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Hi Josie,

Standards for our lab....

Time:....
        1 hour for ABI / ABI and EX (the other techs get 1 hour and 30 
min...can u believe it? but I tell them to book them 1 hour in my room)
        1 hour for Unilat LEA
        1 hour 30 min for Bilat LEA
        (our schedulers do not understand our testing and so it cannot get 
more specific than that)
        A basic ABI /PPG takes 30 min with NO ex but our new tech takes 1 
hour.
        A graft imaging takes 20 min but these are rarely booked 
correctly. 
        I can do an ABI and Unilat graft imaging in one hour, maybe less 
but it is hard to depend on the schedulers...arterial imaging takes longer 
than graft imaging for sure. 

Scanning Protocol...
Our docs tried to give me a hard time about doing the left leg before the 
right but honestly, I am getting old and my arm is tired after one leg so 
I want the leg I finish with to be closest to me (much easier to scan), 
same with Iliacs and Venous Studies.  The doc couldn't really argue with 
that.  We hurt ourselves each and everyday so this is one way I adapt.  I 
have learned to scan with my left arm so I do all unilat left side studies 
with my left arm but bilateral studies get done with my right.  I scan 
much slower with my left and would run out of time if I scanned left.  I 
am not saying it is the right thing to do but it is my explanation.  Other 
than that I cannot see why someone would do the left first.  It keeps the 
docs on their toes reading reports lol.

Measurements...
This has recently been brought to my attention.  The employees change so 
often that I often feel I am the only one who remembers when the protocols 
were enacted lol.  I keep doing things the same and as new employees come 
in they do things their way.  After awhile people are all doing things 
differently.  I measure and record TRV AP x TRV Width x Long AP for 
Aneurysm studies, this was agreed on years ago.  They may soon change how 
it is recorded because we have a new Tech Director but we will see. 

Not sure if this helps...Take care,

Sincerely, 

Nicole Ball, BS, RVT
President for NNEVS
Frisbie Memorial Hospital
Vascular Lab
Rochester, NH
(w) 603-332-3100 ext 8127





From:   Lisa Kincaid <[log in to unmask]>
To:     [log in to unmask]
Date:   12/28/2016 09:54 AM
Subject:        Standards
Sent by:        UVM Flownet <[log in to unmask]>



Just a note :
  We still allow 2 hrs for a LE arterial. I can do in an hour , but I have 
a lot of experience. I will squeeze in an arterial and even do within a 
1/2hour, but not general rule. 
There are still those patients that require multiple "potty" breaks, 
assistance with dressing and in and out of wheelchairs, and just general 
caring needs. We have a lot of woundcare patients, and they are time 
consuming in general. 
This is why we allow extra time. It is not all about the sonographer. We 
have great reporting software but still takes time to download the 
information into the report. 
We are a small lab in a surgeon's office. This is a lot different than the 
20 years I put in at the hospital and research. But I have noticed the 
hospital studies are abbreviated since I left (and there are reasons for 
this also). 
 The "extra time" that may be available to a sonographer is used to get 
studies ready for the next day, catch up on studies they couldn't write up 
before the next patient, and add ons ,ect.
I am very lucky to work with a surgeons who cares as much about their 
sonographers as their patients. We try very hard to avoid work injuries 
and repetitive injuries, thereby keeping our consistency and standards 
high.  And as a benefit, patient satisfaction. 
 
Lisa Kincaid, RVT
 


-----Original Message-----
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automatic digest system
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Subject: UVMFLOWNET Digest - 24 Dec 2016 to 27 Dec 2016 (#2016-190)

There are 6 messages totaling 2477 lines in this issue.

Topics of the day:

  1. DEVELOPED STANDARDS FOR IMAGING (6)

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----------------------------------------------------------------------

Date:    Tue, 27 Dec 2016 17:51:30 +0000
From:    "Douville, Colleen" <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Andrew<
Which reporting software are you using?


Colleen Douville 
Director l Vascular Ultrasound & Neurophysiology
[log in to unmask]
Office:          206-320-4080
Cell:            206-601-8077

Swedish Neuroscience Institute
500 17th Ave l 4 West, Room 400
Seattle l WA l 98122




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bachman, 
Andrew
Sent: Friday, December 23, 2016 8:02 AM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Hi Josie,
I can not answer what the 'standard' is across the board because there are 
some labs that go above and beyond,  some labs that do the bare minimum 
and hundreds in between.  I work for the largest heart and vascular center 
in the country currently (by sheer number of locations and studies, and 
techs) and I will answer based on our practices but we by no means set the 
standards for our field.

