Complete AbdScan 01 2010

The Academy of Veterinary Imaging2409 Avenue J, Suite C Arlington, TX 76006 (800) 268-5354 opt 4

www.soundeklin.com/academy-of-imaging

Introduction

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.

Directions

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 imagesIndividual image listOrgansTable of contentsAbdominal anatomyProbe orientationScreen orientationImage optimizationImages only

ORGANSIMAGE LISTPage: 1, 2

RightLeftVD abdomenfrom the ventral aspectLiverStomachSpleenLeft kidneyUrinarybladderIntestinesGBAdrenalsRightkidneyPancreas

Probe orientation

Reference markerNear fieldFar fieldScreen orientation

Image optimizationLOGIQ P5LOGIQ 5LOGIQ BookGo to:Transitions General info Depth Frequency Auto-optimize Focal points Gain Overall gain TGC

LOGIQ eLOGIQ 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 optimizationP5L5LBLeL200

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.TransitionsImage optimizationP5L5LBLeL200

Depth Starting guidelines: Large dog: 12-14 cm Medium dog: 8-10 cm Small dogs and cats: 6-7 cm

Adjust as needed throughout scan

TransitionsImage optimizationP5L5LBLeL200

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


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.TransitionsImage optimizationP5L5LBLeL200

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.


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).


LOGIQ P5Auto optimizeGainDepthTGCFocal pointsFrequencyImage optimizationTransitions

LOGIQ eAuto optimizeGainDepthTGCFocal pointsFrequencyImage optimizationTransitions

LOGIQ 5TGCAuto optimizeGainDepthFocal pointsFrequency(press to toggle)Image optimizationTransitions

LOGIQ BookAuto optimizeGainDepthTGCFocal pointsFrequency(toggle)Image optimizationTransitions

LOGIQ 200TGCDepthGainFocal pointsAuto optimizeFrequencyImage optimizationTransitions

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 left adrenal Left adrenal to UB UB to RK RK to right adrenal/pancreas/GIImage optimization

Start liverImage 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

TransitionsScan

Liver to splenic head (sagittal) Depth increase Frequency increase Auto-optimize on or off Focal points GainOverall gainTGC bottom levers same or to middleScanImage optimizationTransitions

Splenic head to body/tail of spleen Depth decrease Frequency same Auto-optimize on or off Focal points move up GainOverall gainTGC same or top levers to right

ScanImage optimizationTransitions

Body of spleen to splenic head (tx) Depth increase Frequency same Auto-optimize on or off Focal points move down GainOverall gainTGC same or top levers to center


Splenic head (tx) to LK Depth decrease Frequency same or decrease Auto-optimize on or off Focal points move down GainOverall gainTGC same


LK to left adrenal Depth decrease Frequency same or increase Auto-optimize on or off Focal points move up GainOverall gainTGC same


Left 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


UB to RK Depth varies Frequency decrease Auto-optimize on or off Focal points same GainOverall gain maybe increaseTGC top levers to center


RK to right adrenal/pancreas/GI Depth decrease Frequency increase Auto-optimize on or off Focal points move up or down GainOverall gainTGC same or top levers to right


Organs Liver Spleen Kidneys (Left, Right) Adrenal glands (Left, Right) Urinary bladder Pancreas Stomach Intestines Ovaries (Left, Right), Uterus Prostate, Testicles

Individual images, page 1

For complete CD 1

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 viewsTransverse views

Splenic headSplenic head

Cranial bodyCranial body

Mid body (hilus)Mid body (hilus)

TailTail

LEFT KIDNEY:


MedialCranial pole

Renal sinus/pelvisMid (renal sinus/pelvis)

MidCaudal pole

Lateral

LEFT ADRENAL GLAND

LEFT OVARY

&Rupdated &D

For complete CD 2

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:


MedialCranial pole


MidCaudal pole

Lateral

RIGHT ADRENAL GLAND

PANCREAS:

Right limb

Body

Left limb

DUODENUM

MIDABDOMEN:

Jejunum

Ileum (cats only)

Colon

&Rupdated &D

Reporting form complete

Ultrasound report: Complete abdominal exam

DATE:

ANIMAL NAME:

CLINICIAN:

HOSPITAL:

NORMALABNORMALNOT SEENCOMMENTS:

LIVER

SPLEEN

KIDNEYS:

-LEFT

-RIGHT

ADRENAL GLANDS:

-LEFT

-RIGHT

URINARY BLADDER

STOMACH

SMALL INTESTINE

COLON

PANCREAS

LYMPH NODES

BLOOD VESSELS

UTERUS/PROSTATE

OVARIES/TESTICLES

MIDABDOMEN

OTHER

ADDITIONAL COMMENTS:

ULTRASONOGRAPHIC DIAGNOSIS:

ULTRASOUND DONE BY:

For basic CD

Protocol for a basic abdominal ultrasound exam

The "Big 5"

Perform a clockwise scan starting in the cranial right abdomen.

Scan each organ, then collect representative still images, following the protocol below.

When initially scanning, fan through each organ until it is no longer in view.

Structures in parentheses are landmarks that may or may not be seen in each view.

LIVER:

Sagittal views







Transverse views




SPLEEN:

Sagittal and transverse views

Splenic head

Cranial bodyMid body (hilus)

Tail

LEFT KIDNEY:


MedialCranial pole


Mid sagittalCaudal pole

Lateral

URINARY BLADDER:

Sagittal views


Mid apex

Mid trigone

Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

RIGHT KIDNEY:


MedialCranial pole



Lateral

MIDABDOMEN:

&Rupdated &D

Basic Abdomen

Standard Telemedicine Abdominal Ultrasound Exam

Part I: The "Big 5" Basic Exam

2005

RR

LIVER

Sagittal views







Transverse views

Right lateral from intercostal space (porta hepatis: AO, CVC, PV)




SPLEEN

Sagittal views

Splenic head (from left ventral abdomen or intercostal space 11-12)

Cranial body

Mid body (hilus)

Tail

Comparison view (split screen if needed) of liver and spleen

Transverse views


Cranial body

Mid body

Tail

KIDNEYS (Fan until kidney is no longer in view)

Sagittal views (left kidney)Sagittal views (right kidney)

Mid (cortex/medulla)Mid (cortex/medulla)

LateralLateral

Medial (renal sinus/pelvis)Medial (renal sinus/pelvis)

Measure LKMeasure RK

Comparison view (split screen if needed) of liver and kidney

Transverse views (left kidney)Transverse views (right kidney)

Mid (renal sinus/pelvis)Mid (renal sinus/pelvis)

Cranial poleCranial pole

Caudal poleCaudal pole

URINARY BLADDER

Sagittal views

Mid (may need separate views to see the apex and the trigone)


Lateral to the left

Blood vessels/lymph nodes dorsal to bladder

Transverse views

Cranial

Mid

Caudal (trigone)


MIDABDOMEN

Moving cranial to caudal, grid approach, view midabdomen

Moving medial to lateral, grid approach, view midabdomen

&CCopyright (C) 2005 Sound Technologies&R&D

Advanced Abdomen


Part II: Advanced "Small parts"

2005

RR

STOMACH


Midline (midbody)


Measure wall thickness in one or more of the above images

Observe for 3 minutes to evaluate peristalsis

BOWEL

Sagittal (longitudinal) viewsTransverse views

DuodenumDuodenum

JejunumJejunum

Ileum (cats only)Ileum (cats only)

ColonColon



Grid approach to view all regions of abdomen

PANCREAS

Right limb (RK/duodenum)

Body (GB/stomach)

Left limb (stomach/spleen/LK)

ADRENALS

Left adrenalRight adrenal

Sagittal viewSagittal view

Sagittal view: MeasureSagittal view: Measure

LYMPH NODES

MesentericOther

Sublumbar

Along aorta

OVARIES/UTERUS

Left ovaryRight ovary

Body of uterusUterine horns

PROSTATE/TESTICLES

Sagittal prostateTransverse prostate

Left testicleRight testicle


Whole abdominal exam

Complete Telemedicine Abdominal Ultrasound Exam Protocol

Clockwise scan starting in upper right abdomen

Fan until organ is no longer in view

LIVER:

Sagittal views







Transverse views





STOMACH:

Ventral right (antrum/pylorus)Measure wall thickness in these images

Midline (midbody)Observe for 3 minutes to evaluate peristalsis


PANCREAS: Left limb (stomach/spleen/LK)

SPLEEN:




TailComparison view of liver and spleen

LEFT KIDNEY:


Mid (cortex/medulla)Mid (renal sinus/pelvis)

LateralCranial pole

Medial (renal sinus/pelvis)Caudal pole

Measure in sagittal plane


LEFT ADRENAL GLAND: Sagittal view with and without measurements

LEFT OVARY

URINARY BLADDER:

Sagittal views



Lateral to the left


Transverse views

Cranial

Mid

Caudal (trigone)



RIGHT KIDNEY:



LateralCranial pole



RIGHT ADRENAL GLAND: Sagittal view with and without measurements

PANCREAS:Right limb (RK/duodenum)Body (GB/stomach)

DUODENUM

MIDABDOMEN:Moving cranial to caudal, then medial to lateral, grid approach

JejunumMeasure wall thickness

Ileum (cats only)Observe for 3 minutes to evaluate peristalsis

Colon


Image count abdomen

Complete Abdominal Ultrasound Exam Protocol

Clockwise scan starting in the cranial right abdomen

Fan until each organ is no longer in view

Image count:

10LIVER:

Sagittal views







Transverse views





3STOMACH:




1PANCREAS: Left limb (stomach/spleen/LK)

9SPLEEN:





8LEFT KIDNEY:



LateralCranial pole




2LEFT ADRENAL GLAND: Sagittal view with and without measurements

1LEFT OVARY

8URINARY BLADDER:

Sagittal views



Lateral to the left


Transverse views

Cranial

Mid

Caudal (trigone)


2UTERUS OR PROSTATE/TESTICLES

7RIGHT KIDNEY:



LateralCranial pole



2RIGHT ADRENAL GLAND: Sagittal view with and without measurements

2PANCREAS:Right limb (RK/duodenum)Body (GB/stomach)

1DUODENUM

3MIDABDOMEN:Moving cranial to caudal, then medial to lateral, grid approach



59TOTALColon


Image count complete abdomen

Protocol for a complete abdominal ultrasound exam





Image count:

10LIVER:

Sagittal views







Transverse views





3STOMACH:




9SPLEEN:





8LEFT KIDNEY:

Sagittal views (fan)Transverse views (slide)

Medial (poles symmetrical)Cranial pole

Medial (renal sinus/pelvis)Mid (renal sinus/pelvis)

Mid (with & w/o measurement)Caudal pole

Lateral



1LEFT OVARY

6URINARY BLADDER:

Sagittal views



Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

2SUBLUMBAR REGION:

Blood vessels/lymph nodes dorsal to bladder (sagittal and transverse)


1RIGHT OVARY

8RIGHT KIDNEY:





Lateral



3PANCREAS:Right limb (RK/duodenum)Body (GB/PV/stomach)Left limb (stomach/spleen/LK)

1DUODENUM




Colon

61TOTAL

&Rupdated &D

Image count basic abdomen


The "Big 5"





Image count:

9LIVER:

Sagittal views







Transverse views




9SPLEEN:





8LEFT KIDNEY:





Lateral

Comparison view (split screen) of liver and kidney

6URINARY BLADDER:

Sagittal views



Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

8RIGHT KIDNEY:





Lateral



42TOTAL

&Rupdated &D

Individual images, page 2

For complete CD 1

LIVER:

Sagittal views







Transverse views




Right lateral from intercostal space

STOMACH:


Midline (midbody)


SPLEEN:


Splenic headSplenic head

Cranial bodyCranial body

Mid body (hilus)Mid body (hilus)

