Peer Review
Reviewer*
First Name Last Name
Performing Sonographer*
First Name Last Name
Accession Number*
Indication:*
Exam is:*
Appendix Pylorus Baby Head Spine
Grayscale Images
Focus and Depth Optimized*
Always Mostly Sometimes Rarely
Gain and TGCs Optimized*
Always Mostly Sometimes Rarely
Annotations and Preset Optimized*
Always Mostly Sometimes Rarely
Images/clips taken in appropriate plane?*
Always Mostly Sometimes Rarely
Appropriate clip(s) taken:*
Yes No N/A
Appropriate Probe(s) Used*
Yes No
Spine labeled appropriately*
Yes No
Anatomy imaged adequately:*
Yes No
Corpus Callosum
Rt Germinal Matrix
Rt Lateral Ventricle
Lt Germinal Matrix
Lt Lateral Ventricle
Posterior Fossa (Mastoid View)
Rate the overall quality of the study:*
1 2 3 4 5
1 is Worst, 5 is Best
Additional Comments:
Measurements
Appendix Measured Accurately
Yes No Not Visualized
Pylorus Measured Accurately
Yes No
Additional Comments:
Color Doppler
Is the color gain optimized?*
Is the color scale optimized?*
Additional Comments:
Worksheet

*

	Yes	No	N/A
Spelling Accurate
Additional Charges Noted
Appropriate patient comments added
Labs and procedure comments added
Pathology/Incidental findings noted
Results communicated when needed
Prior imaging comparisons

Overall Worksheet Quality:*
Additional Comments:
Appropriate Protocol Followed:*
Dictation
Radiologist:*
Does the dictation correlate with the worksheet?*
Very well Somewhat Hardly
Is the dictation accurate?*
Yes No
Accurate Spelling
Comprehendible
All-inclusive
Accurate
Additional Comments:
Should be Empty: