Scenario Analysis: This scenario is professionally challenging because it requires the sonographer to integrate advanced imaging modalities beyond ultrasound, specifically CT and MRI, into the diagnostic pathway for a complex obstetric complication. The challenge lies in determining the most appropriate and timely imaging modality when initial ultrasound findings are equivocal, balancing diagnostic accuracy with patient safety, radiation exposure concerns (for CT), and resource availability. The need for rapid, accurate diagnosis in obstetric cases adds significant pressure. Correct Approach Analysis: The best professional practice involves a systematic approach that prioritizes non-ionizing radiation modalities when clinically indicated and feasible. In this case, after an equivocal ultrasound for suspected placental accreta spectrum, proceeding to MRI is the most appropriate next step. MRI offers superior soft tissue contrast and depth penetration compared to ultrasound, allowing for detailed visualization of placental myometrial invasion, bladder wall involvement, and other critical anatomical structures without exposing the fetus to ionizing radiation. This aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm, including unnecessary radiation exposure). Regulatory guidelines in advanced practice obstetrics often advocate for the judicious use of advanced imaging, favoring modalities with lower risk profiles when diagnostic efficacy is comparable or superior. Incorrect Approaches Analysis: Proceeding directly to CT scan without further consideration of MRI is professionally unacceptable. While CT can provide detailed anatomical information, its primary drawback in this obstetric context is the exposure of the fetus to ionizing radiation. Unless there is an immediate, life-threatening indication for CT (e.g., suspected hemorrhage requiring urgent surgical intervention not amenable to MRI), the radiation dose makes it a less desirable choice for further evaluation of placental abnormalities when a safer alternative like MRI exists. This approach fails to adhere to the principle of minimizing radiation exposure to the fetus. Relying solely on repeat ultrasound examinations without considering advanced modalities is also professionally inadequate. While serial ultrasounds can sometimes clarify findings, if the initial examination is equivocal for a condition like placental accreta spectrum, and advanced imaging is available and indicated, delaying definitive diagnosis by repeatedly performing the same modality may prolong uncertainty and potentially delay appropriate management. This approach risks failing to provide the most accurate and timely diagnosis possible with available technology. Deferring any further imaging until after delivery is professionally unsound. Conditions like placental accreta spectrum have significant implications for management during pregnancy and delivery, including the risk of catastrophic hemorrhage. Delaying definitive diagnosis until after delivery can lead to unexpected complications during the birth process, potentially jeopardizing maternal and fetal well-being. This approach fails to proactively manage a known or suspected high-risk obstetric condition. Professional Reasoning: Professionals should employ a tiered approach to advanced imaging in complex obstetric cases. The initial step is always the most appropriate modality for the suspected condition (in this case, ultrasound). When findings are equivocal, the decision-making process should involve considering the diagnostic capabilities of alternative advanced modalities, their associated risks (e.g., radiation, contrast agents), and the urgency of the diagnosis. Prioritizing non-ionizing radiation modalities like MRI when they offer superior or comparable diagnostic accuracy for specific obstetric conditions is a cornerstone of best practice. This requires a thorough understanding of the strengths and limitations of each imaging modality and a commitment to patient safety and ethical considerations.

The evaluation methodology shows a scenario where a sonographer is faced with a critical finding during an advanced obstetric ultrasound that requires immediate and clear communication to the referring physician, while also considering the patient’s emotional state and the need for further specialist consultation. This situation is professionally challenging because it demands a balance between urgent medical reporting, patient advocacy, and adherence to established communication protocols within the healthcare system. The sonographer must act as a crucial link in the patient’s care pathway, ensuring that vital information is conveyed accurately and promptly without causing undue distress or compromising the integrity of the diagnostic process. The correct approach involves the sonographer meticulously documenting the abnormal findings and immediately communicating them directly to the referring obstetrician or designated physician, adhering to established reporting timelines and protocols. This direct communication ensures that the physician receives the most accurate and up-to-date information for timely patient management. This approach is correct because it prioritizes patient safety and timely intervention, aligning with ethical principles of beneficence and non-maleficence. It also adheres to professional guidelines that mandate clear and prompt reporting of significant findings to the responsible clinician, ensuring continuity of care and appropriate follow-up. An incorrect approach would be to delay reporting the findings until the next scheduled departmental meeting, even if the findings are potentially serious. This failure to communicate urgently breaches the professional duty to act in the patient’s best interest and could lead to significant delays in diagnosis and treatment, potentially harming the patient. Another incorrect approach would be to discuss the findings extensively with the patient before informing the referring physician, especially if the findings are complex or require specialist interpretation. While patient communication is important, bypassing the referring physician for initial critical reporting can lead to misinterpretation, anxiety, and a breakdown in the established referral pathway, undermining the physician’s role in patient management. Finally, an incorrect approach would be to rely solely on a written report without any verbal confirmation for critical findings, especially if the report is not immediately accessible to the referring physician. This can lead to delays in the physician becoming aware of the critical information, jeopardizing prompt patient care. Professionals should employ a decision-making framework that prioritizes patient safety and adherence to established protocols. This involves understanding the urgency of the findings, knowing the specific communication channels and timelines mandated by their institution and professional body, and maintaining clear, concise, and accurate documentation. When faced with critical findings, the immediate step should always be to inform the responsible clinician directly, followed by comprehensive documentation and any necessary patient counseling or further referral, always in coordination with the referring physician.

Scenario Analysis: This scenario is professionally challenging because it requires an individual to navigate the specific eligibility criteria for an advanced practice examination without misinterpreting or circumventing established requirements. The pressure to advance one’s career and gain specialized credentials can lead to a temptation to overlook or downplay certain prerequisites. Careful judgment is required to ensure adherence to the examination’s purpose and the established pathways for demonstrating competency. Correct Approach Analysis: The best professional approach involves a thorough review of the official examination handbook and any published supplementary guidance from the relevant Caribbean professional body overseeing the Advanced Caribbean Obstetric and Gynecologic Ultrasound Advanced Practice Examination. This handbook will detail the precise educational qualifications, clinical experience, and any prerequisite certifications or training required for eligibility. Understanding and meeting these specific criteria, as outlined by the governing body, is the only legitimate pathway to applying for the examination. This approach is correct because it directly aligns with the regulatory framework established by the professional body, ensuring that all candidates meet a standardized level of preparedness and competence deemed necessary for advanced practice in this specialized field. It upholds the integrity of the examination and the profession by ensuring that only qualified individuals are certified. Incorrect Approaches Analysis: Pursuing eligibility based solely on a colleague’s informal advice, without verifying the information against official documentation, is professionally unacceptable. This approach risks acting on outdated or inaccurate information, potentially leading to a wasted application fee and significant disappointment. It bypasses the established regulatory process and demonstrates a lack of due diligence. Another unacceptable approach is assuming that general ultrasound experience is sufficient without confirming if it meets the specific obstetric and gynecologic advanced practice requirements. The examination is specialized, and general experience may not encompass the depth or breadth of knowledge and skills required. This failure to confirm specific advanced practice requirements is a regulatory oversight. Finally, attempting to contact the examination board with a vague inquiry about “general advanced practice requirements” without having first consulted the official documentation is inefficient and unprofessional. It places an undue burden on the examination board and suggests a lack of personal initiative in understanding the stated prerequisites. This approach fails to demonstrate a commitment to understanding the specific regulatory framework governing the examination. Professional Reasoning: Professionals seeking to undertake advanced practice examinations should adopt a systematic approach. This begins with identifying the specific examination and the governing professional body. The next crucial step is to locate and meticulously review all official documentation, including handbooks, guidelines, and FAQs, provided by that body. Any ambiguities or questions should then be addressed by directly consulting the official contact channels of the examination board, armed with specific queries derived from the official documentation. This methodical process ensures adherence to regulatory requirements, upholds professional integrity, and maximizes the likelihood of a successful and legitimate application.

This scenario presents a professional challenge due to the critical need to balance the diagnostic benefits of contrast agents with the potential risks to a pregnant patient, particularly concerning fetal well-being. The advanced practice professional must navigate complex pharmacological considerations, patient safety protocols, and the management of potential adverse events within the specific regulatory and ethical landscape of obstetric ultrasound in the Caribbean. Careful judgment is required to ensure the procedure is both medically indicated and performed with the highest regard for maternal and fetal safety. The best professional approach involves a thorough pre-procedure assessment and informed consent process that specifically addresses the use of contrast agents in pregnancy. This includes a detailed review of the patient’s medical history, an evaluation of the necessity of contrast for diagnostic clarity, and a comprehensive discussion of the known and potential risks and benefits of the specific contrast agent being considered, tailored to the gestational stage. This approach is correct because it aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as the regulatory requirement for informed consent, which mandates that patients understand the risks, benefits, and alternatives of any medical intervention. It also reflects a commitment to patient autonomy by empowering the patient to make an informed decision. Furthermore, it necessitates adherence to established guidelines for contrast agent use in pregnancy, which prioritize fetal safety. An incorrect approach would be to administer the contrast agent without a clear indication of its necessity for diagnosis, or without a thorough discussion of the risks and benefits with the patient. This fails to uphold the principle of beneficence, as the potential risks to the fetus may outweigh the diagnostic gain if the contrast is not strictly indicated. It also violates the ethical and regulatory requirement for informed consent, as the patient would not be fully aware of the implications of the procedure. Another incorrect approach would be to defer the decision solely to the referring physician without engaging in an independent assessment of the risks and benefits in the context of obstetric ultrasound. While collaboration is essential, the advanced practice professional has a responsibility to critically evaluate the use of contrast agents in pregnancy and advocate for the safest course of action based on their specialized knowledge and understanding of current guidelines. This failure to exercise independent professional judgment could lead to suboptimal patient care and potential harm. Finally, proceeding with the contrast administration without a clear protocol for managing potential adverse events, such as anaphylaxis or hemodynamic instability, would be professionally unacceptable. This neglects the principle of non-maleficence by failing to adequately prepare for and mitigate potential harms. Regulatory frameworks and professional guidelines universally emphasize the importance of having robust emergency preparedness plans in place for any procedure involving potentially hazardous agents. The professional decision-making process for similar situations should involve a systematic evaluation: 1) Is the procedure medically indicated and is contrast essential for diagnosis? 2) What are the known risks and benefits of the specific contrast agent for both the mother and the fetus at this gestational stage, referencing current guidelines? 3) Has the patient provided truly informed consent after a thorough discussion of these factors? 4) Are there established protocols for managing potential adverse events? 5) Is there a clear plan for post-procedure monitoring?

The analysis reveals a common yet complex challenge in advanced obstetric and gynecologic ultrasound practice: balancing the imperative for robust regulatory compliance and accreditation with the practicalities of integrating new informatics systems. This scenario is professionally challenging because it requires a deep understanding of the regulatory landscape governing medical imaging and patient data, coupled with the technical acumen to implement and manage information systems that meet these standards. Failure to navigate this intersection effectively can lead to significant legal, ethical, and operational repercussions, including loss of accreditation, patient safety risks, and data breaches. Careful judgment is required to prioritize patient care and data integrity while embracing technological advancements. The best approach involves a proactive and systematic integration strategy that prioritizes regulatory adherence from the outset. This means establishing clear protocols for data management, security, and quality assurance that are aligned with the relevant Caribbean regulatory framework and any applicable professional accreditation standards. It necessitates thorough training for all staff on the new informatics system, emphasizing its role in maintaining compliance and ensuring accurate, secure patient records. Furthermore, this approach includes establishing a continuous monitoring and auditing process to verify ongoing compliance and identify any potential vulnerabilities or deviations from established protocols. This ensures that the informatics system not only functions efficiently but also serves as a tool to uphold the highest standards of patient care and regulatory adherence. An incorrect approach would be to implement the informatics system without a comprehensive review of its compatibility with existing regulatory requirements and accreditation standards. This oversight could lead to the system inadvertently creating data management gaps or security vulnerabilities that violate established guidelines. Another professionally unacceptable approach is to prioritize system functionality and ease of use over data security and patient privacy. This could result in non-compliance with data protection regulations, potentially exposing sensitive patient information and jeopardizing accreditation. Finally, adopting a reactive stance, where compliance issues are only addressed after they arise, is also a failure. This approach demonstrates a lack of foresight and a disregard for the preventative measures mandated by regulatory bodies, increasing the risk of significant penalties and reputational damage. Professionals should employ a decision-making framework that begins with a thorough understanding of the specific regulatory requirements and accreditation standards applicable to their practice. This should be followed by a comprehensive assessment of any new informatics system’s capabilities and limitations in meeting these requirements. A risk-based approach, identifying potential compliance challenges and developing mitigation strategies before implementation, is crucial. Continuous education and engagement with regulatory updates are also vital to ensure sustained compliance.

This scenario is professionally challenging due to the potential for misinterpretation of complex ultrasound findings in a sensitive obstetric context, which can lead to significant patient anxiety and potentially inappropriate clinical management. The need for advanced interpretation skills, coupled with clear and empathetic communication, is paramount. Careful judgment is required to balance diagnostic accuracy with patient well-being and adherence to professional standards. The best approach involves a comprehensive review of all available imaging data, correlation with the patient’s clinical history and any prior imaging, and consultation with a senior colleague or specialist if any ambiguity exists. This ensures the most accurate diagnosis is reached, minimizing the risk of diagnostic error. This approach aligns with the ethical imperative of providing competent care and the professional responsibility to seek assistance when faced with complex cases. It also implicitly adheres to the principles of good medical practice, which emphasize thoroughness and collaboration in patient care. An incorrect approach would be to provide a definitive interpretation based solely on the initial scan without further investigation or consultation, especially when faced with subtle or unusual findings. This fails to meet the standard of care expected in advanced practice and could lead to misdiagnosis, causing undue distress to the patient and potentially impacting the management plan. Ethically, this demonstrates a lack of diligence and a failure to prioritize patient safety. Another incorrect approach would be to communicate preliminary or uncertain findings to the patient without adequate context or a clear plan for further investigation. This can generate significant anxiety and fear, violating the principle of beneficence and potentially causing harm. Professional communication requires clarity, accuracy, and a focus on patient understanding and reassurance. Finally, an incorrect approach would be to delay reporting or discussing findings due to personal uncertainty without seeking timely consultation. This constitutes a failure to act in the patient’s best interest and can lead to delays in necessary treatment or management, which is ethically unacceptable and professionally negligent. Professionals should employ a systematic decision-making framework that includes: thorough data acquisition and review, critical analysis of findings in the context of clinical information, recognition of personal limitations and the need for consultation, clear and empathetic communication with the patient, and adherence to established professional guidelines and ethical principles.

Scenario Analysis: This scenario is professionally challenging because it requires the sonographer to move beyond a standard protocol and adapt imaging techniques based on evolving clinical information. The challenge lies in balancing the need for comprehensive diagnostic data with the efficient use of resources and patient comfort, all while adhering to established best practices and potential regulatory guidelines for obstetric and gynecologic ultrasound. The sonographer must critically evaluate the initial findings and determine the most appropriate adjustments to the protocol without compromising diagnostic accuracy or patient safety. Correct Approach Analysis: The best professional practice involves a systematic and informed modification of the existing protocol. This approach begins with a thorough review of the initial findings and the specific clinical question. The sonographer then identifies which elements of the standard protocol are insufficient or require enhancement to address the new information. This might involve extending scanning planes, increasing transducer frequency for better resolution of specific structures, or employing Doppler techniques to assess vascularity. This adaptive strategy is correct because it directly addresses the diagnostic uncertainty, prioritizes patient care by seeking definitive answers, and aligns with the ethical principle of beneficence (acting in the patient’s best interest). It also reflects a commitment to professional competence by demonstrating the ability to critically analyze and respond to complex imaging situations. While specific Caribbean regulatory frameworks for ultrasound protocols might vary by island nation, the overarching principles of good medical practice and professional conduct, often guided by international standards and professional bodies, would support this tailored approach. Incorrect Approaches Analysis: One incorrect approach is to simply abandon the standard protocol and initiate a completely new, unguided scan. This is professionally unacceptable because it lacks a systematic basis, potentially leading to missed pathology or redundant imaging. It fails to leverage the diagnostic information already gathered and could be seen as inefficient and potentially outside the scope of standard practice without clear justification. Another