TailTail

LEFT KIDNEY:


MedialCranial pole


MidCaudal pole

Lateral

LEFT ADRENAL GLAND

LEFT OVARY

&Rupdated &D

For complete CD 2

URINARY BLADDER:

Sagittal views


Mid apex

Mid trigone

Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

SUBLUMBAR REGION:

Blood vessels/lymph nodes


RIGHT OVARY

RIGHT KIDNEY:


MedialCranial pole


MidCaudal pole

Lateral

RIGHT ADRENAL GLAND

PANCREAS:

Right limb

Body

Left limb

DUODENUM

MIDABDOMEN:

Jejunum

Ileum (cats only)

Colon

&Rupdated &D

Reporting form complete

Ultrasound report: Complete abdominal exam

DATE:

ANIMAL NAME:

CLINICIAN:

HOSPITAL:

NORMALABNORMALNOT SEENCOMMENTS:

LIVER

SPLEEN

KIDNEYS:

-LEFT

-RIGHT

ADRENAL GLANDS:

-LEFT

-RIGHT

URINARY BLADDER

STOMACH

SMALL INTESTINE

COLON

PANCREAS

LYMPH NODES

BLOOD VESSELS

UTERUS/PROSTATE

OVARIES/TESTICLES

MIDABDOMEN

OTHER

ADDITIONAL COMMENTS:

ULTRASONOGRAPHIC DIAGNOSIS:

ULTRASOUND DONE BY:

For basic CD


The "Big 5"





LIVER:

Sagittal views







Transverse views




SPLEEN:


Splenic head


Tail

LEFT KIDNEY:


MedialCranial pole



Lateral

URINARY BLADDER:

Sagittal views


Mid apex

Mid trigone

Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

RIGHT KIDNEY:


MedialCranial pole



Lateral

MIDABDOMEN:

&Rupdated &D

Basic Abdomen


Part I: The "Big 5" Basic Exam

2005

RR

LIVER

Sagittal views







Transverse views





SPLEEN

Sagittal views


Cranial body

Mid body (hilus)

Tail

Comparison view (split screen if needed) of liver and spleen

Transverse views


Cranial body

Mid body

Tail

KIDNEYS (Fan until kidney is no longer in view)

Sagittal views (left kidney)Sagittal views (right kidney)

Mid (cortex/medulla)Mid (cortex/medulla)

LateralLateral

Medial (renal sinus/pelvis)Medial (renal sinus/pelvis)

Measure LKMeasure RK


Transverse views (left kidney)Transverse views (right kidney)

Mid (renal sinus/pelvis)Mid (renal sinus/pelvis)

Cranial poleCranial pole

Caudal poleCaudal pole

URINARY BLADDER

Sagittal views



Lateral to the left


Transverse views

Cranial

Mid

Caudal (trigone)


MIDABDOMEN

Moving cranial to caudal, grid approach, view midabdomen

Moving medial to lateral, grid approach, view midabdomen


Advanced Abdomen


Part II: Advanced "Small parts"

2005

RR

STOMACH


Midline (midbody)




BOWEL

Sagittal (longitudinal) viewsTransverse views

DuodenumDuodenum

JejunumJejunum

Ileum (cats only)Ileum (cats only)

ColonColon



Grid approach to view all regions of abdomen

PANCREAS

Right limb (RK/duodenum)

Body (GB/stomach)

Left limb (stomach/spleen/LK)

ADRENALS

Left adrenalRight adrenal

Sagittal viewSagittal view

Sagittal view: MeasureSagittal view: Measure

LYMPH NODES

MesentericOther

Sublumbar

Along aorta

OVARIES/UTERUS

Left ovaryRight ovary

Body of uterusUterine horns

PROSTATE/TESTICLES

Sagittal prostateTransverse prostate

Left testicleRight testicle


Whole abdominal exam

Complete Telemedicine Abdominal Ultrasound Exam Protocol

Clockwise scan starting in upper right abdomen

Fan until organ is no longer in view

LIVER:

Sagittal views







Transverse views





STOMACH:




PANCREAS: Left limb (stomach/spleen/LK)

SPLEEN:





LEFT KIDNEY:



LateralCranial pole




LEFT ADRENAL GLAND: Sagittal view with and without measurements

LEFT OVARY

URINARY BLADDER:

Sagittal views



Lateral to the left


Transverse views

Cranial

Mid

Caudal (trigone)



RIGHT KIDNEY:



LateralCranial pole



RIGHT ADRENAL GLAND: Sagittal view with and without measurements

PANCREAS:Right limb (RK/duodenum)Body (GB/stomach)

DUODENUM

MIDABDOMEN:Moving cranial to caudal, then medial to lateral, grid approach



Colon


Image count abdomen

Complete Abdominal Ultrasound Exam Protocol

Clockwise scan starting in the cranial right abdomen

Fan until each organ is no longer in view

Image count:

10LIVER:

Sagittal views







Transverse views





3STOMACH:




1PANCREAS: Left limb (stomach/spleen/LK)

9SPLEEN:





8LEFT KIDNEY:



LateralCranial pole





1LEFT OVARY

8URINARY BLADDER:

Sagittal views



Lateral to the left


Transverse views

Cranial

Mid

Caudal (trigone)



7RIGHT KIDNEY:



LateralCranial pole




2PANCREAS:Right limb (RK/duodenum)Body (GB/stomach)

1DUODENUM




59TOTALColon


Image count complete abdomen

Protocol for a complete abdominal ultrasound exam





Image count:

10LIVER:

Sagittal views







Transverse views





3STOMACH:




9SPLEEN:





8LEFT KIDNEY:

Sagittal views (fan)Transverse views (slide)




Lateral



1LEFT OVARY

6URINARY BLADDER:

Sagittal views



Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

2SUBLUMBAR REGION:

Blood vessels/lymph nodes dorsal to bladder (sagittal and transverse)


1RIGHT OVARY

8RIGHT KIDNEY:





Lateral



3PANCREAS:Right limb (RK/duodenum)Body (GB/PV/stomach)Left limb (stomach/spleen/LK)

1DUODENUM




Colon

61TOTAL

&Rupdated &D

Image count basic abdomen


The "Big 5"





Image count:

9LIVER:

Sagittal views







Transverse views




9SPLEEN:





8LEFT KIDNEY:





Lateral

Comparison view (split screen) of liver and kidney

6URINARY BLADDER:

Sagittal views



Lateral to the left

Transverse views

Cranial

Mid

Caudal (trigone)

8RIGHT KIDNEY:





Lateral



42TOTAL

&Rupdated &D







Right lateral, cranial(Right liver, diaphragm)Optimize






Right lateral, toward midline(GB, diaphragm)





Midline (CVC, PV, CBD)









Right lateral, caudal(Caudate lobe, RK)












Midline to left lateral (AO, left HV, left PV, stomach)





Left lateral












Mid (GB, PVs)




Caudal (CVC, HV, PV, GB)









IC TX LIVER
















Optimize




Optimize





























Optimize











LK




Medial(renal sinus/pelvis)Optimize








LateralLK






LK












Caudal poleLK
















Optimize









To L ovarySkip







Optimize

































To UterusTo ProstateTo RK










Medial (polessymmetrical)RK




Medial(renal sinus/pelvis)

OptimizeRK




Mid sagittalRK




LateralRK






Mid (renal sinus/pelvis)





Cranial poleRK






Caudal poleRK













Optimize









SkipTo R ovary



DUODRK










GB








StomachL limb panc





L limb panc














Duodenum






GBPylorus











Stomach (fundus)













To Ileum (cats only)Skip













Sagittal bowel





StomachColon













Transverse bowel







End of scan








UB







To TesticlesTo RK















Transverse feline ileum Colon




Sagittal feline ileumColon




















































































































































































































































End of scan



















Transverse


























GBPancreatic body


StomachL limb pancreas

















Documents

Complete AbdScan 01 2010