Ebook Pocket protocols for ultrasound (2nd edition): Part 1

(BQ) Part 1 book Pocket protocols for ultrasound presents the following contents: Introduction - Purpose and use, image protocol for abnormal sonographic findings, the abdomen, image protocols for full sonographic studies of the abdomen, image protocols for limited sonographic studies of the abdomen.

This page intentionally left blank

Second Edition

Adapted from: Ultrasound Scanning: Principles and Protocols, Third edition

Betty Bates Tempkin, BA, RT(R), RDMS

Ultrasound Consultant Formerly Clinical Director of the Diagnostic Medical Sonography Program

Hillsborough Community College, Tampa, Florida

This page intentionally left blank

11830 Westline Industrial Drive

St Louis, Missouri 63146

ISBN-10: 1-4160-3101-4

Copyright © 2007, 1999 by Saunders, an imprint of Elsevier Inc.

All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or

mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writingfrom the publisher

Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1)

215 239 3804, fax: (+1) 215 239 3805, e-mail: healthpermissions@elsevier.com You may also complete your request on-line viathe Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’

This page intentionally left blank

Previous edition copyrighted in 1999.

ISBN-13: 978-1-4160-3101-7

ISBN-10: 1-4160-3101-4

Acquisitions Editor: Jeanne Wilke

Developmental Editor: Rebecca Swisher

Publishing Services Manager: Pat Joiner

Project Manager: Jennifer Clark

Designer: Amy Buxton

Printed in the United States of America

Notice

Neither the Publisher nor the Author assumes any responsibility for any loss or injuryand/or damage to persons or property arising out of or related to any use of the materialcontained in this book It is the responsibility of the treating practitioner, relying onindependent expertise and knowledge of the patient, to determine the best treatment andmethod of application for the patient

The Publisher

This page intentionally left blank

Wayne C Leonhardt, BA, RT(R), RVT, RDMS

Faculty

Foothill College School of Ultrasound

Los Altos, California;

Staff Sonographer, Technical Director, and

Continuing Education Director

Summit Medical Center

Oakland, California

Scrotum Scanning Protocol; Thyroid and

Parathyroid Glands Scanning Protocols

Maureen E McDonald, BS, RDMS, RDCS

Staff Echocardiographer Adult Echocardiography Instructor and Lecturer Thomas Jefferson University Hospital

Philadelphia, Pennsylvania

Adult Echocardiography Scanning Protocol; Pediatric Echocardiography Scanning Protocol

This page intentionally left blank

Marsha M Neumyer, BS, RVT

Assistant Professor of General and Vascular

Surgery and Director of the Vascular Studies

Section

The Milton S Hershey Medical Center

Pennsylvania State University College of

Medicine

Hershey, Pennsylvania

Abdominal Doppler and Color Flow;

Cerebrovascular Duplex Scanning Protocol;

Peripheral Arterial and Venous Duplex Scanning

Protocols

Betty Bates Tempkin, BA, RT(R), RDMS

Ultrasound Consultant Formerly Clinical Director of the Diagnostic Medical Sonography Program

Hillsborough Community College Tampa, Florida

Scanning Planes and Scanning Methods;

Pathology; Scanning Protocol; Abdominal Aorta Scanning Protocol; Inferior Vena Cava Scanning Protocol; Liver Scanning Protocol; Gallbladder and Biliary Tract Scanning Protocol; Pancreas Scanning Protocol; Renal Scanning Protocol; Spleen Scanning Protocol; Scanning Protocols for Full and Limited Studies of the Abdomen; Female Pelvis Scanning Protocol; Obstetrical Scanning Protocol; Male Pelvis Scanning Protocol; Scrotum Scanning Protocol; Thyroid and Parathyroid Glands Scanning Protocols; Breast Scanning Protocol; Female Pelvis Scanning Protocol

This page intentionally left blank

IMAGE PROTOCOLS FOR FULL SONOGRAPHIC

STUDIES OF THE ABDOMEN 9

I Liver Study with Full Abdomen 11

II Aorta Study with Full Abdomen 42III Inferior Vena Cava Study with Full Abdomen83

IV Gallbladder and Biliary Tract Study with FullAbdomen 119

V Pancreas Study with Full Abdomen 157

VI Renal Study with Full Abdomen 192VII Spleen Study with Full Abdomen 242

This page intentionally left blank

SECTION TWO

IMAGE PROTOCOLS FOR LIMITED

SONOGRAPHIC STUDIES OF THE ABDOMEN

276

I Aorta Study 278

II Inferior Vena Cava Study 291

III Right Upper Quadrant Study 299

IV Gallbladder and Biliary Tract Study 330

V Pancreas Study 358

VI Renal Study 383

VII Spleen Study 407

P A R T IV

The Pelvis 415

SECTION ONE

IMAGE PROTOCOL FOR THE

TRANSABDOMINAL SONOGRAPHIC STUDY OF

THE FEMALE PELVIS 417

I Transabdominal Female Pelvis Study 418

I Transrectal Prostate Gland Study 459

II Scrotum Study 469III Penis Study 516

This page intentionally left blank

SECTION TWO

IMAGE PROTOCOL FOR THE SONOGRAPHIC

STUDY OF THE LATE FIRST TRIMESTER 535

I Late First Trimester Study 536

SECTION THREE

IMAGE PROTOCOL FOR SONOGRAPHIC

STUDIES OF THE SECOND AND THIRD

TRIMESTERS 545

I Second and Third Trimesters Study 546

SECTION FOUR

IMAGE PROTOCOL FOR THE SONOGRAPHIC

STUDY OF MULTIPLE GESTATIONS 591

I Multiple Gestations Study 592

II The Biophysical Profile 595

I Breast Lesion Characterization 620

II Whole Breast Study 623

I Mesenteric Arterial Study 640

II Renal Arterial Study 644III Image Examples of Various Studies 649

SECTION TWO

IMAGE PROTOCOL FOR CEREBROVASCULAR

This page intentionally left blank

SECTION THREE

IMAGE PROTOCOLS FOR PERIPHERAL

ARTERIAL AND VENOUS DUPLEX SCANNING

665

I Lower Extremity Venous Duplex Study 665

II Lower Extremity Peripheral Arterial Duplex

This page intentionally left blank

Introduction: Purpose and

Use

Pocket Protocols is a response to the need for a practical imaging reference to use during

ultrasound examinations This flip-card presentation sits upright on the machine, making

it easy to see and access.

The majority of the image protocols follow the American Institute of Ultrasound in Medicine’s (AIUM) imaging guidelines Any other image protocols are patterned after the AIUM’s suggestions and the authors’ collective experiences.

Pocket Protocols is a reference devoted to documenting technically accurate and

thorough ultrasound image studies for diagnostic interpretation by the physician These comprehensive imaging protocols include image and labeling examples for abdominal,

I

Images are presented in a logical manner and specify the scanning plane and area of interest Every image is accompanied by a gray-scale, color-coded schematic to help identify anatomy.

These reference materials are just that They do not include or endorse the exclusion

of the necessary prerequisites for accomplished scanning skills.

I hope Pocket Protocols serve as a practical reference and imaging standard that helps

sonographers obtain comprehensive, consistent, and technically accurate image tations of ultrasound studies.

represen-Betty Bates Tempkin

Image Protocol for

Abnormal Sonographic

Findings

This section describes a universal imaging protocol for documenting pathology, regardless

of the type All pathology visualized by ultrasound in some way disrupts the normal sonographic pattern of the organ or structure involved and may alter its shape, size, contour, position, or textural appearance Although familiarity with specific diseases and abnormalities is not necessary to document them accurately for physician interpretation,

an understanding of pathological processes and the ways in which they affect pendent body systems can be beneficial.

interde-II

CRITERIA FOR DOCUMENTING ABNORMAL SONOGRAPHIC FINDINGS

a) Survey of the abnormality in at least two scanning planes following the survey of the

primary area(s) of interest (This is not to say that the abnormality is not evaluated

as the area of interest is evaluated, but it ensures that a total evaluation is made of a structure, not just its abnormal part.)

b) Volume measurement of the abnormality.

c) High- and low-gain technical setting images of the abnormality in at least two

scanning planes.

