Abdominal Ultrasound Basics Wendy Blount, DVM Free PowerPoint Templates

The Learning Curve It’s Mostly in Your Mind – Three Steps Turn the Machine On Apply Coupling Gel or Alcohol (+ Shave) Scan Learning curve no greater than doing an exam, reading bloodwork, reading x-rays or doing surgery Develop a pattern of scanning to follow every time Resist temptation to gravitate to abnormalities Complete the exam despite finding abnormalities The pattern doesn’t matter, if evaluation is complete Free PowerPoint Templates

“You can’t be too rich, too thin or use too much lube” The Learning Curve Things You Need: Ultrasound and Probe – 5-7 MHz microconvex Padded positioners, cart, stool for echocardiograms Clippers!!! Shave the @#$%^ dog!!! Add extras as you become more proficient: Other probes – linear, curvilinear, echocardiogram Lower and higher frequencies (2-5MHz, 7-10MHz) Stand-off pads “You can’t be too rich, too thin or use too much lube” --Linda Homco, DACVR Free PowerPoint Templates

“You can’t be too rich, too thin or use too much lube” The Learning Curve Things You Need: Ultrasound and Probe – 5-7 MHz microconvex Freeze button, Measurement Calipers, way to save images Padded positioners, cart, stool for echocardiograms Clippers!!! Shave the @#$%^ dog!!! Add extras as you become more proficient: Other probes – linear, curvilinear, cardiac Lower and higher frequencies (2-5MHz, 7-10MHz) Stand-off pads “You can’t be too rich, too thin or use too much lube” --Linda Homco, DACVR Free PowerPoint Templates

Jacquelyn Rich - Lott TX Free PowerPoint Templates

The Learning Curve Things You Need: Ultrasound and Probe – 5-7 MHz microconvex Freeze button, Measurement Calipers, way to save images Padded positioners, cart, stool for echocardiograms Add extras as you become more proficient: Other probes – linear, curvilinear, cardiac Lower and higher frequencies (2-5MHz, 7-10MHz) Stand-off pads Free PowerPoint Templates

The “Big 5” 1 2 4 3b 3a 5 Free PowerPoint Templates

Indications for Abdominal Ultrasound See indications for each of the focused exams Anorexia, weight loss, lethargy – repeat visit Abdominal Pain or enlargement** Vomiting, diarrhea PU-PD Collapse (GlobalFAST®) Abnormalities on CBC, panel, lytes, UA Fever of unknown origin, hypercalcemia Free PowerPoint Templates

provides acoustic window Indications for Abdominal Ultrasound Ultrasound does not preclude abdominal radiographs!! Abdominal rads Abdominal US Gut thickness & layers only of markedly thickened yes Gut motility no Evaluation of small structures (lymph nodes, adrenals, pancreas, mets, etc.) Organ architecture Contents of fluid filled structures only if air or mineral Organ size only if markedly abnormal Differentiates fluid vs. tissue Penetrates air Presence of fluid obscures soft tissue provides acoustic window Free abdominal air Difficult to interpret Free PowerPoint Templates

Documenting the Exam Save Standard Videos and Images Videos convey and save more info than still images The Big 5 - 2 views of each area, at 90o to each other Run videos from right to left, and cranial to caudal Overlap videos for complete view of organ, from edge to edge SonixOne has a 7 second video loop (1-2 videos per orthogonal organ) Use a template or form as a check-sheet and guide Review saved images!! when writing your report Save Images/Videos of all abnormalities found Write your report for the record Charge sufficiently for your time 30 minutes for Focused Exam, 45 minutes for complete abdomen, 1 hour to include FNAs PLUS record keeping & client communication Free PowerPoint Templates

The Probe Reference marker on the probe is cranial or right corresponds to left side of the ultrasound monitor Often a ridge or colored dot on the probe Free PowerPoint Templates

The Probe Reference marker on the probe is cranial or right corresponds to left side of the ultrasound monitor Often a ridge or colored dot on the probe Sagittal Views Marker points cranially Slices the patient cranial to caudal Transverse Views Marker points to the patient’s right (your left when patient is in dorsal recumbency) Slices the patient left to right, or medial to lateral Free PowerPoint Templates

