Registry Reports - ARDMS

Registry Reports
Volume XVIII, Number 1
Jan./Feb. 2001
®
®
®
Index
CME Documentation 1
Chair Letter 2
New Breast Foundation 3
On-line CMEs 3
Registrant Spotlight 4
New OSHA Rules 6
Occupational Injury 7
CME Calendar 8
Registry Reports
Cathy A. Babiak,
MRT(R), RDMS
Chair, ARDMS Board of
Directors
Dale R. Cyr,
MBA, RDMS, RDCS
Executive Director
Dana Murphy
Director, Communications
& Marketing
Karla M. Smith
Publications Coordinator
Registry Reports welcomes
submissions from the field.
Send inquiries to: Karla
Smith, Editor, Registry
Reports. Fax: (301) 517-8511
E-mail: soundoff@ardms.org
Registry Reports is a bimonthly
publication of
ARDMS.
© 2001, Rockville, MD
The ideas and opinions
expressed herein do not
necessarily reflect those
of ARDMS.
Professional Excellence Quality Care e Patient Safety Worldwide W
Reach
ARDMS CONTINUING MEDICAL EDUCATION:
WE WANT YOUR CME DOCUMENTATION!
CME EDUCATION SERIES, PART 1
Thank you for your prompt response in remitting your
CME documentation. The Registrant Services staff has
been “snowed under” by the number of documents
received in the last 60 days. Due to the recently
adopted policies regarding the continuing competency
requirement and the eventual loss of certification,
should registrants fail to comply with the requirement
of earning 30 continuing medical education credits in a
three-year tracking period, we recommend that you send
in your CME documentation throughout the year. In doing
so, please note that all continuing education course credits must
be validated by a certificate or letter of attendance from an approved
provider, and must include the following information:
1) Complete Name of Registrant
2) ARDMS Registry Number
3) Date of Course or Activity
4) Title of Course or Activity
5) Approved Sponsor (see list, below)
6) Total Number of Credits Awarded
THE ROLLING CONCEPT
THE ROLLING CONCEPT
If you are a Registrant with a tracking period of 1/1/1999
through 12/31/2001, to retain your Active CME status you must
have, by the last day of this period, a total of 30 CME credits.
After it has been determined that you have met the requirement,
based on the “rolling” concept, the number of CME credits you
earned in 1999 will “roll off” (be deleted from your ARDMS
transcript), and you will have in reserve (for use for the next
period) the number of credits you earned in 2000 and in 2001.
Tracking Period: 1/1/1999 – 12/31/2001
For example:
Year
Number of CME credits
1999 10
2000 11
2001 12
Total
33 credits
Tracking Period: 1/1/2000 – 12/31/2002
The 10 credits earned in 1999 have “rolled off”
Year
Number of CME credits
1999 10 (previous year)
2000 11
2001 12
2002 7 (earn # of credits equal to 30)
Total
30 credits

LETTER FROM THE CHAIR
Cathy A. Babiak, MRT(R), RDMS
New Rule about Possible Loss of
Registry Status: What It Means to You
The new ARDMS policy about what
registrants must do to maintain their
status as an Active registrant has quite
understandably, led to some turmoil and confusion for some
of our registrants.
First—in case you have somehow missed all of the
multiple mailings on this policy—here is the text of the new
rule, as adopted by the ARDMS Board of Directors:
“Effective December 31, 2000, all registrants who have not
met CME requirements by accumulating 30 continuing
medical education credits in a 3-year cycle and have not
paid outstanding Registry fees will have 120 days (until
April 30, 2001) to document compliance with these
requirements. If after this time a registrant has failed to meet
these requirements, he/she will no longer be considered a
registrant.”
The price for loss of registrant status is, intentionally, fairly
steep: If you lose your Registry status on April 30 2001, you
will be required to retake the exams you needed for your
credential(s) in the first place and, once again, earn a passing
grade on each.
We realize that coming into compliance under this new
policy has meant, for some registrants, the arduous task of
compiling and faxing to ARDMS large stacks of CME
documents, and in other cases, scrambling to take enough
new CMEs to meet the established deadlines for submission
of these credits.
At the same time, many of you have had questions for
ARDMS about the new requirements for Active status and,
in particular, about your own personal Registry record and
the possible implications of its current contents.
Know that everyone on the ARDMS staff has bent over
backwards to try and answer every one of your phone calls,
promptly and helpfully. But with thousands of phone calls
coming in every day, the staff would like to extend an
apology if you were, on some occasion, unable to have your
call taken promptly by an ARDMS staff member.
If this transition to a new policy on Active ARDMS
Registry status has been rough for you, please try to
concentrate on the underlying intent of the policy: to bolster
the value and prestige of all your ARDMS credentials. We
hope you agree that this is an objective that is well worth
striving for.
E-mail: cbabiak@ardms.org
A LETTER FROM AN
INTERNATIONAL TIONAL REGISTRANT
The Role of Ultrasound in Private General Practice
I have been in general-practice medicine for 25 years. In
my country (Pakistan), the health-systems structure is not
developed properly, due to the poor economy and lack of
advanced facilities. The general practitioner is often the
first to come in contact with the patient.
In our practice, we deal with surgical emergencies, general
medicine, and OB/GYN, including many other kinds of
cases as well. Because a full clinical investigation is frequently
unaffordable for many patients, I think that ultrasound
specialists, with proper qualifications and training,
can play an important role in diagnosis and referral, in
addition to reducing the cost of treatment.
I have performed ultrasound examinations since 1991.
When I heard about a Registry examination in ultrasonography,
I did not waste much time. I went to the U.S.
and qualified as a Registered Diagnostic Medical
Sonographer (RDMS), with a specialty in OB/GYN. My
special thanks to ARDMS Testing Director Tim Sares and
Registrant Services Director Gwen Henderson for helping
me during that period. Since then, I have returned to my
country, and now have more confidence about my skills,
and greater insight into the field of ultrasonography. My
small ultrasound machine (though not very expensive) is a
great help to me in diagnosing cases. During the last year, I
was able to diagnose hepatitis, cholelithiasis, kidney stones,
glomerulonephritis, malignancy, pyelonephritis, and so on.
My main interest is in acute abdomen. I diagnosed 10
cases of appendicitis (with only two negative results). In
eight cases, surgery was performed within hours of my
diagnosis, which saved several patients’ lives...without high
cost or wasted time. Few cases had positive ultrasound
findings before the patients' pain shifted to the right iliac
fossa. Some patients whose conditions were diagnosed,
using ultrasound, as acute hepatitis and who had correlating
positive blood tests were treated as outpatients. Also, two
patients who had tubal pregnancies were able to reach the
hospital in time.
I believe proper ultrasound training and skill testing should
be introduced into Third World countries. There should also
be awareness among professionals about proper training in
ultrasound, so patients who are poor can avail themselves of
inexpensive diagnostic ultrasound facilities. These measures
would go a long way toward advancing the cause of public
health in my country and in other Third World countries.
Dr. Firoza Zahir, RDMS
2 January/February 2001 • Registry Reports

Announcement! The Breast Cancer and
Women’s Health Ultrasound Foundation
The ARDMS is pleased and proud to announce the launch of its new foundation:
The Breast Cancer and Women’s Ultrasound Foundation. The Foundation
has assembled, and convened in person for the first time on January 7, 2001, to
an impressive and diverse Board of Directors made up of sonographers, physicians,
and representatives of the general public, including a breast cancer survivor.
Many women do not know about the diverse applications of ultrasound that have become available in recent years.
Prominent among these has been the emerging use of ultrasound as an important adjunct to mammography in the
diagnosis of breast disease. Women need to know that an ultrasound exam can, in many cases, provide critical
information for diagnosing cancers, as well as several other common conditions, in the breast.
In order to fill this critical knowledge gap, ARDMS has established the Foundation—a unique organization that will
have the key resources needed to fill the critical need for widespread, effective dissemination of the public-health message
about ultrasound. To get the word out to as many women as possible, the Foundation will develop strategically
integrated use of every suitable medium—the Web, lay and professional print publications, television and radio, and
videotape—to reach a “critical mass” of information about the benefits of ultrasound procedures. When that critical
mass has been attained, women themselves will be empowered to ask important questions about ultrasound procedures.
