Student Handbook 2013 - Merced College

MERCED COLLEGE
DIAGNOSTIC MEDICAL SONOGRAPHY
STUDENT HANDBOOK
Revised November 2013
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Table of Contents
I. Introduction……………………………………………………………………………2
A. Welcome
B. Purpose of Handbook
C. Merced College Philosophy
D. Programmatic Philosophy
E. Objectives
II. Accreditation………………………………………………………………………….6
A. Merced College
B. Diagnostic Medical Sonography Program
III. Attendance…………………………………………………………………………….6
A. Enrollment
B. Attendance
C. Excessive Absences or Tardiness
D. Holidays
E. Vacation
F. Professional Development
G. Sick Leave
H. Funeral Leave
I. Jury Duty
J. Make up Time
K. Completion of Clinical Hours
IV.
Scholarship Criteria & Information…………………………………………………9
A. Grade Computation
B. Scholarship and Promotion
C. Class Drops
D. Incomplete Grades ( "I" )
E. Unsatisfactory Progress – Probation
F. Suspension
G. Academic Dishonesty
H. Conduct
I. Nonacademic Counseling
J. Re-Admission
K. Pinning Ceremony & Receipt of Certificate of Achievement
L. Job Placement
M. ARDMS Sanctions
N. National Examination
V. Student Rights and Grievances (Administrative Procedure 5530)………..19
A. District Student Rights and Grievances Procedure
B. General Statement Regarding Clinical Setting
VI.
Records………………………………………………………………………………..20
A. Student Records
B. Patient Records
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VII. Financial Expenditures……………………………………………..……….20
A. Fees
B. Additional Expenses - estimates
C. Licensing
D. Books
E. Drop/Withdrawal Refunds
VIII. General Policies……………………………………………………….……22
A. Changes in Personal Data
B. CPR Requirement
C. Employment
D. Health
E. Immunizations
F. TB Screening & General Updates
G. Infectious Disease Control Policy
H. Library References
I. Right of Privacy
J. Sexual Harassment Policy
K. Transportation
L. Use of Drugs
M. Visitors
N. Positioning Disclaimer
O. Background Clearance
P. Drug Screening
Q. Graffiti
IX. Insurance, Accidents and Incidents…………………………………….28
A. Student Clinical Injury
B. Incidents
X. Clinical Assignments……………………………………………………....28
XI. Student Dress and Grooming for Clinical Education………………..29
A. Uniforms
B. Grooming
C. Jewelry
D. Body Art
E. Miscellaneous
XII. Student Orientation to Clinical Facilities………………………………..32
XIII. Clinical Experience………………………………………………………….32
A. Duties of a Student Sonographer
B. Clinical Placement
C. Scheduling
D. Clinical Hours
E. Clinical Exams
F. Student Evaluation of Clinical Experience
G. Breaks and Lunch
H. Personal Phone Calls
I. Early Release
J. New Facility Orientation
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XIV.
XV.
XVI.
K. Removal of Cervical Collars
L. Cutting Away of Patient Clothing
M. Student Availability During Site Visits
N. Handwashing
O. Personal Protective Equipment
P. Miscellaneous
Clinical Radiation Protection Rules………………………………………35
Pregnancy Policy and Procedures………………………………………..36
Student Supervision…………………………………………………………37
A. Direct
B. Indirect
XVII. Personnel Descriptions……………………………………………………..38
XVIII. Professionalism, Job Description…………………………………………39
A. Description of Profession
B. Scope of Practice-Overview
C. SDMS Scope of Practice for the Diagnostic Ultrasound Professional
D. SDMS Code of Ethics
E. Diagnostic Ultrasound Clinical Practice Standards
F. “Registry Eligible”
G. Professional Job Description: Example
H. Student Memberships in Professional Organizations
XIX. Patient Safety and Risk Management……………………………………52
A. Age Appropriate Care
B. Process of Reporting Complications (includes Incident Report)
C. Infectious Diseases
D. Communicable Diseases
E. Transducer Cleaning
F. Universal Precautions
G. Emergency Procedures
XXI. Equipment Safety and Maintenance………………………………………58
XXII. Technical Protocols………………………………………………………….59
A. General Policy: Ensuring Medical Necessity
B. AIUM Policy Guidelines
C. AIUM Documentation of Ultrasound Examinations
D. AIUM Guidelines for Abdomen & Retroperitoneum
E. Abdominal and Superficial Exams
Liver (AIUM and MC)
Gallbladder and Biliary Tree (AIUM and MC)
Pancreas (AIUM and MC)
Bowel and Peritoneal Fluid (AIUM)
Aorta, IVC (AIUM and MC)
Urinary Tract: Kidneys, Urinary Bladder, Adrenal Glands (AIUM and
MC)
Spleen (AIUM and MC)
Appendix (MC)
Abdominal Wall (AIUM and MC)
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FAST (AIUM and MC)
Scrotum (AIUM and MC)
Prostate (AIUM and MC)
Thyroid, Cervical Lymph Nodes, and Parathyroid (AIUM and MC)
Breast (AIUM and MC)
F. Gynecology and Obstetrics
Gynecology (AIUM and MC)
Obstetrics (AIUM and MC)
G. Musculoskeletal (AIUM)
H. Neurosonography (AIUM and MC)
I. Basic Vascular
Extracranial Cerbrovascular System (AIUM)
Peripheral Arterial (AIUM)
Peripheral Venous (AIUM)
XXII. Ergonomics……………………………………………………………….131
XVIII. Appendices……………………………………………………………….134
A. Hepatitis A & B Vaccine Notice & Status
B. Remediation Plan and Outcome
C. Academic Honesty Procedure
D. Student’s Consent to Background Clearance & Drug Screening
E. Student Acceptance Form
F. Clinical Rotation Acknowledgement Form
G. Clinical Orientation Forms
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Overview of the Diagnostic Medical Sonography Program
The Sonography Program is a full-time, 18 month allied vocational health program. The
purpose of the program is to provide didactic education and practical experience as
preparation for employment as a sonographer in a medical imaging facility.
The program is divided into two components: (a) didactic with laboratory, and (b) clinical
education. Graduates of the program are awarded a Certificate of Achievement in
Diagnostic Medical Sonography, and are eligible to sit for the SPI, ABD, and OB-GYN
American Registry for Diagnostic Medical Sonography board examinations.
The didactic portion of the program facilitates learning in the following areas: General
Sonography: Abdomen, OB-GYN, Superficial Structures, and an introduction to vascular
technology. The basic on-campus scanning procedures required are included within this
handbook.
Continued programmatic eligibility: the student must complete all didactic and laboratory
courses sequentially in conjunction with completing the entire clinical education
component.
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I. Introduction
A. Welcome
Welcome to the Diagnostic Medical Sonography Program! It is my pleasure, as the
Director, to congratulate you on your acceptance to the program, and to wish you
success in your newly chosen health career.
As a student in the Diagnostic Medical Sonography Program, you represent Merced
College and the Diagnostic Medical Sonography program. The highest ethical and
professional standards of conduct will be expected of you at all times.
My responsibility is to direct and facilitate your educational experience with a final
outcome: the privilege to write RDMS (Registered Diagnostic Medical Sonographer) after
your name. You are responsible for learning the material (reading; studying; practicing in
open lab; attending class, lab and clinic); time management, professional behavior, and
enjoying every aspect of personal development in this exciting career.
The program requires 18 consecutive months as a full-time student to complete. The
Sonography Program is rigorous and fast-paced. The curriculum consists of lecture,
collaboration, laboratory, library research, homework, individual and group projects,
diagnostic-quality sonographic image creation, portfolio creation, and practical clinical
experience. Professorially directed laboratory sections are held on campus in the
Sonography Scanning Suite by means of hands-on live scanning, and simulation
scanning.
Clinical practicum consists of four (4) rotations at our affiliated hospitals and clinics under
the guidance and direction of credentialed sonographers, hospital/clinical managers, and
board certified Radiologists/Sonologists. The clinical component requires 100% clinical
attendance. Success in the clinical arena requires excellent patient care and
communication skills, your ability to function as a team member, sonographic
performance, and professional interaction with our clinical personnel. Your total
commitment to the program is a major component to your successful completion of the
program and becoming an erudite sonographer. The secret to success in the clinical
arena: remember the clinical experience is a full-time interview.
B. Purpose of Handbook
This handbook is designed to serve as an informational guide to assist in the orientation
of new students and to clarify policies and procedures governing your actions and
practices while a student in the program. This handbook is designed to be utilized as a
supplement to the Merced College Catalog and the Clinical Competency Handbook. It is
expected that the students will be familiar with the following information. Students are
expected to comply with the policies and procedures contained within this handbook
throughout their educational experience.
Whenever possible, data from the Society of Diagnostic Medical Sonography (SDMS),
the American Institute of Ultrasound in Medicine (AIUM), the American Registry for
Diagnostic Medical Sonography (ARDMS), and the American Registry of Radiologic
Technologists (ARRT) has been included. Document inclusion consists of data
approved for reprinting or includes reference documentation.
The DMS student is encouraged to read this document carefully, and to place in an
accessible location. This document will serve as your primary programmatic reference
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tool throughout your educational experience. Please contact the program director for
clarification or additional information.
C. Merced College Philosophy
A democratic society functions best when its members are educated and active
participants. To encourage this participation, Merced College provides education
opportunity for all who qualify and can benefit. This education involves having a respect
for, and awareness of, all cultures, as well as the dignity and worth of all individuals.
Merced College is dedicated to the pursuit of excellence. The leadership and educational
services provided by the College reflect and enhance the cultural, economic, and social
life of the community and respond to its changing needs and interests. Recognizing that
learning is a life-long process, the College provides preparation for a complex and
changing society while maintaining high academic standards. The College also fosters
individual learning and critical thinking to enhance awareness of the inter-relationship and
inter-dependence of all persons.
Mission Statement
Students are our focus and we are known by their success.
Vision Statement
Students are our focus at Merced College. We set high standards to encourage students
to reach their highest potential in a supportive environment. Diversity is a strength of our
institution. Merced College is a leader in instruction and cultural activities. We value and
respect all members of our community. We are known by the success of our students.
Core Values and Beliefs
Students, both current and potential, are the focus of Merced College
Merced College establishes high standards and provides a challenging education
to encourage students to reach their highest potential.
Merced College respects and values all members of its community.
Merced College serves the community by responding to the cultural, educational,
technological, and economic development challenges.
Fostering and maintaining diversity is a strength of the institution.
Merced College provides a nurturing and joyful environment.
D. Sonography Program Philosophy
We believe that all people have the right to safe and competent medical care. We further
believe that students have a right and a responsibility to learn and faculty have an
obligation to ensure a curriculum that prepares students to practice in the professional
discipline. To ensure this outcome, we provide an educational training program
dedicated to the pursuit of excellence.
Mission
The mission of the Sonography Program is to provide relevant education in the cognitive,
psychomotor, and affective learning domains to prepare competent, and responsible
entry-level general, or cardiac, sonographers, with a commitment to life-long learning.
Goals
In support of this Mission, the Diagnostic Medical Sonography Program:
will uphold standards for satisfactory educational preparation for entry-level work
experience
will provide a curriculum which
o supports and assesses the knowledge and skills required to intelligently
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perform entry-level tasks to practice the profession;
will encourage students to develop
o effective communication skills
o critical thinking and problem solving skills
o commitment to life-long professional learning
will advocate and expect ethical and compassionate treatment of patients.
SLOs (Student Learning Outcomes)
Upon completion of the Diagnostic Medical Sonography Program, students will be able
to:
1. Describe the acoustic parameters of sound waves
2. Relate accurate medical terminology
3. Prioritize patient transfer, immobilization techniques, and safety precautions
4. Recommend methods to assure patient privacy
5. Recognize patient clinical history, which may impact the sonographic exam
6. Design individualized patient assessment plans
7. Calculate geometric mesasurements of anatomic structures
8. Evaluate sonographic images for optimal acoustic resolution
9. Select the appropriate sonographic instrumentation, while maintaining ALARA
10. Correlate clinical indications and laboratory values
11. Create diagnostic sonographic exams using recognized scanning parameters
12. Evaluate anatomic structures on sonographic images
13. Assess sonographic images for specific pathologies
14. Describe sonographic pathologies and sequelae relative to specific diseases
15. Differentiate normal and abnormal sonographic appearances
16. Select correct ergonomic devices and techniques
17. Compile effective data acquisition for submission to the interpreting physician
18. Describe the importance for sonographic quality assurance programs
19. Compare and contrast emerging sonographic techniques
20. Analyze academic strengths and weaknesses to determine corrective measures
required to successfully pass a pre-registry written examination
21. Evaluate prospective employment opportunities
22. Formulate a personal vocational plan
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E. Objectives
The Diagnostic Medical Sonography Program faculty believe that the philosophy of the
program can be fulfilled through providing a curriculum that encompasses all the areas
required to prepare students to practice in the professional discipline. Since sonography
is a practice discipline, the objectives will reflect what areas a graduate sonographer will
be competent. The objectives reflect those areas included in the curriculum content as
stated in the Standards and Guidelines for Diagnostic Medical Sonography from the
Commission on Accreditation of Allied Health Education Programs (CAAHEP) in
conjunction with the Joint Review Committee on Education in Diagnostic Medical
Sonography (JRCDMS). At the completion of the Program, the student will be prepared
to practice in the professional discipline because, at a minimum, they are competent in
the following areas:
1. Oral and written communication
2. Provide basic patient care and comfort
3. Demonstrate knowledge and understanding of human gross anatomy and
sectional anatomy
4. Demonstrate knowledge and understanding of physiology, pathology, and
pathophysiology
5. Demonstrate knowledge and understanding of acoustic physics, Doppler
ultrasound principles, and ultrasound instrumentation
6. Demonstrate knowledge and understanding of the interaction between
ultrasound and tissue and the probability of biological effects in clinical
examinations including:
a. Biologic effects
b. Pertinent in-vitro and in-vivo studies
c. Exposure display indices
d. Generally accepted maximum safe exposure levels
e. ALARA principle
7. Employ professional judgment and discretion
8. Understand the fundamental elements for implementing a quality assurance and
Improvement program, and the policies, procedures for the general function of
the ultrasound laboratory, including
a. Administrative procedures
b. Quality control procedures
c. Elements of quality assurance program
d. Records maintenance
e. Personnel and fiscal management
f. Trends in health care systems
9. Recognize the importance of continuing education
10. Recognize the importance of, and employ, ergonomically correct scanning
Techniques
11. Demonstrate the ability to perform sonographic examinations of the abdomen,
superficial structures, non-cardiac chest, and the gravid and nongravid pelvis
according to protocol guidelines established by national professional
organizations and the protocol of the employing institution utilizing real-time
equipment with both transabdominal and endocavitary transducers, and Doppler
display modes.
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II.
Accreditation
A. Merced College
Merced College is approved by the Chancellor of the California Community
Colleges and Accrediting Commission for Community and Junior Colleges,
Western Association of Schools and Colleges (ACCJC-WASCO). It meets all
standards of the California State Department of Education and is listed in the
Education Directory, Higher Education, published by the United States Office of
Education. The University of California and other colleges and universities of
high rank give full credit for appropriate courses completed at Merced College.
B. Diagnostic Medical Sonography Program
The Diagnostic Medical Sonography Program, which leads to eligibility to write
the SPI, AB, and OB-GYN sonography examinations by the American Registry
for Diagnostic Medical Sonography (ARDMS). The General Sonography Track is
accredited by the Joint Review Committee on Education in Diagnostic Medical
Sonography (*JRC-DMS) in conjunction with the Commission on Accreditation of
Allied Health Education Programs (**CAAHEP.)
*JRC-DMS: Joint Review Committee on Education in Diagnostic Medical
Sonography, 6021 University Boulevard, Suite 500, Ellicott City, MD
21043; www.jrcdms.org
**CAAHEP: Commission on Accreditation of Allied Health Education
Programs, 1361 Park Street, Clearwater, FL 33756; www.caahep.org
III.
Attendance
A. Enrollment
Students must be enrolled in all SONO classes by the first day of the
semester/session to attend class or a clinic assignment. In particular, a student
may not start a clinic assignment without being officially enrolled in that specific
course as the student would not be covered by malpractice insurance. Any
missed clinical time due to non-enrollment will have to be made up according to
the make-up policy.
B. Attendance
Regular attendance and consistent study are the two factors which contribute
most to success in college. Due to the rigor and accelerated aspect of the
Diagnostic Medical Sonography Program, DMS students are expected to attend
all course lectures, laboratories, and clinical hours.
The only excused absence is for illness of the student or death in the immediate
family. A student may be dropped from the program for more than three days of
un-excused absences. After 3 days of consecutive absences from class and/or
clinic, either a doctor’s excuse or proof of death of an immediate family member
will be required to be submitted to the instructor(s) of record. If a student is
dropped from lecture class, they will be dropped from the corresponding clinical
practice and vice versa, and from the DMS program.
Absence in no way relieves the student's responsibility for material or hours
missed in class and/or clinic. Arrangements must be made with the instructor of
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ecord for any lecture/lab classes missed and/or the Clinical Preceptor for any
clinical education missed for "make-up" time.
The student must notify their instructor of an absence before the scheduled class
time by calling their instructor directly, or call the Allied Health Office
(209.384.6309) and ask the AH secretary to convey the students’ absence to the
appropriate instructor(s). The student must notify the College AND the Clinical
Preceptor and/or Department Manager of an absence one-half hour before the
scheduled clinical assignment. Take note of whom you speak with and the time,
in the event that the message is not properly conveyed. Following the absence,
the student will submit an email to the DMS program director addressing the
date(s) of the absence, reason for the absence, and a statement addressing the
mechanism by which the clinical hours will be made up. All missed hours must
be completed during that particular rotation; students cannot accrue more than
40 hours of combined didactic and clinical experience in one week. This
document will become part of your personal file. Bear in mind that the program
director keeps track of your programmatic hours.
Prolonged illness or injury requiring absence from the clinic warrants a doctor's
release to return to the clinic. The student is required to complete all clinical
hours assigned to that particular clinical education course. This is necessary
because a student's presence is critical for successful performance and
application of knowledge, and a requirement for board examination.
After the first week of any lecture/lab course, students who arrive late or leave
class early will be regarded as tardy. Students who are late or leave clinic early
will deduct the time missed from the day's hourly total. Habitual tardiness will not
be tolerated and can be cause for dismissal.
Failure to attend a laboratory practical examination will result in an automatic
zero for that examination. Students are permitted one “redo” practical
examination per term. Both scores will be averaged for the final grade.
Students are advised to schedule medical, dental, and other appointments
outside clinical and/or classroom hours to avoid a penalty.
Students with children are advised to have contingency arrangements made for
child-care in case of illness or other unforeseen circumstances. Students with
children are not allowed to bring their sick children to class. For clarification:
Students may not bring children to class.
C. Excessive Absences or Tardiness
Excessive absences in school or clinic will not be tolerated. Students are
required to be punctual for both didactic and clinical training. A student will be
issued a Remediation Plan if either the clinical personnel or faculty feel that
actions should be taken to address this issue
1. Students who are late reporting to their clinical site will be warned once
verbally. The second time they are tardy to the clinical site the student must
call and leave a message with the program secretary. The third time the
student is put on probation, and this may lead to program dismissal. Some
clinical sites have a zero tolerance for tardiness and absenteeism.
2. Students are expected to be in the classroom before the start of class.
Students who are more than ten minutes late for class may be asked to
leave. Homework assignments will be considered late after the start of a
particular class session and will not be recognized.
3. Quizzes or exams are not lengthened for students who are tardy.
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D. Holidays
All students, including interns, will follow the approved Merced College Calendar
concerning legal holidays, flex days, and spring break for classroom and clinical
education. As such, students are not required to attend clinic on legal holidays,
breaks or flex days recognized by the College. However, all required clinical
hours must be completed.
E. Vacation
As an internship is not part of this course of study, students will not be provided
with clinical vacation days. Vacations should be scheduled only during times
when classes, including clinical, are not in session.
F. Professional Development
With prior College approval by the Program Director or Clinical Coordinator,
students may be granted time off from their clinical assignment to attend
professionally related seminars or workshops. Attendance shall be officially
documented and submitted to the program director upon return to class. These
professional development hours will be applied to any missed clinical hours. All
assigned clinical hours must be completed prior to the end of the semester.
G. Sick Leave
As this program does not have an internship, students do not accrue clinical sick days.
All hours used for sick leave must be made up according to the policy on making up time.
H. Funeral Leave
Students will be granted excused funeral leave when appropriate. Requests should be
submitted to the Program Director and Coordinator by phone or email and followed up
with an absence form. Excused leave will be provided for spouse, parent, child,
grandparent, and siblings. As a general rule, two days are allowed. All clinical hours
must be made up prior to the end of that term.
I. Jury Duty
Jury duty is a civic obligation, and it is an individual’s responsibility to serve when
summoned. However, students called to serve should work with officials to defer service
until graduation, whenever possible. Absence from class or clinic due to jury duty
requires written verification from the court.
• Students should report summons to the program director as soon as possible.
• Program faculty will inform the student of the academic material that needs to be
covered and completed. All lab practicals must be successfully completed prior
to the end of the semester.
• Clinical time missed must be coordinated with the Program Director and the
Clinical Proctor, and made up prior to the end of the semester.
J. Makeup Time
Makeup time may be completed before or following a leave, with all time being made up
during the current semester. Special consideration for clinical hours may be required for
situations such as jury duty. If all of the clinical hours have not been made up by the end
of the semester, an Incomplete Grade will be assigned (refer to the section on Incomplete
Grades).
Makeup hours will be accrued during non-scheduled times through PRIOR arrangement
with the affiliate's Clinical Preceptor and the College's Clinical Coordinator to insure
adequate supervision during makeup time.
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When making up time, no student may work more than a combined forty hour work week,
to include clinic and class hours.
K. Completion of Clinical Hours
To ensure that all clinical responsibilities are completed in a timely manner, once the
Clinical Preceptor is confident that the student has or will fulfill all their clinical hours the
Clinical Preceptor must sign-off in the appropriate place in the students’ Clinical
Competency Handbook. Students are not to leave the clinical affiliation early. If this
happens, those hours will not be included in that day’s tally, and the hours must be made
up prior to the end of that term. One thousand, seven hundred, ten (1710) clinical hours
are required to complete the DMS program at Merced College as per our CAAHEP/JRC-
DMS programmatic accreditation.
IV.
Scholarship Criteria & Information
A. Grade Computation
A minimum of a "C" grade must be maintained in each Sonography course. The
percentage value of the alphabetical grading in all Sonography courses are as follows:
A 93-100% Excellent
B 84-92% Good
C 75-83% Satisfactory
D* 68-74% Failing
F* 6-67% Failing
*Transcripts will report grades of D and F. Continuation in the DMS program will cease
when either of these grades are earned.
Each instructor will advise the student how she or he evaluates or weighs the graded
components of her/his particular courses. This will be addressed in the course syllabus.
Laboratory Practical Examination
Each course with a laboratory component will include two or more lab practical
Examinations. Laboratory Practical examinations must earn 80% or higher to pass.
Students who fail one practical will be eligible to repeat that one scanning examination at
the end of the term. As scanning skills are an essential function for Sonography student,
students who fail two practical examinations will fail the course.
Note: Clinical competency assessments are not laboratory practical examinations
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Clinical Competencies
Initial and Final clinical competencies are earned at the clinical affiliation. Students
will earn initial competencies by passing a 10-point assessment with ten points.
Students are eligible for assessment after scanning at least three examinations at
the clinical affiliation. Generally, an initial competency is carried forward to the
following clinical rotation; however, the clinical preceptor has the right/obligation to
determine the student’s competency at his/her affiliation and may require a second
initial competency.
Final competencies are earned during the fourth clinical rotation. Final
competencies are earned only with a passed initial competency. Final
competencies are detailed. Students will pass a final competency when they earn
80% on the assessment.
Initial and Final competencies are limited. Students may attempt an initial
competency at one location no more than three times. On the third (failed) attempt
the clinical preceptor will submit the assessment tool to the DMS Program Director
who will meet with the student to determine an intervention. Students who fail a
final exam are eligible to repeat a second time. Should the second attempt result
in a failure, the clinical preceptor will notify the Program Director. The PD will
schedule additional on-campus scanning time. All final competency scores will be
averaged and included into the term grade.
STUDENTS WHO ARE DROPPED or WITHDRAW DUE TO
UNSAFE CLINICAL PRACTICE WILL NOT BE READMITTED.
Clinical Case Study Presentations
Students, during the completion of the DMS program, will be responsible for
writing clinical case studies. Specifics will be addressed in the course syllabus.
In some cases, presentation to the clinical staff will be required, some
presentations will be given in the DMS course on campus to the student’s peers
and professor, and in some events both of these scenarios will take place.
Students are to schedule clinical presentations with their clinical preceptor at
least two weeks in advance of the presentation. The on campus schedule will be
coordinated by the instructor of record. Grading rubrics will be provided for both
presentations. Students who miss either presentation will earn a score of zero.
These presentations are not eligible for make-up.
B. Scholarship and Promotion
To remain enrolled and advance in the Sonography Program the student must
maintain a grade of "C" or higher in all ultrasound courses and maintain an
overall G.P.A. of "C" (2.35).
It is the student’s responsibility to be aware of his or her academic progress
throughout each semester.
Each instructor has weekly scheduled office hours for the sole purpose of
meeting with a student privately to discuss any issues or concerns that the
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student might have. It is the student’s responsibility to come in and set up an
appointment to meet with the instructor.
C. Class Drops
Classes dropped in a regular semester within the first 3 weeks will not be shown
on the student's permanent record. For classes dropped beginning with the 4th
week and prior to the end of the 14th week of a regular semester, a "W" grade
will be recorded on the student's permanent record.
Classes dropped after the 14th week of a regular semester will receive a letter
grade (not a "W").
In courses other than semester-length, consult the instructor or Guidance Center
regarding class drop date deadlines.
As the sequencing of the course material will be eliminated, students who drop a
course are not eligible to continue in the program.
D. Incomplete Grades ("I")
An incomplete grade may be granted for an unforeseeable emergency or
justifiable reason at the end of a term, and only when the student has maintained
a satisfactory performance prior to the request for the "I.”
Conditions for removal of the "I" and a grade to be assigned after one semester
in the event the conditions for removal are not completed by the student will be
submitted to the Program Director for final approval, following a joint
faculty/student petition. The "I" must be satisfactorily completed prior to the
conclusion of the next semester/session for continued enrollment in the DMS
Program.
If the conditions are completed within the one semester allowed, a final grade will
be assigned when the work is evaluated. An "I" may not be assigned as a
withdrawal grade.
E. Unsatisfactory Progress - Probation
A conference will be held for failure(s) to transfer classroom knowledge to clinical
training; failure(s) to adhere to clinical, college or program policy; or failure(s) to
follow generally accepted rules of personal cleanliness, professional ethics and
conduct, academic failure, and for failure to demonstrate knowledge, skill and
judgment at the expected level. The issuing instructor will confer with the student
and discuss the reasons for, and means of, correcting the cause for the
conference.
A remediation plan will be drawn up for discussing and documenting the cause of
the DMS Departmental Probation, the terms of the probation and the length of
time identified for improvement and reevaluation. The student will receive a copy
and the original will be placed in her/his personal file. The situation will be
discussed between the instructor, student and with the DMS Program Director,
12

as necessary. The final decision for student dismissal will be made by the DMS
Program Director after consultation with the area Dean.
F. Suspension
A situation may arise that may require immediate and effective discipline, when an
extremely serious infraction of rules has occurred. When this situation develops, the
student will be suspended from the clinical setting pending a full investigation of the
situation. An example of actions that may lead to immediate suspension and possible
dismissal may include the following:
1. Under the influence of drugs or alcohol while on duty
2. Physical abuse to a patient, visitor or other personnel
3. Petty theft
4. Sexual misconduct
5. Unsafe clinical practice
6. Breach of confidentiality (HIPAA)
Students dismissed for any of the above acts will not be eligible to reapply to the
program.
13

F. Academic Dishonesty
If the instructor has reason to believe a student has committed an act of lying,
cheating or plagiarism which can be documented, the student will be counseled
and an Allied Health Advisement form will be completed and permanently placed
in the student's personal file.
If the incident involves cheating on an exam or paper, no credit will be given,
neither may the assignment be repeated. For more information, please refer to
Merced College “Academic Honesty Procedure” located at the Guidance
Division, Student Activities Office.
A repeat act of academic dishonesty may be cause for immediate dismissal from
the program. Students dismissed for academic dishonesty will not be eligible to
reapply to the program.
G. Conduct
Students should conduct themselves in a professional and ethical manner at all
times. No profanity in patient care areas or in the classroom is tolerated.
Insubordination or dishonesty are grounds for immediate dismissal from the
program.
H. Nonacademic Counseling
For nonacademic problems, the student will be referred to the appropriate
services on or off campus for assistance.
I. Re-Admission
Any student who withdraws or who is dropped from the Ultrasound Program due
to academic weakness will NOT be allowed re-admission into the Ultrasound
Program.
K. Pinning Ceremony & Receipt of Certificate of Achievement
A Certificate of Achievement will be awarded at the traditional Diagnostic Medical
Sonography Certification and Pinning Ceremony to all students who have
successfully completed the entire program. Students are encourage and
expected to attend the pinning ceremony. The program director is responsible for
the content of the ceremony; however, the planning of the Certification and
Pinning Ceremony is the responsibility of each individual class. This includes
determining the number of guests each student may invite. Students may submit
specific requests regarding speakers, music, food, etc. A faculty member will be
appointed to assist with the preparations. Participation in the annual
commencement ceremonies is restricted to students who have completed all
requirements and obligations for programmatic completion.
M. Job Placement
Upon graduation, please inform the DMS Program Director of your job status.
This information is critical to accurately reflect program statistics. A guarantee of
job placement is not applicable, but we are happy to refer graduates and
potential employers to each other. Please assist future graduates by informing
the DMS staff of openings within your department once you've entered the work
force.
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N. ARDMS Sanctions
Go to the following link if you have a prior criminal history.
http://www.ardms.org/apply/discipline_ada_appeal_process_information/preapplication_criminal
ARDMS Pre-Application: Criminal
ARDMS rules indicate that ARDMS may take action against an applicant,
candidate, or Registrant in the case of conviction, plea of guilty or plea of nolo
contendere to any crime. If you are presently charged with, or been convicted or
found guilty of or plead nolo contendere to any crime (felony and/or
misdemeanor), other than a speeding or parking violation, you may have
questions concerning this rule and may wish to obtain clarification as to how it
pertains to your circumstances.
ARDMS conducts a "pre-application review", for a $125 non-refundable fee, for
individuals who wish to determine the impact of a previous criminal matter on
their eligibility to apply for ARDMS certification. The pre-application review
process is recommended for individuals who have not yet applied for
examination and are contemplating employment in the field of sonography and/or
enrollment in a sonography program. Individuals who have already completed a
program and are ready to apply to the ARDMS for examination should simply
respond to the questions on the ARDMS examination application relating to
criminal matters and provide the requested documentation regarding such
matter(s).
For purposes of the ARDMS application process “crimes” may include, but
are not limited to, rape, sexual abuse; violence or threat of violence; driving
while intoxicated (e.g. alcohol and drug related driving offenses); the
unlawful sale, use or distribution of controlled substances; and use or
distribution of fraudulent medical records, prescription blanks or health
insurance claims.
Please note that the pre-application review procedure is available only for
criminal matters, not other issues of eligibility.
O. National Examination
Eligibility to write the national examination (ARDMS) requires completion of all
program requirements. Each application is assessed individually by the ARDMS.
Students will be eligible to write the ARDMS SPI exam following successful
completion of both Physics courses. Although each student is encouraged to
apply for the SPI registry examination during week one of the final fall semester
and to sit for the exam ASAP thereafter, this is not a mandatory portion of the
DMS program. The ARDMS examinations incur costs, which are the
responsibility of the student. The SPI exam must be passed along with at least
one organ specific ARDMS examination to hold the title of Registered Diagnostic
Medical Sonographer. Completion of the SPI exam will allow you to focus
specifically on the abdomen and OB-GYN content at the completion of the
program. Many hospitals/clinics will not hire sonographers unless they possess
full ARDMS credentials. ARDMS credentials do not equate as a state license to
practice Sonography.
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Graduates who wish to work in the states of New Mexico or Oregon must have
ARDMS to obtain those states’ licensure. Montana is currently seeking licensure
requirements.
Go to www.ardms.org to review the requirements to sit for the board exams.
1. Advanced Item Type Questions
Go to:
www.ardms.org/prepare_for_an_examination/advnaceditemtypequestion
s
Effective December 2012 some examinations feature new types of
questions called Advanced Item Types (AIT). These questions assess a
candidate in formats similar to actual scanning practice, and provide a
better measure of practical skills. By reviewing the additional links at the
above website, you will be better prepared to take the ARDMS SPI
examination during your final semester on campus.
2. Prerequisites for ARDMS examinations:
http://www.ardms.org/files/downloads/Prerequisite_Chart.pdf
A. SPI
Successful completion of sonographic physics course
requirements with grade of C or better
Currently enrolled in a course of DMS study
Transcripts reflecting the course and grade
Photocopy of a non-expired government issued photo ID
with signature; the names must match identically
B. ABD; OB-GYN: Apply under prerequisite #2
Graduate of a program accredited by CAAHEP
Copy of diploma from the program or an official
transcript with the date of conferred degree
Original letter signed by the program director indicating
date of successful completion
CV is not required if application is submitted and
received in the ARDMS office within one year of
programmatic completion
Photocopy of non-expired government issued photo ID
with signature…names must match identically
3. New ARDMS Testing Center Update:
At the test center, you must present two current, valid signature IDs,
one of which must be a non-expired government-issued photo ID
with your signature; see the accepted list of IDs here.
The name on this application must EXACTLY MATCH the name on
both current, valid signature IDs.
Jane R. Doe and Jane Rachel Doe DO NOT EXACTLY MATCH.
Failure to present two acceptable IDs will prevent your admission to
the test center. If this happens, you will be marked absent and you
will forfeit the entire examination fee and seat.
If the names do not EXACTLY MATCH, update your ARDMS name
of record.
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A candidate is NOT ALLOWED to leave the testing center to obtain
their ID’s, and the candidate is NOT ALLOWED to have someone
bring them their ID’s while they wait at the testing center.
V. Student Rights and Grievances (Administrative Procedure 5530)
A. District Student Rights and Grievances Procedure
When a student feels subjected to unfair action or denied rights as stipulated in
published College regulations, policies, or procedures, redress can be sought
according to the grievance procedure.
This procedure is referenced in the college catalog, under the College Policies,
Regulations and Procedure section. Copies of Merced College’s current Student
Rights and Grievances Procedure can be found in the classroom (AHC-148) or
can be pick-up in the Administration Building - Student Personnel Services
Office.
B. General Statement Regarding Clinical Setting
Actions which are taken against students in the clinical setting may result in a
request from affiliate representatives that a student be removed from the affiliate
in accordance with our affiliation agreement with that particular facility. In such a
case, the sonography program faculty (Program Director and/or Clinical
Coordinator) request prior notification.
There may be cases of other disciplinary actions or situations that do not involve
student removal, as such the procedure for appeal is as follows:
1. Student presents the action being appealed to the Clinical Coordinator
within ten (10) working days of action or situation.
2. The Clinical Coordinator reviews the appeal and contacts the Clinical
Instructor of the student’s assigned clinical facility for further information,
clarification, and/or resolution of the incident. The Clinical Coordinator
then provides the student and Program Director a written answer within
ten (10) working days of the receipt of the appeal.
3. The student may request that the Clinical Coordinator refer the appeal to
the Program Director. The Program Director reviews the appeal and may
contact the Clinical Preceptor and/or Department Manager to discuss the
manner further. The Program Director then provides the student a written
answer within ten (10) working days of the receipt of the appeal.
4. If the student wishes to appeal the Program Director’s decision, he or
she may request a meeting with the Area Dean of Instruction for the
Allied Health Division. The Area Dean of Instruction will provide the
student with a written answer within ten (10) working days of the receipt
of the appeal. The Area Dean of Instruction’s decision is final.
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VI.
Records
A. Student Records
A master file will be started when the student applies for admission and will
contain the application, standardized test scores, transcripts and other data
required for evaluation for admission.
At the completion of the program all official information (copy of transcripts,
records of clinical performance, radiation exposure record and record of program
completion, etc.) will remain on file. Permanent transcripts will be maintained by
the Office of Admissions. All other information will be destroyed.
If a student withdraws prior to graduation, a summary statement of the student's
progress and reason for withdrawal will be placed on file.
Students may inspect their master file anytime under the direct supervision of a
faculty member.
All student records are confidential and information from them will only be given
to authorized persons. Data such as grades, Registry and State Board
Examination scores, health records and performance evaluations may not be
revealed without a student's written consent.
Only personnel authorized by the Program Director will have access to student
records and this will be used only for student evaluation and progress within the
program.
B. Patient Records
Patient records may be used only for providing patient care. They may not be
removed from the department. Information acquired from patient records is
confidential. For classroom purposes, discarded or copied radiographs,
sonograms, CT scans, etc.; any reports must have all patient identification
removed.
VII.
Financial Expenditures
Legal residents of the State of California are required to pay nominal fees. In addition,
students may expect other miscellaneous fees and expenses during the length of the
program. (Non-Resident tuition fee: $173 per unit, plus enrollment fee)
http://www.mccd.edu/alliedhealth/SONO/sonohp.htm
A. Fees - (estimates only)
­ Enrollment Fee (entire program) 3266.00
Contact Admissions and Records for details.
Fees subject to change as per the State Legislature
­ Student Body Fee 50.00
­ Health Fee (entire program) 79.00
­ Parking (optional; regular semester $20 x 3; summer $10 x 2) 80.00
21

B. Additional Expenses - (estimates only)
­ Program Pin (optional) 53.00
­ Books (entire program) 1500.00
­ CPR Certification 50.00
­ Physical & Immunizations 200.00
­ Uniforms (entire program) 180.00
­ Background Clearance (criminal/financial/social security trace) 65.00
­ Drug Screening 35.00
C. Licensing
­ ARDMS SPI (Physics) $200.00
­ ARDMS OB-GYN $250.00
­ ARDMS Abdomen $250.00
D. Books
Fees are subject to change at any time
Total $6258.00
The DMS program recognizes that ultrasound textbooks are expensive, as such;
the program does its best to minimize this cost. Books are selected, not just for
the course in which they are required, but for other programmatic courses and for
study during the first years of the student’s ultrasound career. The campus
bookstore carries all the required textbooks. Students are expected to purchase
these books prior to the start of classes and to read all assignments.
E. Drop/Withdrawal Refunds
Students withdrawing from courses within the first two weeks of class meetings
may apply for a full refund of all fees except International Student Insurance,
Audit, Credit by Exam, ID Card, or other fees not listed on the typical registration
form for classes in the credit mode.
Most of the textbooks purchased in the first semester will be utilized throughout
the duration of the program. The remaining textbooks will be used as often as
possible, but will serve you well when preparing for your board examinations.
Students may not be permitted to attend classes and/or clinic until all registration
fees are paid in full.
Nonresident students are required by state law to pay nonresident tuition.
Consult the Merced College catalog for current fees.
VIII. General Policies
A. Changes in Personal Data
Notify the Allied Health Secretaries, Program Director and the Admission &
Records Office if there is a change of your name, address, telephone number,
family doctor, or change of person(s) to notify in case of an emergency. Use the
22

appropriate form, for reporting these changes. The form can be found in the form
rack located in the classroom.
B. CPR Requirement
Students must be CPR certified through the American Heart Association: BLS for
Health Care Providers or its equivalent (must include a hands-on component). It
is the student’s responsibility to maintain current certification. NO on-line CPR
courses only or American Red Cross courses are acceptable. Online CPR
courses with a lab are acceptable. Do not anticipate, nor request that your
clinical affiliation will pay or sponsor your CPR course. Notify the ALH Secretary
with a copy of recertification documentation.
C. Employment
Due to the concentrated and intensified nature of the Diagnostic Medical
Sonography Program, full-time employment is not recommended. If a student
must accept employment while enrolled in the program, this implies that the
student will NOT:
1. Function under the job description of a Sonographer, or Ultrasound
Technologist
2. Use the abbreviation “RDMS” after their name of any purpose; neither
refer to himself/herself as an ultrasound technologist unless they were
employed as an ultrasound technologist prior to admission to the DMS
program.
3. Accept employment hours which conflict with class/clinical time;
4. Attempt to get any clinical competency sign-offs during hours of
employment at a hospital or clinic
5. Use his/her College I.D. badge during hours of employment
The student will avoid practices in which they are substituted for regular staff to
perform any sonographic examination procedures. Students will not take the
responsibility or place of qualified staff.
The key point is that regardless of what the job position is called, a person that is
not working in the capacity as a sonographer or student sonographer may not
perform a sonographic examination. On the other hand, an individual can be
employed in a hospital/imaging center in positions other than ultrasound
technologist/Sonographer, i.e.: patient transporter and as such will bring in the
patient and may set them up for the exam.
The Program does not have any jurisdiction over what a student does outside of
the program as long as they are not working outside the scope of what’s legal.
Students during off hours are not covered under the school’s insurances.
D. Health
A student should be in satisfactory physical and mental condition to ensure the
safe and effective care of patients. If a student's physical condition or mental
condition is less than satisfactory, the Program Director, Clinical Coordinator, or
person of authority at the clinical affiliate has the right and responsibility to
remove the student from the patient care area. Before returning to the clinical
area, the student may be requested to submit a doctor's written release before a
student is allowed back into the clinical area.
If the student is subsequently dismissal due to academic weakness or
unprofessional behavior, the student will not be allowed read-admittance.
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E. Immunizations
As a student in an allied health program you have an increased risk of
contracting Hepatitis A and/or B, which can lead to a very serious illness. Prior to
entering the clinical aspect of your training you will be required to specify in
writing your Hepatitis A/B vaccine status. It should be noted that a clinical facility
has the right to refuse a student clinical assignment if the student has not been
immunized–even if the student signs a waiver of liability.
A Hepatitis B vaccination which can decrease your chances of contracting
Hepatitis B is available through the Merced County Health Department for a fee
for the three shot series. Once the three shot series has been completed, to
ensure that antibodies are being produced, a follow-up Hepatitis B surface
antigen test is recommended. Check your county’s Health Department for their
vaccination schedule.
Routine immunizations (MMR, Tdap, Polio, Varicella) must be up to date for your
protection as well as the protection of patients. After 10 years, a titer is required
to ensure continued immunity.
Tdap is a booster to DTap Vaccine in people 11 - 64 years. Tdap can be
normally given as early as 2 years after you received the Td vaccine. Tdap is not
the same as DTap.
Current flu shot documentation is due by November 10 th of each year or else the
student must wear a facemask in clinic until documentation is provided or until
the student graduates, whichever comes first. The CDC recommends the flu shot
to pregnant women because the flu is more likely to cause severe illness in
pregnant women than in women who are not pregnant. Additionally, it helps
protect the unborn from serious illness and complication of the flu too. It is
advised to get the flu shot as soon as possible so one can be protected early on
in the flu season and not take the chance of catching it. Contact the Allied Health
Secretary to update your immunization file.
F. TB Screening & General Updates
Annual TB paper screening is a mandatory condition of enrollment in the
program. An annual negative PPD screening is also required, unless
contraindicated.
If you cannot have a skin-test or if a previous PPD has been reactive/positive or if
you have been vaccinated with BCG*, an initial negative chest x-ray taken within
the last six months must be completed prior to the beginning of the program.
If and when you convert to a reactive/positive reaction on a PPD test, you will be
required to supply an initial negative chest x-ray report. If your annual paper TB
screening is questionable, you will be required to submit a negative chest x-ray
report.
*BCG (Bacille Calmette-Guerin) is a vaccination given to persons in countries
with a high incidence of TB. It is about 50% effective, may or may not produce
skin-test reactivity, and can leave a scar
ALL IMMUNIZATIONS & CPR UPDATES MUST BE COMPLETED BEFORE A
STUDENT CAN BEGIN A NEW CLINICAL ASSIGNMENT. Update all health
and certification records with the Allied Health Secretary.
24

G. Infectious Disease Control Policy
Persons involved in reporting and/or evaluating an individual with an infectious
disease (e.g., hepatitis, measles, acquired immune deficiency syndrome (AIDS),
aids related complex (ARC), rubella, tuberculosis, etc.) are required to respect
the individual’s right to privacy and must maintain appropriately strict
confidentiality regarding the person's identity and the nature of his or her illness.
The determination of whether or not under what conditions an individual who has
been diagnosed with an infectious disease will be permitted to participate in
campus activities will be made on a case-by-case basis by the Infectious Disease
Control Team. For further information consult Board Policy 3981.
All students must wear protective devices, gloves, gowns, masks, etc., when
performing examinations on patients with infectious disease.
Blood and body secretions such as semen, saliva, urine, tears, stool, emesis,
sputnum, wound drainage, bile, and pleural or peritoneal fluid may contain the
HIV or hepatitis virus. All should be considered infectious. Any tissue, biopsy, or
patient specimen should also be handled with care, including wearing gloves.
While exposure to a communicable disease in the clinic setting may need
immediate attention, TB exposure can be base lined in the Student Health
Services Office at the college.
H. Library References
Students are encouraged to utilize the books, professional journals and
pamphlets in the Learning Resource Center (LRC) as well as the Sonography
Program's Library (AHC-157).
Check the Library’s internet site for medical imaging books and magazines
available in the Merced College LRC.
1. Merced College LRC - Students are encouraged to approach the library
staff for aid in locating information and materials. Interlibrary loan service
is available through the Reference Librarian.
2. Sonography Program's Library - Books, magazines, audiovisual
materials, radiographs and other items, in AHC-157, maybe checked-out
for varying lengths of time (see instructor for times). Log all check out
requests on your personal student check out card and have an instructor
initial and date all checkout and returns.
All material checked out during a particular semester must be returned
by the last day of lecture class for that particular semester.
I. Right of Privacy
Be aware of your responsibility as well as the legal implications in respecting the
rights of others, especially the right of privacy.
Do not discuss any patient, any member of the health team, or any disease or
symptoms in a place where you might be overheard and possibly infringe on
someone's right to privacy. You never know whose relative or neighbor is
standing next to you, or around the corner.
25

J. Sexual Harassment Policy
It is the policy of Merced Community College District to provide a neutral
educational environment for all students free from unwelcome sexual overtures
and advances. District employees and clinical affiliate employees are expected
to adhere to a standard of conduct that is respectful and courteous to all
students. The use of authority to emphasize the sexuality or sexual identity of a
student in a manner which prevents or impairs that student's full enjoyment of
educational benefits, climate, or opportunity is in strict violation of our affiliate
agreement, as well as College policy.
Any student who believes that she or he has been sexually harassed within the
clinical setting should initiate a complaint with either the Program Director or
Clinical Coordinator. If the complaint concerns a district employee, board policy
will prevail.
A copy of the District Sexual Harassment Policy can be found in the District
Policy Handbook
K. Transportation
Students are responsible for transportation to and from school and the clinical
facilities. Students may park only in designated areas, both at the College and
clinical sites. Refer to the Campus Parking Regulations, outlined in the College
catalog and Clinical Parking Policies.
All students are responsible for fulfilling clinical assignment transportation
challenges. The clinical affiliation is NOT responsible for student transportation
costs. Students are encouraged to be proactive in making transportation
accommodations.
L. Use of Drugs
Students must abide by the following policies and guidelines.
1. Any drugs used should be with physician guidance. Prescription drug
use must not alter the student’s ability to perform safely in the field.
2. Drugs may not be taken from the clinical areas.
3. Proof of misuse of drugs are grounds for immediate dismissal from the
program.
4. A clinical facility may request a random drug screening test. Positive
drug screening test results can lead to dismissal from the facility and the
program.
26

M. Visitors
The student will not entertain visitors (personal and/or classmates not assigned
to facility) in the Diagnostic Imaging Department/Sonography Department
anytime without specific permission from the respective personnel.
Students are not allowed to bring guests into the classroom/laboratory without
specific permission from the instructor of record. It is against school policy to
bring children to class or leave them unattended on school grounds while the
student is in class.
When scanning visitors/volunteers during open skills labs the following policies
must be followed:
No one under the age of 18
No pregnant volunteers
No volunteers with known disease processes
No suggestion or hint of a questionable disease process will be
addressed; this is out of your scope of practice
No endocavitary applications
No breast, scrotal, or penile sonographic scans will be generated on a
human; simulations may be completed with phantoms or with simulation
equipment
M. Positioning Disclaimer
In the course of learning about sonographic scanning and positioning
(classes/labs/demonstrations and/or practice) students will be touched by faculty
and fellow students and scanned with an external sonographic transducer by
faculty or fellow students in areas that are routinely used as scanning landmarks
and windows.
N. Background Clearance
A background clearance will be required upon acceptance into the program. This
includes a criminal offense, criminal history, sex offender check and social
security trace. A background clearance means that your background report is
free from negative information. Negative information (charges & disposition &
sentencing, including probation) can remain on your report for up to seven years.
mybackgroundcheck.com
P.O. Box 492770
Redding, CA 96049
www.mybackgroundcheck.com
Any clinical facility may require a current background clearance. It will be the
students’ responsibility to pay for any additional screening required by the clinical
facility for student placement.
O. Drug Screening
A drug screening will be required upon acceptance into the program. Failure to
pass this screening may cancel admission to the program. Any clinical facility
may require a current drug screen. This is the financial responsibility of the
student.
27

P. Graffiti
Absolutely no written notes, reminders, answers, questions, doodlings, etc., are
permitted on desks, tables, counters/etc. even if you plan on erasing them! Ask
for a scratch sheet of paper if you need something to write on. If you see any
writings where you are seated, please inform the instructor of record immediately
so you will not be held accountable for the graffiti.
IX.
Accidents and Incidents
A. Student Clinical Injury
Student insurance coverage is provided for all students for accidents that occur
on campus or at college related activities including clinical education. All injuries
sustained by students in the clinical areas or on campus must be reported as per
the VIPJPA Injury Reporting Flow Chart. Failure to report accidents and
complete the required college documents within 10 days from the time of the
injury may result in rejection of a claim by the student insurance. In this event,
the student will be responsible for claim payment.
Basically the role of the Clinical Preceptor (or whomever is supervising the
student) is to call the “Company Nurse” (CN) at 1-877-854-6877 and report the
injury before the student seeks treatment. CN will evaluate the student’s injury
and give further instruction on how to proceed. When the Clinical Preceptor or
supervising technologists calls, make sure to identify the student as a
Sonography student from Merced College. Make sure the student is present to
speak with the CN over the phone to provide their personal information. If it is an
emergency, the student should seek treatment first and call CN after treatment.
If possible, the student should report their injury to the Program Director
immediately. If the student is unable to report their injury to the Program Director,
the Clinical Preceptor or supervising technologist should report the injury to the
Program Director.
The Clinical Preceptor’s or supervising technologist’s responsibility ends at this
point.
B. Incidents
Incident reports will be completed and placed in the student's file when a safety
violation or injury occurs in the clinical area. This will be done even if the health
agency does not require that an official report be submitted. The student and
Clinical Preceptor must sign the report. A copy of the incident report should be
forwarded to the Program Director.
Should you observe any injury to a patient caused by someone else and are
asked to sign an accident report, sign it as a “witness.”
**Important: If you were not in any way responsible for the injury–sign the
report if asked, but designate yourself as a WITNESS.
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X. Clinical Assignments
A. Students successfully progressing in the program will be assigned four
clinical rotations.
B. Students, based on the application process, will accept assigned clinical
rotations without complaint
C. Students will complete at least one Hospital rotation
D. Students will complete at least one Imaging Center rotation
E. Students will complete at least 1710 hours of non-paid clinical
experience
F. Stipends are not provided by the clinical affiliations as the clinical hours
are required for programmatic completion and eligibility to sit for the
ARDMS board exams (as per CAAHEP accreditation)
G. Students will complete all site entry requirements of the assigned clinical
affiliation as per program and clinical site requirements prior to entrance
at that location
H. The clinical affiliate has the right to refuse or terminate the student’s
rotation
XI.
Student Dress and Grooming for Clinical Education
Student dress and grooming will reflect the policies of the clinical affiliate, the technical
requirements of the task, the positive image of the Sonography Program and the
Profession as a whole.
A. Procedure
1. Students are responsible and accountable to observe the dress and
grooming standards of their assigned hospital.
2. Students are to adjust their dress appropriately prior to an assigned
clinical experience; i.e., surgery, isolation, etc.
3. Inappropriate dress and/or grooming will be discussed with the student
by the Clinical Preceptor and/or College Supervisor. A verbal warning will
be given for the first dress or grooming infraction. Subsequent
occurrences will result in exclusion from clinical education for the
remainder of the day.
4. Students who are absent from an assigned clinical experience because
of inappropriate dress and/or grooming are to make up this time prior to
the end of the semester.
5. Failure to follow the dress code will result in loss of clinical points.
B. Policy
The following dress and personal grooming standards will be expected of all
students in the Sonography Program. Students shall appear professional in
attire at all times. Clinical students are expected to serve as role models for the
school and the profession.
1. Uniforms/Scrubs
a. Must be clean, pressed and conservative in design. They should be
free of odor and strong fragrances. Each clinical affiliation will
identify their color preferences. Scrubs, unless otherwise identified
by the clinical affiliation, will be solid, matching colors. Scrubs will
not have stripes, prints or floral designs, unless approved in writing
29

o
by the clinical affiliate. Ask for clarification during your DMS Program
orientation to the department.
b. Business attire, if an option at your facility, includes the following:
o Full length white lab coat without embroidery
o Women: Respectable length (about of just above
the knee) dress/skirt
o Women: Sleeved top, no spaghetti straps; opaque
(can’t see through); no “T” shirts
o Women: Dress slacks; ankle length; no jeans, or
denim; no shorts, stirrup pants, no fleece, nor
spandex
o Women’s hose: Transparent skin-tone colors , no
prints, no fishnets
o Men: Dress shirt with tie, “T” shirts, if worn, will be
under the dress shirt
o Men: Dress pants (no jeans, no denim, no westernstyled,
no fleece, no shorts)
Shoes: Appropriate dress shoes; quiet soles, heels
2-inches or less
c. Scrubs used in the Operating Room (OR) are only to be worn
while working an OR cases in the surgical suite and are not to be
removed from the facility unless authorization is received from
the supervisor. If you must step out of the OR suite, you must
either change from your OR scrubs or wear an approved surgical
gown over the OR scrubs. Removal of any hospital property
from the premises is considered theft.
c. Hospital scrubs/lab coats are not to be removed from the clinical
setting without prior approval from the supervising technologist.
d. Clothing with stenciled names of another clinical facility shall not
be worn during clinical assignments.
e. Shoes must be clean and/or polished. Shoes generally should be
white leather. Shoes should be comfortable and appropriate for
use in a clinical facility. Shoes must be closed-toed, closedheeled.
Shoes should not have excessive heels, i.e., dress
shoes/stilettos, or boots. Heels should be 2-inches or less.
Sandals are not to be worn. Shoes that make noise are not
acceptable.
g. A name badge must be worn and must state the student's first
name and last initial. The badge must identify the wearer as a
student in the Diagnostic Medical Sonography Program. The
student is responsible for purchasing the standard college I.D.
badge. The student will wear the clinical affiliate’s required
identification.
h. Dosimetry badges, IF required, must be worn at all time while in
the clinical area. If a lead apron is being used, the dosimetry
badge must be worn at collar level outside the lead apron. Most
Sonography departments do not require dosimetry badges.
Dosimetry badges will not be a component of the Sonography
Program.
2. Grooming
Students must maintain high personal hygiene standards. Strong
fragrances and/or odors (body or smoke) cannot be tolerated.
Students are to refrain from using cologne, perfume, aftershave, and
fragranced body wash at all times in the clinical arena. Some of the
DMS affiliates have employees who are highly allergic to these
30

fragrances. Most ill patients cannot tolerate heavy smells or
fragrances.
Hair must be clean, neatly groomed and controlled.
Hair, moustaches, beards, and sideburns must comply with the
regulations of the clinical affiliate and be neatly trimmed. Clean
shaven is the accepted practice.
If hair is longer than shoulder length, it must be clasped back at the
nape of the neck or worn on top of the head at all times during
clinical training.
As a condition of continued enrollment in the Diagnostic Medical
Sonography Program, fingernails must be kept moderately short and
clean. Artificial nail enhancements are not to be worn. Anything
applied to natural nails other than clear polish is considered to be an
enhancement. This includes, but is not limited to: artificial nails, tips,
wraps, appliqués, acrylics, gels and any additional items applied to
the nail surface. Chipped nails should be filed.
Makeup should be conservative.
No chewing gum in the ultrasound department or imaging areas.
o Gum chewing will be limited to recognized eating areas.
Smoking is not permitted in class and is only permitted in designated
areas on the Merced College campus. Smoking is prohibited in all
medical facilities; use the designated outside areas at the clinical
facility and follow the distance requirements from any opening into
the building.
o Compliance with all smoking rules is expected. Some
clinical facilities prohibit smoking 100% of the time while
at work.
o Failure to comply in clinical sites may result in being
dismissed from the site.
o Students also need to be mindful of the odors associated
with smoking, and the impact this may have on patients.
Some patients will refuse to permit students to scan
them when the student smells of tobacco products.
3. Jewelry
Rings may be worn but students may be required to remove them in
the specialty areas or certain procedures. Rings with stones are a
risk to patients, and may tear the required scanning glove.
"Dangling" or hoop earrings are not being permitted in the clinical
setting. Earrings are limited to a single post/small stud per ear.
Earrings shall not be larger than a dime in diameter.
To prevent patient injury, it is advised that jewelry not be worn on the
external surface of the uniform.
4. Body Art
Visible forms of body piercing, including but not limited to nose
studs or screws, chin or cheek labret, barbells, ear grommets
and tongue door knocker, etc., are not permitted in any size. In
general, modifications that alter the original integrity of your body
would be open for review (i.e., loops as a results of grommet
holes, neck stretching, etc.).
If you have a tattoo, it must be covered while on duty.
5. Miscellaneous
Merced College and Clinical Affiliates are not responsible for loss
of valuables.
Points will be deducted from your clinical evaluation grade for not
meeting the dress code and grooming guidelines.
31

XII.
Student Orientation to Clinical Facility
A. Policy
Students must be oriented to all new clinical affiliates. It is the responsibility of
the Clinical Preceptor to provide this orientation either personally or by
arrangement with other staff members.
Orientation forms, for each rotation, are located in the clinical forms handbook.
Your signature on this form indicates you have reviewed and understood each
statement. Should you have questions, be sure to ask the Clinical Preceptor,
Department Manager of the Personnel Department for clarification prior to
signing these forms.
This form must be completed and returned to the program director or
clinical coordinator for their signature within 14 calendar days from the
beginning of a new semester/session.
The signed form should then be placed in your Clinical Competency Handbook
binder for the remainder of the rotation. At the end of the rotation, this form
should be filed in the student’s personal folder in the classroom.
XIII. Clinical Experience
A. Duties of a Student Sonographer
While the student is assigned to clinical training she/he will be expected to
participate not only in sonographic imaging exams and procedures but also in
image filing, image processing, stocking of room supplies, cleaning the
ultrasound systems, patient transport and other office procedures and other
sonographer work tasks, as long as their clinical education is not being
compromised.
B. Clinical Placement
The Clinical Coordinator is responsible for arranging the diagnostic clinical
education rotations. Student placement is subject to clinical approval.
Vacations are to be scheduled only during times when classes, to include
clinic are not in session.
C. Scheduling
Clinical Scheduling - Monthly clinical scheduling will be completed by either the
Clinical Preceptor and/or Department Manager/Chief Technologist of respective
assigned hospital. Individual copies of each student's schedule are to be posted
in the clinic facility for review and signature by the College's Clinical Supervisors
to document valid and appropriate clinical schedules.
It is the student's responsibility to submit to the College past signed copies of
their clinical schedules. Submitted past schedules are to be filed alphabetically in
the Clinic Schedule Notebook located in the classroom. The student's schedule
file must be up-to-date and complete by the given dates.
It is the student’s responsibility to check updated posted schedules to see if there
are any errors/omissions/changes/etc. that need to be brought to the C.P.’s
32

immediate attention. Do not wait until the last moment to notify the C.P. of an
error or change. If your C.P. has not heard from you within five (5) scheduled
working days, then the posted schedule will take precedence and you will be held
responsible for adhering to it.
Generally speaking, routine assignment hours are considered to be from 0500 -
2100 hours. Anything other than that is considered as nontraditional, (i.e., “offhour”).
Students may be scheduled during weekend hours.
Complete weekend assignments should reflect no more than TWO weekends per
month to ensure assignments are educationally valid and not abusive of
students. It is acceptable for a clinical site to schedule a student for weekly
Saturday or Sunday rotations.
Students are not required to attend clinic on legal holidays recognized by the
College.
Students will not be required to work graveyard shifts or on-call. Clinic scheduling
will not include “double-back” shifts either by design or trading of clinical days.
There should be a minimum of twelve (12) hours between scheduled shifts.
Supervision remains constant no matter what hour or day scheduled. Direct
supervision is required prior to documentation of student competency, with
transition into indirect supervision following competency documentation of
competency. This is true for all areas using sonography: operating room, delivery
room, mobile examinations, and the emergency department.
Class - Unless otherwise notified, students will attend class at the College as per
the catalog schedule. When available, students are encouraged to practice in
faculty observed open scanning sessions.
D. Clinical Hours
Clinical hours are required for each semester beginning with the second
semester. These are cumulative hours and if a student does not complete these
hours during the allotted time she or he may be put on probation with the
possibility of dismissal from the Program. Individual consideration will be given to
the student with a valid excuse after consultation with the Clinical Coordinator
and Program Director.
Students must complete no fewer than 1710 clinical hours. On campus
laboratory hours are not counted as clinical hours. Clinical hours must be
completed in a legally operated place of business with emphasis on patient care,
i.e.: hospital, clinic, imaging center.
Students are required to keep a monthly record of laboratory/clinical hours they
have accrued. This monthly record is validated by the Clinical Preceptor and
College staff.
E. Clinical Exams
Students are required to keep records of sonographic examinations they have
observed, assisted, and/ or performed. All repeat examinations are to be
completed under direct supervision and are to be logged as such in the Daily
Clinical Exam form. These records are to be compiled daily, utilizing the Daily
Record of Examinations Form, verified by the Clinical Preceptor or their designee
and submitted to the instructor of record.
33

F. Student Evaluation of Clinical Experience
At the end of each clinical course the student may be required to complete an
evaluation of their respective clinical facility. This is an opportunity for the student
to provide an evaluation of her/his clinical experience. Through candid
evaluations, the faculty can identify the strengths and weaknesses of a particular
clinical affiliate and utilize this information for continued program review. Another
area where this information is useful is in matching student's clinical weaknesses
with affiliates that rate high in providing clinical experiences that address a
student's weaknesses.
G. Breaks & Lunch Periods
Generally, there will be morning, lunch and afternoon breaks. Observe the
departmental policy regarding breaks, and do not take excess advantage of the
coffee room/lounge. Lunch breaks are 30 minutes regardless of the
Staff/Departmental policy and should be included in the total hours recorded per
day.
H. Personal Phone Calls
No personal phone calls should be received while in the clinical area except
emergencies. Departmental telephones may not be used for personal calls.
Leave cell phones in your locker and only check them during break or lunch. If
there is an extenuating circumstance, advise you C.I. or supervising technologist
at the beginning of your shift.
While on campus, cellular phones and pagers are to be turned off during class.
I. Early Release
No early releases are granted. Students must attend all classes, including clinical
education classes until the completion of their final semester to be eligible for
graduation. All hours will be counted.
J. Orientation to a New Facility
Students are not required to make-up time for mandatory orientation to a new
facility for a current or upcoming rotation.
K. Removal of Cervical Collars
In trauma situations, have the E.D. staff remove the cervical collar once patient’s
x-rays have been cleared.
L. Cutting Away of Patient Clothing and/or Jewelry
In trauma situations, request permission from supervising staff before cutting
away pieces of clothing or jewelry.
M. Student Availability During Site Visitations
When a Clinical Supervisor, or other program official is scheduled to make a site
visitation, please make sure you are available to be observed. This is especially
true when it comes to OR or extended mobile cases. Don’t assume just because
one Clinical Supervisor (CS) has seen you recently, (even if it was yesterday),
you don’t have to be available. Work with your Clinical Preceptor (CP) so that
when a CS is scheduled to visit, you’re there.
This may mean coordinating with your CP to come in earlier or later or switch
days so you are present when the CS makes his/her site visitation. This is
34

especially true if you haven’t been visited for a mid-term evaluation. If you have
not been evaluated due to an absence on your part, it will be particularly
important that you make arrangements to ensure you are available for the next
CS visitation. Keep in mind that a one-to-one student-technologist ratio must be
maintained at all times.
N. Handwashing
Students are required to wash or sanitized hands prior to donning gloves and to
rewash hands after removing gloves. Students are also required to wear gloves
with every patient.
O. Personal Protective Equipment-PPE (gloves, face masks,
booties, gowns, hair covers, nets, etc.)
All PPEs should be removed and disposed of properly once an exam is
completed and before the student moves out of the patient’s room to prevent the
spread of infection.
P. Miscellaneous
When not busy, there will be no loitering. Use idle time for studying and
pathology case review. Now is the time to ask questions about specific
examinations or procedures you're unsure or curious about.
It is the student’s responsibility to seek out sonographic learning
experiences. Students should have equitable and open communication with
their clinical instructor/coordinator/preceptor.
Students who appear to lack interest in the clinical learning environment may
be asked to leave by the sonographer, or may fail to be included in more
desirable forms of learning.
Seek first to understand by sharing your clinical needs with your preceptor.
Be prepared to answer to your program director: “What did you learn at clinic,
yesterday?”
XIV. Clinical Radiation Protection Rules
Although the Sonography Department generally is exempt from radiation tracking, as
students working in a medical imaging department you may be required to participate in
procedures that use both ionizing and non-ionizing energies. As such the procedure is
as follows:
Procedure
The following safety rules have been established for the protection of the patient,
other personnel and you from ionizing radiation during your hospital observation
and clinical education. These rules are a combination of state and federal
regulations and/or laws and additional guidelines condensed from man's 110+
years experience with ionizing radiation. These rules are mandatory and any
exception must be reported to the Department Manager and Program Director as
soon as possible.
Policy
1. Regarding dosimetry badges:
35

a. A dosimetry badge, properly placed, must be worn at ALL
times during both the observation and clinical education
phases.
b. When protective aprons are used, the dosimetry badge must
be placed above the apron, at collar level.
c. Dosimetry badges must be turned into the Allied Health
Secretary by the 10 th of each quarter.
2. When an X-ray exposure is about to be made, you MUST:
a. Leave the room, or
b. Get behind the lead shield, or
c. Be otherwise suitably protected for surgery, portable and
fluoroscopic work.
3. Specifically, you must not hold or support a patient during exposure, nor
hold or support a cassette during exposure.
4. You may not observe the patient during exposure from an adjacent room
or hall unless through a lead-glass protective window. You must NOT
"peak" around a door nor though a crack between door and wall.
5. When sitting to rest in the hall do not sit in direct line with the tube or
radiographic table even if it is not being used.
6. During an exposure or procedure do not place yourself in direct line with
the central ray, even though you are wearing a lead apron.
7. Under no circumstances will you permit yourself or any other human
being to serve as "patients" for test exposures or experimentation.
8. If, during fluoroscopic procedures, you remain in the radiographic room
the following will prevail:
a. A lead apron must be worn at all times/or you must remain
behind an adequate lead protective screen and not in visible
line with either tube or patient.
b. The dosimetry badge must be worn above lead apron at
collar level.
9. Do not make exposures on patients.
XV. Pregnancy Policy and Procedures
Policy Regarding Declared Pregnant Students
It is your responsibility to notify the program director of the pregnancy.
‣ The student must receive written permission from her physician to continue in the
program
o Should the student be completing a clinical rotation, the data must be shared
with the clinical affiliation as well.
‣ Pregnant students need to be aware that there is a high probability that completion of
the program will be delayed/extended/terminated as required courses are offered
sequentially and only once in the 18-month program
‣ Pregnant students will not be scanned nor volunteer to be scanned during their
clinical experience.
‣ Any rotations in a radiographic application will not be scheduled during the term of
pregnancy
‣ The pregnant student needs to be aware that the biggest risk to the unborn occurs
during the first trimester. As all clinical affiliation rotations occur within a Diagnostic
Imaging Department (Radiology), students need to be tested for pregnancy as soon
36

as she feels there is a reason to do so. This will allow for appropriate adjustments to
be made, if possible.
‣ Pregnancies will NOT be scanned on the Merced College campus. Pregnant
students, who learn of their pregnancy in the DMS laboratory, will cease that
scanning session immediately and notify the Program Director. Students who are
scanning a volunteer in the open skills lab who find an incidental pregnancy will
cease that scanning session.
‣ The student will notify her clinical preceptor of a declared pregnancy. The clinical
affiliation will enact their policy for pregnant students. The program director and/or
clinical coordinator will communicate with the clinical affiliate.
XVI. Student Supervision
A. Policy on Supervision of Sonography Students
1. Students must have adequate and proper supervision during all clinical
assignments, which would include direct supervision until a student is
signed off for competency on the respective sonographic exam &/or
procedure.
Direct Supervision - The following conditions constitute direct
supervision:
a. A qualified sonographer reviews the request for the sonographic
examination (a) to determine the capability of the student to
perform the examination with reasonable success; or (b) to
determine if the condition of the patient contraindicates
performance of the examination by the student.
b. If either of the above determinations is questionable or negative,
a qualified sonographer should be present in the ultrasound
room.
c. The qualified sonographer reviews and approves the
sonographic images prior to the dismissal of the patient. Medical
judgment may supersede this provision.
2. Once a student has demonstrated competency in a particular
sonographic exam, or procedure, the student may be indirectly
supervised by a qualified sonographer.
Indirect Supervision is defined as supervision provided by a qualified
sonographer immediately available to assist students regardless of the
level of student achievement. Immediately available is interpreted as the
presence of a qualified sonographer adjacent to the room or location
where an ultrasound examination or procedure is being performed.
3. The student will be under direct supervision when making a repeat
sonographic examination during 100% of clinical training.
4. The student will be under direct supervision when working in the
Operating Room, Emergency Room (ED), and labor and delivery during
100% of clinical training unless (1) the student has been signed-off on
that particular examination or procedure AND (2) prior approval has
been granted by the Department’s Imaging Manager.
37

XVII. Personnel Descriptions
A. Faculty
1. Medical Advisor - Stephen K. Hansen, M.D.
The Medical Advisor is a board certified physician who is responsible for
the general supervision of staff who work in an imaging department. Our
Medical Advisor, Dr. Hansen, is a Radiologist who is certified by the
American Board of Radiology. He who works with the Program Director
in developing the goals and objectives of the Program and in
implementing the standards of achievement. DMS Programs may have
one or more medical advisors.
2. Program Director/Instructor/Clinical Supervisor – Cheryl Zelinsky
Under general direction is responsible for the total coordination of the
program with direct responsibility to the Division Chairperson working
closely with the Medical Advisor and the Advisory Board. Directs formal
classroom instruction and demonstration and is responsible for
coordination of class schedules.
3. Clinical Coordinator/Clinical Supervisor –TBD
Under the direct supervision of the Radiography Program Director is
responsible for formal classroom instruction and demonstration, and is
responsible for coordination of student clinical assignment. The CC/CS
is employed by Merced College in a full or part-time capacity. The
CC/CS maintains a schedule of regular visits to the clinical education
centers to observe, evaluate and assure clinical education effectiveness,
and record student clinical performance.
4. Instructor: TBD
Direct formal classroom instruction and demonstration.
5. Adjunct/Part-time Faculty -TBD
Direct formal classroom instruction and demonstration; observes,
evaluates, and records student performance in the clinical areas.
C. Clinical Personnel
1. Radiologist/Sonologist: Unique to each facility
Radiologist and/or Sonologist is a board certified Physician responsible
for the interpretation of the sonographic examination. The
Radiologists/Sonologist is at the upper level of the chain of command.
For all intensive purposes, the R/S is your boss.
2. Imaging/Department Manager/Chief Technologist:
Personnel employed by a hospital to oversee the entire operation of a
Diagnostic Medical Imaging (Radiology) Department.
3. Medical Imaging Director
The Imaging Director/Manager may be a Radiographer, Sonographer, or
another credentialed member of the Allied Health Field. This position is
responsible for the daily operations of the Imaging Department. Your
clinical preceptor will report to the supervisory staff who reports to the
Imaging Director.
38

4. Clinical Preceptor (C.P.)
Registered Diagnostic Medical Sonographer appointed in each clinical
affiliate department who is directly responsible for the students assigned
to their department; makes assignments of students so the student may
benefit from as many new experiences as possible; completes evaluation
reports on each sonography student and communicates directly to the
Program Director regarding problems or suggestions.
5. Staff Technologist/Sonographer
Ultrasound Technologist or Sonographer employed by the clinical affiliate
department. The makeup of the sonography staff is generally
composed of sonographers with variable years of experience, areas of
expertise, registry status, and areas of interest. The sonography staff will
act as a cohesive unit to perform ultrasound procedures of exceptional
quality and will promote ethical and culturally competent care of their
patient.
6. Imaging Department Staff
The make-up of the imaging department includes: Radiographers, CT
Technologists, MRI Technologists, NMT Technologists, Registered
Nurses, clerical, and transportation staff. No matter the position, all
members are treated equally and with respect.
7. Students
Persons actively enrolled in the Diagnostic Medical Sonography program
who are eligible to participate in the clinical sonographic experience.
Duration begins at the onset of term two and concludes after the 5 th
semester hours, competencies, and other program requirements have
been successfully completed.
XVIII.
Professionalism, Professional Job Description
A. Description of the Profession
The Diagnostic Medical Sonographer/Vascular Technologist utilizes high frequency
sound waves and other diagnostic techniques for medical diagnosis. The professional
level of this health care service requires highly skilled and competent individuals who
function as integral members of the health care team. The Diagnostic Medical
Sonographer/Vascular Technologist must be able to produce and evaluate ultrasound
images and related data that are used by physicians to render a medical diagnosis. They
must acquire and maintain specialized technical skills and medical knowledge to render
quality patient care.
Sonographers are highly trained individuals.
B. Sonographic Scope of Practice:
Overview
The Diagnostic/Vascular Technologist is a highly skilled individual qualified by academic
and clinical experience to provide diagnostic patient services using ultrasound and
related diagnostic techniques. The Diagnostic Medical Sonographer/Vascular
Technologist is responsible for producing the best diagnostic information possible with
the available resources. They acquire and evaluate data, while exercising discretion and
judgment in performance of the clinical examination. The Diagnostic Medical
Sonographer/Vascular Technologist is able to:

Obtain, review, and integrate pertinent
‣ Patient history, physical examination, and supporting clinical data to
facilitate optimum diagnostic results.
Perform diagnostic procedures by
‣ Producing, accessing, and evaluating ultrasound images and related data
that are used by physicians to render a medical diagnosis.
Provide interpreting physicians with an
‣ Oral or written summary of technical findings.
Provide patient and public education and
‣ Promote principles of good health.
C. SDMS Scope of Practice for the Diagnostic Ultrasound Professional
Preamble:
The purpose of this document is to define the Scope of Practice for Diagnostic Ultrasound
Professionals and to specify their roles as members of the health care team, acting in the best
interest of the patient. This scope of practice is a "living" document that will evolve as the
technology expands.
Definition of the Profession:
The Diagnostic Ultrasound Profession is a multi-specialty field comprised of Diagnostic Medical
Sonography (with subspecialties in abdominal, neurologic, obstetrical/gynecologic and ophthalmic
ultrasound), Diagnostic Cardiac Sonography (with subspecialties in adult and pediatric
echocardiography), Vascular Technology, and other emerging fields. These diverse specialties
are distinguished by their use of diagnostic medical ultrasound as a primary technology in their
daily work. Certification 1 is considered the standard of practice in ultrasound. Individuals who are
not yet certified should reference the Scope as a professional model and strive to become
certified.
Scope of Practice of the Profession:
The Diagnostic Ultrasound Professional is an individual qualified by professional credentialing 2
and academic and clinical experience to provide diagnostic patient care services using ultrasound
and related diagnostic procedures. The scope of practice of the Diagnostic Ultrasound
Professional includes those procedures, acts and processes permitted by law, for which the
individual has received education and clinical experience, and in which he/she has demonstrated
competency.
Diagnostic Ultrasound Professionals:
Perform patient assessments
Acquire and analyze data obtained using ultrasound and related diagnostic technologies
Provide a summary of findings to the physician to aid in patient diagnosis and
management
Use independent judgment and systematic problem solving methods to produce high
quality diagnostic information and optimize patient care.

Copyright © 1993-2000
Society of Diagnostic Medical Sonography
Dallas, Texas USA
All Rights Reserved Worldwide
Organizations that endorse the Scope of Practices and Practice Standards may use them for their own
internal use, including copying or distributing the text, provided that the text is reproduced in its entirety with
no changes, and includes proper attribution and the copyright notice displayed above.
D. Code of Ethics for the Profession of Diagnostic Medical Sonography
Approved by SDMS Board of Directors, December 6, 2006
PREAMBLE
The goal of this code of ethics is to promote excellence in patient care by fostering responsibility
and accountability among diagnostic medical sonographers. In so doing, the integrity of the
profession of diagnostic medical sonography will be maintained.
OBJECTIVES
1. To create and encourage an environment where professional and ethical issues are
discussed and addressed.
2. To help the individual diagnostic medical sonographer identify ethical issues.
3. To provide guidelines for individual diagnostic medical sonographers regarding ethical
behavior.
PRINCIPLES
Principle I: In order to promote patient well-being, the diagnostic medical sonographer
shall:
A. Provide information to the patient about the purpose of the sonography procedure and
respond to the patient's questions and concerns.
B. Respect the patient's autonomy and the right to refuse the procedure.
C. Recognize the patient's individuality and provide care in a non-judgmental and nondiscriminatory
manner.
D. Promote the privacy, dignity and comfort of the patient by thoroughly explaining the
examination, patient positioning and implementing proper draping techniques.
E. Maintain confidentiality of acquired patient information, and follow national patient
privacy regulations as required by the "Health Insurance Portability and Accountability Act
of 1996 (HIPAA)."
F. Promote patient safety during the provision of sonography procedures and while the
patient is in the care of the diagnostic medical sonographer.
Principle II: To promote the highest level of competent practice, diagnostic medical
sonographers shall:
A. Obtain appropriate diagnostic medical sonography education and clinical skills to
ensure competence.
B. Achieve and maintain specialty specific sonography credentials. Sonography
credentials must be awarded by a national sonography credentialing body that is
accredited by a national organization which accredits credentialing bodies, i.e., the
National Commission for Certifying Agencies (NCCA);
http://www.noca.org/ncca/ncca.htm or the International Organization for Standardization
(ISO); http://www.iso.org/iso/en/ISOOnline.frontpage.
C. Uphold professional standards by adhering to defined technical protocols and
diagnostic criteria established by peer review.

D. Acknowledge personal and legal limits, practice within the defined scope of practice,
and assume responsibility for his/her actions.
E. Maintain continued competence through lifelong learning, which includes continuing
education, acquisition of specialty specific credentials and recredentialing.
F. Perform medically indicated ultrasound studies, ordered by a licensed physician or
their designated health care provider.
G. Protect patients and/or study subjects by adhering to oversight and approval of
investigational procedures, including documented informed consent.
H. Refrain from the use of any substances that may alter judgment or skill and thereby
compromise patient care.
I. Be accountable and participate in regular assessment and review of equipment,
procedures, protocols, and results. This can be accomplished through facility
accreditation.
Principle III: To promote professional integrity and public trust, the diagnostic medical
sonographer shall:
A. Be truthful and promote appropriate communications with patients and colleagues.
B. Respect the rights of patients, colleagues and yourself.
C. Avoid conflicts of interest and situations that exploit others or misrepresent
information.
D. Accurately represent his/her experience, education and credentialing.
E. Promote equitable access to care.
F. Collaborate with professional colleagues to create an environment that promotes
communication and respect.
G. Communicate and collaborate with others to promote ethical practice.
H. Engage in ethical billing practices.
I. Engage only in legal arrangements in the medical industry.
J. Report deviations from the Code of Ethics to institutional leadership for internal
sanctions, local intervention and/or criminal prosecution. The Code of Ethics can serve as
a valuable tool to develop local policies and procedures.
E. Diagnostic Ultrasound Clinical Practice Standards
Standards are designed to reflect behavior and performance levels expected in clinical practice
for the Diagnostic Ultrasound Professional. These Clinical Practice Standards set forth the
standards (principles) that are common to all of the specialties within the larger category of the
diagnostic ultrasound profession. Individual specialties or subspecialties may adopt standards
that extend or refine these general Standards and that better reflect the day to day practice of
these specialties. Certification is considered the standard of practice in ultrasound. Individuals not
yet certified may reference these Clinical Practice Standards to optimize patient care.
Section 1
Patient Information Assessment and Evaluation
Patient Education & Communication, Procedure Plan
STANDARD - Patient Information Assessment & Evaluation:
1.1 Information regarding the patient's past and present health status is essential in
providing appropriate diagnostic ultrasound information. Therefore, pertinent data
regarding the patient's medical history, including familial history as it relates to the
diagnostic ultrasound procedure, should be collected whenever possible and
evaluated to determine its relevance to the ultrasound examination.

The Diagnostic Ultrasound Professional:
1.1.1 Verifies patient identification and that the requested procedure correlates
with the patient's clinical history and presentation. In the event that the
requested procedure does not correlate, either the interpreting physician
or the referring physician will be notified.
1.1.2 Uses interviewing techniques to gather relevant information from the
patient or patient's representative and the patient's medical records
regarding the patient's health status and medical history.
1.1.3 Assesses the patient's ability to tolerate procedures.
1.1.4 Evaluates any contra-indications to the procedure, such as medications,
insufficient patient preparation or the patient's inability or unwillingness to
tolerate the procedure.
STANDARD - Patient Education and Communication:
1.2 Effective communication and education are necessary to establish a positive
relationship with the patient and/or the patient's representative, and to elicit patient
cooperation and understanding of expectations.
The Diagnostic Ultrasound Professional:
1.2.1 Communicates with the patient in a manner appropriate to the patient's
ability to understand. Presents explanations and instructions in a
manner which can be easily understood by the patient and other health
care providers.
1.2.2 Explains the examination procedure to the patient and responds to
patient questions and concerns.
1.2.3 Refers specific diagnostic, treatment or prognosis questions to the
patient's physician.
STANDARD - Analysis and Determination of Procedure Plan for Conducting the Diagnostic
Examination
1.3 The most appropriate procedure plan 1 seeks to optimize patient safety and comfort,
diagnostic ultrasound quality and efficient use of resources, while achieving the
diagnostic objective of the examination.
The Diagnostic Ultrasound Professional:
1.3.1 Analyzes the previously gathered information and develops a
procedure plan for the diagnostic procedure. Each procedure plan is
based on age appropriate and gender appropriate considerations and
actions.
1.3.2 Uses independent professional judgment to adapt the procedure plan
to optimize examination results. Performs the ultrasound or vascular
technology procedure under general 2 or direct 3 supervision, as defined
by the procedure.
1.3.3 Consults appropriate medical personnel, when necessary, in order to
optimize examination results.
1.3.4 Confers with the interpreting physician, when appropriate, to determine
if contrast media administration will enhance image quality and provide
additional diagnostic information.
1.3.5 Uses appropriate technique for intravenous line insertion and contrast
media administration when the use of contrast is required.
1.3.6 Determines the need for accessory equipment. 4
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1.3.7 Determines the need for additional personnel to assist in the
examination.
1.3.8 Acquires prior written approval from the medical director for contrast
media injection. 5
STANDARD - Implementation of the Procedure Plan
1.4 Quality patient care is provided through the safe and accurate implementation of a
deliberate procedure plan.
The Diagnostic Ultrasound Professional:
1.4.1 Implements a procedure plan that falls within established protocols. 6
1.4.2 Elicits the cooperation of the patient in order to carry out the procedure plan.
1.4.3 Modifies the procedure plan according to the patient's disease process or
condition.
1.4.4 Uses accessory equipment, when appropriate.
1.4.5 Modifies the procedure plan, as required, according to the physical
circumstances under which the procedure must be performed (i.e., operating
room, ultrasound laboratory, patient's bedside, emergency room.)
1.4.6 Assesses and monitors the patient's physical and mental status during the
examination.
1.4.7 Modifies the procedure plan according to changes in the patient's clinical
status during the procedure.
1.4.8 Administers first aid, or provides life support in emergency situations, as
required by employer policy.
1.4.9 Performs basic patient care tasks, as needed.
1.4.10 Requests the assistance of additional personnel, when warranted.
1.4.11 Recognizes sonographic characteristics of normal and abnormal
tissues, structures and blood flow; adjusts scanning technique to
optimize image quality and spectral waveform characteristics.
1.4.12 Analyzes sonographic findings throughout the course of the
examination so that a comprehensive exam is completed and
sufficient data is provided to the physician to direct patient
management and render a final diagnosis.
1.4.13 Performs measurements and calculations according to laboratory
protocol.
1.4.14 Strives to minimize patient exposure to acoustic energy without
compromising examination quality or completeness.
STANDARD - Evaluation of the Diagnostic Examination Results
1.5 Careful evaluation of examination results 7 in the context of the procedure plan is
important in order to determine whether the procedure plan goals have been met.
The Diagnostic Ultrasound Professional:
1.5.1 Establishes that the examination, as performed, complies with
applicable protocols and guidelines. 8
1.5.2 Identifies any exceptions to the expected outcome. 9
1.5.3 Documents any exceptions 10 clearly, concisely and completely. When
necessary, develops a revised procedure plan in order to achieve the
intended outcome.
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1.5.4 Initiates additional scanning techniques or administers contrast agents
as indicated by the examination and according to established
laboratory policy and procedures under state law.
1.5.5 Notifies an appropriate health provider when immediate medical
attention is necessary, based on procedural findings and patient
conditions.
1.5.6 Evaluates the patient's physical and mental status prior to discharge
from the Diagnostic Ultrasound Professional.
1.5.7 Upon assessment of the examination findings, recognizes the need for
an urgent rather than routine report and takes appropriate action.
1.5.8 Provides a written or oral summary of preliminary findings to the physician.
STANDARD - Documentation
1.6 Clear and precise documentation is necessary for continuity of care, accuracy of care
and quality assurance.
The Diagnostic Ultrasound Professional:
1.6.1 Documents diagnostic and patient data in the appropriate record,
according to the policy and procedure of the facility.
1.6.2 Ensures that the documentation is timely, accurate, concise and
complete.
1.6.3 Documents any exceptions from the established protocols and
procedures.
1.6.4 Records diagnostic images and data for use by the interpreting
physician in rendering a diagnosis and for archival purposes.
1.6.5 Provides an oral or written summary of preliminary findings to the
interpreting physician.
Section 2
Quality Assurance Performance Standards
STANDARD - Implementation of Quality Assurance
2.1 Implementation of a quality assurance action plan is imperative for quality diagnostic
procedures and patient care.
The Diagnostic Ultrasound Professional:
2.1.1 Obtains assistance appropriate personnel to implement the quality
assurance action plan.
2.1.2 Implements the quality assurance action plan.
STANDARD - Assessment of Equipment, Procedures and the Work Environment
2.2 The planning and provision of safe and effective medical service relies on the
collection of pertinent information about equipment, procedures and the work
environment.
The Diagnostic Ultrasound Professional:
2.2.1 Strives to maintain a safe workplace environment.
2.2.2 Performs equipment quality assurance procedures, as required, to
determine that equipment operates at an acceptable performance
level.
2.2.3 Seeks to ensure that each work site in which the Diagnostic Ultrasound
Professional conducts patient examinations has in place a policy
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manual that addresses environmental safety, equipment maintenance
standards and equipment operation standards and that this policy
manual is reviewed and revised on a regular basis. Knows,
understands and implements the policies set forth in the work site
policy manual.
STANDARD - Analysis and Determination of a Quality Assurance Plan
2.3 The Diagnostic Ultrasound Professional uses quality assurance and continuous
quality improvement methods to assess and evaluate all aspects of ultrasound
practice.
The Diagnostic Ultrasound Professional:
2.3.1 Strives to become knowledgeable about the theory and practice of
quality assurance and continuous quality improvement methods and
procedures as they are applied in the clinical environment. Works with
all concerned parties to implement such methods and procedures with
the objective of continuously improving the quality of ultrasound
diagnostic services.
2.3.2 Compares quality assurance results to established and acceptable
values.
2.3.3 Works with all concerned parties to formulate and implement an action
plan.
STANDARD - Outcomes Measurement
2.4 Outcomes assessment 11 is an integral part of the ongoing quality assurance plan to
enhance diagnostic services.
The Diagnostic Ultrasound Professional:
2.4.1 Based on outcomes assessment, determines whether the
performance, of equipment and materials is in accordance with
established guidelines and protocols.
2.4.2 Based on outcomes assessment, determines whether the diagnostic
information provided as a result of the ultrasound examination
correlates with other diagnostic testing or procedures performed on the
same patient.
2.4.3 Based on outcomes assessment, determines that each test achieves
the same outcome when performed by different Diagnostic Ultrasound
Professionals.
2.4.4 Develops and implements an action plan when outcome measurement
results are not within currently accepted tolerances.
2.4.5 Is knowledgeable of, or works with the medical director to develop,
written diagnostic ultrasound procedure protocols that meet or exceed
established guidelines. 12
STANDARD - Documentation
2.5 Documentation provides evidence of quality assurance activities designed to
enhance the safety of patients, the public, and health care providers, during
diagnostic ultrasound procedures.
The Diagnostic Ultrasound Professional:
2.5.1 Maintains documentation regarding quality assurance activities,
procedures, and results, in accordance with the established laboratory
policies and protocols.
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2.5.2 Provides timely, concise, accurate and complete documentation of
quality assurance activities.
2.5.3 Adheres to the established quality assurance performance standards.
Section 3
Professional Performance Standards
STANDARD - Quality of Care
3.1 All patients expect and deserve excellent care during the ultrasound examination.
The Diagnostic Ultrasound Professional:
3.1.1 Works in partnership with other health care professionals to provide
the best medical care possible for all patients.
3.1.2 Obtains and maintains appropriate professional credentials. 13
3.1.3 Adheres to the standards, 14 policies, 15 and procedures 16 adopted by
the profession and regulated by law.
3.1.4 Provides the best possible diagnostic exam for each patient by
applying professional judgment and discretion.
3.1.5 Anticipates and responds to the needs of the patient.
3.1.6 Participates in quality assurance programs.
3.1.7 Stays current with required continuing medical education (CME) in
order to stay abreast of changes in the field of diagnostic ultrasound
and to maintain professional credentials.
STANDARD - Self-Assessment
3.2 Self-assessment is an essential component in professional growth and development.
Self-assessment involves evaluation of personal performance, knowledge and skills.
The Diagnostic Ultrasound Professional:
3.2.1 Recognizes personal strengths and uses them to benefit patients,
coworkers, and the profession.
3.2.2 Performs diagnostic procedures only after receiving appropriate
education and supervised clinical experience.
3.2.3 Recognizes and takes advantage of educational opportunities,
including improvement in technical and problem-solving skills and
personal growth.
STANDARD - Education
3.3 Advancements in medical science and technology occur very rapidly, requiring an
on-going commitment to professional education.
The Diagnostic Ultrasound Professional:
3.3.1 Maintains professional credentials that are specifically related to the
currently practiced discipline(s).
3.3.2 Participates in continuing education activities through professional
societies and organizations, to enhance knowledge, skills and
performance.
STANDARD - Collaboration
3.4 Quality patient care is provided when all members of the health care team
communicate and collaborate efficiently.
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The Diagnostic Ultrasound Professional:
3.4.1 Promotes a positive and collaborative atmosphere with all members of
the health care team.
3.4.2 Effectively communicates with all members of the health care team
regarding the welfare of the patient.
3.4.3 Shares knowledge and expertise with colleagues, patients, students,
and all members of the health care team.
STANDARD - Ethics
3.5 All decisions made and actions taken on behalf of the patient adhere to the Code of
Ethics 17 upon which the accepted professional standards are based.
The Diagnostic Ultrasound Professional:
3.5.1 Adheres to the accepted professional ethical standards as defined by
the Code of Ethics.
3.5.2 Is accountable for professional judgments and decisions, as outlined
in the professional standard of ethics.
3.5.3 Provides patient care with bias toward none and equal respect for all.
3.5.4 Respects and promotes patients rights.
3.5.5 Provides patient care with respect for patient dignity and needs.
3.5.6 Acts as a patient advocate supporting patient rights.
3.5.7 Adheres to the established professional performance standards of
practice.
Copyright © 1993-2000
Society of Diagnostic Medical Sonography
Dallas, Texas USA
All Rights Reserved Worldwide
Organizations which endorse the Scope of Practices and Practice Standards may use them for their own
internal use, including copying or distributing the text, provided that the text is reproduced in its entirety
with no changes, and includes proper attribution and the copyright notice displayed above.
E. The Myth of "Registry-Eligible"
The short list of things many folks believe in, but are not real:
Santa Claus
Easter Bunny
A free lunch
ARDMS "registry-eligible" classification
Thousands, perhaps tens of thousands, of ultrasound providers are working in hospitals and
other imaging facilities throughout the country by invoking the ARDMS credentialing category,
"registry-eligible". Recruitment ads for sonographers, vascular sonographers, and cardiac
sonographers routinely call for employment candidates who have ARDMS certification or who are
"registry-eligible". Some sonographers have created long-term careers without ever having
acquired ARDMS certification because they fulfill the job description qualification of "registryeligible".
Problem is, that like the Easter Bunny, "registry-eligible" simply does not exist.
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In an interview with the ARDMS Executive Director, Dale Cyr, the issue of "registry-eligible" came
up for discussion. Mr. Cyr stated, "ARDMS does not recognize the term "registry-eligible". We
have three recognized levels within our examination process:
1. Applicant: an individual sends in an application for internal review in hopes he/she will be
allowed to sit for our examination(s).
2. Candidate: an applicant has met all required prerequisites and is allowed to sit for
ARDMS examination(s). A candidate will receive official notification in the mail and has
90 days to take the approved examination(s).
3. Registrant: a candidate has successfully completed a Physics (or Principles) and
Instrumentation examination with a correlating specialty examination to earn a RDMS,
RDCS, or RVT credential.
It is also important to note that first-time candidates have 5 years to successfully complete both
examinations (physics and correlating specialty), from the time they are officially notified that they
are a candidate. Failure to achieve the first credential prior to the end of the 5 year timeframe will
require reapplying as a first-time candidate and retaking any previous examination to achieve an
ARDMS credential (RDMS, RDCS, RVT, ROUB)."
Patients served by sonographers throughout the country deserve the highest quality provider
accountability tool available. The "gold standard" within the ultrasound community is ARDMS
certification.
"Registry-eligible" is a myth and the patients we serve deserve more than myth.
For information, visit the ARDMS website at: http://www.ardms.org
F. Model Job Description: Diagnostic Medical Sonographer
The following is a recommended MODEL job description for the position of Diagnostic Medical
Sonographer. This model job description is basic and may be used as is or modified as
necessary to meet other specific requirements of employment.
For additional related information, see the Scope of Practice for the Diagnostic Ultrasound
Professional (http://www.sdms.org/positions/scope.asp) and the Diagnostic Ultrasound Clinical
Practice Standards (http://www.sdms.org/positions/clinicalpractice.asp).
JOB TITLE
• Diagnostic Medical Sonographer
JOB DESCRIPTION
• A Diagnostic Medical Sonographer is a Diagnostic Ultrasound Professional that is qualified
by professional credentialing and academic and clinical experience to provide diagnostic
patient care services using ultrasound and related diagnostic procedures. The scope of
practice of the Diagnostic Medical Sonographer includes those procedures, acts and
processes permitted by law, for which the individual has received education and clinical
experience, has demonstrated competency, and has completed the appropriate ARDMS
certification(s) which is the standard of practice in ultrasound.
ORGANIZATIONAL REPORTING RELATIONSHIP
• Administrative Supervisor: Chief Sonographer *
• Medical Supervisor: Attending or Supervising Physician *
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* As defined by institution.
JOB SUMMARY
• The Diagnostic Medical Sonographer is responsible for the independent operation of
sonographic equipment, and for performing and communicating results of diagnostic
examinations using sonography.
• The Diagnostic Medical Sonographer is responsible for daily operations of the sonographic
laboratory, patient schedule, equipment maintenance, the report of equipment failures, and
quality assessment (QA). The sonographer maintains a high standard of medical ethics at all
times and is self-motivated to increase level of understanding and knowledge of the field,
disease, and new procedures as they evolve.
ESSENTIAL FUNCTIONS
• Performs clinical assessment and diagnostic sonography examinations.
• Uses cognitive sonographic skills to identify, record, and adapt procedures as appropriate to
anatomical, pathological, diagnostic information and images.
• Uses independent judgment during the sonographic exam to accurately differentiate between
normal and pathologic findings.
• Analyses sonograms, synthesizes sonographic information and medical history, and
communicates findings to the appropriate physician.
• Coordinates work schedule with Departmental Director and/or scheduling desk to assure
workload coverage.
• Assumes responsibility for the safety, mental and physical comfort of patients while they are
in the sonographer's care.
• Assists with the daily operations of the sonographic laboratory.
• Maintains a daily log of patients seen / completes exam billing forms.
• Maintains ultrasound equipment and work area, and maintains adequate supplies.
• Participates in the maintenance of laboratory accreditation.
• Establishes and maintains ethical working relationships and good rapport with all interrelating
hospitals, referral or commercial agencies.
• Performs other work-related duties as assigned.
EXAMPLES OF DUTIES & RESPONSIBILITIES
• Performs all requested sonographic examinations as ordered by the attending physician.
• Prepares preliminary reports and contacts referring physicians when required, according to
established procedures.
• Coordinates with other staff to assure appropriate patient care is provided.
• Addresses problems of patient care as they arise and makes decisions to appropriately
resolve the problems.
• Organizes daily work schedule and performs related clerical duties as required.
• Assumes responsibility for the safety and well-being of all patients in the sonographic
area/department.
• Reports equipment failures to the appropriate supervisor or staff member.
• Provides in-service education team on requirements of sonographic procedures as requested
by other members of the health care team.
• Performs other related duties as assigned.
QUALIFICATIONS
Education
• Graduate of a formal Diagnostic Medical Sonography Program or Cardiovascular Technology
Program that is accredited by the Commission on Accreditation of Allied Health Education
Programs (CAAHEP) is required.
• Bachelor of Science degree in Diagnostic Medical Sonography is desirable.
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Required Licenses/Certifications
• Active certification by American Registry of Diagnostic Medical Sonographers (ARDMS) in
the specialty(ies) as appropriate.
• Current compliance with Continuing Medical Education (CME) requirements for specialty(ies)
as appropriate.
Experience
• As defined by institution.
Demonstration of Skills and Abilities
• Ability to effectively operate sonographic equipment.
• Ability to evaluate sonograms in order to acquire appropriate diagnostic information.
• Ability to integrate diagnostic sonograms, laboratory results, patient history and medical
records, and adapt sonographic examination as necessary.
• Ability to use independent judgment to acquire the optimum diagnostic sonographic
information in each examination performed.
• Ability to evaluate, synthesize, and communicate diagnostic information to the attending
physician.
• Ability to communicate effectively with the patient and the health care team, recognizing the
special nature of sonographic examinations and patient’s needs.
• Ability to establish and maintain effective working relationships with the public and health
care team.
• Ability to follow established departmental procedures.
• Ability to work efficiently and cope with emergency situations.
PHYSICAL REQUIREMENTS
The employee must be physically capable of carrying out all assigned duties:
• Emotional and physical health sufficient to meet the demands of the position.
• Strength sufficient to: lift some patients, move heavy equipment on wheels (up to
approximately 500 lbs), and to move patients in wheelchairs and stretchers.
• Ability to maintain prolonged arm positions necessary for scanning.
RISK OF EXPOSURE TO BLOOD BORNE PATHOGENS
• Category I – Tasks involve exposure to blood, body fluids, or tissues.
SALARY/BENEFITS
As defined by institution.
(Note: Salary should be competitive for geographic location, practice setting, and practice
specialty. Refer to the latest edition of the SDMS Annual Income Report for specific
information.)
Date Reviewed:
_______________
DEPARTMENT AND HUMAN RESOURCES APPROVAL:
__________________________
Department Approval
_________________________
Human Resources Approval
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G. MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
Society of Diagnostic Medical Sonography
2745 Dallas Pkwy, Ste. 350
Plano, TX 75093-8730
Society membership (SDMS) is strongly encouraged. Attendance at local meetings,
when sponsored by sonographic organizations, is strongly encouraged. Faculty may
require attendance if the subject matter is part of a course being taught. Students with
faculty permission may also attend other meetings in the field of ultrasound.
DMS Students are encouraged to hold student membership in the national ultrasound
society. Membership is not required as there is an annual membership fee. Student
(STU) applications may be downloaded and printed. Due to additional written
documentation that must be provided by the Program Director, online
applications are not available. Please go to:
http://www.sdms.org/membership/apply.asp#print
Students who are interested: Complete the above application, attach the membership
fee and submit with a letter of interest to your program director.
Other professional membership options:
AIUM: American Institute of Ultrasound in Medicine
ASRT: American Society for Radiologic Technology
CSRT: California Society for Radiologic Technologists
SVT: Society for Vascular Technology
ASE: American Society for Echocardiography
Other local, state and national societies.
XIX. Patient Safety and Risk Management
A. Age Appropriate Care: JCAHO Standards for AGE APPROPRIATE CARE
Age Appropriate Care Through the Life Span
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires that
any healthcare providers who have patient contact be competent in age appropriate characteristics and
needs. JCAHO requires that all individuals with patient contact receive education and training related to
the characteristics and needs of the age groups with which they come into contact. Although the
following information may include age groups with for which you do not provide care, it is important to
understand an overview of the needs across the life span.
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AGE GROUPS: A DEFINITION
Although it is not always clear when one age group ends and another begins, the following is a
generalized definition of the age groups.
Infant
Toddler
Preschool
School Age
Adolescent
Young Adult
Middle Age Adult
Old Adult
Birth to one year
One to three years
Three to five years
Five to twelve years
Twelve to eighteen years
Eighteen to forty-four years
Forty five to sixty five years
Over sixty five
Although all characteristics of an age group do not apply to all individuals, they are meant to be guidelines
that should be considered when providing care to patients of differing ages.
DEVELOPMENTAL NEEDS
The developmental psychologist Erik Erikson probably most notably writes about developmental needs
across the life span. He has identified eight stages with corresponding tasks that must be met and
resolved in order for individuals to progress through the life span in a fulfilling manner.
Health care providers must consider the developmental challenges facing their patients and adjust their
care accordingly.
ERIKSON’S STAGES
Age Group Task Lack of Resolution
Infant Development of trust Mistrust; failure to thrive
Toddler
Autonomy
Self-control & will power
Shame and doubt
Low frustration tolerance
Preschool
Initiative; confidence
Has purpose and direction
Guilt
Fear of punishment
School age
Industry; self-confidence
Competency
Inferiority
Fears about meeting
Adolescent
Identify formation
Devotion and fidelity
Sense of self
Intimacy
Affiliation and love
expectations
Role confusion
Poor self-concept
Young Adult
Isolation
Avoidance of relationships
Middle age Concern about others Stagnation; self-absorption
Old age
Ego integrity; wisdom
Views life with satisfaction
Lack of concern about others
Despair
Life is meaningless
COGNITIVE DEVELOPMENT THROUGH THE LIFE SPAN
Developmental psychologist Jean Piaget is considered to be the primary source on how humans develop
cognitively from birth through age twelve. He developed his theories after hundreds of hours of direct
observation of children of all ages. Piaget defined three major stages of cognitive development: pre-
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operations, concrete operations and formal operations. He theorizes that cognitive development is nearly
complete by age fifteen when the child is capable of abstract thought.
AGE STAGE FEATURES
Up to 2 years Sensorimotor thought Physical manipulation of
objects
2 to 7 years Peroperational symbolic Language development
functioning
7 to 11 years Concrete operations Logical reasoning
Can solve concrete problems
11 to 15 years Formal operations Fully developed
Complex, logical abstract
thought
Manipulation of abstract
concepts
SAFETY THROUGH THE LIFE SPAN
Safety is a basic human need that is of paramount importance to healthcare providers for all age groups
of patients. During all phases of childhood and the later years safety needs are the greatest. Some
childhood characteristics that make safety a primary concern are lack of impulse control, lack of good
judgment, intense curiosity, and the need to develop autonomy. Older adults may suffer from cognitive
impairment, sensory loss and the degenerative changes of aging. These make safety a primary concern
for healthcare providers caring for an aging population.
PHARMACOLOGY THROUGH THE LIFE SPAN
Pharmacology dosage and route considerations vary according to the characteristics of virtually all age
groups. For pre-adolescent children dosage is determined according to the weight of the child in
kilograms. By the time a child reaches adolescence most adult dosages are usually acceptable. As with
all medications, the nurse should be knowledgeable about any medication he/she is administering and
should question or clarify any medication orders that are unclear or seem inappropriate.
For children, the oral route of administration is preferred. Liquid forms should be used when appropriate.
Pharmacological implications for very young children involve close monitoring of the effects of medication.
In these age groups absorption and metabolic rates may be unpredictable.
The aging adult population has special pharmacological considerations based on distinguishing
characteristics of this group. Diminished blood flow, decreased peristalsis, and slowing of the basal
metabolic rate lead to changes in physical functioning. As with young children, older adults may require
close monitoring based on the unpredictability of absorption. A general rule with the elderly is to “start low
and go slow.”
If a swallowing disorder is a concern, medications may need to be crushed or given in liquid form.
Always consult a pharmacist to see if either is a possibility since some medications may be time release,
enteric-coated, sublingual, effervescent, or foul tasting.
NUTRITION AND HYDRATION THROUGH THE LIFE SPAN
Nutritional needs and considerations vary somewhat across the life span. Caloric requirements are
greatest during infancy, adolescence, pregnancy and lactation.
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Infants require iron supplements and fat from whole milk. They should be introduced to solids beginning
with cereal at four to six months of age. New foods should be introduced slowly so that intolerances can
be determined.
Toddlers like finger foods and should be introduced to utensils and cups instead of bottle-feeding and
caregiver feeding. Preschoolers will begin to develop food preferences and the manual dexterity to use
utensils. School age children prefer fast food and dining with friends.
Adolescents, despite their increased nutritional needs, demonstrate irregular eating patterns and a
preference for fast food and snacks. It is also during adolescence that eating disorders such as anorexia,
bulimia and trendy diets may emerge.
In the absence of pregnancy and lactation, the nutritional needs of the young and middle adult remain
fairly constant. For the aging adult, fewer calories are required as appetite and digestive processes
decrease. Other factors affecting nutritional status to be considered are dentition, financial resources,
physical limitations and the ability to get to and from the store. “Meals on Wheels” may be a resource for
the homebound elderly.
AGE RELATED IMPLICATIONS FOR THE HEALTH CARE PROVIDER
There are many other aspects of health care delivery that must be considered based on age
characteristics. These include patient and family education, discharge planning, motivational techniques,
ability to participate in care, communication techniques, and the impact of illness or hospitalization on the
patient.
The families of infants and the cognitively impaired must be the focus of teaching. Toddlers and school
age children, however, must be given explanations according to their developmental stages. Very often
dolls and puppets may be effective props for teaching these age groups.
Discharge planning may also be affected by the age of the patient. Age appropriate community resources
must be considered. Reporting mechanisms and agencies for age related abuse also vary.
A patient’s level of involvement in care is also affected by age. While a minor may have an opinion
regarding healthcare, decision-making is usually placed on the parent or legal guardian. At the other end
of the life span, the older adult may be physically or cognitively impaired and unable to participate in
certain decisions or aspects of his/her care.
The meaning of illness and hospitalization varies widely across the life span. For an infant, it means
separation from the primary caregiver. For a school age child it means missing school. For an adolescent
it means separation from the peer group. For the young adult illness may mean loss of a job. For the
older adult, illness may bring up issues of physical decline or mortality.
REFERENCE: http://www.thenurseagency.com
B. Process of Reporting Complications
The policy for reporting complications is to report any occurrences to the ultrasound
supervisor as soon as the incident occurs. This includes complications or incidents
involving complaints or injuries to the patient and also complaints or injuries of the
employee. An incident report will be filled out the same day and given to the ultrasound
supervisor. If the ultrasound supervisor is not available, the incident should be reported to
the office manager and/or medical director. All employees should be made aware of the
location of incident forms.
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C. Infectious Diseases
The policy for preventing the spread of infectious disease and hand washing policies
follow the guidelines developed by the U.S. Department of Labor Occupational Safety
and Health Administration (OSHA). See attached. Reference: www.osha.gov
D. Communicable Diseases
Students may need to be restricted from clinical work settings during the incubation
period of a communicable disease and/or during a known period of communicability.
1. Students with a suspected diagnosis of the following diseases must report the
infection to the program director. Confirmation and treatment if desired or
recommendation will be required:
Chicken pox (required)
scabies/lice
Hepatitis-acute
tuberculosis
Measles (rubella)
2. During a known period of communicability, students may not work in the clinical
setting unless authorized to do so.
3. Students assigned to clinical settings may require restrictions if diagnosed or
suspected of having the following communicable diseases:
Conjunctivitis
herpes zoter (shingles)
Hepatitis
herpes simplex (cold sores)
Influenza
skin infections
Herpes Whitlow (finger)
4. Non-immune students who have been accepted into the program should notify the
program director following exposure to any of the following communicable diseases:
Chicken pox
rubella
Mumps
herpes zoter
Hepatitis (acute)
measles
5. Any time missed due to illness or any nature is considered absence and will be
handled according to attendance policies established by the program.
E. Transducer Cleaning
The policy for cleaning and preparing endocavitary ultrasound transducers between
patients follows the recommended guidelines produced by the AIUM Ultrasound Practice
Committee as found in the AIUM Reporter 11:7, 1995.
The following specific recommendations were made for the use of endocavitary
ultrasound transducers:
1. Cleaning
After removal of the probe cover, use running water to remove any residual gel or
debris from the probe. Use a damp gauze pad other soft clot and a small amount of
nonabrasive liquid soap to thoroughly cleanse the transducer. Consider the use of a
small brush especially for the crevices and areas of angulation depending on the
design of your particular transducer. Rinse the transducer thoroughly with running
water, and then dry the transducer with a soft cloth or paper towel.
2. Disinfection
a. If a sterile processing department is available, take the transducer to sterile
processing for further disinfection. Upon completion of the sterile processing,
return transducer to carrying case until the next usage.
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. Cleaning with a detergent/water solution as described above is clearly the
cornerstone of disinfection. However, additional use of liquid chemical
germicides may help to ensure further statistical reduction in microbial load.
Because of the variance of the cleaning process and the potential disruption
of the barrier sheath, addition disinfection with chemical agents may be
desirable. Examples of such chemical agents include but are not limited to
2.4-3.2% glutaraldehyde products (a variety of available
proprietary products including "Cidex", "Metricide," or "Procide."
Common household bleach (5.25% sodium hypochlorite) diluted to
yield 500 parts per million chlorine (10cc in one liter of tap water)
Iodophor disinfectant/detergents (hard surface disinfectants diluted
for use per manufacturer's instruction [e.g., "Westcodyne"]).
Antiseptic-type iodophors (e.g., "Betadine") are not acceptable for
use as disinfectants.
Practioners should consult the labels of proprietary products for specific instructions.
They should also consult instrument manufacturers regarding compatibility of those
agents with probes. Note that such agents are potentially toxic and many require
adequate precautions such as proper ventilation, personal protective devices (gloves,
face/eye protection, etc.) and thorough rinsing before reuse of the probe.
3. Probe Covers
The transducer should be covered with a barrier, usually a latex condom. These
should be non-lubricated and non-medicated. Practioners should be aware that
condoms have a six-fold enhanced AQL (acceptable quality level) when compared to
standard examination gloves. They have an AQL equal to that of surgical gloves.
Occasionally, patients may be latex-sensitive, and alternative barriers (vinyl) should
then be used.
4. Aseptic Technique
Obviously, for the protection of the patient and the sonographer, all endocavitary
examinations should be performed with the operator properly gloved throughout the
procedure. Gloves should be used to remove the condom or other barrier from the
transducer and to wash the transducer as outlined above. As the barrier (condom) is
removed, care should be taken not to contaminate the probe with secretions from the
patient. At the completion of the procedure, hand should be washed with soap and
water. Note" Obvious disruption in condom integrity does NOT require modification of
this protocol. These guidelines take into account possible probe contamination due to
a disruption in the barrier sheath.
F. Universal Precautions
The policy regarding universal precautions follows the guidelines developed by the U.S.
Department of Labor Occupational Safety and Health Administration (OSHA). See
attached. Reference: www.osha.gov
Blood Borne Pathogens
Bloodborne pathogens are infectious microorganisms in human blood that can cause
disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV),
hepatitis C (HCV) and human immunodeficiency virus (HIV). Needlesticks and other
sharps-related injuries may expose workers to bloodborne pathogens. Workers in many
occupations, including first aid team members, housekeeping personnel in some
industries, nurses and other healthcare personnel may be at risk of exposure to
bloodborne pathogens.
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How to control exposure to bloodborne pathogens?
In order to reduce or eliminate the hazards of occupational exposure to bloodborne
pathogens, an employer must implement an exposure control plan for the worksite with
details on employee protection measures. The plan must also describe how an employer
will use a combination of engineering and work practice controls, ensure the use of
personal protective clothing and equipment, provide training , medical surveillance,
hepatitis B vaccinations, and signs and labels, among other provisions. Engineering
controls are the primary means of eliminating or minimizing employee exposure and
include the use of safer medical devices, such as needleless devices, shielded needle
devices, and plastic capillary tubes.
How can OSHA Help?
OSHA has developed this webpage to provide workers and employers useful, up-to-date
information on bloodborne pathogens. For other valuable worker protection information,
such as Workers' Rights, Employer Responsibilities and other services OSHA offers,
read OSHA's Workers page.
If you are stuck by a needle or other sharp or get blood or other
potentially infectious materials in your eyes, nose, mouth, or on
broken skin, immediately flood the exposed area with water and
clean any wound with soap and water or a skin disinfectant if
available. Report this immediately to your employer and seek
immediate medical attention.
http://www.cdc.gov/niosh/topics/bbp/universal.html
G. Emergency Procedures
For hospital employees, refer to hospital wide emergency preparedness plan. For
outpatient services employ the following standard provided by the U.S Department of
Health and Human Services- Center of Disease Control. Visit the website for up-to-date
emergency preparedness information at http://www.bt.cdc.gov/planning.
Examples of readily available information:
Preparedness for Specific Types of Emergencies
Bioterrorism Emergencies Anthrax, smallpox...more
Chemical Emergencies
Mass Casualties
Natural Disasters
Radiation Emergencies
Preparedness for Healthcare Facilities
Adapting Standards of Care under Extreme Conditions: Guidance for
Professionals During Disasters, Pandemics, and Other Extreme Emergencies
Bioterrorism Readiness Plan: A Template for Healthcare Facilities
Hospital Preparedness for Mass Causalities
OSHA Best Practices for Hospital-Based First Receivers of Victims
58

