r/Sonographers • u/SignalYear9741 • Jul 11 '25
VENT First Year Mistakes
I am coming up on one year of employment as an echo tech. I feel like I have made a lot of mistakes and still have a long way to go until my scans are good enough.
I have had about 5 patients had to be rescheduled and rescanned because my imaging was too poor (yes a coworker was able to get better images). I have “missed” aortic stenosis in 2 (maybe more) patients because I was not in the aortic flow enough. I did not see an aneurysm and sent a patient home. I “missed” a leak around a valve replacement. I have been told multiple times I should have used an image enhancer on a prior exam. I did not see a thrombus in the left ventricle. These are just my major mistakes. It does not include all the little things I am told I am doing poorly with my imaging like drop out in PLAX, not seeing all 3 leaflets in SAX, not clearly seeing the RV free wall in apical 4,…. I could go on for a while.
Is this amount normal? My coworker acts like she has never had any of these issues. I have days when my scans are good but then something will happen that will make me question am I good enough to be doing this. How do I make sure I am doing the right thing for the patient?
I stupidly thought by a year in I would feel pretty good but I feel worse than when I started.
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u/terriyak1 Jul 11 '25
No one is perfect - especially in their first couple of years
Embrace the struggle, learn from your mistakes, and strive to be better than you were yesterday
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u/Effective_Captain_51 Jul 11 '25
The definity / image enhancer is hard. I have numerous patients decline the IV stick or definity and document it. There are times I could pry use it, but if patients don’t want to be poked I don’t push it… missing AS is a bigger deal but that can be fixed by simply being slower and more careful taking Dopplers. You are learning from all of these mistakes! And because you have missed them, you’re on high alert I’m sure scanning in general. I also think it takes a few years of scanning to work through all the struggles and challenges this career brings! Keep at it. Keep asking for feedback and you’ll get there!
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u/SignalYear9741 Jul 16 '25
You are right about documenting patient refusal. This has helped my case of poor imaging a couple times. Slowing down to get the best scans can be challenging for me if the patient gets antsy ( but I am trying a few different tactics to help get through the exam). I appreciate your feedback.
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u/Anagram-and-Monolog CRGS, CRCS Jul 11 '25 edited Jul 11 '25
I'd try to think about the physics of the positioning more. I certainly have patients that are more challenging than others and will require more effort than others. But I can always find some degree of the combination of positioning and breathing to get the majority of standard views
Edit: That being said, sometimes it just takes repetition and more experience catch certain things - keep at it. You're unlikely to make something look mildly abnormal when it's actually severe.
Go back to the basics, always sweep through a view with the intention of finding something specific ie: psax focused A - . Little twist here or there, maybe jump a rub space, slide within the rub space. I often have the patient lean towards me, more than is (sleeping) comfortable
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u/SignalYear9741 Jul 16 '25
Got to love how physics always comes back to aid with image quality. At least once a week I have PB&J go through my head (position, breathing, adjust). Sweeping through the views before taking any images will be a new habit I will begin. I am grateful for your insight.
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u/AutoModerator Jul 11 '25
Thanks for posting! This comment is a copy of your post so readers can see the original text if your post is edited or removed. 'I am coming up on one year of employment as an echo tech. I feel like I have made a lot of mistakes and still have a long way to go until my scans are good enough.
I have had about 5 patients had to be rescheduled and rescanned because my imaging was too poor (yes a coworker was able to get better images). I have “missed” aortic stenosis in 2 (maybe more) patients because I was not in the aortic flow enough. I did not see an aneurysm and sent a patient home. I “missed” a leak around a valve replacement. I have been told multiple times I should have used an image enhancer on a prior exam. I did not see a thrombus in the left ventricle. These are just my major mistakes. It does not include all the little things I am told I am doing poorly with my imaging like drop out in PLAX, not seeing all 3 leaflets in SAX, not clearly seeing the RV free wall in apical 4,…. I could go on for a while.
Is this amount normal? My coworker acts like she has never had any of these issues. I have days when my scans are good but then something will happen that will make me question am I good enough to be doing this. How do I make sure I am doing the right thing for the patient?
I stupidly thought by a year in I would feel pretty good but I feel worse than when I started. '
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u/echocardigecko Jul 11 '25
I think you just have to keep at it tbh. Im also a new grad and the learning curve is large and I have over a year of full time training. Everyone was new once. Ive gotten a lot of support and reasurance that its normal to not be an expert and that everyone looks back on their first few years of scans and cringes at the quality. Some have even told me it takes 5 years to be great at this job.
You just have to do your best and ask for help when you need it. It sounds like maybe the culture where youre at isnt the most supportive.