What You Missed on Ultrasound This Year (and How to Fix It)

It’s that sinking feeling — the moment you realise you nearly missed something on a scan.  

For me, it was a bladder case not long ago. I scanned from my usual left-sided start, but I didn’t fan quite far enough back. When I checked from the right, there it was: a trigone mass I’d almost missed. That familiar “oh no” feeling hit me — quickly followed by relief and a mental note to slow down next time. 

The reality is every vet misses things on ultrasound, even the confident ones. The real question isn’t if you miss something — it’s what you do next.  

Let’s talk about how to turn those missed moments into the biggest source of growth in your scanning practice.

Why Do We Miss Things on Ultrasound?

If you’ve ever found yourself halfway through an abdominal scan thinking, “Did I already check the spleen?” I promise, you’re in good company.  

We rarely miss things because we’re bad at scanning. It’s usually because we’re:

• Tired or distracted  
• Rushed between consults  
• Stuck in autopilot  
• Assuming an organ “looks normal” before we’ve fully imaged it  

Sometimes it’s as simple as not adjusting our settings between organs. (Raise your hand if you’ve scanned the whole abdomen on the same settings 🙋‍♀️)  

Our brains love shortcuts. They fill in gaps and tell us “everything looks fine”  even when we haven’t finished looking. That’s how we slip into the “within normal limits” trap.  

And then there’s annotation. You save what seems like a great image… but when you look back later, it’s just grey dots. No clues about which part you were scanning. We’ve all been there and it’s not failure, it’s feedback.

How Can I Stop Missing Things on Ultrasound?

The most confident scanners don’t have perfect eyesight - they have structure.  

At FOVU, we use two key frameworks to keep scans consistent and thorough:

1. The Abdominal Scanning Framework

A set order for scanning each organ, so nothing gets forgotten. Once this becomes habit, you’ll notice how much calmer and more systematic your scans feel.

2. The SPEEDS™ Framework

A methodical way to assess every organ or lesion:

• S - Size and Shape
• P - Position
• E - Echogenicity and Echotexture
• E - Edge
• D - Distribution and Dynamics
• S - Sampling

Having a structure like this stops your brain from skipping steps when you’re tired or rushed. You start scanning with intention, not just motion and that’s when confidence quietly builds.

Why Reflection Is the Secret Ingredient

Reflection isn’t fluffy or optional. It’s one of the most practical (and underused) tools we have in clinical learning.  

At FOVU, we’ve designed an Ultrasound Reflection Worksheet, and it’s genuinely transformative for vets who use it.  

Here’s how to use it effectively:

1. Pick one recent scan — good, bad, or somewhere in between.  
2. Ask yourself:

•    Did I image the whole organ in two planes?  
•    Did I fan to the outer edges of the organ?  
•    Did I annotate properly — including gravity orientation and left/right markers?  

3. Write down one thing you did well. 

   (This feels awkward at first, but you’ll get used to celebrating progress.)  

4. Choose one thing to improve next time.  

   Keep it specific: “adjust depth on the spleen” beats “get better at scanning spleens.”  

You don’t need to reflect on every case just enough to spot patterns. That’s how you replace random repetition with real growth.

Try this today:

After your next scan, jot down one small thing you changed — even if it’s just adjusting depth or switching to Doppler earlier. Noticing those micro-improvements is how ultrasound confidence sneaks up on you.

What to Look for in Your Reflection

If you’re unsure where to start, try using these prompts from the worksheet:

Machine Settings

• Did you change gain, depth, or focal zone between organs?  
• Did you optimise settings for any lesion you found?  
• Did you use colour or power Doppler appropriately?  

Organ Assessment

• Did you view each organ in two planes?  
• Did you see it to the extremities?  
• Did you describe it using SPEEDS™?  

Reporting and Annotation

• Did you label your images clearly (organ, side, and orientation)?  
• Did you save under the correct patient details?  
• Did you fully describe any pathology you found?  

If you’re ticking “no” for a few of these — excellent. That’s your roadmap for next year.

My Own Reflection This Year

This year, I’ve been working on a habit that used to slip: measuring organs even when they look normal.  

Things like gallbladder wall thickness or colon wall.  I used to skip them if they seemed fine. But building that habit has sharpened my eye and made my reports more consistent.

The funny thing about reflection is that it shifts your focus. You stop obsessing over mistakes and start noticing how much you’re actually improving.  

And that’s the key difference between anxious scanners and confident ones: confident vets reflect, adjust, and celebrate small wins.

How to Turn Reflection Into Real Progress Next Year

Once you’ve reflected, the next step is planning — but gently.  

Pick one focus per month and stick with it. This is exactly what we do in FOVU Club: a structured monthly theme with small, achievable actions.  

Here’s an example plan for your year's focus:

• January: Take three longitudinal kidney measurements on every scan.  
• February: Apply Doppler to every lesion.  
• March: Look for medial iliac lymph nodes (even if you can’t always find them).  
• April: Review your annotations for clarity and consistency.  

Simple, realistic goals like these add up faster than you think. You don’t need to scan more, just scan with intention.

Should I Feel Bad About Missing Things?

Absolutely not. Missing things isn’t the issue — ignoring them is.  

Every missed finding is a chance to refine your process. Once you see where you went off-track, you can build a habit that prevents it next time. That’s how reflection turns frustration into growth.

And if you want accountability, support, and ready-made monthly challenges, you’ll love the FOVU January 5-Day Challenge — it’s built entirely around this process.

Key Takeaways for Vets

• Missing things isn’t failure — it’s feedback.  
• Structure (like SPEEDS™ and the Abdominal Scanning Framework) prevents repeat mistakes.  
• Reflection turns random repetition into confident progress.  
• Focus on one improvement per month — not perfection.  
• You don’t need to scan more. You need to scan with intention.  

Final Thought

You’re probably doing better than you think.  

The fact that you’re reading this, reflecting, and planning your next steps means you’re already ahead of where you were this time last year.  

So make yourself a cuppa ☕, download the FOVU Ultrasound Reflection Worksheet, and write down one thing you’ll focus on in January.  

Confidence in ultrasound doesn’t arrive overnight.  It builds quietly through small, thoughtful actions.  

And you’re already on that path. 

Happy Scanning! 

Camilla 🐾

Dr. Camilla Edwards (DVM, CertAVP, MRCVS) is a peripatetic veterinary ultrasonographer and founder of FOVU. She helps first-opinion vets build confidence in scanning and reporting so they can deliver better care with less stress.