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:
*
Rows
Yes
No
Corpus Callosum
1
2
Rt Germinal Matrix
3
4
Rt Lateral Ventricle
5
6
Lt Germinal Matrix
7
8
Lt Lateral Ventricle
9
10
Posterior Fossa (Mastoid View)
11
12
Rate the overall quality of the study:
*
1
2
3
4
5
Worst
Best
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?
*
Yes
No
N/A
Is the color scale optimized?
*
Yes
No
N/A
Additional Comments:
Worksheet
*
Rows
Yes
No
N/A
Spelling Accurate
13
14
15
Additional Charges Noted
16
17
18
Appropriate patient comments added
19
20
21
Labs and procedure comments added
22
23
24
Pathology/Incidental findings noted
25
26
27
Results communicated when needed
28
29
30
Prior imaging comparisons
31
32
33
Overall Worksheet Quality:
*
1
2
3
4
5
Additional Comments:
Appropriate Protocol Followed:
*
Yes
No
Dictation
Radiologist:
*
Does the dictation correlate with the worksheet?
*
Very well
Somewhat
Hardly
Is the dictation accurate?
*
Rows
Yes
No
Accurate Spelling
34
35
Comprehendible
36
37
All-inclusive
38
39
Accurate
40
41
Additional Comments:
Submit
Should be Empty: