Ultrasound Technologist / Diagnostic Medical Sonographer

What Do People Think You Do?

Did you know it is extremely common to evaluate the prostate by ultrasound? A prostate ultrasound is usually a 15-20 minute exam that involves inserting the ultrasound camera into the rectum. A bold first statement, sure, but the biggest misconception by far about ultrasound is that it is primarily scanning babies all day. Most people don’t realize the true diversity in what can be diagnosed by ultrasound (or sonography). You will be scanning for blood clots, appendicitis, and breast masses, among loads of other things. If you work in a hospital, you can add assisting radiologists with biopsies and draining fluid build-up in the abdominal/chest cavities to the long list. You will encounter heavily bleeding mothers intensely studying your face for the slightest clue as to if their baby is still alive, teenagers writhing in pain so bad that you can’t get a good image of their extremely painful, dying testicle due to torsion, and dementia patients restrained to their bed who do not want you near them and will absolutely swing on you to prove it.

What Do You Really Do?

There are two primary routes you can take, and yes, it usually is one or the other: Cardiac Sonography or General Sonography. I will only speak on behalf of General Sonography as this is what I do.

General Sonographers perform many different types of exams in a day. This includes helping physicians with biopsies (taking samples of tissue from an area to be evaluated by the lab), and para/thoracentesis’ (draining fluid from the abdomen/chest). We scan to evaluate various parts of the body, including the scrotum, prostate, breast, uterus, ovaries, fetuses in all trimesters, appendix, infant hips, infant brain, bladder, kidneys, liver, gallbladder, pancreas, aorta, IVC, spleen, thyroid, carotid arteries, upper and lower extremity arteries and veins, and many, many more.

The first exam of the day could be a quick 10-minute thyroid ultrasound for follow-up measurements of a few nodules, to an hour-long breast biopsy in which halfway through the ER orders a STAT first trimester OB for vaginal bleeding, to the next patient having a lump in their groin in which you would evaluate for possible hernia. Everything we do is different with each exam. Essentially, we take measurements of organs and relevant structures (i.e. masses) and take note of their relative appearance and possible pathology.

Sonographers work as a team amongst each other, giving input on what was seen on a certain exam, splitting the workload, and helping make sure the day runs smoothly. There could be anywhere from 3 to 5 to 10 other sonographers working each day, depending on the environment and patient load.

The two primary working environments are outpatient clinics and hospitals. I work in the hospital. This means that we not only perform ultrasounds on scheduled outpatients, but we also examine ER patients and patients admitted to the hospital, in addition to add-ons and cancellations in our schedule throughout the day.

Sonographers interact with many different people every single day: fellow sonographers, patients, nurses, doctors, receptionists, custodians, and CNAs amongst others. Learning to effectively communicate information in any situation is a must in this field- whether it is written, typed, verbal, or nonverbal. Most exams last anywhere from 10 minutes to an hour. It is important to recognize that patients may not always be the happiest or most cooperative.

Never be afraid to ask a fellow sonographer or the patient’s nurse/CNA to assist you in positioning a patient or giving you relevant information if needed. Oftentimes you may have to hold urinals for patients or help them in the restroom during your short time visiting them. Sometimes, patients refuse the exam altogether. All we can do is educate them and maybe even have their nurse convince them to try again another day.

A part of your job is also making sure the doctor’s order for each exam makes sense. The reason for the exam has to line up with which exam we are performing. Quite often, this doesn’t happen. You may have to call the patient’s doctor’s office to clarify, and you may have to call the patient’s doctor’s office to give them STAT results on certain exams immediately after.

Such as venous Doppler exams, in which you may find a dangerous blood clot. In these cases, many doctor’s offices recommend the patient be admitted to the ER for treatment as the clot could travel to their lungs. If you are in the hospital, you may have to wheel the patient down to ER and help kickstart their registration process.

Another key part to a sonographer’s job is their tech sheets. This is a preliminary report written by the scanning sonographer about the patient and the exam just performed. Things like medical history, reason for the exam, relevant information and the measurements and appearance of the organs scanned are included.

As a sonographer, we cannot make diagnoses, so it is important to use words like “appears within normal limits” or “possible cyst” as describing terms. The doctor is the one who will pull the trigger on calling something normal or definitely a cyst in the official report. If something were to be incorrect, say the cyst was really a life-threatening rupture, the doctor would take the brunt of the repercussions. We will never be the ones to tell the patient if their baby is okay or if the area you’re measuring is supposed to be there or not. You will have to master the poker face and the ability to inform the patients we cannot interpret their exam, only the doctor can. After the exam is finished and the preliminary tech sheet has been written up, you send your images off for the doctor to read and your job, essentially, done. Though sometimes, the doctor may speak to you about your images or any questions they may have about the patient. The doctor uses the information you’ve given them and the images you’ve taken for them to determine next steps: a diagnosis, additional imaging, surgery, etc.