XX. Equipment Safety And Maintenance
Safety Checks
Safety checks for electrical and transducer cord integrity should be performed daily. Any potential
electrical faults should be reported immediately and the equipment should be taken out of
commission until it is repaired and inspected by an authorized service representative.
Calibration
Calibration of the ultrasound machine will be performed by the service representative on an
annual basis as part of the preventative maintenance process. If the machine is not functioning
properly, an interim calibration may be necessary. The calibration should include phantom
images to meet the AIUM and/or ACR accreditation criteria for quality assurance.
Maintenance Procedures
Maintenance contracts will remain current between the vendors and administration. Preventative
maintenance will be performed on each machine on an annual basis with interim service calls as
needed to ensure the proper functioning of all equipment.
XXI. Technical Protocols
A. DMS Program On-Campus: Scanning Protocol
‣ Data from the AIUM is provided for clinical reference
o Refer to the web links in the following pages for clarification
o Entire documents are not included in this protocol; numbering will appear to be
incorrect in some areas
‣ You will complete the assigned images from this document while on campus
‣ All scans on campus begin with long/trans and short/long survey scans
‣ You will create scanning protocol for some exams based on AIUM and affiliate guidelines
‣ You will follow data similar to the AIUM guidelines at each clinical facility
‣ Each facility will utilize a variation of these protocol
B. CAMPUS SCANNING POLICIES
Right hand
o “contaminated,” hold gel bottle, transducer; scanning hand
Left hand
o “clean,” manipulate instrumentation, keyboard, moniter/screen, printer, nonpatient/gel
covered areas; stays free of gel and transducer
Begin by typing information (prior to touching transducer)
Place thermographic paper into printer prior to touching gel bottle
Hold transducer properly & manipulate correctly
Use proper scanning ergonomics
Find the proper scanning depth (ie: liver/kidney interface) and do not change this depth
o This applies ONLY to the campus laboratory
Use RES/expand/enlarge when appropriate
o DO NOT eliminate necessary surrounding tissue on any image
o DO NOT RES/EXPAND all images
Use appropriate transducer (footprint, frequency, shape) for anatomy in question
o Switch transducers throughout exam as needed for anatomy & anomalies
Adjust technical factors throughout the examination to improve image quality
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o On campus: “Perfection” is the goal
o At clinic: Diagnostic quality is the outcome
Adjust focal zone locations for proper image resolution and detail
o These will vary throughout the exam
Maintain 90 degree relationship with anatomical interface and the sound beam
Sonography is “organ specific.” Align scan plane to longitudinal axis or short axis
especially with required measurements
o Long and short axes are not necessarily sagittal and transverse
Label based on primary scan plane (long/sag, transverse, coronal, tangential, axial)
o MSK: Long Axis and Short Axis
o Breast: Long, Trans, Radial, Antiradial; quadrant may be used
Label organ; body side; scanning plane; patient position (supine is usually implied)
Measure (ON CAMPUS) length in sagittal/ long axis plane; width and depth (AP) in short
axis/transverse plane
o AIUM guidelines may state differently
o There is a purpose for this policy on campus
Doppler implies Pulsed Wave (PW) unless otherwise identified
When color Doppler is required: take the image with color Doppler and print.
o The image will show the “color” in shades of white on the thermographic print
When printing (thermographic paper):
o Take/print required images in the order requested
• I will review the date and time of the image
• Use a single system
o Do NOT separate images (keep in a single strand)
o Additional images will result in points being deducted from your score—unless a
position change is required; i.e.: erect for pancreas, or water-filled stomach for
pancreas
• Should additional images be essential, document rationale
o Do not eliminate required images from the required submitted list. This will place
your images out of order and lower your score.
• If you can’t get the image required: take what you can and move on.
Something is better than nothing.
Use proper breathing &/or bladder preparation techniques and modify as required
o When preparing to be an abdominal “patient” in the US lab, avoid fatty foods, and
other foods that contract the GB. Students should NEVER come to class NPO.
Align the table, scanning system, scanning chair, and patient to YOUR body habitus
Use adequate amount of scanning gel
o Too little will diminish image quality
o Too much is wasteful, inappropriate, unprofessional, and really makes a mess
o Additional gel, if needed, may be added throughout the exam
Use adequate amount of scanning pressure (transducer compression)
o Most abdominal exams require about 40 pounds of pressure
o When possible use less force (generating a hematoma on the patient is NOT the
goal)
o When additional pressure is essential…consider standing
When exam is complete: Wipe gel off patient and clean equipment; return system, table,
and chair to routine position
Use YOUR towels to clean YOUR skin; use the school’s towels to clean the machine; use
your “patient’s” towels to clean your “patient”
Never rest the transducer on the “patient’s” skin. Return the probe to the holder when not
in use…after removing gel/wiping clean
Use proper medical/sonography terminology and language while in the lab
Maintain a professional attitude and demeanor at all times
Complete required worksheets using proper medical terms and avoid personal
conclusions or negative observations
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Wear uniforms in the laboratory as required
No food or drink in the lab
o Exception: For courses that require a filled urinary bladder, or filled stomach
technique, you may bring a bottle of water (with re-sealable cap)
o No gum, candy, or other products designed for oral consumption
Rotate as required during lab courses: All students will assume both sonographer and
“patient” roles in lab.
During “after-class” scanning: document your time on your scanning hours form, and in
the lab sign-in log book; a faculty member must be present
During open lab you may scan anyone who is over the age of 18, does not have a known
pathologic condition, and is not and does not suspect being pregnant;
o patients will sign a release prior to your scanning session
o neither a diagnosis nor finding will be shared with a “patient”
o should you determine, on a pelvic exam, that your patient may be or is pregnant:
STOP
Data from the AIUM (American Institute of Ultrasound in Medicine)
Complete Policy for Practice Guidelines: (www.aium.org)
Practice Guidelines may be downloaded for free on the website by members and
nonmembers.
Individuals may make as many photocopies as needed of the guidelines.
http://aium.org/resources/guidelines/documentation.pdf
C. AIUM Practice Guideline for Documentation of an Ultrasound
Examination
Introduction
Adequate documentation by all members of the diagnostic ultrasound health care team is
essential for high-quality patient care. There should be a permanent record of the ultrasound
examination and its interpretation. Images of all relevant areas, both normal and abnormal,
should be recorded in a retrievable format. Retention of the ultrasound images and report should
be consistent both with clinical needs and with relevant legal and local health care facility
requirements. The reader is urged to refer also to the individual guidelines for each ultrasound
examination since they may contain additional documentation requirements.
Documentation Included for the Ultrasound Examination
Official documentation for the ultrasound images should include but is not limited to the following:
• Patient’s name and other identifying information.
• Facility identifying information.
• Date of ultrasound examination.
• Image orientation when appropriate.
If a worksheet is utilized and retained, documentation should include:
• Patient’s name and other identifying information.
• Date of ultrasound examination.
• Relevant clinical information and/or ICD 9 code.
• Specific ultrasound examination requested.
• Name of patient’s health care provider and contact information as appropriate.
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Final Report Provided by the Interpreting Physician
A final report of the ultrasound findings is included in the patient’s medical record. The official final
report should include but is not limited to the following:
• Patient’s name and other identifying information.
• Name of patient’s health care provider.
• Location of ultrasound facility and contact information.
• Relevant clinical information, including indication for the examination and/or
ICD 9 code.
• Date of ultrasound examination.
• Specific ultrasound examination performed.
• If endocavitary techniques are used, the method should be specified.
• The report should include comment on the components of the examination as
outlined in the relevant practice guideline(s).
• Appropriate anatomic and sonographic terminology should be used; variations
from normal size should be accompanied by measurements when appropriate
(eg, organomegaly, masses); and limitations of the examination should be noted.
• Pertinent, commonly utilized anatomic measurements should be listed (eg, fetal
biometry).
• Comparison with prior relevant imaging studies if available; recommendations,
including appropriate follow-up studies; an impression or conclusion; and a
specific diagnosis or differential diagnosis should all be included.
• The final report should be generated, signed, and dated by the interpreting
physician in accordance with state and federal requirements. (Electronic
signature, transmission, and storage of the report is acceptable if patient privacy
is ensured and legal requirements are met.) Verified final reports must be
available within 24 hours of completion of the exam or, for nonemergency
cases, by the next business day; exceptions to this time frame must be clarified.
• Reports should be completed and transmitted to the patient’s health care
provider in a timely fashion and in accordance with state and federal
requirements.
Nonroutine Results Reporting
Preliminary Report Policy
In an outpatient setting, sonographers are not permitted to give preliminary results to the
referring physicians. The only exception would be if it were an emergent case in which the
patient's condition will greatly suffer from even a slight delay. Examples include testicular
or ovarian torsion, aortic dissection, and cardiac tamponade. In such cases, if a
Radiologist is not immediately available, a preliminary verbal impression can be made to
the referring physician followed by a written note documenting the conversation and
confirming the information as "preliminary" with the formal Radiologist report to follow.
In "inpatient" or hospital settings where the referring physician may shadow the
sonographer and ask for a verbal impression, it is acceptable to give a verbal preliminary
report with an absolute declaration that this is merely a "preliminary sonographer
impression" and that the Radiologist will read the films shortly and follow with the official
results. Every effort should be made to not offer preliminary findings and wait for the
Radiologist's report.
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The Radiologists can give preliminary reports verbally, by phone, by fax, or through the
standard dictation procedure. The standard policy is a one-hour turn around on
emergency cases, and 24-48 hour turn around of reports from dictation to mailing for
nonemergent cases.
Reconciliation between differences of preliminary and final reports will be reported
immediately to the referring physician and a record will be kept in a permanent Q.A. file.
In certain instances, the results of the ultrasound study may need to be directly conveyed
to the patient’s referring health care provider prior to the final report. Documentation of
this communication in the final report, including date, time, and to whom the findings were
reported, is necessary. Any variation from the preliminary report should be communicated
with the patient’s physician and highlighted in the final report.
If results of the ultrasound exam are considered by the interpreting physician to be
important and unexpected, or require urgent intervention to ensure appropriate patient
care, communication should occur directly between the interpreting physician and the
patient’s health care provider. Communication by phone or in person is preferred to allow
verification of receipt and discussion and should occur in a timely manner in accordance
with the patient’s clinical state and the ultrasound findings, typically immediately following
the exam. The final report should include all of the elements noted in section III, as well as
the date, time, and method that the report was conveyed to the patient’s health care
provider.
Specifications for Individual Examinations
Spectral, color, and power Doppler imaging may be useful to differentiate vascular from nonvascular
structures in any location. Measurements should be considered for any abnormal area.
D. AIUM Practice Guideline for the Performance of an Ultrasound
Examination of the Abdomen and/or Retroperitoneum
http://www.aium.org/resources/guidelines/abdominal.pdf
Indications/Contraindications
Indications for an ultrasound examination of the abdomen and/or retroperitoneum include but are
not limited to:
A. Abdominal, flank, and/or back pain.
B. Signs or symptoms that may be referred from the abdominal and/or
retroperitoneal regions such as jaundice or hematuria.
C. Palpable abnormalities such as an abdominal mass or organomegaly.
D. Abnormal laboratory values or abnormal findings on other imaging
examinations suggestive of abdominal and/or retroperitoneal pathology.
E. Follow-up of known or suspected abnormalities in the abdomen and/or
retroperitoneum.
F. Search for metastatic disease or an occult primary neoplasm.
G. Evaluation of suspected congenital abnormalities.
H. Abdominal trauma.
I. Pretransplantation and posttransplantation evaluation.
J. Planning for and guiding an invasive procedure.
K. Searching for presence of free or loculated peritoneal and/or retroperitoneal
fluid.
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L. Suspicion of hypertrophic pyloric stenosis or intussusceptions.
M. Evaluation of a urinary tract infection.
An abdominal and/or retroperitoneal ultrasound examination should be performed when there is a
valid medical reason. There are no absolute contraindications.
Written Request for the Examination
The written or electronic request for an ultrasound examination should provide sufficient
information to allow for the appropriate performance and interpretation of the examination. The
request for the examination must be originated by a physician or another appropriately licensed
health care provider or under the physician’s or provider’s direction. The accompanying clinical
information should be provided by a physician or another appropriate health care provider familiar
with the patient’s clinical situation and should be consistent with relevant legal and local health
care facility requirements.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged.
An official interpretation (final report) of the ultrasound findings should be included in the patient’s
medical record. Retention of the ultrasound examination should be consistent both with clinical
needs and with relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
Equipment Specifications
Abdomen and/or retroperitoneum sonographic studies should be conducted with real-time
scanners, preferably using sector or linear transducers. The equipment should be adjusted to
operate at the highest clinically appropriate frequency, realizing that there is a trade-off between
resolution and beam penetration. For most preadolescent pediatric patients, mean frequencies of
5 MHz or greater are preferred, and in neonates and small infants a higherfrequency transducer
is often necessary. For adults, mean frequencies between 2 and 5 MHz are most commonly
used.
When Doppler studies are performed, the Doppler frequency may differ from the imaging
frequency. Image quality should be optimized while keeping total ultrasound exposure as low as
reasonably achievable.
Quality Control and Improvement, Safety, Infection Control, and Patient
Education
Policies and procedures related to quality control, patient education, infection control, and safety
should be developed and implemented in accordance with the AIUM Standards and Guidelines
for the Accreditation of Ultrasound Practices.
Equipment performance monitoring should be in accordance with the AIUM Standards and
Guidelines for the Accreditation of Ultrasound Practices.
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ALARA Principle
The potential benefits and risks of each examination should be considered. The ALARA (as low
as reasonably achievable) principle should be observed when adjusting controls that affect the
acoustic output and by considering transducer dwell times. Further details on ALARA may be
found in the AIUM publication Medical Ultrasound Safety, Second Edition.
Liver (AIUM)
The examination of the liver should include long-axis and transverse views. The liver
parenchyma should be evaluated for focal and/or diffuse abnormalities. If possible, the
echogenicity of the liver should be compared with that of the right kidney. In addition,
the following should be imaged:
a. The major hepatic and perihepatic vessels, including the inferior vena cava
(IVC), the hepatic veins, the main portal vein, and, if possible, the right and
left branches of the portal vein.
b. The hepatic lobes (right, left, and caudate) and, if possible, the right
hemidiaphragm and the adjacent pleural space.
c. For vascular examinations of the native or transplanted liver, Doppler
evaluation should be used to document blood flow characteristics and blood
flow direction. The structures that may be examined include the main and
intrahepatic arteries, the hepatic veins, the main and intrahepatic portal veins,
the intrahepatic portion of the IVC, collateral venous pathways, and
transjugular intrahepatic portosystemic shunt stents.
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Merced College: LIVER
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
SAGITTAL-LONGITUDINAL
1. Left lobe
2. Lateral to aorta; show lig venosum and caudate lobe
3. Level of aorta
4. level of IVC
5. Right/lateral to IVC
6. Right main lobar fissure (include GB)
7. Right lobe (no kidney)
8. Right lobe with renal interface
9. Right lobe with renal interface using a coronal (through the ribs) approach
10. Right with dome of the liver (may require steep cephalic transducer angle)
TRANSVERSE
1. Dome of liver (with steep cephalic transducer angle)
2. Left lobe with lig teres/lig venosum/caudate lobe
3. Left portal vein demonstrate lateral and medial branches
a. Left lateral PV with Doppler (when required)
b. Left medial PV with Doppler
4. Right portal vein with anterior and posterior branches
a. R anterior PV with Doppler
b. R posterior PV with Doppler
5. Main portal vein
a. Main portal vein with Doppler
6. Hepatic veins joining the IVC
a. Left hepatic vein with Doppler
b. Middle hepatic vein with Doppler
c. Right hepatic vein with Doppler
7. Right lobe of liver
8. Right lobe of liver using a coronal (through the ribs) approach
9. Right lobe with body of GB
10. Right lobe with body of GB using a coronal approach
11. Right lobe to include middle pole of right kidney
12. Right lobe to include middle pole of kidney using coronal approach
13. Right lobe of liver with inferior renal pole
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Gallbladder and Biliary Tract (AIUM)
A routine gallbladder examination should be conducted on an adequately
distended gallbladder whenever possible. In most cases, fasting before elective
examination will permit adequate distension of a normally functioning gallbladder.
In infants and children, fasting may not be necessary in all cases. The
gallbladder evaluation should include long-axis and transverse views obtained in
the supine position. Other positions such as left lateral decubitus, erect, and
prone may be helpful to evaluate the gallbladder and its surrounding areas
completely. Measurements may aid in determining gallbladder wall thickening. If
the patient presents with pain, tenderness to transducer compression should be
assessed.
The intrahepatic ducts can be evaluated by obtaining views of the liver
demonstrating the right and left branches of the portal vein. Doppler imaging may
be used to differentiate hepatic arteries and portal veins from bile ducts. The
intrahepatic and extrahepatic bile ducts should be evaluated for dilatation, wall
thickening, intraluminal findings, and other abnormalities. The bile duct in the
porta hepatis should be measured and documented. When visualized, the distal
common bile duct in the pancreatic head should be evaluated.
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Merced College: Gallbladder
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
SAGITTAL/LONGITUDINAL
1. Medial wall (long axis)
2. Midline of GB (longest axis); middle portion with neck, body and fundus.
a. Include MLF and PV
3. Measurement of middle portion/long axis of GB
4. Measure the anterior GB wall
5. Lateral wall (long axis)
6. Coronal scan in long axis demonstrating the longest longitudinal image
TRANSVERSE
1. Neck of GB
2. Body (short axis) use proper transducer angle (dependent upon the
anatomy)
3. Body with measurements
4. Fundus
5. Coronal image of GB body and measure
DECUBITUS
1. Long axis include MLF, PV, Middle portion of GB
2. Demonstrate the CBD with PV; show duct length and include GB (long
axis)
3. Measure CBD in above position (inner to inner)
4. Coronal plane demonstrate the long axis of the GB
5. Coronal plane measure the CBD
PRONE
1. Demonstrate long axis/middle portion
ERECT
1. Long axis of GB
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Pancreas (AIUM)
Whenever possible, all portions of the pancreas—head, uncinate process, body,
and tail—should be identified. Orally administered water or a contrast agent may
afford better visualization of the pancreas. The following should be assessed in
the examination of the pancreas:
a. Parenchymal abnormalities.
b. The distal common bile duct in the region of the pancreatic head.
c. The pancreatic duct for dilatation and any other abnormalities, with
dilatation confirmed by measurement.
d. The peripancreatic region for adenopathy and/or fluid.
Merced College: Pancreas
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
Transverse (long axis)
Entire length of pancreas with head, body, tail and pancreatic duct (use fluid-filled
stomach as window if necessary)
Pancreatic head with GDA , CBD, and uncinate process
Pancreatic neck and body with pancreatic duct
Pancreatic body with splenic vein (more caudal) and portal confluence
Doppler of splenic vein
Pancreatic body with splenic artery (more cephalic)
Doppler of splenic artery
Pancreatic tail
Longitudinal (short axis)
Pancreatic head with GDA and CBD
Pancreatic body measure depth
Transverse/ Erect
Length of gland (use water if not done previously)
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Bowel (AIUM)
The bowel may be evaluated for wall thickening, dilatation, muscular
hypertrophy, masses, vascularity, and other abnormalities. Sonography of the
pylorus and surrounding structures may be indicated in evaluation of the vomiting
infant. Graded compression sonography aids in the visualization of the appendix
and other bowel loops. Measurements may aid in determining bowel wall
thickening.
Peritoneal Fluid (AIUM)
Evaluation for free or loculated peritoneal fluid should include documentation of
the extent and location of any fluid identified.
For evaluating peritoneal spaces for bleeding after traumatic injury, particularly
blunt trauma, the examination known as focused abdominal sonography for
trauma (FAST, also known as focused assessment with sonography for trauma)
may be performed.27 The objective of the abdominal portion of the FAST
examination is to screen the abdomen for free fluid.
Longitudinal and transverse plane images should be obtained in the right upper
quadrant through the area of the liver with attention to fluid collections peripheral
to the liver and in the subhepatic space. Longitudinal and transverse plane
images should be obtained in the left upper quadrant through the area of the
spleen with attention to fluid collections peripheral to the spleen.
Longitudinal and transverse images should be obtained at the periphery of the
left and right abdomen in the areas of the left and right paracolic gutters for
evidence of free fluid.
Longitudinal and transverse midline images of the pelvis are obtained to evaluate
for free pelvic fluid. Analysis through a fluid-filled bladder (which if necessary can
be filled through a Foley catheter, when possible) may help in evaluation of the
pelvis.
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Aorta (AIUM)
Representative images of the aorta should be obtained. When evaluation of the aorta is specifically
requested, see the AIUM Practice Guideline for the Performance of Diagnostic and Screening Ultrasound
of the Abdominal Aorta.
Indications/Contraindications
Indications for ultrasound of the abdominal aorta include but are not limited to:
A. Diagnostic Evaluation for an Abdominal Aortic Aneurysm
1. Palpable or pulsatile abdominal mass.
2. Unexplained lower back pain, flank pain, or abdominal pain.
3. Follow-up of a previously demonstrated abdominal aortic aneurysm.
4. Follow-up of patients with an abdominal aortic and/or iliac endoluminal
stent graft.
B. Screening Evaluation for an Abdominal Aortic Aneurysm
1. Men 65 years or older.
2. Women 65 years or older with cardiovascular risk factors.
3. Patients 50 years or older with a family history of aortic and/or
peripheral vascular aneurismal disease.
4. Patients with a personal history of peripheral vascular aneurysmal
disease.
Groups with additional risk include patients with a history of smoking, hypertension, and certain
connective tissue diseases (eg, Marfan syndrome). There are no absolute contraindications to
ultrasound of the aorta. If aortic rupture or dissection is clinically suspected, ultrasound is usually
not the examination of choice.
Specifications of the Examination
Diagnostic Examination
The examination includes the following, when feasible:
1. Abdominal aorta:
a. Longitudinal images (along the long axis of the vessel):
i. Proximal
ii. Mid
iii. Distal.
b. Transverse images (perpendicular to the long axis of the vessel):
i. Proximal (near diaphragm)
ii. Mid
iii. Distal.
c. Measurements:
i. Measurements of the proximal, mid, and distal aorta should
be obtained.
1. Measurements are taken at the greatest diameter of
the aorta from outer edge to outer edge.
ii. If an aneurysm is present, the maximal size and location
of the aneurysm should be documented and recorded.
The relationship of the dilated segment to the renal
arteries and to the aortic bifurcation should be
determined if possible.
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ii. A measurement of the length of the aneurysm is not
necessary.
2. Common iliac arteries:
a. Longitudinal images of the proximal right and left common iliac arteries
(along the long axis of the vessel).
b. Transverse images (perpendicular to the long axis of the vessel) of the
proximal common iliac arteries just below the bifurcation.
c. Measurement of the widest visualized portion of each common iliac
artery from outer edge to outer edge.
Color Doppler and/or spectral Doppler imaging with waveform analysis of the
aorta and iliac arteries may provide additional information.
After endoluminal graft placement, color (or power) Doppler imaging and spectral
Doppler imaging are required to document the presence or absence of
endoleaks.
Interobserver measurements of an aortic aneurysm can vary by as much as 5
mm. This variation makes visual comparison with previous studies particularly
important to determine whether a significant change in size has occurred
Screening Examination for an Abdominal Aortic Aneurysm
1. Abdominal aorta:
a. Longitudinal images (along the long axis of the vessel):
i. Proximal;
ii. Mid;
iii. Distal.
b. Transverse images (perpendicular to the long axis of the
vessel):
i. Proximal (near diaphragm);
ii. Mid;
iii. Distal.
Interpretation of the screening examination should include at least 3
categories:
1. Positive—Infrarenal abdominal aortic aneurysm greater than or equal to 3 cm
in diameter or greater than or equal to 1.5 times the diameter of the more
proximal aorta.4 The latter definition is particularly important in women.
2. Negative—No infrarenal abdominal aortic aneurysm.
3. Indeterminate—Aneurysmal status not defined because of nonvisualization
or only partial visualization of the infrarenal abdominal
aorta.
The report should also state whether the suprarenal aorta was seen and, if seen, should reflect
whether it is normal.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements.
Images should be labeled with the patient identification, facility identification, examination date,
and the side (right or left) of the anatomic site imaged. An official interpretation (final report) of the
72

ultrasound findings should be included in the patient’s medical record. Retention of the ultrasound
examination should be consistent both with clinical needs and with relevant legal and local health
care facility requirements.
Inferior Vena Cava (AIUM)
Representative images of the IVC should be obtained. Patency and abnormalities may be
evaluated with Doppler imaging. Vena cava filters, interruption devices, and catheters may need
to be localized with respect to the hepatic and/or renal veins
Merced College: Aorta & IVC
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
Use color Doppler as required
AORTA
Sagittal/Longitudinal
Proximal AO with diaphragm and celiac axis
Doppler of proximal AO above celiac
axis
Doppler of celiac axis
Aorta with celiac axis and SMA
Doppler of AO between these vessels
Doppler SMA
Aorta with SMA and IMA branches
Doppler of mid/distal aorta
Distal aorta with iliac branching
Longitudinal right Iliac artery
Doppler R iliac
Longitudinal left iliac artery
Doppler L iliac
Transverse
Proximal aorta above celiac trunk
at celiac trunk
below celiac trunk
Measure
at SMA
at renal arteries
Doppler right renal artery
Doppler left renal artery
Color of renal arteries
Aortic measurement inferior to renal arteries
Distal Aorta
Distal with measurements
Distal with bifurcation
Distal below bifurcation to demonstrate
R and L iliacs (one image)
IVC
Longitudinal
Distal IVC (show diaphragm and liver tissue)
Mid IVC
Proximal show bifurcation
R iliac vein
L iliac vein
Transverse
Distal
Middle
Proximal
Proximal with bifurcation (one image)
73

Kidneys (AIUM)
An examination of native or transplanted kidneys should include long-axis and transverse views
of the kidneys. The cortices and renal pelvises should be assessed. A maximum measurement of
renal length should be recorded for both kidneys. Decubitus, prone, or upright positioning may
provide better images of the native kidneys. When possible, renal echogenicity should be
compared to the adjacent liver or spleen. The kidneys and perirenal regions should be assessed
for abnormalities.
For a vascular examination of native or transplanted kidneys, Doppler imaging can be used:
a. To assess renal arterial and venous patency.
b. To evaluate suspected renal artery stenosis. For this application, angle-adjusted
measurements of the peak systolic velocity should be made proximally, centrally, and
distally in the extrarenal portion of the main renal arteries when possible. The peak
systolic velocity of the adjacent aorta should also be documented for calculating the renal
to aortic peak systolic velocity ratio. Spectral Doppler evaluation of the intrarenal arteries
may be of value as indirect evidence of proximal stenosis in the main renal artery.
c. For vascular examinations of transplanted kidneys, Doppler evaluation should be used
to document vascular patency and blood flow characteristics. The structures that may be
examined include the main renal artery and vein, arterial and venous anastomoses, the
iliac artery and vein, and the intrarenal arteries
Urinary Bladder and Adjacent Structures (AIUM)
When performing a complete ultrasound evaluation of the urinary tract, transverse and
longitudinal images of the distended urinary bladder and its wall should be included, if possible.
Bladder lumen or wall abnormalities should be noted. Dilatation or other distal ureteral
abnormalities should be documented. Transverse and longitudinal scans may be used to
demonstrate any postvoid residual, which may be quantitated and reported.
Adrenal Glands (AIUM)
When possible, usually in the neonate or young infant, long-axis and transverse images of the
adrenal glands may be obtained. Normal adrenal glands are less commonly shown by ultrasound
imaging in adults.
74

Merced College: Right & Left Kidneys
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
All longitudinal images must show kidney horizontally while maintaining AP
relationship
Longitudinal:
Medial
Middle
Middle: measure
length
Lateral
Transverse
Superior or upper pole
Middle
Middle measure width
and depth (AP)
Middle show hilum,
renal artery
Middle Doppler
Inferior or lower pole
Doppler arcuate artery
Decubitus
Left Lateral Decub
(Right Kidney) Right
Lateral Decub (Left
Kidney)
Coronal approach
demonstrate Middle
portion of kidney (long
axis)
Coronal approach
demonstrate renal
hilum in short axis
Prone (place bolster or pillow
under belly to arch back)
Long axis of kidney
middle pole
Short axis of kidney
middle pole
Preparation: Filled urinary bladder
Merced College: Urinary Bladder
Long axis
Midline
Midline with length and depth measurements
Right
Lateral right
Midline
Left
Lateral left
Transverse axis
Lower portion
Middle portion
Middle with width measurement
Middle with ureteral jets
(color Doppler)
Superior portion
Post void
Midline Long axis with measurements
Middle with measurement
75

Spleen (AIUM)
Obtain representative views of the spleen in long-axis & transverse projections.
Splenic length measurement may be helpful in assessing enlargement.
Echogenicity of the left kidney should be compared to splenic echogenicity when
possible. An attempt should be made to demonstrate the left hemidiaphragm and
the adjacent pleural space.
Merced College: Spleen
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
Longitudinal/coronal
Superior border and
splenic hilum
Inferior border with
splenic hilum
Measure Longest axis
Transverse/coronal
Middle portion with
splenic hilum
Doppler of splenic
artery
Doppler of splenic vein
Measure widest axis
and include depth
76

Merced College: Appendix
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
Thoroughly survey the pelvic region beginning at the hepatic flexure and trace
the bowel to the cecum. Survey the entire pelvis in all females looking for
ovarian or uterine pathology. Review the RUQ renal and biliary systems. Check
for free fluid.
Longitudinal
Long Medial axis of the appendix
Long Middle axis of the appendix
Measure length
Long Lateral axis of the appendix
Color Doppler as indicated
Transverse
Superior portion of the appendix with and without compression
Middle portion of the appendix with and without compression
Lower portion of the appendix with and without compression
Measure the width and depth from outer to outer walls with and without
compression
Color Doppler as indicated
77

Abdominal Wall (AIUM)
The examination should include images of the abdominal wall in the location of symptoms or
signs. The relationship of any identified mass with the peritoneum should be demonstrated. Any
defect in the peritoneum and abdominal wall musculature should be documented. The presence
or absence of bowel, fluid, or other tissue contained within any abdominal wall defect should be
noted. Images obtained in upright position and/or with use of the Valsalva maneuver may be
helpful. Doppler examination may be useful to define the relationship of blood vessels with a
detected mass.
Merced College: Abdominal Wall
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
When possible use panoramic imaging or dual image and match tissues.
Use Color and PW Doppler as indicated
Use Val Salva Maneuver as indicated
Look for peristalsis, protrusions, fluid collections
Demonstrate and label:
Linea Alba
Skin
Subcutaneous fat
Rectus abdominus muscle
Rectus sheath
External oblique muscle
Internal oblique muscle
Transabdominus muscle
Peritoneum
Transverse Plane
Begin at the xiphoid and scan and image in 1-2 cm increments to the
pubic symphysis.
Longitudinal Plane
Beginning at midline scan at 1-2 cm increments including the distal xiphoid
process to the pubic symphysis.
Align scan to the midsagittal plane unless specific mass is seen or
indicated
Demonstrate the above tissues in both right and left regions.
78

