Everything you Thought you knew about Ultrasound as a Profession is a Lie

Ultrasound as an occupation is a highly misunderstood profession. Let’s get real about what working as a Sonographer is, and isn’t…

Ultrasound is often perceived as an easy, fascinating job, where the tech waves a wand over the skin with ease, taking images of babies all day. It has somehow gained the reputation of being an acceptable “starting career” before the ultrasound tech decides to get serious and get a “real job.” Yes, those are all statements that patients have said to me over the years! Sigh…

Are you exploring the idea of ultrasound as a career? Is ultrasound the right fit for you? Before deciding, let’s explore some common misconceptions about being a Sonographer (our official title, aka Ultrasound Technologist).

It’s finally time to view the field of ultrasound through a technologist’s eyes.

Misconception 1: You Set the Ultrasound Wand (aka Transducer) Down and a Beautiful Image Magically Appears

Oh man…. I only wish this was true! In my current job I serve as an associate college professor, teaching general ultrasound to the newest generation of Sonographers….ask any one of them- Sonography is hard! Not only do you have to conceptualize a 3D structure or organ into a 2D ultrasound image in your mind, but it’s not even the whole organ we are looking at on the screen.

Ultrasound takes slices of information, looking at only a thin layer of a structure at a time, and to make it even more fun, the slices can be taken from multiple different angles. Think of a loaf of bread- it can be sliced lengthwise, creating long rectangular pieces (Sagittal Ultrasound Plane); it can be sliced vertically, creating what we’d think of as traditional sandwich sized square pieces of bread (Transverse Ultrasound Plane); and it can be sliced top to bottom, creating long rectangular pieces of bread (Coronal Ultrasound Plane).

An organ (like the kidney) or a structure (like the aorta) can be sliced in all of the same ways as the loaf of bread, allowing us to look through an organ or structure not only from different viewpoints, but via one tiny slice of information at a time. So it’s not enough to just know your anatomy inside and out, you also have to be able to conceptualize what each slice of a 3D organ or structure will look like from multiple different angles and then translate that picture in your mind to what appears on the ultrasound image- a 2D representation of that slice of information.

And just cause we like to add in additional layers of fun, Sonographers must also work around bowel, gas, ribs, body habitus, and numerous other factors that make obtaining each of the slices of information that we take challenging, to say the least.

Do Sonographers wave the ultrasound wand (called a transducer) over the skin and a perfect image materializes? No way! Sonographers are critical thinking masters…using a multitude of problem solving skills and techniques to produce the images that are necessary for each exam.

Misconception 2: Sonography is a Good Stepping Stone Position Before Obtaining a “Real Job”

Seriously? I really don’t know how this misconception started, but I would be asked at least once a week by a patient if I was planning to go back to school to get a “real job”. Say what? You do know how much I’m paid right? (The average Sonographer makes around 6 figures a year).

And you do know that Sonographers are among the highest respected imaging professionals. A highly trained Sonographer is worth their weight in gold (ask any Radiologist)…cause we do know what we are looking at, we are trained to find and recognize pathology, and we have to use a lot of critical thinking skills to not only capture the correct slices of information unique to that patient and exam, but to also ensure that we don’t miss any subtle pathologies along the way.

So this begs the question…what constitutes a “real job”? A high paid position? Sonography- check! A career that challenges your mind, your critical thinking skills and varies with every patient and every exam? Sonography- check! A field that is highly respected and contains highly skilled professionals? Sonography- check! A career that requires only 2–4 yrs of schooling to enter (no giant student loans)? Sonography- check! If that’s not the definition of a real job, then I really want to see the lists of professions that make that list!

Misconception 3: Sonographers Don’t Know What They Are Looking At

Ok, I confess, even I have told a patient that I don’t know what I’m looking at (because some patients get aggressive and get in your face, and will not accept that they will not be receiving their results right there and then). So this misconception likely came about because Sonographers have to resort to misinformation sometimes in order to safely complete their exams.

Yes, I know what I’m looking at. No, I’m not gonna tell a patient. And I don’t even care if the patient is “that kind” of patient (you know…the one that says “I won’t tell anyone, if you tell me what you see”) trust me….this is a statement you should pay close attention to! Because this type of patient will tell 20 people (before they even leave the imaging center) whatever it is you told them. “But that tech [insert your name here] just told me everything is fine…there can’t be anything wrong”

Not only will that patient tell on you, but they will also often completely twist around anything you said to them…so don’t say I didn’t warn you! Even benign seeming statements such as “I don’t see anything obvious, but the Doctor still needs to look over everything” can suddenly cost you your job, or even land you in a lawsuit.