1- Measuring:
        - I have always seen vascular measuring AP x TRV but this could be 
a regional issue or a difference in whom is reading studies (Surgeons vs 
Radiologists).  We have had issues with dual general/vascular 
technologists giving push back on this in years past.
        - If everything is consistent and uniform across the board with 
all techs, this should not be an issue but 1 person differs and you will 
create a ton of confusion to both ordering doctors and reading physicians.
2- Imaging order/standard
        - This depends slightly on your reporting software.
        - We use a software that allows our doctors to click on a segment 
of the artery and pull up only the images for that location allowing them 
to see diseased areas side by side with previous images.  In our case, 
order is never a problem and techs are free to scan right then left, or 
left then right, or any variation.
        - If your physicians review each individual image, then you will 
need a standard across the board for everyone but I think in the grand 
scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you take them
        - We do on average 150-200 studies a day with 5 surgeons reading 
daily, and 5 radiologists reading a few times a month.  If we didn’t have 
our reporting system, we would 100% have a standard image order or we 
would never function.
3- Timeframe
        - This again depends on your u/s equipment, ABI machine and 
software.   Years ago the standard was 1.5hours for an LEA but the older 
machines required pressing 5 buttons to change 1 thing and 15 different 
tweaks to make a pretty image.
                - We have all new GE machines, newer parks machines (at 
majority of our locations), and techs do a short H&P with a full detailed 
report at completion.  We perform ABI's and B/L Arterial with the 
completed report in 1 hour but in some of our locations we have 1.5hrs for 
B/L due to dual techs and older machines.  Unilateral studies are always 
1hour or less regardless of the location/machine.
                - I have worked in labs with older machines and you do 
need that extra 30mins at times for bilateral studies or 
difficult/challenging patients.
                        - For a Unilateral study (especially simplistic 
bypass graft such as a fem-pop), they should not need more then 1 hour.
                        - I would recommend monitoring their studies.  See 
if they are using that entire 1.5 hours or if they are finishing early and 
lounging for 30mins.
        - All this aside, I have also, in the past, worked in a VERY 
respectable lab with old HDI-5000 machines and we did ABI's, B/L Arterial 
and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess even 
by old practice standards I am reluctant to really say 1.5hrs is 'needed'.

I hope this helps.
Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network
The Heart and Vascular Center

"To handle yourself, use your head. To handle others, use your heart"




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Josie 
Klapec
Sent: Friday, December 23, 2016 10:15 AM
To: [log in to unmask]
Subject: DEVELOPED STANDARDS FOR IMAGING

Hello Everyone -

I posted this on the SVU site and got one response.  I understand that the 
questions are a bit basic but everyone's opinions are welcome.

I am updating protocols at a new job.  They haven't been updated since 
2001.

The technologists were taught to always measure vessels TRV x AP.
New students and myself (not new by any stretch of the imagination!)
have been taught to measure vessels (not masses) as AP x TRV.    I
need to standardize and am wondering if this is an industry standard?

Also, the team has not had an effective supervisor for some time (4-5
years)  Anarchy is rampant.  Some scan the left first and others scan the 
right.  Once again, new students and myself have been taught to always 
start on the right, (disregard extenuating circumstances).  Any 
standardization is met with a lot of criticism.  I have repeated 
reproducibility, surgeons wishes, etc.

Finally, I have gotten a lot of push back from them stating they are 
unable to complete a unilateral fem-pop bypass graft and ABIs in one hour. 
 How much time do you allow?

I have reference both IAC and SVU standards/guidelines.  This is not a 
small lab - I have 22 direct reports.  Any thoughts are greatly 
appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer away!

Josie Klapec, BS, RVT

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[St. Luke’s University Hospital is a 4-time recipient of this prestigious 
award – Click the image to learn more]<http://www.slhn.org/top100>

Confidentiality Notice: This e-mail message, including any attachments, is 
for the sole use of intended recipient(s) and may contain confidential and 
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distribution is prohibited. If you are not the intended recipient, please 
contact the sender by reply e-mail and destroy all copies of the original 
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------------------------------

Date:    Tue, 27 Dec 2016 18:01:26 +0000
From:    "Bachman, Andrew" <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Colleen,
Please email me on my work email and we can discuss this.  We love our 
software but don’t want to start a software battle in this email chain.

[log in to unmask]

Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network
The Heart and Vascular Center
 
"To handle yourself, use your head. To handle others, use your heart"



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Douville, 
Colleen
Sent: Tuesday, December 27, 2016 12:52 PM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Andrew<
Which reporting software are you using?


Colleen Douville
Director l Vascular Ultrasound & Neurophysiology 
[log in to unmask]
Office:          206-320-4080
Cell:            206-601-8077

Swedish Neuroscience Institute
500 17th Ave l 4 West, Room 400
Seattle l WA l 98122




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bachman, 
Andrew
Sent: Friday, December 23, 2016 8:02 AM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Hi Josie,
I can not answer what the 'standard' is across the board because there are 
some labs that go above and beyond,  some labs that do the bare minimum 
and hundreds in between.  I work for the largest heart and vascular center 
in the country currently (by sheer number of locations and studies, and 
techs) and I will answer based on our practices but we by no means set the 
standards for our field.

1- Measuring:
        - I have always seen vascular measuring AP x TRV but this could be 
a regional issue or a difference in whom is reading studies (Surgeons vs 
Radiologists).  We have had issues with dual general/vascular 
technologists giving push back on this in years past.
        - If everything is consistent and uniform across the board with 
all techs, this should not be an issue but 1 person differs and you will 
create a ton of confusion to both ordering doctors and reading physicians.
2- Imaging order/standard
        - This depends slightly on your reporting software.
        - We use a software that allows our doctors to click on a segment 
of the artery and pull up only the images for that location allowing them 
to see diseased areas side by side with previous images.  In our case, 
order is never a problem and techs are free to scan right then left, or 
left then right, or any variation.
        - If your physicians review each individual image, then you will 
need a standard across the board for everyone but I think in the grand 
scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you take them
        - We do on average 150-200 studies a day with 5 surgeons reading 
daily, and 5 radiologists reading a few times a month.  If we didn’t have 
our reporting system, we would 100% have a standard image order or we 
would never function.
3- Timeframe
        - This again depends on your u/s equipment, ABI machine and 
software.   Years ago the standard was 1.5hours for an LEA but the older 
machines required pressing 5 buttons to change 1 thing and 15 different 
tweaks to make a pretty image.
                - We have all new GE machines, newer parks machines (at 
majority of our locations), and techs do a short H&P with a full detailed 
report at completion.  We perform ABI's and B/L Arterial with the 
completed report in 1 hour but in some of our locations we have 1.5hrs for 
B/L due to dual techs and older machines.  Unilateral studies are always 
1hour or less regardless of the location/machine.
                - I have worked in labs with older machines and you do 
need that extra 30mins at times for bilateral studies or 
difficult/challenging patients.
                        - For a Unilateral study (especially simplistic 
bypass graft such as a fem-pop), they should not need more then 1 hour.
                        - I would recommend monitoring their studies.  See 
if they are using that entire 1.5 hours or if they are finishing early and 
lounging for 30mins.
        - All this aside, I have also, in the past, worked in a VERY 
respectable lab with old HDI-5000 machines and we did ABI's, B/L Arterial 
and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess even 
by old practice standards I am reluctant to really say 1.5hrs is 'needed'.

I hope this helps.
Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network The Heart and Vascular 
Center

"To handle yourself, use your head. To handle others, use your heart"




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Josie 
Klapec
Sent: Friday, December 23, 2016 10:15 AM
To: [log in to unmask]
Subject: DEVELOPED STANDARDS FOR IMAGING

Hello Everyone -

I posted this on the SVU site and got one response.  I understand that the 
questions are a bit basic but everyone's opinions are welcome.

I am updating protocols at a new job.  They haven't been updated since 
2001.

The technologists were taught to always measure vessels TRV x AP.
New students and myself (not new by any stretch of the imagination!)
have been taught to measure vessels (not masses) as AP x TRV.    I
need to standardize and am wondering if this is an industry standard?

Also, the team has not had an effective supervisor for some time (4-5
years)  Anarchy is rampant.  Some scan the left first and others scan the 
right.  Once again, new students and myself have been taught to always 
start on the right, (disregard extenuating circumstances).  Any 
standardization is met with a lot of criticism.  I have repeated 
reproducibility, surgeons wishes, etc.

Finally, I have gotten a lot of push back from them stating they are 
unable to complete a unilateral fem-pop bypass graft and ABIs in one hour. 
 How much time do you allow?

I have reference both IAC and SVU standards/guidelines.  This is not a 
small lab - I have 22 direct reports.  Any thoughts are greatly 
appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer away!

Josie Klapec, BS, RVT

To unsubscribe or search other topics on UVM Flownet link to:
https://urldefense.proofpoint.com/v2/url?u=http-3A__list.uvm.edu_archives_uvmflownet.html&d=DQIBaQ&c=kLuyfJs8xHieIsti43i5Bw&r=nowbzADbgbSQGUo4tYN6uL7V4skFKveH2RQh4AiNuKs&m=EX5MA9x3D7W_q8SmeNCaBmdGYHFx3OYgY4gB2s5y62E&s=5XGuKWYeJIQGlMptsioOsUa71N5E8TiRWxZcpvTCMyI&e=


[St. Luke’s University Hospital is a 4-time recipient of this prestigious 
award – Click the image to learn more]<http://www.slhn.org/top100>

Confidentiality Notice: This e-mail message, including any attachments, is 
for the sole use of intended recipient(s) and may contain confidential and 
privileged information. Any unauthorized review, use, disclosure or 
distribution is prohibited. If you are not the intended recipient, please 
contact the sender by reply e-mail and destroy all copies of the original 
message.

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------------------------------

Date:    Tue, 27 Dec 2016 13:49:15 -0800
From:    Steve Knight <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Josie, when you say AP X TRV, do you mean AP in a longitudinal plane or AP
in a transverse plane? AP in a transverse plane is prone to error due to
misalignment (particularly in the proximal aorta). TRV in the transverse
plane is also prone to error due to poor resolution of the lateral walls
and misalignment.
I like to use AP in a long plane. I will also measure in TRV for 
comparison
and they should be close but I trust the AP long more.

I know my stance on this is not the popular one but I believe my reasons
are valid.

~S

On Tue, Dec 27, 2016 at 10:01 AM, Bachman, Andrew 
<[log in to unmask]>
wrote:

> Colleen,
> Please email me on my work email and we can discuss this.  We love our
> software but don’t want to start a software battle in this email chain.
>
> [log in to unmask]
>
> Andrew M. Bachman, Bs RVT
> St. Lukes University Hospital and Health Network
> The Heart and Vascular Center
>
> "To handle yourself, use your head. To handle others, use your heart"
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of 
Douville,
> Colleen
> Sent: Tuesday, December 27, 2016 12:52 PM
> To: [log in to unmask]
> Subject: Re: DEVELOPED STANDARDS FOR IMAGING
>
> Andrew<
> Which reporting software are you using?
>
>
> Colleen Douville
> Director l Vascular Ultrasound & Neurophysiology
> [log in to unmask]
> Office: 206-320-4080
> Cell:   206-601-8077
>
> Swedish Neuroscience Institute
> 500 17th Ave l 4 West, Room 400
> Seattle l WA l 98122
>
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bachman,
> Andrew
> Sent: Friday, December 23, 2016 8:02 AM
> To: [log in to unmask]
> Subject: Re: DEVELOPED STANDARDS FOR IMAGING
>
> Hi Josie,
> I can not answer what the 'standard' is across the board because there 
are
> some labs that go above and beyond,  some labs that do the bare minimum 
and
> hundreds in between.  I work for the largest heart and vascular center 
in
> the country currently (by sheer number of locations and studies, and 
techs)
> and I will answer based on our practices but we by no means set the
> standards for our field.
>
> 1- Measuring:
>         - I have always seen vascular measuring AP x TRV but this could 
be
> a regional issue or a difference in whom is reading studies (Surgeons vs
> Radiologists).  We have had issues with dual general/vascular 
technologists
> giving push back on this in years past.
>         - If everything is consistent and uniform across the board with
> all techs, this should not be an issue but 1 person differs and you will
> create a ton of confusion to both ordering doctors and reading 
physicians.
> 2- Imaging order/standard
>         - This depends slightly on your reporting software.
>         - We use a software that allows our doctors to click on a 
segment
> of the artery and pull up only the images for that location allowing 
them
> to see diseased areas side by side with previous images.  In our case,
> order is never a problem and techs are free to scan right then left, or
> left then right, or any variation.
>         - If your physicians review each individual image, then you will
> need a standard across the board for everyone but I think in the grand
> scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you
> take them
>         - We do on average 150-200 studies a day with 5 surgeons reading
> daily, and 5 radiologists reading a few times a month.  If we didn’t 
have
> our reporting system, we would 100% have a standard image order or we 
would
> never function.
> 3- Timeframe
>         - This again depends on your u/s equipment, ABI machine and
> software.   Years ago the standard was 1.5hours for an LEA but the older
> machines required pressing 5 buttons to change 1 thing and 15 different
> tweaks to make a pretty image.
>                 - We have all new GE machines, newer parks machines (at
> majority of our locations), and techs do a short H&P with a full 
detailed
> report at completion.  We perform ABI's and B/L Arterial with the 
completed
> report in 1 hour but in some of our locations we have 1.5hrs for B/L due 
to
> dual techs and older machines.  Unilateral studies are always 1hour or 
less
> regardless of the location/machine.
>                 - I have worked in labs with older machines and you do
> need that extra 30mins at times for bilateral studies or
> difficult/challenging patients.
>                         - For a Unilateral study (especially simplistic
> bypass graft such as a fem-pop), they should not need more then 1 hour.
>                         - I would recommend monitoring their studies. 
See
> if they are using that entire 1.5 hours or if they are finishing early 
and
> lounging for 30mins.
>         - All this aside, I have also, in the past, worked in a VERY
> respectable lab with old HDI-5000 machines and we did ABI's, B/L 
Arterial
> and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess 
even
> by old practice standards I am reluctant to really say 1.5hrs is 
'needed'.
>
> I hope this helps.
> Andrew M. Bachman, Bs RVT
> St. Lukes University Hospital and Health Network The Heart and Vascular
> Center
>
> "To handle yourself, use your head. To handle others, use your heart"
>
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Josie
> Klapec
> Sent: Friday, December 23, 2016 10:15 AM
> To: [log in to unmask]
> Subject: DEVELOPED STANDARDS FOR IMAGING
>
> Hello Everyone -
>
> I posted this on the SVU site and got one response.  I understand that 
the
> questions are a bit basic but everyone's opinions are welcome.
>
> I am updating protocols at a new job.  They haven't been updated since
> 2001.
>
> The technologists were taught to always measure vessels TRV x AP.
> New students and myself (not new by any stretch of the imagination!)
> have been taught to measure vessels (not masses) as AP x TRV.    I
> need to standardize and am wondering if this is an industry standard?
>
> Also, the team has not had an effective supervisor for some time (4-5
> years)  Anarchy is rampant.  Some scan the left first and others scan 
the
> right.  Once again, new students and myself have been taught to always
> start on the right, (disregard extenuating circumstances).  Any
> standardization is met with a lot of criticism.  I have repeated
> reproducibility, surgeons wishes, etc.
>
> Finally, I have gotten a lot of push back from them stating they are
> unable to complete a unilateral fem-pop bypass graft and ABIs in one 
hour.
> How much time do you allow?
>
> I have reference both IAC and SVU standards/guidelines.  This is not a
> small lab - I have 22 direct reports.  Any thoughts are greatly
> appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer
> away!
>
> Josie Klapec, BS, RVT
>
> To unsubscribe or search other topics on UVM Flownet link to:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__list.
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>
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> award – Click the image to learn more]<http://www.slhn.org/top100>
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------------------------------

Date:    Tue, 27 Dec 2016 23:50:57 +0000
From:    Derek Butler <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Steve –

Had to comment – I love this statement: “I know my stance on this is not 
the popular one but I believe my reasons are valid.” – I wonder if that 
will work at home, lolol.

