image quality review 3rd quarter wednesday october 19 th 2011 iibc 5:30-7:30

Image Quality Review3rd Quarter

Wednesday October 19th 2011IIBC 5:30-7:30

Agenda

•Review from 2nd Quarter•General announcements• Image review for 3rd quarter 2011.•Questions and wrap up.

2nd Quarter review 2011

• Presentation posted on SharePoint

• Proper measurements for cervix, lateral ventricle and aorta

• Imaging tips for finding ovaries, proper vascular technique, and imaging large patients on the E9

dddddddBad Cervix

Good CervixGood Cervix

Bad Ventricle

Good Ventricle

General Announcements

Scheduling ultrasound and vascular exams

• If we do a venous exam, we use the code WITHOUT THE DASH.  If we do a Carotid or upper extremity venous, we USE THE DASH.

  • VVDVT  LOWER EXTREMITY VENOUS FOR DVT   (NO DASH FOR

ULTRASOUND)  • -UCARDU  CAROTID DUPLEX  EXAM   ( WITH DASH FOR ULTRASOUND)  • -UUEVEN  UPPER EXTREMITY VENOUS UNILATERAL (on call)  CPT 93971 

( WITH A DASH FOR ULTRASOUND)  • -UUEVEB   UPPER EXTREMITY VENOUS BILATERAL (on call)  CPT 93970  

( WITH A DASH FOR ULTRASOUND) 

Announcements Cont.…..

• Limited versus follow- up

• 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal

heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses This code is used for a selected, limited purpose such as evaluation of fetal viability, fetal position, or amniotic fluid check. It includes gray scale real time images with written interpretation and, if possible, image documentation. Code 76815 is used only once per exam and not per element or per fetus.

• 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, reevaluation of fetal size by measuring standard growth parameters and amniotic fluid

volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus.

This examination is designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously identified on an ultrasound. This code should be used once for each fetus requiring reevaluation using modifier ‘59’ for each fetus after the first.

More Announcements MULTIPLE GESTATIONS:

• When evaluating a pregnancy with multiple gestations, the following criteria must be met in addition to the established obstetrical ultrasound protocols:

• Attempt to establish chorionicity and amnionicity if it has not previously been established. Documenting separate placentas and/or differing fetal genders can confirm dichorionicity. Documentation of a membrane separating the fetuses confirms diamnionicity.

• Fetal positions should be documented in longitudinal and transverse planes with the fetuses labeled “A” and “B” in these images. The fetus that is presenting is designated as “Baby A”. This must remain consistant. The fetus designated as “Baby A” on the first ultrasound remains “Baby A” regardless of presentation changes. If necessary, simply specify that “Baby B is now the presenting fetus”. It is also mandatory to draw the fetal positions on the online form.

• Note: In Viewpoint, “Baby A” is “Fetus 1” and “Baby B” is “Fetus 2”.

Twins Continued…• When evaluating biometry in Viewpoint, the fetal growth must be

anchored to one fetus. On the first ultrasound, the larger fetus should be selected. On all subsequent ultrasounds, the gestational age is always anchored to the fetus that was selected on the first examination (the selection should not change regardless of whether or not the relative sizes of the fetuses change).

• A four quadrant AFI is performed without regard to the membrane(25 wks +). A subjective evaluation should be made of the amount of amniotic fluid in each sac, and a maximum vertical pocket measurement should be obtained in each sac.( 18 wks +)

• The placental cord insertion site(s) should be evaluated and imaged. The incidence of velamentous cord and vasa previa is increased in twins.

Other Stuff

• Ovarian cysts should be measured to include the cyst wall.

• The GB section on the online form is for comments, not a routine GB measurement.

• Cervices less than 3 cm are not routine unless otherwise specified by Radiologist.

RadWorkFlow Feedback 3RD Quarter

2011

Show Placental Edge

Need Placental edge with this

picture

Need placental edge picture with this image as well

“Images of fetal heart need to be magnified”

“Images of fetal heart need to be magnified”

“Images of fetal heart need to be magnified”

“Images of fetal heart need to be magnified”

Much better magnification of heart

Only image of Fetal Heart…..but good cine documented

Poor image of fetal kidneys

Poor image of fetal kidneys

Better image of fetal kidneys

Poor measurement of HC

Poor measurement of HC

Better results using point to point HC

“Unacceptable images of posterior fossa”

“Unacceptable images of posterior fossa”

Long and short axis cine images must be oriented to the uterus ,not the patient

Long and short axis cine images must be oriented to the uterus ,not the patient

Long and short axis cine images must be oriented to the uterus ,not the patient

No color Doppler of thickened endometrium

No color Doppler of thickened endometrium

Coronal Images of IUD’s

Do we begin again?

How would you measure?

Include uterine mass in

measurement.

Transverse measurement

Geez (crap) did I really just do that?

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

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

• Incorrect Uterine volumes, no uterine volumes.

• Right and left ovarian measurements transposed.

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

• No Doppler of left testicle.

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

Sick gallbladders need to be addressed

Take Home Message

1. Look at prior report . 2. Document that you looked and

couldn’t find it.

Thyroid Nodules

Thyroid Nodules

How should we label?

A

B

C

OR

1

2

How to measure

Sagittal Transverse

What about nodules less than 1

CM?

Uterine Masses

Uterine Masses

Uterine Masses

A

B

A

B

The End