Ultrasound
Table of Contents
Page No.
Transplants
Renal Transplant 5
Pancreas Transplant 6
Liver Transplant 7
Pre-Liver Transplant Sonography of Abdomen 8
Ascites Search:
Limited Abdomen for Ascites Search 9
FAST Scan for Fluid Search in Patients with Acute Blunt Abdominal Trauma 9
Abdomen
Liver 10
Biliary (Gallbladder, Biliary Ducts) 11
Pancreas 12
Spleen 13
Retroperitoneum 14
Renal 15
Complete Abdomen 16
Abdominal Aorta 17
Right Lower Quadrant (Rule Out Appendicitis) 18
Pelvis
Male Pelvis/Bladder 19
Scrotum 20
Prostate-Transrectal 21
Female Bladder 22
Female Pelvis (Non-Pregnant) 23
Pregnancy
First Trimester Pregnancy 25
Second and Third Trimester Pregnancy 26
Attached: Amniotic Fluid Index Values between pp. 27-28
Page No.
Chest 28
Thyroid (Parathyroid) 29
Pylorus 30
Brain 31
Hips 32
Spine 33
Soft Tissue Mass 34
Ultrasound Guidance for Interventional Procedures 35
Renal Transplant
A. Preparation: None
B. Real-time scanning:
1. Assess size of kidneys, echogenicity, corticomedullary differentiation, masses, scarring, and calcifications
2. Check collecting system for hydronephrosis, wall thickening
3. With color Doppler, evaluate pattern of vascularity
4. Look for adjacent fluid collections (perirenal and in pelvis)
C. Routine renal images as per Renal Protocol (include sagittal, transverse and anteroposterior measurements
D. Pulsed Doppler with angle correction, if possible, of main renal artery and vein
E. Anastomosis of renal vessels to iliac vessels with Doppler of main renal artery and vein
F. Three images with Doppler tracings of intrarenal arteries with calculation of resistive indices (black and white and color images) in upper, mid and lower poles
G. Power Doppler image of kidney in sagittal
H. Sagittal and transverse images of bladder area. If one day post-op, do not clamp Foley
I. Post void of bladder/pelvis
Pancreas Transplant
A. Preparation: None
B. Real-time scanning:
1. Assess size, echogenicity
2. Look for adjacent fluid collections
3. With color Doppler, assess overall vascularity
4. Look carefully for any thrombus in splenic artery/vein
C. Routine pancreas images to include splenic artery and vein. In A-P plane, measure head, body, tail. Also measure pancreatic duct.
D. Three Doppler tracings with resistive indices of intrapancreatic vessels in head, body and tail. Doppler tracings of splenic artery and vein.
E. Document vascular anastomosis
Liver Transplant
A. Preparation: NPO after
B. Follow complete Liver
Protocol
C. Using a combination of color and pulsed Doppler, document direction and flow in:
1. Common hepatic artery - with angle correction
2. Main portal vein
3. Left and right portal branches in the liver
4. Hepatic veins (right, middle and left)
5. Splenic vein near portal junction and splenic hilum, splenic artery
6. IVC – intrahepatic
D. Perform a realtime search of the rest of the abdomen, but only document abnormalities, e.g., pleural effusion, hydronephrosis.
Pre-Liver Transplant Sonography
of Abdomen
A. Preparation: NPO after
B. Follow Liver
Transplant Protocol
C. Include routine Abdominal US
Protocol
D. Supplement with extra images to complete protocol for ascites check
E. Specifically search for and document any varices with duplex and/or color Doppler.
Ascites Search
I. Limited Abdomen for Ascites
A. Preparation: NPO after
B. Realtime scanning:
1. Search through abdomen and pelvis with specific attention to dependent areas (Morrison's pouch, both flanks, cul-de-sac and lesser sac)
C. Images:
1. Morrison's pouch - longitudinal and transverse
2. Liver/diaphragm in sagittal
3. Spleen/diaphragm in coronal longitudinal
4. Spleen/left kidney region in transverse and coronal longitudinal
5. Both flanks in sagittal
6. Pelvis cul-de-sac in transverse and sagittal
II. FAST Scan for Fluid Search in Patients with Acute Blunt Abdominal Trauma
A. Preparation: None
B. Realtime scanning:
1. Search through abdomen, pelvis, lung bases (adjacent pleural spaces), and pericardium with specific attention to dependent areas.
