“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
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
