• The worse thing is if you are stressed or trying to be fast then you make a mistake with the name and the accession number or the patient info as this will delay you more. You have to fix the images and delete some call the PAC system manager or the IT tech to help and it will take lots of time just because you didn’t check the detail at the start.
• Remember when I said BAD CLERKS – as they have the number and you already logged but they change the name and the details while you scan and the PAC system will not show the images and the IT tech need to fix it , sometimes the patients give wrong detail on the phone but when they arrive their id card say different name than they gave over the phone as they used nick name.
• Eat good and always keep peptic bismuth in your room, keep yogurt in the fridge , the worse thing when you have a bad food and you find yourself getting the run to the washroom and some stay 5 to 10 minutes because of it, trust me I worked with all these scenarios.
• I had to pick at least 2 to 3 patients from other sonographers because they are slow. I do them in the spirit of the team. But sometimes it gets on my nerve as always one or two sonographers and not the others, and always me. We all take the same salary so when that happened I get upset as it is not just 1,2,3,,4 times but almost always . SO I ALWAYS REFUSE TO WORK WITH SOME SONOGRAPHERS, and try to avoid the shift or change my shift ,or move to different clinic when they are in the clinic .
• Punctuality Never arrive late, again I had to do many extra cases because some sonographer don’t arrive on time and because I am fast I can fit them as it is not the patient fault and some cases have a full bladder so I have to run and do the cases and later fill the technical notes the problem is no one ever say thank you or sorry!! Including the manager!
• It is a great to be a team player but it is not good when other see that in you and take advantage of you specially in winter time here in Canada, as always the same problem my car problem, too much snow on the road, my baby sitter problem, she have to drive the kids to school, and so on.
• I keep telling the manager that it’s OK to have problem but it is not OK to make your problem other people problem and the best thing is to make a solution to solve the problem as if you are not part of the solution you are part of the problem so they can start afternoon shift or evening shift, or start 10 am to 6 pm and not 7 or 8 am like all of us. 
• Try to ask for fairness distribution of big patients (OBESE), It seem that some clerk and the manager sometimes ask them to book all difficult cases and BIG people with Steve (myself) and he forget that I am human and we should share but he knows the other sonographers complained and always get lousy images and we must all share the deal.
• Ask for extended time for some cases ,as we do here in our clinic we usually give extended time anywhere from 6 weeks to 6 months , and some of them in my clinic have it for almost 3 years !!!! They will get extra 15 minutes on leg dvt so it is 45 minute for one leg for them! And 45 minutes for EV for the female sonographer while the male sonographers 30 minutes only. But you can ask them and select the case that you are not fast at it.

 Take (constructive) criticism gracefully. One of the hardest things for all of us to learn is how to handle constructive criticism and how to use these critiques to improve our performance on the job. Yes, some bosses are truly nit-pickers, wanting everything done their way or not at all, but most bosses are simply providing feedback so you can perform your job better, so you can excel at your work, at your speed then at the clinic speed. SO COMMUNICATION WITH THE RADIOLOGIST AND THE BOSS is very important.

 Use a Timer on Every Major Task 

Long time ago they teach me in college the Parkinson's Law, which states that "Work expands to fill the time allotted for it". If you leave the amount of time you'll devote to a task open ended, then you will almost always take more time to complete it. Conversely, if you set a clear amount of time to do each task, you'll work far more rapidly, as you attempt to beat the clock.

As an added bonus, if you challenge yourself like this you will more often experience Flow, the state identified by the esteemed human performance expert Professor Mihaly Csikzentmihalyi as strongly correlated with feelings of well being. In other words, you'll not only be much more effective you'll be happier too. So you don’t just focus on been effective sonographer but you need to be an efficient sonographer the different between both is the TIME factor. Efficient sonographer uses the time factor to their benefits.

 Pretend Your Day Ends At 2 after noon 

So if you start at 8 am , think that you will finish at 2 pm .Each morning when you start work, behave as though you can no longer work past 2 pm . If you knew you had to go home at that point, yet you still wanted to achieve some really worthwhile jobs, what would you do? Start on important tasks; get the history of the case day before.

The 2 pm technique works for me, you can start step by step like 30 min shorter, or one hour, until you set your mind to the time that’s fit your ability, and it will forces you to take action quickly on what really counts, what important image, the basic, what the radiologist want, no duplicate images, focus, less talk to the patient after you get all the important notes, and so on.

Reduce chatting with your co-workers, or checking your emails, or grabbed many a coffee breaks, and reduce the net surfing. Start fast and you'll be amazed what you can achieve before the end of the working day. Don’t be worrywart sonographer or panic sonographer. Trust in your ability and be confident sonographer and it is not shame to say I don’t know this or that and you are willing to learn.

Write down what are your weakness is it pelvis, OBS, abdominal, MSK, Vascular, large patients, children who cries allot, OBS detail scan with parents who ask so many questions and distract you, testes cases make you uncomfortable, artifacts and normal variants that make you think to come up with an answer for your technical notes so you stay longer and longer trying to answer the question and get best image in different direction and using all other color and tools , remember at the end it is the radiologist job to do that and recommend other modality or he might come to the room and scan himself and hopefully don’t take another 10 minutes from your time.

Your boss nowadays can see the exact time you spend in each case by his IT -PAC system digital track and he will know the start to finish time and in many cases he or she always add extra case and say please fit in this patient it is stat or urgent case and you done your case you have time more than other sonographers and it is always me , and if you refuse they get upset , as they get the money and you get the extra cases and injured your shoulder but they do not think of that as to them you are just a working horse to make money for them and if you question them to pay you they say it is patient care and and we are here for the patient etc but in reality it is the money for them. Again one time two times are OK but not every time and always goes to the fast and efficient sonographers!

Summary ;

These are my tips for more efficient ultrasound scanning.

Labeling the images , Organize  images  , Equipment settings, and Getting diagnostic images

As many experts agrees that each sonographer has a method, try to label Liver like this:   [Liver TRV sup/inf] or [Liver sag L/R]. This saves time as, produce the images slice by slice from the Left lobe to the lateral aspect of the Right Lobe.  It works for Pelvis too :  Uterus Trans Inferior to Superior.  Think of methods to make labeling efficient on other types of exams. Labeling the image is certainly necessary, but the sonographer needs to focus on demonstrating the anatomy rather than constantly changing the label with each image produced. Only if you have a modified oblique views You will have to make sure your radiologist is good with this type of labeling, and follow your department protocol .

2- Organize the images.  Some labs require that images are taken in a certain order.  If you are using newer ultrasound systems they often have a feature called 'Protocol' which 'sets up' the images, complete with labeling and settings.  This is ideal, but not all systems have this feature. many have final report so when you have the measurement and log , at the end the report give you all the measurement and doppler velocities etc .

Think about the most efficient method for obtaining the required images. As an example, Organize your GB images in supine after you done with the liver, pancreas, aorta, IVC and CBD. Obtain your GB images in supine then turn the patient Left Lateral and get GB images in that position. Since the patient is already in left lateral, you will then get the Right Kidney Long and Trans.This way the patient only has to move once in that position. Another way is to organize images for thyroid masses:

Scan the entire thyroid, then when demonstrating the nodule, use the 'dual image' feature to show the nodule in long and trans in a side-by-side image. If there are multiple nodules label them nodule 1,2,3. This also makes it easier to fill out the tech sheet and the radiologist loves that all the nodules are grouped together in both views. This works on Ovarian cysts, Renal Masses, etc. 

3-Equipment settings.  Know your equipment. When I watch beginner sonographers scan, I will notice their process between thinking about a function change and executing that change is very slow.  Once you REALLY know your equipment, the steps to move over the operation panel should be fluid, like playing a musical instrument.  

 For example, if you know the next image you will take will be color like the portal vein, as soon as you move from 'store image', immediately 'unfreeze' and before a blink of an eye, push 'color'.  New graduates lose a lot of time scanning when they do not know the equipment function and location of the knobs/switches. Watch an experienced sonographer, their fingers move fast from one button to another. Some sonographers start with left side, some start with retro trv and then sag aorta, then left lobe of the liver in sag and trv then GB , and do the GB with lld position and do the right side , then turn to rlq and do the left side . For difficult GB case I do sitting position too.

4 - Diagnostic Images.  You need to make a quick decision about an image and if it shows diagnostic quality.  This is not to say the image will be 'textbook'. We have large body types, gas, and other obstacles to get an image. New sonographers aim at getting the 'perfect image' and loose site of proving the diagnosis. The first thing to do is you must answer the question , the doctor what's to know where is the disease and what is it . The best way to help with quicker decisions is to go to websites, YouTube videos and any other media to view thousands of images.  The eye-brain-decision mechanism will become more acute and result in making quicker decisions about accepting the image as diagnostic.

5- Do you have invasive procedure where the radiologist take longer time, or you have to go and call him while he is on the phone and you wait another 15 minutes there are so many scenarios to your question and the best is to discuss them in your monthly departmental meetings .

Steve Ramsey, PhD.

Okotoks , Alberta - Canada