Ebook Pocket protocols for ultrasound (2nd edition): Part 1

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Second Edition
Adapted from: Ultrasound Scanning: Principles and Protocols, Third edition

Betty Bates Tempkin, BA, RT(R), RDMS
Ultrasound Consultant
Formerly Clinical Director of the Diagnostic Medical Sonography Program
Hillsborough Community College, Tampa, Florida


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11830 Westline Industrial Drive
St. Louis, Missouri 63146

POCKET PROTOCOLS FOR ULTRASOUND SCANNING

ISBN-13: 978-1-4160-3101-7
ISBN-10: 1-4160-3101-4

Copyright © 2007, 1999 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher.
Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1)
215 239 3804, fax: (+1) 215 239 3805, e-mail: You may also complete your request on-line via

the Elsevier homepage (), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’.


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Notice
Neither the Publisher nor the Author assumes any responsibility for any loss or injury
and/or damage to persons or property arising out of or related to any use of the material
contained in this book. It is the responsibility of the treating practitioner, relying on
independent expertise and knowledge of the patient, to determine the best treatment and
method of application for the patient.
The Publisher

Previous edition copyrighted in 1999.
ISBN-13: 978-1-4160-3101-7
ISBN-10: 1-4160-3101-4
Acquisitions Editor: Jeanne Wilke
Developmental Editor: Rebecca Swisher
Publishing Services Manager: Pat Joiner
Project Manager: Jennifer Clark
Designer: Amy Buxton
Printed in the United States of America.
Last digit is the print number: 9 8 7 6 5 4 3 2 1


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Contributors

Wayne C. Leonhardt, BA, RT(R), RVT, RDMS
Faculty
Foothill College School of Ultrasound
Los Altos, California;
Staff Sonographer, Technical Director, and
Continuing Education Director
Summit Medical Center
Oakland, California

Maureen E. McDonald, BS, RDMS, RDCS
Staff Echocardiographer
Adult Echocardiography Instructor and Lecturer
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Adult Echocardiography Scanning Protocol;
Pediatric Echocardiography Scanning Protocol

Scrotum Scanning Protocol; Thyroid and
Parathyroid Glands Scanning Protocols
v


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Betty Bates Tempkin, BA, RT(R), RDMS
Ultrasound Consultant
Formerly Clinical Director of the Diagnostic
Medical Sonography Program

Hillsborough Community College
Tampa, Florida

Marsha M. Neumyer, BS, RVT
Assistant Professor of General and Vascular
Surgery and Director of the Vascular Studies
Section
The Milton S. Hershey Medical Center
Pennsylvania State University College of
Medicine
Hershey, Pennsylvania

Scanning Planes and Scanning Methods;
Pathology; Scanning Protocol; Abdominal Aorta
Scanning Protocol; Inferior Vena Cava Scanning
Protocol; Liver Scanning Protocol; Gallbladder
and Biliary Tract Scanning Protocol; Pancreas
Scanning Protocol; Renal Scanning Protocol;
Spleen Scanning Protocol; Scanning Protocols for
Full and Limited Studies of the Abdomen; Female
Pelvis Scanning Protocol; Obstetrical Scanning
Protocol; Male Pelvis Scanning Protocol; Scrotum
Scanning Protocol; Thyroid and Parathyroid
Glands Scanning Protocols; Breast Scanning
Protocol; Female Pelvis Scanning Protocol

Abdominal Doppler and Color Flow;
Cerebrovascular Duplex Scanning Protocol;
Peripheral Arterial and Venous Duplex Scanning
Protocols

vi


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Contents

PA R T

I

Introduction: Purpose and Use . . . . . . . . . . . 1
PA R T

II

Image Protocol For Abnormal Sonographic
Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
PA R T

III

The Abdomen. . . . . . . . . . . . . . . . . . . . . . . . . 7
SECTION ONE
IMAGE PROTOCOLS FOR FULL SONOGRAPHIC
STUDIES OF THE ABDOMEN 9

vii

I. Liver Study with Full Abdomen 11
II. Aorta Study with Full Abdomen 42
III. Inferior Vena Cava Study with Full Abdomen

83
IV. Gallbladder and Biliary Tract Study with Full
Abdomen 119
V. Pancreas Study with Full Abdomen 157
VI. Renal Study with Full Abdomen 192
VII. Spleen Study with Full Abdomen 242


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SECTION TWO

SECTION TWO

IMAGE PROTOCOLS FOR LIMITED
SONOGRAPHIC STUDIES OF THE ABDOMEN
276
I. Aorta Study 278
II. Inferior Vena Cava Study 291
III. Right Upper Quadrant Study 299
IV. Gallbladder and Biliary Tract Study 330
V. Pancreas Study 358
VI. Renal Study 383
VII. Spleen Study 407

