Ultrasound As a Bridge to Imaging Service

Why don’t more BMETs work on Diagnostic Ultrasound Machines?

Patrick K. Lynch, CBET, CCE, MBA

plynch@gmi3.com

Note from author: The following was written over a year before I knew who GMI was, and almost 18 months before I knew I would be working for them.

An ultrasound machine costs from $100,000 to $250,000 to purchase. A service contract costs from $15,000 to $21,000 per year. A single transducer may cost as much as $20,000 ($40,000 for a TEE).

The average hospital in the United States might have 10 or more ultrasound machines, with an average cost of around $120,000. Your hospital may be spending as much as $200,000 per year on the upkeep of these units, especially when you include the transducers.

Is this an opportunity for you, as a hospital BMET to branch out into another area of your hospital? To increase your skills and talents? To learn something? To make yourself even more indispensable to your hospital? OF COURSE!

So what’s stopping you? Let me venture a couple of guesses as to why you haven’t picked this low-hanging fruit yet. . . . .

1. I am intimidated by all the knobs and controls on the units. I don’t know what to mess with, and I’m afraid of messing up something.

2. I can’t make sense of those images they look at – it all looks like smoke and fuzz to me.

3. It’s imaging equipment, so our Imaging Engineers are the only ones who can work on it.

4. I don’t know where to get parts and probes.

5. I am afraid that if I cancel our contract and I need a real expensive part, that all of our cost savings will be gone and I’ll have to take the heat for making a bad decision to cancel the contract.

Let’s deal with these one at a time. . . . .

1. Yes, there are lots of knobs and controls on an ultrasound. And they do look intimidating. But so do most of the other items we work on routinely. In my experience, almost any sonographer will be glad to have you shadow her (or him) and teach you about what they do. Most people are glad to show off what they do to someone who can appreciate it and ask intelligent questions. In spending a few hours with an operator, you do several things – first, you get to observe the steps the sonographer goes through to operate the equipment. Next, you get to learn some of the terminology they routinely use – and we all know that vocabulary is critical for effective communications. Lastly, you form a personal relationship with the operator. If you have been a good student, and observed intensely, the operator shouldn’t have any reservations about calling you the next time she / he has a problem with their unit.

2. Making sense of the images – As technical types, we like things cut and dried – exact. Ultrasound images are far from that. In fact, they are about as far from exact as you can get. Experience and practice under the guidance of a trained sonographer is a great way to find out what is significant and what is not important on an image. It is also good to get a machine alone and scan various parts of yourself. You carry your own phantom with you. For the most part, the images you take of your own anatomy won’t change, so it is a good place to practice.

3. Imaging equipment? Yes, it makes images, but it doesn’t make x-rays. There is no compelling reason for ultrasound to fall under the domain of X-ray engineers except that many ultrasound machines reside in the x-ray department. General BMETs can fix ultrasounds just as well as imaging engineers.

4. Parts and probes – If you are reading this in Medical Dealer magazine, you are already most of the way there. There are many suppliers of parts, probes, repairs, and training listed in this magazine. An internet search for “ultrasound repair” yielded 1,950,000 hits. It’s just a matter of finding a company to partner with, one who will train you to be the front line, while providing you access to technical help, parts and a means to cap your costs.

5. I’m afraid to go bare – without a contract. See number 4 above. You probably need special training, as well as a full-service company specializing in your type of ultrasound, and one which has a complete stock of parts and repair facilities. Some companies will even train you for free just to get your business.

Let’s begin your training. The most commonly mishandled issues with ultrasounds are those of image quality. The most common cause of poor image quality is the video monitor. Sonographers are taught to operate the ultrasound machine itself, so if the image is poor, they will adjust the ultrasound machine – not the video monitor. Video monitors age with time, become degraded, get bumped down the hall, or get misadjusted by residents playing around at night. Let’s first run through a little video image vocabulary.

When a sonographer says their image is GRAINY, they are referring to the fact that they are seeing too many pixels. These are the individual dots which make up the picture on the screen.

A WASHED OUT image refers to a lack of contract. It appears as if there is an opaque film over the screen. Sometimes you might be told that there is a VEIL OVER THE IMAGE.

A very common expression in the ultrasound world is BiStable, as in “the image has become bistable” or “too contrasty”. This means that there isn’t enough gray – it is too black and white.

When a sonographer encounters a problem, I am told that they are rarely wrong. If a sonographer says there is an image quality issue, they will be right over 90% of the time.

A good technique is to enlist the sonographer to assist you. The first thing you must do is to mark all of the settings on the monitor – brightness and contrast. Use a pencil or a Sharpie to do this.

After these are marked, and with an image on the screen, ask the sonographer tell you when the image is improving as you SLOWLY turn ONLY ONE of the knobs on the monitor. This is very important – never adjust multiple knobs at once. Without experience, you may not get them reset properly.

Again, slowly (very slowly) adjust the brightness through its range, and back down to the original position. If it doesn’t result in a better image, move on to the contrast control. SLOWLY adjust it up and down, letting the sonographer tell you if there is an improvement.

If adjusting the monitor controls is successful, then mark the new setting with a permanent marker or, if digital, record the settings on the side of the machine on a piece of tape. This will serve as a future reference.

If no improvement is obtained, you likely have a monitor which needs replacement,

I don’t claim to be an ultrasound expert, but I have access to specialists who are. My specialists work for a subsidiary of my company, and I got all of the above information in just a short interview.

So the message is – think outside the conventional box and stretch to find opportunities. Ultrasound is one of the best, easiest and most natural progressions for a BMET to take. So what are you waiting for?

The Toolbox, Medical Dealer Magazine, March 2006Pat Lynch 23:24, 14 January 2008 (UTC)