Question

Use your knowledge and understanding of the standards of SDMS to answer the following question.

As a sonographer, you have a patient scheduled for a carotid ultrasound tomorrow. You notice that this patient had this study done 3 months prior and it was normal. The order states the same indication as the previous order. You contact the ordering physician to inform them of the previous report and ask if there are any clinical changes to be aware of that would indicate the need for the study to be repeated. The physician tells you that the patient has no new symptoms, but her insurance will reimburse the practice for vascular studies every 3 months. Do you perform the study? Explain thoroughly why

Answer 1

Carotid Ultrasound is a safe, painless procedure that uses sound waves to examine the blood flow through the carotid arteries, which supplies the brain. The normal velocity of common carotid artery is 30-40cm/second. Carotid Ultrasound can be done to check the velocity of blood flow through the carotid artery. Carotid Ultrasound tests can help to identify the blocked or narrowed carotid arteries and take appropriate measures to prevent the risk of stroke. According to Dr. Marc Schermerhorn, chief of vascular surgery at Harvard- affiliated Beth Israel Deaconess Medical Centre , said that "But unless you have symptoms or multiple risk factors for Heart disease, a carotid artery ultrasound doesn't make sense. There are no risks associated with carotid ultrasound as it uses sound waves instead of X-rays but doing ultrasound without indication sounds unethical.

A sonographer has to follow certain principles as he is a member of SDMS (Society of Diagnostic Medical Sonography). SDMS is the largest professional association of sonographers in the World. It has made some principles which the members has to follow at any circumstances. According to these principles, the sonographer should not conduct carotid ultrasound for this patient as he or she has no medical indications for the study. The principles which hinder the conduction of carotid ultrasound for such a patient developed by SDMS is discussed below:

1. In order to promote patient well-being, the diagnostic medical sonographers shall promote patient safety during provision of sonography procedures and while the patient is in the care of the diagnostic medical sonographer.

2. To promote the highest level of competence practise, diagnostic medical sonographers shall perform medically indicated ultrasound studies, ordered by a licensed physician or their designated health care provider. This means, the sonographer must conduct carotid ultrasound only for patients with risk factors or symptoms.

3. To promote professional integrity and public trust, the diagnostic medical sonographer shall avoid conflicts of interest and situations that exploit others or misinterpret information. In this case, patient and physician is trying to exploit insurance which is unethical.

4. To promote professional integrity and public trust, the diagnostic medical sonographer shall communicate and collaborate with others to promote ethical practise. That is why the sonographer asked the physician for any clinical indications for the test.

5. To promote professional integrity and public trust, the diagnostic medical sonographer shall engage only in legal arrangements in the medical industry. In this scenario, performing the test is an illegal arrangement.

6. To promote professional integrity and public trust, the diagnostic medical sonographer shall report deviations from code of ethics to institutional leadership for internal sanctions, local intervention and criminal prosecution. The code of ethics can serve as a valuable tool to develop local policies and procedures.

So based on these principles and code of ethics mentioned by the SDMS, the carotid ultrasound test should not be conducted for the patient.