Derek -


From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steve 
Knight
Sent: Tuesday, December 27, 2016 4:49 PM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Josie, when you say AP X TRV, do you mean AP in a longitudinal plane or AP 
in a transverse plane? AP in a transverse plane is prone to error due to 
misalignment (particularly in the proximal aorta). TRV in the transverse 
plane is also prone to error due to poor resolution of the lateral walls 
and misalignment.
I like to use AP in a long plane. I will also measure in TRV for 
comparison and they should be close but I trust the AP long more.
I know my stance on this is not the popular one but I believe my reasons 
are valid.

~S

On Tue, Dec 27, 2016 at 10:01 AM, Bachman, Andrew 
<[log in to unmask]<mailto:[log in to unmask]>> wrote:
Colleen,
Please email me on my work email and we can discuss this.  We love our 
software but don’t want to start a software battle in this email chain.

[log in to unmask]<mailto:[log in to unmask]>

Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network
The Heart and Vascular Center

"To handle yourself, use your head. To handle others, use your heart"



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]<
mailto:[log in to unmask]>] On Behalf Of Douville, Colleen
Sent: Tuesday, December 27, 2016 12:52 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Andrew<
Which reporting software are you using?


Colleen Douville
Director l Vascular Ultrasound & Neurophysiology 
[log in to unmask]<mailto:[log in to unmask]>
Office: 206-320-4080<tel:206-320-4080>
Cell:   206-601-8077<tel:206-601-8077>

Swedish Neuroscience Institute
500 17th Ave l 4 West, Room 400
Seattle l WA l 98122




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]<
mailto:[log in to unmask]>] On Behalf Of Bachman, Andrew
Sent: Friday, December 23, 2016 8:02 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Hi Josie,
I can not answer what the 'standard' is across the board because there are 
some labs that go above and beyond,  some labs that do the bare minimum 
and hundreds in between.  I work for the largest heart and vascular center 
in the country currently (by sheer number of locations and studies, and 
techs) and I will answer based on our practices but we by no means set the 
standards for our field.

1- Measuring:
        - I have always seen vascular measuring AP x TRV but this could be 
a regional issue or a difference in whom is reading studies (Surgeons vs 
Radiologists).  We have had issues with dual general/vascular 
technologists giving push back on this in years past.
        - If everything is consistent and uniform across the board with 
all techs, this should not be an issue but 1 person differs and you will 
create a ton of confusion to both ordering doctors and reading physicians.
2- Imaging order/standard
        - This depends slightly on your reporting software.
        - We use a software that allows our doctors to click on a segment 
of the artery and pull up only the images for that location allowing them 
to see diseased areas side by side with previous images.  In our case, 
order is never a problem and techs are free to scan right then left, or 
left then right, or any variation.
        - If your physicians review each individual image, then you will 
need a standard across the board for everyone but I think in the grand 
scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you take them
        - We do on average 150-200 studies a day with 5 surgeons reading 
daily, and 5 radiologists reading a few times a month.  If we didn’t have 
our reporting system, we would 100% have a standard image order or we 
would never function.
3- Timeframe
        - This again depends on your u/s equipment, ABI machine and 
software.   Years ago the standard was 1.5hours for an LEA but the older 
machines required pressing 5 buttons to change 1 thing and 15 different 
tweaks to make a pretty image.
                - We have all new GE machines, newer parks machines (at 
majority of our locations), and techs do a short H&P with a full detailed 
report at completion.  We perform ABI's and B/L Arterial with the 
completed report in 1 hour but in some of our locations we have 1.5hrs for 
B/L due to dual techs and older machines.  Unilateral studies are always 
1hour or less regardless of the location/machine.
                - I have worked in labs with older machines and you do 
need that extra 30mins at times for bilateral studies or 
difficult/challenging patients.
                        - For a Unilateral study (especially simplistic 
bypass graft such as a fem-pop), they should not need more then 1 hour.
                        - I would recommend monitoring their studies.  See 
if they are using that entire 1.5 hours or if they are finishing early and 
lounging for 30mins.
        - All this aside, I have also, in the past, worked in a VERY 
respectable lab with old HDI-5000 machines and we did ABI's, B/L Arterial 
and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess even 
by old practice standards I am reluctant to really say 1.5hrs is 'needed'.

I hope this helps.
Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network The Heart and Vascular 
Center

"To handle yourself, use your head. To handle others, use your heart"




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]<
mailto:[log in to unmask]>] On Behalf Of Josie Klapec
Sent: Friday, December 23, 2016 10:15 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: DEVELOPED STANDARDS FOR IMAGING

Hello Everyone -

I posted this on the SVU site and got one response.  I understand that the 
questions are a bit basic but everyone's opinions are welcome.

I am updating protocols at a new job.  They haven't been updated since 
2001.

The technologists were taught to always measure vessels TRV x AP.
New students and myself (not new by any stretch of the imagination!)
have been taught to measure vessels (not masses) as AP x TRV.    I
need to standardize and am wondering if this is an industry standard?

Also, the team has not had an effective supervisor for some time (4-5
years)  Anarchy is rampant.  Some scan the left first and others scan the 
right.  Once again, new students and myself have been taught to always 
start on the right, (disregard extenuating circumstances).  Any 
standardization is met with a lot of criticism.  I have repeated 
reproducibility, surgeons wishes, etc.

Finally, I have gotten a lot of push back from them stating they are 
unable to complete a unilateral fem-pop bypass graft and ABIs in one hour. 
 How much time do you allow?

