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Requisition needed for transvaginal ultrasound component??
Within our health system, the administrators have decided that we need
to call the referring doctor for permission (i.e., obtain a requisition)
for the transvaginal component of a pelvic ultrasound examination --
this is if the original requisition did not specifically ask for this.
This seems, to our group, as craziness -- AIUM guidelines specifically allow for this if the transabdominal component is insufficient or
inconclusive.
What say you all??
to call the referring doctor for permission (i.e., obtain a requisition)
for the transvaginal component of a pelvic ultrasound examination --
this is if the original requisition did not specifically ask for this.
This seems, to our group, as craziness -- AIUM guidelines specifically allow for this if the transabdominal component is insufficient or
inconclusive.
What say you all??
Views: 113
Replies to This Discussion
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Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on -
well, though TVS is a gold standard for pelvic exam these days, I personally perform it only when really very necessary. With experience, well filled bladder, and careful knobology adjustment and getting the beam target by angling it right across the point of interest, and, of course to prepare your brain what to expect.....basing on the HISTORY, CLINICAL FINDINGS, ETC, I find most transpubic scans sufficient,
I agree with you at the same time, if you not happy with what you see, then place your eye (the TV probe) closer....and I do not think you need permission for that, You but call the requesting doc, if it costs more to the patient. If you are employed, it is better to cooperate with your rules in the administration, as some customers may take TVS as offfensive in some cultures. -
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Permalink Reply by Rebecca Strole on -
Whatever it takes to achieve the desired result. If a TA exam isn't sufficient, than a TV exam should be performed. I always give the patient the option of refusing, but most people realize that it's only for their benefit. Even though I suggest doing what your superiors request, perhaps your group could approach them collectively and explain the inconvenience of requesting a referring order. It could be that they don't have any background in ultrasound and don't understand that a radiologist will more than likely ask you why you did NOT perform a TV if a TA scan was not adequate.
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Permalink Reply by Daftary on
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Interestingly, this decision came down from Admin AFTER they interviewed the system hospital ultrasound suites and found out that it is sanctioned by AIUM ! Now, I don't know what ACR says...
Oh, well. Nose to the grindstone and keep plugging away !!
Rebecca Strole said:Whatever it takes to achieve the desired result. If a TA exam isn't sufficient, than a TV exam should be performed. I always give the patient the option of refusing, but most people realize that it's only for their benefit. Even though I suggest doing what your superiors request, perhaps your group could approach them collectively and explain the inconvenience of requesting a referring order. It could be that they don't have any background in ultrasound and don't understand that a radiologist will more than likely ask you why you did NOT perform a TV if a TA scan was not adequate. -
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Permalink Reply by Robin Hurni on -
This is standard practice at the hospital where I work. All pelvic orders come with a note "TV prn". However, we must then call the ordering MD and ask that the Transvaginal componet be added. This is time consuming. I know that the ACR guidlines specify that a pelvic with a transvaginal scan is the gold standard in pelvic imaging. Sometimes the ER tries to order a TV only scan without the transabdominal scan. I have been scanning for over 25 years. I know both components are needed to get the most information available. There are cases where the TV scan can not be done.Those are usually age related issues. I, too do not understand this reasoning. This appears to be a new trend from the past where both Transabdominal and Tranvaginal were automaticlly done.
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Permalink Reply by Carol Rossa on
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Our protocol has been for many years, to do both TA and TV. I cannot stress how often pathology is found on a negative transabdominal. The fact that you see "nothing" transabdominal is not a good indicator that the pelvis is normal. That's
when they really need a transvaginal. -
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