AIUM Practice Guideline for the Performance of the Focused Assessment With
Sonography for Trauma (FAST) Examination
http://aium.org/resources/guidelines/fast.pdf
Introduction
The clinical aspects of this guideline (Indications/ Contraindications, Specifications for Individual
Examinations, and Equipment Specifications) as well as Responsibilities of the Physician were
developed collaboratively by the American Institute of Ultrasound in Medicine (AIUM) and the
American College of Emergency Physicians (ACEP). Recommendations for physician
qualifications, procedure documentation, and quality control vary among these organizations and
are addressed by each separately.
This guideline has been developed to provide assistance to practitioners performing focused
assessment with sonography for trauma (FAST) ultrasound examinations. The FAST ultrasound
examination is a proven and useful procedure for the evaluation of peritoneal spaces for bleeding
after traumatic injury, particularly blunt trauma but including penetrating injury. Prior to its
development, more invasive, including surgical, procedures were required to evaluate these
patients. Over the last 3 decades, particularly with its wide advocation during the early 1990s, the
FAST examination has evolved into one that now includes assessments of the peritoneal cavity
for evidence of hemorrhage as well as analysis of the pericardium and pleural spaces for
hemorrhage, particularly in cases of chest trauma. While it is not possible to detect every
abnormality using the FAST examination for the analysis of the traumatized patient, adherence to
the following guideline will maximize the probability of detecting free fluid and allowing rapid
analysis for intraperitoneal hemorrhage and other abnormal fluids, such as urine and bile. In its
extended form, the FAST examination allows analysis for possible hemopericardium,
hemothorax, pneumothorax, solidorgan damage, and retroperitoneal injury. The ready portability
of ultrasound equipment allows the FAST examination to be used at the patient’s bedside or in
the rapid triaging of multiple individuals in mass casualty situations, including assessments in the
field.
Indications/Contraindications
Indications for the FAST examination of the torso include but are not limited to traumatic injury.
FAST examinations should be performed when there is a valid medical reason. There are no
absolute contraindications.
There are limitations to FAST assessments, including limitations in their ability to detect free fluid
in some injured children, patients with mesenteric injury, and patients with isolated penetrating
injury to the peritoneum.
Limitations to the diagnosis of free traumatic fluid in the peritoneum may be due to fluid present in
patients for physiologic reasons, including ovarian cyst rupture, as well as pathologic reasons,
such as patients with ascites. One must be wary of free fluid typically found intraperitoneally in
patients with ventriculoperitoneal shunts and in those who undergo peritoneal dialysis. Free fluid
may be also be due to recent peritoneal lavage. Limitations to pericardial assessment for
hemopericardium include pericardial cysts and preexisting pericardial fluid. Limitations to pleural
assessment for hemothorax include preexisting pleural fluid from preexisting pleural disease as
well as extension into the pleural space of fluid from the pericardium or peritoneum.
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Qualifications of the Physician
See the training guidelines of the physician provider’s respective specialty society, eg, the ACEP
or the AIUM. Training, as defined by the AIUM or the ACEP, is accepted as qualifying a
physician for performance and/or interpretation of the FAST examination. Credentialing should be
based on published standards of the physician’s specialty society, such as the ACEP or the
AIUM.
Responsibilities of the Physician
Trauma ultrasound, or the FAST examination, provides information that is the basis for immediate
decisions about further evaluation, clinical management, and therapeutic interventions. Rapid
provision and interpretation of such examinations are critical to proper patient care.
The clinical care of patients in life-threatening situations should always take precedence over
these guidelines.
Physicians/sonologists of a variety of medical specialties may perform the FAST examination. If
appropriately trained, physician extenders, emergency medical personnel, and sonographers can
obtain the ultrasound images.
Image interpretation should be performed by a supervising physician. Training of physicians in
the diagnostic interpretation of FAST examinations should be in accordance with specialtyspecific
guidelines. Physicians who supervise nonphysician sonographers should render a
diagnostic interpretation in a time frame consistent with the management of acute trauma, as
outlined above.
Specifications for Individual Examinations
The objective of the abdominal portion of the examination is to analyze the torso for free fluid.
This requires examination of the abdomen’s 4 quadrants and pelvis. This is achieved by
obtaining images of both upper quadrants as well as the pelvis. The ability to denote free fluid in
the pelvis is aided by the presence of a fluid-filled bladder. As with all ultrasound examinations,
orthogonal images (transverse, longitudinal, and coronal planes) help elucidate areas of concern
seen in any single plane.
Subtle changes in transducer angle and position can help improve analysis of a given area.
Images may be obtained through anterior, coronal, or other approaches to denote free fluid in the
evaluated areas.
As with most imaging and ultrasound examinations, techniques evolve over time and with
increased clinical and imaging experience. The current primary FAST examination includes
transverse and longitudinal images obtained through the heart to denote intrapericardial fluid. The
images may be obtained by placing the transducer in the upper abdomen and pointing superiorly
or placing the transducer directly above the heart in various echocardiographic planes,
particularly a parasternal longitudinal plane. Pleural effusion can be analyzed by a midline
transverse plane image in the upper abdomen, concentrating on the area posterior and therefore
superior to the echogenic diaphragms. This may be the same image as that used to evaluate the
(inferior) pericardium for fluid.
More specifically, primary ultrasound windows for the FAST examination include the following:
The Right Upper Quadrant View (Also Known as the Perihepatic,
Morison Pouch, or Right Flank View)—
This uses the liver as an ultrasound window to interrogate the liver as well as the
hepatorenal space (Morison pouch) for free fluid. Slight superior angulation of the
transducer allows imaging of the right pleural space for free fluid. Inferior
angulation allows visualization of the inferior pole of the right kidney as well as
the right paracolic gutter for free fluid assessment.
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The Left Upper Quadrant View (Also Known as the Perisplenic or Left
Flank View)—
This uses the spleen as a window to interrogate the spleen and the perisplenic
space above the spleen, below the diaphragm, and above the left kidney.
Angulation superiorly allows visualization of the left pleural space. Inferior
angulation allows visualization of fluid above the left kidney or in the left
paracolic gutter.
The Pelvic View (Also Known as the Retrovesical, Retrouterine, or
Pouch of Douglas View)—
This allows assessment of the most dependent space in the peritoneum for free
fluid. Analysis through a fluid-filled bladder (which can be filled, if necessary, by
fluid placed through a Foley catheter when possible) may help analysis for pelvic
fluid. When free fluid is present, it is noted most often superior and posterior to
the bladder and uterus.
The Pericardial View (Also Known as the Subcostal or Subxiphoid
View)—
This uses the left lobe of the liver as a window for the analysis of the heart,
particularly its right side. Both sagittal and transverse 4-chamber planes may be
used. The potential space of the pericardium is analyzed for the presence of any
free fluid in an anterior or posterior location. Slight angulation posteriorly or
inferiorly in this view allows visualization of the inferior vena cava and hepatic
veins, including their normal respiratory variability.
Additional views may include the following:
The Right and Left Pericolic Gutter Views—
Longitudinal and transverse views through peritoneal windows inferior to the
level of theipsilateral kidney and next to the ipsilateral iliac crest may reveal free
fluid surrounding bowel.
These windows may be of limited use because of the absence of an ultrasound window, such as
a fluid-filled bladder or a solid organ. Airfilled bowel may also limit these views. They rely on there
being sufficient free fluid present to be imaged.
The Pleural Space Views—
Each pleural space may be investigated via angulation and superior
movement of the transducer along the ipsilateral flank. Abnormal fluid
collections in the pleural space are visualized as anechoic collections above the
echogenic diaphragm.
The Anterior Pleural Space View—
The anterior visceral and parietal pleura may be analyzed through this view for
free fluid. The pleura normally appose each other and slide on each other easily.
Absence of this sliding and the potential separation of the pleura by a
pneumothorax may be imaged typically in the second or third intercostal space
with a higher-frequency near-field transducer, although lower-frequency
transducers may also be used.
81

The Parasternal View—
The parasternal window allows visualization of the heart in sagittal or transverse
planes. This view is used in cases in which a patient’s subcostal view is
suboptimal.
The Apical View—
The apical view may allow visualization of pericardial fluid in the difficult patient
by placing the transducer at the nipple line at the left fifth intercostal space and
aiming it toward the spine or the right shoulder.
Other considerations for the FAST examination include the following points:
Trendelenburg or sitting positions may increase the sensitivity of the ultrasound
examination for visualizing abnormal fluid.
A FAST ultrasound examination may be repeated during the patient’s stay for
reassessment of the patient’s condition either routinely or because of sudden clinical
decompensation.
As a caveat, one must remember that a trauma ultrasound examination provides a
picture of a patient’s condition at one point in time. It never eliminates the possibility of
injuries or fluid collections that are below the detectable threshold of a well-performed
ultrasound examination.
Further information may be obtained by referring to the ACEP Ultrasound Imaging
Criteria–Trauma.
Documentation
Focused sonograms, as all sonograms, require documentation. Whenever feasible, images
should be created and stored as part of the medical record, and a full description of the findings is
required. The analysis of findings on FAST examinations is limited to those areas assessed and
imaged. In particular, a FAST analysis may not allow the diagnostic evaluation of all abnormalities
in the chest, abdomen, or pelvis.
Merced College: FAST
Procedure will follow the guidelines set forth in the SONOSIM simulation package.
82

Scrotum (AIUM)
http://www.aium.org/resources/guidelines/scrotal.pdf
Indications
Indications for scrotal ultrasound include but are not limited to:
1. Evaluation of scrotal pain, including but not limited to testicular trauma,
ischemia/torsion, and infectious or inflammatory scrotal disease.
2. Evaluation of palpable inguinal, scrotal, or scrotal masses.
3. Evaluation of scrotal asymmetry, swelling, or enlargement.
4. Evaluation of potential scrotal hernias.
5. Detection/evaluation of varicoceles.
6. Evaluation of male infertility.
7. Follow-up of prior indeterminate scrotal ultrasound findings.
8. Localization of undescended testes
9. Detection of occult primary tumors in patients with metastatic germ cell
tumors.
10. Follow-up of patients with prior primary testicular neoplasms, leukemia, or
lymphoma.
11. Evaluation of abnormalities noted on other imaging studies (including but not
limited to computed tomography, magnetic resonance imaging, and positron
emission tomography).
12. Evaluation of intersex conditions.
Specifications of the Examination
The testes should be evaluated in at least 2 planes: longitudinal and transverse.
Transverse images should be obtained in the superior, mid, and inferior portions of the
testes.
Longitudinal views should be obtained centrally as well as medially and laterally.
Each testis should be evaluated in its entirety, as should the epididymis (head, body, and
tail) when technically feasible.
The size and echogenicity of each testis and epididymis should be compared to the
contralateral side. Comparison of the testes, including gray scale and color Doppler
imaging, is best accomplished with a side-by-side transverse image.
Scrotal skin thickness should be evaluated. If a palpable abnormality is the indication for
the sonogram, this area should be directly imaged.
Relevant extratesticular structures should be evaluated.
Additional techniques such as the Valsalva maneuver or upright positioning can be used
as needed.
Any abnormality should be documented.
Doppler sonography (spectral and color/power Doppler imaging) should be used as necessary in
all examinations of the scrotum, particularly in the setting of acute scrotal pain. If used, color
and/or power Doppler Sonography should include at least 1 side-by-side image comparing both
testes and 2 images with identical Doppler settings to evaluate symmetry of flow. Low-flow
detection settings should be used to document testicular blood flow, and the transducer
frequency should be optimized for maximum Doppler sensitivity while maintaining adequate
penetration. If flow cannot be demonstrated on color Doppler imaging, power Doppler imaging, if
available, should be used to increase flow sensitivity.
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Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged. An official interpretation
(final report) of the ultrasound findings should be included in the patient’s medical record.
Retention of the ultrasound examination should be consistent both with clinical needs and with
relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
Merced College: Scrotum
Long & short axes of the right and left testes will be examined independently
Longitudinal/ Long axis
◦ Lateral testicle
◦ Medial testicle
◦ Middle testicle
◦ Epididymal head in proximity with the superior testis
◦ Epididymal body and tail demonstrated throughout the testis
◦ Spermatic cord (from inguinal canal to scrotum—use Doppler and Val
Salva technique)
Short axis: Begin at the superior border
◦ Spermatic cord (from inguinal canal to scrotum- Use Val Salva Technique)
◦ Epididymal head
◦ Superior portion of testis
◦ Middle portion of testis
◦ Inferior portion of testis
◦ Single image with both testicles
84

Prostate (AIUM)
http://www.aium.org/resources/guidelines/prostate.pdf
Indications
Indications for prostate ultrasound include but are not limited to:
1. Guidance for biopsy in the presence of an abnormal digital rectal examination or
elevated PSA.4
2. Assessment of gland and prostate volume before medical, surgical, or radiation
therapy.5,6
3. Symptoms of prostatitis with a suspected abscess.7
4. Assessment of congenital anomalies.
5. Infertility.
6. Hematospermia.
Specifications of the Examination
The following guidelines describe the examination of the prostate and surrounding structures:
Prostate
The transrectal approach to ultrasound of the prostate is the method of choice, as image quality is
superior to transabdominal or transperineal examinations. However, in patients for whom the
transrectal approach is not possible, a transperineal ultrasound examination may be used to
direct a biopsy procedure. A transabdominal approach can be useful to obtain an estimate of
prostate size in some settings.
The prostate should be imaged in its entirety in at least 2 orthogonal planes, sagittal and axial or
longitudinal and coronal, from the apex to the base of the gland. An estimated volume is
The volume of the prostate may be correlated with the PSA level.
The gland should be evaluated for a focal mass, echogenicity, symmetry, and continuity of
margins. Color and power Doppler sonography may be helpful in detecting areas of increased
vascularity that can be used to select potential sites for biopsy. The periprostatic fat and
neurovascular bundle should be evaluated for symmetry and echogenicity. The course of the
prostatic urethra should be documented, when possible, and asymmetry between left and right
periurethral tissues as well as their impact on the base of the bladder should be noted.
Seminal Vesicles, Vasa Deferentia, and Perirectal Space
The seminal vesicles should be evaluated for size, shape, position, symmetry, and echogenicity
from their insertion into the prostate via the ejaculatory ducts to their cranial and lateral extents.
Particular attention should be given to the normal tapering of the seminal vesicle as it joins the
prostate. In patients being evaluated for infertility, the vasa deferentia must be evaluated. The
presence and size of seminal vesicle, ejaculatory, müllerian, or utricle cysts or evidence of
seminal vesicle or ejaculatory duct obstruction should be noted. Inclusion of the anterior perirectal
space, in particular the region that abuts the prostate and perirectal tissues, is important.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged. An official interpretation
(final report) of the ultrasound findings should be included in the patient’s medical record.
85

Retention of the ultrasound examination should be consistent both with clinical needs and with
relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
Merced College: Prostate
On campus protocol will be provided as needed.
http://www.aium.org/resources/guidelines/thyroid.pdf
Thyroid (AIUM)
Indications
Indications for a thyroid and parathyroid ultrasound examination include but are not limited to:
1. Evaluation of the location and characteristics of palpable neck masses,
including an enlarged thyroid;
2. Evaluation of abnormalities detected by other imaging examinations, eg, a
thyroid nodule detected on computed tomography, positron emission tomography–
computed tomography, or magnetic resonance imaging, or seen on another
ultrasound examination of the neck (eg, carotid ultrasound);
3. Evaluation of laboratory abnormalities;
4. Evaluation of the presence, size, and location of the thyroid gland;
5. Evaluation of patients at high risk for occult thyroid malignancy;
6. Follow-up imaging of previously detected thyroid nodules, when indicated;
7. Evaluation for regional nodal metastases in patients with proven or suspected
thyroid carcinoma before thyroidectomy;
8. Evaluation for recurrent disease or regional nodal metastases after total or
partial thyroidectomy for thyroid carcinoma;
9. Evaluation of the thyroid gland for suspicious nodules before neck surgery for
nonthyroid disease;
10. Evaluation of the thyroid gland for suspicious nodules before radioiodine
ablation of the gland;
11. Identification and localization of parathyroid abnormalities in patients with
known or suspected hyperparathyroidism
12. Assessment of the number and size of enlarged parathyroid glands in patients
who have undergone previous parathyroid surgery or ablative therapy with
recurrent symptoms of hyperparathyroidism;
13. Localization of thyroid/parathyroid abnormalities or adjacent cervical lymph
nodes for biopsy, ablation, or other interventional procedures; and
14. Localization of autologous parathyroid gland implants.
Specifications of the Examinations
The Thyroid Examination
The examination should be performed with the neck in hyperextension. The right and left lobes of
the thyroid gland should be imaged in the longitudinal and transverse planes. Recorded images
86

of the thyroid should include transverse images of the superior, mid, and inferior portions of the
right and left thyroid lobes; longitudinal images of the medial, mid, and lateral portions of both
lobes; and at least a transverse image of the isthmus. The size of each thyroid lobe should be
recorded in 3 dimensions, anteroposterior, transverse, and longitudinal.
The thickness (anteroposterior measurement) of the isthmus on the transverse view should be
recorded. A color or power Doppler examination can be used to supplement the grayscale
evaluation of either diffuse or focal abnormalities of the thyroid. It is often necessary to extend
imaging to include the soft tissue above the isthmus (eg, to evaluate a possible pyramidal lobe of
the thyroid), congenital abnormalities such as a thyroglossal duct cyst, or if any superior palpable
abnormality is noted. The examination should also include a brief evaluation of the lateral neck
compartments.
Thyroid abnormalities should be imaged in a way that allows for reporting and documentation of
the following:
1. The location, size, number, and character of significant abnormalities,
including measurements of nodules and focal abnormalities in 3 dimensions;
2. The localized or diffuse nature of any thyroid abnormality, including
assessment of overall gland vascularity
3. The sonographic features of any thyroid abnormality with respect to
echogenicity, composition (degree of cystic change), margins (smooth or irregular),
presence and type of calcification (if present), and other relevant sonographic
patterns7–19; and
4. The presence and size of any abnormal lymph node in the lateral compartment
of the neck (see section B below).
In patients who have undergone complete or partial thyroidectomy, the thyroid bed should be
imaged in transverse and longitudinal planes. Any masses or cysts in the region of the bed
should be measured and reported. Additionally, the lateral neck should be evaluated as described
in section B.
Whenever possible, comparison should be made with other appropriate imaging studies.
Sonographic guidance may be used for aspiration or biopsy of thyroid abnormalities or other
masses of the neck or for other interventional procedures.
The Cervical Lymph Node Evaluation
A high-resolution ultrasound examination of the neck is used for the staging of patients with
thyroid cancer and other head and neck cancers and in the surveillance of patients after
treatment of such cancers.23–29 In these patients, the size and location of abnormal lymph
nodes should be documented. Suspicious features such as calcification, cystic areas, absence of
a central hilum, round shape, and abnormal blood flow should be documented. The location of an
abnormal lymph node should be described according to the image-based nodal classification
system developed by Som et al,30 which corresponds to the clinical nodal classification system
developed by the American Joint Committee on Cancer and the American Academy of
Otolaryngology–Head and Neck Surgery, or in a fashion that allows the referring clinician to
convert the location of abnormal nodes to that system.
The Parathyroid Examination
An examination for suspected parathyroid enlargement should include images in the region of the
anticipated parathyroid gland location. One of the important uses of parathyroid ultrasound is to
try to localize parathyroid adenomas in patients with primary hyperparathyroidism to help with
surgical planning.
The examination should be performed with the neck hyperextended and should include
longitudinal and transverse images from the carotid arteries to the midline bilaterally and
87

extending from the carotid artery bifurcation superiorly to the thoracic inlet inferiorly. As
parathyroid glands may be hidden below the clavicles in the lower neck and upper mediastinum,
it may also be helpful to have the patient swallow during the examination with constant real-time
observation. Color and/or power or spectral Doppler ultrasound may be helpful. The upper
mediastinum may be imaged with an appropriate probe by angling under the sternum from the
sternal notch. Rarely, parathyroid adenomas may also be intrathyroidal.
Although the normal parathyroid glands are usually not visualized with available sonographic
technology, enlarged parathyroid glands may be visualized. When visualized, their location, size,
and number should be documented, and measurements should be made in 3 dimensions. The
relationship of any visualized parathyroid gland(s) to the thyroid gland should be documented, if
applicable.
Whenever possible, comparison should be made with other appropriate imaging studies.
Sonographic guidance may be used for aspiration or biopsy of parathyroid abnormalities or other
masses of the neck or for other interventional procedures.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged.
An official interpretation (final report) of the ultrasound findings should be included in the patient’s
medical record. Retention of the ultrasound examination should be consistent both with clinical
needs and with relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
88

Merced College: Thyroid
Patient in supine position, unless otherwise indicated
Use an Anterior-Posterior scan alignment, unless otherwise indicated
Survey:
Place pillow under patient’s shoulders (you may have to fold the
pillow to get enough neck extension). Place a rolled towel or
sponge under the neck for support.
Have the patient turn his/her head to the left slightly and begin the
survey on the right in transverse beginning at the inferior pole.
Scan through (and beyond) the entire right lobe inferiorly to
superiorly and return back to the inferior border. Complete
longitudinal survey from the trachea to the carotid/jugular regions
and return to trachea. Use Color Doppler. Complete the same
protocol on the left side. Remember, this is a SURVEY and you will
NOT print any images. Set depth based upon the deepest AP
dimension of either lobe. Use RES when one side is smaller.
Take in the following order:
1. Long trachea Right
2. Long medial Right
3. Long middle Right
4. Long middle Right with LENGTH measurement
5. Long middle Right with Color Doppler
6. Long lateral Right
7. Long carotid Right
8. Trans inferior pole Right
9. Trans middle pole Right
10. Trans middle pole Right with AP and Width measurements
11. Trans middle pole Right with Color Doppler
12. Trans superior pole Right
13. Long RES Isthmus Midline
14. Long medial Left
15. Long middle Left
16. Long middle Left LENGTH measurement
17. Long middle Left with Color Doppler
18. Long lateral Left
19. Long carotid/jugular Left
20. Trans inferior Left
21. Trans middle Left
22. Trans middle Left Measurements
23. Trans middle Left with Color Doppler
24. Trans superior Left
25. Trans isthmus RES (midline)
26. Trans dual image Right and Left middle poles
89

http://aium.org/resources/guidelines/breast.pdf
Breast (AIUM)
Indications
Appropriate indications for breast sonography include:
1. Identification and characterization of palpable abnormalities and further evaluation of
clinical and imaging findings.
2. Guidance for interventional procedures.
3. Evaluation of problems associated with breast implants.
4. Treatment planning for therapy.
Breast sonography is the initial imaging technique for evaluating palpable masses in women
younger than 30 years and in lactating and pregnant women.
Although the efficacy of sonography as a screening study for occult masses is an area for
research, at this time Sonography is not considered a primary screening modality in other
populations.
Specifications of the Examination
A. Lesion Characterization and Technical Factors
1. The breast sonogram should be correlated with mammographic and other appropriate
breast imaging studies as well as with a physical examination directed to the area in
question. If sonography has been performed previously, the current examination should
be compared with prior sonograms, as appropriate. A lesion or any area of the breast
being studied should be viewed in 2 perpendicular
projections; 1 view is insufficient.
2. At least 1 set of images of a lesion should be obtained without calipers. The maximal
dimensions of a mass should be recorded in at least 2 dimensions.
3. The images should be labeled as to the right or left breast, the lesion’s location, and
the orientation of the transducer with respect to the breast (eg, transverse or longitudinal
and radial or antiradial). The location of the lesion should be recorded; the quadrant
should be specified, or the location can be indicated by using clock notation and distance
from the nipple or shown on a diagram of the breast. Several sonographic features may
be helpful in characterizing breast masses. These features should be noted: size, shape,
echogenicity, margin features, orientation, and attenuation (eg, shadowing or
enhancement). Features may also be described using the American College of Radiology
Breast Imaging Reporting and Data System (BI-RADS) lexicon.
4. Mass characterization with sonography is highly dependent on technical factors.
Proper depth, gain, and focal zone settings should be optimized to obtain high-quality
images. The patient should be positioned to minimize the thickness of the portion of the
breast being evaluated. For evaluation of superficial lesions, a standoff device or use of a
thick layer of gel may be helpful.
B. Guidance of Interventional Procedures
1. Interventional procedures that can be performed with sonographic guidance include
but are not limited to cyst aspirations, presurgical needle hook wire localization,
therapeutic procedures, and fine-needle, core, or vacuum-assisted biopsy.
2. A full sonographic examination of the area of interest should be completed before the
procedure.
3. There is no single correct method for accomplishing interventional procedures with
sonographic guidance. Both a freehand technique and the use of a transducer with a
90

needle guide are suitable for breast interventions. The type of equipment on hand and
the experience of the physician performing the procedure will determine the technique.
4. High-frequency transducers with a center frequency of 7.0 MHz or higher used for
imaging the breast are suitable for guiding interventional procedures. With these
transducers, continuous visualization of the device path is possible. Depending on the
transducer configuration, the geometry of the acoustic beam, and the route of device
entry, either a small portion of the device may be visible as an echogenic focus, or, if the
device entry is aligned with the acoustic beam and nearly perpendicular to it, the entire
device may be visible.
5. Sonographic guidance can be used to aid in infiltration of anesthetics around the mass.
Documentation
Images of all important findings, including in the case of interventional procedures the relationship
of the device to the lesion, should be recorded on a retrievable and reviewable image storage
format.
A. Official documentation for the ultrasound images should include but is not limited to the
following:
1. Patient’s name and other identifying information.
2. Facility’s identifying information.
3. Date of sonographic examination.
4. Image orientation when appropriate.
B. The physician’s report of the sonographic findings should be placed in the patient’s medical
record.
C. Retention of the breast sonograms should be consistent with the policies for retention of
mammograms in compliance with federal and state regulations, local health care facility
procedures, and clinical needs.
D. Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
91

Merced College: Breast (Simulation)
Quadrant Survey: Entire breast using a standard abdominal transducer approach (notch to
patient’s head and to patient’s right). Patient is placed in a supine position with slight contralateral
obliquity. Survey each quadrant long and trans beginning with the RUOQ. Move to the
RUIQ, RLIQ, and RLOQ (clockwise approach). Survey of the left breast follows the clockwise
approach, too beginning with the LUIQ, LUOQ, LLOQ and LLIQ.
Images RUOQ Longitudinal at 12:00 ML +0
move about 1 cm to the right and take RUOQ +1
continue until the entire RUOQ has been imaged at 1 cm
Scan axilla and label AX
RUOQ Transverse at lower portion (about 9:00) RUOQ +0
increments.
Move transducer at 1 cm increments throughout the entire quadrant +1,
+2, Etc.
Scan axilla and label AX
Complete the above for each quadrant in Long and Trans sections as
listed above.
Do the same for the left breast.
Clock Method Survey: Entire breast using standard patient positioning as in Quadrant
Survey, but transducer notch directed towards nipple on all images.
Begin with the transducer in an “upside-down” approach, longitudinal at 12:00. Keeping the notch
directed toward the nipple rotate the transducer in a clockwise fashion around the breast stopping
“on the hour.”
Images “Longitudinal” /Radial at 12:00, 1:00, etc. to 11:00. You will create 12
images per breast.
If masses are found using the clock method additional “transverse” / Anti-radial images
are taken by rotating the transducer 90 degree from the radial image. This will place the
long and short axis along the ductal planes of the breast.
Make certain you have the breast labeled Right or Left.
Complete the above for the Left breast
Variations will be disseminated as required.
92

E. OB-GYN Applications
http://aium.org/resources/guidelines/pelvic.pdf
Pelvis (AIUM)
Indications
Indications for pelvic sonography include but are not limited to the following:
1. Pelvic pain;
2. Dysmenorrhea (painful menses);
3. Amenorrhea;
4. Menorrhagia (excessive menstrual bleeding);
5. Metrorrhagia (irregular uterine bleeding);
6. Menometrorrhagia (excessive irregular bleeding);
7. Follow-up of a previously detected abnormality;
8. Evaluation, monitoring, and/or treatment of infertility patients;
9. Delayed menses, precocious puberty, or vaginal bleeding in a prepubertal child;
10. Postmenopausal bleeding;
11. Abnormal or technically limited pelvic examination;
12. Signs or symptoms of pelvic infection;
13. Further characterization of a pelvic abnormality noted on another imaging
study;
14. Evaluation of congenital anomalies;
15. Excessive bleeding, pain, or signs of infection after pelvic surgery, delivery,
or abortion;
16. Localization of a intrauterine contraceptive device;
17. Screening for malignancy in patients at increased risk;
18. Urinary incontinence or pelvic organ prolapse; and
19. Guidance for interventional or surgical procedures.
Specifications of the Examination
This section details the examination to be performed for each organ and anatomic region in the
female pelvis. All relevant structures should be identified by a transabdominal and/or transvaginal
approach. In some cases, both will be needed. A transrectal or transperineal approach may be
useful in patients who are not candidates for introduction of a vaginal probe and in assessing the
patient with pelvic organ prolapse.
A. General Pelvic Preparation
For a complete transabdominal pelvic sonogram, the patient’s bladder should, in general,
be distended adequately to displace the small bowel from the field of view. Occasionally,
overdistention of the bladder may compromise the evaluation. When this occurs, imaging
may be repeated after the patient partially empties the bladder.
For a transvaginal sonogram, the urinary bladder is preferably empty. The patient, the
sonographer, or the physician may introduce the vaginal transducer, preferably under
real-time monitoring. Consideration of having a chaperone present should be in
accordance with local policies.
B. Uterus
The vagina and uterus provide anatomic landmarks that can be used as reference points
for the other pelvic structures, whether normal or abnormal.
93

In examining the uterus, the following should be evaluated: (1) the uterine size, shape,
and orientation; (2) the endometrium; (3) the myometrium; and (4) the cervix. The vagina
may be imaged as a landmark for the cervix and lower uterine segment.
Overall uterine length is evaluated in the long axis from the fundus to the cervix (to the
external os, if it can be identified). The depth of the uterus (anteroposterior dimension) is
measured in the same long-axis view from its anterior to posterior walls, perpendicular to
the length. The maximum width is measured in the transaxial or coronal view.
If volume measurements of the uterine corpus are performed, the cervical component
should be excluded from the uterine length measurement. Abnormalities of the uterus
should be documented. The myometrium and cervix should be evaluated for contour
changes, echogenicity, masses, and cysts. Masses that may require follow-up or
intervention should be measured in at least 2 dimensions, acknowledging that it is not
usually necessary to measure all fibroids. The endometrium should be analyzed for
thickness, focal abnormalities, and the presence of fluid or masses in the endometrial
cavity. The endometrium should be measured on a midline sagittal image, including
anterior and posterior portions of the basal endometrium and excluding the adjacent
hypoechoic myometrium and any endometrial fluid. Assessment of the endometrium
should allow for variations expected with phases of the menstrual cycle and with
hormonal supplementation. If the endometrium is difficult to image in its entirety or poorly
defined, this should be reported. Sonohysterography may be a useful adjunct for
evaluating the patient with abnormal or dysfunctional uterine bleeding or to further clarify
an abnormally thickened endometrium.7 If the patient has an intrauterine contraceptive
device, its location should be documented.
(See the AIUM Practice Guideline for the Performance of Sonohysterography.)
When available, the addition of a reconstructed coronal view of the uterus from a 3-
dimensional volume may be useful.
C. Adnexa Including Ovaries and Fallopian Tubes
When evaluating the adnexa, an attempt should be made to identify the ovaries first since
they can serve as a major point of reference for assessing the presence of adnexal
pathology. Ovarian size may be determined by measuring the ovary in 3 dimensions
(width, length, and depth), on views obtained in2 orthogonal planes. Any ovarian
abnormalities should be documented.9–12 The ovaries may not be identifiable in some
females. This occurs most frequently prior to puberty, after menopause, or in the
presence of a large leiomyomatous uterus.
The normal fallopian tubes are not commonly identified. The adnexal region should be
surveyed for abnormalities, particularly masses and dilated tubular structures. If an
adnexal abnormality is noted, its relationship to the ovaries and uterus should be
assessed. The size and sonographic characteristics of adnexal masses should be
documented. Spectral, color, and/or power Doppler ultrasound may be useful for
evaluating the vascular characteristics of pelvic lesions.
D. Cul-de-sac
The cul-de-sac and bowel posterior to the uterus may not be clearly defined. This area
should be evaluated for the presence of free fluid or a mass. If a mass is detected, its
size, position, shape, sonographic characteristics, and relationship to the ovaries and
uterus should be documented. Differentiation of normal loops of bowel from a mass may
be difficult if only a transabdominal examination is performed. A transvaginal
examination may be helpful to distinguish a suspected mass from fluid and feces within
the normal rectosigmoid colon.
94

Documentation
Adequate documentation is essential for high-quality patient care. There should be a permanent
record of the ultrasound examination and its interpretation. Images of all appropriate areas, both
normal and abnormal, should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged. An official interpretation
(final report) of the ultrasound findings should be included in the patient’s medical record.
Retention of the ultrasound examination should be consistent both with clinical needs and with
relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an
Ultrasound Examination.
Merced College: Pelvic Protocol
Follow the same scanning guidelines as abdominal. Gynecologic exams will
utilize a filled urinary bladder technique. Male pelvic protocols are not provided
in this section.
When scanning female gynecologic anatomy it is important to follow the contour
of the anatomy. It may be necessary to utilize a steep caudal transducer angle to
properly visualize the vaginal canal and walls and a steep cephalic transducer
angle to demonstrate the uterus and endometrial stripe.
Adequate scanning pressure is required even though you are pressing on a filled
urinary bladder.
An over-filled bladder will compromise the exam.
Merced College: Gynecologic Exam: Uterus
Longitudinal
Vagina
Cervix with measurement
Uterus midline with length
measured
Right uterine section
Right adenxal region
Midline with endometrial
measurement
Left uterine section
Left adnexal region
Transverse
Cervix
Lower uterine
segment/isthmus
Uterine body
Body with AP and width
measurements
Fundus
Superior to uterine fundus
95

Merced College: Gynecologic Exam: Ovaries
Start with contralateral ovary; no Hx: begin with right ovary
Complete the following
images for each ovary
Longitudinal
Longest portion
Longest long axis with
measurement
Lateral to ovary (iliac
vessel)
Transverse
Inferior segment
Middle/largest segment
Middle/largest segment
with measurements
Superior portion
Doppler
RI or PI as indicate
96

OBSTETRIC (AIUM)
http://aium.org/resources/guidelines/obstetric.pdf
Classification of Fetal Sonographic Examinations
A. First-Trimester Examination
A standard obstetric sonogram in the first trimester includes evaluation of the presence,
size, location, and number of gestational sac(s). The gestational sac is examined for the
presence of a yolk sac and embryo/fetus. When an embryo/fetus is detected, it should be
measured and cardiac activity recorded by a 2-dimensional video clip or M-mode
imaging.
Use of spectral Doppler imaging is discouraged. The uterus, cervix, adnexa, and cul-desac
region should be examined.
B. Standard Second- or Third-Trimester Examination
A standard obstetric sonogram in the second or third trimester includes an evaluation of
fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal
biometry, and fetal number, plus an anatomic survey. The maternal cervix and adnexa
should be examined as clinically appropriate when technically feasible.
C. Limited Examination
A limited examination is performed when a specific question requires investigation. For
example, in most routine nonemergency cases, a limited examination could be performed
to confirm fetal heart activity in a bleeding patient or to verify fetal presentation in a
laboring patient. In most cases, limited sonographic examinations are appropriate only
when a prior complete examination is on record.
D. Specialized Examinations
A detailed anatomic examination is performed when an anomaly is suspected on the
basis of the history, biochemical abnormalities, or the results of either the limited or
standard scan. Other specialized examinations might include fetal Doppler ultrasound, a
biophysical profile, a fetal echocardiogram, and additional biometric measurements.
Specifications of the Examination
First-Trimester Ultrasound Examination
Indications: Indications for first-trimesterb sonography include but are not limited to:
a. Confirmation of the presence of an intrauterine pregnancy3–5;
b. Evaluation of a suspected ectopic pregnancy6,7;
c. Defining the cause of vaginal bleeding;
d. Evaluation of pelvic pain;
e. Estimation of gestational (menstrual)c age;
f. Diagnosis or evaluation of multiple gestations;
g. Confirmation of cardiac activity;
h. Imaging as an adjunct to chorionic villus sampling, embryo transfer, and localization
and removal of an intrauterine device;
i. Assessing for certain fetal anomalies, such as anencephaly, in high-risk patients;
j. Evaluation of maternal pelvic masses and/or uterine abnormalities;
k. Measuring the nuchal translucency (NT) when part of a screening program for fetal
aneuploidy; and
l. Evaluation of a suspected hydatidiform mole.