While other organizations focus on basic research, this Foundation will concentrate its efforts—by promoting
awareness about ultrasound as a procedure that can help improve diagnosis in women. To guide its important work, the
Foundation’s Board of Directors comprises some of the most eminent names in the field of cancer, and breast cancer
in particular.
Clearly, the other goals of the Foundation—to build awareness about the benefits of ultrasound tests, and to expand
women’s utilization of them—will not be attainable unless there are sufficient numbers of sonography professionals
armed with the expertise needed to do breast ultrasound tests thoroughly and accurately.❖
Increase the Pool of ARDMS-certified Breast Ultrasound Sonographers: For more information
about the new Breast specialty exam, visit the ARDMS Website (www.ardms.org). The Breast
Content outline is now available on the ARDMS site, in addition to other content outlines.
FOR FREE
FOR A SMALL FEE
ON-LINE
CMES
ATL Ultrasound:
www.atl.com/pro_ed/E2102_Casestudy
Acuson:
www.acuson.com
Biosound:
www.biosound.com/cme.html
GE:
www.ge.com/medical/ultrasound/msucme.html
Jackson:
www.jackson.cc.mi.us/CME
AIUM:
www.aium.org/cme/cmes_offered.
html
MedEd Interactive:
www.mededinteractive.com
HP:
www.hp.com/go/soundings
Institute for Advanced Medical Education:
www.iame.com/learning/online.html
Registry Reports • January/February 2001 3

REGISTRANT SPOTLIGHT
Phillip G. Ladisa, RT, R , RDMS, and
Julie Ladisa, RDMS
In this issue of Registry
Reports, we interviewed
father and daughter sonographers,
Phillip G. Ladisa, RT,
RDMS, and Julie Ladisa,
RDMS. For 15 years, Phillip
has been a staff sonographer at
West Suburban Hospital in
Oak Park, Illinois. Julie has
worked as a staff sonographer at Resurrection Medical
Center in Chicago for the last three years.
What inspired you to get involved with sonography?
PHILLIP: “My parents have always played an influential
role in my life. However, it was the advice of my father,
Alex, and my grandmother Angeline (who was an X-ray
technologist) that perpetuated my interest in radiology and
growing further in diagnostic ultrasound.”
JULIE: “My father inspired me to become a sonographer.
I also had a strong career desire to help other people. At age
17, I had a sudden onset of severe abdominal pain. My doctor
ordered an ultrasound for me. My father performed the
exam. The results showed a ruptured ovarian cyst. During
the exam, my father turned the machine around so I could
view it, and explained everything he was looking at. I was
able to see what the inside of my body looked like. I was so
intrigued by his profession and I became so fascinated by his
work that I shadowed my father while he worked. He
patiently taught me, and I eagerly learned. I graduated from
an accredited program at Triton College. He has been my
mentor ever since.”
What are your specialties?
PHILLIP: “Although my RDMS is in abdominal, my
technical experience also includes OB-GYN, adult echocardiography,
vascular technology, and small parts procedures.”
JULIE: “My specialty is abdominal sonography. However,
I am proficient in OB-GYN, vascular, small parts, neonatal
heads, and abdominal Doppler, as well as assisting
physicians in biopsies and amniocentesis.”
How does your work affect your patients?
PHILLIP: “I would like to think that it affects them in a
positive sense. After all, humor is often said to be the best
medicine. However, a respectful and tactful attitude is still a
must.”
JULIE: “My work affects the lives of my patients by the
quality of the care I provide. I am a true believer in being
respectful and professional at all times. I want all of my
patients to be comfortable and have the utmost trust in me.”
Describe a typical workday.
PHILLIP: “Because of family health reasons, I have
requested that my shift be in the evenings. Most scheduled
studies are done during this time, which limits emergency
studies ordered by ER, LD, and ICU.”
JULIE: “A typical workday at Resurrection Medical
Center is very busy. I work under the direction of Dr. Moss
in a dynamic ultrasound department. I perform a variety of
exams throughout the day. I try to make reference to
literature, when possible abnormalities are found. It is
important for me to enhance my learning process as much
as possible. I interact with patients, physicians, and other
health professionals to ensure proper care is given. In
addition, the institution where I am employed is a teaching
hospital. Therefore, this gives me the opportunity to work
with students and my peers. It is an honor for me to
clinically instruct students properly for clarity of thought
and ease of understanding. Working with others is important
to me. It keeps me on my toes and abreast of the field of
ultrasonography.”
What is the most interesting case you worked on, and
what was the result?
PHILLIP: “One of the most interesting cases I have ever
seen was detecting a left atrial myxoma in a 59-year-old
male outpatient whose only complaint was occasional chest
pain. Surgery was successfully performed by Dr. John
Natale, at Northwest Community Hospital in Arlington
Heights, Illinois.”
JULIE: “The most interesting case I worked on was an
emergency call case. A 65-year-old female came into the ER
because she had fallen down the stairs at home. She came in
walking and talking. As she was being evaluated her
conditioned worsened. The woman coded after the CT scan
of her head was completed. The doctors could not evaluate
the abdominal region because her life was in danger. After
rushing her back to the emergency room, the doctors called
me in to do a portable exam. Her hemoglobin was dropping
fast. They were concerned that she had possible internal
bleeding. She was now on a balloon pump and vent. As I
scanned the quadrants, I found minimal fluid. There were
about 10 people in a tiny room trying to save her life. At
least six doctors of various specialties were surrounding me.
I then surveyed the abdomen and found a ruptured
aneurysm. There was not a significant amount of fluid.
Concentrating on the aorta, I found a dissection at the
proximal region. As soon as my radiologist confirmed the
finding, the woman coded again and died. I found out what
was wrong and it was still too late. It is difficult to assess the
aorta for a dissection, as most sonographers know. However,
this was a textbook case of an aortic dissection and rupture.
This was also confirmed on an autopsy later that month.”
See Ladisa, continued on next page
4 January/February 2001 • Registry Reports

Ladisa, Continued from Page 4
“Understanding anatomy, the disease process,
and physics is imperative. Applying these skills
makes my scanning more proficient and me a
better sonographer.” ––Julie Ladisa, RDMS
How do you use your skills in your work?
PHILLIP: “I feel it is a combination of not only skills I
was taught in school, but also experience that is applied to
everyday study.”
JULIE: “In my work, I use my skills by applying different
strategies and techniques to get the image with the most
information. I also utilize the machine’s proper instrumentation.
I always try different things to optimize the image.
My excellence in technique stems from my knowledge.
Understanding anatomy, the disease process, and physics is
imperative. Applying these skills makes my scanning more
proficient and me a better sonographer.”
What do you find most challenging?
PHILLIP: “Every ultrasound procedure is challenging
because you cannot predict the results prior to performing
the study.”
JULIE: “The most challenging area of ultrasound is trying
to shut off my emotions. There are many times I become
upset because of hopeless situations. It is a mental challenge
to let go of pain and sadness.”
PHILLIP: “It is very difficult to act as though everything
is ‘normal’ especially when you are performing an OB study,
and the fetus turns out to be encephalic. Parents are excited
about being pregnant, so being tactful in the way you
present yourself is very important, no matter how
devastating the results are.
“Some time ago, I performed an echocardiogram on a
middle-aged female (who was a dialysis patient). Shortly
before starting the procedure, I saw the ordering cardiologist
before he left the hospital. After a very short time into the
exam, I had detected a large pericardial effusion
(Tamponade). I remember calling another technologist to
stay with my patient and excusing myself, while I ran to the
parking lot, hoping to be able to catch her doctor and advise
him of the finding. To my surprise, I was able to, and he
instructed me to send her to the emergency room
immediately where he met and treated her.”
What do you find most rewarding?
PHILLIP: “It is very rewarding to able to determine what
and where an abnormality is. However, it is even more
rewarding to see my patients for their routine follow-up
studies in their fully recovered states.”
JULIE: “The most rewarding part of my job is my
personal happiness. I am proud to say I have a passion for
my work. Helping others and making a difference in their
lives will forever enrich mine.”❖
REGISTRANT SERVICES IS
WORKING HARD FOR YOU!
On behalf of all of us at ARDMS,
and especially the staff in
Registrant Services, please accept
our sincere apologies if your
phone call was, at times, unable to
get through to a Registrant
Services staff member. Please
know that we are all doing our
utmost to serve your needs, at all
times, with a highly dedicated,
staff. And please bear in mind that
we have been undergoing some
major changes here at ARDMS,
including a switch to a new and
more powerful database, which
will very soon allow you to serve
your own needs as a registrant,
quickly and accurately. Also, we
have been very much occupied in
mailing out documents, on time, to
11,000 registrants. In a few weeks,
we hope, the volume of work here
at ARDMS will return to its usual
level–always high, but not quite
the avalanche we've seen in recent
weeks. Then, we will be better able
to respond to your calls more
promptly.❖
The new vascular technology content
outline is now available on our
Website (www.ardms.org). The
vascular technology examinations
reflect these content outline changes.
Registry Reports • January/February 2001 5

OSHA Issues New Rules on
Ergonomic Standards
In a new regulation that will go into effect on January 15,
2001, the U.S. Occupational Safety and Health
Administration (OSHA) has spelled out what it terms a
“musculoskeletal incident,” and has provided detailed
guidance indicating what employers must do to correct these
incidents. Knowing the specifics of what is contained in this
rule will help sonographers make certain that they get the
remedies due them under law from what has
been called
“scanning in pain.”
The regs were
developed to reduce
the number and
severity of musculoskeletal
disorders
(MSDs) caused by
(among other risk factors)
repetitive motions
and awkward postures.
The assumption underlying
the new rules is
that these problems can
be eliminated, or
greatly reduced, “by fitting
the job to the worker
through adjusting a workstation,
rotating between
jobs, or using mechanical
assists.” (OSHA Standard
1910.900)
Under the rule, employers
have an obligation to educate their employees about MSDs.
Specifically, they must inform their workers about potential
MSDs and their signs and symptoms, as well as the importance
of reporting MSDs, how to file reports, the particular
jobs and risk factors most likely to cause MSDs, and a short
description of what is required under OSHA’s ergonomic
standards.
How must employers deal with MSDs, according to
OSHA’s standards? OSHA has specified several sets of
criteria that must be met, each of which prompts a
particular action.
1. If an employee reports an MSD, the employer must
(after consultation of a healthcare provider) determine if the
problem constitutes a “musculoskeletal incident,” as defined
according to OSHA’s criteria:
“(i) The MSD is work-related and requires days away from
work, restricted work, or medical treatment beyond first aid;
or (ii) The MSD signs or symptoms are work-related and last
for 7 consecutive days after the employee reports them [to
the employer].” (OSHA Standard 1910.900)
6 January/February 2001 • Registry Reports
2. Next, the employer must determine if the MSD meets
the criteria for what OSHA terms an “action trigger.” A job
meets the action trigger if (1) the MSD incident occurred on
the job, and the job involves routine—on more or more days
each week—one of the risk factors listed by OSHA.
3. If a job meets the criteria for the action trigger, employers
can either implement what OSHA calls “the Quick Fix
option” (basically, re-engineer the job within 90 days so that
the MSD is eliminated), or set up a full-fledged ergonomics
program. This program must
include management
leadership and employee
participation, job-hazard
analysis, hazard-reduction
and control measures
(with ongoing evaluation
of their effectiveness),
and employee training in
the MSD-remediation
measures adopted by
the employer.
Any employer
with more than 11
employees will have to
keep detailed records
on all of this, including
employee reports
of MSDs and MSD
hazards, the
employer’s response
to these reports, the
job-hazard analysis,
and the hazard-control measures put
in place to remedy the reported MSDs.
But will this regulation have any real impact, in terms of
potential penalties to employers? An OSHA spokesman to
Registry Reports seemed a bit guarded about this, noting,
“The standard isn’t final until January 1, 2001, and the first
elements in terms of compliance with it won’t go into effect
until October 15. Until that time, we’re just looking to
educate employers about what’s contained in the
regulations.”
He also pointed out that this standard represents new
territory for OSHA. But when pressed, he did note that the
penalties for non-compliance would probably resemble those
used in enforcing OSHA’s standards on airborne pathogens.
If OHSA hears that an employer is violating these standards,
an OSHA inspector visits the site. If the complaint is
verified, OSHA and the employer jointly develop an
abatement schedule for the violation. If the employer fails to
make sufficient progress in abatement, then OHSA penalties
kick in. They may be as low as $7,000, the OHSA
spokesman noted, but can be as high as $1 million, “if a
company repeatedly and knowing commits a violation. ❖

Industry Experts Form Innovative Company to
Address Occupational Injury Among Sonographers
Surveys over the past five years have unequivocally
demonstrated that work-related injury among
sonographers is a serious problem. Sound Ergonomics,
L.L.C., a Washington-based consultant group, brings
together three leading experts to address the issues related
to the ergonomics of ultrasound practice.
The company consists of Joan Baker, first chair of ARDMS
and former president of the SDMS; Carolyn Coffin,
program director of the University of Colorado Ultrasound
program in Denver; and Susan Murphey, faculty member
in Ultrasound at Bellevue Community College in Bellevue,
WA; and injury-prevention specialist.
In accordance with the recent regulations on ergonomics
from OSHA, Sound Ergonomics, L.L.C., provides clinicalsite
evaluations and in-service education, to prevent
ergonomic-related injuries among sonographers, vascular
technologists, and cardiac sonographers.
In addition, Sound Ergonomics, L.L.C., consultants focus
on the complexity of risk-related factors by providing local
educational seminars and equipment-design consulting.
Visit the company’s Website, at www.soundergonomics.com,
or contact Sound Ergonomics directly at (206) 417-8151.❖
Registry Reports • January/February 2001 7

®
®
600 Jefferson Plaza • Suite 360 • Rockville, Maryland • 20852-1150
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U.S. POSTAGE
PAID
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www.ardms.org
CME CALENDAR
This calendar of ultrasound meetings and review courses may help you find places
to earn CME credits. ARDMS publishes meeting notices as an information source
only. Registrants seeking CME credits should ensure in advance that ARDMS
accepts the sponsor of a particular activity. Meetings are listed based on space
availability. If you wish to have your meeting or school listed, please fax your
information to the editor of Registry Reports at (301) 517-8511, or send your
CME schedule via e-mail to soundoff@ardms.org.
April 2001
20-22 Current Practice of Vascular Ultrasound, Carotid and Transcranial Doppler,
—Institute for Advanced Medical Education (IAME), Chicago, IL.
Call (914) 921-5700, or e-mail info@iame.com.
MAY 2001
1 First Trimester Ultrasound: What’s New and Important?––Cedars-Sinai
Medical Center, Los Angeles, CA . Call (310) 423-3361 or e-mail
james.jenkins@cshs.org.
2-5 The 22 nd Annual Scientific Sessions, North American Society of Pacing
and Electrophysiology, Boston, MA. Call (508) 647-0100.`
2-6 Clinical Essentials of CT & MRI—IAME), Las Vegas, NV.
Call (914) 921-5700, or e-mail info@iame.com.
27-31 The 3 rd World Congress of Pediatric Cardiology and Cardiac Surgery,
Toronto, Canada. Call (416) 504-4500.
June 2001
1 Current Practice of Vascular Ultrasound—IAME, San Francisco, CA .
Call (914) 921-5700, or e-mail info@iame.com.
July 2001
16 First Trimester Ultrasound:What’s New and Important?—Cedars-Sinai
Medical Center, Los Angeles, CA. Call (310) 423-3361.
The following organizations and
companies offer CME opportunities
too numerous to list here. Please
contact them for further information.
• Burwin Institute, U.S. and Canada
(800) 322-0737
www.burwin.com
• Gulfcoast Ultrasound Institute,
Inc., St. Pete Beach, FL
(800) 619-1900 or (727) 363-4500
www.gcus.com
• ESP Ultrasound,
Sidney K. Edelman, Ph.D.
(281) 292-9400
www.esp-inc.com
• MedEd Interactive, nationwide
(888) 639-0817
www.mededinteractive.com
• Jefferson Ultrasound Institute,
Philadelphia, PA
(888) 390-5051 or (215) 955-8533
http://jeffline.tju.edu/ultrasound