Thyroid Written Comp

Student Name: Courtney Mashburn

Date Submitted: 3/29/2015

Directions:

Students are required to complete each area based on the scan comp completed to receive maximum
points.
There are 10 sections; each section is worth a maximum of 5 points. Answers provided must relate to
specific information requested. Additional information including non-applicable information will result in
point deduction

Before the exam: Patient Interview, Chart Review, Possible Pathology, Patient Set Up, and Preparation
Section 1:
Identify the patients age, sex, ethnicity, current symptoms and pertinent history relevant to the exam.
Answer: 56 year old African American female with altered mental status and hyperthyroidism.

Identify the patients labs relevant to the exam (as high, low, or normal) and explain what the patients lab values
indicate.
If the patient had no labs, identify the labs relevant to the exam and explain what deviations from normal values
indicate.
Answer: T3 total = 4.0 which is high, normal range is between 0.8-2.0 which would indicate hyperthyroidism. T3
provides information regarding function of the thyroid. ; T4 free = 6.52 which is normal, normal range between
4.5-11.2. T4 reflects thyroid hormone activity. ; TSH = 0.02 which is low because the normal range is from 0.5-5.0
which would indicate hyperthyroidism. TSH is used to identify thyroid disease.

Identify the patients previous exams and results relevant to this exam.
If the patient had no previous exams, identify one other imaging modality that could be used to evaluate your
patients symptoms. Explain why this modality would be used in conjunction with sonography.
Answer: The patient had no previous thyroid exams but a modality that could also be used to look at thyroid is a
nuclear medicine thyroid uptake scan to see how well the thyroid is functioning.
Grade for Section 1
Section 2:
Based on the patients clinical history, labs, and previous exams and results, what did you expect to find during this
exam and why?
Answer: Since the patient had a history of hyperthyroidism I expected to see an enlarged, heterogeneous thyroid
gland with hypervascularity throughout the gland.
Grade for Section 2
Section 3:
Describe how you identified the patient and educated the patient on the exam being performed. Identify the
patient set up and exam preparation.

Thyroid Written Comp

Answer: I identified the patient by checking her arm band and asking her date of birth. I matched her armband to
the information on the machine. I explained to the patient that I am an ultrasound student and I will be taking
pictures of her neck and thyroid and then the sonographer would come in and check behind me. I gathered my
materials of 2 small towels, gloves, and gel. I had the patient lie in the supine position with the pillow behind her
shoulders to properly extend her neck for best visualization of the thyroid gland.
Grade for Section 3

During the Exam: Sonographic findings of structures, pathologies, measurements, and instrumentation
Section 4:
Identify the sonographic features of the thyroid gland in its entirety, as well as the surrounding neck muscles.
Answer: The normal thyroid gland is uniformly echogenic. With medium to high level echoes similar to those of the
liver and testes. A thin bright line that bounds the thyroid lobes and isthmus is the thyroid capsule. Normal thyroid
parenchyma is more echogenic than the surrounding contiguous muscular structures and vasculature. Branches of
the inferior and superior thyroid arteries and veins appear as anechoic structures with bright thin echogenic walls.
Grade for Section 4
Section 5:
Identify all protocol measurements obtained and identify if each measurement is normal or abnormal. If
abnormal, what is indicated?
Answer: Right lobe measurements = 3.73 X 5.24 X 3.96 cm.
Left lobe measurements = 3.20 X 4.95 X 2.64 cm.
Isthmus measurement = .77 cm.
Normal adult thyroid gland measures 4-6 X 1.3-1.8 X 1.5-2 cm. The overall thyroid gland measures abnormally high.
The thyroid gland is enlarged. The normal isthmus measures 0.2-0.6 cm in AP diameter. The isthmus measurement
is also abnormally high. These measurements represent an overall enlarged thyroid gland associated with
overactive thyroid gland.
Grade for Section 5
Section 6:
Identify the pathology documented during the exam including location, size, vascularity, and sonographic features.
If no pathology is seen, identify a common pathology seen with this exam and how you would need to modify your
protocol to document this pathology.
Answer: There was a small round hyperechoic nodule found in the left midlobe of the thyroid measuring .8 X .29 X
.27 cm without vascularity most likely representing a small calcification.
Grade for Section 6
Section 7:
Identify the ultrasound preset, transducer, and frequency utilized to provide diagnostic images and explain why
the specific instrumentation was correct.

Thyroid Written Comp

Answer: The thyroid preset was utilized throughout the exam while using a 15L8w-S transducer at 14.0 MHz. All of
these instrumentations utilized were correct for imaging the thyroid gland to properly display the thyroid gland in
its entirety at the correct echotexture. The frequency was lower from 15 MHz to 14 MHz to penetrate the enlarged
thyroid gland better.
nd

For your transverse isthmus image (2 protocol image) identify the depth and focal zone(s) used and explain why
they were correct.
Answer: The depth when imaging the transverse isthmus was set at 9 cm while the focal zones were set at 3 and 7
cm. With the depth and focal zones set at this, I was able to correctly display the isthmus near the middle of the
screen with the beam focused at level of the isthmus to enhance the quality of the entire isthmus.
For your right lobe transverse inferior image, identify the depth and focal zone(s) used and explain why they were
correct.
Answer: The depth when imaging the inferior right lobe in transverse was set at 10 cm with the focal zones set at
4, 6, and 8 cm. The depth was correctly increased to show the inferior lobe in its entirety and the focal zones were
increased to 3 and set to enhance the overall quality of the parenchyma of the thyroid gland.
Grade for Section 7

Exam Findings: Students Preliminary Report and Physicians Interpretation

Section 8:
What did you report to the sonographer and/or physician regarding the exam? Describe your interaction.
Answer: I reported to the sonographer that I saw an overall enlarged, heterogeneous thyroid gland. There was a
small round hyperechoic area in the left midpole without vascularity measuring .27 X .30 X .29 cm that most likely
is a calcification. After scanning behind me, she agreed and said that I did a very thorough job on the exam.
Grade for Section 8
Section 9:
What was the physicians interpretation of the exam?
Answer: The radiologist reported a prominent thyroid gland with tiny punctuate calcification in the left lobe of
thyroid. No additional sonographic abnormalities.
Grade for Section 9
Section 10:
Do you agree or disagree with the physicians interpretation of the exam? Why or why not? (This must be
supported by current literature)
Answer: I agree with the physicians interpretation of a prominent thyroid gland since the gland was overall
enlarged with the right lobe measuring 2.7 X 5.2 X 3.9 cm and the left lobe measuring 3.2 X 4.9 X 2.6 cm with the

Thyroid Written Comp

normal range for the lobes within 4-6 X 1.3-1.8 X 1.5-2 cm and the isthmus measuring .77 cm with the normal
range between 0.2-0.6 cm in AP diameter. The physician also noted the tiny punctuate calcification in the left lobe
since it was hyperechoic, small, round with well-defined borders and no vascularity. I also thought that the
physician should have noted the increased vascularity of the thyroid gland corresponding with hyperthyroidism.
Grade for Section 10

Clinical Site:
Sonographer with credentials and
specialties:

St. Francis Bartlett

Ronni BomarRDMS (AB) (BR), RVT (VT), RDCS (AE)

Patient MRN:
Exam order on request:

US head/neck/soft tissue

Performance date of final scan comp:

Is this a second attempt written comp?

NO

Points

50=100
40=88
30=75

No errors were identified

One error was identified

Errors identified In less than the of the components required

Errors identified In up to s of the components required

Immediate action required

errors identified in more than s of the components required

evidence of an unsafe event (unsafe events may result in failure of the

competency)

required image not included

49=98
39=86
29=74

20=60
19=57
10 or less = 0
Section
1
2
3
4
5
6

Description

Point Value Conversion Chart

48=97 47=96 46=95 45=93 44=92
38=85 37=84 36=82 35=80 34=79
28=73 27=72 26=71 25=70 24=68

43=91
33=78
23=66

42=90
32=77
22=64

41=89
31=76
21=61

18=55 17=45

13=30

12=25

11=20

16=40

Points Received

15=45

14=35

Thyroid Written Comp

7
8
9
10
Total/Final score
Instructor:
Comments: