Sonographer: Robert De Jong, RDMS, RDCS, RVT, FSDMS, FAIUM
Facility: The Johns Hopkins Hospital, Baltimore, MD
Featured Topic: Ultrasound First
Q. How did you become interested in the ultrasound field?
A. After graduating from high school, I entered The Johns Hopkins School of Radiologic Technology. I discovered I did not want to be a radiologic technologist but decided to finish the program, as I could work as an RT to put me through college. I married my wife Linda in 1975 and therefore couldn't just go to college and live in a dorm. During our second year we rotated through the Radiology specialties available in 1975: Nuclear Medicine, Radiation Oncology and a new modality called Ultrasound. After a few days in the ultrasound lab, I knew I had found my calling. Upon graduation, a local hospital was looking to hire a RT to learn ultrasound. I applied, expressed my interest in learning ultrasound and was offered the position.
Q. Describe what led you to your current position at The John Hopkins Hospital.
A. After graduating from X-Ray, I started to work at St. Joseph's Hospital in Baltimore. To learn ultrasound, I was sent to an evening course at Hopkins to learn. I did very well on the tests and in scanning, which was B-scanner in those days. After completing the advanced course, there was a position for a sonographer at Hopkins. I applied and was accepted. After 2-years, I left Hopkins to work at Greater Baltimore Medical Center to learn echocardiography. I continued to accept positions to help me grow in ultrasound. I was working for GE Medical Systems when we had our first child. It was getting difficult to leave home for 3-5 days a week and miss Alex growing. A position opened up at Hopkins. I applied and was offered the position. With the business experience I received working at GE, I was promoted to Chief Sonographer when the position was vacant. As the Radiology department evolved, I was eventually promoted to Technical Manager along with my colleagues in the other Radiology divisions like; CT, Nuclear Medicine, etc.
Q. Describe your current role in the ultrasound department.
A. I am responsible for the operation of the ultrasound division in Radiology. Some of my duties include: hiring and training of staff, teaching staff and students, giving input into purchasing equipment, learning new procedures and techniques, budget responsibilities, and mentoring and engaging my staff.
Q. How has this position helped you educate and advance the field of sonography?
A. I have been encouraged and mentored by my medical director, Dr. Ulrike Hamper, over the past 24 years to learn with her new technologies, such as 3D, power Doppler and fusion. I am fortunate to work with such a respected radiologist, and we work with the ultrasound companies to discover the uses of technologies or how they can help improve diagnosing, improve workflow and help the sonographer in their scanning and sonographic knowledge. Working at Hopkins has given me that unique opportunity to scan a variety of pathology, work with leaders in the ultrasound field, scan on state-of-the-art equipment, and work with the ultrasound companies. I would not be where I am today if I did not work at an academic institution with a radiologist that shared my passion for ultrasound.
Q. What would you like to tell the next generation about choosing the field of sonography as a career?
A. This is an incredible time to choose Sonography as a profession. Our future is bright with new technologies: elastography, fusion and hopefully contrast soon. No other imaging modality gives you the amount of time with a patient as ultrasound. No other imaging technologist knows pathology or has the impact to make a difference in someone's life as a sonographer.
We are the only imaging modality that also has positive interactions with the patients through scanning their normal fetus. Nothing can take away the feeling of knowing you just helped a patient with your special skills. As our theme says this year, I can see with sound, and we do.
Q. There have been major improvements in reducing the spread of infection in the patient care setting over the last several years. How have infection control policies changed the standard of practice in your ultrasound department?
A. I have been in this field since 1976 and cannot remember such an outside influence affecting ultrasound so drastically. We are no longer allowed to have our transducers hang on a rack on the wall and be exposed to the air and germs. They must be stored in a closed cabinet or drawer. We can only have the transducers necessary for the exam on the unit. We cannot refill gel bottles but must dispose of them when they are empty. The minimum 20 minute Cidex disinfection process is placing a major strain on workflow. Infection control and the joint commission are looking very closely at the high level disinfection (HLD) process in ultrasound. We have to document the entire process and results. The Trophon unit for HLD of transducers is a major life saver for the sonographer. I was fortunate to be allowed to switch to the unit. Newest rumblings from Infection Control is now about heating of gel, which might cause organisms to grow. I see single packets in our department's future.
Q. Sterile and non-sterile transducer covers and system drapes are engineered to assist with limiting the spread of infection. How are these products used in your department?
A. We use them to protect our patients as required. For sterile procedures, a sterile cover must cover the transducer. To reduce the transducer from being directly exposed to body fluids, we use the non-sterile covers. With Cidex, we would have to soak the transducer for 24-hours if contaminated. With the Trophon device it is the same 7-minute process. Still, the cover has psychological benefits to both the sonographer and patient. We need to remember that it is not always about protecting the transducer from being infected, but at times the need for a cover is to protect the patient from the germs on the transducer.
Q. How can sonographers help reduce the spread of infection at their facility?
A. Please perform HLD on every transducer, not just the vaginal or rectal transducers. The transducer is an extension of our hand. We are required to wash our hands every time we touch a patient. Shouldn't we do the same things to our transducers? We are scanning people that cannot fight these infections as easily as a healthy person. In some patients, these infections can be fatal. As sonographers, we aren't properly educated about infections like a nurse. This is something we need to really start thinking about performing HLD on all transducers as well as wiping the ultrasound unit down between patients. Remember that if the patient obtains an infection while in the hosptial that tests and the hosptial where they stay, infections may not be billable. We need to start thinking more on what is needed to protect our patients from getting infected. It would be sad to think the patient became infected from an ultrasound exam.
Q. In your professional opinion, where do you think the future of ultrasound is headed?
A. Again, we are headed to a very bright future. These new technologies coming out are allowing us to help our patients obtain a diagnosis and not be referred to CT or MRI. With elastography, the patient may not even require a biopsy of their liver. Sonographers need to start learning about technology now so when you are working on a new ultrasound system, you know how to use them. New technology allows images to be imported from ultrasound, MRI and CT for direct on-screen comparison which will help decrease scanning time as well as reassure the sonographer they are scanning the proper area. Less scanning = less MSK strain. As for contrast, all I can say is watch out CT and MRI. People believe CT and MRI are perfect, but they are not. They have limitations and artifact just like ultrasound. Fusion is allowing us to perform biopsies that would not be able to be performed or easily performed using ultrasound. Remember CT and MRI is not real-time and biopsies under them can be challenging. Ultrasound will succeed and grow more quickly if the sonographer is ready and pushing the sonologist. We need to be the agents of change.