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Chapter 8- Introduction to Abdominal Scanning: Technique and Protocol

Terms in this set (62)

diagnostic images
The ultimate goal of the sonographer is to produce ________ that can be interpreted by the physician to answer a clinical question.
patient position, transducer, scanning, breathing, survey
To create images that are diagnostically useful, you must be familiar with ultrasound instrumentation and the clinical considerations of the patient exam.

Clinical considerations include:
1. Knowing which _______ should be used for specific examinations
2. _____ selection
3. ______ techniques
4. Patient _____ techniques
5. How to perform your sonographic _____ of the abdomen
nose, stomach
A recommended patient breathing technique tip is to have the patient breathe in through the ______ to reduce the amount of air going into the ______.
ultrasound equipment, operator's manuals, protocols, ID bracelet, procedure
Orientation to the Clinical Lab
1. Learn the _______ in your department
2. Know where the ______ are for each piece of equipment so you may have a reference for troubleshooting.
3. Find out what ______ are used for each examination.
4. Understand how to read the patient request, find out what question the ordering physician needs to have answered, and know which items are relevant for patient identification.
5. When you call for patients, be sure to check their _____ or ask them to say their name and birth date.
6. Introduce yourself and briefly explain the ______ you are going to do. Also explain the procedure the department will follow to notify the patient's physician of the results of the exam.
7. Keep conversations professional
8. Discuss the case only with your mentor or with the physician responsible for interpreting the study.
interface, interface
Ultrasound can distinguish multiple interfaces between the soft tissue structures of different acoustic densities. The strength of the echoes reflected depends on the acoustic ______ and the angle at which the sound beam strikes the _______.
window, transducer
The sonographer must determine which patient _____ is best to record optimal ultrasound images, and which ______ best fits into that window.
large
The curved array transducer provides a ______ field of view but in some patients, it may be difficult to fit closely between the ribs to provide adequate contact for accurate reflection of the sound wave.
near field
The smaller vector transducer allows the sonographer to scan between the intercostal spaces with the patient in supine, coronal, decubitus, or upright position, but limits the _________ of view.
no
Is it unusual to use multiple transducers on one patient to complete the examination?
supine
The typical abdominal ultrasound is done primarily in the ______ position. However, the oblique, lateral decubitus, upright, and prone positions have also been used for examination of specific areas of interest.
yes
Will the size of the patient influence what megahertz transducer will be used?
decontamination
If the transvaginal transducer is used, be familiar with the _______ process for the transducer.
survey, organs, scanning window, xiphoid, head, left shoulder
Initial Survey of the Abdomen

1. Before you begin the protocol for the specific exam, take a minute to _____ the area in question. This will give you the opportunity to see how the patient images appear with routine instrument settings, to observe where the ______ are in relationship to the patient's breathing pattern, and to see if the patient has a good _______ in the supine position, or if the patient needs to be moved.
2. In a general abdominal survey, ask the patient to take a deep breath; begin at the level of the ______ in the midline with the transducer angled steeply toward the patient's ______, so as to be perpendicular to the diaphragm.
3. Slowly angle the transducer inferiorly to "sweep" through the liver, gallbladder, head of pancreas, and right kidney.
4. The transducer then may be redirected in the same manner, only angled toward the ______ with a gradual angulation made inferiorly to see the stomach, spleen, pancreas, and left kidney.
aorta, aorta, inferior vena cava, liver, TGC
A quick survey of the abdomen may be done with the transducer in the midline sagittal position.
1. Image the ____ first with the vertebral column posterior to the ____.
2. Then, slowly angle the transducer to the right to image the dilated _____ and ______.
3. Continue to angle toward the right to image the right lobe of the liver, gallbladder, and right kidney.
4. If adequate penetration is seen with balanced _____ and overall gain adjustments, then you can proceed with the routine protocol for the abdominal study as provided later in this chapter.
specific organ
Ultrasound images are labeled as transverse or longitudinal for a _______. The smaller organs that can be imaged on a single plane, such as the kidney, are labeled as long-midline, long-lateral, or long-midline, whereas the transverse scans are labeled transverse-low, transverse-high, or transverse-high
left
All transverse supine scans are oriented with the liver on the ____ of the monitor.
left, right
Longitudinal scans display the the patient's head to the ____ and feet to the ____ of the screen and use the xiphoid, umbilicus, or symphysis to denote the midline of the scan plane.
labeled
All scans should be appropriately _____ for future reference, including the patient's name, date, and anatomic position.
markers
Body position ______ are available on many ultrasound machines and may be used in the place of written labels.
scanning table
The position of the patient should be described in relation to the ______.
landmarks
With the use of real-time ultrasound, it is sometimes difficult to become oriented to all of the anatomic structures on a single image. It is therefore critical to obtain as many _____ of the anatomy as possible in a single image.
rib
Make every effort to avoid _______ interference to eliminate artificial ring-down, attenuation, or reverberation noise that may distort anatomic information
rib
Variations in the patient's respiration may also help eliminate ______ interference and improve image quality. The sonographer can easily watch in real time how much interference is caused by patient breathing and can ask the patient to take a deep breath and hold it, or to stop breathing at critical points.
6, 8, gallbladder, bowel gas
Patients should be instructed not to eat or drink for ____ to _____ hours before the abdominal ultrasound procedure. This will enable the _____ to be distended and will prevent unnecessary _______ that could interfere with the visualization of the smaller abdominal and vascular structures.
stomach, pancreas
If the left upper quadrant is not adequately imaged, the patient may be given water to fill the ________. As the patient is rolled into a right decubitus position, the fluid flows from the body of the stomach to fill the antrum and duodenum, allowing the _____ and great vessels to be imaged.
retroperitoneal, flank, mass, lab, metastatic, congenital, trauma
Indications for Abdominal Sonography:
1. Signs or symptoms that may be referred from the abdominal or _______ region such as jaundice or hematuria
2. Generalized abdominal, _______, or back pain
3. Palpable _____ or organomegaly
4. Abnormal _____ values or on other imaging modalities
5. Follow up of known or suspected abnormalities in the abdomen or retroperitoneum
6. Search for ______ disease or occult primary neoplasm
7. Evaluation of suspected ______ abnormalities
8. _______ to the abdomen or peritoneum
9. pretransplant and posttransplant evaluation
10. Invasive procedure localization
11. Localization for free or loculated peritoneal, pleural, or retroperitoneal fluid
symptoms, history
The documentation that must be met for medical necessity include:
1. patient signs and _____
2. previous ____ pertinent to exam requested
medical necessity
The request for an abdominal or retroperitoneal sonographic exams needs to provide sufficient information to demonstrate ________ of the exam and allowance for proper performance and interpretation.
anechoic
opposite of echogenic; without internal echoes; the structure is fluid-filled and transmits sound easily. Examples include vascular structures, distended urinary bladder, gallbladder, and amniotic cavity
echogenic
or hyperechoic; opposite of anechoic; echo producing structure; reflects sound with a brighter intensity; examples include gallstone, renal calyx, bone, fat, fissures, and ligaments
enhancement
increased through transmission; sound that travels through an anechoic (fluid-filled) substance and is not attenuated; brightness is increased directly beyond the posterior border of the anechoic structure as compared with the surrounding area
fluid-fluid level
interface between two fluids with different acoustic characteristics; this level will change with patient position. An example is dermoid with fluid level
heterogeneous
not uniform in texture or composition. Example: many tumors have characteristics of both decreased and increased echogenecity
homogeneous
opposite of heterogeneous; completely uniform in texture or composition. Example: the textures of the liver, thyroid, testes, myometrium are generally considered to be this.
infiltrating
usually refers to a diffuse disease process or metastatic disease
irregular borders
borders are not well-defined, are ill-defined, or are not present. Examples include access, thrombus, or metastases
isoechoic
very close to the normal parenchyma echogenecity pattern. An example is metastatic disease
loculated mass
well-defined borders with internal echoes; the septa may be thin (likely benign) or thick (likely malignant)
shadowing
the sound beam is attenuated by a solid or calcified object. This reflection or absorption may be partial or complete; air bubbles in the duodenum may cause a "dirty shadow" to occur secondary to reflection; a stone would cause a sharp shadow posterior to its borders
pathology
The sonographer needs to be able to demonstrate the normal anatomic structures, as well as the _______ that may invade or surround structures.
cystic, complex, solid
Pathology may be identified by the internal composition as ______, ______, or ______. This is determined by how easily sound is able to transmit through the mass.
simple cyst
A ______ has smooth borders, is anechoic, and there is increased transmission
hypoechoic mass
A _________ has few to low-level internal echoes, smooth border, and no increased transmission
complicated cyst
A ________ has a mixed pattern of cystic and solid, fluid, debris, and blood; transmission may or may not increase.
loculated cyst
A ________ is well-defined with thin septa, and has increased transmission
abcess
An _______ may have irregular borders, debris within, and transmission may or may not be increased
homogeneous mass
A _______ has uniform texture within.
heterogeneous mass
A ______ has nonuniform texture within
infiltrating mass
An _______ has distorted architecture, irregular borders, and decreased transmission
irregular, heterogeneous, homogeneous, anechoic, isoechoic, echogenic, hyperechoic, hypoechoic, increased, decreased
Ultrasound Criteria for Identifying Abnormal Structures

Border- may be smooth and well-defined, or _______
Texture- texture (parenchyma) of the structure may be ______ or _______

Characteristic- characteristic or an organ or of a mass is said to be ______, _____, ______, _______, or _______ in comparison to the rest of the parenchyma

Transmission- transmission of sound may be increased, decreased, or unchanged. An anechoic mass (fluid-filled cyst) will show an ________ transmission of sound, whereas a dermoid tumor (composed of muscle, teeth, and bone) will show ________ transmission
anterior, medial
The gallbladder is _______ to the right kidney and ______ to the liver
identifying, confidentiality, privacy, nursing
It is the responsibility of the sonographer to ensure that patients are afforded the highest quality care possible during the exam. This includes:
1. properly ______ the patient
2. ensuring ______ of information and patient ______
3. providing proper ______ care
4. maintaining clean and sanitary equipment and examination rooms
high, curved array, muscle, 2.25, 7.5, depth, transverse, longitudinal
The abdomen is imaged with ____-resolution real-time ultrasound equipment. The transducer selected may be a sector, ______, or a combination of the two. The frequency of the transducer often depends on the size, ______, and fat composition of the patient. Generally, a broad-bandwidth transducer is used with variations of _____ to _____ MHz, depending on the size of the patient and _____ of the field. All organs are imaged in at least two planes: _____ and ____.
vertebral column, focal, right kidney
In transverse scans, the horseshoe-shaped contour of the ______ should be well-delineated to ensure sound penetration through the abdomen without obstruction from bowel gas interference. The liver parenchyma should be evaluated for _____ and/or diffuse abnormalities. The homogeneous echogenecity of the liver parenchyma should be compared with that of the _______.
confidentiality, nursing
It is the responsibility of the sonographer to identify the patient properly, ensure ______ of information and patient privacy, provide proper ____ care, and maintain clean and sanitary equipment and examination rooms.
sector
The upper abdomen is imaged with high-resolution real-time ultrasound equipment. The transducer selected may be a _____ or curvilinear array or, in may cases, a combination of the two.
2.25, 7.5
Generally, a broad-bandwidth transducer is used, with variations of _____ to _____ MHz
perpendicular
In a _____ position, the transducer is straight up and down
subcostal
In a ______ position, the transducer is angled superiorly beneath the inferior costal margin
intercostal
In an _____ position, the transducer is between the ribs. It can be perpendicular, subcostal, or angled.
angled
In an ________ position, the transducer is angled superiorly, inferiorly, or right and left laterally at varying degree
rotated
In a ______ position, the transducer is rotated varying degrees to oblique the scanning plane
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