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Ultrasound Spokesperson-Reporter Has Questions
Posted: Monday, May 6, 2013
Joined: 8/31/2011
Posts: 231

On May 6, 2013 a lively discussion began with regard to the topic of ultrasound technician availability for the performance of examinations like appendicitis ultrasounds. The question came from a San Francisco reporter and the text is listed at bottom.


ACEP EUS Member Dr. Elizabeth Schoenfeld initially brought this topic to the attention of the section.


Responses included:



We are aware of the situation and are crafting a response.  Thank you for bringing it to our attention. 
Rajesh Geria MD RDMS FACEP
Chief, Division Emergency & Critical Care Ultrasound 
Assistant Professor 
Chair ACEP Emergency Ultrasound  Section



There is a lot of variation and will definitely vary depending on type of hospital, but in general if an imaging test is needed, ultrasound in most cases is recommended.  There are ACEP and ACR (Radiology) policy statements that recommend ultrasound first, and if non-diagnostic or not available, then CT scan.     Jim Tsung




I certainly won't be answering her based on my much fewer years of experience compared with others on this email list who may be more eager but I find it intriguing that she mentioned appy in particular as a medical emergency in a child requiring ultrasound. I can't see many hospitals calling an oncall ultrasound tech for appy (vs testicular/ovarian torsion which are the classic ultrasound emergencies at the hospitals I've worked at) unless they truly had no ct. My imagination may be running wild but I can only imagine that an appy was missed because parents refused ct which is actually standard of care for appy (though all of us here would have at least tried bedside ultrasound on our own). I hope the lawyers aren't getting too interested in ultrasound yet. 

Dasia Esener, MD
San Diego Medical Center 
Kaiser Permanente 




Below is the initial post that sparked the discussion on the listserve:


From: Katharine Mieszkowski [
Sent: Friday, May 03, 2013 7:47 PM
To: PR
Subject: ? about access to ultrasounds in emergency rooms


I'm a reporter for the Center for Investigative Reporting,, a non-profit newsroom based in California. I'm hoping you can tell me what the standard of care is for emergency room doctors having access to ultrasound technicians to do ultrasounds in the case of, for instance, suspected appendicitis in a child. 


Is the standard that all hospitals should have ultrasound technicians available to perform ultrasounds to your emergency rooms on a 24/7 basis either in house or on call? If they’re on call, are they available within one hour or less?


Or, does it vary by the size of the hospital. Please let me know. 


Thanks, Katharine 





Katharine Mieszkowski 

Senior Reporter, Environment

The Bay Citizen / Center for Investigative Reporting 










Posted: Monday, May 6, 2013
Joined: 8/31/2011
Posts: 231

 I work at both a children's hospital and a very small community hospital and at both institutions US is the first imaging modality used. The children's hospital has 24hr US techs, while we call in the on-call US tech at the community hospital. If this test is inconclusive we still do not proceed with CT scan. Our standard at both institutions is calling the Ped's surgeon and they usually admit and perform serial abdominal exams. In adolescents I find that some surgeons will elect to go ahead and perform a CT scan.

Negean Vandordaklou

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