I have reference both IAC and SVU standards/guidelines.  This is not a 
small lab - I have 22 direct reports.  Any thoughts are greatly 
appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer away!

Josie Klapec, BS, RVT

To unsubscribe or search other topics on UVM Flownet link to:
https://urldefense.proofpoint.com/v2/url?u=http-3A__list.uvm.edu_archives_uvmflownet.html&d=DQIBaQ&c=kLuyfJs8xHieIsti43i5Bw&r=nowbzADbgbSQGUo4tYN6uL7V4skFKveH2RQh4AiNuKs&m=EX5MA9x3D7W_q8SmeNCaBmdGYHFx3OYgY4gB2s5y62E&s=5XGuKWYeJIQGlMptsioOsUa71N5E8TiRWxZcpvTCMyI&e=


[St. Luke’s University Hospital is a 4-time recipient of this prestigious 
award – Click the image to learn more]<http://www.slhn.org/top100>

Confidentiality Notice: This e-mail message, including any attachments, is 
for the sole use of intended recipient(s) and may contain confidential and 
privileged information. Any unauthorized review, use, disclosure or 
distribution is prohibited. If you are not the intended recipient, please 
contact the sender by reply e-mail and destroy all copies of the original 
message.

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------------------------------

Date:    Tue, 27 Dec 2016 15:53:03 -0800
From:    Steve Knight <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

You can try. It's sort for declaring in advance that you agree to 
disagree.

On Dec 27, 2016 3:51 PM, "Derek Butler" <[log in to unmask]> wrote:

Steve –



Had to comment – I love this statement: “I know my stance on this is not
the popular one but I believe my reasons are valid.” – I wonder if that
will work at home, lolol.


Derek -





*From:* UVM Flownet [mailto:[log in to unmask]] *On Behalf Of *Steve
Knight
*Sent:* Tuesday, December 27, 2016 4:49 PM

*To:* [log in to unmask]
*Subject:* Re: DEVELOPED STANDARDS FOR IMAGING



Josie, when you say AP X TRV, do you mean AP in a longitudinal plane or AP
in a transverse plane? AP in a transverse plane is prone to error due to
misalignment (particularly in the proximal aorta). TRV in the transverse
plane is also prone to error due to poor resolution of the lateral walls
and misalignment.

I like to use AP in a long plane. I will also measure in TRV for 
comparison
and they should be close but I trust the AP long more.

I know my stance on this is not the popular one but I believe my reasons
are valid.



~S



On Tue, Dec 27, 2016 at 10:01 AM, Bachman, Andrew 
<[log in to unmask]>
wrote:

Colleen,
Please email me on my work email and we can discuss this.  We love our
software but don’t want to start a software battle in this email chain.

[log in to unmask]

Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network
The Heart and Vascular Center

"To handle yourself, use your head. To handle others, use your heart"



-----Original Message-----

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Douville,
Colleen
Sent: Tuesday, December 27, 2016 12:52 PM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Andrew<
Which reporting software are you using?


Colleen Douville
Director l Vascular Ultrasound & Neurophysiology
[log in to unmask]
Office: 206-320-4080
Cell:   206-601-8077

Swedish Neuroscience Institute
500 17th Ave l 4 West, Room 400
Seattle l WA l 98122




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bachman,
Andrew
Sent: Friday, December 23, 2016 8:02 AM
To: [log in to unmask]
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

Hi Josie,
I can not answer what the 'standard' is across the board because there are
some labs that go above and beyond,  some labs that do the bare minimum 
and
hundreds in between.  I work for the largest heart and vascular center in
the country currently (by sheer number of locations and studies, and 
techs)
and I will answer based on our practices but we by no means set the
standards for our field.

1- Measuring:
        - I have always seen vascular measuring AP x TRV but this could be
a regional issue or a difference in whom is reading studies (Surgeons vs
Radiologists).  We have had issues with dual general/vascular 
technologists
giving push back on this in years past.
        - If everything is consistent and uniform across the board with 
all
techs, this should not be an issue but 1 person differs and you will 
create
a ton of confusion to both ordering doctors and reading physicians.
2- Imaging order/standard
        - This depends slightly on your reporting software.
        - We use a software that allows our doctors to click on a segment
of the artery and pull up only the images for that location allowing them
to see diseased areas side by side with previous images.  In our case,
order is never a problem and techs are free to scan right then left, or
left then right, or any variation.
        - If your physicians review each individual image, then you will
need a standard across the board for everyone but I think in the grand
scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you
take them
        - We do on average 150-200 studies a day with 5 surgeons reading
daily, and 5 radiologists reading a few times a month.  If we didn’t have
our reporting system, we would 100% have a standard image order or we 
would
never function.
3- Timeframe
        - This again depends on your u/s equipment, ABI machine and
software.   Years ago the standard was 1.5hours for an LEA but the older
machines required pressing 5 buttons to change 1 thing and 15 different
tweaks to make a pretty image.
                - We have all new GE machines, newer parks machines (at
majority of our locations), and techs do a short H&P with a full detailed
report at completion.  We perform ABI's and B/L Arterial with the 
completed
report in 1 hour but in some of our locations we have 1.5hrs for B/L due 
to
dual techs and older machines.  Unilateral studies are always 1hour or 
less
regardless of the location/machine.
                - I have worked in labs with older machines and you do 
need
that extra 30mins at times for bilateral studies or difficult/challenging
patients.
                        - For a Unilateral study (especially simplistic
bypass graft such as a fem-pop), they should not need more then 1 hour.
                        - I would recommend monitoring their studies.  See
if they are using that entire 1.5 hours or if they are finishing early and
lounging for 30mins.
        - All this aside, I have also, in the past, worked in a VERY
respectable lab with old HDI-5000 machines and we did ABI's, B/L Arterial
and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess even
by old practice standards I am reluctant to really say 1.5hrs is 'needed'.

