1. Abdominal Ultrasound Basics Wendy Blount, DVM
Free PowerPoint Templates

2. 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

3. “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 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

4. “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 dog!!!
Add extras as you become more proficient:
Other probes – linear, curvilinear
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

5. 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
Lower and higher frequencies (2-5MHz, 7-10MHz)
Stand-off pads
Free PowerPoint Templates

6. Kim Hendrick, Bryan TX
Free PowerPoint Templates

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

8. 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

9. The “Big 5” Basic Abdominal Ultrasound focuses on free fluid and:
Liver & Gall Bladder
Spleen
Kidneys
Mid-abdomen – stomach, small intestine, colon
Urinary Bladder
As Your skills improve, you will add:
Colon, pancreas, adrenals, local fluid, lymph nodes, great vessels, reproductive organs, ureters, etc.
Fine needle aspirates of fluid, liver, spleen, masses, etc.
Free PowerPoint Templates

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

11. The “Big 5” 4 3 6 5 2 1
Free PowerPoint Templates

12. Documenting the Exam Save Standard Videos and Images
Videos convey and save more info than still images
The Big 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

13. 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

14. 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

15. 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

16. The Screen contrast scale Should range from white to black
Increased gain – lose black & dark grays
Increased map – gradient shift to whites
MAP
Adjust up for more white & down for more black
Decreased gain – lose white & light grays
Decreased map – gradient shift to blacks
Increased contrast – lose middle grays
Decreased contrast – more middle grays
Free PowerPoint Templates

17. The Screen
Adjust whiteness, darkness (gain, map) and contrast according to your preference
Be sure contrast scale ranges from white to black
Compare and use knowledge of relative echogenicity to determine hypo- or hyper-echogenicity of each tissue
Set the focal point at the level of the area of interest on the screen
Improved resolution at the focal point
Usually 1 focal point for cardio and 2 for abdomen
Free PowerPoint Templates

18. 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:
Freeze/Unfreeze (cine loop track ball or slider)
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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. Gain
Gain = Brightness
Set to the whiteness-blackness on the screen that you like
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
Free PowerPoint Templates

26. Gain
Set to the general whiteness-blackness on the screen that you like
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
Free PowerPoint Templates

27. Gain
Total Gain Too High
Set to the general whiteness-blackness on the screen that you like
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
TGC Too High at Top
TGC Too Low at Bottom
Free PowerPoint Templates

28. Gain
Total Gain Too High
Set to the general whiteness-blackness on the screen that you like
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
TGC Too High at Top
Total Gain & TGC Just Right
TGC Too Low at Bottom
Free PowerPoint Templates

29. 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
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
Free PowerPoint Templates

30. Frequency Frequency = Penetration
5-10MHz in small animals (5-7.5 MHz most common)
High frequencies for fluid filled and superficial structures, or thin/small animals
Right - duodenum, right limb of pancreas, right kidney
Left - normal spleen (especially cat)
Caudal – urinary bladder
If the far field (lower part of the screen) loses detail, try a lower frequency for more penetration
Some adjustments can be made on the machine, and some will require changing the probe
Free PowerPoint Templates

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

32. Transducers Transducer = Probe Microconvex Viewing between ribs
Echocardiograms
Lung/thorax
Intercostal liver &
kidneys
Medium to large pet
abdomens
Deep structures on small dogs and cats, or excess gas
Free PowerPoint Templates

33. Transducers Transducer = Probe Curvilinear large pets Deep structures
Microconvex is the most
multi-purpose probe
Free PowerPoint Templates

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

35. 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

36. Probe Movements Tilt (Fan) Tilt beam on a single point on the
skin, w/o sliding, rocking or rotating
From acute angle to perpendicular
to obtuse angle, and back again
Rock (Heel-Toe)
Rock probe w/o changing reference
marker orientation
Apply more pressure to one end of
the transducer’s long axis
Free PowerPoint Templates

37. 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

38. 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

39. Pat Davis, Killeen TX

40. 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
PVM Emergency US
AVI Basic Abdomen

41. Acknowledgments The Academy of Veterinary Imaging Robert Fulton
2409 Avenue J, Suite C Arlington, TX (800) opt 4
Robert Fulton
Chapter 1 - Focused – Basic Ultrasound Principles and Artifacts
Focused Ultrasound Techniques for the Small Animal Practitioner
Editor, Gregory Lisciandro

42. 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