1. Abdominal Ultrasound Basics Wendy Blount, DVM
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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
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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
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
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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, 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
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5. Jacquelyn Rich - Lott TX
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6. 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
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7. The “Big 5” 1 2 4 3b 3a 5
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8. 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
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9. 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
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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
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15. 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 screen 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)
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16. 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
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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
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26. Nathan Boynton - Humble TX
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27. 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
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28. 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
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29. 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
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30. Transducers Transducer = Probe Curvilinear large pets Deep structures
Microconvex is the most
multi-purpose probe
(previous slide)
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31. Transducers Transducer = Probe Cardiac Probe Smallest footprint
CW Doppler
Can be used also for
abdominal and transcranial
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32. 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
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33. 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
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34. 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

35. 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

36. 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

37. 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

38. 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