Rad Tech vs Sonographer: Salary, Job, Education & Suggestions 12 Sep 2016 7:58 PM (8 years ago)

Switching a career or choosing a career is a tough choice. There are pros and cons to any and all jobs, but looking into a career that has a great job growth rate and competitive salary is a great place to guarantee that you will have a productive and fruitful career. Two jobs that offer both positive job growth and competitive salary are either a sonographer or radiology techs.

Sonographer

A sonographer is a non-physician professional who is trained and certified to work with equipment and patient in using high frequency sound waves to create visuals that can help in locating possible issues in the patient. To become a sonography specialist, you can either go through a one-year certified program with healthcare experience, or earn a bachelor's degree if there is no healthcare experience. An annual sonographer salary of $73,360 per year can be expected once working in the field, reference: http://sonographersalarydata.com/. Becoming a medical ultrasonographer is a great way to provide one-to-one care with patients. Become knowledgeable and skilled using high-tech equipment, and become an integral part of a healthcare team. An ultrasonographer is a way to join a rapidly growing profession that has a lot of outlooks. The job is not all positive though, a professional will have to work long hours, endurance is required to be on one's feet all day. A lot of the job is taken up by administrative work. There is also a high injury rate from moving heavy equipment and operating it.

Rad Technician

A radiographer is similar to a ultrasonographer in that the profession uses diagnostic imaging examinations to see what is going on inside a patient. A medical radiation technologist specializes in using x-ray, CT,and MRI equipment. In order to become eligible for this profession one must become certified or earn an associates degree. On average the medium salary for radiology technicians is slightly less than $64,450 a year, source: http://radiologytechniciansalarysource.com/. X-ray technicians are an in demand field with employment expected to keep expanding. Similar advantages for a general ultrasonographer apply to a rad tech. There are two unique disadvantages to being a radiologic technologist, work availability is twenty-four hours a day, and there is a minimal risk to radiation exposure.

If a student is looking for a job that is in an extremely active and growing field than either becoming a sonographer or a rad tech is a best option. Having the ability to be part of a successful team is important to job satisfaction, and both of these careers make you an important part of success. If you want to be in the medical field but feel that earning a Ph.D is not a viable option, than take a look into these two promising careers.

For more information, you can go to Healthcare Occupations - Bureau of Labor Statistics.

Doppler Sonography 11 Jul 2015 6:41 AM (9 years ago)

This clip shows the use of color flow Doppler which will light up the Lumen, but you can also see Mural Thrombus surrounding this Aortic Aneurysm scene in a transverse view.

This is a Sagittal view of an Aneurysm. Again you can see Mural Thrombus both interiorly and posterioly, the indicator is turn towards the head.

This shows the correct measurement and still images of an Aneurysm in both the transverse in a Sagittal view. Note that we're measuring from the outside wall to the outside wall and not simply the Lumen of the Aneursym.

We need to be aware of other fluid filled structures anatomically speaking in the Abdomin. The Gallbladder is encapsulated and should not be mistaken for a vessel.

The IVC is a little bit more difficult. It can be very helpful to look transversely first to identify the IVC on the right of the Aorta and then rotate. But generally the IVC will be thinner walled. It will show respiratory variation that looks like pulsations. However, color flow would not show an Aortic character to those pulsations.

This is a Subcostal sagittal or long axis view showing the IVC draining from the feet into the right Atrium. You can see that the indicator is towards the patient's head and the heart is superior. You can also sometimes see the cephalic veins draining into the IVC as we follow it into the right Atrium.

These 2 clips show the Intra-organic Cava on the left, very plethoric or diluted great within 2 centimeters without respiratory collapse. Whereas the clip on the right shows a complete collapse of the IVC consistent with a fluid lost or dehydration.

The one on the left shows fluid overload and this can be helpful to qualitatively assess the fluid status of the patient. This clip shows a patient that actually had a descending Aortic dissection or flat which is something that sonography fairly specific to pick up but not sensitive to rule out. If you wanted to rule it out you should get a Contrast Enhanced CT Scan.

Sonographic Indicator 20 Jun 2015 6:33 AM (9 years ago)

The indicator, it is initially to the patient's right and again here we're fanning through the Aorta in a transverse view. And this is what we should be seeing on the screen. The indicator again towards the patient's right. Our major landmark is the Lumbar spine also known as the horseshoe spine. And sitting right on top of that is the Aorta towards the patient's left.

The IVC is another landmark to the patient's right. In this picture we can also see the Splenic vein and a little bit of a superior mesenteric artery.

This is an example of using color flow Doppler to make sure that you're looking at the Aorta. In this case we see the spine in post sterile part of the screen and we've used the color flow Doppler to pick up Aortic pulsations in the center of the screen. It may help to angle the probe slightly to pick up the color flow.

