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Practical echocardiography cases: video index, east tennessee state university.

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• Australas J Ultrasound Med
• v.21(1); 2018 Feb

The clinical ultrasound report: Guideline for sonographers

Martin necas.

1 Department of Ultrasound, Waikato Hospital, Level 1 Waiora Building, Pembroke Street, Hamilton New Zealand

The reporting roles of sonographers in Australasia vary considerably. A large number of sonographers already routinely produce formal reports, while others are moving into clinical ultrasound roles where reporting is expected. This article summarises the best practice in reporting of ultrasound examinations based on international literature and addresses key topics including report structure, clinical content, style and language. Numerous examples and sample phrases are provided and common pitfalls are discussed.

Introduction

Ongoing advances in ultrasound technology coupled with the wide availability of ultrasound and its excellent safety track record have resulted in increased clinical utility of ultrasound technology across all medical specialties and a dramatic rise in the clinical demand for ultrasound 1 . In this changing healthcare environment, sonographers have long been recognised as experts in ultrasound imaging and are afforded considerable professional respect, autonomy and responsibility. 2 The high level of diagnostic accuracy of experienced sonographers (90–99%) has been shown in a number of studies across all subspecialties. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 For this reason, sonographers are now increasingly expected not only to perform ultrasound examinations, but to provide a diagnostic interpretation 2 , 12 and prepare formal written reports. 2 , 13 , 14 While some countries, such as the United Kingdom, have a long tradition of sonographer practice that includes the provision of a formal report 13 , 15 , in Australia and New Zealand, the practice of sonographer reporting varies considerably between individual sonographers and between different departments. 16 Although professional organisations such as the Australasian Society for Ultrasound in Medicine (ASUM) and the Australasian Sonographer's Association (ASA) encourage professional progression of sonographers, 2 , 17 formal stratification of the ultrasound profession into minimally competent sonographers vs. advanced or specialist sonographers is yet to occur. 14 , 18 As a result, the Australasian sonographer community is composed of a vastly heterogeneous cohort of practitioners, some of who practice at the minimum required level and are not involved in reporting, while others practice at a very high level and formally report all their ultrasound examinations. A survey conducted by the New Zealand Branch of ASUM in July 2011 revealed that 48% of sonographers already prepared formal reports and 20% of sonographers routinely prepared formal reports that were not going to be sighted by a radiologist prior to the report being available to the referring clinician. Indeed, reporting responsibilities of sonographers have been recognised in New Zealand employment contracts for a number of years under the title of ‘reporting sonographer’, ‘specialist sonographer’ or ‘clinical specialist sonographer’. 19 , 20 , 21 As the profession of sonography moves into the future, it will be increasingly important for sonographers to acquire proficient reporting skills. The purpose of this article is to provide a detailed overview of the best practice in formal reporting of ultrasound examinations supported by a comprehensive literature review.

The reporting sonographer

A wide range of health practitioners who perform ultrasound examinations are involved in the provision of a diagnostic report. These include sonographers, radiologists and point‐of‐care practitioners (emergency doctors, general practitioners, subspecialists, midwifes, nurse practitioners, physiotherapists and other healthcare professionals trained in ultrasound). 13 , 22 , 23 The ability to produce quality reports that are accurate, clinically relevant and composed in a clear style is an acquired skill 24 requiring familiarity with current reporting standards, clinical experience, mentorship by senior experienced colleagues, practice, peer review and audit. 23 , 25 Specific instruction in formal report writing, supervised practice and audit should be a part of the sonographer's training. Academic and professional institutions providing ultrasound training programmes must ensure that formal written reporting is incorporated into academic curricula. 26 , 27 The Central Queensland University already includes written reporting in the Master's level curriculum (email from Dr Aamer Aziz, CQ University, September 2017) 28 while the University of Auckland plans to introduce it in the future (email from Associate Professor Jenny Sim, September 2017). Monash University, University of South Australia and Queensland University of Technology do not intend to address reporting in their curricula in the short term (email from Paul Lombardo, Course Convenor Master of Medical Ultrasound, September 2017, email from Associate Professor Kerry Thoirs, September 2017, and email from Chris Edwards, Course Coordinator Medical Ultrasound).

Report structure

There is good agreement in the literature on the structure of an ultrasound report. 13 , 22 , 23 , 25 , 29 , 30 , 31 In general, an ultrasound report should contain the following sections:

• (2) Patient identification, demographics, date, recipients, provider details
• (3) Indications: history and clinical information
• (4) Technique and procedural description (when required)
• (a) Itemised findings
• (b) Normal and abnormal observations
• (c) Diagnostic comments
• (6) Impression/Conclusion
• (7) Names of the individuals involved in the examination
• (8) Inclusion of reference standards in the footnotes (when required)

The title of the examination should clearly identify the type and scope (including laterality) of the examination.

Abdominal ultrasound examination Targeted ultrasound examination of the right groin Targeted hepatobiliary ultrasound, portable examination in ICU

The term ‘scan’ should be avoided because the assessment of a patient with ultrasound often goes beyond a simple scanning procedure. Unlike other radiology scans, an ultrasound examination involves important elements of clinical interaction between the sonographer and the patient such as history‐taking, observation, palpation, dynamic assessment using various manoeuvres, sonopalpation and assessment in different body positions. It is a comprehensive examination, not a scan.

Patient identification, demographics, date, recipients, provider details

It is important that the report is correctly identified by patient's full name, date of birth and one of the following: address, national health identifier, patient clinic identifier, clinic attendance code or other similar identifier. 30 The date and time (if appropriate) of the examination should be clearly noted. The sonographer should ensure that the referrer and recipients are acknowledged and that a procedure exists for the recipients to receive the report, whether in electronic or hard‐copy form. For external reports, the facility name and contact details should be clearly stated.

Indications: history and clinical information

The patient's history and clinical information may come from a number of sources including:

• history and clinical information provided by the referrer;
• history and clinical information from other medical records;
• information provided by the patient to the sonographer at the time of examination;
• clinical observations made by the sonographer; and
• clinical tests performed at the time of examination.

The patient's relevant clinical history should be copied from the referral and be included in the report. Many patients present with exhaustive medical history including multiple co‐morbidities, serial investigations, complex interventions, detailed management plans and extensive medication regimes. It may not be practical (or desirable) to include all of this information in the body of the report. 32 In these cases, the sonographer should exercise sound clinical judgement and select the clinical information that is specifically relevant to the ultrasound examination and the clinical question.

A sonographer working in regional or tertiary‐level centres may also be able to obtain valuable medical history from other sources including electronic records (admission and discharge summaries, clinic letters, surgical reports, laboratory tests, past imaging investigations) as well as hard‐copy notes. Access to medical records may become more universally available in the near future as more patients will choose cloud‐based medical records storage.

