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You need to either print or save your ultrasound images if you are billing out for them. In order to ensure that your records are kept properly you will need two forms of documentation on each ultrasound exam. One piece of that documentation is your actual report on the findings or results of your exam or the ultrasound procedure you conducted. (You can make use of our sample report templates here on this site.) The other piece of documentation you need is the annotated image itself, either printed out and kept in the patient’s chart, or saved digitally and stored on your computer or in your EMR.

And keep in mind that it can’t hurt to both print your images and save them digitally. The images you are saving are valuable, and having both a paper copy and a digital copy — or a digital copy archived on two different computers — is only making everything safer over the long-haul.

Printing Your Images

If you have an ultrasound printer and you are keeping paper charts, you will simply want to press Print at the end of your procedure and get a thermal print-out to tape to a piece of paper and stick in the patient’s medical chart. You can either tape the print-out to the ultrasound report itself, or you can create a general template page you can print out and make copies of, so your assistant or nurse can easily take care of this for you. (You can download a very simple form like this by clicking here or right-clicking the link and choosing Save Target As and then saving the file to your computer’s desktop.)

If you do not have a thermal ultrasound printer, you can still move the images to your computer and print from there. Just keep in mind that printing out ultrasound images on a normal computer printer is going to mean going through a great deal of ink. That is why ultrasound printers print to thermal paper. If you see yourself printing more than one or two ultrasound images a day, it makes sense to invest in an actual thermal ultrasound printer.

(Note: if you do have a thermal printer, remember the value of printing out a second copy to give to the patient to take home with him. You don’t want to do this all the time, but if you have an especially good image and you think the patient interested, it can be a good practice to give the patient a copy, being sure to first staple two of your business cards to the back, and also taking a moment to explain a little of what is in the image to the patient. This can lead to a lot of referrals!)

 

Saving Your Images Digitally

Even if you keep paper charts, saving an image digitally as a back-up is a great idea. And if you are not keeping paper charts, if you are entirely in EMR, you absolutely needto keep your images saved digitally.

Fortunately, it is quite easy to do, as long as you stick to a consistent system.

Having well-organized archives of your images, each consistently and accurately named, also makes your records all the more bullet-proof.

Note: There are two ways you should not save your images. You should avoid using the “Save” and “Recall” buttons on the right-hand side of the ultrasound console. Pretend those buttons aren’t even there. Those are meant for short-term memory only. The other way you should avoid saving images is to save them to your hard drive on the ultrasound itself. You don’t want to trust your image archive here (and it will be cleared whenever you upgrade the software, in any event). Instead, always save your images using the “DISK” button and save them to your USB thumb drive.

Two Approaches To Saving Your Images Digitally

There are two ways to save images on your CTS-5500+. There is the long version, which has multiple steps but gives you the greatest control over the name of the resulting image file. And there is the short version, which requires a short one-time preparation and assigns numbers for the file names, but is lightning quick — and therefore quite popular.

Approach 1: Long Version

If you have your USB drive plugged into the back of the ultrasound, when you press DISK (on the far left of your ultrasound console), one of two things is going to happen. You are either going to get a big menu box to come up OR you are going to see a little menu box come up (maybe 1″ x 2″) with “DISK” as the bottom option in the menu. Depending on which type of menu you see come up on your system, the steps are just a little different.

SMALL MENU

  1. Make sure your USB drive is plugged into the back, then press DISK (button on the left side of your ultrasound console). When the little box comes up, the first thing to ALWAYS do is scroll to the bottom option and highlight “DISK” in the menu. So in effect, you pressed the DISK button and then selected DISK from the menu and pressed Enter. Just remember: Disk-Disk.
  2. In the menu that comes up, the first choice given to you will be for where you want to save the image, and you always want to choose USB DEVICE and press Enter.
  3. In the next column, it will already be highlighting WRITE IMAGE. Just press Enter. (If you were pulling an image back up that you had already saved to the USB drive, you would scroll down to the second item on the list: Read Image.)
  4. Now you get to select the image file type. Select JPG as your file type and press Enter. (If you want to save the full cineloop as a short video file — probably not something you will do often — select AVI instead.)
  5. You now should be highlighting either two little dots or possibly an arrow. These mean "root directory," which is what you want, so just press Enter again. (Any other images you currently have saved on the USB drive will also be displayed here, below the two dots.)
  6. Now you have the field in which to type a name for the image. You can’t use commas or any weird characters, but I do recommend last name, first initial, with the date either preceding or following the name, maintaining a consistent format. (You can read my suggestions on naming images by clicking here.) With the file name typed in, press Enter.
  7. After a short pause, the original little dialogue box should come back up. The image has been saved. Press ESC (to the left of your trackball) to escape out of the little dialogue box and return to your frozen image on the screen.

It looks like a lot of steps, but really three of the steps only require scrolling down a little and pressing "Enter," and two steps don’t even require any scrolling — just the "Enter." So it goes by pretty quickly, and after you have done a few, you should be able to zip through the saving process in a few seconds. And if it still feels as if it takes too long, you can likely train your assisting nurse to handle these steps for you while talk with the patient and wrap things up.

LARGE MENU

If when you press "Disk" you get one big dialogue box with each of the above steps displayed in it, you will choose the same settings as above, but you won’t have to select "Disk" from a little menu at the beginning or press "Esc" at the very end to make the little menu go away. Just follow steps 2 through 6 above and you are done.

MOVING IMAGES TO YOUR COMPUTER

I highly recommend reviewing the steps on how to properly transfer images from your USB drive to your computer.

For those click here.