C. Images:
1. Morrison's pouch - longitudinal
2. Liver/diaphragm - sagittal
3. Spleen/diaphragm - longitudinal
4. Spleen/left kidney - coronal
5. Lesser sac - transverse
6. Heart - transverse subxyphoid for pericardial effusion
7. Pelvis cul-de-sac - transverse and sagittal
Liver
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Realtime scanning:
1. Assess the following:
a. Liver size
b. Parenchyma for space occupying lesions
c. Echogenicity
d. Texture
e. Intra and extrahepatic biliary ductal system for size, sludge, stones and/or mass
2. Echogenicity of the liver should be compared to the right kidney
3. Assess diaphragm and hepatic capsule for juxtadiaphragmatic collections
4. Assess for ascites, varices as necessary
B. Sagittal images to include:
1. Left lobe of liver, aorta and diaphragm
2. Quadrate lobe of liver, IVC, caudate lobe and diaphragm
3. Medial aspect right lobe of liver and diaphragm
4. Lateral aspect right lobe of liver and diaphragm
5. Lateral inferior aspect of right lobe and right kidney
6. Inferior medial aspect of right lobe and gallbladder
C. Transverse images to include:
1. Left lobe of liver at level of left portal vein
2. Upper aspect of liver at confluence of hepatic veins into IVC
3. Right lobe of liver superior to portal vein
4. Right lobe of liver at level of right portal vein
5. Left lobe of liver at level of left portal vein
6. Right lobe of liver and right kidney at mid pole
7. Right lobe of liver and gallbladder
Biliary (Gallbladder, Biliary
Ducts)
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Realtime examination:
1. Assess gallbladder in sagittal (including neck) and transverse planes:
a. Supine position
b. Left lateral decubitus (erect or prone)
2. Evaluate for:
a. Sludge
b. Calculi (mobility)
c. Polyps
d. Wall thickness
e. Masses
f. Pericholecystic fluid
g. Sonographic Murphy sign
3. Assess liver, especially for biliary ductal dilatation
C. Images:
1. Long axis (sagittal or coronal) taken in left lateral decubitus position
2. Transverse liver images showing:
a. Left lobe at level of left portal vein
b. Right lobe at level of right portal vein
c. Left lobe at level of left portal vein
d. Common bile duct with measurement (inner to inner) at level of porta hepatis
e. If possible, an oblique view to show length of common bile duct to level of pancreatic head
f. Pancreas (if possible, include CBD in head) with transverse views of head/body/tail
Pancreas
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Realtime scanning:
1. Assess parenchymal echogenicity
2. Look for:
a. Masses
b. Cysts
c. Fluid collections
d. Calcifications
e. Ductal dilatation
3. Search peripancreatic region for adenopathy
4. Use positional maneuvers and water ingestion as necessary and permissible for visualization of the pancreas
C. Sagittal views:
1. Head / Uncinate
2. Body
3. Tail
D. Transverse views:
1. Include:
a. Head
b. Uncinate
c. Body
d. Tail
2. Image with pancreatic duct, if visible
3. Measure pancreatic duct, if visible
4. Measure CBD in head of pancreas
5. Assess peripancreatic region for adenopathy
Spleen
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Realtime scanning:
1. Size
2. Echogenicity
3. Masses
4. Relationship to left pleural space, diaphragm and left kidney
C. Coronal (longitudinal): Three images to show:
1. Medial aspect
2. Lateral aspect
3. Measurement of long axis (include splenic hilum on film with maximal length)
Note: If possible, include image with
spleen and left kidney
D. Transverse: Three images:
1. Superior aspect
2. Mid aspect
3. Inferior aspect
Retroperitoneum
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Realtime scanning:
1. Adenopathy, collections, aneurysms, masses
C. Transverse views:
1. Celiac axis
2. SMA origin / portal confluence
3. Origins of renal arteries, if possible
D. Sagittal views of aorta and IVC from diaphragm to bifurcation as possible
E. Coronal longitudinal view of:
1. Spleen/left kidney/aorta
2. IVC (for adrenal glands)
Renal
A. No preparation
B. Realtime scanning:
1. Assess the following:
|
a. Echogenicity (relative to liver/spleen) |
f. Cysts |
|
b. Corticomedullary differentiation |
g. Calcifications |
|
c. Contour |
h. Hydronephrosis |
|
d. Scarring |
i. Perinephric collections |
|
e. Masses |
|
2. Use color/pulsed Doppler as necessary, e.g., suspicion of pyelonephritis, differentiate collecting system from vessel.
