Can You Fake an Ultrasound in Real Time?

Gerard Asks:

I came across your blog as I was googling my question. This week, I was watching Grey’s Anatomy (Season 14, episode 18) in which an unscrupulous (or maybe it he was just a fraud?) doctor was giving false diagnoses for breast cancer through ultrasound—I think to sell treatment?

Knowing a little about computers, I wondered how that could be possible. Can an ultrasound store the millions of images or 3d imaging from another patient to be “played” on another patient? Of course, I wrecked the show for my wife by questioning the episode she was enjoying.

So, in case I’m all wet in my assumptions, is it possible to fake an ultrasound in real time?

Jordyn Says:

Hi Gerard! Thanks for submitting your question to me. The perfect person to answer your question is Redwood’s resident medical expert, Shannon Moore Redmon.

Shannon Says:

Today’s ultrasound technology does offer the ability to record video clips that an extremely unethical doctor could replay while pretending to scan a patient with a probe. Most patients would not know the difference between normal breast tissue compared to a malignant mass and the shape of the entire breast isn’t really a factor on the ultrasound screen, since we’re only scanning a small section at a time.

With that said, the hoax displayed in the Grey’s Anatomy episode – Hold Back The River, would be difficult to achieve in real medical life.

Gold Standard

First, ultrasound is not the Gold Standard for detecting breast cancer. That role belongs to mammography (x-rays of the breast). Highly trained technologists position and complete several different mammography views. Ultrasound simply supports suspicious lesions first detected on these images. Doctors use the scan to provide more information and ultrasound should never be used alone to detect malignancy. I hope most patients would not simply take a doctor’s word based on an ultrasound alone when determining whether they have breast cancer or not.

When a mass is identified on a mammogram and followed up with ultrasound, these images or video clips do not give a complete diagnosis of cancer. We can suspect cancer by the appearance of the mass we see, but the only way to know for sure if the mass is malignant, is through a biopsy. Stereotactic breast biopsies are often performed at imaging centers or hospitals. A large needle is used to take samples of the mass and then send them off for pathology testing. Those results tell if a mass is cancerous or not. If the patient is not a candidate for stereotactic breast biopsy, then the mass can be removed in surgery and sent to pathology for testing.

Appearance

When a sonographer finds a suspicious mass on ultrasound, we look for several factors in the appearance. Is it solid or fluid filled? Does is have smooth borders or finger-like spiculations extending into normal tissue? Does a shadow present posterior to the mass? The mass shown during the episode did not meet the specified criteria for malignancy. Let’s break the moment down:

The doctor shows the female character a mass on the screen. There was no shadowing posterior. The borders were smooth and looked like the normal tissue adjacent to it. The area the physician suggested was solid but had a Cooper’s ligament running through the tissue which is typical for a normal lobe of the breast. I’ve included an ultrasound image of a true malignant mass, so you can see for yourself what a true breast cancer might look like on ultrasound. I think you’ll find the video clip played in the scene looked nothing like the true cancer below.

 

 

 

Exam Inaccuracies

During the scene, a swishing heartbeat noise can be heard in the room. Grey’s Anatomy seems to think that when an ultrasound is being used, every machine creates this noise. Let me assure you, that’s unrealistic.

The noise heard in the background is created by a Doppler sample of a vascular structure, such as an unborn baby’s heartbeat or blood flowing through an artery. Neither of these were being scanned during our breast exam.

When no Doppler is activated on the screen, this sound cannot be heard. But yet, we have the heartbeat noise once again. I wish someone at Grey’s Anatomy would update their sound effects team.

After the blond female doctor goes back to Seattle Grace, she has her doctor friend scan her breast to make sure there is no cancer. The doctor who performs the scan and supposed to be knowledgeable enough to detect breast cancer, is holding the wrong probe. She should be holding a linear transducer used in high frequency imaging and provides a rectangular footprint on the screen. Instead, her probe is curved and used for abdominal and pelvic scanning because of the lower frequency range.

Another flaw in the episode is how all these doctors are experts at performing scans in every area of the body. In real life, trained, registered sonographers and technologist work in these modalities. They would be the ones to execute the imaging. Then a radiologist would read the exam and communicate with the surgeon or other physicians. But once again on TV, we see the Grey’s Anatomy doctors performing all the imaging exams. No sonographers or technologists around anywhere. So unrealistic and a little insulting.