The Screen reference marker near field patient’s right or cranial near field patient’s ventrum (in dorsal recumbency) Patient’s left (in right lateral recumbency) contrast scale Should range from white to black centimeter scale for reference MAP Adjust up for more white & down for more black Harmonics On For water filled organs Urinary bladder, GB, gut GE Logic – THI button patient’s dorsum (in dorsal recumbency) Patient’s right (in right lateral recumbency) far field Free PowerPoint Templates

The Screen contrast scale Should range from white to black Over Gained – lost black & dark grays Increased map – gradient shift to whites MAP Adjust up for more white & down for more black Under Gained – lost white & light grays Decreased map – gradient shift to blacks High Contrast – lose middle grays Low Contrast – more middle grays Free PowerPoint Templates

Big 8 Buttons Adjustments: Know where they are: Depth (Zoom) Adjusting Grays - Gain, TGC Sliders, MAP Adjusting Contrast & Noise - Harmonics, Contrast Focal Positions - highest resolution here Know where they are: 5. Freeze/Unfreeze (cine loop track ball or screen slider) 6. Store Still Image and/or Video (digital, printer, smart phone) Measurement Calipers Keyboard/quick labels for labeling images (patient, R/L, organ) (Auto-optimize, speckle reduction) Free PowerPoint Templates

Harmonics Harmonics allows the ultrasound to identify tissue better and reduce artifact or “noise” in the image. When the organ is fluid filled, eliminating noise and shades of gray is not a problem, and makes the image more crisp Free PowerPoint Templates

Harmonics Harmonics allows the ultrasound to identify tissue better and reduce artifact or “noise” in the image. When the organ is fluid filled, eliminating noise and shades of gray is not a problem, and makes the image more crisp Artifacts can be created in solid tissue Penetration is sacrificed May need to turn harmonics off for fluid filled structures that are deep in large dogs, if details are dropping out Free PowerPoint Templates

Presets Unique to each ultrasound machine Examples Should be explained in machine set-up & training Good starting settings for common exams Set up a Quick Reference Sheet Examples Choose abdomen, heart, shallow or OB-GYN Many choose small dog/cat or large dog Templates for common measurements Some make calculations for you Free PowerPoint Templates

Image Depth (Zoom) Starting Guidelines What you are looking at should take up ¾ of the screen Liver - include attachment of the diaphragm to the dorsal abdominal wall at the bottom of the screen Adjust as you go, to fill the screen with what you are looking at, for greatest detail Free PowerPoint Templates

Image Depth (Zoom) Starting Guidelines Include attachment of the diaphragm to the dorsal abdominal wall at the bottom of the screen Large dogs will be deeper (12-14 cm) Small dogs and cats will be more shallow (6-7 cm) Adjust as you go, to fill the screen with what you are looking at, for greatest detail Too Shallow Too Deep Free PowerPoint Templates

Image Depth (Zoom) Starting Guidelines Include attachment of the diaphragm to the dorsal abdominal wall at the bottom of the screen Large dogs will be deeper (12-14 cm) Small dogs and cats will be more shallow (6-7 cm) Adjust as you go, to fill the screen with what you are looking at, for greatest detail Too Shallow Too Deep Just Right Free PowerPoint Templates

Gain Gain = Brightness TGC Sliders – Time Gain Compensation Very few adjustments once it is set Some decrease gain for the bladder TGC Sliders – Time Gain Compensation Make up for loss of energy as sound waves pass deep into tissue Slide left for more black and to the right for more white Adjust these as you go Free PowerPoint Templates

Gain Gain = Brightness TGC Sliders – Time Gain Compensation Very few adjustments once it is set Some decrease gain for the bladder TGC Sliders – Time Gain Compensation Make up for loss of energy as sound waves pass deep into tissue Slide left for more black and to the right for more white Adjust these as you go Free PowerPoint Templates

Gain Gain = Brightness TGC Sliders – Time Gain Compensation Total Gain Too High Gain = Brightness Very few adjustments once it is set Some decrease gain for the bladder TGC Sliders – Time Gain Compensation Make up for loss of energy as sound waves pass deep into tissue Slide left for more black and to the right for more white Adjust these as you go TGC Too High at Top TGC Too Low at Bottom Free PowerPoint Templates

Gain Gain = Brightness TGC Sliders – Time Gain Compensation Total Gain Too High Gain = Brightness Very few adjustments once it is set Some decrease gain for the bladder TGC Sliders – Time Gain Compensation Make up for loss of energy as sound waves pass deep into tissue Slide left for more black and to the right for more white Adjust these as you go TGC Too High at Top Total Gain & TGC Just Right TGC Too Low at Bottom Free PowerPoint Templates

Nathan Boynton - Humble TX Free PowerPoint Templates

Transition Adjustments Adjustments often made when moving from one area of the abdomen to the next These are in the PowerPoints for each focused exam Start with depth, TGC and harmonics on/off Don’t sweat the buttons and knobs in the beginning – just scan Then as you begin to see more, you will be able to fine tune your image as you like it Frequency, probe change, focal distances Free PowerPoint Templates

Transducers Transducer = Probe Linear – better detail Smaller animals superficial structures Cannot view through small windows More limited field of view (doesn’t usually expand deeply) rectal Free PowerPoint Templates

Transducers Transducer = Probe Microconvex Viewing between ribs Echo, Lung/thorax Intercostal liver & kidneys Between loops of gut Medium to large pet abdomens Deep structures on small dogs and cats Free PowerPoint Templates

Transducers Transducer = Probe Curvilinear large pets Deep structures Microconvex is the most multi-purpose probe (previous slide) Free PowerPoint Templates

Transducers Transducer = Probe Cardiac Probe Smallest footprint CW Doppler Can be used also for abdominal and transcranial Free PowerPoint Templates

Probe Movements Slide Beam perpendicular to skin Move across the skin without rotating, tilting, or rocking Rotate/Twist Rotate probe on a single point on the skin, beam perpendicular From sagittal to transverse or vice versa Free PowerPoint Templates

Probe Movements Tilt (Fan) Tilt beam on a single point on the skin, w/o sliding, rocking or rotating Change the angle of the beam axis, relative to skin (off perpendicular) Rock (Heel-Toe) Change the angle of the probe contact surface relative to skin Apply more pressure to one end of the transducer’s contact surface Free PowerPoint Templates

Probe Movements TIP: Use the Rocking Motion to place the area of interest in the center of the screen Point the center of the beam toward the object of interest, by rocking

Probe Movements TIP: Use the Rocking Motion to place the area of interest in the center of the screen Point the center of the beam toward the object of interest, by rocking

Summary PowerPoint – Abdominal Ultrasound Basics .pdf of PowerPoint – Abdominal Ultrasound Basics (1 or 6 slides per page) Oncura Abdomen Ultrasound TIPs Sheet – full Oncura Abdomen Ultrasound TIPs Sheet Animated PowerPoint – Basic Abd scan Forms – PVM Basic Abdomen (Word) AVI Basic Abdomen Hidden Slides – Basic vs. Advanced Abdomen, Screen adjustments, Frequencies

Acknowledgments The Academy of Veterinary Imaging Robert Fulton 2409 Avenue J, Suite C Arlington, TX 76006 (800) 268-5354 opt 4 www.soundeklin.com/academy-of-imaging Robert Fulton Chapter 1 - Focused – Basic Ultrasound Principles and Artifacts Focused Ultrasound Techniques for the Small Animal Practitioner Editor, Gregory Lisciandro - 2014

Acknowledgments John Mattoon, Danelle Auld, Thomas Nyland Chapter 4 – Abdominal Ultrasound Scanning Techniques Small Animal Diagnostic Ultrasound Editor, Nyland & Mattoon – 3rd edition 2014 John P. Graham, MVB, MSc, DVR, MRCVS Diplomate, ECVDI, Diplomate, ACVR Diagnostic Imaging in Dogs and Cats Nestle Purina – Clinical Handbook Series Martha Moon Larson, DVM & David S Biller, DVM Chapter 11: Gastrointestinal Ultrasound of the Gastrointestinal Tract Editors Nyland and Mattoon – 3rd Edition 2014