C. Right Kidney
1. Liver and right kidney coronal longitudinal
2. Right kidney longitudinal (measure length)
a. For infants and children: Obtain additional length measurement in posterior sagittal plane
3. Right kidney transverse
a. Upper pole
b. Mid-pole (measure width)
c. Lower pole
D. Left Kidney
1. Spleen and left kidney coronal longitudinal
2. Left kidney coronal longitudinal (measure length)
a. For infants and children: obtain additional length measurement in posterior sagittal plane
3. Left kidney transverse
a. Upper pole
b. Mid-pole (measure width)
c. Lower pole
E. Image bladder based on clinical history and pertinent findings on ultrasound
Complete Abdomen
A. Preparation:
1. Adults: NPO after
2. Children
> 1 yr: NPO after
3. Infants 6-12 mos: 6 hour fast
4. Infants < 6 mos: 3-4 hour fast
B. Use protocols for:
1. Liver
2. Biliary
3. Pancreas
4. Retroperitoneum
C. Include longitudinal image of each kidney with long axis measurement
D. Include longitudinal image of spleen with length measurement
E. Add Complete Renal and Spleen Protocols if these organs are ordered or an abnormality is detected
Abdominal Aorta
A. Preparation: NPO after
B. Realtime scanning:
1. Assess size and course of aorta, any aneurysm, intraluminal thrombus, calcific plaques
B. Sagittal images:
1. Entire aorta from level of diaphragm to bifurcation
2. Celiac origin
3. SMA origin
4. Measure AP diameter of aorta proximal, mid and distal levels
C. Transverse images at level of:
1. Proximal (with measurements)
2. Renal artery region
3. Mid (with measurements)
4. Distal (with measurements)
5. Bifurcation
D. If possible, sagittal and transverse images of common iliac arteries (with measurements in one plane)
E. If an aneurysm is present:
1. Measure length and depth on sagittal image
2. Measure depth and width on transverse image
3. Use color Doppler to check for internal thrombus and dissection
4. Measure internal (true) lumen on transverse images
F. Document any paraaortic masses, collections, atherosclerotic plaques
G. Image with color Doppler to screen for any areas of stenosis and further document with pulsed Doppler
Right Lower Quadrant (Rule out
Appendicitis)
A. No preparation
B. Realtime scanning:
1. Attempt to visualize appendix and if so look for appendicolith
2. Attempt to visualize appendix junction with cecum and terminal ileum using highest frequency possible
C. Scan right lower quadrant, particularly the area of maximal tenderness, with a linear or curved linear transducer (7.5-10 MHz) and graded compression
D. If appendix is visualized:
1. Image appendix in transverse and sagittal to the long axis of the appendix
a. Measure maximal cross-sectional diameter on sagittal view
b. On transverse image, measure width and depth
c. Document any periappendiceal fluid, appendicolith and/or disruption of mucosal stripe
d. Check pelvis for fluid
E. If appendix is not visualized:
1. Take representative images to show:
a. Psoas muscle
b. Cecum
c. External iliac vessels
2. If patient is female and this scan is negative, proceed with a Pelvic sonogram
3. Regardless of patient's gender, if appendix is negative, check right kidney and gallbladder
Male Pelvis/Bladder
A. Preparation: 32 oz. fluid one hour prior to exam
B. Transverse using bladder as sonic window
1.
2. Mid
3. Inferior
4. Measure width of prostate
5. Image seminal vesicles
6. Right and left angled views lateral walls of pelvis
C. Sagittal
1. Mid
2. Left
3. Right
4. At least one sagittal view to include prostate with sagittal and AP measurements and measurement of bladder wall thickness
Note: For bladder examination: If indicated, add transverse and sagittal
postvoid views of bladder to document post-void
residual (measurements should include W x L x D).
Scrotum
A Use
highest frequency linear scanhead routinely
1. May need step-off pad
2. For measurements, may need 5 MHz curved; may require
step-off pad
B. Transverse
scans:
1. From superior to inferior poles
including mediastinum testes.
