DD I am currently in school studying to be a Diagnostic Medical Sonographer. The thing that I’m having the hardest time with is knowing when the image is as good as it will get. I mean every patient is so different. I just don’t know if I could be doing something more to get a better image, or if it’s just the best image possible considering the patient’s anatomy. Any words of advice? – Questioning Myself Dear Questioning, That is a common dilemma for new sonographers. My students all struggle with this issue. Knowing when the image is as good as it will get takes experience and judgment. That is something that will become clearer to you as you gain more confidence in your scanning abilities. There is no definitive answer. One of the reasons that the learning curve is long for a sonographer is for this very reason. Keep practicing and be patient with yourself. The answer to your problem will come with more practice and time. 
DD I’m really worried about the SPI exam’s Semi-Interactive console questions. I ‘m not sure about the correct way to approach these questions. How should I prepare for these questions? – Janet in Manitoba Dear Janet, The first thing that you should do to prepare for these questions is to visit the ARDMS Semi-Interactive questions webpage: http://www.ardms.org/Pages/SIC-Instructions.aspx This page includes a video tutorial, frequently asked questions, practice questions, and information about how the questions are scored. Make sure that you fully understand how to technically operate the controls to make the adjustments. Here is how I would approach answering this type of question. Since there is no change to the image with an adjustment change, I would simply think of these Semi-Interactive questions as multiple choice questions that lack listed answer choices. To begin the process of answering the question: > Read the problem statement at the bottom of the image. Keep in mind that points will not be deducted if your adjustment(s) positively impacts the image. You will lose points if your adjustment would not improve the image or would impact the image in a negative way. I would strive to choose just one adjustment change, not multiple. Hope this helps!
> Next, look at the image itself. Keep in mind what the problem statement is asking you to change or correct. Is it an artifact, a 2D gain setting, a Doppler adjustment that would more accurately depict flow, etc.?
> Using your knowledge and experience, determine what control adjustment will improve or fix the issue on the image.
> Now, adjust that control with the mouse until appropriate (remember that you will not see a change to the image).
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