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Correcting Ultrasound images
When a tech pulls the wrong patient from the worklist and scans, there is not a way to edit the exam and resend to PACS (We have GE logic). The patient information is imbedded on the US images. How are you guys handling this – rescanning the patient or annotating on each image on PACS. Thanks in advance for your feed back, Michelle
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31 Replies
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This is a problem I have seen for years. The only method I have seen used is annotating the images and making a note on the report. Otherwise, there are some US units where you can change the name and then resend correctly.
These days radiating, rescanning, patients is avoided.
This should be seldom especially if techs use patient identifiers and pay attention to the worklist.-
Ultrasounds emit radiation? We better quit doing OB’s here then.
Our policy is to rescan for US. No reason the tech can’t get the right name.-
Correction – US are not like regular X-rays. Pick the right name in the first place and you won’t have a problem.
[b]Risks/Benefits [/b] Ultrasound imaging has been used for over 20 years and has an excellent safety record. It is non-ionizing radiation, so it does not have the same risks as x-rays or other types of ionizing radiation.
Even though there are no known risks of ultrasound imaging, it can produce effects on the body. When ultrasound enters the body, it heats the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term effects of tissue heating and cavitation are not known.
Because of the particular concern for fetal exposures, national and international organizations have advocated prudent use of ultrasound imaging. Furthermore, the use of diagnostic ultrasound for non-medical purposes such as fetal keepsake videos has been discouraged.
(source: http://www.fda.gov/cdrh/radhealth/products/ultrasound-imaging.html)
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I’m just giving you a hard time…
However I feel annotating the exam is a risk, and not a permanent solution. Annotations can be manipulated and deleted. For the short-term we may annotate to get the exam read, but ultimately we rescan the patient for the permanent archive.
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We are also adding a note to either a memo and/or the report. But I think rescanning is best. On some of the newer models of US the patient demo. can be turned off. In that case the demo. are not part of the pixel data. I like this option also. Though splitting cases is a little more difficult. I have not seen on our US units anyway of changing demo. and resending. But I will have to look again.
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[b]Ultrasounds emit radiation? We better quit doing OB’s here then[/b]
Ultrasound (sound wave) is radiation, just not ionizing radiation.-
Do you know how to read? I said “radiating” comma “Rescanning”
Either one…
Should not have to do the study twice if your competent.
Learn how to read… Even US are not completely safe – no evidence to prove or disprove. Try reading it again.
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OK
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Ibrock, dude calm down. Why don’t you read [b]my[/b] post again. If you look closer I was responding to josh metzger & [b]NOT[/b] you! [font=arial]See (in reply to [link=http://www.auntminnie.com/forum/tm.aspx?m=145168#145175]josh metzger[/link])[size=2] in my lower right hand box[/size]
[/font][u]josh metzger said:[/u]
[b]Ultrasounds emit radiation? We better quit doing OB’s here then.
Our policy is to rescan for US. No reason the tech can’t get the right name.[/b]I just pointed out that sound waves are radiation but [u]NOT[/u] ionizing radiation.
[u]Ibrock:[/u]
[b]Do you know how to read? I said “radiating”[/b]
[b]Learn how to read…[/b]
Might say the same to you.[b]Even US are not completely safe – no evidence to prove or disprove.[/b]
Where did that come from? I made no statement. Again read it again and comprehend this time.I intended no attack. This is a PACS forum and some PA’s don’t have a clincal background. I just wanted to point out that “radiation” encompasses more than “x-rays”.
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& I was mainly just joking…
Back to the topic though. This is a good post, and I too am curious about what others do.-
Josh, I meant no disrespect to you. I did “get” the joke. I think you already know that, but if not I appologize.
I/we Rad techs spend alot of time educating the public about “radiation” especially now with this CT “scare”. I once spent 2.5 hours on the phone talking to a father about his son’s CT and the exposure he recieved. The father went on the internet & “educated” himself. He “is an enginneer” so he wanted me to eplain mR, mGy, expsoure, etc..
Again, I just wanted to point out that there are 2 types of radiation: ionizing & non-ionizing for anyone out there in this “public forum”.
By the way josh we do the same as you do.
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Ha hahahahahha
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I’m embarrassed to admit that all I do is add annotation to obscure the wrong name, copy it to all images in the series, and then scold the ultrasound tech.
It’s a more complicated story if an ultrasound student has to check out images for a school project. That involves a laser printer and an x-acto knife.
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…kind of reminds me of this thread… 🙂
[image]local://4905/2135D75B48B2424EB58B15DF0E70F70C.jpg[/image]
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Just like in any other type of medical record, the only acceptable way to alter it is:
– run a straight line through the wrong information (so the underlying writing remains discernible)
– add the correct information
– document who made the change and when.I get a fit if US techs use their editing priviledges to put big black boxes over whatever screw-ups they committed.
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because the US images are screen captures, it is the scanning techs responsibility to edit over the incorrect pt name with the correct info and save it.
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This is the bane of Ultrasound, and happened yesterday when there were two K Smiths in succession. Our procedure is to add an US image to the case that is text stating that there is a demographic error, and to go by the screen overlay, not the embedded information. It also states to contact the scanning department if there is any question as to this information. This was approved by our org’s Risk Management dept. We then add annotation to each image with the correct patient information, but annotations do not copy over to CD/DVD or to other PACS systems/archives, which is why we have the image as well. The PACS Admin takes care of all of the above; the US tech gets a verbal flogging. It would be nice if US manufactures would make this information editable like other modalities – keep hearing rumours but have seen nothing yet.
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Ive seen in the Clinical Trials (anonymizing images very important) world where they apply a mask to the images that covers up all demographic information. The mask can be applied to all images within the series. It actually modifies the original pixel data. Then, you can modify the demographic data in the DICOM file to adjust what is displayed in the overlay.
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Daniel, what software do they use that applys the mask to all images in a series?
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The commercially available one that was used was from a company called Etiam. I think they also made some film scanning and segmenting software.
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David Clunie has a tool for blacking out the annotations that I’ve heard is helpful for this. I just found out about it yesterday from one of my trainers and plan to start using it.
It looks to be a bit manual, but maybe its a good educational tool.
“….I mostly use one I wrote myself; there is a blackout routine in myJava PixelMed DICOM toolkit, which has a crude main() method but caneasily be incorporated in more complicated applications or work flowautomated tools (which is what we do in our deployed productionsystems in our business).
[link=http://www.dclunie.com/pixelmed/software/javadoc/com/pixelmed/display/DicomImageBlackout.html]detail link[/link]
You can try it (one single or multi-frame file at a time) [link=http://www.dclunie.com/pixelmed/software/webstart/DicomImageBlackout.html]webstart link[/link]
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you can download our DICOMPROXY software. It allows changing any DICOM field to any string, so you can correct the name easily. [link=http://www.medimagingtools.com]www.medimagingtools.com[/link]
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ORIGINAL: abrms
you can download our DICOMPROXY software. It allows changing any DICOM field to any string, so you can correct the name easily. [link=http://www.medimagingtools.com]www.medimagingtools.com[/link]
We’re not talking about DICOM headers. With ultrasound, the demographics are burned into the image.
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Now that’s a good point (Flint)
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I am just starting as PACS admin but on our Vivid & Philips US (I am cardio/vascular/cath lab PACS), we can choose whether or not to have the images contain the patient data, which we do not. It is a selection on the modality. The only place patient data lives is in the dicom header and that I am sorry to say happens often here as there has not been a lot of push in the past to make sure the tech is pulling the right one from the worklist. Trying to clean that up, will try the DICOMPROXY software, might help.
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this happens to us quite a bit also.
this is our workaround..(rightly or wrongly).. and working within the limitations of our PACS..
rather than annotate images to obscure names which looks downright ugly and unprofessional, we crop the dicom images in pacs (impax) to exclude the wrong patient header information and then export the cropped images as jpg’s. Once exported we reimport the cropped jpgs back to the patient and delete the dicom ones. The image quality while not as “nice’ as the dicom ones, it is deemed satisfactory and a better alternative in this situation.
A better option for us would be to just to crop and save the cropped dicom images in PACS. However we need to do the jpg bit above as when transmitted to our web viewing platform for the broader hospital community, uncropped images always get sent.-
Xing out the incorrect patient data on the PACS or adding an image to the file that states that there is an error with patient demographics works just fine until you need to burn a CD.
At that point in time you start to deal with patient privacy issues.
At this institution, the patient is rescanned.
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When you search Aunt Minnie for a solution to a problem, only to see your own post from 14 years ago.. [X(]
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Why are we still burning Pt. data into US images. Don’t most scanners have the option to turn that off?
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We have a Siemens Acuson machine. We de-identify the patient on the machine, and resend the images that now have no demographic information. In our PACS, we put in a note confirming it is the specific patient’s images.
We’ve had some success of having the US techs take a screenshot of the patient’s demographic information as their first image, as this cuts down on the error to begin with.-
We have 2 GE LogicQ that still burn some pt info into the screen. I use Clune’s DicomCleaner program. Works well once you get the hang of it. Fortunately these machines will be replaced soon.
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