I hope this helps.
Andrew M. Bachman, Bs RVT
St. Lukes University Hospital and Health Network The Heart and Vascular
Center

"To handle yourself, use your head. To handle others, use your heart"




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Josie 
Klapec
Sent: Friday, December 23, 2016 10:15 AM
To: [log in to unmask]
Subject: DEVELOPED STANDARDS FOR IMAGING

Hello Everyone -

I posted this on the SVU site and got one response.  I understand that the
questions are a bit basic but everyone's opinions are welcome.

I am updating protocols at a new job.  They haven't been updated since 
2001.

The technologists were taught to always measure vessels TRV x AP.
New students and myself (not new by any stretch of the imagination!)
have been taught to measure vessels (not masses) as AP x TRV.    I
need to standardize and am wondering if this is an industry standard?

Also, the team has not had an effective supervisor for some time (4-5
years)  Anarchy is rampant.  Some scan the left first and others scan the
right.  Once again, new students and myself have been taught to always
start on the right, (disregard extenuating circumstances).  Any
standardization is met with a lot of criticism.  I have repeated
reproducibility, surgeons wishes, etc.

Finally, I have gotten a lot of push back from them stating they are 
unable
to complete a unilateral fem-pop bypass graft and ABIs in one hour.  How
much time do you allow?

I have reference both IAC and SVU standards/guidelines.  This is not a
small lab - I have 22 direct reports.  Any thoughts are greatly
appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer
away!

Josie Klapec, BS, RVT

To unsubscribe or search other topics on UVM Flownet link to:
https://urldefense.proofpoint.com/v2/url?u=http-3A__list.
uvm.edu_archives_uvmflownet.html&d=DQIBaQ&c=kLuyfJs8xHieIsti43i5Bw&r=
nowbzADbgbSQGUo4tYN6uL7V4skFKveH2RQh4AiNuKs&m=EX5MA9x3D7W_
q8SmeNCaBmdGYHFx3OYgY4gB2s5y62E&s=5XGuKWYeJIQGlMptsioOsUa71N5E8T
iRWxZcpvTCMyI&e=

[St. Luke’s University Hospital is a 4-time recipient of this prestigious
award – Click the image to learn more]<http://www.slhn.org/top100>

Confidentiality Notice: This e-mail message, including any attachments, is
for the sole use of intended recipient(s) and may contain confidential and
privileged information. Any unauthorized review, use, disclosure or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of the original
message.

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EIjFKGl9cMgs4mwlhhWwzj8ldS5jKwRLNhLwEIY8&s=T-IUflS8MOd58Ea_
lOwz8qZc0y0-UlgN7LWTDUM2QbY&e=

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EIjFKGl9cMgs4mwlhhWwzj8ldS5jKwRLNhLwEIY8&s=T-IUflS8MOd58Ea_
lOwz8qZc0y0-UlgN7LWTDUM2QbY&e=


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------------------------------

Date:    Tue, 27 Dec 2016 15:53:38 -0800
From:    Steve Knight <[log in to unmask]>
Subject: Re: DEVELOPED STANDARDS FOR IMAGING

It sounds better than "I'm right and the rest of the world is wrong".

On Dec 27, 2016 3:51 PM, "Derek Butler" <[log in to unmask]> wrote:

> Steve –
>
>
>
> Had to comment – I love this statement: “I know my stance on this is not
> the popular one but I believe my reasons are valid.” – I wonder if that
> will work at home, lolol.
>
>
> Derek -
>
>
>
>
>
> *From:* UVM Flownet [mailto:[log in to unmask]] *On Behalf Of 
*Steve
> Knight
> *Sent:* Tuesday, December 27, 2016 4:49 PM
> *To:* [log in to unmask]
> *Subject:* Re: DEVELOPED STANDARDS FOR IMAGING
>
>
>
> Josie, when you say AP X TRV, do you mean AP in a longitudinal plane or 
AP
> in a transverse plane? AP in a transverse plane is prone to error due to
> misalignment (particularly in the proximal aorta). TRV in the transverse
> plane is also prone to error due to poor resolution of the lateral walls
> and misalignment.
>
> I like to use AP in a long plane. I will also measure in TRV for
> comparison and they should be close but I trust the AP long more.
>
> I know my stance on this is not the popular one but I believe my reasons
> are valid.
>
>
>
> ~S
>
>
>
> On Tue, Dec 27, 2016 at 10:01 AM, Bachman, Andrew <
> [log in to unmask]> wrote:
>
> Colleen,
> Please email me on my work email and we can discuss this.  We love our
> software but don’t want to start a software battle in this email chain.
>
> [log in to unmask]
>
> Andrew M. Bachman, Bs RVT
> St. Lukes University Hospital and Health Network
> The Heart and Vascular Center
>
> "To handle yourself, use your head. To handle others, use your heart"
>
>
>
> -----Original Message-----
>
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of 
Douville,
> Colleen
> Sent: Tuesday, December 27, 2016 12:52 PM
> To: [log in to unmask]
> Subject: Re: DEVELOPED STANDARDS FOR IMAGING
>
> Andrew<
> Which reporting software are you using?
>
>
> Colleen Douville
> Director l Vascular Ultrasound & Neurophysiology
> [log in to unmask]
> Office: 206-320-4080
> Cell:   206-601-8077
>
> Swedish Neuroscience Institute
> 500 17th Ave l 4 West, Room 400
> Seattle l WA l 98122
>
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bachman,
> Andrew
> Sent: Friday, December 23, 2016 8:02 AM
> To: [log in to unmask]
> Subject: Re: DEVELOPED STANDARDS FOR IMAGING
>
> Hi Josie,
> I can not answer what the 'standard' is across the board because there 
are
> some labs that go above and beyond,  some labs that do the bare minimum 
and
> hundreds in between.  I work for the largest heart and vascular center 
in
> the country currently (by sheer number of locations and studies, and 
techs)
> and I will answer based on our practices but we by no means set the
> standards for our field.
>
> 1- Measuring:
>         - I have always seen vascular measuring AP x TRV but this could 
be
> a regional issue or a difference in whom is reading studies (Surgeons vs
> Radiologists).  We have had issues with dual general/vascular 
technologists
> giving push back on this in years past.
>         - If everything is consistent and uniform across the board with
> all techs, this should not be an issue but 1 person differs and you will
> create a ton of confusion to both ordering doctors and reading 
physicians.
> 2- Imaging order/standard
>         - This depends slightly on your reporting software.
>         - We use a software that allows our doctors to click on a 
segment
> of the artery and pull up only the images for that location allowing 
them
> to see diseased areas side by side with previous images.  In our case,
> order is never a problem and techs are free to scan right then left, or
> left then right, or any variation.
>         - If your physicians review each individual image, then you will
> need a standard across the board for everyone but I think in the grand
> scheme of things, WHAT IMAGES YOU TAKE is more important then the order 
you
> take them
>         - We do on average 150-200 studies a day with 5 surgeons reading
> daily, and 5 radiologists reading a few times a month.  If we didn’t 
have
> our reporting system, we would 100% have a standard image order or we 
would
> never function.
> 3- Timeframe
>         - This again depends on your u/s equipment, ABI machine and
> software.   Years ago the standard was 1.5hours for an LEA but the older
> machines required pressing 5 buttons to change 1 thing and 15 different
> tweaks to make a pretty image.
>                 - We have all new GE machines, newer parks machines (at
> majority of our locations), and techs do a short H&P with a full 
detailed
> report at completion.  We perform ABI's and B/L Arterial with the 
completed
> report in 1 hour but in some of our locations we have 1.5hrs for B/L due 
to
> dual techs and older machines.  Unilateral studies are always 1hour or 
less
> regardless of the location/machine.
>                 - I have worked in labs with older machines and you do
> need that extra 30mins at times for bilateral studies or
> difficult/challenging patients.
>                         - For a Unilateral study (especially simplistic
> bypass graft such as a fem-pop), they should not need more then 1 hour.
>                         - I would recommend monitoring their studies. 
See
> if they are using that entire 1.5 hours or if they are finishing early 
and
> lounging for 30mins.
>         - All this aside, I have also, in the past, worked in a VERY
> respectable lab with old HDI-5000 machines and we did ABI's, B/L 
Arterial
> and AortoIliac all in 1 hour.  Plus we did the reporting.  So I guess 
even
> by old practice standards I am reluctant to really say 1.5hrs is 
'needed'.
>
> I hope this helps.
> Andrew M. Bachman, Bs RVT
> St. Lukes University Hospital and Health Network The Heart and Vascular
> Center
>
> "To handle yourself, use your head. To handle others, use your heart"
>
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Josie
> Klapec
> Sent: Friday, December 23, 2016 10:15 AM
> To: [log in to unmask]
> Subject: DEVELOPED STANDARDS FOR IMAGING
>
> Hello Everyone -
>
> I posted this on the SVU site and got one response.  I understand that 
the
> questions are a bit basic but everyone's opinions are welcome.
>
> I am updating protocols at a new job.  They haven't been updated since
> 2001.
>
> The technologists were taught to always measure vessels TRV x AP.
> New students and myself (not new by any stretch of the imagination!)
> have been taught to measure vessels (not masses) as AP x TRV.    I
> need to standardize and am wondering if this is an industry standard?
>
> Also, the team has not had an effective supervisor for some time (4-5
> years)  Anarchy is rampant.  Some scan the left first and others scan 
the
> right.  Once again, new students and myself have been taught to always
> start on the right, (disregard extenuating circumstances).  Any
> standardization is met with a lot of criticism.  I have repeated
> reproducibility, surgeons wishes, etc.
>
> Finally, I have gotten a lot of push back from them stating they are
> unable to complete a unilateral fem-pop bypass graft and ABIs in one 
hour.
> How much time do you allow?
>
> I have reference both IAC and SVU standards/guidelines.  This is not a
> small lab - I have 22 direct reports.  Any thoughts are greatly
> appreciated!!  Quite a bit to respond to, but please, if it is slow, 
answer
> away!
>
> Josie Klapec, BS, RVT
>
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