Physically Impaired Patients in Sonography: Practical Ways to Overcome Scanning Challenges

How Do Sonographers Overcome Scanning Challenges?

Sonographers may encounter challenges scanning certain types of patients because of certain physical and health factors. These situations can affect image quality, patient positioning, comfort, and the amount of time available for the examination. Sonographers can overcome many of these difficulties through technical adjustments, careful positioning, effective communication, patient comfort, preparation, and knowing when alternative imaging approaches are necessary.

Patients with Obesity

Patients with obesity can be challenging to scan because increased amounts of subcutaneous fat diminish ultrasound waves, reducing penetration and image quality. Body size can also make positioning and equipment use more difficult.

Sonographers can improve the examination by:

• Using a lower-frequency transducer to increase penetration into deeper tissues. The American Institute of Ultrasound Medicine (AIUM) recommends curvilinear probes such as 1–6 MHz or 2–5 MHz when scanning patients with higher Body Mass Indexes (BMIs).
• Adjusting Time Gain Compensation (TGC) and other machine settings to improve the appearance of deeper structures. Harmonic imaging can also improve contrast and reduce artifacts.
• Applying appropriate transducer pressure to reduce the amount of adipose tissue between the probe and the organ being examined.
• Changing the patient’s position. Having the patient roll onto their side can allow gravity to move excess tissue. Different lateral positions may improve visualization of organs such as the kidneys, gallbladder, liver, and spleen.
• Using different equipment when available. Different ultrasound machines and transducers may produce better images for a particular patient’s body habitus.
• Planning ahead. Facilities should consider equipment limitations and ensure that appropriate equipment is available before beginning the examination.
• Sonographers should avoid making the patient feel embarrassed or judged because of their size. A respectful approach and clear explanation of why certain positions or techniques are necessary can improve cooperation and comfort.

Patients with Critical Illness

Patients with critical illness present a different challenge because their medical condition may be unstable and time may be limited. They may be connected to ventilators, IV lines, monitors, catheters, or other equipment that restricts movement. In these situations, ultrasound is particularly valuable because it can often be performed at the bedside without transporting the patient.

Sonographers can:

• Perform focused examinations when appropriate instead of unnecessarily prolonging the examination. Critical-care ultrasound protocols such as EFAST, RUSH, and SHoC-ED organize scanning into important views that can quickly answer urgent clinical questions.
• Adapt to the patient’s existing position. Critically ill patients may not be able to sit up, roll over, or transfer to another bed. The sonographer should use available acoustic windows while maintaining patient safety.
• Use portable ultrasound equipment. Bedside and wireless systems can make imaging more practical in intensive-care and emergency environments.
• Choose the appropriate transducer. For example, critical-care protocols may use a phased-array probe for cardiac imaging, a curvilinear probe for abdominal imaging, and a linear probe for high-resolution lung imaging.
• Adjust depth and gain to obtain the best possible image without spending excessive time repeating views.
• Work around medical equipment carefully. The sonographer needs to be aware of IV lines, ventilator tubing, drains, catheters, monitoring equipment, and other devices before repositioning the patient.
• Communicate with the medical team. In an unstable patient, the sonographer should understand the patient’s condition and coordinate scanning with nurses, physicians, or other healthcare professionals.
• Avoid interfering with life-saving treatment. During cardiac arrest, for example, ultrasound can be incorporated into rhythm-check pauses, with the goal of obtaining useful information without unnecessarily delaying resuscitation.

Patients with Terminal Illness

Patients with terminal illness may experience weakness, pain, fatigue, limited mobility, anxiety, or difficulty maintaining a required position. For these patients, the goal should be to obtain the necessary diagnostic information while causing as little discomfort and physical stress as possible.

Sonographers can:

• Communicate before and throughout the examination. Explaining what will happen and giving step-by-step instructions can reduce anxiety and help the patient understand why repositioning or transducer pressure may be necessary. Effective communication helps patients relax and cooperate.
• Ask permission before touching or repositioning the patient. This is especially important when a patient is experiencing pain or is physically vulnerable.
• Use gentle positioning techniques and avoid unnecessary movement. If the patient cannot tolerate a standard position, the sonographer should look for another position or acoustic window that can provide diagnostic information.
• Prioritize comfort. Simple measures such as blankets, maintaining a comforting presence, and communicating clearly can reduce discomfort and improve cooperation.
• Work efficiently. Preparing the equipment and knowing the required anatomy before beginning can minimize the amount of time the patient must remain in an uncomfortable position.
• Respect the patient’s limitations. A terminally ill patient may not be able to hold their breath, turn completely onto their side, or remain still for a long examination. The sonographer should adapt the examination rather than unnecessarily forcing the patient into a standard position.
• Coordinate with the healthcare team when necessary. If a patient requires assistance with movement or has significant medical needs, additional staff should be involved rather than risking injury to the patient or sonographer.

Why Adaptability Matters in Diagnostic Medical Sonography

Sonographers must be adaptable. There won’t always be one correct way to scan a patient. A difficult examination may require changing the transducer, adjusting machine settings, modifying patient positioning, trying a different acoustic window, or using a different imaging modality when ultrasound cannot provide adequate diagnostic information.

Technical skill should be combined with compassionate patient care. Listening to patients, explaining the examination, asking permission before touching them, respecting their physical limitations, and providing comfort can reduce anxiety and improve cooperation.

Together, these approaches help sonographers obtain the best possible diagnostic images while maintaining the patient’s safety, dignity, and comfort.

References

This article was developed using guidance and educational resources from the following medical and clinical organizations:

• American Institute of Ultrasound (AIUM)
• Centre for Innovative Ultrasounds
• Great Lakes Medical Imaging
• National Library of Medicine

Learn More About Diagnostic Medical Sonography

• About the Diagnostic Medical Sonography Career
  • What Is the Difference Between Sonography and Cardiovascular Sonography as a Career Choice?
  • Sonography Student Success Story – Venessa G.
  • What Areas Can Sonography Techs Specialize In?
  • Sonography: From A-Mode to B-Mode – Key Advancements in Imaging Technology
  • 10 Common Sonography Terms That Will Help You Feel Ahead on Your First Day of Class
  • What Does a Sonographer Really Do? Inside the World of Diagnostic Soundwaves
  • What Sonographers Look For: How They Use Anatomy, Angles, and Intuition to Get the Right Image
  • Understanding Patient Care in Sonography: The Human Side of Imaging
  • Physically Impaired Patients in Sonography: Practical Ways to Overcome Scanning Challenges

About the Author

Arthur Bagdasaryan is Content Creation & Editorial Specialist at Midwestern Career College. He develops informative, accessible content designed to help readers better understand career-focused education, healthcare topics, and the professional landscape.