Once we're interrogated the Aorta in the transverse plane from the Celiac axis to the verification. We'd like to turn the probe clockwise, 90 degrees so that the indicator is towards the patient's head. And this will give us a Sagittal plane.

When we look on the screen, what we should using the Liver as a window, the Aorta which runs along the spine becoming more close to the abdominal walls. It goes distally. And in this case we can see the celiac artery, the first major branch of the Intra-abdominal Aorta followed in this case by the superior mesenteric artery traveling inferiorly.

When we're measuring the Aorta, we want to make sure that we include the entire wall, outside wall, the outside wall and this is generally to make sure that we don't underestimate the size of an Aneurysm. Normally Aorta is generally considered to be less than 3 centimeters from outside wall to outside wall. And this shows a correct measurement of the abdominal Aorta with a normal Aorta.

One of the things we need to be aware of, when we see an Abdominal Aortic Aneurysm as in this case is that the Lumen may look very anechoic, but there maybe Mural Thrombus or Otosclerosis on the outside of the Lumen, and this should be included when measuring the entire Aorta as that is part of the Aneurysm.

Point of Care Ultrasonography 27 May 2015 6:33 AM (9 years ago)

When we place this on the patient we're using a Coronal image here. Again the indicator is towards the head, this is similar to the FAST examination except that we slide the probe up a little bit higher to look at the area above the diaphragm.

This shows a normal view of the right Thorax. You can see the diaphragm, and above the diaphragm is what's called a mirror image artifact. It actually looks like Liver. This is normal. It's a trick of physic. It actually shows as if there is no evidence of a Pleural effusion in this case.

This clip shows the Liver and the Diaphragm again, but above that is a large, moderate to large anechoic space which represents a Pleural effusion and you can see consolidated lung within the Pleural effusion.

This shows a smaller Pleural effusion. In the Costophrenic angle there is small amount of anechoic space right there just superior to the Liver and the Diaphragm.

This clip shows a loculated or septated Pleural effusion. Sonography is generally better than CT at figuring out whether there are spetations and this would indicate a Pleural effusion that might be difficult to aspirate.

On perform Point of Care Ultrasound at the Abdominal Aorta with the focus on finding Abdominal Aortic Aneurysm, also take a look at the anatomy IVC and some other findings.

Like all Point of Care Ultrasonography we begin by selecting an appropriate probe. We should be using generally the curvilinear wide footprint with the frequency of about 2 - 5 megahertz. We want to identify the indicator, place a small amount of gel on the side of the indicator and verify that it's oriented correctly so that the indicator is towards the left side of the screen as it is viewed. We generally keep this to the right side of the patient or the patient's head when we're doing out scanning.

Begin by placing the probe between the Umbilicus in a Xiphoid process in a transverse orientation with the indicator to the patient's right. We can tilt the probe inferiorly and superiorly as well sliding it, a little bit of general pressure to get the Bal out of the way. It's usually very helpful.

Pleural Ultrasonography 30 Apr 2015 6:29 AM (9 years ago)

In this image we see 2 Pleural lines in a patient that suffered blunt trauma. On the left side of the screen is normal lung sliding which is on the right side of the patient. On the right side of the screen there was a lack of lung sliding on the left side of the patient.

This is a Supine chest radiograph from the same patient. It was read as a possible small Pneumothorax on the lower left side of the plain film. However when viewed on CT Scan you can see that Pneumothorax is actually quite large. It is interior which is why it doesn't show up so well on the plain radiograph, but it is well visualized using sonography.

When we're looking at the Pleural line, we also want to look for artifacts. Here you can see some small tape ring Comet tail artifacts also known as Z lines and these are normal. However, when you look at the lung and you see these Comet tail artifacts which are long, hyperechoic or bright lines that go from the front of the probe face all the way to the back, these are known as B lines or Lung Rockets. And they're consistent with Alveolar interstitial syndrome which is typically congested heart failure in the acute setting which you may also see B lines with interstitial lung disease and other acute lung processes.

This clip shows the use of a linear probe also showing B lines with these hyperechoic lines going all the way from the Pleural line to the back of the screen.

If we're interested in looking for a Pleural effusion it's generally better to switch to the curvilinear probe, the penetrational view a little bit, the frequency is a bit lower. Again we check the orientation by putting a small amount of gel on the side of the indicator and confirming that this does indeed correspond to the left side of the screen as it is viewed.

Example 2: Parasternal view, Midclavicular line 7 Apr 2015 6:25 AM (10 years ago)

This is an example of a Parasternal view of the heart and the key point here is that there is a slight anechoic area but it does have echoes in it and it disappears distally and this typical of a fat pad, and should not be mistaken for a Pericardial effusion.

This is a series about the use of Point of Care Ultrasound in Interrogation of the Thorax, specifically looking for Pneumothorax, Alveolar Interstitial Syndrome and Pleural effusion.

Begin by selecting a probe; generally the high frequency linear probe is going to be best for interrogating the Pleural line. Identify the indicator which we can confirm by using a small amount of gel; this should correspond to the left side of the screen as it is viewed. Generally the indicator will equate towards the patient's head.

And here we are placing it on the patient, again with the indicator towards the head. We are in the Midclavicular line just lateral to the Sternum and we can slide up and down a little bit to get in between the rib shadows.

Here we see the image on the screen. Again the indicator is towards the head, the face of the probe is on the skin. You can see subcutaneous fat. The rib, rib shadow and at the post sterile part of the rib is the Pleural line which is visualized by a shimmering or sliding. This is normal sliding at the Pleural line.

Example 1 12 Mar 2015 6:21 AM (10 years ago)

This is an example of significant fluid in the Pelvis that actually should not be mistaken for the Bladder. The reason you could tell it's not Bladder is that tracks into areas around the Bal although on a single transverse it may actually look like the Bladder. So this is a potential pitfall.

In the left upper quadrant we have to be aware that the stomach is present there. If there's any fluid in the stomach it may appear as a fluid filled structure, but again this is an encapsulated structure, in this case we can see some hyperechoic air bubbles in there, but the fluid does not track between the Spleen and the Kidney.

When we're interrogating the chest we want to be careful about differentiating Pericardial from Pleural fluid. This image actually shows both. In this case there's a small pericardial effusion which tracks between the posture board of the heart and the descending Aorta. There's also a left Pleural effusion that is lateral to the descending Aorta and should not be mistaken for a pericardial effusion.

Sonography: Pelvic, Renal, etc 22 Feb 2015 6:18 AM (10 years ago)

This is an example of a positive Pelvic view in a Sagittal orientation. You can see the Bladder and the Bladder wall with free fluid superior to the Bladder and you can actually see some lips of dal floating in the free fluid. That's indicative of significant free fluid.

Following the exam of the human Pelvis, we'd like to look at the heart. We place the probe in a Subxiphoid view, the indicator to the patient's right. We often have to flatten this probe out in order to get a view of the heart. If we're unable to get a view there we may try a Parasternal view with the indicator in this case towards the patient's right shoulder to see if we can get a view of the heart Parasternally.

This is an image of the heart seen from a Subxiphoid view. You can see the Liver which is acting as a window; we're looking through that to the inferior Pericardium, right adjacent to the right ventricle. You can see the Pericardium, this is a negative view. There is no anechoic fluid around or no pericardial effusion.

This is an example of patient with a significant pericardial effusion. You can see that there is a black or anechoic area around the heart interior to the right ventricle that's surrounding the entire heart significant for pericardial effusion.

Couple of pitfalls, one thing to be aware of is to make sure that you're not looking encapsulated fluid. In this case we're actually looking at the Gallbladder in the right upper quadrant. You can tell that the fluid is not tracking acute angles and it's actually enclosed by the Gallbladder wall.

Similarly this is an enclosed fluid collection, actually a Renal Cyst associated with the Kidney. It's very round, does not track into acute angles. It's completely anechoic and thin walled consistent with a simple Renal Cyst.

Fluid wave test 25 Jan 2015 6:12 AM (10 years ago)

Once we're finished with the right upper quadrant, we can move to the left upper quadrant. The indicator is kept towards the patient's head with the probe placed on the patient's left plank. This will similarly give a Coronal view. It appears quite similar to what we see in the right upper quadrant. However, the face of the probe is to the patient's left.

Here we see the Spleen, Kidney, Diaphragm, This is an example of positive free fluid in the left upper quadrant and you can see it surrounding the interior tip of Spleen. There's an anechoic or black area around there that represents free fluid.

This is an example of a smaller amount of free fluid. You can see it right near the Splenic Hilum. But note that it is anechoic and it does track acute angles indicative of free fluid around the Spleen.

When we finished with the left upper quadrant, we can move to the Pelvis. The indicator is directed towards the patient's right; generally we want to scan down into the Pelvis to really image the Bladder. And then in this case we're starting with a transverse view of the Bladder, the indicator to the patient's right.

This is what we should see on the screen. Patient's right, patient's left Bladder and we're looking post interior to the Bladder to see if there's any fluid which is not present in this normal examination.

In order to get a Sagittal view we rotate the probe clockwise, 90 degrees. So indicator is towards the patient's head. Similarly we're looking behind the Bladder to see if there's any free fluid, the left side of the screen is towards the patient's head, the right side of the screen is towards the patient's feet.
ndicator to the patient's head and we want to interrogate for fluid between the Kidney and Spleen, also down at the tip of the Spleen or over the top of the Spleen.

Morison's pouch 30 Dec 2014 6:09 AM (10 years ago)

This is an example of a positive Morison's pouch examine. You can see an anechoic black stripe between the Liver and Kidney that is in Morison's pouch. Note the acute angles and the fact that it's very black or anechoic stripe that indicates free fluid thought to be hemorrhage in acute trauma.

Once we're finished with the right upper quadrant, we can move to the left upper quadrant. The indicator is kept towards the patient's head with the probe placed on the patient's left plank. This will similarly give a Coronal view. It appears quite similar to what we see in the right upper quadrant. However, the face of the probe is to the patient's left.

Here we see the Spleen, Kidney, Diaphragm, indicator to the patient's head and we want to interrogate for fluid between the Kidney and Spleen, also down at the tip of the Spleen or over the top of the Spleen.

Focused Assessment with Sonography in Trauma (FAST) 4 Dec 2014 6:05 AM (10 years ago)

This is a brief series of performing the Focused Assessment with Sonography in Trauma or FAST examination. Note the extended fast would include assessment for Pneumothorax which is covered in the post on Thoracic Ultrasound.

To begin the FAST we should choose probe. Generally we'll use the wide footprint Curvilinear, although you could potentially use a phased array probe here. We find the indicator, put some gel on there just to confirm that the indicator does correspond to the left side of the screen as it is viewed, similar to all other exams we're doing.

So here you can see the gel coming down. We place the probe on the patient generally for blunt trauma starting in the right upper quadrant or right plank to try to get a view of Morison's pouch, the Hepatorenal space. The indicator should be directed towards the patient's head and this is a Coronal plane, the plane is parallel to the bed.

This is the image we should see on the screen. The face of the probe is on the right plank. The indicator is directed towards the patient's head. You can see the Diaphragm superior to the Liver and just below the Liver with the Morison's pouch or Hepatorenal space between the Kidney and the Liver and that's where we're looking for fluid. You can also a rib shadow coming down there.

In-Plane vs Out-of-Plane Approach 8 Nov 2014 6:02 AM (10 years ago)

The plane of the sonography cuts across the shaft to the needle. We can rotate this to an in plan approach where the needle is in the plane of the ultrasonography. The advantage of this is that you can see the entire tip of the needle. However, the out of plane approach is a little bit better for centering the needle over the vessel of interest.

This shows a target a sign which is what you want to see when you're accessing something in a short axis or out of plane; you can see the needle on the center of vessel. Here again is a short axis procedure where we are accessing the internal jugular. You can see the Endothelium kind of tempting into the internal jugular vein there and we are across or out of plane with the transducer in that particular clip.

Here is an in plane or long axis procedure where the needle is being inserted into the internal jugular vein. You can see the tip and again we're showing this as it would occur in a peripheral vein. You can see the tip of the needle entering the vessel and then we thread the Catheter.

You can check that the Catheter has been threaded by placing the sonography on there. Here we can actually see a Catheter in peripheral vessel. The other thing that you can do is flush the Catheter. Here's we're actually following the wire for central venous access into the IJ. When you flush the Catheter, just take some agitated saline when injected and you can see bubbles through the vessel.

Sonography Guidance for Central Venous Access 14 Oct 2014 5:55 AM (10 years ago)

This is a short presentation on the use of sonography for procedural guidance and vascular access, those peripheral and central. You want to start with a Linear Probe which is a flat probe, high frequency, 3 - 12 megahertz. Identify the indicator which is a bumper grove on the side. Put a little bit of gel on there and make sure that the indicator corresponds to the left side of the screen as it is viewed. That will be your orientation for looking at vessels.

Vessels can be either in the short or the long axis. The long axis in plane, the short axis is out of plane. This is a short axis clip of a peripheral vessel. So you see the collapse ability of the vein, the indicator is to the left side of the screen which is the left of the patient as you're looking up.

This is showing the application of the Linear Probe to the neck of a patient around the area that you would look for the internal jugular access. The indicator in this case is to the patient's right and the fingers placed right here over the vessel as it's going into the neck. When this is done you should be able to see the internal jugular vein lateral to the Carotid Artery. Here is a short clip showing collapse of the internal jugular lateral to the Carotid, the Trachea shown medial to this.

When you're doing a central access procedure you need to use sterile precautions, this shows the application of a sterile probe cover. The gel which doesn't need to be sterile inside is placed inside the probe cover and the probe is then lowered into this cover and allowed to fall down without touching anything creating a sterile probe cover that can then be used for central vascular access.

Here we're putting rubber band and some sterile gel on top of the probe. Once this is done you could use it for central venous access. Again when you're looking at a needle you can look at it in the in plane approach or the outer plane approach. The indicator is identified here to my left and I'm using the use of a middle in the short axis or out of plane approach.