Complete abdominal ultrasound scanning protocol Copyright © 2010 The Academy of Veterinary Imaging

Complete abdominal Complete abdominal ultrasound scanning protocolultrasound scanning protocol

Copyright © 2010 The Academy of Veterinary Imaging

The Academy of Veterinary ImagingThe Academy of Veterinary Imaging2409 Avenue J, Suite C

Arlington, TX 76006(800) 268-5354 opt 4

www.soundeklin.com/academy-of-imaging

http://www.soundeklin.com/academy-of-imaging

http://www.soundeklin.com/academy-of-imaging

IntroductionIntroduction

This program demonstrates the scanning planes to perform and the still images to collect to archive a complete abdominal ultrasound exam. Video clips can be saved to supplement the still images. Additional images would be indicated to document any pathology encountered.

Please see the Basic Abdominal Scanning Protocol CD if you are just starting to learn abdominal ultrasound. The basic exam focuses on the liver, spleen, kidneys and urinary bladder.

DirectionsDirections• In this program you may view the entire complete abdominal ultrasound exam from start to finish, with or without superimposed ultrasound images, or you may navigate to each organ or each individual image from the corresponding pages.

• You may view abdominal anatomy, probe orientation, screen orientation and image optimization by selecting the appropriate buttons.

• During the entire complete exam with images, the presentation will pause when an ultrasound image appears. When you are finished viewing the image, select the forward arrow button or left click the mouse to continue the exam. The ‘home’ key takes you to the table of contents. The ‘i’ key on the table of contents takes you to the title page.

Entire complete exam with images

Entire complete exam without images

Individual image list

Organs

Table of contentsTable of contents

Abdominal anatomy

Probe orientation

Screen orientation

Image optimizationImages only

ORGANS

IMAGE LISTPage: 1, 2

Right LeftVD abdomenfrom the ventral aspect Liver

Stomach

Spleen

Left kidney

Urinarybladder

Intestines

GB

Adrenals

Rightkidney

Pancreas

Probe orientationProbe orientation

Sagittal plane

Reference marker points

cranially

Transverse plane

Reference marker points to the right

Reference marker

Near field

Far field

Screen orientationScreen orientation

ImageImage optimizationoptimization

LOGIQ P5

LOGIQ 5

LOGIQ Book

Go to:

Transitions

• General info

• Depth

• Frequency

• Auto-optimize

• Focal points

• Gain• Overall gain• TGC

LOGIQ e

LOGIQ 200

General info page 1General info page 1

• During an abdominal ultrasound exam, the ultrasound machine settings should be changed as needed to optimize the image.

• However, please note, when comparing the echogenicity of different organs, all machine settings must be kept the same!!!

Image optimization

P5

L5

LB

Le

L200

General info page 2General info page 2

• Machine settings are most often adjusted when transitioning from one organ to another. Transitions encountered during the basic exam are listed on the ‘Transitions’ page.

• Within the abdominal scan, the ‘Optimize’ button will show how to typically adjust the machine when transitioning to the view in question.

Transitions

Image optimization

P5

L5

LB

Le

L200

DepthDepth

• Starting guidelines:• Large dog: 12-14 cm• Medium dog: 8-10 cm• Small dogs and cats: 6-7 cm

• Adjust as needed throughout scan

Transitions

Image optimization

P5

L5

LB

Le

L200

FrequencyFrequency• High frequency• Better resolution• Less depth

•Lower frequency• Lower resolution • Better for depth

•Starting points:• Large dog liver: 6 MHz• Small dog/cat liver: 8 MHz

Transitions

Image optimization

P5

L5

LB

Le

L200

Auto optimizeAuto optimize

• ‘Personal preference’ button.

• Adds more contrast.

• Try on or off. Chose the setting that looks better to you.

• Auto optimize must be deselected then reselected for every new structure imaged.

Transitions

Image optimization

P5

L5

LB

Le

L200

Focal pointsFocal points

• Improved resolution is seen where the focal points are.

• Place focal points at the region of interest.

• Typically use: –1 focal point with cardiac scanning.–2 with abdominal scanning.

Transitions

Image optimization

P5

L5

LB

Le

L200

GainGain

• Overall gain• May only adjust in beginning of exam. Perhaps may decrease when imaging the urinary bladder.

• TGC• Compensates for beam attenuation (loss of energy as it passes through tissue).