I think it is time for the Grey’s Anatomy team to hold back more than the river— they need to hold back on performing any more ultrasounds until they consult a living breathing registered Sonographer.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Flatliners: The Real MRI Story

As followers of this blog know, I did my own medical review of the recent movie version of Flatliners here and here. I thought there was something off about the MRI scenes, so I asked our resident radiology expert, Shannon Moore, to watch the film and give her thoughts.

Welcome back, Shannon.

I’m a huge fan of the 1990’s version of Flatliners. Kieffer Sutherland and Julia Roberts were brilliant outside of his Lost Boys role and her Pretty Woman phenomenon.

In 2017, an updated version of the Flatliner’s movie was released with Ellen Page. Of course, I had to watch and give my opinion. The movie was as enjoyable as the first one and held my interest and nerves through the entire film.

However, some flaws invaded the magnetic resonance imaging (MRI) scenes.

MRI Magnets

MRI machines contain a highly charged magnet thousands of times beyond the magnetic field of the earth. Metal objects become projectiles when they are close to the machine. Just to give an idea of this device’s strength, click on the link or search You Tube for MRI accidents after reading this post.

With a magnet so powerful, how can these students use a defibrillator right next to the scanner? The metal paddles, as well as other components in the device, would have become projectiles and caused damage not only to the equipment, but also to the people in the room standing next to the system. An MRI safe defibrillator is being explored, but so far not approved or on the market.

Even the argument they turned off the magnet is not logical. To “quench” or shut off an MRI magnet is not as simple as flipping a switch. In a hospital setting, MRI magnets are only “quenched” in case of a fire or if someone is pinned to the machine. Neither of these happen in this movie. The reason the magnets stay on constantly is because the shutdown process demands a release of helium and causes days of down time. The magnet could be damaged from the quenching process. Therefore, the magnet remains active on a daily basis or in this movie’s case, during their experiment.

The residents use the defibrillator to stop and restart the heart with the person on the MRI table. Real-life cardiac arrest procedures, with the patient in an MRI scanner, is to remove the patient from the scanner and place them on an MRI safe stretcher. They are removed from the room and provided life-saving measures.

Other metal objects in the movie’s experiment room are Courtney’s laptop computer, the heating blanket, laryngoscope, etc. – all containing metal objects and life-threatening projectiles.

MRI Images

 When the residents are gathered in her apartment reviewing the images on a laptop, bolts of lightning or electrical currents appear on the scans—that is all Hollywood.

The type of scan they were showing on the screen was a Diffusion Tensor Imaging (DTI). This scan is a type of functional MRI that tracts the diffusion of water molecules in the white matter fibers of the brain. The colors in these images are assigned based on orientation. Front and back are usually blue, right to left are red and interior to exterior are green. Recorded electrical pulses are not shown on real MRI images. To be accurate the lightning bolts should not have been added and the actors could have pointed to the areas they were discussing.

MRI Brain Coils

The final inaccuracy is with the brain coil placed on the resident’s heads. It was dainty and petite showing the entire face of the actor.

 

Here is a real brain coil:

 

Quite a bit different from what was shown in the movie. In real life, there are a couple of coils to show the face, but they would have hindered the actor’s ability to intubate which again would not be done in an MRI Scan room because of the metal Laryngoscope used.

 

Overall, the movie was entertaining and interesting, but the MRI scenes need some resuscitation.
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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Love Matt Czuchry, but The Resident Needs Help

As you all know, I’ve been taking my own jabs at The Resident which you can read here and here. Today, our resident radiology expert Shannon Redmon offers her insight of some of the show’s inaccuracies.

Welcome back, Shannon!

As a huge fan of Matt Czuchry since his Gilmore Girl days, I must say that his new show, The Resident, is quite entertaining. Too bad several episodes include inaccurate medical information.

For example, two MRI scenes have aired on this series and both are misrepresented as to what happens in a real hospital.

In the first scene, Drs. Conrad and Pravesh are viewing an exam in the MRI control room. No one else is around. No technologists, radiologists or even patients. The reason this is out of character is because most surgeons view the images from their workstations or with a radiologist in their office, not in the technologist control room.

Digital radiographic photos can be accessed from computers all over the hospital. All doctors need is their login and the patient’s name to access any record in the system. Why would both surgeons trek all the way to the MRI room to look at the images? They can pull them up right from where they are sitting and in the operating room before surgery.

The second MRI scene shows Nic, the well-rounded nurse, marching into the MRI room to confront a billing lady who convinced a doctor to order an MRI on a patient with a penile implant – a metallic based penile implant according to the dialogue in the scene. When nurse Nic enters, the patient is already in the machine. She stops the exam because the patient has a metal penile implant which could be “ripped out” by the powerful magnet.

If this patient were going to have any issues from the MRI, then the damage would already be done. MRI magnets are always activated. The patient with a metal implant would not even be allowed in the room. MRI technologists have strict vetting procedures in place to conduct on all patients. These policies keep at-risk patients from harm and are emblazoned into the brains of all technologists. They would have been the ones to prevent the test from being completed, not the nurse from an outside department. This scene makes the MRI tech seem inept.

Also, where does the billing consultant get so much authority? If any employee confronted physicians and nurses the way she did, she’d be tossed out on her head. No surgeon is going to stand there and let a consultant from billing tell them what to order or how to treat their patients. This woman strongly encourages all staff to upcode patient exams for more money. Without proper documentation or a legitimate reason, upcoding is illegal and hospitals can be highly fined for healthcare fraud in violation of the False Claims Act.

Although I cringe when I see such inaccurate scenes, I will continue to watch for two reasons. Because I love Matt Czuchry and … I love Matt Czuchry!
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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Radiation and Spiderman

So pleased to have back our radiology expert Shannon Moore Redmon.

Welcome back, Shannon!

When in elementary school, our teacher rewarded good behavior with an episode of Spiderman. The thought of a once nerdy boy turned superhero, gave all the kids in class grand ideas of swinging from tall buildings and capturing bad guys with web like nets. Thankfully, no one ran out and searched for spiders to bite them.

However, when humans are truly exposed to radiation, we do not acquire superpowers like our wonderful Spidey, but overdoses of radiation lead to a variety of sickening symptoms or cancer, depending on the size of the dose.

Peter Parker’s symptoms do not demonstrate the real effects of radiation exposure.

  • Peter is bitten by a radioactive spider.

First, a radioactive spider does not contain the ability to provide humans with special powers. Peter’s hand develops a large boil on the area of the bite, but instead of going to the hospital, the teenager goes home and lies down.

This is science fiction, but wouldn’t a normal teenager at least tell the grownups living in the same house of his insect bite and go see a doctor? My boys would.

  • Peter feels the results of the radiation in his body and his DNA changes.

Some real world medical tests use radioisotopes or expose patients to radiation, but the small dosage rarely manifests into any biological changes. We receive more radiation exposure from our televisions, microwaves and cell phones we use every day then we do from medical tests.

Nuclear Medicine is a radiological modality where small doses of radioisotopes are given to patients to discover diseased areas within the body. These scans can detect cancers, non-functioning organs or other medical conditions, such as Alzheimer’s disease.

Fluoroscopy, another radiology modality, uses live x-ray beams to study the stomach and intestines. Technologists and radiologists must protect themselves with lead aprons, gloves, and thyroid shields. They also wear dosimeter badges to record their exposure.

  • Peter wakes up no longer needing glasses and his body has evolved into a buffed-up physique.

If only radiation exposure was that transformative. We’d all be rushing to our local x-ray departments for the latest dose of tummy tightening effects.

Larger doses of radiation are destructive, but in the case of a cancer patient, the damaging exposure can be helpful. Medical facilities use therapeutic radiation to attack malignant tumors, shrinking or eliminating them.

According to the NCBI, there are two types of radiation exposure, acute and late onset disorder. If you want your character to die quickly, then review the following symptoms:

Acute disorder:

Alopecia – hair loss
Skin erythema – redness of skin
Hematopoietic damage – destruction of blood cells
Gastrointestinal damage
Central Nervous damage

Late onset disorder:

Cancer
Non-cancer disease
Genetic effects

So, for now, Spiderman fan’s need to steer clear of those radioactive insects. But if your character has a medical condition that requires a dose of radiation, the positive effects can be as life changing as Spiderman’s.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

5 Tips for a Character’s Stroke

Even some famous authors get medical details wrong.