Comment: A limited examination may be performed to evaluate interval growth, estimate
amniotic fluid volume, evaluate the cervix, and assess the presence of cardiac activity.
Imaging Parameters
Comment: Scanning in the first trimester may be performed either transabdominally or
transvaginally.
If a transabdominal examination is not definitive, a transvaginal scan or transperineal
scan should be performed whenever possible.
The uterus (including the cervix) and adnexa should be evaluated for the presence
of a gestational sac. If a gestational sac is seen, its location should be
documented. The gestational sac should be evaluated for the presence or absence
of a yolk sac or embryo, and the crown-rump length should be recorded when
possible.
Comment: A definitive diagnosis of intrauterine pregnancy can be made when an
intrauterine gestational sac containing a yolk sac or embryo/fetus with cardiac activity is
visualized. A small, eccentric intrauterine fluid collection with an echogenic rim can be
seen before the yolk sac and embryo are detectable in a very early intrauterine
pregnancy. In the absence of sonographic signs of ectopic pregnancy, the fluid collection
is highly likely to represent an intrauterine gestational sac. In this circumstance, the
intradecidual sign may be helpful.10 Follow-up sonography and/or serial determination of
maternal serum human chorionic gonadotropin levels are/is appropriate in pregnancies of
undetermined location to avoid inappropriate intervention in a potentially viable early
pregnancy.
The crown-rump length is a more accurate indicator of gestational (menstrual) age than is
the mean gestational sac diameter. However, the mean gestational sac diameter may be
recorded when an embryo is not identified.
Caution should be used in making the presumptive diagnosis of a gestational sac in the
absence of a definite embryo or yolk sac. Without these findings, an intrauterine fluid
collection could represent a pseudo–gestational sac associated with an ectopic
pregnancy.
The presence or absence of cardiac activity should be documented
with a 2-dimensional video clip or M-mode imaging.
Comment: With transvaginal scans, while cardiac motion is usually observed when the
embryo is 2 mm or greater in length, if an embryo less than 7 mm in length is seen
without cardiac activity, a subsequent scan in 1 week is recommended to ensure that the
pregnancy is nonviable.
Fetal number should be documented.
Comment: Amnionicity and chorionicity should be documented for all multiple gestations
when
possible.
Embryonic/fetal anatomy appropriate for the first trimester should be
assessed.
The nuchal region should be imaged, and abnormalities such as
cystic hygroma
should be documented.
Comment: For those patients desiring to assess their individual risk of fetal aneuploidy, a
very specific measurement of the NT during a specific age interval is necessary (as
determined by the laboratory used). See the guidelines for this measurement below.

NT measurements should be used (in conjunction with serum biochemistry) to determine
the risk of having a fetus with aneuploidy or other anatomic abnormalities such as heart
defects.
In this setting, it is important that the practitioner measure the NT according to
established guidelines for measurement. A quality assessment program is recommended
to ensure that false-positive and false-negative results are kept to a minimum.
Guidelines for NT Measurement:
i. The margins of the NT edges must be clear enough for proper placement of the
calipers.
ii. The fetus must be in the midsagittal plane.
iii. The image must be magnified so that it is filled by the fetal head, neck, and upper
thorax.
iv. The fetal neck must be in a neutral position, not flexed and not hyperextended.
v. The amnion must be seen as separate from the NT line.
vi. The + calipers on the ultrasound must be used to perform the NT measurement.
vii. Electronic calipers must be placed on the inner borders of the nuchal line space with
none of the horizontal crossbar itself protruding into the space.
viii. The calipers must be placed perpendicular to the long axis of the fetus.
viiii. The measurement must be obtained at the widest space of the NT.
The uterus including the cervix, adnexal structures, and cul-de-sac
should be
evaluated. Abnormalities should be imaged and documented.
Comment: The presence, location, appearance, and size of adnexal masses should be
documented. The presence and number of leiomyomata should be documented. The
measurements of the largest or any potentially clinically significant leiomyomata should
be documented. The cul-de-sac should be evaluated for the presence or absence of
fluid. Uterine anomalies should be documented.
B. Second- and Third-Trimester Ultrasound Examination
Indications: for second- and third-trimester sonography include but are not limited to:
a. Screening for fetal anomalies
b. Evaluation of fetal anatomy;
c. Estimation of gestational (menstrual) age;
d. Evaluation of fetal growth;
e. Evaluation of vaginal bleeding;
f. Evaluation of abdominal or pelvic pain;
g. Evaluation of cervical insufficiency;
h. Determination of fetal presentation;
i. Evaluation of suspected multiple gestation;
j. Adjunct to amniocentesis or other procedure;
k. Evaluation of a significant discrepancy between uterine size and clinical dates;
l. Evaluation of a pelvic mass;
m. Evaluation of a suspected hydatidiform mole;
n. Adjunct to cervical cerclage placement;
o. Suspected ectopic pregnancy;
p. Suspected fetal death;
q. Suspected uterine abnormalities;
r. Evaluation of fetal well-being;
s. Suspected amniotic fluid abnormalities;
t. Suspected placental abruption;

u. Adjunct to external cephalic version;
v. Evaluation of premature rupture of membranes and/or premature labor;
w. Evaluation of abnormal biochemical markers;
x. Follow-up evaluation of a fetal anomaly;
y. Follow-up evaluation of placental location for suspected placenta previa;
z. History of previous congenital anomaly;
aa. Evaluation of the fetal condition in late registrants for prenatal care; and
bb. Assessment for findings that may increase the risk for aneuploidy.
Comment: In certain clinical circumstances, a more detailed examination of fetal
anatomy may
be indicated.
Imaging Parameters for a Standard Fetal Examination
Fetal cardiac activity, fetal number, and presentation should be
documented.
Comment: An abnormal heart rate and/or rhythm should be documented.
Multiple gestations require the documentation of additional information: chorionicity,
amnionicity, comparison of fetal sizes, estimation of amniotic fluid volume (increased,
decreased, or normal) in each gestational sac, and fetal genitalia (when visualized).
A qualitative or semiquantitative estimate of amniotic fluid volume
should be documented.
Comment: Although it is acceptable for experienced examiners to qualitatively estimate
amniotic fluid volume, semiquantitative methods have also been described for this
purpose
(eg, amniotic fluid index, single deepest pocket, and 2-diameter pocket).
The placental location, appearance, and relationship to the internal
cervical os should be documented. The umbilical cord should be imaged and
the number of vessels in the cord documented. The placental cord insertion site25 should
be documented when technically possible.
Comment: It is recognized that the apparent placental position early in pregnancy may not
correlate well with its location at the time of delivery. Transabdominal, transperineal, or
transvaginal views may be helpful in visualizing the internal cervical os and its relationship
to the placenta. Transvaginal or transperineal ultrasound may be considered if the cervix
appears shortened or cannot be adequately visualized during the transabdominal
sonogram. A velamentous (also called membranous) placental cord insertion that crosses
the internal os of the cervix is vasa previa, a condition that has a high risk of fetal mortality
if not diagnosed before labor.
Gestational (menstrual) age assessment.
First-trimester crown-rump measurement is the most accurate means for sonographic
dating of pregnancy. Beyond this period, a variety of sonographic parameters such as
biparietal diameter, abdominal circumference, and femoral diaphysis length can be used to
estimate gestational (menstrual) age. The variability of gestational (menstrual) age
estimation, however, increases with advancing pregnancy. Significant discrepancies
between gestational (menstrual) age and fetal measurements may suggest the possibility
of a fetal growth abnormality, intrauterine growth restriction, or macrosomia.
Comment: The pregnancy should not be redated after an accurate earlier scan has been
performed and is available for comparison.
i. The biparietal diameter is measured at the level of the thalami and cavum septi
pellucidi or columns of the fornix. The cerebellar hemispheres should not be visible

in this scanning plane. The measurement is taken from the outer edge of the
proximal skull to the inner edge of the distal skull.
Comment: The head shape may be flattened (dolichocephaly) or rounded
(brachycephaly) as a normal variant. Under these circumstances, certain variants
of
normal fetal head development may make measurement of the head
circumference more reliable than biparietal diameter for estimating gestational
(menstrual) age.
ii. The head circumference is measured at the same level as the biparietal
diameter, around the outer perimeter of the calvarium. This measurement is not
affected by head shape.
iii. The femoral diaphysis length can be reliably used after 14 weeks’ gestational
(menstrual) age. The long axis of the femoral shaft is most accurately measured
with the beam of insonation being perpendicular to the shaft, excluding the distal
femoral epiphysis.
iv. The abdominal circumference or average abdominal diameter should be
determined at the skin line on a true transverse view at the level of the junction of
the umbilical vein, portal sinus, and fetal stomach when visible.
Comment: The abdominal circumference or average abdominal diameter measurement is
used with other biometric parameters to estimate fetal weight and may allow detection of
intrauterine growth restriction or macrosomia.
Fetal weight estimation.
Fetal weight can be estimated by obtaining measurements such as the biparietal
diameter, head circumference, abdominal circumference or average abdominal diameter,
and femoral diaphysis length. Results from various prediction models can be compared
to fetal weight percentiles from published nomograms.
Comment: If previous studies have been performed, appropriateness of growth should
also be documented. Scans for growth evaluation can typically be performed at least 2 to
4 weeks apart. A shorter scan interval may result in confusion as to whether
measurement changes are truly due to growth as opposed to variations in the technique
itself. Currently, even the best fetal weight prediction methods can yield errors as high as
±15%. This variability can be influenced by factors such as the nature of the patient
population, the number and types of anatomic parameters being measured, technical
factors that affect the resolution of ultrasound images, and the weight range being
studied.
Maternal anatomy.
Evaluation of the uterus, adnexal structures, and cervix should be performed when
appropriate. If the cervix cannot be visualized, a transperineal or transvaginal scan may
be considered when evaluation of the cervix is needed.
Comment: This will allow recognition of incidental findings of potential clinical
significance.
The presence, location, and size of adnexal masses and the presence of at least the
largest and potentially clinically significant leiomyomata should be documented. It is not
always possible to image the normal maternal ovaries during the second and third
trimesters.

Fetal anatomic survey.
Fetal anatomy, as described in this document, may be adequately assessed by
ultrasound after approximately 18 weeks’ gestational (menstrual) age. It may be possible
to document normal structures before this time, although some structures can be difficult
to visualize due to fetal size, position, movement, abdominal scars, and increased
maternal abdominal wall thickness. A second- or third-trimester scan may pose
technical limitations for an anatomic evaluation due to imaging artifacts from acoustic
shadowing. When this occurs, the report of the sonographic examination should
document the nature of this technical limitation. A follow-up examination may be helpful.
The following areas of assessment represent the minimal elements of a standard
examination of fetal anatomy. A more detailed fetal anatomic examination may be
necessary if an abnormality or suspected abnormality is found on the standard
examination.
i. head
o Lateral cerebral ventricles;
o Choroid plexus;
o Midline falx;
o Cavum septi pellucidi;
o Cerebellum;
o Cistern magna; and
o Upper lip.
Comment: A measurement of the nuchal fold may be helpful during a specific age
interval to assess the risk of aneuploidy.
Chest:
o Heart41–43:
o Four-chamber view;
o Left ventricular outflow tract; and
o Right ventricular outflow tract.
Abdomen:
o Stomach (presence, size, and situs);
o Kidneys;
o Urinary bladder;
o Umbilical cord insertion site into the fetal abdomen; and
o Umbilical cord vessel number.
Spine:
o Cervical, thoracic, lumbar, and sacral spine.
Extremities:
o Legs and arms.
Sex: In multiple gestations and when medically indicated.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a
permanent record of the ultrasound examination and its interpretation. Images of all
appropriate areas, both normal and abnormal, should be recorded. Variations from
normal size should be accompanied by measurements. Images should be labeled with
the patient identification, facility identification, examination date, and side (right or left) of
the anatomic site imaged.
An official interpretation (final report) of the ultrasound findings should be included in the patient’s medical
record. Retention of the ultrasound examination should be consistent both with clinical needs and with relevant
legal and local health care facility requirements. Reporting should be in accordance with the AIUM Practice
Guideline for Documentation of an Ultrasound Examination.

Merced College: Obstetrics (Simulation)
Students will apply creative thinking and logic to generate scanning
protocol for:
First Trimester
Second-Third Trimester
Anatomical Survey
Multigestational
Biophysical Profile
Others

AIUM Practice Guideline for the Performance of a Musculoskeletal
Ultrasound Examination
http://www.aium.org/resources/guidelines/musculoskeletal.pdf
Indications
Indications for MSK ultrasound include but are not limited to:
A. Pain or dysfunction.
B. Soft tissue or bone injury.
C. Tendon or ligament pathology.
D. Arthritis, synovitis, or crystal deposition disease.
E. Intra-articular bodies.
F. Joint effusion.
G. Nerve entrapment, injury, neuropathy, masses, or subluxation.
H. Evaluation of soft tissue masses, swelling, or fluid collections.
I. Detection of foreign bodies in the superficial soft tissues.
J. Planning and guiding an invasive procedure.
K. Congenital or developmental anomalies.
L. Postoperative or postprocedural evaluation.
An MSK ultrasound examination should be performed when there is a valid medical
reason.
There are no absolute contraindications.
Specifications for Individual Examinations
Depending on the clinical request and the patient’s presentation, the ultrasound
examination can involve a complete assessment of a joint or anatomic region, or it can be
focused on a specific structure of interest. If a focused study is performed, it is essential
to have a full understanding of the relevant abnormalities, including those that may
correspond to the patient’s symptoms. General ultrasound scanning principles apply.
Transverse and longitudinal views should always be obtained with the transducer parallel
(that is, ultrasound beam perpendicular) to the axis of the region of interest to minimize
artifacts. Abnormalities should be measured in orthogonal planes. Patient positioning for
specific examinations may vary depending on the indication, clinical condition, and
patient’s age.
A. Specifications for a Shoulder Examination
Patients should be examined in the sitting position when possible, preferably on a
rotating seat. Examination of the shoulder should be tailored to the patient’s clinical
circumstances and range of motion. Color and power Doppler imaging may be useful in
detecting hyperemia within the joint or surrounding structures.
The long head of the biceps tendon should be examined with the forearm in supination
and resting on the thigh or with the arm in slight external rotation. The tendon is
examined in a transverse plane (short axis), where it emerges from under the acromion,
to the musculotendinous junction distally. Longitudinal views (long axis) should also be
obtained. These views should be used to detect fluid or intra-articular loose bodies within
the bicipital tendon sheath and to determine whether the tendon is properly positioned
within the bicipital groove,
subluxated, dislocated, or torn.
The rotator cuff should be examined for signs of a tear, tendinosis, and/or calcification.
Both long- and short-axis views of each tendon should be obtained. To examine the
subscapularis tendon, the elbow remains at the side while the arm is placed in external
rotation. The subscapularis is imaged from the musculotendinous junction to the insertion

on the lesser tuberosity of the humerus. Dynamic evaluation as the patient moves from
internal to external rotation may be helpful.
To examine the supraspinatus tendon, the arm can be extended posteriorly, and the
palmar aspect of the hand can be placed against the superior aspect of the iliac wing with
the elbow flexed and directed toward the midline (instruct the patient to place the hand in
the back pocket). Other positioning techniques also may be helpful.
To scan the supraspinatus and infraspinatus tendons along their long axis, it is important
to orient the transducer approximately 45° between the sagittal and coronal planes to
obtain a longitudinal view. The transducer then should be moved anteriorly and
posteriorly to completely visualize the tendons.
Short-axis views of the tendons should be obtained by rotating the probe 90° to the long
axis. The tendons are visualized by sweeping medially to the acromion and laterally to
their insertions on the greater tuberosity of the humerus. The more posterior aspect of the
infraspinatus and teres minor tendons should be examined by placing the transducer at
the level of the glenohumeral joint below the scapular spine while the forearm rests on
the thigh with the hand supinated. Internal and external rotation of the arm is helpful in
identifying the infraspinatus muscle and its tendon and in detecting small joint effusions.
To visualize the teres minor tendon, the medial edge of the probe should be angled
slightly inferiorly.
Throughout the examination of the rotator cuff, the cuff should be compressed with the
transducer to detect nonretracted tears. In evaluating rotator cuff tears, comparison with
the
contralateral side may be useful. Dynamic evaluation of the rotator cuff also is useful: for
example, to evaluate the rotator cuff for impingement or to assess the cuff tear extent. In
patients with a rotator cuff tear, the supraspinatus, infraspinatus, and teres minor muscles
should be examined for atrophy, which may alter surgical management.
During the rotator cuff examination, the subacromial-subdeltoid bursa should be
examined for the presence of bursal thickening or fluid. It is also important to evaluate the
glenohumeral joint with the probe placed in the transverse plane from a posterior
approach to evaluate for effusions, intra-articular loose bodies, synovitis, or bony
abnormalities. If symptoms warrant, the suprascapular notch and spinoglenoid notch also
may be evaluated. The acromioclavicular joint should be evaluated with the probe placed
at the apex of the shoulder, bridging the acromion and distal clavicle examined in a
decubitus position, and older children are examined seated. The shoulder is scanned
from a posterior approach to evaluate the relationship between the humeral head and
glenoid, as well as the shape of the posterior glenoid. Both static and dynamic images
are obtained. The shoulder is scanned through the full range of internal to external
rotation. Posterior subluxation is assessed visually and by measuring the ı angle, which
is the angle between the posterior margin of the scapula and the line drawn tangentially
to the humeral head and posterior edge of the glenoid. The normal value of the ı angle is
30° or less. The clavicle and proximal humerus are also evaluated for fracture.
B. Specifications for an Elbow Examination
The patient is seated with the arm extended and the hand in supination, resting on a
table, and the examiner sitting in front of the patient. The elbow may also be examined
with the patient supine and the examiner on the same side as the elbow of interest. The
examination is divided into 4 quadrants: anterior, medial, lateral, and posterior. The
examination may involve a complete assessment of 1 or more of the 4 quadrants or may
be focused on a specific structure depending on the clinical presentation. Color and
power Doppler imaging may be useful in detecting hyperemia within the joint or
surrounding structures.

1. Anterior
The anterior joint space and other recesses of the elbow are assessed for effusion,
synovial proliferation, and loose bodies. Longitudinal and transverse scanning of the
anterior humeroradial and humeroulnar joints and coronoid and radial fossae is
performed to assess the articular cartilage and cortical bone. The annular recess of the
neck of the radius is scanned dynamically with the patient alternatively supinating and
pronating the forearm. The same dynamic assessment can be made for the biceps
tendon and its attachment to the radial bicipital tuberosity. Evaluation of the brachialis
muscle, the adjacent radial and brachial vessels, and the median and radial nerves can
also be performed as clinically warranted.
2. Lateral
The patient extends the arm and places both palms together, or if the patient is supine,
the forearm is placed across the abdomen. This position allows assessment of the lateral
epicondyle and the attachments of the common extensor tendon as well as the more
proximal attachments of the extensor carpi radialis longus and brachioradialis. The hand
is then pronated with the transducer on the posterolateral aspect of the elbow to scan the
radial collateral ligament.
3. Medial
The hand is placed in supination, or if the patient is supine, the upper limb is placed in
abduction and external rotation to expose the medial side of the elbow. The medial
epicondyle, common flexor tendon, and ulnar collateral ligament are scanned in both
planes. The ulnar nerve is visualized in the cubital tunnel between the olecranon process
and medial epicondyle. Static examination of the ulnar nerve may be facilitated by placing
the elbow in an extended position. Dynamic subluxation of the ulnar nerve is assessed by
imaging with flexion and extension of the elbow. Dynamic examination with valgus stress
is performed to assess the integrity of the ulnar collateral ligament. During stress testing,
the elbow must be slightly flexed to disengage the olecranon from the olecranon fossa.
4. Posterior
The palm is placed down on the table, or if the patient is supine, the forearm is placed
across the abdomen, with the elbow flexed to 90°. The posterior joint space, triceps
tendon, olecranon process, and olecranon bursa are assessed.
C. Specifications for a Wrist and Hand Examination
The patient sits with hands resting on a table placed anteriorly or on a pillow placed on
the patient’s thighs. Alternatively, the examination can be performed with the patient
supine. The volar examination requires the wrists to be placed flat or in mild dorsiflexion
with the palm up and during both ulnar and radial deviation to delineate all the necessary
anatomy. The dorsal scan requires the wrist to be placed palm down with mild volar
flexion. The examination may involve a complete assessment of 1 or more of the 3
anatomic regions described below or may be focused on a specific structure depending
on the clinical presentation. Color and power Doppler imaging may be useful in detecting
hyperemia within the joint or surrounding structures.
1. Volar
Transverse and longitudinal images should be obtained from the volar wrist crease to the
thenar muscles. The transducer will require angulation to compensate for the normal
contour of the wrist. The flexor retinaculum, flexor digitorum profundus and superficialis
tendons, and adjacent flexor pollicis longus tendon should be identified within the carpal
tunnel. Dynamic imaging with flexion and extension of the fingers will demonstrate normal
motion of these tendons. The median nerve lies superficial to these tendons and deep to

the flexor retinaculum, and it moves with the tendons but with less amplitude on dynamic
imaging. The distal end of the median nerve is tapered and divides into multiple divisions
for the hand. The palmaris longus tendon lies superficial to the retinaculum. On the radial
side of the wrist, the flexor carpi radialis longus tendon lies within its own canal. It is
important to evaluate the region of the flexor carpi radialis and the radial artery for occult
ganglion cysts, which typically originate from the radiocarpal joint capsule. On the ulnar
side, branches of the ulnar nerve and artery lie within the Guyon canal. The flexor carpi
ulnaris tendon and pisiform bone border the ulnar aspect of the Guyon canal. All of the
tendons can be followed to their sites of insertion if clinically indicated.
2. Ulnar
Placing the transducer transversely on the ulnar styloid and moving distally will allow
visualization of the triangular fibrocartilage complex (TFCC) in its long axis. The
transducer is then moved 90° to view the short axis of the TFCC. The ulnomeniscal
homologue may be seen just deep to the extensor carpi ulnaris tendon. This tendon
should be viewed in supination and pronation to assess for subluxation.
3. Dorsal
Structures are very superficial on the dorsal surface, and a high-frequency transducer is
required with or without the use of a standoff pad. The extensor retinaculum divides the
dorsal aspect of the wrist into 6 compartments, which accommodate 9 tendons. These
tendons are examined in their short axes initially and then in their long axes in static and
dynamic modes, the latter being performed with flexion and extension of the fingers. The
tendons can be followed to their sites of insertion when clinically indicated. Moving the
transducer transversely distal to the Lister tubercle identifies the dorsal aspect of the
scapholunate ligament, a site of symptomatic ligament tears and ganglion cysts. The
remaining intercarpal ligaments are not routinely assessed. In patients with suspected
inflammatory arthritis, the dorsal radiocarpal, midcarpal, metacarpophalangeal, and, if
symptomatic, proximal interphalangeal joints are evaluated from the volar and dorsal
aspects in both the longitudinal and transverse planes for effusion, synovial hypertrophy,
and bony erosions. Other joints of the wrist and hand are similarly evaluated as clinically
indicated.
D. Specifications for a Hip Examination
Depending on the patient’s habitus, a lower-frequency transducer may be required to
scan the hip. However, the operator should use the highest possible frequency that
provides adequate penetration. The patient is placed supine to examine the anterior hip
and turned as necessary to visualize the posterior, medial, and/or lateral hip. The
examination may involve a complete assessment of 1 or more of the 4 anatomic regions
of the hip described below or may be focused on a specific structure depending on the
clinical presentation. Color and power Doppler imaging may be useful in detecting
hyperemia within the joint or surrounding structures.
1. Anterior
A sagittal oblique plane parallel to the long axis of the femoral neck is used for evaluating
the femoral head, neck, joint effusion, and synovitis. The sagittal plane is used for the
labrum, iliopsoas tendon and bursa, femoral vessels, and sartorius and rectus femoris
muscles. The above structures are then scanned in the transverse plane, perpendicular
to the original scan plane. When a “snapping hip” is suspected, dynamic scanning is
performed over the region of interest using the same movement that the patient
describes as precipitating the complaint. The snapping hip is usually related to the
iliopsoas tendon as it passes anteriorly over the superior pubic bone or laterally where
the iliotibial tract crosses the greater trochanter.

2. Lateral
In the lateral decubitus position, with the symptomatic side up, transverse and
longitudinal scans of the greater trochanter, greater trochanteric bursa, gluteus medius,
gluteus maximus, gluteus minimus, and tensor fascia lata should be performed. An
iliotibial tract that snaps over the greater trochanter can be assessed in this position using
dynamic flexion-extension.
3. Medial
The hip is placed in external rotation with 45° knee flexion (frog leg position). The distal
iliopsoas tendon, due to its oblique course, may be better seen in this position. The
adductor muscles are imaged in their long axis with the probe in a sagittal oblique
orientation, with short-axis images obtained perpendicular to this plane. In addition, the
pubic bone and symphysis and the distal rectus abdominis insertion should be evaluated.
4. Posterior
The patient is prone with the legs extended. Transverse and longitudinal views of the
glutei, hamstrings, and sciatic nerve are obtained. The glutei are imaged obliquely from
origin to greater trochanter (gluteus medius and minimus) and linea aspera (gluteus
maximus). The sciatic nerve is scanned in its short axis from its exit at the greater sciatic
foramen, deep to the gluteus maximus. It can be followed distally, midway between the
ischial tuberosity and greater trochanter, lying superficial to the quadratus femoris
muscle. For information on the neonatal hip, see the AIUM Practice Guideline for the
Performance of an Ultrasound Examination for Detection and Assessment of
Developmental Dysplasia of the Hip.
E. Specifications for a Prosthetic Hip Examination
The hip is assessed for joint effusions and extra-articular fluid collections, often as part of
an ultrasound-guided procedure for fluid aspiration in the clinical scenario of possible
prosthetic joint infection. The regions of the greater trochanter and iliopsoas are
evaluated for fluid collections or tendon abnormalities such as tendinosis or tears of the
iliopsoas, gluteus medius, and gluteus minimus tendons.
F. Specifications for a Knee Examination
An ultrasound examination of the knee is divided into 4 quadrants. The examination may
involve a complete assessment of 1 or more of the 4 quadrants of the knee described
below or may be focused on a specific structure depending on the clinical presentation.
Color and power Doppler imaging may be useful in detecting hyperemia within the joint or
surrounding structures
1. Anterior
The patient is supine with the knee flexed to 30°. Longitudinal and transverse scans of
the quadriceps and patellar tendons, patellar retinacula, and suprapatellar recess are
obtained. The distal femoral trochlear cartilage can be assessed with the probe placed in
the suprapatellar space in the transverse plane and with the knee in maximal flexion.
Longitudinal views of the cartilage over the medial and lateral femoral condyles are
added as indicated. The prepatellar, superficial, and deep infra-patellar bursae are also
evaluated.
2. Medial
The patient remains supine with slight flexion of the knee and hip and with slight external
rotation of the hip. Alternatively, the patient may be placed in the lateral decubitus
position. The medial joint space is examined. The medial collateral ligament, pes
anserine tendons and bursa, and medial patellar retinaculum are scanned in both planes.

The anterior horn and body of the medial meniscus may be identified in this position,
particularly with valgus stress. If meniscal pathology is suspected either clinically or by
ultrasound, further imaging with magnetic resonance imaging (MRI) or computed
tomographic arthrography if there are contraindications to MRI is advised.
3. Lateral
The patient remains supine with the ipsilateral leg internally rotated or in a lateral
decubitus position. A pillow may be placed between the knees for comfort. From posterior
to anterior, the popliteus tendon, biceps femoris tendon, fibular collateral ligament, and
iliotibial band are scanned. The lateral patellar retinaculum can also be assessed in this
position (as well as in the anterior position). The joint line is scanned for lateral meniscal
pathology, with varus stress applied as needed.
4. Posterior
The patient lies prone with the leg extended. The popliteal fossa, semimembranosus,
medial, and lateral gastrocnemius muscles, tendons, and bursae are assessed. To
confirm the diagnosis of a popliteal cyst, the comma-shaped extension toward the
posterior joint has to be visualized sonographically in the posterior transverse scan
between the medial head of the gastrocnemius and semimembranosus tendon. In
addition, the posterior horns of both menisci can be evaluated. The posterior cruciate
ligament may be identifiable in a sagittal oblique plane in this position.
G. Specifications for an Ankle and Foot Examination
An ultrasound examination of the ankle is divided into 4 quadrants (anterior, medial,
lateral, and posterior). The examination may involve a complete assessment of 1 of the 4
quadrants described below or may be focused on a specific structure depending on the
clinical presentation. Examination of the foot is most often focused on a particular
structure to answer the clinical question (for example, plantar fasciitis, Morton neuroma,
or a ganglion cyst). Color and power Doppler imaging may be useful in detecting
hyperemia within the joint or surrounding structures.
1. Anterior
The patient lies supine with the knee flexed and the plantar aspect of the foot flat on the
table. The anterior tendons are assessed in long- and short-axis planes from their
musculotendinous junctions to their distal insertions. From medial to lateral, this tendon
group includes the tibialis anterior, extensor hallucis longus, extensor digitorum longus,
and peroneus tertius tendons (the latter being congenitally absent in some patients). The
anterior joint recess is scanned for effusion, loose bodies, and synovial thickening. The
anterior joint capsule is attached to the anterior tibial margin and the neck of the talus,
and the hyaline cartilage of the talus appears as a thin hypoechoic line. The anterior
inferior tibiofibular ligament of the syndesmotic complex is assessed by moving the
transducer proximally over the distal tibia and fibula, superior and medial to the lateral
malleolus, and scanning in an oblique plane.
2. Medial
The patient is placed in a lateral decubitus position with the medial ankle facing upward.
The posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons (located in
this order from anterior to posterior) are initially scanned in the short-axis plane proximal
to the medial malleolus to identify each tendon. They are then assessed in long- and
short-axis planes from their proximal musculotendinous junctions in the supramalleolar
region to their distal insertions. To avoid anisotropy, the angulation of the transducer
must be adjusted continuously for the ultrasound beam to remain perpendicular to the
tendons as they curve under the medial malleolus. The same holds true when assessing
the lateral aspect of the ankle, as described below. The tibial nerve can be scanned by
identifying it between the flexor digitorum tendon anteriorly and the flexor hallucis longus

tendon posteriorly, at the level of the malleolus. The nerve can then be followed
proximally and distally. The flexor hallucis longus may also be scanned in the posterior
position, medial to the Achilles tendon. The deltoid ligament is scanned longitudinally
from its attachment to the medial malleolus to the navicular, talus, and calcaneus.
3. Lateral
The patient is placed in a lateral decubitus position with the lateral ankle facing upward.
The peroneus brevis and longus tendons are identified proximal to the lateral malleolus in
their short-axis planes, and they can then be assessed in long- and short-axis planes
from their proximal (supramalleolar) musculotendinous junctions to their distal insertions.
The peroneus longus can be followed in this manner to the cuboid groove where it turns
to course medially along the plantar aspect of the foot to insert on the base of the first
metatarsal and medial cuneiform. This latter aspect of the tendon can be scanned in the
prone position as clinically indicated. The peroneus brevis tendon is followed to its
insertion on the base of the fifth metatarsal. The peroneus brevis and longus tendons are
assessed for subluxation using real-time images with dorsiflexion and eversion.
Circumduction of the ankle can also be a helpful maneuver. The lateral ligament complex
is examined by placing the transducer on the tip of the lateral malleolus in the following
orientations: anterior and posterior horizontal oblique for the anterior and posterior
talofibular ligaments and posterior vertical oblique for the calcaneofibular ligament.
4. Posterior
The patient is prone with feet extending over the end of the table. The Achilles tendon is
scanned in long- and short-axis planes from the musculotendinous junctions (medial and
lateral heads of the gastrocnemius and soleus muscles) to the site of insertion on the
posterior surface of the calcaneus. Dynamic scanning with plantar and dorsiflexion may
aid in the evaluation of tears. The plantaris tendon lies along the medial aspect of the
Achilles tendon and inserts on the posteromedial calcaneus. It should be noted that this
tendon may be absent as a normal variant but is often intact in the setting of a fullthickness
Achilles tendon tear. The retrocalcaneal bursa, between the Achilles and
superior calcaneus, is also assessed. Assessment for a superficial retro Achilles bursa is
facilitated by floating the transducer on ultrasound gel and evaluating for fluid within the
subcutaneous tissues. The plantar fascia is scanned in both long- and short-axis planes
from its proximal origin on the medial calcaneal tubercle distally where it divides and
merges into the soft tissues.
5. Digital
In patients with suspected inflammatory arthritis, the metatarsophalangeal joints and, if
symptomatic, proximal interphalangeal joints are evaluated from the plantar and dorsal
aspects in both the longitudinal and transverse planes for effusion, synovial hypertrophy,
synovial hyperemia, and bony erosions. Other joints of the foot are similarly evaluated as
clinically indicated.
6. Interdigital
The patient is supine with the foot dorsiflexed 90° to the ankle. Either a dorsal or plantar
approach can be used. The latter will be described here. The transducer is placed
longitudinally on the plantar aspect of the first interdigital space, and the examiner applies
digital pressure on the dorsal surface. The transducer is moved laterally with its center at
the level of the metatarsal heads. The process is repeated for the remaining interspaces
and then repeated in the transverse plane. When a Morton neuroma is clinically
suspected, pressure can be applied to reproduce the patient’s symptoms. The
intermetatarsal bursa lies on the dorsal aspect of the interdigital nerve, and care must be
taken to correctly identify a neuroma and differentiate it from the bursa.

H. Specifications for a Peripheral Nerve Examination
Nerves have a fascicular pattern with hypoechoic longitudinal neuronal fascicles
interspersed with hyperechoic interfascicular epineurium. In addition, they have a
hyperechoic superficial epineurium. As a nerve bifurcates, each fascicle enters one of the
subdivisions without splitting. Nerves course adjacent to vessels and are readily
distinguished from the surrounding tendons with a dynamic examination, during which the
nerve demonstrates relatively little movement compared to the adjacent tendons. Nerves
may become more hypoechoic as they pass through fibro-osseous tunnels, as the
fascicles become more compact. Examination in the short-axis plane is usually preferred
to assess the course of the nerve because it may be difficult to separate the nerve itself
from the surrounding tendons and muscles on a longitudinal scan. Assessment at the
level of fibro-osseous tunnels may require a dynamic examination. A statically dislocated
nerve is readily identifiable on ultrasound imaging, but an intermittently subluxating nerve
requires a dynamic examination. Perhaps the most commonly subluxating nerve is the
ulnar nerve within the cubital tunnel (see Specifications for an Elbow Examination).
Entrapment neuropathies also typically occur within fibro-osseous tunnels, (eg, cubital
and Guyon tunnels for the ulnar nerve, carpal tunnel for the median nerve, fibular neck
for the common peroneal nerve, and tarsal tunnel for the tibial nerve). Adjacent pathology
of tendons, soft tissues, and bone can be readily evaluated to determine the potential
underlying cause of the nerve dysfunction. In addition, congenital abnormalities, (eg,
accessory muscles or vessels) can be assessed.
I. Specifications for a Soft Tissue Mass Examination
The mass should be scanned in both long- and short-axis planes. Ultrasound imaging is
an excellent method for differentiating solid from cystic masses. The mass should be
measured in 3 orthogonal dimensions, and its relationship with surrounding structures,
particularly joints, neurovascular bundles, and tendons, should be determined.
Compressibility of the lesion should be evaluated. A color or power Doppler evaluation
may help delineate intralesional and extralesional vessels and vascularity of a mass.
J. Specifications for Interventional MSK Ultrasound
Ultrasound imaging is an ideal modality for image guidance of interventional procedures
within the MSK system. The usual standards for interventional procedures apply (ie,
review prior imaging, appropriate consent, local anesthetic, and sterile conditions). The
use of a sterile drape that surrounds the prepared site, a sterile ultrasound probe cover,
and sterile gloves will lower the risk of contamination and infection. Ultrasound provides
direct visualization of the needle, monitors the needle pathway, and shows the position of
the needle within the target area. Direct visualization of the needle allows the practitioner
to avoid significant intralesional and extralesional vessels, adjacent nerves, and other
structures at risk.
Before any procedure, an ultrasound examination to characterize the target area and its
relationship to surrounding structures is performed. Color or power Doppler imaging is
useful to delineate any vessels within the target zone. Ideally, the shortest pathway to the
region of interest should be selected, with consideration given to regional neurovascular
structures. The transducer is aligned in the same longitudinal plane as the needle. The
needle can be attached directly to the transducer or held freehand. Either way, the
needle is visualized throughout the procedure. Slight to-and-fro movement or injection of
a small amount of sterile saline or air may be beneficial in visualizing the needle. In cases
of biopsy, focal areas of vascularity indicate viable tissue for pathologic examination.

K. Specifications for an Ultrasound Examination for Detecting
Foreign Bodies
Most foreign bodies are associated with an acoustic shadow or comet tail artifact. Foreign
bodies also commonly have a surrounding soft tissue reaction. Once a foreign body is
detected, ultrasound can be used to demonstrate its relationship to adjacent structures.
In addition to a high-frequency linear array transducer, detection of foreign bodies in
superficial subcutaneous tissues may require a standoff pad. Color and power Doppler
imaging may be useful in detecting the tissue reaction that often surrounds a soft foreign
body. When available, 3-dimensional imaging may be useful for localization.
VII. Documentation
Adequate documentation is essential for high-quality patient care. There should be a
permanent record of the ultrasound examination and its interpretation. Images of all
appropriate areas, both normal and abnormal, should be recorded. Variations from
normal size should be accompanied by measurements. Images should be labeled with
the patient identification, facility identification, examination date, and side (right or left) of
the anatomic site imaged. An official interpretation (final report) of the ultrasound findings
should be included in the patient’s medical record. Retention of the ultrasound
examination should be consistent both with clinical needs and with relevant legal and
local health care facility requirements. Reporting should be in accordance with the AIUM
Practice Guideline for Documentation of an Ultrasound Examination.

NEONATAL SPINE (AIUM)
http://www.aium.org/resources/guidelines/neonatalSpine.pdf
Indications/Contraindications
A. Indications
The indications for sonography of the neonatal spinal canal and its contents include but
are not limited to:
1. Lumbosacral stigmata known to be associated with spinal dysraphism, including but
not limited to:
a. Midline or paramedian masses;
b. Skin discolorations;
c. Skin tags;
d. Hair tufts;
e. Hemangiomas;
f. Pinpoint midline dimples; and
g. Paramedian deep dimples;
2. The spectrum of caudal regression syndrome, including patients with sacral agenesis
and patients with anal atresia or stenosis;
3. Evaluation of suspected defects such as cord tethering, diastematomyelia,
hydromyelia,
and syringomyelia;
4. Detection of sequelae of injury, such as:
a. Hematoma after spinal tap or birth injury;
b. Sequelae of prior instrumentation, infection, or hemorrhage; and
c. Posttraumatic leakage of cerebrospinal fluid (CSF);
5. Visualization of fluid with characteristics of blood products within the spinal canal in
patients with intracranial hemorrhage;
6. Guidance for lumbar puncture9; and
7. Postoperative assessment for cord retethering.
Infants with simple, low-lying sacrococcygeal dimples typically have normal spinal
contents; for them, the examination has a low diagnostic yield. On the other hand,
atypical dimples, such as those larger than 5 mm, located greater than 2.5 cm above the
anus, or seen in combination with other lesions, are at higher risk of occult spinal
dysraphism.3 A sacral dimple or congenital sinus that is leaking CSF will need further
assessment with magnetic resonance imaging, and sonography is therefore not a
mandatory first examination in this circumstance.
B. Contraindications
1. Preoperative examination in patients with open spinal dysraphism; and
2. Examination of the contents of a closed neural tube defect if the skin overlying the
defect is thin or no longer intact.
V. Specifications of the Examination
The examination should be performed with the infant lying in the prone position, although
the study can also be done with the patient lying on his or her side when necessary. A
small bolster, such as a rolled blanket, may be placed under the lower abdomen/pelvis to
help position the patient. The knees may be flexed to the abdomen to allow adequate
spacing of the spinous processes and visualization of the spinal canal contents. An infant
who has recently been fed will generally lie quietly during the examination. If feeding is
not possible, a pacifier dipped in glucose solution will often be helpful in keeping an infant
still for an optimal examination. It is important to note that infants, particularly if not full

term, have difficulty maintaining normal body temperature. Therefore, the examination
should be performed in a warm room, and the coupling agent should be warmed.
The cord should be assessed in the longitudinal and transverse planes, with right and left
labeled on transverse images. The examination may be limited to the lumbosacral region
in specific cases, such as in patients being evaluated for a sacrococcygeal dimple or in
those patients being scanned to look for the presence of hematoma after an unsuccessful
or traumatic spinal tap. The entire spinal canal, from the craniocervical junction to the
coccyx, may be included in appropriately selected cases.
The normal cord morphologic characteristics and the level of termination of the conus
should be assessed and documented. To do this, the vertebral body levels need to be
accurately identified and numbered. Once the vertebral bodies are clearly numbered, the
level of termination of the conus can be determined. In normal patients, the conus should
lie at or above the L2 to L3 disk space In fetuses and extremely preterm neonates, the
normal conus medullaris may be caudal to the superior endplate of L3.14 In a preterm
neonate with a conus that terminates at the L3 midvertebral body, a follow-up sonogram
after age correction of 40 weeks’ gestation but before age correction of 6 months is
warranted.8 The level of termination of the conus and its configuration should be
documented, as well as any deviations from normal.
The vertebral level can be determined in a number of ways. These include:
1. After assessment of the normal lumbosacral curvature to locate the last lumbar
vertebra or L5, the vertebral level of the conus is determined by counting the
cephalad. This method tends to be more reproducible than the other methods
described below, which rely on counting the number of rib-bearing vertebrae or
the number of ossified sacral and coccygeal segments and can lead to less
reliable results.
2. The first coccygeal segment has variable ossification at birth but, if ossified, can
be distinguished by its more rounded shape compared with the square or
rectangular shape of the sacral bodies. Counting cephalad from S1 again can
help determine the vertebral level of the conus.
3. The last rib-bearing vertebra can be presumed to be T12, and the sequential
lumbar level can be thus determined.
4. When the level of the conus cannot be definitively assessed as normal or
abnormal, correlation with previous plain radiographs, if available, is helpful. A
radiopaque marker can be placed on the skin at the level of the conus under
sonographic guidance, followed by and correlated with a spine radiograph.
The level of termination of the cord is important in assessment of tethering. The cord
position within the spinal canal and motion of cord and nerve roots are also helpful
parameters in assessment for cord tethering. The normal position of the cord within the
spinal canal, and deviation from normal, such as apposition to the dorsal aspect of the
spinal canal as seen in tethering, should be documented. Cine evaluation can be helpful
both in depicting anatomy and in showing movement of the distal cord and nerve roots in
conjunction with cardiac-related pulsations of the spinal CSF. M-mode imaging can also
be very helpful in documenting motion of the cord and nerve roots. The normal nerve
roots pulsate freely with cardiac and respiratory motion, layer dependently with variable
patient positioning, and are not adherent to each other. Cine evaluation can also
document changes that occur with head flexion and extension.
A standoff pad or a thick layer of coupling gel may be used, if needed, to follow a tract
from the skin surface.
The integrity of the cord should be documented. Areas of abnormal fluid accumulation,
such as hydromyelia or syringomyelia, anterior, lateral, or posterior meningoceles or

pseudomeningoceles, or arachnoid cysts, should be documented and their level
identified. Transverse images are essential to identify and document diastematomyelia,
with off-center scanning to avoid the potential pitfall of a reverberation artifact creating a
lateral duplication or ghost image The subarachnoid space should be evaluated for a
normal anechoic appearance, interrupted by normal hyperechoic linear nerve roots and
dentate ligaments. The subarachnoid space, dura, and epidural space should be
evaluated, and abnormalities such as hematoma, lipoma, and other masses should be
documented.
In addition to the termination of the conus, the termination of the thecal sac, typically
located at S2, should be documented. The normal filum measures less than 2 mm in
thickness. If the filum is abnormally hyperechoic or appears thickened, it should be
measured and documented. The nerve roots of the cauda equina should be delineated
within the thecal sac. In cases of failed lumbar puncture, additional imaging with the child
supported in a seated position, bending forward, may be useful to allow gravity to distend
the lower thecal sac with CSF. Meningoceles or pseudomeningoceles in some patients.
Anterior meningoceles or presacral masses should also be scanned from an anterior
position.
The vertebral bodies and posterior elements should be evaluated for deformities.
Dysraphic defects with open posterior elements should be documented on transverse
views.
VI. Documentation
Adequate documentation is essential for high-quality patient care. There should be a
permanent record of the ultrasound examination and its interpretation. Images of all
appropriate areas, both normal and abnormal, should be recorded. Variations from
normal size should be accompanied by measurements. Images should be labeled with
the patient identification, facility identification, examination date, and side (right or left) of
the anatomic site imaged.
An official interpretation (final report) of the ultrasound findings should be included in the
patient’s medical record. Retention of the ultrasound examination should be consistent
both with clinical needs and with relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation
of an Ultrasound Examination.
VII. Equipment Specifications
Sonography of the infant spine should be performed with real-time scanners using
highfrequency linear array transducers, typically 7 to 10 MHz or higher in neonates.19
When possible, panoramic views of the entire spinal canal are very helpful in providing an
overview of the anatomy and termination of the cord and thecal sac. Images of the
craniocervical junction may need to be obtained with a small vector or tightly curved array
transducer.

Neurosonography (AIUM)
http://www.aium.org/resources/guidelines/neurosonography.pdf
Indications/Contraindications
Indications for neurosonography in preterm and term neonates and infants
include but are not limited to the
following:
1. To screen for hemorrhage or parenchymal abnormalities in
preterm infants;
2. To evaluate for hemorrhage;
3. To evaluate for hydrocephalus;
4. To evaluate for the presence of vascular abnormalities;
5. To evaluate for possible or suspected hypoxic ischemic
encephalopathy;
6. To evaluate for the presence of congenital malformations;
7. To evaluate patients with signs and/or symptoms of central
nervous system
disorders, eg, seizures and facial malformations;
8. For follow-up or surveillance of previously documented
abnormalities,
including prenatal abnormalities;
9. For screening before surgical procedures.
There are no contraindications to neurosonography.
Specifications of the Examination
Standard Imaging Examination of the Neonate and Infant
The coronal view, by convention, should have the patient’s right side on
the left side of the image. The right or left side of the patient should be
clearly annotated on the images.
Representative coronal views angling from anterior to posterior are
performed through the anterior fontanelle and should include, sequentially:
1. The frontal lobe and frontal horns of the lateral ventricles;
2. The septum pellucidum, corpus callosum, and portions of the
frontal, parietal,
and temporal lobes;
3. The caudothalamic groove and basal ganglia;
4. The bodies of the lateral ventricles; and
5. The posterior portions of the temporal lobes, occipital lobes,
fourth ventricle,
cerebellum, and cisterna magna.

The transducer may be tilted from side to side to image as much of the
superficial peripheral surfaces of the cerebral hemispheres as possible.
The frequency of the transducer should be selected to ensure that the
superficial and deep structures are well depicted. This may necessitate
using more than 1 frequency setting, a linear transducer, or a standoff pad
to aid in imaging of the superior sagittal sinus and superficial central
cerebral structures.
The sagittal view, by convention, should place the anterior aspect of the
brain on the left side of the image. The right side, midline, or left side
should be clearly annotated. Sequential representative sagittal views are
obtained with appropriate degrees of left and right transducer angulation.
On each side, these views should include the caudothalamic groove, the
lateral ventricle with demonstration of the occipital horn and its choroid
plexus, the periventricular white matter, the sylvian fissure, and the middle
cerebral artery branches (angiographic sylvian triangle equivalent). A
midline sagittal view should include the corpus callosum, the cavum
septum pellucidum and cavum vergae extension (if present), the third
ventricle, the area of the aqueduct of Sylvius, the fourth ventricle, the
vermis of the cerebellum, and the cisterna magna.
Additional views, if necessary, may be taken through the posterior or
mastoid fontanelles, the foramen magnum, any open suture, or thin areas
of the temporoparietal bone. The transtemporal approach may also be
used to visualize the circle of Willis and its major branches. Cine loop
software, when available, can be useful in demonstrating real-time
information.
When clinically indicated, spectral, color, and/or power Doppler imaging
may be useful for evaluating vascular structures through any fontanelle or
via the transcranial technique.
Documentation
Adequate documentation is essential for high-quality patient care. There
should be a permanent record of the ultrasound examination and its
interpretation. Images of all appropriate areas, both normal and abnormal,
should be recorded. Variations from normal size should be accompanied
by measurements. Images should be labeled with the patient
identification, facility identification, examination date, and side (right or left)
of the anatomic site imaged. An official interpretation (final report) of the
ultrasound findings should be included in the patient’s medical record.
Retention of the ultrasound examination should be consistent both with
clinical needs and with relevant legal and local health care facility
requirements.

Merced College: Neonatal Head (Simulation)
‣ Use warm gel and keep the baby warm
‣ Use VERY gentle scanning pressure…do not push!
‣ Coronal scan plane survey
‣ Sagittal scan plane survey
Coronal at Anterior Fontanelle
Frontal lobes and orbital roof
Anterior horns
Third ventricle and mid lateral ventricles
Trigone/Atria of the lateral ventricles
Occipital region/lobe
Additional images may be required for specific pathology
Sagittal at Anterior Fontanelle
Right Midline
Right Parasagittal Caudothalamic Groove
Right Tangential Parasagittal with Sylvian Fissure
Left Midline
Left Parasagittal Caudothalamic Groove
Left Tangential Parasagittal with Sylvian Fissure
Additional images may be required for specific pathology

AIUM Practice Guideline for the Performance of an
Ultrasound Examination of the Extracranial Cerebrovascular
System
© 2011 by the American Institute of Ultrasound in Medicine
http://aium.org/resources/guidelines/extracranial.pdf (refer to this website for the
complete document)
Extracranial Cerebrovascular Ultrasound
Indications
Indications for an ultrasound examination of the extracranial carotid and vertebral arteries
include but are not limited to:
Evaluation of patients with hemispheric neurologic symptoms, including stroke,
transient
ischemic attack, and amaurosis fugax
Evaluation of patients with a cervical bruit;
Evaluation of pulsatile neck masses;
Preoperative evaluation of patients scheduled for major cardiovascular surgical
procedures;
Evaluation of nonhemispheric or unexplained neurologic symptoms;
Follow-up of patients with proven carotid disease;
Evaluation of postoperative patients after cerebrovascular revascularization,
including
carotid endarterectomy, stenting, or carotid-to-subclavian bypass;
Intraoperative monitoring of vascular surgery;
Evaluation of suspected subclavian steal syndrome;
Evaluation for suspected carotid artery dissection, arteriovenous fistula, or
pseudoaneurysm; and
Patients with carotid reconstruction after extracorporeal membrane oxygenation
bypass.
Specifications of the Examination
A. Technique
Extracranial cerebrovascular ultrasound evaluation consists of assessment of the
accessible portions of the common and internal carotid arteries and basic assessment of
the external carotid and vertebral arteries. All arteries should be scanned using
appropriate gray scale and Doppler techniques and proper patient positioning. Gray
scale imaging of the common carotid artery, its bifurcation, and both the internal and
external carotid arteries should be
performed in longitudinal and transverse planes. The internal carotid and common carotid
arteries should be imaged as completely as possible with caudad angulation of the
transducer in the supraclavicular area and cephalad angulation at the level of the
mandible. Color Doppler imaging should be used to detect areas of narrowing and
abnormal flow to select areas for Doppler spectral analysis. Color Doppler imaging
should also be used to clarify the cause of image/pulsed Doppler mismatches and to
detect narrow flow channels seen in high-grade (near-occlusive) stenoses.8 Power
Doppler evaluation may be helpful to search for a narrow channel of residual flow in
suspected occlusion or near occlusion.

Spectral Doppler imaging with angle-corrected blood-flow velocity measurements should
be obtained at representative sites in the vessels. Additionally, scanning in areas of
stenosis or suspected stenosis must be adequate to determine the maximal peak systolic
velocity associated with the stenosis and to document disturbances in the waveform
distal to the stenosis. Consistent angle correction is essential for determining blood flow
velocity. All angle-corrected spectral Doppler waveforms must be obtained from
longitudinal images.
Angle correction should be applied in a consistent manner for all measurements (typically
either parallel to the vessel wall or in line with the color lumen but not both). The angle
between the direction of flowing blood and the applied Doppler ultrasound signal (angle
[theta], the Doppler angle) should not exceed 60°. The reliability of velocity
measurements decreases significantly at angles greater than 60°, and the use of velocity
measurements obtained at angles greater than 60° is discouraged. Deviations from the
protocol may be unavoidable (eg, with a very tortuous vessel) but should be minimized.
Gain should be appropriate for the vessel scanned (undergaining or overgaining may
affect velocity measurements).
B. Recording
1. Gray Scale Images—At a minimum, for each normal side evaluated, gray scale images
must be obtained at each of the following levels:
a. Long axis, common carotid artery;
b. Long axis, at the carotid artery bifurcation;
c. Long axis, internal carotid artery; and
d. Short axis, proximal internal carotid artery.
If abnormalities are found, additional images must be recorded:
a. If atherosclerotic plaques are present, their extent, location, and characteristics
should be documented with gray scale imaging in both the longitudinal and
transverse
planes.
b. Other vascular or significant perivascular abnormalities should be
documented.
2. Color Doppler Images—Color images may be recorded using appropriate color
technique
to show filling of the normal lumen and/or flow disturbances associated with stenoses. In
cases of occlusion, a color and/or power Doppler image of the abnormal vessel should be
obtained to confirm that it is occluded.
3. Spectral Doppler Images—For each normal side evaluated, spectral Doppler
waveforms
and maximal peak systolic velocities must be recorded at each of the following levels:
a. Proximal common carotid artery;
b. Mid or distal common carotid artery (generally 2–3 cm below the bifurcation);
c. Proximal internal carotid artery;
d. Distal internal carotid artery;
e. Proximal external carotid artery; and
f. Vertebral artery (in neck or near origin).
If significant stenosis is found or suspected, additional images must be recorded and the
location
of the stenosis determined:

a. At the site of maximum velocity due to the stenosis; and
b. Distal to the site of maximal velocity to document the presence or absence of
disturbed flow.
Diastolic velocities and velocity ratios may also be calculated as warranted depending on
the
laboratory interpretation criteria.
The peak systolic velocity and flow direction in each of the vertebral arteries should be
recorded.
Stents require additional images. Indwelling stents should be sampled within, proximal,
and
distal to each stent, and the site of highest velocity should be determined and recorded.
Interpretation
The interpretation of cerebrovascular ultrasound images requires careful attention to
protocol
and interpretation criteria.
1. Each laboratory must have interpretation criteria that are used by all members of
the
technical and physician staff.
2. Diagnostic criteria must be derived from the literature from internal validation
based
on correlation with other imaging modalities or from surgical and/or pathologic
correlation.
3. The report must indicate internal carotid artery stenosis categories that are
clinically
useful and nationally accepted. Stenosis of greater than 50% should be graded as
a
range (eg, 50%–69% or 70% to near occlusion) or a numeric grade (eg, 60% ±
10%)
to provide adequate information for clinical decision making. Numerous factors
affect
interpretation criteria (eg, contralateral severe disease or occlusion and ipsilateral
near
occlusion).
4. The report must indicate the vertebral artery flow direction and should indicate
an
abnormal waveform shape.
5. The report may indicate plaque characterization depending on the laboratory
interpretation
criteria.
6. The report should indicate other significant nonvascular abnormalities.
7. The criteria for common and external carotid artery stenosis differ from internal
carotid artery criteria.
8. Stents require different criteria than native vessels.
When available, modalities, parameters, and tests other than duplex ultrasound
imaging may
add valuable information to the cerebrovascular Doppler ultrasound examination.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a
permanent record of the ultrasound examination and its interpretation. Images of all
appropriate areas, both normal and abnormal, should be recorded. Variations from
normal size should be accompanied by measurements. Images should be labeled with

the patient identification, facility identification, examination date, and side (right or left) of
the anatomic site imaged.
An official interpretation (final report) of the ultrasound findings should be included in the
patient’s medical record. Retention of the ultrasound examination should be consistent
both with clinical needs and with relevant legal and local health care facility requirements.
Practice Guideline for the Performance of Peripheral Arterial
Ultrasound Examinations
© 2010 by the American Institute of Ultrasound in Medicine
Indications
The indications for peripheral arterial ultrasound examination include but are not limited
to:
1. The detection of hemodynamically significant stenoses or occlusions in
specified segment(s) of the peripheral arteries in symptomatic patients with
suspected arterial occlusive disease. These patients could present with
recognized clinical indicators,
including claudication, rest pain, ischemic tissue loss, and suspected arterial
embolizations.
2. The monitoring of sites of previous surgical interventions, including sites of
previous bypass surgery with either synthetic or autologous vein grafts.
3. The monitoring of sites of various percutaneous interventions, including
angioplasty, thrombolysis/ thrombectomy, atherectomy, and stent placements.
4. The evaluation of suspected vascular and perivascular abnormalities, including
such entities as masses, aneurysms, pseudoaneurysms, and arteriovenous
fistulas.
5. Mapping of arteries before surgical interventions.
6. Clarifying or confirming the presence of significant arterial abnormalities
identified by other imaging modalities.
Additional uses of Doppler ultrasound can include preoperative mapping for dialysis
access and postoperative follow-up
Specifications of the Examination
The initial examination for determining the presence of arterial occlusive disease remains
the determination of blood pressures in the extremities being studied. Blood pressure
measurement at different levels should be reported as a ratio (eg, ankle/brachial index)
where appropriate. The sonographic examination consists of gray scale imaging and the
evaluation of the spectral Doppler waveforms in the corresponding arterial segments.
Color Doppler ultrasound should be used to improve detection of arterial lesions and
guide placement of the sample volume for spectral Doppler assessment.
Appropriate Techniques and Diagnostic Criteria
Specific sonographic techniques must be tailored to the different arterial segments
studied and to the specific pathology being evaluated. Established imaging, Doppler, and
pressure criteria may be used to identify arterial stenoses and occlusions, identify graft

abnormalities, detect abnormal arteriovenous communications, and evaluate suspected
soft tissue abnormalities in proximity to an artery.
Arterial Occlusive Disease
For arterial occlusive disease, the following general considerations apply. The full length of
the arterial segment(s) of interest should be evaluated with color Doppler ultrasound.
Suspected abnormalities should also be imaged with gray scale ultrasound.
Representative spectral Doppler waveforms with velocity measurements should be
obtained and documented along the length of the arterial segment(s) and at any area of
color or gray scale abnormality. A spectral Doppler waveform with velocity measurements
in the arterial segment 2 to 4 cm proximal to (upstream of) any stenosis should be
documented. The location and the length of any diseased or nonvisualized segment(s)
should also be documented. Every attempt should be made to acquire spectral Doppler
waveforms with velocity measurements with the angle between the direction of moving
blood and the direction of the ultrasound beam kept at less than or equal to 60°. Velocity
estimates made with larger angles are less reliable.
An evaluation of the following arterial segments should generally be performed as
indicated below. However, a focused or limited examination may be appropriate in certain
clinical situations. At a minimum, an angle-corrected spectral Doppler waveform with
velocity measurements should be obtained from the following sites:
1.Lower extremity:
a.Common femoral artery;
b.Proximal superficial femoral artery;
c.Mid superficial femoral artery;
d.Distal superficial femoral artery;
e. Popliteal artery.
If clinically appropriate, imaging of the iliac, deep femoral, tibioperoneal, and dorsalis pedis
arteries can be performed.
2. Upper extremity:
a. Subclavian artery;
b. Axillary artery;
c. Brachial artery.
If clinically appropriate, imaging of the innominate, radial, and ulnar arteries and/or the
palmar arch can be performed.
Evaluation of Surgical and Percutaneous Interventions
1.Bypass grafts: An attempt should be made to sample the full length of any
bypass graft whenever possible with color Doppler ultrasound. Suspected
abnormalities should also be imaged with gray scale ultrasound. Spectral
Doppler waveforms and velocity measurements should be documented in the
native artery proximal to the graft anastomosis, at the proximal anastomosis, at
representative sites along the graft, at the distal anastomosis, and in the native
artery distal to the anastomosis. Angle-corrected spectral Doppler waveforms
and velocity measurements should also be obtained in regions of suspected flow
abnormalities noted on gray scale or color Doppler imaging.
2.Sites having undergone percutaneous interventions: An attempt should be
made to sample the site of selective arterial interventions as well as the segment
immediately proximal (upstream) and distal (downstream) to the site of
intervention. Spectral Doppler
waveforms and velocity measurements should be documented.

Other
1. Suspected soft tissue abnormalities in proximity to arteries: The entire area of
a suspected soft tissue abnormality should be imaged. If appropriate, spectral
and color
Doppler examinations may be performed to determine the presence and nature
of blood flow in the region of the suspected abnormality.
2. Pseudoaneurysms: The size of the pseudoaneurysm, the residual lumen, and
the length and width of the communicating channel should be documented.
Spectral Doppler waveforms should be obtained in the communicating channel to
demonstrate “to-andfro”
flow. In cases of therapeutic intervention, color and/or spectral Doppler
ultrasound may be used as a guide to therapy and as a means of documenting
therapeutic success.
3.Abnormal communication between artery and vein: Color and spectral color
Doppler ultrasound may be used to document the location of abnormal vascular
communications. Angle-corrected spectral Doppler waveforms should be
documented from within vessels
proximal to, in the area of, and distal to abnormal communications. Color Doppler
ultrasound is particularly useful for identifying the level of such communications
and resultant transmitted soft tissue vibrations secondary to the flow
disturbances produced by abnormal vascular communications.
Documentation
Adequate documentation is essential for high-quality patient care. There should be a
permanent record of the ultrasound examination and its interpretation. Images of all
appropriate areas, both normal and abnormal, should be recorded. Variations from
normal size should be accompanied by measurements. Images should be labeled with
the patient identification, facility identification,
examination date, and side (right or left) of the anatomic site imaged. An official
interpretation (final report) of the ultrasound findings should be included in the patient’s
medical record. Retention of the ultrasound examination should be consistent both with
clinical needs and with relevant legal and local health care facility requirements.
Reporting should be in accordance with the AIUM Practice Guideline for Documentation
of an Ultrasound Examination.
Practice Guideline for the Performance of Peripheral Venous
Ultrasound Examinations
© 2010 by the American Institute of Ultrasound in Medicine
Guideline developed in collaboration with the American College of Radiology and the
Society of Radiologists in Ultrasound.
Indications
The indications for peripheral venous ultrasound examinations include but are not limited
to:
1. Evaluation of possible venous thromboembolic disease or venous obstruction
in symptomatic or high-risk asymptomatic individuals.
2. Assessment of venous insufficiency, reflux, and varicosities.
3. Assessment of dialysis access.

4. Venous mapping before surgical
5. Evaluation of veins before venous access.
6. Follow-up for patients with known venous thrombosis near the anticipated end
of anticoagulation to determine if residual venous thrombosis is present.
Specifications of the Examination
The requesting health care provider should be encouraged to provide the pretest
probability of acute deep venous thrombosis and/or the results of a D-dimer assay if
known.
Note: The words proximal and distal refer to the relative distance from the attached end
of the limb, per Gray’s Anatomy. For example, the proximal femoral vein is closer to the
hip, and the distal femoral vein is closer to the knee. The longitudinal or long axis is
parallel to or along the
length of the vein. The transverse or short axis is perpendicular to the long axis of the
vein.
Venous Thromboembolic Disease: Lower Extremity
1. Technique
a. Compression ultrasound: The fullest visualized extent of the common
femoral, femoral (formerly known as the superficial femoral), and
popliteal veins must be imaged using an optimal gray scale compression
technique. The popliteal vein is examined distally to the tibioperoneal
trunk. The proximal deep femoral and proximal great saphenous veins
should also be examined. Venous compression is applied in the
transverse plane with
adequate pressure on the skin to completely obliterate the normal vein
lumen. Focal symptoms will generally require evaluation of those areas.
b. At a minimum (even if the examination is otherwise unilateral), right
and left common femoral or right and left external iliac venous spectral
Doppler waveforms should be recorded to evaluate for asymmetry or
loss of respiratory phasicity. A popliteal venous spectral Doppler
waveform of the symptomatic leg should also be obtained. All spectral
Doppler waveforms should be obtained from the long axis.
c. Color or spectral Doppler evaluation can be used to support the
presence or absence of an abnormality.
2. Recording
a. For normal examinations, at a minimum:
i. Gray scale images should be recorded without and with
compression at each of the following levels:
a. Common femoral vein;
b. Junction of the common femoral vein with the great
saphenous vein;
c. Proximal deep femoral vein;
d. Proximal femoral vein;
e. Distal femoral vein;
f. Popliteal vein.
ii. Spectral Doppler waveforms from the long axis should be
recorded at each of the following levels:
a. Right common femoral or external iliac vein;
b. Left common femoral or external iliac vein;
c. Popliteal vein on symptomatic side or on both sides if
there are bilateral symptoms.
b. Abnormal findings generally require additional images to document the
complete extent of the abnormalities:

i. Symptomatic areas such as the calf generally require
additional evaluation and additional images if the cause of the
symptoms is not readily elucidated by the standard examination.
ii. The extent and location of sites where the veins fail to
compress completely should be clearly recorded and generally
require additional images. Long-axis views without compression
may be helpful to characterize the abnormal vein.
c. The patient presentation, clinical indication, or clinical management
pathways may require protocol adjustments such as more detailed
evaluation of the superficial venous system, evaluation of the deep calf
veins, or a bilateral study.
d. Other vascular and nonvascular abnormalities, if found, should be
recorded but may require additional imaging for diagnosis or further
characterization. Anatomic variations such as duplications should be
noted.
Venous Insufficiency
1. Technique
a. When evaluating for venous insufficiency, the location and duration of
reversed blood flow should be determined during the performance of accepted
maneuvers.
b. Duplex interrogation should be performed at as many levels as necessary to
ensure a complete examination based on the clinical indications. Generally,
veins in the superficial and deep systems should be evaluated.
c. Augmentation with squeezing of the calf musculature should generally be
used. The Valsalva maneuver may be used at the groin.
d. The patient should be situated in the erect position for the detection or
exclusion of reflux. The reverse Trendelenburg position can be used if erect
scanning is not possible. The examined leg should be in a non–weight-bearing
position. The patient should not be studied for reflux in the supine position.
e. All spectral Doppler waveforms should be obtained from the long axis.
2. Recording
a. Recordings should document the extent and location of reflux. Varicosities and
abnormal perforating veins should generally also be documented.
b. Recording the size of dilated vessels may be helpful for clinical management.
c. Anatomic variations such as hypoplastic or aplastic segments, significant
accessory veins, or duplications should be noted.
d. The patient presentation, clinical indication, or clinical management pathways
may require protocol adjustments such as more detailed evaluation of the deep
venous system or a bilateral study.
e. Other vascular and nonvascular abnormalities, if found, should be recorded
but may require additional imaging for diagnosis or further characterization.
Venous Thromboembolic Disease: Upper Extremity
1. Technique
a. Upper extremity duplex evaluation consists of gray scale and Doppler
assessment of all the accessible portions of the subclavian, innominate, internal
jugular, and axillary veins, as well as compression gray scale ultrasound of the
brachial, basilic, and cephalic veins in the upper arm to the elbow. All accessible
veins should be scanned using optimal gray scale and Doppler techniques as
well as appropriate positioning. Venous compression is applied to accessible
veins in the transverse plane with adequate pressure on the skin to

completely obliterate the normal vein lumen.
b. Symptomatic areas, such as the forearm, may require additional evaluation if
the cause of the symptoms is not already elucidated by the standard
examination.
2. Recording
a. For each normal examination, at a minimum:
i. Gray scale images should be recorded without and with compression
at each of the following levels:
a. Internal jugular vein;
b. Peripheral subclavian vein;
c. Axillary vein;
d. Brachial vein in the arm;
e. Cephalic vein in the arm;
f. Basilic vein in the arm;
g. Focal symptomatic areas, if present.
ii. Color images are recorded at each of the following levels using the
appropriate color technique to show filling of the normal venous lumen:
a. Internal jugular vein;
b. Subclavian vein;
c. Axillary vein;
d. If seen, the innominate vein should be recorded with color Doppler imaging.
iii. At a minimum (even if the examination is otherwise unilateral), the
right and left subclavian venous spectral Doppler waveforms should be
recorded to evaluate for asymmetry or loss of cardiovascular pulsatility
and respiratory phasicity. All spectral Doppler should be obtained from
the long axis:
a. Right subclavian vein;
b. Left subclavian vein (from the same location in the vein and in
same patient position as the right one).
b. Abnormal examinations generally require additional images.
The extent and location of sites where the veins fail to compress
or fill with color completely should be clearly recorded and
generally require additional images. Long-axis views without
compression may be helpful to characterize the abnormal vein.
c. The patient presentation, clinical indication, or clinical
management pathways may require protocol adjustments such
as imaging the forearm veins or performing a bilateral study.
d. Other vascular and nonvascular abnormalities, if found, should
be recorded but may require additional imaging for diagnosis or
further characterization.
Vein Mapping
Mapping of superficial leg or arm veins is performed to determine the patency, size,
condition (such as calcification or thickening), and course of superficial veins to be used
for vein grafts. The location of the vein may be marked on the skin overlying the veins.
Tourniquets or other methods to accentuate the veins may be used based on the clinical
indication (for instance, mapping before hemodialysis grafts or fistulas).

XXII. Ergonomics
The following data is from: http://www.sdms.org/msi/default.asp
Industry Standards for the Prevention of Work-Related
Musculoskeletal Disorders in Sonography
Work-related musculoskeletal disorders (WRMSDs) affect a large number of
sonographers and sonologists, particularly those with heavy workloads and those who
have been in the profession for a long time. Good ergonomic design must be an integral
part of equipment design, and significantly influence purchasing decisions. The
employer, manufacturer, user, and educational programs have the responsibility to
prevent health and safety problems that cause WRMSDs.
EQUIPMENT CONTROL MEASURES
A. ULTRASOUND SYSTEM
State-of-the-art equipment allows for optimal visualization which increases diagnostic
accuracy and reduces sonographer/sinologist fatigue. These industry standards are
specific to floor-standing models. Therefore, some recommendations may not apply to
non-floor-standing models.
‣ Fully adjustable equipment that suits the anthropometrics of the 5th to 95th
percentile of the population and is specific to the demographic area of the users.
‣ Easily accessible controls for achieving two-wheel, four-wheel, and braked
positions Central locking is preferable.
‣ Recording devices positioned to minimize the user’s reach to external devices;
external devices should not interfere with adjustability of the system.
‣ Footrest on the equipment designed to encourage neutral position of the ankle.
‣ Transducer holder incorporates ease of access (unobstructed); should not be
detrimental to the distance required to access controls; low force, minimal effort
required for single-handed use.
‣ Cables should not interfere with access to equipment or system interaction.
‣ Port Connector permits ease of use, single-handed use, minimizing the user’s
reach, force, and necessity of a pinch grip; does not interfere with access to
equipment or system interaction.
‣ System design such that transporting the equipment does not exceed 50 pounds
of force for pushing or pulling by a single user on usual flooring surfaces.
Otherwise, it is required that additional personnel are available to assist in moving
the equipment.
‣ Height-adjustable handles suitable for transporting the equipment.
B. CONTROL PANEL
‣ Height-adjustable, separate from the monitor with appropriate degree of tilt to
allow for standing or seated user to achieve neutral posture of wrist and forearm.
Independent movement of control panel allows users to work while maintaining
their elbow at their side.
‣ Optimized control layout to allow use by both right and left-handed users.
‣ Size, shape, and spacing of controls designed according to occupational
ergonomic guidelines. Font size and control layout are visually discernable,
according to occupational ergonomic guidelines . The range of illumination
permits clear identification of control functions at applicable user positions.
‣ Entire system designed to be used in seated position without obstruction of
legs/knees.