2. The number of sections depends on the size of the gonads
3. Obtain maximal AP and transverse diameter measurements
4. At least one image shall include portions of both testes for
comparison of echogenicity
C. Sagittal
scans:
1. Three of each testis including maximal length and depth
measurements
2. Include epipididymal head
3. If epididymis is enlarged, obtain views of entire structure
D. Obtain additional views of areas of pathology (e.g., hydrocele, varicocele, hematoma, tumor, cyst)
E. Observe
arterial pulsations in the testicular arteries in all cases of possible torsion
and obtain duplex/color Doppler signals when indicated
F. Obtain
color flow images of both testes and epididymides
Prostate - Transrectal
Examination
A. Preparation: Fleet enema 2 hours prior to exam
B. Coronal: Six or more images to include:
1. Seminal vesicles
2. Base
3. Mid
4 Apex
5. At least one transverse measurement at mid portion of gland
C. Sagittal: Six or more images to include:
1. Right and left portions of the gland
2. Mid gland with posterior urethra
3. Seminal vesicle/prostate junction on both sides
4. At least one measurement in midline of gland including length and depth
D. Extra images of any pathology
E. Calculate volume of prostate gland (L x W x D x 0.523 = volume in cc)
F. Realtime scanning should evaluate the following for echogenicity, symmetry and contour:
1. Prostate gland
2. Seminal vesicles
3. Surrounding periprostatic fat
G. Imaging of the perirectal space that adjoins the prostate gland should be included
H. For US-guided biopsy, obtain a minimum of 3 specimens from right and left side of the gland with additional specimens as indicated by realtime findings and obtain hard copy image of each needle pass.
Female Bladder
A. Preparation: 32 oz. fluid one hour prior to exam
B. Transverse using bladder as sonic window
1.
2. Mid
3. Inferior
C. Sagittal
1. Mid
2. Left
3. Right
4. Sagittal view of urethra
5. At least one sagittal view with measurement of bladder wall thickness
6. Document uterus
D. If indicated, transverse and sagittal postvoid views of bladder with measurements of W x L x D
Note: In patients aged newborn to 16
years, obtain sagittal measurement of uterus and ovaries.
Female Pelvis (Non-Pregnant)
A. Preparation
1. Transabdominal: 32 oz. fluid one hour prior to exam
2. Transvaginal: Empty bladder immediately before study
Note: Patient is given choice of herself or the
technologist or physician inserting the transvaginal
probe.
B. Note on screen:
1. LMP
2. Gravida
3.
4. If post-menopausal - how long?
5. Ask about type of hormone therapy, tamoxifen, etc.
C. May be transabdominal or transvaginal
1. Sagittal:
a. Midline of uterus, including endometrial stripe
b. Measure length and depth of uterus
c. Midline to include cervix and vaginal stripe
d. Right - sagittal view of right ovary with length and AP measurements
e. Right - adnexal region
f. Left - sagittal view of left ovary with length and depth measurements
h. Left - adnexal region
2. Transverse:
a. Cervix, cul-de-sac
b. Body and fundus images to include width measurement
c. Right ovary and adnexa with width measurement of ovary
d. Left ovary and adnexa with width measurement of ovary
e. If there is any pelvic mass (adnexal or uterine) or collection:
sagittal view of each kidney to check for hydronephrosis
D. Evaluate endometrium for thickness, echogenicity and location within uterus
F. In evaluation of the ovaries, the following should be assessed:
1. Size
2. Shape
3. Contour
4. Echogenicity
G. Surrounding adnexal regions should be scanned to document any masses
H. Check cul-de-sac for any fluid
I. Check bladder wall for irregularity and areas of thickening
Pregnancy - First Trimester
A. Preparation:
1. Endovaginal: Empty bladder just prior to exam
2. Transabdominal: 32 oz. fluid one hour prior to exam
B. Note on screen:
1. LMP
2. Gravida
3.
C. Midline sagittal views
1. Uterus
2. Cervix
D. If early pregnancy, document gestational sac either adjacent to endometrial stripe or with double sac sign
E. Transverse views of uterus to include:
1. Cervix / cul-de-sac
2. Gestational sac
F. Gestational sac with length, width and height measurements
G. At least three crown rump length measurements, when possible
H. Images of yolk sac, amnion
I. M-mode of cardiac activity, if possible
J. Anatomy images as they become apparent when embryo/fetus is mature enough
|
1. Cranium |
5. Midgut herniation into cord |
|
2. Choroid plexuses |
6. Extremities |
|
3. Spine |
7. Fluid in stomach |
|
4. Cord and insertion |
8. Nuchal translucency (measure in sagittal view of embryo) |
K. Document motion of body/extremities
L. Sagittal and coronal images of ovaries with measurements and documentation of any pathology
Pregnancy - Second and Third
Trimesters
A. No preparation
B. Note on screen:
1. LMP
2. Gravida
3.
C. Sagittal images
1. Lower uterine segment showing:
a. Internal cervical os
b. Cervix
c. Vagina
d. Fetal lie
2. Sagittal image of fundus
3. Further sagittal and/or transverse images to document fully:
a. Fetal lie
b. Placental location
c. Level of amniotic fluid - take appropriate images for amniotic fluid index if requested or if levels of amniotic fluid appear abnormal (see table, attached)
D. Cranium
1. Cerebral ventricles at level of atria
2. Axial image of cerebellar hemispheres and cisterna magna with measurement of depth of cisterna magna
3. Nuchal skin thickness
E. Spine
1. Images of complete spine in sagittal or coronal, as necessary
2. Three transverse images:
a. Cervical
b. Thoracic
c. Lumbosacral
F. Heart
1. Four chamber view
2. M-mode
3. Outflow tracts if possible
G. Stomach
H. Urinary bladder
I Kidneys
J. Umbilical cord insertion and 3 vessel cord
K. Face – with attention to palate, nose, eyes
L. During realtime scanning: Assess fetal wellbeing
1. Movement of trunk and extremities
2. Tone
3. Respiratory motion
M. Measurements: Two each of:
1. Biparietal diameter (outer to inner)
2. Head circumference
3. Abdominal circumference
4. Femur
N. Using software packages, print out composites of:
1. Measurements
2. Estimated gestational age and weight
Chest
A. Prerequisite: Chest radiographs must be available for review prior to sonography
B. Appropriate sagittal / coronal and transverse views of one or both hemithoraces.
Label images regarding which surface is being scanned, scanning plane, locations (e.g., superior, inferior), and position of patient (e.g., erect).
C. Document fluid, atelectasis and/or consolidation.
D. When necessary, mark for subsequent thoracentesis with patient in appropriate position.
E. When necessary, observe diaphragmatic motion.
Thyroid (Parathyroid)
A. Use highest frequency linear transducer available. For large gland, step-off with curvilinear high frequency probe may be necessary for global imaging and measuring the gland.
B. Transverse:
1. Three views of each lobe:
a.
b. Mid
c. Inferior
2. Isthmus to be included on at least one view
C. Sagittal:
1. Three views of each lobe:
a. Medial
b. Mid
c. Lateral
D. AP, transverse and length measurement
E. Take additional views and measurements of any pathology
F. Parathyroid glands:
1. Search carefully in both sides of the neck for usual (posterior to thyroid gland) and unusual (near neck vessels, etc.) locations of the parathyroid glands
2. If enlarged parathyroid glands are found, document location and measurements
Pylorus
A. Preparation
1. NPO 3 hours prior to exam
2. Use highest frequency scanhead available, preferably 10 MHz or 7.5 MHz phased array or curvilinear
B. Using
the head of the pancreas, gall bladder and gastric antrum as landmarks:
1. Identify the region of
the pylorus
2. Obtain long and short axis
views
3. Indicate the
measurements of the channel length and the muscle thickness
C. If
the pylorus is obscured by excess gas and retained gastric contents:
1. Call the radiologist to
pass a nasogastric tube for aspiration of the stomach
2. When the stomach is
empty, repeat "B" (above)
D. Place
the infant in a right prone oblique position:
Allow him/her to drink approximately 30 cc of D5W, via a bottle and
nipple or hand inject via NG tube if one is in place during sonographic
observation
E. Turn
the baby into a supine or a partial left posterior oblique position:
1. Obtain long and short
axis views
2. Measure the channel
length (abnormal if > 1.4 cm)
3. Measure muscle wall
(abnormal if > 4 mm)
4. Obtain measurement of
cross sectional diameter (should be < 1.5 cm)
F. If
there is evidence of hypertrophic pyloric stenosis:
Visualize the muscle shoulders in the region of the antrum and the base
of the duodenal bulb and observe whether or not the pyloric channel opens to
allow passage of fluid.
G. If
there is any question:
Allow the infant to rest for 10 minutes with no one scanning or
palpating the pyloric area, and then examine the channel again for evidence of
opening.
H. If
a nasogastric tube is in place at the conclusion of the study: Aspirate the
stomach
I. If
the infant has hypertrophic pyloric stenosis, obtain single coronal view of
each kidney
Brain
A. Coronal
scans:
1. Frontal horns of lateral ventricles.
2. Lateral ventricles at level of lateral and 3rd ventricles.
3. Lateral ventricles with body of caudate nuclei laterally and
thalami lying inferiorly with choroid plexus seen in the groove between. Include Sylvian
fissures and hippocampal gyri.
4. Quadrigeminal cistern and
cerebellum.
5. Lateral ventricles with choroid plexus.
6. Far posterior view of
occipital lobes
B. Additional
views:
1. Right parasagittal view including caudo-thalamic groove.
2. Right parasagittal view of lateral
ventricle showing choroid plexus.
3. Far right lateral parasagittal
view of brain parenchyma.
4. Midline sagittal
5. Left parasagittal view including caudo-thalamic groove.
6. Left parasagittal view of lateral
ventricle showing choroid plexus.
7. Far left parasagittal view of
brain parenchyma.
8. Coronal magnification view of extra-axial fluid space,
including only peripheral brain structures (use next highest frequency)*
9. Coronal magnification
view scanning through inferior frontal horns seen separated by the cavum septum
pellucidi, to view extra-axial fluid space (use next highest
frequency)*
* = measure
cranial-cortical depth, sino-cortical depth, and
width of interhemispheric fissure
Note: For patients with ventricular
shunt tubes, additional oblique views via anterior fontanelle
and/or axial views should be obtained, if shunt tube and its tip are not
visualized on routine scans.
Hips
A. For
Infants with Developmental Dysplasia of Hip (DDH)
1. Preparation:
Feed baby 3 hours before scheduled US scan, so a feeding can be given
during exam to calm the infant
2. Transducer:
Use highest possible frequency linear probe that permits optimal
penetration of soft tissues and hip joint (7.5 MHz for 0-3 months, 5 MHz for
3-7 months, 3.0 MHz for > 7 months).
3. Images:
a. Transverse/flexion
i. Without stress
ii. Adduction
push
iii. Abduction
b. Coronal/flexion
i. Without stress
ii. Adduction
push over depth of acetabulum
iii. Adduction
push over posterior lip
iv. Abduction
Note:
You may add coronal neutral view at rest and/or with stress
Note: For
babies in harness, omit stress maneuvers until hip is stable and weaning
process can begin.
B. For
Hip Effusion in All Age Patients:
1. Anterior sagittal and
transverse scans of hip in question with comparison views of opposite hip. Measure depth of joint
space bilaterally on comparable views and compare.
2. Coronal longitudinal
and transverse scans of hip in question with comparison views of opposite
hip. Measure depth of
joint space bilaterally on comparable views.
Spine
A. Obtain
AP and lateral plain radiographs prior to sonogram if required by radiologist
B. Use
highest frequency linear scanhead with step-off, if
necessary
C. Sagittal
views
1. Area of interest
2. Inferiormost
aspect of spinal cord, including:
a. Conus
medullaris - note vertebral level on image
b. Cauda equina
c. Sacral canal
3. Be
sure to image skin surface, including over area of suspicion (e.g., dimple)
D. Sequential
transverse scans
Soft
Tissue Mass
A. Use
the highest frequency linear scanhead that allows for
penetration of the adjacent structures.
At times, step-off and/or curvilinear probe is necessary. Use lower frequency transducer for deeper
abnormalities near bone.
B. Obtain
sagittal and transverse scans including measurements of the mass
C. If
vascular structures are displaced or encased, label them and use Doppler, if
necessary
Ultrasound Guidance for Interventional
Procedures
A. Preparation
1. Instructions to be given by physician performing procedure, who is responsible for arranging sedation and/or anesthesia and assessing clotting factors
B. Percutaneous Techniques
1. Transducer selection
a. Use appropriate sector, linear, phased array, or curvilinear scanhead, with biopsy attachment when necessary
2. Procedure
a. Scan area of interest prior to scheduling interventional procedure to determine feasibility
b. Wash transducer with alcohol or ultrasound antiseptic solution
c. Using sterile gel, place sterile glove over the scanhead and maintain sterile technique
d. When indicated, observe monitor during passage of needle or mark skin site while noting depth from skin surface to periphery of target or the distance to center of area of interest
e. Obtain hardcopy images during passage of the needle (and videotape if desired), and if realtime guidance was used. When necessary, re-scan post-biopsy to document presence or absence of complication
C. Intraoperative Techniques
1. Ultrasound transducers should be thoroughly washed with antiseptic
2. Choose appropriate transducer
3. Use sterile gel on scanhead
4. Place long sterile microscope sleeve onto transducer and secure with sterile rubber bands
5. Obtain hardcopy images of all pertinent observations and videotape if desired.