REQUIRED IMAGES

1 Longitudinal image of the abnormality with measurement from the most superior to

most inferior margin.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”

2 Same image as Number 1, without measurement calipers.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”

3 Axial image of the abnormality with measurement from the most anterior to most

posterior margin and from the most lateral to lateral or lateral to medial margin.

SCANNING TIP: Required images of abnormal findings follow the study’s required images of the area(s) of interest.

SCANNING TIP: In cases where the origin of an abnormality cannot be determined, adjacent structures must be noted for a site location Look for bright, echogenic

interfaces where fat separates adjacent structures.

4 Same image as Number 3., without measurement calipers.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”

5 Longitudinal image of the abnormality with high-gain technique.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”, HIGH

GAIN

6 Axial image of the abnormality with high-gain technique.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”, HIGH

GAIN

7 Longitudinal image of the abnormality with low-gain technique.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”, LOW

GAIN

8 Axial image of the abnormality with low-gain technique.

L A B E L E D : “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”, LOW

GAIN

I. Liver Study with Full Abdomen

II. Aorta Study with Full Abdomen

III

III Inferior Vena Cava Study with Full Abdomen

IV. Gallbladder and Biliary Tract Study with Full Abdomen

V. Pancreas Study with Full Abdomen

VI. Renal Study with Full Abdomen

VII Spleen Study with Full Abdomen

III Right Upper Quadrant Study

IV. Gallbladder and Biliary Tract Study

V. Pancreas Study

VI. Renal Study

VII Spleen Study

II. Aorta Study with Full Abdomen

III Inferior Vena Cava Study with Full Abdomen

IV. Gallbladder and Biliary Tract Study with Full Abdomen

V. Pancreas Study with Full Abdomen

VI. Renal Study with Full Abdomen

VII Spleen Study with Full Abdomen

1. Longitudinal image of the left lobe of the liver to include the inferior margin and the aorta.

Posterior

Anterior

Splenic artery

Inferior Superior Bowel

Pancreas bodyLeft lobe

Aorta

Spine

SplenicveinDiaphragm

L A B E L E D : LIVER SAG LT LOBE

2. Longitudinal image of the left lobe of the liver to include the diaphragm and

caudate lobe.

Caudate lobe

Hepaticvein

Posterior

Anterior

Inferior Superior Left lobe

SplenicveinDiaphragm

Inferiorvenacava

Ligamentumvenosum

L A B E L E D : LIVER SAG LT LOBE

3. Longitudinal image of the right lobe of the liver to include the inferior vena cava where it passes through the liver.

Caudate lobe

Hepaticvein

Posterior

Anterior

Inferior Superior

IVC

Bowel

Right lobeRight lobe

Right renal artery

Hepaticvein

Portal veinStomach

Diaphragm

L A B E L E D : LIVER SAG RT LOBE

4. Longitudinal image of the right lobe of the liver to include the main lobar fissure, gallbladder, and portal vein.

Posterior

Anterior

Inferior Superior

Right lobe

Portalvein

BowelGallbladder

Diaphragm

Main lobarfissure

Throughtransmission

L A B E L E D : LIVER SAG RT LOBE

5. Longitudinal image of the right lobe of the liver to include part of the right kidney for parenchyma comparison.

Posterior

Anterior

Inferior Superior

Right lobe

L A B E L E D : LIVER SAG RT LOBE

6. Longitudinal image of the right lobe of the liver to include the dome and adjacent pleural space.

Posterior

Anterior

Inferior Superior

Right lobe

Diaphragm

Diaphragmaticmotion

DomePleural

space

L A B E L E D : LIVER SAG RT LOBE

Left lobe

Caudate lobe

AortaIVC

L A B E L E D : LIVER TRV LT LOBE

8. Axial image of the left lobe of the liver to include the ligamentum teres.

SCANNING TIP: Depending on liver size and shape, it may be possible to document

an axial image of the left lobe that includes both the lateral margin and ligamentum

Posterior

Anterior

Left Right

Portalvein

Sidewall shadow

Spine

Splenicvein

PancreasLeft lobe

Left renalvein

Superiormesentericartery

L A B E L E D : LIVER TRV LT LOBE

9. Axial image of the right lobe of the liver to include the hepatic veins.

Posterior

Anterior

Left Right

IVC

Left hepaticvein

Right lobeMiddle

hepatic veinRighthepatic vein

Diaphragm

L A B E L E D : LIVER TRV RT LOBE

10 Axial image of the right lobe of the liver to include the right and left branches of the

portal vein.

Posterior

Anterior

Left Right

Left portalvein

IVC

Aorta

Right lobe

Rightportal vein

Right kidney

Spine

L A B E L E D : LIVER TRV RT LOBE

11 Axial image of the right lobe of the liver to include the right lateral inferior lobe.

Posterior

Anterior

Left Right

Right lobe

Right kidney

GallbladderBowel

L A B E L E D : LIVER TRV RT LOBE

12 Axial image of the right lobe of the liver to include the dome and adjacent pleural

Right lobe

Pleuralspace

Diaphragm

L A B E L E D : LIVER TRV RT LOBE

Superior

Stomach

SplenicveinProximal and Middle aorta

SCANNING TIP: The images of the aorta may be included with the liver images if the aorta is well visualized.

L A B E L E D : AORTA SAG MID

Leftrenalartery

Inferior Vena Cava (IVC)

LONGITUDINAL IMAGE

15 Longitudinal image of the distal and middle inferior vena cava.

SCANNING TIP: The images of the inferior vena cava (IVC) may be included with the liver images if the IVC is well visualized.

Posterior

Anterior Hepatic

artery

Inferior Superior

Distal and Middle IVCVertebrae

Smallbowelshadow

Portalvein

Liver

L A B E L E D : IVC SAG DISTAL

Right hepatic vein

Left Right

Liver

L A B E L E D : IVC TRV DISTAL

Gallbladder and Biliary Tract

LONGITUDINAL GALLBLADDER IMAGE

17 Long axis image of the gallbladder.

Posterior

Anterior

Gallbladder

Inferior Superior

Small bowelThroughtransmissionPortal vein

Diaphragm

IVCLiver

L A B E L E D : GB SAG LONG AXIS

AXIAL GALLBLADDER IMAGE

18 Axial image of the gallbladder fundus.

Posterior

Anterior

Gallbladderfundus

Left Right

Sidewallshadow

IVC

Liver

L A B E L E D : GB TRV FUNDUS

LONGITUDINAL BILIARY TRACT IMAGES

19 Longitudinal image of the common hepatic duct.

Posterior

Anterior Gallbladder

Inferior Superior

Hepatic arteryIVC

Liver

Commonhepatic duct

Portal vein

L A B E L E D : SAG CHD

SCANNING TIP: Biliary tract images may be magnified to aid interpretation.

SCANNING TIP: The common hepatic duct (CHD) image may be omitted if the CHD was visualized on the gallbladder long axis image.

20 Longitudinal image of the common bile duct with anterior to posterior measurement

at the widest margins of the lumen.

Posterior

Anterior Duodenum

Inferior Superior

Hepatic artery

Liver

Commonbile duct

Portal vein

L A B E L E D : SAG CBD

21 Same image as Number 20 without measurement calipers.

L A B E L E D : SAG CBD

LONGITUDINAL IMAGES

22 Long axis image of the pancreas to include as much head, uncinate, neck, body, tail,

and pancreatic duct as possible.

Pancreaticduct

Left kidney

Anterior

Left Right

Posterior

Body

TailSplenicveinAorta

Right renalarteryIVCHead

SpineDuodenum

Commonbile duct

duodenalartery

Gastro-Confluence

of superiormesenteric veinand splenic vein

Neck

23 Longitudinal image of the pancreas head to include the uncinate process and

common bile duct (if bile-filled).

Superiormesentericartery

Liver

Splenic vein

Left renalartery

Anterior

Left Right

Posterior

Neck

Rightkidney

LeftkidneyAorta

Superiormesenteric vein

Commonbile duct

GallbladderDuodenum

L A B E L E D : PANC TRV HEAD