The Baseline Upper Abdominal Scan
· Fasted patient – 6 to 8 hours
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· Survey ROI for gross pathology – patient supine
· Examination must not be limited to just one patient position
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the upper abdomen. These can be reduced or extended, depending on the pathology seen.
Images
· Scan through from the xyphoid to the umbilicus in transverse
· Pancreas : Trans may require multiple images
demonstrate CBD if possible
Sagt pancreas head
· Para Aorta : Long demonstrate the SMA branching
measure distal segment
· Liver : Trans left lobe – portal vein
right/left lobe – hepatic veins (playboy sign)
right lobe – right hepatic vein
right lobe – portal vein
right lobe – dome/high
Sagt left lateral lobe
lateral left lobe with caudate lobe (include IVC)
right lobe with whole diaphragm at level of GB
right lobe with whole diaphragm at level of right kidney
measurement : mid-clavicular
· Gall bladder : Long demonstrate neck and fundus
demonstrate in at least two planes and with patient in more than one position
Trans dual screen – neck and fundus
measure wall thickness at fundus (portion closest to the transducer)
· Common : Long proximal and distal portions
Bile Duct measure maximum diameter
· Right kidney : Long liver and kidney echotexture comparison
bipolar measurement (horizontal kidney)
must include both upper and lower poles
may require multiple images
Trans upper, mid (show renal pelvis) and lower poles
· Left kidney : as per right kidney
echotexture comparison with the spleen
· Spleen : Coronal measurement
Trans include splenic hilum
Scan through the gallbladder again with the patient standing upright.
Renal ultrasound
· Fasted patient – 6 to 8 hours
· Full bladder imperative
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· Examination must not be limited to just one patient position
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the renal system. These can be reduced or extended, depending on the pathology seen.
Images
· Bladder
Sagt left and right lateral aspects (scan through)
Mid - measurement
Trans superior and inferior (scan through)
Jets
Mid – measurement
Male
Prostate
Mid-sagittal measurement
Trans measurement
Post mictuarition bladder volume
Female
Post mictuarition bladder volume
· Right kidney : Long bipolar measurement
Parenchymal measurement
include both poles – multiple images
include right lobe liver
Trans upper, mid and lower poles
· Left kidney : Long bipolar measurement
Parenchymal measurement
include both poles – multiple images
include spleen
Trans upper, mid and lower poles
Female Pelvic Ultrasound
· Explanation of procedure to patient.
· Determine patient clinical history
· Previous surgery – myomectomy, oophrectomy etc
· Children? How many? Para and Grava to be recorded
· LNMP ?regularity
· Oral contraception
· System configuration presets established
· Survey performed in both planes – must include both fossae
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the upper abdomen. These can be reduced or extended, depending on the pathology seen.
Images
· Uterus : Sagt include bladder
Zoom in
right and left lateral views (scan through)
midline length and height
Trans include bladder (midline)
Zoom in
superior and inferior (scan through)
measure width
cervix – Nabothian cysts
· Endometrium zoomed sagt with measurement
Note stage of cycle
Align from vagina to fundus
· Right ovary : Long zoomed with measurements
Trans measurement
· Left ovary : as per right ovary
· Left and right adnexa
· Sagittal left and right kidney
· The scan may proceed to transvaginal if indicated.
· It is important to precede the transvaginal scan with all measurements and findings recorded from the trans abdominal scan. Improved image quality is not guaranteed on transvaginal scanning.
· Disinfection technique to be practiced.
· Patient consent necessary.
Thyroid ultrasound
· Hyperextend the patient’s neck by requesting the patient to lie in supine, placing the shoulders above a small pillow
· Determine patient clinical history.
· Explanation of procedure to patient.
· System configuration presets established
· The standard images recommended below are to reflect the sonographers systematic approach for a complete assessment of the renal system. These can be reduced or extended, depending on the pathology seen
Images
· Right lobe: Trans: Upper pole
Middle pole (measure width and height)
Lower pole
Sagt: Measure length
Assess vascularity with Colour Doppler
Scan through the right lateral neck along the neck vessels to identify the presence of lymph nodes. Document if seen
· Left lobe: As per the right lobe
· Isthmus: Trans: Measure height
· Whole thyroid gland
2nd Trimester Obstetric Scan
1. Fetal number
2. Assess fetal viability and position
3. Assess entire uterus and maternal adnexa
4. Cervix – length, open/closed
5. Placenta – localization, placenta edge (from os), placenta cord insert
6. Biometry – BPD, HC, AC, FL
7. Brain/head :
- Falx, Cavum septum pellucidum, Skull bone
- Lateral ventricles, choroid plexus
- Cerebellum, cisterna magna, nuchal thickness
- Orbits
- Nose & lips
8. Heart (assess whenever the fetus is in a favourable position):
- 4 chambered heart – heart position, axis, chamber size
- Intraventricular septum
- Mitral valve, Tricuspid valve
- Right and Left outflow tracts
- 3 vessel view
- Heart rate
9. Diaphragm
10. Stomach/situs
11. Cord insertion/abdominal wall
12. 3VC
13. Bladder
14. Kidneys (trans & sagt)
15. Spine (trans & sagt/coronal)/skin line
16. Limbs
- Upper and lower limbs (12 long bones)
- Hand & feet
17. Amniotic fluid volume
18. Reassess cervix before completing the examination
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