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

The Academy of Veterinary Imaging 2409 Avenue J, Suite C Arlington, TX (800) opt 4

Introduction This program demonstrates the scanning planes to perform and the still images to collect to archive a basic abdominal ultrasound exam. A basic abdominal ultrasound exam focuses on the “Big 5” organs, which are the liver, spleen, both kidneys, the urinary bladder and the midabdomen. Video clips can be saved to supplement the still images. Additional images would be indicated to document any pathology encountered. After mastering this material, please see the Complete Abdominal Scanning Protocol CD which includes scanning planes and images of the smaller organs (adrenal glands, pancreas, GI, reproductive organs).

Directions In this program you may view the entire basic 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 basic 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 basic exam with images Entire basic exam without images Individual image list The ‘Big 5” Organs Table of contents Abdominal anatomy Probe orientation Screen orientation Image optimization Images only

ORGANS IMAGE LIST Right Left VD abdomen from the ventral aspect Liver Stomach Spleen Left kidney Urinary bladder Right kidney Intestines

Probe orientation Sagittal plane Reference marker points cranially Transverse plane Reference marker points to the right

Reference marker Near field Far field Screen orientation

Image optimization 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 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 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 L5 LB Le L200 P5

Depth Starting guidelines: Large dog: cm Medium dog: 8-10 cm Small dogs and cats: 6-7 cm Adjust as needed throughout scan Transitions Image optimization L5 LB Le L200 P5

Frequency 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 L5 LB Le L200 P5

Auto 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 L5 LB Le L200 P5

Focal 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 L5 LB Le L200 P5

Gain 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 L5 LB Le L200 P5

LOGIQ P5 Auto optimize Gain Depth TGC Focal points Frequency Image optimization Transitions

LOGIQ e Auto optimize Gain Depth TGC Focal points Frequency Image optimization Transitions

LOGIQ 5 TGC Auto optimize Gain Depth Focal points Frequency (press to toggle) Image optimization Transitions

LOGIQ Book Auto optimize Gain Depth TGC Focal points Frequency (toggle) Image optimization Transitions

LOGIQ 200 TGC Depth Gain Focal points Auto optimize Frequency Image optimization Transitions

Transitions 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 UB UB to RK RK to midabdomen Image optimization

Start 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) Depth increase Frequency increase Auto-optimize on or off Focal points Gain Overall gain TGC bottom levers same or to middle Image optimization Transitions Scan

Splenic 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 Image optimization Transitions Scan

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 Image optimization Transitions Scan

Splenic head (tx) to LK Depth decrease Frequency same or decrease Auto-optimize on or off Focal points move down Gain Overall gain TGC same Image optimization Transitions Scan

LK to UB Depth varies Frequency increase Auto-optimize on or off Focal points same Gain Overall gain maybe decrease TGC top levers to left Image optimization Transitions Scan

UB to RK Depth varies Frequency decrease Auto-optimize on or off Focal points same Gain Overall gain maybe increase TGC top levers to center Image optimization Transitions Scan

RK to midabdomen Depth decrease Frequency increase Auto-optimize on or off Focal points move up Gain Overall gain TGC top levers to right Image optimization Transitions Scan

LIVER SPLEEN BLADDER Right Left KIDNEYS The ‘Big 5’ organs

Individual images

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ORGANS IMAGE LIST Right lateral, cranial (Right liver, diaphragm) Optimize

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ORGANS IMAGE LIST Right lateral, toward midline (GB, diaphragm)

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ORGANS IMAGE LISTMidline (CVC, PV, CBD)

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ORGANS IMAGE LIST Right lateral, caudal (Caudate lobe, RK)

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ORGANS IMAGE LIST Midline to left lateral (AO, left HV, left PV, stomach)

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ORGANS IMAGE LIST Left lateral

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ORGANS IMAGE LIST Cranial (liver, diaphragm)

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ORGANS IMAGE LIST Mid (GB, PVs)

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ORGANS IMAGE LIST Caudal (CVC, HV, PV, GB)

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ORGANS IMAGE LIST Cranial body Optimize

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ORGANS IMAGE LIST Midbody (hilus)

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ORGANS IMAGE LIST Cranial body

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ORGANS IMAGE LIST Medial (poles symmetrical) LK

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ORGANS IMAGE LISTMedial (renal sinus/pelvis) Optimize

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ORGANS IMAGE LIST Mid sagittal LK

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ORGANS IMAGE LISTLateral LK

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ORGANS IMAGE LISTCaudal UB

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ORGANS IMAGE LISTMedial (renal sinus/pelvis) Optimize RK

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ORGANS IMAGE LIST Mid sagittal RK

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ORGANS IMAGE LISTLateral RK

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ORGANS IMAGE LIST Caudal pole RK

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ORGANS IMAGE LIST Sagittal bowel Optimize

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End of scan

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End of scan

Right lateral, cranial

Right lateral, toward midline

Midline

Right lateral, caudal RK

Midline to left lateral

Left lateral

Cranial

Mid

Caudal

Sagittal

Sagittal cranial body

Sagittal midbody (hilus)

Sagittal tail

Transverse tail

Transverse midbody (hilus)

Transverse cranial body

Transverse

Medial (poles symmetrical) LK

Medial (renal sinus/pelvis)

Mid sagittal LK

Lateral

Mid (renal sinus/pelvis LK

Cranial pole LK

Caudal pole LK

Mid (apex) and vessels UB

Mid (trigone) UB

Lateral to the right UB

Lateral to the left UB

Cranial transverse UB

Mid transverse UB

Caudal transverse UB

Medial(polessymmetrical) RK

Medial (renal sinus/pelvis)

Mid sagittal

Lateral RK

Mid (renal sinus/pelvis)

Cranial pole RK

Caudal pole RK

Sagittal bowel

Transverse bowel