DON’T TELL A PATIENT ANYTHING. It’s not worth it.

Do I know what I’m looking at? Of course. Am I gonna tell a patient? No way, never!

Let’s illustrate why…..

Let’s say I find a mass in the pancreas. Most of the time this is bad news. Let’s say I tell a patient that I found a mass in their pancreas. That tiny piece of knowledge is where ultrasound training stops! I know the where and the what (mass in pancreas)…but I do NOT know the why, how, when, or the 20 other questions that come after “you have a mass in your pancreas”

Like…how long has it been there, how did I get this, what treatment options are available, what is my prognosis (life expectancy) with this, and so on and so on and so on.

Trust me….my badge says technologist for a reason! I may be a highly trained technologist, but I am NOT a doctor. Thank goodness!

So watch what you say! Technologists are not trained to diagnose, to deliver results to patients or to answer patient diagnostic questions…that’s why we have doctors.

Also….and this is especially true when you are newer in the field…we are trained to find, recognize and document pathology. And trained in a limited sense to recognize differential diagnosis (if it’s not this, then it could be…?)

But we are not trained in the art of differential diagnosis like a doctor is. So yes! We can (and do!) think something is one thing, but later learn from the Radiologist that we were wrong.

Life lesson….Sonographers are not doctors (and that’s a good thing!) so don’t act like one.

In reality, of course we know what we are looking at! If we didn’t, we couldn’t obtain the slices of information that we need to capture amongst a multitude of varying factors (such as patient size, stomach and bowel gas, ribs, ability of the patient to move into different positions and complete various breathing techniques, etc). Our job is to scan through every organ and structure, from different views, slice by slice, determine if it’s normal or abnormal, and then document what we find. And that documentation varies considerably depending upon the structure, organ, and pathology found.

So if we didn’t know what we were looking at, we couldn’t perform our job. Because we would miss stuff. Great Sonographers don’t miss stuff, untrained Sonographers do. So one of the most important things in this field is to have your name associated with being a Sonographer that goes the extra mile, who pays attention and recognizes the tiny details. Missed details can cost a patient their life.

Misconception 4: The Only Thing We Scan Is Babies

To be fair…I actually thought that all Sonographers scanned was pregnant patients (babies), before I entered the field. And I went into Ultrasound thinking that I wanted to do only OB Ultrasound. Ultrasound is actually a vast field, encompassing a multitude of specialties and subspecialties. If I had to guess? Obstetrical (baby) ultrasounds are probably amongst the lower end of the totem pole in terms of volume scanned per year.

So what are the different types of ultrasound exams? Let’s dive in….

There’s 4 primary ultrasound specialties, which are further divided into multiple subspecialties- echocardiography, vascular ultrasound, MSK, and general ultrasound.

Echocardiography

Echocardiography is an ultrasound of the heart. They evaluate the structures of the heart, such as the valves and chambers, and the function of the heart, by examining the blood flow patterns through the different portions of the heart. Subspecialties in this field include adult echocardiography, fetal echocardiography and pediatric echocardiography.

Vascular Ultrasound

Vascular ultrasound evaluates all the arteries and the veins of the body, looking at blood flow patterns and evaluating for obstructions. There’s not really any subspecialties that a tech can be registered in for vascular ultrasound but there’s a multitude of exam types performed under the vascular ultrasound specialty. Types of exams include arterial and venous examination of the extremities (arms and legs), carotid ultrasound, abdominal Doppler (vessels of the abdomen), evaluating stents and grafts, examining organ transplants for vascular issues, at looking at vessels in the brain (transcranial Doppler).

General Ultrasound

General ultrasound is the field with the widest range of exams and subspecialties. Subspecialties include abdominal ultrasound, OBGYN ultrasound, small parts ultrasound (which falls under abdominal ultrasound), and pediatric ultrasound. Within these various subspecialties the major organs of the body are evaluated including the abdominal organs, like the liver, kidneys and gallbladder, the small parts organs, like the thyroid, testicles, breast, and prostate, obstetrical ultrasound, including first, second and third trimester ob, and high-risk ob, and the male and female pelvic organs, and pediatric ultrasound which evaluates the neonatal brain, pylorus, and the infant spine and hips, among other exams.

Musculoskeletal Ultrasound (MSK)

This is a newly emerging ultrasound specialty that evaluates the muscles, tendons and ligaments of the body, looking for injuries. There are various different types of exams, evaluating shoulders, knees and other parts of the body, but there are no specific subspecialties within this ultrasound category.

Misconception 5: Ultrasounds Are Entertainment, Rather Than A Medical Exam

Ultrasound is a diagnostic medical test…not a trip to the movies.

I know that your patient is ecstatic to bond with and see the ob ultrasound movie play out in front of them. However, it’s essential to remember that ultrasounds are a diagnostic medical test, not an entertainment show for the patient.

OB ultrasound from a patient’s perspective…we are going to meet our baby today! We will get to learn the gender, see all the fingers and toes, the ultrasound tech can point out every part of baby, and give us photos and a video. This is going to be so incredible! An hour of truly bonding with our baby. We need to invite both sets of our parents, bring the kids (so they can meet their new sibling) and don’t forget Grandma Mae…the room is big, I’m sure they can fit all 13 of us in the room. And then all of us can ask questions about the baby during the entire exam! How exciting! I cannot wait for our appointment!

OB ultrasound from a Sonographer’s perspective….I need to take 100 images of baby, slice-by-slice, through every organ and structure of baby (who is a moving target!), and also document the placenta, ovaries, and 100 other things. Praying to the ultrasound gods that baby starts face-up in position, so that I can get the heart views that I need. Omg….they did NOT bring 13 people with them to this appointment! How am I supposed to manage the rapid-fire questions of 13 people, plus the parent’s questions, while focusing on baby, to ensure that I don’t miss any small, subtle anomalies, or any images? The last patient came 1/2 hour late, so I only have 1/2 an hour to get all 100 images, write up the Sonographer worksheet with all of the data and measurements, present the case to the Doctor, clean the room and get the next patient in the room, and it’s gonna take me 45 minutes alone…just to get the images. I am going to be so far behind…the patient’s the rest of the day are going to be yelling at me for being so late. I guess it’s another no lunch, no break day. Why do patients think that this is a trip to the movies, and not a medical test? My job is to make sure that baby is normal and that I don’t miss anything important, and it takes a huge amount of concentration to ensure that I’m not missing some tiny detail. I mean, do you want me to focus on showing you and your 12 family members every part of baby, or do you want me to focus on baby and make sure that I don’t miss any subtle fetal anomalies? Oh yeah, by the way….baby never got in a good enough position to see the gender…that part is out of my hands…even though you are really angry at me right now. Sigh…I need a vacation.

I know you are excited to meet baby and to see the ultrasound (I’m a mom of 3, so I know how exciting this is!)….however, please remember that your ob ultrasound is a medical exam, not a trip to the movies to be entertained. Please have a little compassion for your Sonographer…they will do everything they can to show you parts of baby so that you can bond, but they also have a job to do…and trust me, you don’t want them distracted to the point that they miss that your baby has a subtle heart defect, or is missing a kidney, or has a cleft lip. Medical test means that the focus really needs to be on baby and gathering the critical information, not on entertaining a roomful of people who are excited to meet baby. Yes…I understand that this is going to result in hateful comments…but someone has to say it!

Misconception 6: Quiet Sonographers & Sonographers who Refuse to Give Results to their Patients are “Mean”

Dear Angry Patient…..

I’m sorry that I was quiet during your ultrasound exam, and I’m sorry that I did not give you the results of your ultrasound during or after the exam. The truth is that while I was scanning your abdomen, I found 14 masses in your liver, and not the good looking benign kind of masses, but more like the ugly, you have metastasis to your liver from some other part of the body kind of masses.

You seem like the nicest person…and I’m quiet because I’m concentrating on making sure that I document everything that I need to during this exam. I’m also quiet because some days (like today!) being a Sonographer sucks…because I’m human too, and I often hate knowing what I know about Ultrasound, because the pathologies we find are pathologies that are happening to real people.

So no, I didn’t enthusiastically talk with you throughout your exam, because your exam was a complicated one for me, not only technically, because I could barely see what I needed to see, but also mentally, because yes, I do have a heart, and it sucks seeing liver metastasis in a patient’s liver…especially in a nice patient.

Also…I am SO not trained to tell you that you have metastasis to your liver! So of course I cannot (and would never) give you results of any kind. Those kinds of results (any kinds of results) need to come from your Physician…who is trained to answer the 50 questions that will come up when they give you the results of your ultrasound.

Please don’t hate me for doing my job….

Signed…every Sonographer who ever performed an Ultrasound exam.

Misconception 7: Ultrasound Is An Easy Job

A day in the life of a Sonographer…..

And yes, this is an actual day that I went through (more than once) in my life as a Sonographer. TRUE STORY!

Arrive to work at 7 am…sigh, they double booked the patients again, and I am starting the day with 2 patients waiting for me in the same time slot. I better start with the one that’s most angry. Oh man…one of these exams is a 2 hour exam put into a 30 minute time slot! Better find my 5 hour energy….

It’s noon! Sooo excited! Because I have been 2 hours behind all morning due to scheduling errors and a patient that arrived 45 minutes late for their exam (No, we are not allowed to turn patients away for being late…we are only allowed to “accomodate” anything and everything that a patient does or does not do. The patient is always right (even when they show up 45 minutes late). It’s going to be another no lunch, no break day, BUT…plus side! I am FINALLY going to catch up my patient schedule by working through lunch! Whoo hoo!

2pm…just received a STAT page from the ER. There’s a patient that needs a thyroid ultrasound because they are feeling a lump in their neck. Seriously? Since when are thyroid ultrasounds STAT? Couldn’t this be scheduled for later today or tomorrow? My coworker called in sick today, so I’m the only Sonographer on duty. Better let the front desk know that all of my afternoon scheduled patients are going to have to wait because I need to drop everything and get over to the ER to do that exam.

3pm…got to the ER, did the thyroid ultrasound. The ER doctor saw that I was in the ER, and suddenly 4 more ER ultrasounds were ordered. I also have 4 outpatients waiting for me on the other side of the hospital. I think I need another 5 hour energy.

6pm…just finished the last ER exam (6 ER exams total), heading back over to the outpatient clinic to scan the 5 patients waiting for me over there (the first one was my 2:00 patient…that’s gonna be a happy patient!)

7:30pm…my shift was over at 5:30pm, but I still have 2 more outpatients to do and the ER just ordered another exam. Just called the ER Doctor to beg them to let me finish the two outpatient exams first (since they’ve been waiting hours for me already), and thankfully, the ER Doctor said ok (thank goodness!)

9:20pm…my shift was over at 5:30pm today and I was not supposed to be on call today, but my coworker called in sick, so I am now on call. I have to pee soooo badly. Have been going non-stop since 7am without even a 5 minute break. Just finished the ER exam ordered at 7:30pm and the last of the outpatient exam. Yeah! All is quiet…I’m going to pee and then try to scarf something down.

9:23pm…I spoke the forbidden words (all is quiet) and have caused a firestorm of chaos to descend upon me….STAT pager just went off….3 new ER cases waiting for me, and the OR is overhead paging me for a STAT case upstairs. I’m gonna pee anyway! But I guess the food thing is gonna have to wait.

2:10am…I am currently completing ER exam number 7 in a stretch of 9 back-to-back ordered ER exams. My hospital has a main branch (where I am currently scanning) and also a satellite clinic (a 15 minute drive away). It’s my job to cover both facilities. I’m the primary tech and the backup tech. I just got a page from the ER at the satellite clinic…there are 3 ER cases waiting over there for me as soon as I finish up the last 2 cases over here.

3:05am…just finished the last ER case at the main hospital and I’m now in my car heading to our satellite clinic. I’m wolfing down 4 granola bars and another 5 hour energy. Nothing has ever tasted so delicious to me in my entire life. When I’m 5 minutes away from the satellite clinic, I get another STAT page…there’s 4 new ER cases waiting for me at the main hospital, as soon as I finish the 3 ER cases at the satellite clinic.

3:10am…get to satellite clinic and find out that I actually have 5 ER cases waiting for me, not 3, and the main hospital now also has 5 ER cases waiting for me. I call both ER doctors (main hospital and satellite clinic) and tell them that there’s 10 ER patients waiting and 1 of me, and ask them to triage who they want done first. Answer….all of them. Great, that was helpful. This night is never going to end.

7:00am…it’s the start of my shift the next day and I still have 4 more ER cases to complete from last night before I can go over to the outpatient clinic and start doing the patients who are scheduled for an Ultrasound. I call the front desk and explain the situation. Gonna be another day full of angry patients…can’t wait. Oh, and my coworker called in sick again..so it’s only me…and an endless see of patients. I’ve been up for 24 hours straight and am feeling dizzy and slightly nauseous from lack of sleep. There’s got to be another 5 hour energy around here somewhere.

Wonder if I’m actually going to get to eat a meal today? That’s the true million dollar question….

My shoulder is killing me and my fingers on my scanning hand are tingling and going numb. Injuries to our bodies is a real thing.

I love my job, I love my job, I love my job….

Misconception 8: You Need Little Training To Be A Sonographer

There’s 4 pathways to becoming a Sonographer:

• Ultrasound Certificate
• Associate’s of Arts Degree in Diagnostic Ultrasound
• Bachelor’s Degree in Health Sciences (Various Pathways)
• Cross-Training Into Ultrasound After Becoming a Radiologic Technologist (X-Ray, CT, Mammogram, or MRI)

I took the associate’s degree pathway, so let’s look at that option specifically. I needed to complete 2 years of prerequisite classes (math, physics, english, biology, anatomy and physiology, and others, with a 4.0 gpa to apply to the ultrasound program). The year I applied there were over 120 applicants for 35 ultrasound school positions. Candidates went through two panels of in-person interviews to try to secure one of the few coveted spots in the program. It’s not uncommon to apply 2–3 years in a row to try to get into the program, and some candidates never make it into ultrasound school at all. Programs choose the brightest and the most driven candidates. To get into ultrasound school, you really have to want it, and need to dedicate yourself to the pursuit of getting one of the few open spots.

Once you enter ultrasound school, the associate’s degree program consists of a year of didactic courses (lectures, scan labs, and courses) which feels like the definition of overwhelm (at its best), and like your drinking from a fire hose (at its most intense moments). Crying, breakdowns and anxiety are normal parts of being an ultrasound student.

The second year consists of a clinical internship (2000 hours) in which you work for free, 40 hrs a week as a Sonography student, under the direction of licensed Sonographers and Radiologists. The stress and overwhelm of the second year far surpasses anything that happened in the first year of school. Now some schools intermix the first and second years, with students attending class a couple days a week and clinical internship the rest of the week.

After you finally make it through all of that fun, you need to pass the ultrasound licensing exams, including exams in ultrasound physics, and every subspecialty of ultrasound that you will be performing. Some programs allow you to take ultrasound physics (and pass the ultrasound physics licensing exam) before entering into ultrasound school (this is an option available to some students while “waiting” to be selected into a coveted ultrasound program spot). If you get this option…take it! Anything you don’t have to take while actually within the ultrasound program will definitely help to reduce the heavy credit load during the program.

The Bachelor’s degree option has two primary pathways- get an associate’s degree in ultrasound (2 years prerequisites + 2 years ultrasound) and then attend 2 more years (6 years of school total) in a health sciences bachelor’s degree program, or….go to a bachelor’s degree ultrasound program (2 years prerequisites + 2 years ultrasound school= bachelor’s degree in ultrasound).

Oh man, do I ever wish that I had done option 2, and that my prerequisite classes would count towards my degree. Instead, I took the harder pathway…the pathway that would include 6 years of school to obtain a Bachelor’s degree. Why would anyone do this, you say (2 extra years!)? Cost…2 year associate’s degree programs are much lower in cost. So for me, it all came down to money. If I had to do it all over again? I’d go the Bachelor’s ultrasound program route, no matter the expense. 2 years less schooling….just saying!

Yes, there are certificate programs, with shorter time periods to graduation. I’d advise not going this route, however, because employers are focusing more and more on education, so you will be much less competitive when interviewing for a job with a certificate than with an associate’s or bachelor’s degree.

So yeah…I’d say we’re highly trained. Ultrasound school is one of the most difficult programs out there, not all students who enter ultrasound school make it all the way to graduation, and others fail to pass their licensing exams after graduation.

As you can see, Sonographers are highly trained, respected medical professionals that are paid a very high salary. But it doesn’t come easy! Sonographers work hard, not only to gain and keep the necessary knowledge level and skills that are required to perform at the high level that is expected of us, but also due to the nature of healthcare in general.

When I first began my healthcare journey, patient care was at the heart of every exam. Things slowed down at lunchtime, and there was ample time for collaboration and training. The field has rapidly expanded since then, and now the name of the game is quantity (sometimes over quality).

Is a career in ultrasound right for you? If you want to be challenged to your very limits, make a real difference in your patient’s lives, and are fueled by the fast pace, constantly changing environment that is today’s healthcare, then this may be the perfect choice. But do your homework! Ensure that you really know what this job entails before devoting your life to it.

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