C. MONITORS
‣ Incorporate features to minimize eye strain, such as:
a. Reduced flicker
b. Appropriate brightness and contrast levels
c. Resolution
d. Visual contrast
‣ Height-adjustable, separate from the control panel with appropriate degree of tilt
to enable standing or seated users to achieve neutral posture of their necks.
‣ Single-handed movement of the monitor allows users to work while maintaining
their neck in a forward, neutral position at a range of 18 - 30 inches.
‣ System must support the ability to use an external monitor.
D. TRANSDUCERS
‣ Lightweight and balanced to minimize torque on the wrist, facilitate a palmar grip
without an expanded stretch of the hand, and encourage a neutral wrist position.
‣ Sized to support appropriate anthropometric data for the majority of users,
encourage a palmar grip, and slip resistant.
‣ Cables and cable management systems must be suitable in length to permit
unrestricted use; and be of suitable length for intended applications.
E. TABLE
Industry standards #1-5 are considered essential when new or replacement tables are
being purchased.
‣ Height-adjustable, capable of being adjusted low enough to allow patients to get
on and off easily unassisted, and to allow user to scan in a sitting or standing
position while maintaining arm abduction of less than 30 degrees.3
‣ Maneuverable, full wheel mobility, and wheel locks that are easily operated.
‣ Open access from all sides to allow the users to place their knees and feet
underneath, if needed. Table support structure and/or table mechanisms should
not extend beyond the table top such that it prevents the user from minimizing
reach and arm abduction.
‣ For endovaginal scanning, suitable patient access and support such as
adjustable footboard and stirrups.
‣ For cardiac imaging, an easily operated, drop away or cut out section to allow
unhindered access to the apical region while allowing the user’s wrist to remain
supported and in a neutral position.
‣ Ideally, electronic controls that are accessible and easy to use.
‣ The following options may assist in reducing scan time by
‣ improved patient positioning depending on the procedure:
a. Trendelenberg and reverse Trendelenberg
b. Fowler back (upright table back)
c. Arm extension
d. Central locks
e. Patient restraints
F. CHAIR
‣ Height-adjustable with sufficient range to suit the majority of the users. Range of
height adjustability optimizes positioning of less than 30 degrees abduction of the
scanning arm and allows the forearm of the non-scanning arm to be
approximately parallel to the floor.
‣ Adjustable lumbar support, adjustable seat for thigh support, and an adjustable
footrest. Seat design must encourage an upright posture.
‣ Swivels to allow the user to rotate from the patient to the ultrasound system while
maintaining an aligned posture.
‣ Casters suitable to the type of flooring.

G. ACCESSORIES
‣ Gel bottles should have large openings to reduce the strength needed to squeeze
the bottle and of suitable diameter to avoid extended grip position.
‣ Support devices available to all users for arm support in abduction.
‣ When required, the patient chair (and/or table converted to sitting position) used
for seated procedures (eg, shoulder ultrasound) should be fully adjustable, easy
to rotate, lockable and armless, or with removable arms to achieve unobstructed
access for proper ergonomics.
‣ A transducer cable support device to allow users to reduce their grip by reducing
the amount of torque on the wrist/forearm.
‣ Properly fitting, textured exam gloves to reduce the force required to grip the
transducer.
II. ADMINISTRATIVE CONTROL MEASURES
A. EMPLOYER
1. Provide annual education to all users on the risk and prevention of
musculoskeletal disorders.
2. Perform risk assessments in consultation with the users on a regular basis to
identify musculoskeletal disorders and formulate and implement controls for the
prevention and/or reduction of these disorders.
3. Provide a system to report and document acute or chronic musculoskeletal
disorders per applicable regulations.
4. Conduct risk assessments prior to the purchase of equipment.
5. Maintain all equipment in good working order.
B. WORKLOAD AND SCHEDULING
1. Solicit user input on establishing protocols on examination scheduling.
2. Provide adequate rest breaks between examinations particularly for procedures
comprised of similar postural and muscular force attributes.
3. Encourage task rotation in the workplace as much as possible.
4. Establish maximum transducer time per hour. (Research to determine maximum safe
transducer time is encouraged.)
5. Minimize portable/bedside examinations.
C. EXAMINATION AREA
1. Dedicated examination area provides adequate space for the maneuverability
of equipment around the exam table and allows
easy access from all sides.
2. Examination room doorway allows easy access for all wheelchairs, beds, and
ultrasound equipment.
3. Suitable flooring to allow easy movement of equipment.
4. Adequate ventilation and temperature control to ensure the comfort of user
and patient while enabling the equipment to operate at a functional temperature.
5. Adjustable room lighting with easily accessible dimmer controls; shaded
windows to eliminate light.
6. Accessories that improve posture and reduce muscular force should be
available and easily accessible to the user.
7. All imaging supplies stored in the examination area and easily accessible.

III. PROFESSIONAL CONTROL MEASURES
A. BEST PRACTICES
It is recommended that sonographers, sonologists, and students follow
current best practices to reduce the risk of developing musculoskeletal
disorders. These best practices include:
‣ Minimize sustained bending, twisting, reaching, lifting, pressure, and awkward
postures; alternate sitting and standing and vary scanning techniques and
transducer grips.
‣ Adjust all equipment to suit user’s size and have accessories on hand before
beginning to scan.
‣ Use measures to reduce arm abduction and forward and backward reach to
include: instructing the patient to move as close to the user as possible; adjust
the table and chair; and use arm supports.
‣ Relax muscles periodically throughout the day:
‣ Stretch hand, wrist, shoulder muscles, and spine
‣ Take mini breaks during the procedure
‣ Take meal breaks separate from work-related tasks
‣ Re-focus eyes onto distant objects
‣ Vary procedures, tasks, and skills as much as reasonably possible
‣ Use correct body mechanics when moving patients, wheelchairs, beds,
stretchers, and ultrasound equipment.
‣ Correct body mechanic guidelines are available from employers or regulatory
bodies.
‣ Report and document any persistent pain to employer and seek competent
medical advice.
‣ Maintain a good level of physical fitness in order to perform the demanding work
tasks required.
‣ Collaborate with employers on staffing solutions that allow sufficient time away
from work.
B. EDUCATION AND TRAINING
Participate in education and training to reduce the risk of developing musculoskeletal
disorders:
a. Attend employer sponsored in-services
b. Attend seminars, lectures, workshops, or conferences offered by professional
organizations or manufacturers
c. Access journals, textbooks, online resources, etc.
d. Attend a formal sonography program that includes WRMSD prevention in the
curriculum

ERGONOMIC GLOSSARY
Anthropometrics: measured data of body dimensions for various populations.
Demographic area: the characteristics of human populations and population segments,
especially when used to identify consumer markets.
Equipment: the ultrasound system without accessories.
Mini breaks: breaks lasting a minute or two taken throughout the examination study to
relax muscles that are put into spasm while scanning. These muscles include, but are not
limited, to the neck, shoulder, wrist, and fingers.
Pressure: force applied uniformly over a surface, measured as force per unit of area.
The application of continuous force by one body on another that it is touching;
compression.
Sonographer: a professional who uses an ultrasound system to create images of
structures inside the human body that are used by physicians to make a medical
diagnosis.
Sonologist: a physician who makes a medical diagnosis using ultrasound and who may
also perform ultrasound procedures.
Suitable Flooring: tile, linoleum or other hard surface (not carpeting).
System: all the components of an ultrasound unit with accessories such as a printing
device or VCR, or the entire workstation.
Unit: a component of an ultrasound system.
User: a professional who uses ultrasound to make diagnostic images in a medical
setting.

XXIII. Appendices
A. Hepatitis B & A Vaccine Notice & Status
B. Remediation Plan and Outcome
C. Academic Honesty Procedure
D. Student’s Consent to Background Clearance and Drug Screening
E. Student Acceptance Form
F. Clinical Rotation Acknowledgement Form
G. Clinical Orientation Forms

Appendix A:
Merced College Allied Health Division
Hepatitis Notice
Hepatitis is a term meaning "inflammation of the liver". There are four forms of the
disease: Hepatitis A, Hepatitis B, Hepatitis C, and Hepatitis D. They are all caused by
viruses, but are very different. Hepatitis A, also known as infectious hepatitis, is the most
common form of hepatitis.
Hepatitis A virus is found in the human feces and is usually spread by eating something
contaminated. Hepatitis C (HCV) accounts for a substantial portion of acute and chronic
liver disease in the U.S. The primary modes of transmission of HCV are parenteral (blood
transfusion, IV drug abuse, needlestick). Although not transmitted as efficiently as
Hepatitis B, HCV can be transmitted sexually and perinatally. Hepatitis D infection only
exists in the presence of HBV with the route of transmission similar to HBV. Fortunately,
Hepatitis D is uncommon in the U.S.
HEPATITIS B: (HBV) is a virus formerly known as serum hepatitis. HBV is a major
cause of acute and chronic hepatitis, cirrhosis, and primary hepatocellular carcinoma. The
virus can be found in an infected person's body fluids, including blood, semen, vaginal
secretions, saliva, and urine. HBV is more dangerous than other viruses because the virus
can survive for more than seven days in dried blood or on exposed surfaces, thus
increases the chances for infection.
Some HBV infections can be asymptomatic; however, symptoms of HBV may also include
jaundice, anorexia, nausea, arthritis, rash, and fever. A screening test for Hepatitis B
surface antibody to determine whether you are presently immune to Hepatitis B is
available. That test is performed on drawn blood.
Should it be determined that you are not immune to Hepatitis B, a vaccine is available
which could decrease your chances of contracting Hepatitis B. Realize that as a student
and future employee in a health occupation, you have an increased risk of contracting this
serious illness.
There are risks involved in performing the test to determine if you are immune to Hepatitis
B. Those risks include, but are not necessarily limited to bleeding, injury from the needle to
various structures surrounding the vein from which the blood is drawn, including injury to
nerves, blood vessels, and surrounding tissue which could result in paralysis, paresthesia,
or numbness and tingling, or formation of a blood clot which could dislodge and enter your
blood stream causing severe injury or death.
There are also risks attendant in receiving the vaccine against Hepatitis B, including but
not necessarily limited to an adverse reaction to the vaccine which could cause anything
from mild discomfort to severe injury or death caused by an anaphylactic or allergic
reaction to the vaccine. In addition to all of the above, there are also unknown, rare,
unpredictable and unanticipated complications which can possibly occur.
A high percentage of healthy people who receive two doses of vaccine and a booster
achieve high levels of surface antibody (anti-HB's) and protection against Hepatitis B.
Persons with immune-system abnormalities, such as dialysis patients, have less response
to the vaccine, but over half of those receiving it do develop antibodies. Full immunization
requires three doses of vaccine over a six month period, although some persons may not
develop immunity even after three doses. There is no evidence that the vaccine has ever
caused Hepatitis B. However, persons who have been infected with HBV prior to receiving
the vaccine may go on to develop clinical Hepatitis in spite of immunization.

The usual vaccine procedure consists of 3 doses. The first does is at the time you wish to
start. The second dose is one month later. The third dose is six months after the first
dose. The cost of these injections ranges from $120 to $180 for the three dose series.
One month after the last dose has been completed, a follow-up HB surface antigen test to
determine whether you have developed immunity is highly recommended. The vaccine is
prepared from recombinant yeast cultures, free of associated human blood or blood
products, thus cannot be infected with HIV or other bloodborne pathogens.
It should be noted that a clinical facility has the right to refuse a student clinical tasks if the
student has not been immunized - even if the student signs a waiver of liability.
INFORMATION ABOUT HEPATITIS B VACCINE
The Disease: Hepatitis B is a viral infection caused by the hepatitis B virus (HBV), which
causes death in 1-2% of patients. Most people with hepatitis B recover completely, but
approximately 5-10% become chronic carriers of the virus. Most of these people have no
symptoms, but can continue to transmit the disease to others. Some may develop chronic
active hepatitis and cirrhosis. HBV also appears to be causative factor in the development
of liver cancer.
The Vaccine: Hepatitis B vaccine is produced from the plasma of chronic HBV carriers.
The vaccine consists of highly purified, formalin-inactivated hepatitis B antigen (viral
coating material). It has been extensively tested for safety in chimpanzees and for safety
and efficiency in large-scale clinical trials with human subjects. A high percentage of
healthy people who receive two doses of vaccine and a booster achieve high levels of
surface antibody (anti-HBs) and protection against Hepatitis B. Persons with immunesystem
abnormalities, such as dialysis patients, have less response to the vaccine/but over
half of those receiving it do develop antibodies. Full immunization requires three doses of
vaccine over a six-month period, although some persons may not develop immunity even
after three doses. There is no evidence that the vaccine has ever caused hepatitis B.
However, persons who have been infected with HBV prior to receiving the vaccine may go
on to develop clinical hepatitis in spite of immunization. The duration of immunity is
unknown at this time.
Possible Vaccine Side Effects: The incidence of side effects is very low. No serious
side effects have been reported with the vaccine. A few persons experience tenderness
and redness at the site of injection. Low-grade fever may occur. Rush, nausea, joint pain
and mild fatigue have also been reported. The possibility exists that more serious side
effects may be identified with more extensive use.

Instructions:
Merced College Allied Health Division
Hepatitis B Vaccine Status
A copy of your immunization record is to be included in your clinical
notebook for examination by clinical personnel during your orientation process to each new
clinical facility and the second copy is to be provided to the program director for filing in your
personal file.
I have received the Allied Health Department's communication concerning Hepatitis B. I
understand that vaccination is indicated for me because of the possibility that I may be
exposed to Hepatitis B in the course and scope of my clinical training and future employment.
I have also been advised as to the potentially dangerous risks and consequences of my failure
to be tested and receive the vaccination at this time.
I have also been advised that a clinical facility has the right to refuse my student clinical
assignment if I have not been immunized - even if I sign a waiver of liability.
My signature below constitutes my acknowledgment:
A. That the testing procedure and vaccination set forth has been adequately explained to
me and that I have received all of the information I desire concerning such procedure
and vaccination; and
B. That I have read, understand and agreed to the testing and/or vaccination procedure
indicated below.
Check One:
[ ] I plan to be tested to determine Hepatitis B immunity. If test results indicate immunity,
I will provide verification, otherwise I plan to seek immunization through my private
doctor or by a health care facility and I will provide a copy of my verification when I
have completed the three inoculations.
Date submitted:
[ ] I do NOT want to be tested for Hepatitis B immunity, but I do plan to seek
immunization through my private doctor or by a health care facility and I will provide a
copy of my verification when I have completed the three inoculations.
Date submitted:
[ ] I am already immunized and will provide verification.
Date submitted:
[ ] I have decided not to pursue immunization for Hepatitis B even though I understand I
am at some risk of contracting this disease. Therefore, with my signature below I am
releasing and hold harmless Merced College and all clinical facilities of any
responsibility for my exposure to or contracting of Hepatitis B.
Sign and Date, have Witness Sign and Date:
____________________________________________________________________________
Student Signature
Date
____________________________________________________________________________
Witness Signature
Date

Instructions:
Merced College Allied Health Division
Hepatitis A Vaccine Status
A copy of your immunization record is to be included in your clinical
notebook for examination by clinical personnel during your orientation process to each new
clinical facility and the second copy is to be provided to the program director for filing in your
personal file.
I have received the Allied Health Department's communication concerning Hepatitis A. I understand that
vaccination is indicated for me because of the possibility that I may be exposed to Hepatitis A in the course and
scope of my clinical training and future employment. I have also been advised as to the potentially dangerous
risks and consequences of my failure to be tested and receive the vaccination at this time.
I have also been advised that a clinical facility has the right to refuse my student clinical assignment if I have not
been immunized - even if I sign a waiver of liability.
My signature below constitutes my acknowledgment:
A. That the testing procedure and vaccination set forth has been adequately explained to me and that I
have received all of the information I desire concerning such procedure and vaccination; and
B. That I have read, understand and agreed to the testing and/or vaccination procedure indicated below.
Check One:
[ ] I plan to be tested to determine Hepatitis A immunity. If test results indicate immunity, I will provide
verification, otherwise I plan to seek immunization through my private doctor or by a health care facility
and I will provide a copy of my verification when I have completed the two inoculations.
Date submitted:______________
[ ] I do NOT want to be tested for Hepatitis A immunity, but I do plan to seek immunization through my
private doctor or by a health care facility and I will provide a copy of my verification when I have
completed the two inoculations.
Date submitted:______________
[ ] I am already immunized and will provide verification.
Date submitted:______________
[ ] I have decided not to pursue immunization for Hepatitis A even though I understand I am at some risk of
contracting this disease. Therefore, with my signature below I am releasing and hold harmless Merced
College and all clinical facilities of any responsibility for my exposure to or contracting of Hepatitis A.
Sign and Date, have Witness Sign and Date:
________________________________________________________________________________________
Student Signature
Date
________________________________________________________________________________________
Witness Signature
Date

MERCED COLLEGE
LIABILITY RELEASE-ASSUMPTION OF RISKS FORM
I have read the attached statement about hepatitis B and the hepatitis B
vaccine. I have had an opportunity to ask questions and understand the
benefits and risks of hepatitis B vaccination as well as the risks of not receiving
the vaccination. I do not wish to receive the vaccination series at this time and
voluntarily assume the risks inherent in not receiving the vaccine series and
hereby further release Merced College, its officers, employees and agents from
any and all liability, loss or damage that I may suffer or incur from whatever
source in the event of any actual or potential exposure or infection due to my
decision not to receive the vaccination.
STUDENT HEPATITIS B VACCINE DECLINATION
I understand that due to my occupational exposure to blood or other potentially
infectious materials. I may be at risk of acquiring hepatitis B virus (HBV)
infection. I have been advised of the importance of being vaccinated with
hepatitis B vaccine from a licensed health care provider. However, I decline
hepatitis B vaccination at this time. I understand that by declining this vaccine, I
continue to be at risk of acquiring hepatitis B, a serious disease. If in the future
I want to be vaccinated with hepatitis B vaccine, I understand that I will need to
receive the vaccination series from a license health care provider.
_________________________________________
Printed Name of Student
________________________________________________
Signature of Student
_________________________
Date
________________________________________________
Signature of Witness
_________________________
Date

APPENDIX B:
Merced College
Sonography Program
Remediation Plan and Outcome
Student:
Semester/Year:
UNSATISFACTORY OBJECTIVE(S) : Unsatisfactory evaluation for SONO _____
As of today, your progress report grade averages out to the following:
Total Points Possible = xx
Percentage Grade = xx %
Total Points Received = xx
Grade = xx
PLAN:
[ ] Counseling - instructor [ ] Suspension for days
[ ] Counseling - outside referral [ ] Dismissal
[ ] Letter of concern [ ] Clinical reassignment
[ ] Probation
[ ] Increase clinic performance evaluation to every two weeks for a total of ______ weeks.
[ ] Increase didactic performance evaluations as noted: ___________________________
As listed in the course outline, the lowest percentage grade a student may receive and still pass the
course is 75%. Your _____ % performance is below this figure and is a cause for concern. This
evaluation is being conducted at this time in order to alert you to a potential problem in remaining in
the DMS Program. As stated in your student handbook, a student must pass each DMS course with a
“C” grade” or better in order to remain enrolled in the DMS Program. In order to ensure your
continued enrollment, your test scores or clinic performance must dramatically improve.
SUGGESTED RESOURCES and ACTIVITIES:
1. Re-evaluate your schedule (home/work/school/recreation) and see where you can modify your
schedule in order to spend more time studying.
2. Involve yourself in a DMS student group session with your classmates.
3. Speak up more when you have a question otherwise it’s assumed we can move onto the next
topic.
4. Seek a special tutorial assistance through the Tutorial Center. (384-6271)
5. If there is a possibility that you may have an undiagnosed learning disability, contact the
Disabled Student Services Office for information about getting tested. (384-6155)
6. Spend some time in the Computer Lab and/or classroom and review available computerized
software.
FOLLOW-UP CONFERENCE TO BE HELD:
STUDENT COMMENTS: __________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

______________________________________________
Instructor's Signature
Date
______________________________________________
Student's Signature
Date
REMEDIATION OUTCOME:
Follow-up Conference Notation:
Has overcome deficiencies and now meets objectives and or requirements, no further
action required.
Has not overcome deficiencies and does not meet objectives and or requirements, see
below for follow-up remediation action.
[ ] Continuation of remediation plan recommended
FOLLOW-UP CONFERENCE TO BE HELD:
[ ] Dismissal
Additional Comments:
REMEDIATION FOLLOW-UP ACTION
Student Comments:
_________________________________________________________________________________
Instructor’s Signature
Date
_________________________________________________________________________________
Student’s Signature
Date
********************************************************************************************************************
*
FINAL REMEDIATION ACTION
[ ] Has overcome deficiencies and now meets objectives and or requirements, no further action
required.
[ ] Did not overcome deficiencies and does not meet objectives and or requirements and is
therefore being dismissed from the program.
_________________________________________________________________________________
Instructor’s Signature
Date
_________________________________________________________________________________
Student’s Signature
Date

APPENDIX C:
Academic Honesty Procedure
Academic dishonesty is a violation of the Student Code of Conduct and is handled by the Vice-
President of Student Personnel.
Merced College has the responsibility to ensure that grades assigned are indicative of the
knowledge and skill level of each student. Acts of academic dishonesty make it impossible to
fulfill this responsibility, and they weaken our society. Faculty, students, administrators, and
classified staff share responsibility for ensuring academic honesty in our college community and
will make a concerted effort to fulfill the following responsibilities.
Faculty Responsibilities
Faculty have a responsibility to encourage academic honesty in their classrooms. In the
absence of academic honesty, it is impossible to assign accurate grades and to ensure that
honest students are not at a competitive disadvantage. Faculty members are encouraged to do
the following:
1. Explain the meaning of academic honesty to their students.
2. Include information about academic honesty in their course syllabi.
3. Conduct their classes in a way that discourages cheating, plagiarism and other
dishonest conduct.
4. Confront students suspected of academic dishonesty and take appropriate disciplinary
action in a timely manner (see "Procedures for Dealing with Violations of Academic
Honesty" which follow.)
Student Responsibilities
Students share the responsibility for maintaining academic honesty. Students are expected to
do the following:
1. Refrain from acts of academic dishonesty.
2. Refuse to aid or abet any form of academic dishonesty.
Administrative Responsibilities
1. Disseminate the academic honesty policy and the philosophical principles upon which it
is based to faculty, students, and staff.
2. Provide facilities, class enrollments, and/or support personnel which make it practical
for faculty and students to make cheating, plagiarism and other dishonest conduct
nearly impossible.
3. Support faculty and students in their efforts to maintain academic honesty.
Classified Staff Responsibilities
1. Support faculty, students, and administration in their efforts to make cheating,
plagiarism and other dishonest conduct nearly impossible.
2. Notify instructors and/or appropriate administrators about observed incidents of
academic dishonesty.
Examples of Violations of Academic Honesty
Academic dishonesty includes cheating, plagiarism, collusion, misuse of college computers and
software, and other dishonest conduct as outlined below. It is not limited to the following
examples:
Cheating
1. Obtaining information from another student during an examination.
2. Communicating information to another student during and examination.
3. Knowingly allowing another student to copy one's work.
4. Offering another person's work as one's own.
5. Taking an examination for another student or having someone take an
examination for oneself.
6. Sharing answers for a take-home examination unless specifically authorized
by the instructor.

7. Using unauthorized materials (such as notes or "cheat sheets") or
unauthorized equipment (such as dictionaries or calculators) during and
examination.
8. Altering a graded examination or assignment and returning it for additional
credit.
9. Having another person or a company do the research and/or writing of an
assigned paper or report.
10. Misreporting or altering the data in laboratory or research projects.
Plagiarism
1. Purposefully presenting as one's own the ideas, words, or creative product of
another.
2. Carelessly or through lack of knowledge presenting as one's own the ideas,
words, or creative product of another.
3. Purposely failing to credit the source for direct quotations, paraphrases, ideas,
and facts which are common knowledge.
4. Failing to credit the source for direct quotations, paraphrases, ideas, and facts
which are common knowledge through carelessness or lack of knowledge.
5. Changing only slightly the wording of another.
6. Using another person's catchy word of phrase.
7. Paraphrasing without using proper citations.
8. Copying word-for-word.
9. Cut and paste from the internet.
Collusion
1. Knowingly or intentionally helping another student perform an act of academic
dishonesty.
Misuse of College Computers and Software
1. Unauthorized use of computer accounts.
2. Unauthorized copying of programs or data belonging to others.
3. Making, acquiring, or using unauthorized software on college equipment.
4. Using college computers to play computer games when other users need the
resources.
5. Attempting to crash the system.
6. Removing licensed software from offices, classrooms, labs, and the library.
7. Using the computers or telecommunications systems in a way that interferes
with the use of those systems by others.
8. Using the computers or telecommunications systems for personal or for-profit
ventures.
Other Dishonest Conduct
1. Stealing or attempting to steal an examination or answer key.
2. Stealing or attempting to change official academic records.
3. Forging or altering grade change cards.
4. Intentionally impairing the performance of other students laboratory samples
or reagents, by altering musical or athletic equipment, or by creating a
distraction meant to impair performance.
5. Forging or altering attendance records.
6. Supplying the college with false information.
Action by the Instructor
1. An instructor who has evidence that an act of academic dishonesty has occurred shall
notify the student of such evidence by speaking with the student or notifying the student
in writing.
2. AFTER notifying the student and giving him or her the chance to respond, the instructor
may take one or more of the following disciplinary actions:

A. Issue and oral reprimand (for example, in cases where there is reasonable
doubt that the student knew that the action violated the standards of academic
honesty). No report form is necessary.
B. Give the student an "F" grade, zero points, or a reduced number of points on all
or part of a particular paper, project, or examination. A written memo of this
action (Use "Academic Dishonesty Report" Form) is to be sent to the Vice-
President of Student Personnel and a copy to the Vice- President of Instruction.
C. Assign an "F" to the student for the course in cases where the dishonesty is
more serious, premeditated, or a repeat offense. A written memo (Use
"Academic Dishonesty Report" Form) must be completed by the instructor and
sent to the Vice-President of Student Personnel and a copy to the Vice
President of Instruction.*
*NOTE:
A grade of "F" assigned to a student for academic dishonesty will not be final if
the student chooses to drop the course before the 14th week of the semester.
In that case, the student would receive a "W" grade on his transcript.
Action by the Administration
1. Upon receipt of the first Academic Dishonesty Report Form concerning a student the
Vice-President of Student Personnel shall send a letter of reprimand to the student
which will inform the student that
- Academic dishonesty is grounds for academic disciplinary probation for the remainder
of his or her career at Merced College.
- Another incident of academic dishonesty reported by any instructor shall result in a
hearing by the Student Discipline Committee and may result in a one-year suspension
from the college.
- The student may make an appointment with the Vice-President of Student Personnel to
discuss the incident and its ramifications.
2. Upon receipt of a second Academic Dishonesty Report Form concerning a student, the
Vice-President of Student Personnel shall immediately refer the student to the Student
Discipline Committee. If the Committee finds the charges to be valid, the Committee
will suspend the student for one calendar year (two full semesters and one summer
session).
3. For more serious incidents of academic dishonesty, the Vice-President of Student
Personnel will meet with the student and immediately take appropriate disciplinary
action or refer the student to the Student Discipline Committee. Offenses warranting
suspension on the first offense include, but are not limited to, the following:
- Taking an examination for another student or having someone take an
examination for oneself.
- Altering a graded examination or assignment and returning it for additional
credit.
- Having another student or a company do the research and/or writing of an
assigned paper or report.
- Stealing or attempting to steal an examination or answer key.
- Stealing or attempting to change official academic records.
- Forging or altering grades.
4. If, after a student returns from a suspension for Academic Dishonesty, the Vice-
President of Student Personnel receives yet another Academic Dishonesty Report
Form, the Vice-President of Student Personnel shall recommend to the Merced College
Superintendent/President that the student be expelled from the District.
NOTE: Disciplinary actions which are taken by the Vice-President of Student Personnel
or the Student Discipline Committee and which are based on alleged cheating may be
appealed as specified in the Student Grievance Policy. (This Academic Honesty Policy has
been adapted from the Academic Honesty Policy of Golden West College with permission.)

APPENDIX D:
Student’s Consent to Background Clearance and Drug Screening
Background Clearance:
A background clearance will be required upon acceptance into the program and possibly
once each year thereafter. This will include criminal offense, criminal history, sex
offender check and social security trace The results for the SSN trace come from more
than 300 public sectors. They are from things like electric/water company accounts,
deed records, change of address forms and so forth. It is quite common for these traces
to return no results. This is not a SSN VERIFICATION, only a trace of where your SSN
may have been used.
These traces are generally used for the purpose of gathering additional information about
your previous residences and possible alternate names. If you would like to have this
search cleared for aesthetic purposes, you may obtain an official Social Security
Administration document from your local SS office and fax it to American DataBank (303-
573-1779) and have them mark your search as clear. For the purposes of your
background check, this is not something that reflects poorly on you.
Drug Screening:
It is the policy of our clinical facilities to require drug screening of Diagnostic Medical
Sonography student assignees for the purpose of detecting drug abuse, and that one of
the requirements for consideration of placement within our clinical facilities is
satisfactorily passing of a drug screening test. The student will be responsible for any
costs incurred in obtaining drug screening clearance(s) for student placement(s).
Students may be required to repeat the drug screening clearance with each new clinical
assignment (3-4 assignments throughout the program).
A clinical facility may request a random drug screening. Failure to comply with a random
drug screening request are grounds for clinical and program dismissal. The student will
not be held responsible for any random drug screening fees. A positive drug screening
test may lead to dismissal from the clinical facility and the program.
Therefore, for the purpose of being considered for student placement at the clinical
facilities, I hereby agree to provide drug screening clearance documentation from an
approved provider. I understand that I will be responsible for any costs incurred in
obtaining drug screening clearance(s) for student placement.
I understand that failure to pass the initial drug screening or any subsequent drug
screening (including a random drug screening) may cancel admission or enrollment to
the program.
_______________________________________________________
Student Signature
(Date signed)
_________________________________________________________
Witness Signature
(Date signed)

APPENDIX E:
Student Acceptance Statement
of
Diagnostic Medical Sonography Program
Student Policies and Procedures
Having read all of Merced College’s Diagnostic Medical Sonography
Program Student Policies and Procedures Handbook with care, I both
understand and accept the responsibilities of my role as a Sonography
student at Merced College. I understand that my clinical responsibilities
are specifically detailed in the Clinical Competency Evaluation Handbook.
The content of this handbook may be subject to change throughout the
program. You will be provided a hard copy of any revised provisions. It is
your responsibility to keep these new provisions in your handbook at all
times.
Student’s Signature_______________________
Date __________
Witness _______________________________
Date _________

APPENDIX F:
Diagnostic Medical Sonography
Clinical Rotation Acknowledgement
My signature below is given as evidence that I am fully aware the Diagnostic Medical
Sonography Program will, upon completion of the required, sequential curriculum
including successful passage of laboratory practical examinations, provide me with four
assigned clinical affiliation rotations.
I further understand:
1. The specific rotation location is not guaranteed.
2. Only clinical sites having been recruited by Merced College, and that hold signed
affiliation agreements, will be used for Sonography Rotations.
3. Refusal of any rotation will relieve Merced College from any further placement
responsibilities.
4. There is no guarantee of a stipend, or employment at any assigned rotation.
5. I am responsible to purchase and wear the appropriate uniforms at my clinical site.
6. Clinical rotations are completed in all but the first term in the DMS program.
7. All clinical hours shall be completed. Any missed hours shall be made up at the
assigned rotation prior to the end of that term.
8. Clinical hours, times, and days may vary at each location. I am responsible to
attend all scheduled days and times. Arrival time may begin at 6:00 am, departure
may be 9:00 pm, and weekend rotations may be required.
9. I shall maintain strict confidentiality of all medical records, and follow all HIPAA
policies.
10. Should I incur a physical disability, including pregnancy, a clinical rotation may be
placed on hold until I submit a physician’s release for “return to work” to the
Program Director and/or the Manager/Director of the clinical affiliation. It is my
responsibility to inform the DMS Program Director of any possible disability, either
current or acquired, that would prohibit successful completion of the clinical aspect
of the program.
11. I understand that I am responsible for additional background and/or drug screening
checks may be required for any clinical affiliation.
12. I understand that I am responsible for my transportation to and from all assigned
clinical experiences. The DMS program will make a concerted effort to keep
affiliations within a 100 mile radius of the Merced College campus.
13. I will maintain a current CPR card throughout the DMS program.
14. I will keep required vaccinations and other medical screenings current throughout
the DMS program.
15. I will abide by all programmatic and clinical affiliation policies.
16. I will follow HIPAA compliance policies
17. I will follow programmatic dress code policy.
18. I understand that successful completion of the entire sequential clinical experience,
and all sequential Sonography courses are required to earn a Certificate of
Achievement in Sonography.
______________________________
Student Signature
________________________
Date

APPENDIX G: Clinical Orientation
1. Clinical Competency:
a. [ ] Review of prior completed clinical competencies
(refer to Clinical Competency Handbook)
b. [ ] Discussion of student's perceived strengths & weaknesses
Please list:
c. [ ] Discussion of specific clinical training goals for student by facility
Please list:
2. Review of Student Information Updates:
(refer to Clinical Competency Evaluation Handbook)
a. [ ] Flu / MMR / Tdap / Varicella vaccination date
b. [ ] Malpractice Coverage - Covered by Merced College Policy
c. [ ] CPR card expiration date
d. [ ] TB expiration date
e. [ ] Hepatitis A/B vaccination status
f. [ ] Background Check clearance results
g. [ ] Drug Screening clearance results
3. Code of Ethics - Confidentiality Standards:
a. [ ] Review program standards as listed in the Clinical Competency Evaluation
Handbook
b. [ ] Review any specific clinical standards, as necessary
4. Supervision Reminder:
a. [ ] Direct Supervision - a qualified sonographer shall be present during the
performance of the procedure
b. [ ] Indirect Supervision - a qualified sonographer is immediately available to
assist the student in the adjacent room or location where an ultrasound
examination/procedure is being performed
c. [ ] Required Supervision for Repeats - always performed under direct
supervision
5. Absences or Tardiness in the Clinical Area:
a. [ ] Who, when, and where to notify
b. [ ] Absenteeism make-up

6. Location of Student Assignment:
a. [ ] Where posted, specific objectives, etc.
7. Communications during Clinical Assignment:
a. [ ] Contact in case of emergency
b. [ ] Making outside phone calls (land-line & cell)
c. [ ] Contacting and working with other students
8. Health and Safety Procedures:
a. [ ] Fire regulations
b. [ ] Codes (resuscitation team)
c. [ ] Security guard services
d. [ ] Reporting accidents and incidents (including exposure to bloodborne
pathogen needlesticks or pathology)
e. [ ] Emergency Disaster Response Plan
f. [ ] Hand washing, gloving, and PPE Policies
g. [ ] Standards Precautions & Transmission-Based Precautions
9. Dress Code:
a. [ ] Discussion of dress code according to facility's guidelines, in particular scrub
colors; appropriate OR scrub usage; hair; nails; body art, etc. Please review
and apply Merced College Sonography Dress Code, when appropriate.
10. Office Protocol:
a. [ ] How to answer phone
b. [ ] Filing/PACS
c. [ ] Emergency phone numbers
11. Information About Hospital:
a. [ ] History
b. [ ] Bed capacity
c. [ ] Administrative personnel
d. [ ] Conference room facilities
12. Meal & Rest Breaks:
a. [ ] Times and duration of meals and coffee breaks
(maximum 30 min. lunch & must take break & lunch, no early release)
Student MUST complete all required programmatic clinical hours as per
our Accreditation Requirements
b. [ ] Provisions for students carrying lunches

13. Locker and Washroom Facilities:
a. [ ] To include proper location for books, outer clothing, purses and valuables
storage.
b. [ ] Both male and female
14. Learning Resource Materials:
a. [ ] Library: rules and privileges (Facility - if applicable/Department)
15. Parking and Building Entrance Regulations:
a. [ ] Includes both day time and evening rules
b. [ ] Entrance to building requirements, if applicable.
16. Orientation to Department:
a. [ ] Review of routine views for procedures
b. [ ] Patient transportation procedures to and from department
c. Operation of equipment:
(1) [ ] Sonographic equipment
(2) [ ] Workstations
(3) [ ] PACS
d. Operation of special equipment:
(1) [ ] Monitors, I.V.'s, Oxygen, etc.
e. Location of equipment and supplies:
(1) [ ] Scanning gel
(2) [ ] Contrast media documentation, if applicable
(3) [ ] Immobilization aides
(4) [ ] Thermographic paper, if applicable
(5) [ ] Biopsy, aspiration, localization supplies
(6) [ ] Emergency cart/supplies
(7) [ ] Linens
(8) [ ] Other accessory items: needles, syringes, tourniquets, I.V. tubing, emesis
basins, bandaging materials, etc.
17. Orientation to Other Departments:
a. [ ] Emergency Department - ED
b. [ ] Operating Room - OR

c. [ ] CCU/ICU/NICU/Peds
d. [ ] Lab
e. [ ] Central Supply
18. Introduction to Key Personnel:
a. [ ] Radiologist(s)
b. [ ] Department Manager/Supervising Technologist
c. [ ] Staff Technologists & Sonographers
d. [ ] Key Ancillary Staff
19. Statement of Responsibility:
a. [ ] Review student’s statement of responsibility document located in
the Clinical Competency Handbook
20. Schedule:
a. [ ] Who generates weekly schedule?
b. [ ] When does the work week start? (Sunday-Saturday or
Saturday-Sunday, etc.)
c. [ ] Will weekend hours be included in schedule? If so, when?
My signature below indicates that I have reviewed and understand each statement above. Should I
have questions regarding any of the above, I will be sure to ask the Clinical Preceptor, Department
Manager or the Personnel Department for clarification prior to signing.
Student’s Signature
Date
Clinical Preceptor’s Signature
Program Director/Clinical Coordinator/Clinical Supervisor
Date
Date