“sonogmaphems.”

reflects in

The

fact

an underlying

other

allied

health

that

he

does

not

problem

in the

professions.

Why

even

field

mention

them

of sonogmaphy,

should

anyone

U

as with

brains go into a field in which his or hem work is not publicly appreciated? Now that the majority of pregnant women undergo sonography at least once and ultrasound is mentioned frequently in the media, sonogram is a household word. But few people are aware of the expertise required of sonogmaphers. We do not wave “the magic transducer” over the patient’s abdomen, to quote Dr Filly’s description of some “level 1” practitioners. We are the ones who frequently scan every centimeter of the fetus and who find the anomalies. But we are not the ones who get the credit for this performance. With

the

reduced

pool

of ultrasonogmaphy with such established py

and

of college-age

students,

are experiencing and prestigious

occupational

therapy

for

some

schools

difficulty in competing fields as physical thema-

intelligent,

motivated

stu-

technicians” lithotmipsy

in their otherwise (2), which appeared

excellent in the

article July

1989 issue of Radiology. If we do not get an acknowledgment from radiologists of Dr Filly’s stature, then someone with less confidence will certainly not give it to us. The spiral of decline will continue, and sonogmaphy will be performed by individuals who scan without knowing what they are doing, who are not credentialed by the American Registry of Diagnostic Medical Sonogmaphers, and whose only satisfaction in their work is receiving

a paycheck.

bother being good and being credentialed if we are not respected for it? If radiologists don’t popularize our profession by acknowledging our skills, those level 1 pmactitioners won’t even know enough to have credentialed sonographers who can perform diagnostic sonogmaphic examinations. They will train their secretaries to “wave the tmansducer.” If nogmaphy difficult

do

not

help

by supporting in the future

to perform

the

us stop

the

spiral

of decline

for

so-

us as a profession, they may find it to find even a secretary who is willing

examinations.

2.

Filly

RA.

Level

your

level

and

raise

HV,

Torres

Steinberg Radiology

Dr

Filly

1. level

1989;

2, level

you

one

WE,

3 obstetric

(editorial).

Nelson

sonography:

Radiology

RC.

I’ll

1989;

Gallbladder

that

see

172:312.

lithotripsy.

172:7-11.

my

statements

ing

to sonographers.

but

about

physician

in any

My

way

editorial

“sonologists”

Roy A. Filly, MD Department of Radiology University of California, 501

Pamnassus

Avenue

San

Francisco,

CA 94143

MD

NY

Center

11554

Editor: The informative article by Hailer et al on spontaneous perforation of the common bile duct in children (1), which appeamed in the September 1989 issue of Radiology, states that “trauma, possibly due to child abuse, may . . . play a role in this disorder, but a proved case has not yet been reported.” In fact, Weissmann et al (2) reported on the use of hepatobiliary

scintigraphy

tion

and

of traumatic

tion

bile

ultrasonogmaphy

leakage.

in

These

authors

the

demonstra-

reported

the

case

after

blunt

abdominal

trauma

in a motor

vehicle

accident.

Although the patient had abdominal pain, umbilical ecchymosis, hypoactive bowel sounds, leukocytosis, and elevated liver function test results for the week after admission, jaundice was not present until the 9th hospital day (total bilirubin, 5.5

mg/dL

[94

mol/L],

primarily

direct).

A disofenin

scan

me-

vealed activity in the biliary tree at 5 minutes, with a focal defect in the liver. Additional small areas of focal activity were noted surrounding the defect, indicating pooling of bile. At a large

the lower penitoneal

portion cavity.

tivity

was

also

amount

of amorphous

activity

of the abdomen, indicating The common bibe duct was

seen

in

were

judged

was

not

who

are

about

San

Francisco

1.

Hailer JO, Condon tion of the common 172:621-624.

as demean-

2.

Weissmann

untmained

either

HS,

Freeman LM. cholescintigraphy

sonographers to

Viewing

U

the

small

was

seen

in

free bile in the patent, and ac-

bowel.

yR. Berdon WE, et al. bile duct in children.

Chun

KJ,

Frank

M,

Spontaneous Radiology

Koenigsberg

perfora1989;

M,

Milstein

DM,

Demonstration of traumatic bile leakage with and ultrasonography. AJR 1979; 133:843-847.

Glasses

as an Alternative

From: Conrad

S. Revak, PA 15215

Pittsburgh,

MD,

703 West

to Bifocals

Waldheim

Road,

Editor: The radiologist wearing bifocals is easily recognized hyperextended neck, bobbing head, unusual postures, constant shifting between sitting and erect positions, she tries to bring the radiographic image into proper

by the and as he or focus.

This

is unnecessary,

put

with

such

wear tance cab.

viewing correction

Eyeglass tive

Radiology

Bile

MD, and Gary J. Wasserstein,

Medical Turnpike

Meadow,

values

#{149}

Common

of Radiology

Nassau County 2201 Hempstead

with interthe mealiza-

obtain or to interpret sonogmams. Had my editorial been about sonogmaphers, it would have disclosed my deep respect for these individuals, who do, in fact, perform the vital services described by Dr Berman. Indeed, I am mammied to an outstanding sonogmapher, who reviewed and mereviewed my editorial before I submitted it. If any registered diagnostic medical sonogmapher felt slighted by my comments, I humbly apologize.

578

of the

References

responds:

I read Dr Berman’s letter concerning my editorial est and some dismay. My dismay originated from tion

Balsam,

Department

East

Perforation

At surgical exploration, a large amount of bilihemorrhagic fluid was found staining the serosa of the abdominal viscera. An intraoperative cholangiogram showed extravasation from the common bile duct about 1 cm below the entrance of the cystic duct. No repair of the common bile duct was attempted, but drains were placed in the gallbladder and the Momison pouch. The patient received antibiotics postoperatively and recovered uneventfully. Our case and the case of Weissmann et al demonstrate the occurrence of bile duct perforation after blunt abdominal trauma in children and illustrate the utility of hepatobiliamy scintigmaphy in that condition.

References 1.

From: Dvorah

15 minutes,

Why

radiologists

Spontaneous in Children

of a 5-year-old boy who had penihepatic cystic collections of leaking bile after being struck by a truck and the case of a 92year-old man with postoperative bile leakage. To these we add our own case, that of a previously well 8year-old girl with bile ascites due to common bile duct lacema-

dents. In large part this is due to the anonymity of sonognaphers created by omissions such as those in Dr Filly’s editorial and by misnomers such as Steinberg et al use when they refer to us as “US on gallbladder

Duct

and

corrections the

more

reason

is not

glasses and

for myopic value,

the

inconvenience

why

clear.

radiologists

It is much

simpler

up to

that are a compromise between the disthe usual reading correction in the bifoare

specified

(nearsighted) myopic

the

in

diopters,

with

persons.

(The

larger

person.)

Accommodation

February

negative

the

negato

1990

Viewing glasses as an alternative to bifocals.

“sonogmaphems.” reflects in The fact an underlying other allied health that he does not problem in the professions. Why even field m...
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