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
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
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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
• Auto-optimize on or off
• 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
• Auto-optimize on or off
• Focal points move up
• Gain•Overall gain•TGC same or top levers to right
ScanImage optimization Transitions
Body of spleen to splenic head (tx)Body of spleen to splenic head (tx)
• Depth increase
• Frequency same
• Auto-optimize on or off
• Focal points move down
• Gain•Overall gain•TGC same or top levers to center
ScanImage optimization Transitions
Splenic head (tx) to LKSplenic head (tx) to LK
• Depth decrease
• Frequency same or decrease
• Auto-optimize on or off
• Focal points move down
• Gain•Overall gain•TGC same
ScanImage optimization Transitions
LK to left adrenalLK to left adrenal
• Depth decrease
• Frequency same or increase
• Auto-optimize on or off
• Focal points move up
• Gain•Overall gain•TGC same
ScanImage optimization Transitions
Left adrenal to UBLeft adrenal to UB
• Depth varies
• Frequency same
• Auto-optimize on or off
• Focal points same
• Gain• Overall gain maybe decrease
• TGC top levers to left
ScanImage optimization Transitions
UB to RKUB to RK
• Depth varies
• Frequency decrease
• Auto-optimize on or off
• Focal points same
• Gain•Overall gain maybe increase
•TGC top levers to center
ScanImage optimization Transitions
RK to right adrenal/pancreas/GIRK to right adrenal/pancreas/GI
• Depth decrease
• Frequency increase
• Auto-optimize on or off
• Focal points move up or down
• Gain•Overall gain•TGC same or top levers to right
ScanImage optimization Transitions
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
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Right lateral, cranialRight lateral, cranial(Right liver, diaphragm)(Right liver, diaphragm)
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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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Cranial bodyCranial body
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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)
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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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To L ovary
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Mid (apex)Mid (apex)
UB
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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
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To Uterus
To Prostate
To RK
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Medial Medial (poles(polessymmetrical)symmetrical)
RK
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MedialMedial(renal sinus/pelvis)(renal sinus/pelvis)
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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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Cranial poleCranial pole
RK
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Caudal poleCaudal pole
RK
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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)
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ORGANS
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ORGANS
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Sagittal bowelSagittal bowel
ORGANS
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ORGANS
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ORGANS
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ORGANS
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StomachStomach
ColonColon
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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Transverse bowelTransverse bowel
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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End of scan
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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UB
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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To Testicles
To RK
ORGANS
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ORGANS
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ORGANS
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Testicles
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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Transverse feline ileum Transverse feline ileum
ColonColon
ORGANS
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ORGANS
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ORGANS
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Sagittal feline ileumSagittal feline ileumColonColon
ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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ORGANS
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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
MedialMedial(renal sinus/pelvis)(renal sinus/pelvis)
Mid sagittalMid sagittal
LK
LateralLateral
LK
Mid (renal sinus/pelvisMid (renal sinus/pelvis
LK
Cranial poleCranial pole
LK
Caudal poleCaudal pole
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
MedialMedial(renal sinus/pelvis)(renal sinus/pelvis)
Mid sagittalMid sagittal
LateralLateral
RK
Mid (renal sinus/pelvis)Mid (renal sinus/pelvis)
Cranial poleCranial pole
RK
Caudal poleCaudal pole
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
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