And for some additional tips on doing this safely, with the least chance of accidentally corrupting your USB drive, click here.

Approach 2: Short and Quick Version

This approach requires making a one-time adjustment to your save settings, but after that saving your images is literally as easy as pressing "Disk" and then "Enter." And that’s it. The only challenge with this approach is that it organizes — and names — your saved images in a different way than you might be used to. If you can adjust to that, though, it’s certainly far quicker, making capturing a sequence of images one after the other much easier to do when you are limited in your time. (You may have already set this up when originally configuring your system.)

The One-Time Set-Up

  1. Start by pressing DISK (located on the left side of your ultrasound console). When the little box comes up, scroll down to "Store Settings" and press "Enter."
  2. In the menu that now comes up you can use your trackball to select the settings you wish to choose and then press "Enter" to select them. These are the settings you want to highlight and select: Image Format = "JPEG." CINE Format = "AVI." Store Location = "USB Disk." Folder Format = "Patient Name / Date." Save Location = "Hard Disk." With all of those set, go to the bottom and highlight "OK" and press "Enter." This should take you back to the little menu. Press "Esc" to escape out of that. You’re all set now.

The Quick-and-Easy Save Procedure

From here on out, as long as your USB drive is plugged into the back of your ultrasound, when you freeze an image and make your measurements and annotations, and you want to save it — simply press "Disk" and with the first item on the menu ("Store Image") selected, just press "Enter." That’s all there is to it. Your screen should flash "Saved Successfully." How’s that for quick and easy?

Important Tip #1: Make sure you are putting in your patient names (under “Pat Data”) last name first. For example, “SMITH JOHN.” Using the Quick Save procedure, your system will alphabetize the image folders according to what you put in for the patient’s name, and by using the last name first, the folders will be properly alphabetized. What’s more, I think it’s best to decide whether to use all capital letters or all lower-case letters. Decide on one or the other and stick with it. Make sure everyone uses all caps or all lower-case, and this will make pulling up past patients much easier, and will give your records a more consistent look.

Important Tip #2: Whenever you use the Quick Save approach, really make sure to watch the bottom right corner of your screen after pressing Disk and Enter — you must see it flash “Saved Successfully.” If it doesn’t, or if it flashes something else (for example “disk not found”), then the image did not save properly, and you may need to make sure your USB drive is plugged in all the way, or move it to the other USB slot.

 

How the Image Files Are Arranged and Named on the USB Drive

Using this system of saving your images takes away your ability to give the image a specific name at the time you save it. (That’s part of what makes it so much faster, of course.) Instead, the ultrasound makes up a name for the image and stores it in a set of folders on your USB drive. When you remove the USB drive and take it to your computer, you will see how they have been arranged.

On your USB drive there will now be a folder titled "PatientInfo."

Inside of this folder will be a folder for each of the patients you conducted ultrasounds on that day. This folder will have taken its name from the Patient Data information you typed in at the beginning of the exam. This means that it is vitally important that you press "Pat Data" at the start of your exam and put in the patient’s name — and it might do well to put it in last name first, using capital letters for the start of the last and first name. Doing it this way will ultimately result in a folder titled, for example, "SmithJohn" (as opposed to "johnsmith" had you put in the patient’s name as "john smith"), making them line up alphabetically for you by last name.

So — on the USB drive there is a "PatientInfo" folder, and inside of that folders named after each of the patients you scanned that day … and inside of those folders you will find folders named with the day’s date, and inside of those the actual .jpg image files with the random names the ultrasound assigned to them.

It’s much easier to see it laid out visually. The following image of the hierarchy of folders and image files should make it clearer:

folder hierarchy

The only trick is to make sure you move everything over to your computer properly. If you are using this system, I recommend keeping a folder named "Ultrasound Images" on your computer, and inside of that start building up folders with each of your patients you have scanned with the ultrasound, and inside of those the folders with each date on which you performed an ultrasound on that patient, and within those the actual scans from that particular day.

In other words, the first time you scan a patient, you will drag the named folder over to the "Ultrasound Images" folder. If you scan that same patient again on another day, however, you will only drag over the dated folder placing it inside of the appropriate named folder.

After moving the folders over to your computer, you will probably want to erase the folders from the USB drive (so you will start the next day with a clean slate), and safely remove the USB drive. (If you’re uncertain of how to do this, please see Step 7 after clicking here).

Using this system of saving your images you will eventually have a master ultrasound images folder containing folders with each patient you have scanned with your ultrasound. From here you can copy them over into your EMR system if you like, although I recommend keeping a master "Ultrasound Images" folder archive as well.

In Case You’re Interested … Saving Your Entire Cineloop as a Video

A final note on saving your entire cineloop as a video file: you can do it, but you probably won’t want to do it all the time — in part because it just takes a long time to save, and in part because you cannot annotate or make measurements on the resulting video file. For your documentation, stick with frozen images and annotate them well. But if you do want to save your cineloop as a video, here is how … Press "Disk" and select "Disk" at the bottom of the menu. Now choose "USB Device" and then "Write Image" (as normal), but then for file type choose "AVI." This will give you a video file that you can watch on any computer. (If you choose "CINE" as your file type, you will only be able to replay the loop on your ultrasound itself.) Now choose the two dots for the root directory and press Enter again, and give your video a name at the bottom. When you press enter at this point it will take a little while to save the entire loop, but when it’s done, you should just be able to press "Esc" to get rid of the little menu box and you will find the .avi video file on your USB thumb drive.

 

 

Quick Links: Post-Capture

  1. Back up in the Cineloop
  2. Make your Measurements
  3. Annotate the Image
  4. Print and Save the Image

 

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