incorrect approach is to ignore the new clinical information and strictly adhere to the original protocol, concluding the examination without further investigation. This is ethically flawed as it fails to act in the patient’s best interest (non-maleficence and beneficence) by not pursuing a potentially critical diagnosis. It demonstrates a lack of clinical judgment and a failure to adapt to evolving patient needs, which is contrary to the principles of competent medical practice. A third incorrect approach is to excessively expand the protocol with numerous additional, unrelated sequences without a clear diagnostic rationale. While aiming for thoroughness, this can lead to an unnecessarily prolonged examination, increasing patient discomfort and resource utilization without a direct benefit to answering the specific clinical question. This approach lacks the targeted optimization required for efficient and effective diagnostic ultrasound. Professional Reasoning: Professionals should approach such situations by first understanding the core clinical question and the initial findings. They should then critically assess the standard protocol’s ability to answer that question. If modifications are needed, they should be specific, targeted, and justified by the evolving clinical picture. This involves a continuous loop of assessment, adaptation, and re-assessment, always prioritizing diagnostic accuracy, patient well-being, and efficient use of resources within the bounds of professional standards and any applicable local regulations.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for accurate assessment of a candidate’s competency with the established policies for examination progression. Misinterpreting or misapplying the blueprint weighting, scoring, and retake policies can lead to unfair assessment, undermine the integrity of the examination process, and potentially impact patient safety if unqualified individuals are certified. Careful judgment is required to ensure adherence to the established framework while also considering the nuances of individual candidate performance. Correct Approach Analysis: The best professional practice involves a thorough review of the candidate’s performance against the established blueprint weighting and scoring criteria, followed by a clear and documented decision regarding retake eligibility based strictly on the defined retake policies. This approach ensures objectivity, fairness, and transparency. The examination board must meticulously assess how the candidate’s score aligns with the predetermined weighting of different sections of the exam as outlined in the blueprint. Subsequently, the retake policy, which dictates the conditions under which a candidate can re-sit the examination (e.g., minimum passing score, number of allowed attempts, required remediation), must be applied without deviation. This adherence to established policy is ethically mandated to maintain the credibility of the certification and is a fundamental aspect of regulatory compliance for advanced practice examinations. Incorrect Approaches Analysis: One incorrect approach involves allowing a candidate to retake the examination based on a subjective assessment of their perceived effort or potential, without strict adherence to the established retake policy. This bypasses the defined criteria for progression and introduces bias, undermining the standardized nature of the examination. It fails to uphold the principle of equitable assessment for all candidates. Another incorrect approach is to modify the scoring criteria or blueprint weighting retroactively for a specific candidate to allow them to pass. This fundamentally compromises the integrity of the examination by altering the established standards after the assessment has occurred. It is a direct violation of regulatory guidelines that mandate consistent application of assessment tools and criteria. A further incorrect approach is to deny a retake opportunity to a candidate who meets all the documented criteria for eligibility, based on a personal feeling that they are unlikely to pass even with a retake. This is arbitrary and punitive, failing to provide the candidate with the recourse outlined in the examination’s policies. It demonstrates a lack of professional judgment and a failure to follow established procedures. Professional Reasoning: Professionals involved in examination governance must operate within a clear framework of policies and regulations. The decision-making process should always begin with a comprehensive understanding of the examination blueprint, scoring rubrics, and retake policies. When evaluating a candidate’s performance, the primary focus should be on objective data and adherence to these established guidelines. Any deviation from policy must be rigorously justified and documented, and in most cases, deviations are not permissible. The goal is to ensure a fair, consistent, and reliable assessment process that upholds the standards of the profession and protects public safety.

Scenario Analysis: This scenario is professionally challenging because it requires the candidate to balance the immediate need for comprehensive preparation with the practical constraints of time and available resources. The pressure to perform well on an advanced examination, particularly in a specialized field like obstetric and gynecologic ultrasound, necessitates a strategic approach to learning. Misjudging the timeline or relying on suboptimal resources can lead to inadequate preparation, impacting the candidate’s confidence and ultimately their performance, potentially affecting patient care in the long run. Careful judgment is required to select a preparation strategy that is both effective and sustainable. Correct Approach Analysis: The best professional practice involves a structured, multi-modal preparation strategy that begins well in advance of the examination date. This approach prioritizes understanding core concepts through a combination of reputable textbooks, peer-reviewed literature, and accredited online modules. It also emphasizes hands-on practice, simulation, and case study review, mirroring the practical demands of the examination. Regular self-assessment through practice questions and mock exams is crucial for identifying knowledge gaps and refining test-taking strategies. This comprehensive approach ensures a deep understanding of the subject matter and familiarity with the examination format, aligning with the professional standards expected of advanced practitioners in diagnostic imaging. Adherence to recommended study timelines, typically starting 3-6 months prior to the exam, allows for systematic coverage of the syllabus without undue stress. Incorrect Approaches Analysis: Relying solely on a single, last-minute review course without prior foundational study is professionally unacceptable. This approach often leads to superficial learning, where information is memorized rather than understood, increasing the risk of forgetting critical details under examination pressure. It fails to build the deep conceptual understanding and practical skill integration required for advanced practice. Another unacceptable approach is exclusively using outdated or non-accredited online resources. This can lead to exposure to inaccurate or incomplete information, which is detrimental to effective learning and may not align with current best practices or examination content. Furthermore, neglecting hands-on practice and simulation in favor of purely theoretical study is a significant ethical and professional failing, as advanced ultrasound practice is inherently skill-based. Finally, delaying preparation until the final weeks before the exam, without a structured plan, creates an unrealistic and stressful learning environment, increasing the likelihood of burnout and incomplete knowledge acquisition. Professional Reasoning: Professionals should approach exam preparation with the same rigor and planning applied to patient care. This involves a systematic assessment of the examination syllabus, identification of personal learning styles and existing knowledge gaps, and the development of a realistic study schedule. Prioritizing high-quality, evidence-based resources and incorporating diverse learning methods, including theoretical study, practical application, and self-assessment, are key. Regular review and adaptation of the study plan based on progress are essential for ensuring comprehensive and effective preparation.

This scenario is professionally challenging because it involves a critical diagnostic finding that has immediate implications for patient management and potential fetal well-being. The sonographer must balance the need for accurate and timely information with the ethical imperative to communicate findings appropriately and avoid causing undue distress. Careful judgment is required to determine the most effective and responsible course of action. The correct approach involves immediate consultation with the supervising obstetrician. This is the best professional practice because it ensures that a qualified medical professional, who is ultimately responsible for patient care, is informed of significant findings without delay. The obstetrician can then assess the clinical context, review the ultrasound images, and determine the appropriate next steps for patient management, including further investigations or immediate intervention. This aligns with ethical principles of patient safety and professional accountability, as well as the established hierarchy of clinical responsibility in diagnostic imaging. An incorrect approach would be to delay reporting the finding until the end of the shift. This fails to acknowledge the potential urgency of the situation and could lead to a delay in necessary medical intervention, potentially compromising fetal health. Ethically, this demonstrates a lack of diligence and prioritisation of patient care. Another incorrect approach would be to discuss the finding directly with the patient without prior consultation with the obstetrician. While patient communication is important, a sonographer’s role is primarily diagnostic. Discussing potentially serious findings without the direct oversight of the treating physician can lead to misinterpretation, anxiety, and premature or inappropriate management decisions by the patient. This bypasses the established clinical pathway and can undermine the physician-patient relationship. A further incorrect approach would be to document the finding in the report but not to actively seek immediate consultation, assuming the obstetrician will review the report in due course. While thorough documentation is essential, this passive approach neglects the sonographer’s professional responsibility to ensure that critical findings are brought to the attention of the responsible clinician in a timely manner, especially when immediate action might be warranted. Professionals should employ a decision-making framework that prioritises patient safety and clinical urgency. This involves a clear understanding of their scope of practice, the established reporting protocols within their institution, and the potential implications of their findings. When a significant or potentially critical finding is identified, the immediate step should be to consult with the supervising physician or designated medical officer to facilitate prompt and appropriate patient management. QUESTION: Operational review demonstrates that a sonographer performing a routine obstetric ultrasound identifies a significant fetal anomaly that requires immediate specialist review. The sonographer is nearing the end of their shift, and the supervising obstetrician is currently in a scheduled surgical procedure. What is the most appropriate course of action for the sonographer? OPTIONS: a) Immediately contact the supervising obstetrician or the on-call obstetrician to report the finding and await further instructions. b) Document the finding thoroughly in the ultrasound report and wait until the supervising obstetrician returns from their surgical procedure to discuss it. c) Inform the patient directly about the suspected fetal anomaly and advise them to schedule a follow-up appointment with their doctor. d) Discuss the finding with a senior sonographer colleague for their opinion before deciding on the next steps.