In order to encourage sonographers to access all available clinical information at the time of the ultrasound examination, some departments have codified such practice in their ultrasound protocol manuals: 33

Prior to commencing the ultrasound examination, the sonographer should: Review the referral letter Elicit relevant history from the patient Review all relevant medical records including: Laboratory findings Previous imaging findings and PACS images (if necessary) Clinic letters Discharge summaries Any other relevant medical records available

The sonographer should elicit further relevant information from the patient. The patient's presenting complaint may have changed, or the patient may reveal hitherto undisclosed clinical information that may be helpful in assessing the patient and interpreting the examination.

When appropriate, the sonographer should also assess the patient clinically prior to commencing the ultrasound examination. 34 Visual assessment and palpation of specific areas of interest can yield significant clinical clues to otherwise ambiguous ultrasound appearances with wide range of differentials. For example, superficial masses can be clinically assessed for parameters such as anatomical location, size, shape, number, firmness, compressibility, fluctuance, smooth or irregular borders, associated skin changes, discolouration, erythema, heat, induration, oedema, pain or tenderness with and without palpation, discharge, mobility, skin retraction, puckering, dimpling, scarring and other features. If the sonographer engages the patient in the performance of clinical tests or manoeuvres such as during musculoskeletal ultrasound examinations, the tests and their results should be noted:

The patient experiences pain and movement restriction with arm abduction beyond 45 degrees.

All relevant observations should be noted and included in the report and the source of the information acknowledged. 30

Technique and procedural description

The inclusion of procedural description and scanning technique is not necessary for most routine examinations such as abdominal or small‐parts ultrasound, but can be helpful for specialised examinations such as transvaginal ultrasound, certain vascular examinations, contrast‐enhanced ultrasound, marking for bedside drainage and others. 35

• Transabdominal and transvaginal ultrasound examinations were performed with patient's consent.
• Contrast‐enhanced ultrasound was performed using Definity ® perflutren microspheres (number of IV bolus injections: X, total volume of contrast: Xml).
• High‐resolution ultrasound assessment of cranial sutures was performed.
• Resting ankle‐brachial pressure index (ABPI) was 1.0 bilaterally. The patient was subjected to a 5‐min walking challenge on a treadmill set at 10 degrees incline and 3.5 km/h speed.

The typical report should present the findings in a logical sequence in the order the examination was performed or in the order of clinical priority. For comprehensive structured examinations, listing specific organs and sites of examination assists in clearly communicating to the referrer what has and what has not been examined (Figure  1 ).

Example of an Itemised Reporting Template for a Normal Upper Abdominal Ultrasound Examination.

For targeted examinations, a short description may be more appropriate:

The right pleural effusion appears simple (not septated) and amenable to percutaneous bedside drainage. A suitable site was marked on patient's skin with a permanent marker. [report end]

Normal and abnormal observations

The report should itemise and describe normal and abnormal observations and offer relevant interpretive comments. Any abnormality should be qualified by its precise anatomical location, imaging characteristics and measurements. 13 , 22 , 30 , 31

Segment 8 of the liver contains an irregular thick‐walled collection 4.5 × 3.5 × 2.8 cm in size containing particulate contents with fluid‐level. The clinical history and imaging findings are consistent with a liver abscess.

Obvious abnormalities with classic and pathognomonic appearance can be referred to directly and do not require a lengthy technical description. 36

• The right ovary contains a 4.5 cm simple cyst.
• (Not: ‘The ovary contains a unilocular, round, thin‐walled, anechoic, fluid‐filled, avascular structure with distal acoustic enhancement, consistent with a simple cyst’.)
• Several gallstones were noted ranging in size from 3 to 6 mm.
• (Not: ‘The gallbladder contains several highly echogenic, rounded, mobile foci with posterior acoustic shadowing characteristic of gallstones, measuring 3–6 mm in size’.)

Incidental findings should be acknowledged 37 and worked up. For instance, the incidental discovery of a multilocular solid‐cystic mass in a post‐menopausal woman presenting for an upper abdominal ultrasound, warrants extending the examination to include a detailed transabdominal and transvaginal scan of the pelvis.

Normal anatomical variants should be reported even if they are of no clinical significance at the time of the examination. Some variants (such as uterine anatomical variants or venous duplications) may become clinically relevant in the future.

• Femoral vein duplication was noted. This is a common normal anatomical variant.

size: 7.2 × 4.2 × 5.0, volume: 79 ccs (normal)

orientation: anteverted

morphology: subseptate

Variation from normal protocol

If the examination was extended or reduced in scope, the reasons for this should be acknowledged and justified. 13

• Cervix: not examined (term pregnancy)
• The ultrasound features of the liver are consistent with cirrhosis.
• The examination was extended to include Doppler assessment of the mesenteric, portal and hepatic vasculature.
• The findings are in keeping with a right testicular neoplasm. The examination was extended to assess the spermatic cord, regional lymph nodes and kidneys.
• I have informed Mrs Smith about the benefits of performing transvaginal ultrasound to assess the endometrial thickness, however, she declined.

Measurements

Where measurements are provided, it is important to ensure the measurement units are used consistently. For instance, an obstetric report listing a variety of measurements should not mix measurements in centimetres and millimetres.

The sonographer should consider rounding measurements to a realistic degree of accuracy as dictated by the given clinical scenario, not necessarily in the same format that they are provided on the ultrasound system. For larger structures such as organ size measurements or mid‐trimester fetal biometry, rounding to the nearest millimetre is appropriate; however, for finer structures (nuchal translucency, bile duct, etc.), rounding should be done to the nearest one tenth of a millimetre.

Fetal biometry: BPD = 73 mm HC = 271 mm AC = 254 mm FL = 55 mm EFW = 1383 g ±15%, 45 th percentile

From the clinical standpoint, it is helpful to identify whether the measurement is normal or abnormal because the referring clinician may not have a working knowledge of the reference standard. 25 , 38

Umbilical Artery Pulsatility Index = 0.95 (normal)

Even if a reference chart is embedded in the report, indicating whether a measurement is normal or not can still be helpful in some instances. For example, if the fetal Middle Cerebral Artery Pulsatility Index lies above the 95 th percentile on a reference chart, it may appear to be outside the normal limits; however, the measurement is only defined as abnormal if it is below the 5 th percentile. 39

Comparison with prior studies

If comparison is made with previous studies, the type of studies and their dates should be noted. 30

Comparison was made with CT dated dd/mm/yyyy. The small indeterminate lesion noted in segment 7 represents a simple cyst measuring 6 mm in diameter.