A Day In The Life

A day in my job starts at 7:30 AM. I clock in, get breakfast in the cafeteria, and return back to our work-station. I login to the computer and look at our scheduled patients for the day. Usually, our first begins at 8 AM. I also take a look to see if any exams were ordered for inpatients overnight and add them onto our schedule where I see fit. If any of the exams require the patient to fast, I will call the patient’s nurse and make sure they have been NPO, and if they haven’t been, I will ask the nurse to make sure they are until we do our exam so we can get the best images possible.

If there is a biopsy or a centesis procedure that day, I will gather supplies needed for the doctor, such as needles, sterile gloves, and vacuum bottles. I work in a rural hospital with two ultrasound-specific rooms, each with an ultrasound machine in it. These machines are portable and weigh around 60 pounds. If exams are ordered on inpatients or ER patients, we push the machine right to their bedside to perform the exam.

Our student doing her clinicals arrives at 8:30, and I usually allow her to begin most exams. If she needs help or is finished or I need to interrupt because of a time crunch, I will look through her images and scan myself to ensure nothing was missed.

The next sonographer arrives at 9:30, and this is usually when we get double-booked or we have two patients arriving at the same time as we can each take one. We go our separate ways for most of the day, coming together back at our work-station to write up tech sheets on the patients and to eat lunch. I usually get around to doing 8-10 patients a day.

Our hospital receptionist checks the patients in when they arrive, and calls us to let us know they are ready for us. I first check any previous imaging history or relevant medical information on the specific patient, then bring them into the exam room, ask them why the doctor ordered what they did, and obtain any other relevant information. I will explain how long the exam usually takes and what is needed from them to be able to complete it. After I take my images, I inform them when they should expect results, and escort them out.

Then, I take time to write up the tech sheet and send it over to the doctor along with the images. For example a patient is here for a pelvic exam (where we look at the uterus and ovaries), the order stating that she has had right-sided pelvic pain. I will bring her back, ask her why the doctor ordered the exam and how long the pain has been going on, if she’s had any bleeding etc.

The more specifics you get, the better for the doctor to be able to come to a diagnosis. I will ask her her last menstrual period, if she’s ever been pregnant and how many live births she has had, and if she has a history of any ovarian cysts/uterine fibroids or any pelvic surgeries. For this exam, the patient is required to prep by having a full bladder as it acts as a window to see the pelvic organs better. I will inform the patient I will need her pants lowered to her hip level, and I will be putting warm gel on the camera and pressing it onto her skin to view her pelvic organs, and it should usually take around 30-40 minutes.

Most of the time, when we perform a pelvic exam, the ovaries cannot be well seen using this method, so we use to perform a transvaginal ultrasound in addition. This means a camera gets inserted into the vaginal canal and drastically improves our view of the uterus and ovaries. I will ask if the patient has ever had this type of exam done before and if she is okay with us doing it now for the above reasons. A transvaginal exam requires an empty bladder, so I will send her into the bathroom to undress and empty out.

This patient happened to have a partial hysterectomy, meaning the uterus had been removed. I will note this on the tech sheet and take images documenting where the uterus would be to ensure there are no masses or suspicious tissue in that area. I will measure her ovaries (we measure everything in two planes), make sure adequate arterial and venous flow are getting to them, make sure there are no masses and if there are, image and measure them, and image the nearby areas to make sure there are no masses around.

After the exam, the patient can get dressed and I will tell her the radiologist will interpret the images and have results over to her doctor in a few days. I will send the images through to the computer, disinfect the machine, camera, and bed, and then I can write up the tech sheet.

This includes all of the pertinent information, measurements, and any other notes I feel are important for the doctor. I will scan this into the computer with her order, and send them and the images through for the doctor to read. And then it’s on the next patient of the day.

My day ends at 4 PM, though two days a week I am on call in the evenings. This means I am on stand-by for the hospital, and they can call me back in to do an exam anytime between 6 PM – 7 AM the next day.

The ER usually calls and tells me what exam they need to be done. I will come clock in (we get paid automatically for 3 hours every time we get called in), do the exam, write up the tech sheet, and send it off to be read by the doctor. I do not have to wait for the doctor to read the exam before I can clock out and go home.

What’s The Average Income?

Beginning ~$20-30 USD hourly, experienced ~$30-40 USD hourly, give or take.

What Education If Any Is Needed?

Cardiac Sonography and General Sonography are separate schooling avenues altogether. However, we share most prerequisites like physics, medical terminology, and anatomy and physiology. Sonography programs are extremely competitive and can range from 2-year programs to 4-year ones. If you wish to move up to a management position, you must attain a Bachelor’s degree. It is imperative the school you attend is CAAHEP accredited as this will, frankly, assure you do not waste your time and money. In my area, only 12-15 students are accepted every year into the program.

High grades combined with an entrance exam known as the TEAS is what was required when I got into the program. The TEAS exam is common for nursing students, though it tests broad knowledge such as science and math topics. Once in the program you will be bombarded with information. And I mean bombarded. You will need efficient studying skills to sort through all of the information thrown at you and be able to comprehend it all. My program director specifically encouraged us to not get pregnant or make any huge life decisions while we were in school because it really does demand so much out of you. It is not easy.

The first year in a 2-year program is taking program-specific classes. You will likely have class lectures along with allotted lab time to practice your scanning skills on your fellow students. Sonography is almost like a different language. You have to train your eyes to make out structures from 256 shades of grade, along with endless pathology. Scanning itself is almost like a muscle memory that you have to build up, and most say they experience “clicking” moments where certain concepts or scanning mechanisms just, suddenly make sense to them.

For every exam, you need to choose the correct camera and machine settings, including frequency and dynamic range, and ensure the images aren’t too bright or too dark. And every human body is different, so though you have mastered how to scan certain organs, you can never predict what you will see when you put the camera down.

You will have good days and bad days scanning, student, and beyond. The final year in a 2-year program is a year-long internship called clinicals. We only had a few holidays off during clinical and were expected to be at our clinical site for 32 hours a week the first two semesters as we were still taking classes and 40 hours a week the remainder of the year once classes had ended.

Keep in mind; you may be required to have an hour-long or more commute to your clinical site, depending on availability. Clinicals are a roller coaster. You will have high highs and low lows. A year-long internship is very long but goes by faster than you think. You will be under the direct supervision of an ultrasound department (hospital/outpatient center) that the school places you with. You will be hands-on, working with real sonographers and real patients. You are not responsible for any of the exams submitted because the sonographers you work with have to put their name on the final tech sheet.

Your clinical experience will vary greatly depending on what environment you are in, and what the sonographers are like there. The way it was at my clinical site was that they allowed me to start the examination and get as far as I could/finish the exam, then a sonographer would come in after me and look through my images, maybe delete some, and they would scan through the patient themselves to take their own images and make sure nothing was missed. I got introduced to writing up tech sheets and working the computer system.

By the end of my clinicals, I was doing everything the sonographers who taught me were doing, only for free. While doing clinical, I had to log every exam I had done each day for the entire year and complete assessments and competencies, in which you perform an entire exam with the required images needed and have a sonographer grade you. We were also required to keep a weekly journal for school and complete discussion boards. Many sonographers can be catty and gossipy with not the best intentions. If you have a good program director, they will have warned you never to speak about your personal life or talk badly about other sonographers during your clinicals.

It is essentially a year-long interview, and since sonography is such a small community, you never know how many of the people you meet you may run into again in the future. Sonographers are required to take pricey (~$250 USD each) board exams in order to become registered sonographers and be able to practice. These board exams include Abdomen, OB/GYN, and Vascular. You can only take these specific boards after you pass the first one- Ultrasound Physics. The upside is that you can take the board exams as many times as needed to pass; the downside is that there is a cool-off period between them, and they are not cheap.

The boards are very extensive and are compared amongst the community to knowledge that doctors would need to know. You pay a yearly fee to keep your credentials; every three years, you must meet a certain number of CMEs (continuing medical education) requirements. These are often obtained by relevant sonography courses/quizzes and are rarely free. You need to keep up on these your whole career in order to keep your credentials.

Something Important To Know

Knowing there are so many options you have when choosing this field is important. You can work in a hospital, out-patient clinic, veterinary ultrasound, mobile ultrasound, or travel ultrasound where you work 3-6 months in a place with compensated housing and are free to move on after your contract. You can work full-time, part-time, or as needed (per diem), or a combination of them. Per diem techs often get paid a higher rate as they do not receive benefits. Hours are pretty flexible depending where you work, although be aware weekends and holidays are required in places like hospitals.

Days, nights, and call shifts are abundant. Sonographers are all familiar with the words “on call.” You may work at a place with no weekends, but you might be required to be on call. This means you get paid a low rate to be on stand-by within 30 minutes or so from your job so you can promptly come in when needed. At my hospital, we rotate calls every weekend, holiday, and every weeknight, 6 pm – 7 am. This field has many pros, but if I had to choose only one thing for you to know, it is the prevalence of injury. Around 90% of sonographers scan in pain, and many suffer career-ending injuries.

Injuries include torn rotator cuffs or carpal tunnel, which can put you out of work for weeks or months or forever. You are holding a camera that often requires loads of pressure with your one arm/hand to be able to get the best image. Patients are only getting larger in size. Pushing on them and the machine, awkwardly positioning your body to get images on those with mobility issues, and repetitive motions throughout the day can quickly wreak havoc on your body.

Correct ergonomics lift this burden substantially, but the number of work-related injuries is still astounding. Take care of yourself and your body, and be aware of the risks before you get invested in this field. We get paid super well for such a short schooling experience, but it comes at a price that some are unwilling to endure.

It is so rewarding to be a part of the medical field and to have the opportunity to meet so many different people and see so many different things. We are an integral part of medical care; after all, we are the doctor’s eyes. We can be the difference between a small size breast cancer being missed and a prompt biopsy and early treatment. Every day is different and exciting; you can never know it all in this field.

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