In a New York Times bestselling novel, the author presented his main character’s mother with a stroke. Almost all the details were accurate, except for the origin of the blood clot in the mother’s leg. This is where the author needed more research and clarification.

For example:

If the blood clot broke loose from the arteries of the leg, it travels to the toes and become lodged in the tiny capillary vessels, never reaching the brain.

If the blood clot broke loose from the veins of the leg, it travels to the heart, out to the lungs and becomes lodged. This obstruction can be fatal and is called a pulmonary embolism, not a stroke.

Therefore, when giving your characters a stroke, let’s get the details right by asking the following questions:

What kind of stroke does the character have?

There are two types:

Ischemic Stroke occurs when blood vessels in the brain become blocked by a moving obstruction that has traveled to the brain and lodged within the vessels, cutting off oxygen supply. These moving obstructions or emboli and most often come from the heart or carotid arteries.

Hemorrhagic Stroke occurs when excessive bleeding in the brain, either from a ruptured blood vessel or from trauma, places pressure on the brain tissue. This cuts off the oxygen supply in that area.

There are two types of hemorrhagic stroke:

Intracerebral – located inside the brain
Subarachnoid – located outside the brain

What are the characters risk factors for a stroke?

Characters need to exhibit a pre-existing condition that contributes to a stroke. Such as:

High blood pressure
High cholesterol
Smoking
Heart Disease
Head Trauma
Drug Abuse

What are the characters symptoms?

Think FAST:

Facial drooping
Arm weakness
Speech Difficulty
Time to call 911

Strokes on the left side of the brain will contribute to symptoms on the right side of the body and vice versa. If the stroke affects the cerebellum or brain stem, then symptoms can affect both sides of the body.

What is the characters treatment?

Ischemic Stroke: t-PA therapy is provided by licensed medical professionals and needs to be administered within three hours of onset symptoms.

Hemorrhagic Stroke: Blood thinner meds are halted and blood pressure meds are administered to decrease bleeding.

What types of medical procedures are provided for a character experiencing a stroke?

Ultrasound of the carotid arteries may be performed to determine blockage in the arteries carrying blood to the brain.

CT or MRI scan of the brain to identify the cause and location of the stroke

For an Ischemic stroke, an angioplasty or endarterectomy is performed to open the narrowed channel and provide blood flow to the brain again.

For Hemorrhagic stroke, a procedure may be performed to place a coil, clip or glue in the affected area to try and stop the bleeding.

Follow these tips and you’ll be thinking FAST in no time!
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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

 

Author Beware: Inaccurate Ultrasound Scenes Part 2/2

Today, we’re concluding Shannon’s series on how to write medically accurate ultrasound scenes. You can find Part I here. Today, Shannon is covering tips #3-#5.

Welcome back, Shannon!

Tip #3: Sonographers scan in the ultrasound department most of the time.

Most scans are performed in the designated ultrasound department for their exams, unless they are in active labor, in the ICU or for some astronomical reason, cannot leave their room. Even in the emergency department, if the patient can be transported to the department, then they will be.

Portable ultrasounds are performed on serious cases when the physician does not want the patient moved for some pertinent reason.

 For Writers: If your character needs an ultrasound exam, is conscious, can move well, or sit in a wheelchair, send them to the ultrasound department.

Tip #4:  Sonographers like top of the line equipment.

One television scene at a top-rated hospital showed a tiny little ultrasound machine from the 1990’s being used for the exam. Seriously?

Get rid of the outdated equipment. The machines in top-rated healthcare systems are the best of the best, large and full-sized pieces of equipment.

Modern portable systems look like laptops, are smaller, and are taken to the inpatient rooms or ICU.

Some facilities provide their ER and L&D doctors with tiny devices the size of a cell phone to carry in their pocket for quick peeks, not full anatomy exams.

For Writers: When describing the machine look at top of the line equipment with GE, Philips, Samsung or other manufacturers. This will give you a good idea of what is being used in the real medical world.

Tip #5:  Sonographers know where to place the probe.

Make sure the anatomy showing on the screen matches the location of the probe and the anatomy being discussed is displayed.

One television scene I witnessed had the actor place the probe in the middle of the abdomen, but a kidney presented on the screen. Sonographers know the kidneys are located on the sides of the abdomen, not in the top middle.

If you’re listening to the baby’s heart on a second or third trimester baby, then the heart will display on the screen. Not the brain, fingers, and toes.

If investigating the liver, then the probe needs to be placed on the right side of the abdomen. With the spleen, move the probe to the left side.

If it is a first trimester scan, then a vaginal exam will be performed. If the baby is in the second or third trimester, then the probe is placed on top of the abdomen.

For writers:  Research anatomy and physiology on the internet or in books before writing the ultrasound scene. Make sure the location is correct and the disease process is represented accurately. If unsure, then find a nurse, physician or medical professional to ask or connect with Jordyn and me.

When researching a specific topic, perform a google search, but select a credible source. Choose sites that end with .edu, .org, or .gov. Those tend to be most accurate. Sometimes I will use others, but always back it up with a healthcare system education site like Mayo Clinic, Cleveland Clinic, or the government site (ncbi.nlm.nih.gov).

Don’t be like one famous author, whose patient’s venous blood clot, located in the leg, traveled to the brain and caused a stroke. However, in real life, strokes most often come from the carotid arteries and heart. Venous blood clots in the legs kill when they break off and travel to the lungs.

Shannon, thank you so much for this valuable insight. I know I learned a lot.

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Shannon Moore Redmon writes Romance Suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

 

Author Beware: Inaccurate Ultrasound Scenes Part 1/2

Redwood’s Medical Edge is pleased to host Shannon Moore Redmon, an ultrasound sonographer, and she’s offering her insights on how to write ultrasound scenes accurately. I know I’ve learned a few things for sure. Today, we’ll cover tips #1 and #2.

Welcome, Shannon!

Americans love to watch medical television shows, like Grey’s Anatomy, ER, or House. We buy up the latest medical thriller and discover the scientific world of healthcare.

What many fail to recognize are the glaring inaccuracies associated with the ultrasound profession and the exams being performed on the television screen. Such scenes contain incorrect anatomy, probes placed in wrong positions, or actors who need more camera face time and scan patients backwards.

Doesn’t Hollywood consult experts when they use ultrasound to determine an abnormality of a baby or find cancer in a patient’s liver?

As a registered diagnostic medical sonographer for over twenty years and an instructor who teaches others to utilize this amazing modality, here are five tips to make those ultrasound scenes more accurate.

Tip #1:  Sonographers perform the majority of scans.

Whether in a hospital setting, an outpatient center, most OB/Gyn offices, vascular offices, and general imaging facilities, registered sonographers are the ones who perform the majority of ultrasounds on patients . . . not doctors.

In my experience, sonographers scan the patient first and sometimes are the only one who take the images. If a patient is high-risk OB, a sonographer will scan her first, then a maternal fetal medicine doctor will scan after to confirm the diagnosis.

When abdominal or vascular ultrasounds are performed, sonographers scan these patients and the reading physician or surgeon may come into the room to discuss with the patient. More than likely, they will read the images from a digital archiving system located in their office down the hall, then attach a report to the patient’s medical record.

Most episodes on television have a doctor performing the exam. Where have all the sonographers gone? Having lunch together down by the river?

For writers: When writing your ultrasound scenes, let the sonographer take the images and discuss the case with the reading physician. If you want to ratchet up the drama, then let them have a heated discussion over what the sonographer believes she sees versus what the physician thinks he knows.

Great radiologists and reading physicians will critique a sonographer’s images and call them out on sloppy pictures. Sonographers will defend their opinions and their patients when a doctor minimizes the seriousness of the findings with a list of differential diagnoses or refuses to discuss the diagnosis with the patient. This happens in real life.

Tip #2:  Sonographers turn off the sound of the heartbeat.

In the famous Doritos commercial, granted the scene is a comedic parody, but if you listen close during the entire exam, the heartbeat is playing in the background and there is no Doppler technology activated. This is also the case in many television scenes, depicting actual exams.

In real life, the heartrate sound does not play during the entire exam. Sonographers know the heart rate plays only when we turn on the Doppler technology, drop the gate into position and hit the update key. We listen for a few seconds, acquire a heartrate strip along the bottom and then turn the sound off.

For writers: If there is background noise, it comes from the cooling fan on the machine.

Next post: Tips #3-#5.

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Shannon Moore Redmon writes romance suspense stories to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.