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To the Editor. —Dr Bundens and colleagues 1 report that the possibility of error in interpretation of venous duplex reports that use the term "superficial femoral vein" may result in improper treatment for patients. However, Bundens et al fail to discuss the responsibility that most radiologists who staff vascular laboratories feel regarding contacting referring physicians when significant abnormalities are detected on venous ultrasound. It is common practice to contact the referring physician and describe the significance of the acute venous thrombosis process when it is noted. As a result, it would be rather unusual for the referring physician to be unaware of the significance of an acute thrombosis involving the superficial femoral vein. While I have no objection to using a new name for this vein to avoid confusion, I do not think changing the name of the vein changes the responsibility of those physicians interpreting this examination to make

Background.— Continuous quality improvement is being advocated as the process that, if adopted, would improve the efficiency, productiveness, and quality of medical institutions, thereby helping to solve the health care crisis our country is facing. To determine if these techniques could be effective in a tertiary-care multispecialty group practice, a model project was undertaken. The model project chosen was to determine if we could improve the turnaround time for "stat" laboratory examinations performed in our large outpatient facility. Methods.— A 10-member team consisting of everyone involved in the process of laboratory testing was empowered to evaluate the present process and make appropriate changes. With traditional techniques of quality improvement, the process was assessed, data were collected and statistically analyzed, changes were introduced, and data were recollected and analyzed. Results.— After intervention, the preanalytic delays were reduced by 76% and the postanalytic delays by 88%. Waiting time for patients was reduced by an average of 62%. By instituting the changes suggested, the institution saved $225 000 on a one-time basis and $40 000 to $50 000 on a recurring basis. Conclusion.— Adoption of quality improvement techniques appears to be a desirable management paradigm that should be explored by all medical institutions interested in maximizing the quality of care offered while at the same time minimizing its cost. ( Arch Intern Med. 1992;152:837-840)

In recent years, ultrasound has become the study of choice for evaluating the abdominal aorta for aneurysmal dilatation. Sonography is noninvasive, relatively inexpensive, easily performed, and does not involve any ionizing radiation. It is an imaging technique in which a high-frequency sound wave produced from the vibration of a transducer crystal is directed through the abdomen where some of the sound is absorbed and continues to traverse, and some is reflected back to the transducer. The sound received by the transducer is converted back into a representative image of the area previously traversed. If the information received is stored in an analogue scan converter or in digital memory before displaying the image, the technique is called a "static B scan." A single image is produced that can be viewed after a small delay. With real time, the two-dimensional B-scan images are generated at a speed high enough to give the

DIAGNOSTIC ultrasound continues to expand in its clinical applicability. A new direction is the sonographic evaluation of the lower extremities. Several recent articles dealing with sonographic evaluation of the popliteal fossa have reported success in imaging popliteal aneurysms and cysts, finding and diagnosing abscesses and cellulitis, and differentiating the pseudothrombophlebitis syndrome from true thrombophlebitis. 1-7 At Ochsner Medical Institutions, New Orleans, the authors have had considerable experience using ultrasound to answer diagnostic problems. It has been learned that patients who can benefit from gray-scale ultrasound may be divided into the following four categories: (1) those with pulsatile masses, (2) those with non-pulsatile masses, (3) those referred for evaluation of calf pain, and (4) those in a high-risk group with possible asymptomatic aneurysms (Table). MATERIALS AND METHODS Patients are examined with both static and real-time scanners using 3.5- to 7.5-MHz transducers of appropriate focal length for the area being examined. Scans