Direct comparison is particularly important in the cases of surveillance where the sonographer is investigating the patient for the presence of interval change. The presence or absence of change should be clearly stated. 40 , 41

• The previously noted small echogenic liver lesion is unchanged when compared to previous ultrasounds performed 6 and 18 months ago.
• The previously noted 4.5 cm AAA remains unchanged. Routine surveillance in 12 months’ time has been arranged as per departmental guideline.

Conversely, it may be necessary to acknowledge the absence of studies for comparison especially if clinicians are requesting a repeat examination at another institution and prior imaging records are not available.

Prior ultrasound examinations performed at [clinic, city] on dd/mm/yyyy are not available for direct comparison. Comments regarding interval change cannot be made.

Sonopalpation

Apart from the performance of the ultrasound scan, sonographers also have the ability to clinically examine the patient with the transducer (sonopalpation) and observe important physiological or pathological changes with various clinical manoeuvres or in different patient positions. These observations can provide further clinical information. It can be valuable to include these findings in the body of the report:

• The left ovary and left adnexa are not tender on application of transducer pressure. Gynaecological cause for LIF pain is therefore considered unlikely.
• Impingement of the supraspinatus muscle is seen beyond 45degree abduction
• The area of pain directly corresponds to a cluster of reactive, but morphologically normal inguinal nodes. The findings are consistent with lymphadenitis.

Examination quality

To what degree comments regarding the image quality are helpful to the recipient of a diagnostic report is debatable, however, significant technical shortcomings that may affect the interpretation of the examination need to be acknowledged. 22 , 25 , 29 , 30 On the other hand, excessive hedging is generally considered unhelpful because clinicians may not understand the degree to which the results can be relied on. 42 For instance, making a comment that ‘examination of the liver is suboptimal due to increased BMI of the patient, however no obvious liver mass was detected’ may leave the referring clinician questioning whether (a) there is no liver mass or (b) a liver mass was not detected because it was not detectable to begin with.

If the quality of the examination significantly impairs the sonographer's diagnostic confidence or the examination is non‐diagnostic, these considerations should be disclosed. Whenever possible, suggestions on how to achieve a diagnostic result should be offered.

• Assessment of the liver with ultrasound is non‐diagnostic due to technical limitations associated with high BMI. Given the background of Hepatitis B and rising AFP, consideration should be made for other cross‐sectional imaging.
• Fetal heart and face anatomy cannot be assessed due to unfavourable fetal position. Repeat ultrasound in 1 weeks’ time is recommended in order to complete fetal morphology assessment.
• Adequate transabdominal and transvaginal ultrasound examinations of the pelvis cannot be achieved because the patient is experiencing severe pain and cannot tolerate the examination. The examination was abandoned. Transvaginal pelvic ultrasound may be achievable under light sedation. Please contact our team on extension ×1234 to discuss.

Dealing with complex findings

Sonographers, like all health care professionals using ultrasound (radiologists, point‐of‐care practitioners, emergency doctors and others), may not have the full spectrum of expertise in all subspecialties of ultrasound. For this reason, sonographers should resist the temptation to provide specific diagnoses in areas that lie outside their areas of expertise. For instance, a sonographer working in a private centre may be highly proficient at performing fetal morphology scanning, but may not be skilled in the performance and interpretation of fetal echocardiography. In case of an incidental discovery of a complex congenital heart anomaly, it may be more appropriate to (a) withhold specific diagnostic comments, (b) report that ‘the examination of the fetal heart raises the suspicion of congenital heart abnormality’ and (c) refer the patient to a tertiary‐level fetal medicine unit for formal echocardiography where the full range of relevant diagnostic comments can be rendered in a format required by the subspecialist paediatric cardiology team.

Fortunately, sonographers most often work as part of a team in a clinic or hospital setting. Such environments offer abundant opportunities for consultation with colleagues in solving complex imaging problems.

Impression/conclusion

The final summary should contain final interpretive comments, recommendations (when appropriate) and any extra actions taken. No new information should be introduced in the conclusion that does not exist in the ‘findings’ section of the report. 29 , 30 , 32 , 43 Urgent or significant findings should be prioritised and listed first with less important findings second. 25 , 32 , 44

Impression: 1 Acute calculous cholecystitis 2 No biliary dilation 3 Fatty liver 4 Simple cyst in the left lobe of the liver

Impression: The findings are strongly suggestive of ruptured right‐sided ectopic pregnancy. Incidental note was made of a simple left ovarian cyst. The patient was immediately transferred to the Emergency Room following the examination.

Formulating a summary

The terms ‘impression’, ‘conclusion’ or ‘summary’ are preferred to ‘diagnosis’. 32 As a matter of reading efficiency, many clinicians have a tendency to skip the body of the report and refer immediately to the conclusion. 25 For this reason, the conclusion should provide a clear and concise summary of the report. In routine examinations, the summary can be brief.

• Normal abdominal ultrasound. No cause for RUQ pain was identified.
• Interval fetal growth has been normal.
• Unremarkable ultrasound examination of the right shoulder.

In other cases, it may be appropriate to state whether the findings are benign or concerning.

• Occasional premature atrial contractions were noted. These represent a benign fetal arrhythmia which typically resolves spontaneously. Further imaging is not required unless CTG or bedside Doppler examination raises the possibility of supraventricular tachycardia.
• The presence of multiple target lesions in the right lobe of the liver is highly concerning for the presence of metastases.

It is acceptable for brief reports not to have a conclusion. 25 , 30 , 31

Clinical interpretation

Interpretive and diagnostic comments can be made within the findings section and/or the conclusion depending on the length and style of the report.

The fetal kidneys and bladder are clearly visualized. The fetus is normal in size. Although the mother reports no fluid loss, premature rupture of membranes is the most likely cause for anhydramnios.

The interpretation requires placing the findings of the ultrasound examination in the clinical context. The sonographer needs to exercise rigorous clinical judgement and consider all information (imaging findings, patient's history, clinical presentation, laboratory findings, past imaging and other sources) in formulating a diagnostic opinion. Whenever possible, the diagnostic comments should be direct and conclusive. 32 , 42

The palpable scrotal lump corresponds to a simple epididymal cyst. There is no testicular mass.

If this is not possible, clinically realistic differentials should be provided and appropriately ranked in terms of probability or clinical priority (Figure  2 ). 13 , 22

Probabilistic Terms.

The cause for biliary dilation is not visualized. Given the acute presentation with pain and jaundice combined with the presence of gallstones in the gallbladder, choledocholithiasis is considered highly likely. The pancreas was well visualized and appears normal. Ampullary‐level pathology while less likely cannot be excluded by ultrasound alone.

Extensive lists of differential diagnoses should be avoided because they are generally unhelpful. 44 If the finding is of equivocal or uncertain nature, the sonographer may still be able to narrow the differentials down to a likely causative process (inflammatory, neoplastic, ischaemic, haemorrhagic or other) or may be able to indicate the likelihood that the appearance represents a benign or sinister process.

The palpable axillary lump represents an enlarged and morphologically abnormal lymph node that demonstrates multiple concerning features including: loss of normal hilar pattern, rounded shape, asymmetry in parenchymal thickness, microlobulated margins and zones of hypoperfusion.

Clinically unrealistic differentials should not be included or should be dismissed.

Right testis: length = 4.5 cm, volume = 14.5 ccs (normal), colour Doppler perfusion: normal Testicular torsion has been excluded.

Findings of no or little clinical significance should be acknowledged as such with appropriate qualifying comments. 32 , 41 , 45

• Two small gallbladder polyps were noted measuring 2 and 3 mm in size. These are of no clinical significance and do not require further follow‐up.
• In isolation, choroid plexus cysts represent a benign finding and no further assessment is required.

The sonographer should ensure the report directly addresses all clinical questions raised in the referral. 13 , 25 , 29 , 30 , 34 Furthermore, the sonographer should also anticipate clinical questions that were not explicitly stated on the referral. 43 In some cases, stating the absence of specific findings can reassure the clinician by emphasising that sufficient attention has been paid to the region of concern.

• The cause for RIF pain was not identified on transabdominal or transvaginal ultrasound. Specifically, there is no evidence of gynaecological abnormality, appendicitis or urolithiasis.
• No anatomical cause for menorrhagia identified. Specifically, no endometrial thickening, polyp or fibroid was detected.

Occasionally, the sonographer may need to disregard misleading clinical information that may have lead the referrer to suspect a disease process other than what the ultrasound convincingly indicates.

Although the patient reports acute onset of left testicular pain following a sporting injury, the ultrasound findings are strongly suspicious for testicular malignancy instead. There is no sonographic evidence of trauma.

Finally, in formulating diagnostic comments the sonographer should be aware of his/her level of competence. Sonographers should exercise a judicious threshold for seeking advice or a second opinion from a senior colleague such as an expert sonographer, radiologist or sonologist, particularly in cases requiring a multimodality approach to reach the diagnosis. 13

Recommendations (further testing, surveillance, referral, treatment)

The conclusion may also include recommendations for further testing, surveillance, referral, treatment and other considerations that may assist the referrer in managing the patient. Adherence to evidence‐based practice principles is especially important. In many instances, the sonographer can refer to established local, national or international guidelines in making recommendations: 36 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54

• No evidence of intrauterine or ectopic pregnancy was detected. This is a pregnancy of unknown location (PUL). Clinical monitoring and serial bHCG are recommended. Repeat transvaginal ultrasound can be offered when bHCG reaches 1000 iu/l or if the patient's clinical presentation changes.
• The finding of absent end‐diastolic flow in the umbilical artery in a 28‐week fetus is highly concerning and immediate specialist obstetric opinion is advised.
• Incidentally detected simple asymptomatic ovarian cysts less than 5 centimetres in diameter in premenopausal women generally do not warrant further surveillance. 48

If a follow‐up recommendation is made, the sonographer should ensure that there is a defined process for this to occur. Alternatively, the report should clearly state who should re‐refer the patient for what examination and when.

AAA surveillance in 6 months is recommended. I have made a booking for a repeat ultrasound in the Vascular Laboratory on dd/mm/yyyy.

As a final step in the preparation of the report, the sonographer should confirm that all clinical questions have been addressed.

Action taken

In special circumstances such as when findings of unexpected or urgent nature arise, the action taken should be recorded in the report. 13

• I have informed Mrs Smith that she has a significant deep vein thrombosis and I have arranged for her to be transferred to the emergency room for review.
• In view of the urgent nature of the findings, I have discussed the results with Dr T Smith, urology registrar by telephone.
• Ultrasound confirms clinical suspicion of a large AAA measuring 7.4 cm in maximum AP diameter. I have arranged immediate consultation with Dr J Smith, vascular consultant.

Names of the individuals involved in the examination

The names and designations of all the individuals involved in the examination should be noted. This may include the sonographer, trainee, registrar, chaperone, radiologist, nurse and any attending clinician. This allows the referrer to directly contact a person with direct knowledge of the examination if the referrer requires clarification or seeks to discuss the report further. 22

Examination performed by: Jane Smith, trainee sonographer Supervised by: John Doe, clinical specialist sonographer Discussed with: Kathy White, radiologist

Inclusion of reference standards

The provision of reference footnotes in the report has not been addressed in radiology guidelines to date; however, such information may enhance the report by informing the referring clinician which standard was used in the interpretation of the examination. Such practice is common in histopathology reports.

*Grading of renal pelvis dilation and management comments are based on New Zealand National Antenatally Detected Asymptomatic Renal Dilation consensus group statement 2017. Postnatal grade N (Normal) = AP Renal Pelvis Diameter <10 mm, no peripheral dilation Follow‐up recommendation: Normal scan before 1 month age – repeat in 3 months Normal scan after 1 month age – no further follow‐up

The inclusion of a reference standard may also be useful where multiple standards for the interpretation of the same finding could be used by different ultrasound providers and the application of different standards may influence the final result. 53 , 54 , 55 , 56

• British Thyroid Association (BTA) classification (2014) was used for ultrasound nodule characterisation.
• The interpretation of carotid artery stenosis was made according to Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom (2009).

Report style and language

Length and detail.

The ultrasound report needs to strike a balance between conciseness and sufficient clinical detail. 32 , 44 , 57 , 58 The sonographer should have a thorough understanding of what information is relevant to the referring clinician and tailor the report accordingly by prioritising clinically important observations.

Structured reports vs. narrative/prose reports

Clinicians tend to prefer structured, itemised reports rather than prose reports written in a narrative form. 24 , 25 , 44 , 57 , 59

The right kidney is normal in size, shape and echotexture, measuring 10.5 cm in craniocaudal length. The renal parenchyma demonstrates normal thickness and echotexture. No masses, stones or hydronephrosis were detected.

Right kidney: 10.5 cm length, normal

Structured reports also enable easier comparison with prior reports because the information is always presented in the same expected location and the same format. Ultrasound providers should strive to develop structured and consistent reporting styles that address the needs of the referrers. 60 , 61 Seeking input from the referrers in the development of report templates can ensure that the report meets the referrer's expectations 62 (Figure  3 ). A range of report samples and templates are available online. 13 , 23 , 63

The Main Body of a Simple Structured Obstetric Report Developed By Sonographers with Input from the Obstetric Team (Waikato Hospital, Hamilton, New Zealand).

Although itemised reports are preferred, occasionally, a brief narrative report may be more appropriate for examinations of targeted nature.

• Targeted Ultrasound Right Dorsal Wrist
• Indications: 53 year old man, T2DM, cellulitis over dorsum of right wrist, ? Joint effusion, ? Septic arthritis, ? Underlying collection
• Findings: High resolution ultrasound was performed. The area of redness and swelling involving the dorsal wrist demonstrates a unilocular subcutaneous abscess measuring 52 × 47 × 9 mm with an approximate internal volume of 11.5 ccs. The distance from the skin surface to the centre of the abscess is 10 mm.
• Conclusion: Subcutaneous abscess amenable to percutaneous drainage.

The sonographer should be mindful that highly specialised reports that are commonly understood in a subspecialist or inpatient setting may need to be tailored or presented in such a way that they are understandable to recipients working in an outpatient or primary‐care setting. 13

Terminology

The language style should be formal, clear, concise, specific, unambiguous and easily understood by a wide variety of recipients ranging from subspecialists to GPs and other health care professionals involved in the care of the patient. 13 , 41 , 64 Increasingly, reports are also read by patients. 41 , 65 The sonographer should refer to established guidelines or lexicons and adhere to widely accepted formal terminology. 36 , 49 , 50 , 51 , 52 , 66 , 67 , 68 Nonspecific or ambiguous terminology should be avoided. For instance, the term ‘complex’ should never be used to describe findings in the ovaries as the term is ambiguous and may refer to appearance that range from normal (haemorrhagic cyst) to malignant (ovarian cystadenocarcinoma).

The description of normal appearances usually involves the terms ‘normal’, ‘unremarkable’, ‘no sonographic abnormality’ or ‘no abnormality detected’. While some authors prefer the more definitive term ‘normal’, 69 it is important to recognise that an absence of abnormality does not necessarily ensure that the organ in question is normal in all respects. For instance, a patient presenting for a hepatobiliary ultrasound with deranged LFTs due to acute hepatitis will most likely demonstrate normal sonographic appearance of the liver. It would be incorrect to state that the ‘liver is normal’. The liver is certainly not normal. It would be accurate to state that ‘the ultrasound appearance is normal’ or ‘no anatomical cause for deranged LFTs was noted’ or that the liver ‘appears sonographically unremarkable’. Figure  4 contains a sample of commonly used descriptive ultrasound terminology.

Commonly Used Descriptive Ultrasound Terminology.

Highly specific histological terms should be used with caution. Ultrasound provides mostly anatomical and acoustic characterisation of findings. In some instances, providing a histological claim may be appropriate:

‘A 4 cm solid, heterogeneous, vascularised renal mass in the interpolar region of the left kidney was detected likely representing a renal cell carcinoma’.

In other instances, the sonographic appearance may represent a wider range of pathologies and broader, more inclusive terminology is appropriate.

• The solid hypoechoic heterogeneous testicular mass is concerning for malignancy (rather than ‘seminoma’)
• The uniformly echogenic lesion in the fetal chest most likely represents a congenital pulmonary airway malformation’ (rather than ‘Type 3 cystic adenomatoid malformation)

The report should be written in a clear and specific style. A sample of common stylistic and wording errors and pitfalls is provided in Figure  5 . 25 , 32

Stylistic and Wording Errors and Pitfalls.

Writing in first person may demonstrate compassion and add a nice personal touch to an otherwise formal and impassive report.

• I have explained to Jenny and her husband that a further scan will be necessary to complete the fetal anatomy assessment and have arranged for them to return in 1 weeks’ time.
• ‘I have discussed the results of the carotid Doppler examination with Mrs Smith and reassured her about the absence of carotid artery disease’.

Abbreviations

The use of abbreviations is discouraged as they can be ambiguous or unfamiliar to the report recipient. 70 Consider that the largest online database of pharmaceutical and medical abbreviations (MediLexicon) 71 contains over 230 000 abbreviations. For instance, the abbreviation ‘AML’ has 7 potential uses ranging from description of normal anatomy (anterior mitral leaflet), benign renal neoplasm (angiomyolipoma) through to sinister haematological malignancy (acute myeloid leukaemia).

Only the most commonly understood abbreviations such as ‘RIF’ or ‘AAA’ are permissible. If an abbreviation is required, it should be defined the first time it is used in the text.

The anterior accessory saphenous vein (AASV) is also incompetent and becomes varicose 20 cm below the groin crease. The AASV is amenable to thermal ablation.

Consistency

Whenever possible, sonographers should use consistent terminology to describe the same finding in different patients and the same finding in the same patient on follow‐up examinations. Inconsistency in description can be difficult for the referring physicians to interpret.

For instance, the following three descriptions were provided for the same stable patient with long standing cirrhosis due to autoimmune hepatitis presenting with no interval change over a three‐year period: Year 1: ‘The liver size, shape and echotexture is normal’. Year 2: ‘The liver appears as expected for known history’. Year 3: ‘Liver texture unremarkable, no nodularity, minor volume redistribution with increased bulk of the left lobe, no evidence of portal HTN’.

Graphical reports

Graphical reports include supplementary diagrams to better communicate the findings of the ultrasound examination. These types of reports have been commonly used in vascular laboratories because vascular surgeons show a strong preference for diagrams rather than plain text 34 (Figure  6 ). Another type of graphical report that may become more widespread in the future is the image‐rich radiology report. Such a report contains a selection of images with annotations. 72

Examples of Graphical Vascular Reports. Left Image: Provided By Author, Tristram Vascular Ultrasound, Hamilton, New Zealand. Right Image: Courtesy of Deb Coghlan, Precision Vascular Imaging, Brisbane, Australia.

Accountability

An ultrasound report is a formal document and represents an important waypoint on the management pathway of the patient. Sonographers therefore have the responsibility to ensure the report is accurate in every respect and is prepared and available as soon as possible, ideally immediately after the examination has been completed. 13 There are obvious clinical, professional and medicolegal risks if the report is inaccurate, incomplete or delayed. 25 , 73 , 74 , 75 , 76

Proofreading

The report needs to be carefully proofread to avoid errors in content, spelling and grammar. 13 , 77 Errors can range from  minor embarrassments due to misspelling or word substitution, 25 to serious errors concerning the opposite meaning (‘avascular’ vs. ‘a vascular’) or wrong side (‘left’ vs. ‘right’).

Formal reporting is an important professional skill for sonographers, radiologists, sonologists and point‐of‐care practitioners. Many sonographers already fulfil reporting roles and are recognised for such roles in employment contracts. This article provides a detailed summary of current best practice taking into account existing guidelines and published literature. The reporting strategies and examples provided in this article can serve as vignettes that the sonographer can implement to enhance his or her own reporting style.

Conflict of interest

No disclosures or conflicts of interest to declare.

Acknowledgement

The author would like to thank the following colleagues for their review of the manuscript, advice and support: Dr Sue Campbell Westerway, Kathryn Busch (Sydney) Debra Paoletti, (Canberra); Peter Coombs, Paul Lombardo, Dr Aamer Aziz, Suean Pascoe (Melbourne); Deb Coghlan, Sue Davies, Christopher Edwards (Queensland); Laura Lukic (Adelaide); Dr Chhaya Mehrotra, Michelle Pedretti (Perth); Dr Kate Thomas, Jill Muirhead, Gerry Hill (Dunedin); Rex de Ryke Christchurch, Josie MacFarlane, Wendy Parker (Christchurch); Angela Browne, (Whangarei); Dr Melissa Haines, Dr Thodur Vasudevan, Dr Cristina Zollo, Nicole Curtis, Bridget Boyle, Fei Yuan, Karen Robertson, Jo McCann, Dr Kara Prout, Sarah Martinez (Hamilton); Carol Bagnall, Scott Allen, Alan Williams, Mike Heath, Sangeeta Kumar, Dr Christina Tieu (Auckland); Dr Barbara Loeliger (Thames); Brendon Cosford, Sally Shaw (Tauranga); Rowena Tyman (Napier); Elaine Hampton (Whanganui); Ruth Tuck (Whangarei); Bridget Sparks (Gisborne); and Jonathan Meredith (Wellington).

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Diagnostic Medical Sonography (SONH1-UC)

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Diagnostic Medical Sonography

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When searching for evidence-based information, one should select the highest level of evidence possible--systematic reviews or meta-analysis. Systematic reviews, meta-analysis, and critically-appraised topics/articles have all gone through an evaluation process: they have been "filtered". 

Information that has not been critically appraised is considered "unfiltered".

As you move up the pyramid, however, fewer studies are available; it's important to recognize that high levels of evidence may not exist for your clinical question.  If this is the case, you'll need to move down the pyramid if your quest for resources at the top of the pyramid is unsuccessful.

Image Credit: Glover, Jan; Izzo, David; Odato, Karen & Lei Wang.  EBM Pyramid . Dartmouth University/Yale University. 2006.

• Meta-Analysis:  A systematic review that uses quantitative methods to summarize the results.
• Systematic Review:  An article in which the authors have systematically searched for, appraised, and summarised all of the medical literature for a specific topic.
• Critically Appraised Topic : Authors of critically-appraised topics evaluate and synthesize multiple research studies.
• Critically Appraised Articles:  Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
• Randomized Controlled Trials:  RCT's include a randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.
• Cohort Study:  Identifies two groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest.
• Case-Control Study:  Involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking to see if they had the exposure of interest.
• Background Information/Expert Opinion:  Handbooks, encyclopedias, and textbooks often provide a good foundation or introduction and often include generalized information about a condition.  While background information presents a convenient summary, often it takes about three years for this type of literature to be published.
• Animal Research / Lab Studies:  Information begins at the bottom of the pyramid: this is where ideas and laboratory research takes place. Ideas turn into therapies and diagnostic tools, which then are tested with lab models and animals.

Different types of clinical questions are best answered by different types of research studies.  You might not always find the highest level of evidence (i.e., systematic review or meta-analysis) to answer your question. When this happens, work your way down the Evidence Pyramid to the next highest level of evidence.

This table suggests study designs best suited to answer each type of clinical question.

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Further your career in diagnostic sonography, exploring theory and clinical practise., virtual tour, explore our campuses online, find out what your program delivery will look like.

Diagnostic Medical Sonography

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• Activities in which students are continually supervised directly by college staff or individuals working on behalf of the college.

The two-year Diagnostic Medical Sonography Ontario College Graduate Certificate program provides you with the crucial knowledge and technical skills to produce sonographic images and carry out diagnostic procedures.

Diagnostic medical sonography is a diverse and dynamic field of work. Sonographers must be able to work well in stressful situations and think critically. The quality of an ultrasound study is dependent on the skills of the sonographer.... (read more)

Programs at Algonquin College are delivered using a variety of instruction modes. Courses may be offered in the classroom or lab, entirely online, or in a hybrid mode which combines classroom sessions with virtual learning activities. Upon registration, each full-time student is provided an Algonquin email account which is used to communicate important information about program or course events.

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Cross-Sectional Imaging for Sonography

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Sonographers co-relate cross-sectional images from multiple modalities to analyze and apply the best possible methodology to current sonogra... + Read More

Sonography Physics and Instrumentation I

A thorough understanding of the foundational scientific theory relating to ultrasound is required for successful use of sonographic technolo... + Read More

Obstetrical and Gynecological Sonography I

Sonographers require comprehensive knowledge of the female reproductive system in both gravid and non-gravid conditions. By investigating an... + Read More

Sonography of Superficial Structures

Scanning superficial structures is an inherent skill that the generalist sonographer needs to be competent at differentiating normal from ab... + Read More

Sonography Skills Laboratory I

It is essential that sonographers are experts at utilizing sonographic equipment. Under direct supervision and assistance of the instructor,... + Read More

Abdominal Sonography

Proper imaging requires a thorough knowledge of sonographic anatomy. Learners review anatomical structures of the abdomen and relate the inf... + Read More

Professional Practice and Legislation for Medical Imaging Professionals

Legislation and regulations govern the practice of the medical radiation technologist. Students gain an understanding of the roles of profes... + Read More

Practice Foundations for Sonography I

Professionals in the field of sonography require knowledge of their roles and responsibilities. In this course, learners explore the foundat... + Read More

Sonography Physics and Instrumentation II

Ultrasound equipment is highly technical and requires intricate knowledge of physics and instrumentation to operate safely and effectively. ... + Read More

Sonographic Pathology of the Abdomen

Sonographers must possess advanced skills in recognition and analysis of sonographic pathology and normal variants. Through in-depth explora... + Read More

Sonography Skills Laboratory II

Essential skills are necessary before integrating into the clinical environment to practice sonography. By scanning various organ systems wi... + Read More

Obstetrical and Gynecological Sonography II

Recognizing and analyzing abnormalities in fetal development, as well as in the female reproductive system are imperative skills for sonogra... + Read More

Vascular Sonography

To be successful at vascular sonography, one requires a thorough knowledge and comprehension of the body's vascular system and its functions... + Read More

Patient Management for Medical Imaging Professionals

Best practice standards guide the Medical Imaging Professional to provide care to the patient. Students learn the principles of conducting r... + Read More

Patient Management Skills for Medical Imaging Professionals

The support, care and understanding of the patient is the primary role of the Medical Imaging Technologist. Using case scenarios, students p... + Read More

Practice Foundations for Sonography II

Investigating the national standards allows learners to gain knowledge of the sonographer's role in healthcare. Learners explore the scope o... + Read More

Sonography Skills Lab III

Sonographers are required to apply advanced scanning techniques to complement and expand on the standard sonographic examinations. Through h... + Read More

Sonography Critical Case Review

Diagnostic Medical Sonographers must analyze complex cases and communicate findings appropriately and accurately to the interpreting physici... + Read More

Clinical Practicum I

It is necessary for sonographers to be proficient at performing sonography in the clinical environment. Learners integrate applied theoreti... + Read More

Clinical Practicum II

Sonographers in the clinical setting are experts in their field and work in a competent and professional manner. Learners enhance their tech... + Read More

IMG1002 Sonography Physics and Instrumentation I

Img1004 obstetrical and gynecological sonography i, img1007 sonography physics and instrumentation ii, img1008 sonographic pathology of the abdomen, img1013 clinical practicum i, img1017 sonography skills laboratory i, img1018 sonography skills laboratory ii, img1034 abdominal sonography, img1035 professional practice and legislation for medical imaging professionals, img1036 obstetrical and gynecological sonography ii, img1037 vascular sonography, img1038 patient management for medical imaging professionals, img1039 patient management skills for medical imaging professionals, img1043 practice foundations for sonography i, img1044 practice foundations for sonography ii, img1047 sonography skills lab iii, img1048 sonography critical case review, careers & pathways.

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Jane St. Germain

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Jane has been with Algonquin since 2010. She was seconded from the Ottawa Hospital to help develop the DMS program, she is the past Program Coordinator, and current Clinical Coordinator who also teaches in the Diagnostic Medical and Cardiac Sonography Graduate Certificate programs. She graduated from the Bilingual MRT program in 1989 and expanded her studies to become a credentialed Canadian Generalist Sonographer in 1993. She also holds the credential Canadian Registered Vascular Sonographer since 1996. In addition, Jane also holds a Certificate in Adult Education and Masters Degree in Medical Ultrasound. Her experiences include those of the tertiary care hospital, private clinic, and community hospitals in Eastern Ontario. Further to this, Jane has volunteered on Sonography Canada’s Board of Directors and continues her commitment as Chair of the Professional Practice Committee, and member of various other committees including the National Education Advisory Committee, Continuing Education Committee, and the Exam Translation Committee.

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Diagnostic Medical Sonography

In Gwinnett Tech’s Diagnostic Medical Sonography program, students learn how to use specialized equipment that directs high-frequency sound waves to produce dynamic images of organs, tissues, blood flow and fetal anatomy for interpretation by a physician, as a tool to assist in the diagnosis and treatment of pathological conditions. Students learn about various types of sonography through didactic instruction, patient simulation, labs and clinical experiences. Coursework includes sonographic physics, sonographic identification of normal and abnormal anatomy, physiology, pathology, and pathophysiology of the abdomen, pelvis, and small parts of the adult, pediatric and fetal patient, clinical application courses, interventional sonography, vascular sonography, journal and case study review, and comprehensive registry reviews. Graduates of Gwinnett Tech’s diagnostic medical sonography program go on to work in hospitals, imaging centers, physicians’ offices and urgent care centers.

Our program is accredited by the Commission on Accreditation of Allied Health Education Programs ( www.caahep.org ) upon the recommendation of Joint Review Committee on Education in Diagnostic Medical Sonography ( JRC-DMS ).

Commission on Accreditation of Allied Health Education Programs 9355 113th Street N., #7709 Seminole, FL 33775-7709 727-210-2350 www.caahep.org

The DMS program is a competitive entry program. For more information on the process and prerequisite courses please attend one of our  Monthly Information sessions  to learn more. Application to the DMS program requires that you attend ONE of these information sessions within a year of applying to the program.

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• Diagnostic Medical Sonography, AAS

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Take the first step toward a career in Diagnostic Medical Sonography and  apply for next semester ! Important  dates and deadlines  are listed to get you started and if you’re looking for ways to pay for your education, explore our  scholarships for this program , as well as  state and federal funds  for which you may be eligible.  You can also learn about our  faculty  and  clubs and organizations  you can join!

Gwinnett Tech builds relationships with local subject-matter experts to develop advisory boards, who provide feedback that ensures we deliver relevant industry-specific curriculum for today’s high-demand careers. See who serves on our  Diagnostic Medical Sonography advisory board .

What can I expect from the Diagnostic Medical Sonography program?

The DMS program provides students with the skills necessary to operate sonographic equipment and to obtain high-quality diagnostic images through various enhancements. The program strives to prepare students to be capable of implementing innovative techniques, to practice excellent patient care skills, ability to respond quickly to adverse or atypical situations, and who have a commitment to keep current with technological changes within the sonography field.

Tell me more about this program.

The DMS program offers the Abdomen-extended and OB/GYN concentrations. Students will learn both concentrations in this 22-month continuous course of study (5 semesters) that includes on-campus didactic and lab sessions and off-campus clinical rotations. The DMS program is a full-time commitment that requires a lot of additional study time outside of class. Classes are scheduled for daytime with a new cohort beginning every fall. 

Students in our program will sit for the ARDMS Sonographic Principles and Instrumentation exam after their first semester. Just prior to graduation, DMS program students will take the ARDMS registry specialty examinations in both Abdomen-extended and OB/GYN.

Abdominal sonographers can help diagnose conditions that affect the aorta, liver, kidneys, gallbladder, pancreas, spleen, bladder, thyroid, breast, scrotum, pediatric sonography, as well as analyze blood flow throughout these organs. Sonographers also assist with interventional procedures which means biopsies, needle aspirations, fluid drainage all of which involve sterile fields, needles, and body fluids.

OB/GYN sonographers specialize in measuring the health of a fetus and expectant mother, as well as detecting or analyzing potential abnormalities in the fetus and assessing the female reproductive organs.  These sonographers will also assist with interventional procedures.

The majority of sonographers are expected to perform all sonographic examinations in hospitals, imaging centers, or urgent care centers. Only in breast centers or a private physician’s office will the sonographer specialize in specific areas.

What career options will I have?