Transitions

Image optimization

P5

L5

LB

Le

L200

LOGIQ P5

Auto optimizeGain

DepthTGC

Focal points

Frequency

Image optimization

Transitions

LOGIQ e

Auto optimize

Gain

Depth

TGC

Focal points

Frequency

Image optimization

Transitions

LOGIQ 5LOGIQ 5

TGCAuto

optimize

Gain

Depth

Focal points

Frequency(press to toggle)

Image optimization

Transitions

LOGIQ BookLOGIQ Book

Auto optimizeGain

Depth

TGC

Focal points

Frequency

(toggle)

Image optimization

Transitions

LOGIQ 200LOGIQ 200

TGC

Depth

Gain

Focal points

Auto optimize

Frequency

Image optimization

Transitions

TransitionsTransitions

• Start liver• Liver to splenic head (sagittal)• Splenic head to body/tail of spleen• Body of spleen to splenic head (tx) • Splenic head (tx) to LK• LK to left adrenal• Left adrenal to UB• UB to RK• RK to right adrenal/pancreas/GI

Image optimization

Start liverStart liver

Image optimization

• Depth increase or decrease

• Frequency usually decrease

• Auto-optimize on or off

• Focal points (2) • Gain• Overall gain adjust

• TGC in middle or bottom levers to right

Transitions Scan

Liver to splenic head (sagittal)Liver to splenic head (sagittal)

• Depth increase

• Frequency increase


• Focal points • Gain•Overall gain•TGC bottom levers same or to middle

ScanImage optimization Transitions

Splenic head to body/tail of spleenSplenic head to body/tail of spleen

• Depth decrease

• Frequency same


• Focal points move up

• Gain•Overall gain•TGC same or top levers to right


Body of spleen to splenic head (tx)Body of spleen to splenic head (tx)

• Depth increase

• Frequency same


• Focal points move down

• Gain•Overall gain•TGC same or top levers to center


Splenic head (tx) to LKSplenic head (tx) to LK

• Depth decrease

• Frequency same or decrease


• Focal points move down

• Gain•Overall gain•TGC same


LK to left adrenalLK to left adrenal

• Depth decrease

• Frequency same or increase


• Focal points move up

• Gain•Overall gain•TGC same


Left adrenal to UBLeft adrenal to UB

• Depth varies

• Frequency same


• Focal points same

• Gain• Overall gain maybe decrease

• TGC top levers to left


UB to RKUB to RK

• Depth varies

• Frequency decrease


• Focal points same

• Gain•Overall gain maybe increase

•TGC top levers to center


RK to right adrenal/pancreas/GIRK to right adrenal/pancreas/GI

• Depth decrease

• Frequency increase


• Focal points move up or down

• Gain•Overall gain•TGC same or top levers to right


OrgansOrgans• Liver• Spleen• Kidneys (Left, Right)• Adrenal glands (Left, Right)• Urinary bladder• Pancreas• Stomach• Intestines• Ovaries (Left, Right), Uterus• Prostate, Testicles

LIVER:Sagittal views

Right lateral, cranial (right liver, diaphragm) Right lateral, caudal (caudate lobe, RK) Right lateral, more toward midline (GB, diaphragm) Midline (common bile duct, PV, CVC) Midline to left lateral (long axis aorta, left HV, left PV, stomach) Left lateral (left liver, head of spleen)

Transverse views Cranial: single view or separate right and left views (liver, diaphragm) Mid: single view or separate right and left views (GB, PVs) Caudal: single view or separate right and left views (CVC, HV, maybe GB) Right lateral from intercostal space

STOMACH: Ventral right (antrum/pylorus) Midline (midbody) Dorsal left (fundus)

SPLEEN:Sagittal views Transverse views Splenic head Splenic head Cranial body Cranial body Mid body (hilus) Mid body (hilus) Tail Tail

LEFT KIDNEY:Sagittal views Transverse views Medial Cranial pole Renal sinus/pelvis Mid (renal sinus/pelvis) Mid Caudal pole Lateral

LEFT ADRENAL GLAND

LEFT OVARY

Individual images, page 1Individual images, page 1

URINARY BLADDER:Sagittal views

Lateral to the right Mid apex Mid trigone Lateral to the left

Transverse views Cranial Mid Caudal (trigone)

SUBLUMBAR REGION: Blood vessels/lymph nodes

UTERUS OR PROSTATE/TESTICLES

RIGHT OVARY

RIGHT KIDNEY:Sagittal views Transverse views Medial Cranial pole Renal sinus/pelvis Mid (renal sinus/pelvis) Mid Caudal pole Lateral

RIGHT ADRENAL GLAND

PANCREAS: Right limb Body Left limb

DUODENUM

MIDABDOMEN: Jejunum Ileum (cats only) Colon

Individual images, page 2Individual images, page 2

ORGANS


ORGANS


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Right lateral, cranialRight lateral, cranial(Right liver, diaphragm)(Right liver, diaphragm)

Optimize

ORGANS


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Right lateral, toward midlineRight lateral, toward midline(GB, diaphragm)(GB, diaphragm)

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Midline Midline (CVC, PV, CBD)(CVC, PV, CBD)

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Right lateral, caudalRight lateral, caudal(Caudate lobe, RK)(Caudate lobe, RK)

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Midline to left lateral (AO, left HV, left Midline to left lateral (AO, left HV, left PV, stomach)PV, stomach)

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Left lateralLeft lateral

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Cranial (liver, diaphragm)Cranial (liver, diaphragm)

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Mid (GB, PVs)Mid (GB, PVs)

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Caudal (CVC, HV, PV, GB)Caudal (CVC, HV, PV, GB)

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IC TX LIVER

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Optimize

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Cranial bodyCranial body

Optimize

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Midbody (hilus)Midbody (hilus)

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TailTail

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TailTail

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Midbody (hilus)Midbody (hilus)

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Cranial bodyCranial body

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Medial Medial (poles symmetrical)(poles symmetrical)

LK

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MedialMedial(renal sinus/pelvis)(renal sinus/pelvis)

Optimize

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Mid sagittal

LK

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Lateral

LK

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Mid (renal sinus/pelvisMid (renal sinus/pelvis

LK

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Cranial poleCranial pole

LK

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Caudal poleCaudal pole

LK

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Optimize

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To L ovary

Skip

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Mid (apex)Mid (apex)

UB

Optimize

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Mid (trigone)Mid (trigone)

UB

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Lateral to the rightLateral to the right

UB

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Lateral to the leftLateral to the left

UB

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CranialCranial

UB

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MidMid

UB

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CaudalCaudal

UB

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To Uterus

To Prostate

To RK

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Medial Medial (poles(polessymmetrical)symmetrical)

RK

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Optimize

RK

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Mid sagittalMid sagittal

RK

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LateralLateral

RK

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Mid (renal sinus/pelvis)Mid (renal sinus/pelvis)

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RK

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Optimize

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Skip

To R ovary

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DUODDUOD

RKRK

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GB

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Stomach

L limb pancL limb panc

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L limb pancL limb panc

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DuodenumDuodenum

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GB

PylorusPylorus

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Stomach (fundus)Stomach (fundus)

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To Ileum (cats only)

Skip

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Sagittal bowelSagittal bowel

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StomachStomach

ColonColon

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Transverse bowelTransverse bowel

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End of scan

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UB

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To Testicles

To RK

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Testicles

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Transverse feline ileum Transverse feline ileum

ColonColon

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Sagittal feline ileumSagittal feline ileumColonColon

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End of scanEnd of scan

Right lateral, cranialRight lateral, cranial

Right lateral, toward midlineRight lateral, toward midline

Midline Midline

Right lateral, caudalRight lateral, caudal

RK

Midline to left lateralMidline to left lateral

Left lateralLeft lateral

CranialCranial

MidMid

CaudalCaudal

liver

Sagittal

Sagittal cranial bodySagittal cranial body

Sagittal midbody (hilus)Sagittal midbody (hilus)

Sagittal tailSagittal tail

Transverse tailTransverse tail

Transverse midbody (hilus)Transverse midbody (hilus)

Transverse cranial bodyTransverse cranial body

Transverse

Medial Medial (poles symmetrical)(poles symmetrical)

LK



LK

LateralLateral

LK

Mid (renal sinus/pelvisMid (renal sinus/pelvis

LK


LK


LK

Mid (apex) and Mid (apex) and vesselsvessels

UB

Mid (trigone)Mid (trigone)

UB

Lateral to the rightLateral to the right

UB

Lateral to the leftLateral to the left

UB

Cranial Cranial transversetransverse

UB

Mid transverseMid transverse

UB

Caudal transverseCaudal transverse

UB

Medial Medial (poles(polessymmetrical)symmetrical)

RK



LateralLateral

RK

Mid (renal sinus/pelvis)Mid (renal sinus/pelvis)


RK


RK

DUOD

RK

R limb pancreasR limb pancreas

GB

Pancreatic bodyPancreatic body

Stomach

L limb pancreasL limb pancreas

L PANCL PANC

DuodenumDuodenum

GBGB

PylorusPylorus

Stomach (fundus)Stomach (fundus)

Tx feline Tx feline ileumileumColonColon

Sagittal felineSagittal felineileumileum

ColonColon

Sagittal bowelSagittal bowel

Transverse bowelTransverse bowel

StomachStomach

ColonColon

UB

Testicles

Documents

Complete abdominal ultrasound scanning protocol Copyright © 2010 The Academy of Veterinary Imaging