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This protocol includes images of several organs and structures. It has been divided into
sections to assist in determining diagnostic images that should be stored for the physician
o Midline structures (Pancreas, Aorta, and IVC)
o Liver
o Gallbladder and Common Bile Duct
o Kidneys and Spleen
Physicians may request a full examination of all abdominal organs or only specific
abdominal organs
o Students will be provided separate protocols for organs in addition to this full
examination protocol
You must always evaluate the entire organ first before you store an image
You should understand completely why you stored the image and identify everything in
the image
Multiple breathing techniques and patient positions will be required
Organ/
Order
Scan
Plane
Label
PANCREAS
Pancrea
s
Transvers
e plane
on the
body
PANCREAS
PANCREAS
AO SAG
PROX
Aorta
Sagittal
AO SAG MID
AO SAG
DISTAL
IVC
Organ/
Order
LIVER
Sagittal
Sagittal
IVC
Pancreas head
Portal splenic confluence
CBD
o If CBD is enlarged, measure internal AP diameter
Pancreas body
Aorta
Measurement
o If pancreatic duct is seen measure internal AP
diameter
Pancreas tail
Splenic vein
Proximal aorta
Celiac axis
SMA
Mid aorta
SMA
Distal aorta as it tapers before bifurcation
IVC
Right atrium
Left lobe
Scan Plane
Label
Sagittal
LIVER SAG
LIVER SAG
Left lobe
Caudate lobe
IVC
Right lobe
The transducer
is placed sagittal
in the mid
portion of the
patients body
LIVER SAG
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Diaphragm
LIVER TX
MPV
LIVER TX
MPV
LIVER SAG
SUP
LIVER
Sagittal
Sagittal
The transducer
is placed
sagittal and
lateral on the
patients body
Transverse
LIVER
Transver
se
LIVER SAG
MPV
LIVER SAG
INF
LIVER TX
The transducer
is placed
transverse in the
mid portion of
the patients
body
Angulation of the
probe is used for
right lobe images
LIVER TX
HV
LIVER TX
LIVER TX
SUP
Transverse
LIVER
Transver
se
The transducer
is placed
transverse and
lateral on the
patients body
LIVER TX
MPV
LIVER TX
INF
Organ/
Order
Gallblad
der
Patient in
Supine
position
Scan
Plane
Sagittal
plane of
the GB
Transvers
e plane of
Label
GB SUPINE
SAG
GB SUPINE
SAG
GB SUPINE
TX
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Gallbladder body
Gallbladder fundus
Gallbladder body
Gallbladder neck
Gallbladder mid body with clear delineation of
anterior wall
the GB
GB SUPINE
TX
Sagittal
plane of
the GB
Patient in
Left lateral
decubitus
position
Transvers
e
plane of
the GB
GB LLD TX
Gallblad
der
Sagittal
plane of
the GB
GB RLD
SAG
GB RLD
SAG
Patient in
Right lateral
decubitus
position
Transvers
e plane of
the GB
Transvers
e plane of
the CBD
level of the
porta
hepatis
GB LLD SAG
Sagittal
plane of
the CBD
Scan
Plane
Sagittal
plane of
the
kidney
Transver
se plane
of the
Gallbladder
Gallbladder
Gallbladder
Gallbladder
Gallbladder
CBD TX
CBD SAG
CBD SAG
Organ/
Order
RT
Kidney
body
fundus
body
neck
mid body
GB RLD TX
CBD SAG
Common
Bile Duct
GB LLD SAG
Gallblad
der
Label
RT KID SAG
LAT
RT KID SAG
MID
RT KID SAG
MID
RT KID SAG
MED
RT KID TX
SUP
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Portal vein
CBD
Hepatic artery
Portal vein
CBD
Enlarged image
Portal vein
CBD
Enlarged image
Portal vein
CBD
Measurement
o Internal AP diameter
Key Landmarks Identified
kidney
LT
Sagittal
Kidney plane of
the
kidney
Renal
Renal
Renal
Renal
Renal
LT KID SAG
MID
LT KID SAG
MED
RT KID TX
MID
RT KID TX
INF
LT KID SAG
LAT
LT KID SAG
MID
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Transver
se plane
of the
kidney
LT KID TX
SUP
LT KID TX
MID
LT KID TX
INF
SPLEEN SAG
Sagittal
plane of
the
spleen
Spleen
Transver
se plane
of the
spleen
SPLEEN SAG
SPLEEN TX
Area of
Interest
Superior, Mid
and Inferior
Plane
Sagittal
Measureme
nt
3 cm or less
Comments
Pancreas
Head
Pancreatic
Duct
Body of the
pancreas
Common Bile
Duct
Level of Porta
Hepatis
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Transver
se plane
on the
body
Transver
se plane
on the
body
Long
Axis
Head 2-3.5
cm
2 mm or less
<7-8 mm
Gallbladder
wall
Liver
Main Portal
Vein
Anterior Wall
RT Lobe
Inferior
Porta Hepatis
Transver
se
Sagittal
Kidneys
Mid
Transver
se plane
on the
body/
long axis
on the
vessel
Sagittal
Spleen
Mid
Sagittal
<3 mm
15-17 cm
Normal AP
measurement
is <13mm
Normal flow
velocity is 2040 cm/s
10-12 cm
8-13 cm
AST (SGOT)
ALT (SGPT)
Alkaline phosphatase
Organ
Pancreas
Pancreas
Aorta (or
any
vessel)
Liver
Level
Increased
Increased
Decreased
Increased
Increased
Increased
Increased
Increased
Increased
Increased
Bilirubin
Liver
Liver
Gallbladd
er
Liver
Gallbladd
er
Kidneys
Kidneys
All organs
Indication or Association
Pancreatitis or other pancreatic disease
Pancreatitis or other pancreatic disease
Vascular rupture, bleeding, hemorrhage,
etc.
Tips
Patient should be NPO for this study to reduce the amount of gas present and to prevent
contraction of the GB
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Have patient poke out their abdomen or take in a deep breath if having trouble seeing the
pancreas
Pancreatic tail may be evaluated using the spleen as a window
Sit the patient erect for scanning if suspicious for stones stuck in the neck that werent
confirmed in LLD or RLD
Watch your gain settings:
o Making the GB lumen too dark with TGC can mask pathology
o Using too much gain can give the appearance of pathology
If the GB appears to have artifacts, change to a higher frequency, use harmonics, use a
different window, or have the patient poke out their abdomen
If the GB is enlarged make sure to evaluate the ducts for signs of stones. These can
obstruct the ducts
To find the CBD:
o Scan from the GB in transverse and follow it to the neck and cystic duct, you will
see CBD
o Follow the portal vein from the portal confluence. The CBD will be anterior to the
vein
If the GB has been surgically removed (postcholecystectomy), document a GB FOSSA
image (main lobar fissure near porta hepatis) instead of the gallbladder images
Roll the patient up LLD and RLD, if necessary, to see kidneys better
o Use the liver on the right as a window
o Use the spleen on the left as a window
If urinary obstruction is a concern, use color Doppler to look for bladder jets to verify open
ureter
Coronal Scanning
o
Sometimes, especially on the left, the kidney can be seen best scanning coronally.
Anterior and posterior images can be obtained from the coronal scan plane.
The medial and lateral images cannot be obtained from this plane.
Therefore, anterior, mid, and posterior images in coronal should documented.
The renal parenchyma, sinus, and capsule will be seen in each image
Label Coronal - Anterior, Mid, or Posterior
Pathology Seen
o
o
o
o
o
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o
o
o
o
o
o
Use color and spectral Doppler to document true and false lumens
If the GB wall measures greater than 3 mm, color Doppler can be used to confirm
increased flow in the wall due to cholecystitis.
If the patient has gallstones and/or gallbladder wall thickening, they should be
evaluated for a positive Murphys sign (extreme tenderness upon transducer or manual
pressure in the RUQ). This needs to be reported to the interpreting physician as it
indicates acute cholecystitis.
Must attempt to demonstrate movement of any pathology seen in the GB sludge and
stones will move masses will not!!
If the CBD is enlarged at the porta hepatis, it should be followed to the pancreatic head
to evaluate for stones or an obstructive lesion
For hydronephrosis, demonstrate connection of the dilated pyramids to the renal pelvis
and include ureter images if the ureter is dilated.
For renal calculi, move the focal zone to the level of the calculus to aid in
demonstrating posterior shadowing
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