• Diagnostic Medical Sonographer
• OB/GYN Sonographer
• Breast Sonographer
• Vascular Technologist
• Pediatric Sonographer
• Musculoskeletal Sonographer
• Applications Specialist
• Sonographic Equipment Sales

How much will it cost?

Gwinnett Tech offers affordability at  $100 per credit hour + fees . Great opportunities for scholarships and financial aid with HOPE Grant, HOPE scholarship, HOPE Career Grants, and more!

• Diagnostic Medical Sonography
• Sonography Home
• Accreditation
• Application
• Concentration Requirements

Frequently Asked Questions

• Program Goals, Expectations, and Effectiveness
• Sonography Educators

What is sonography/ultrasound?

Sonography, commonly referred to as ultrasound, is a diagnostic medical procedure that employs high-frequency sound waves to produce images of structures within the body. These images assist physicians and other healthcare professionals in diagnosing diseases and disorders.

Where does a sonographer work?

Diagnostic Medical Sonographers work in healthcare settings, such as hospitals, outpatient imaging clinics, and physician offices.

How much do sonographers make?

According to the U.S Bureau of Labor and Statistics, the 2023 median pay for sonographers is $80,850 per year.

Is the DMS program accredited?

The Commission on Accreditation of Allied Health Education Programs (CAAHEP) upon the recommendation of the Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS). The program was approved March 2013. For more information contact www.CAAHEP.org

What does accredited mean to a DMS graduate?

Accreditation ensures that graduates of DMS programs have received a quality education, equipping them well for their roles as diagnostic medical sonographers. Earning a degree from an accredited DMS program enhances the credibility of a graduate's qualifications. Employers often favor graduates from accredited programs, confident in the comprehensive education they have received.

How long is the program and when does it start?

The program is 14-months in length and starts every year in June.

How many students are accepted?

We accept a total of 20 students.

What programs are offered?

Our program provides two specialized concentrations: General and Vascular. The General concentration focuses on abdomen-extended and obstetrics/gynecology, while the Vascular concentration is dedicated to the study of vascular anatomy and physiology.

Can I take both concentrations at the same time?

No, however, students can take concentrations consecutively and will not need to retake the virtual lab, introduction to sonography, or the physics courses.

Is the program offered online?

The didactic is delivered online and the clinical rotations are completed at a site near you.

What are the prerequisites to be eligible to apply?

Applicants must have an associate or bachelor’s degree and a medical component such as Radiography, Respiratory Therapy, Nursing, Physical Therapist Assistant, Occupational Therapy Assistant, Certified Nursing Aid, or any other direct patient care specialty approved by our Program Faculty. In addition, you will be required to complete the following prerequisite courses, mathematics (intermediate algebra or higher), public speaking or english composition I, anatomy & physiology, medical terminology, physics

How much does the program cost?

The program cost $14,000-$18,000 depending on in state or out of state tuition.

Do I have to move to Parsons, KS for clinicals?

No, you can complete your clinical rotation at a site near where you live.

How many clinical hours are required?

Students are required to complete their clinical rotations at a local site during the fall and spring semesters for 24 hours per week, which then increases to 32 hours per week during the summer semester.

How do I find a clinical site?

Applicants must fulfill an 8-hour observation day as part of the process. Following the receipt of the day's evaluation, we will contact them to discuss the possibility of hosting you for a clinical rotation. Should they consent, we will initiate the affiliate agreement process. However, if they do not consent, you will need to repeat the process with a new observation.

Does financial aid cover the DMS program?

Yes, financial aid and scholarships can offset some cost of the program depending on your eligibility. Here is the link the financial aid page: Financial Aid & Scholarships | Labette Community College

Program Contacts

Text 620-206-5968 for information

Brandi Clark

Bscte, rrt, dms navigator.

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Simulation of the sulfide phase formation in a KhN60VT alloy

• Simulation of Metallurgical and Thermal Processes
• Published: 23 September 2017
• Volume 2017 , pages 447–453, ( 2017 )

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• I. V. Kabanov 1 ,
• E. V. Butskii 1 ,
• K. V. Grigorovich 2 &
• A. M. Arsenkin 2  

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The conditions of the existence of sulfide phases in Fe–Ni–S alloys and four-component Fe–50 wt % Ni–0.001 wt % S– R ( R is an alloying or impurity element from the TCFE7 database) systems are studied using the Thermo-Calc software package and the TCFE7 database. The modification of nickel superalloys by calcium or magnesium is shown to increase their ductility due to partial desulfurization, the suppression of the formation of harmful sulfide phases, and the uniform formation of strong sulfides in the entire temperature range of metal solidification. The manufacturability of superalloys can decrease at a too high calcium or magnesium content because of the formation of intermetallics with a low melting temperature along grain boundaries.

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Modeling Thermophysical Characteristics of Nickel-Based Superalloys

Phase field modeling of solidification in multi-component alloys with a case study on the Inconel 718 alloy

Phase-Field Simulation of Microstructural Evolution in Nickel-Based Superalloys During Creep and in Low Carbon Steels During Martensite Transformation

H.-P. Chen, R. K. Kalia, E. Kaxiras, G. Lu, A. Nakano, N. Kenichi, A.C.T. van Duin, P. Vashishta, and Z. Yuan, Physical Review Letters, No. 104, 155502 (2010).

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F. Kristofory, M. Mohila, D. Mikulas, and J. Vitec, Acta Metallurgica Slovacia 10 (3), 236–241 (2004).

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J. Morscheiser, L. Thönnessen, and B. Friedrich, “Sulphur Control in Nickel-Based Superalloy Production,” in Proceedings of Conference on EMC (2011), pp. 1–15.

Software Package. Thermodynamic Calculations of Phase Diagrams for Multicomponent Systems . http://www.thermocalc.com.

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OAO Metallurgical Plant Elektrostal’, Elektrostal’, Moscow oblast, Russia

I. V. Kabanov & E. V. Butskii

Baikov Institute of Metallurgy and Materials Science, Russian Academy of Sciences, Moscow, Russia

K. V. Grigorovich & A. M. Arsenkin

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Correspondence to E. V. Butskii .

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On the Centenary of Plant “Elektrostal”

Original Russian Text © I.V. Kabanov, E.V. Butskii, K.V. Grigorovich, A.M. Arsenkin, 2017, published in Elektrometallurgiya, 2017, No. 3, pp. 13–21.

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Kabanov, I.V., Butskii, E.V., Grigorovich, K.V. et al. Simulation of the sulfide phase formation in a KhN60VT alloy. Russ. Metall. 2017 , 447–453 (2017). https://doi.org/10.1134/S0036029517060106

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Received : 21 November 2016

Published : 23 September 2017

Issue Date : June 2017

DOI : https://doi.org/10.1134/S0036029517060106

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