PA R T

IV

The Pelvis. . . . . . . . . . . . . . . . . . . . . . . . . . 415
SECTION ONE

IMAGE PROTOCOL FOR THE TRANSVAGINAL
SONOGRAPHIC STUDY OF THE FEMALE PELVIS
440
I. Transvaginal Female Pelvis Study 441
SECTION THREE
IMAGE PROTOCOLS FOR SONOGRAPHIC
STUDIES OF THE MALE PELVIS 458
I. Transrectal Prostate Gland Study 459
II. Scrotum Study 469
III. Penis Study 516

PA R T

V

Obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . 521
SECTION ONE

IMAGE PROTOCOL FOR THE
TRANSABDOMINAL SONOGRAPHIC STUDY OF
THE FEMALE PELVIS 417
I. Transabdominal Female Pelvis Study 418

viii

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE EARLY FIRST TRIMESTER 523
I. Early First Trimester Study 524


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SECTION TWO

SECTION TWO

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE LATE FIRST TRIMESTER 535
I. Late First Trimester Study 536
SECTION THREE

SECTION THREE

IMAGE PROTOCOL FOR SONOGRAPHIC
STUDIES OF THE SECOND AND THIRD
TRIMESTERS 545
I. Second and Third Trimesters Study 546

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE NEONATAL BRAIN 625

PA R T

SECTION FOUR

VII

Vascular System . . . . . . . . . . . . . . . . . . . . . 638

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF MULTIPLE GESTATIONS 591
I. Multiple Gestations Study 592
II. The Biophysical Profile 595

PA R T

IMAGE PROTOCOLS FOR THE SONOGRAPHIC
STUDY OF THE BREAST 618
I. Breast Lesion Characterization 620
II. Whole Breast Study 623

VI

Small Parts . . . . . . . . . . . . . . . . . . . . . . . . . 604
SECTION ONE

SECTION ONE
IMAGE PROTOCOLS FOR ABDOMINAL
DOPPLER AND COLOR FLOW STUDIES 639
I. Mesenteric Arterial Study 640
II. Renal Arterial Study 644

III. Image Examples of Various Studies 649
SECTION TWO

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE THYROID GLAND 606

ix

IMAGE PROTOCOL FOR CEREBROVASCULAR
DUPLEX SCANNING 655


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SECTION THREE

SECTION ONE

IMAGE PROTOCOLS FOR PERIPHERAL
ARTERIAL AND VENOUS DUPLEX SCANNING
665
I. Lower Extremity Venous Duplex Study 665
II. Lower Extremity Peripheral Arterial Duplex
Study 675

PA R T

VIII

IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE ADULT HEART 688
I. Adult Heart Study 688
SECTION TWO
IMAGE PROTOCOL FOR THE SONOGRAPHIC
STUDY OF THE PEDIATRIC HEART 721
I. Pediatric Heart Study 721

Echocardiography . . . . . . . . . . . . . . . . . . . 687
PA R T

IX

Abbreviation Glossary . . . . . . . . . . . . . . . . 746

x


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Introduction: Purpose and
Use

I

Pocket Protocols is a response to the need for a practical imaging reference to use during
ultrasound examinations. This flip-card presentation sits upright on the machine, making
it easy to see and access.
The majority of the image protocols follow the American Institute of Ultrasound in

Medicine’s (AIUM) imaging guidelines. Any other image protocols are patterned after the
AIUM’s suggestions and the authors’ collective experiences.
Pocket Protocols is a reference devoted to documenting technically accurate and
thorough ultrasound image studies for diagnostic interpretation by the physician. These
comprehensive imaging protocols include image and labeling examples for abdominal,
pelvic, obstetrical, small parts, vascular, and echocardiography studies.
1


Images are presented in a logical manner and specify the scanning plane and area of
interest. Every image is accompanied by a gray-scale, color-coded schematic to help
identify anatomy.
These reference materials are just that. They do not include or endorse the exclusion
of the necessary prerequisites for accomplished scanning skills.
I hope Pocket Protocols serve as a practical reference and imaging standard that helps
sonographers obtain comprehensive, consistent, and technically accurate image representations of ultrasound studies.
Betty Bates Tempkin

2


Image Protocol for
Abnormal Sonographic
Findings

II

This section describes a universal imaging protocol for documenting pathology, regardless
of the type. All pathology visualized by ultrasound in some way disrupts the normal
sonographic pattern of the organ or structure involved and may alter its shape, size,

contour, position, or textural appearance. Although familiarity with specific diseases and
abnormalities is not necessary to document them accurately for physician interpretation,
an understanding of pathological processes and the ways in which they affect interdependent body systems can be beneficial.
3


CRITERIA FOR DOCUMENTING ABNORMAL SONOGRAPHIC FINDINGS
a) Survey of the abnormality in at least two scanning planes following the survey of the
primary area(s) of interest. (This is not to say that the abnormality is not evaluated
as the area of interest is evaluated, but it ensures that a total evaluation is made of a
structure, not just its abnormal part.)
b) Volume measurement of the abnormality.
c) High- and low-gain technical setting images of the abnormality in at least two
scanning planes.

4