RADI 442 EXAM 3

What are the accepted rules of conduct like integrity, compassion, honesty, and respectfulness?

Moral principles

What are some descriptive findings vocab?

echogenic foci in the gallbladder; positive for shadowing; mobile; measure if necessary; twinkle sign with color

finding in the gallbladder

example of abnormal finding

example of normal

What is it called when an entire organ affected by an infiltrative disease or some process that is affecting the cells in the organ?

Diffuse disease

What is it called when a mass or masses are easily seen and measured?

focal or localized

focal (lesion can be seen)

diffuse

How do you describe abnormalities?

How many; origin; adjacent organs/structures involved; composition (sonographic descriptors); size (always 3 measurements in 3 planes LWD); always shown in two planes; vascularity

Understand the echotexture of an image. Is it…

homo/heterogeneous, mixed, isoechoic, hypo/hyperechoic, echogenic, cystic, solid, complex

Understand the borders of the finding. Are they…

regular/smooth, irregular, well defined, not well defined, thickness

Artifact that is fluid, cyst/cystic

posterior enhancement

Artifact that is calcified, solid

shadowing

artifact that is showing air

dirty shadowing

artifact that shows reverberation (EX: gallbladder pathologies)

comet tail artifact

What is a cyst criteria?

round/oval, smooth, well-defined borders, COMPLETELY anechoic, thin walls, increased transmission — true cyst. if does not meet these requirements it is a cystic/complex lesion

What is complex criteria?

has both cystic and solid characteristics (abscess); most lesions happen here

What is solid criteria?

irregular borders, internal echoes, decreased transmission

What is vascularity?

does it have blood flow

What could a not well defined border mean?

bowel gas

Do we want to see thick borders?

no

cyst

cystic lesion

Questions to consider asking yourself when trying to describe an abnormal finding:

how many? location — what organ, where is located within the organ? are any other organs/structures involved? describe — complex, mixed echogenic, anechoic, well-defined, etc…

How would you describe this finding?

solitary, complex but mostly cystic, well-circumscribed cortical lesion within the right kidney with internal septation

how would you describe this finding?

solitary, well-circumscribed hypoechoic lesion within the upper pole of right kidney

How would you describe this finding?

multiple hypovascular (avascular) echogenic cortical lesions within the right kidney

How would you describe this finding?

solitary, well-circumscribed avascular, hypoechoic lesion within the upper pole of left kidney

How would you describe this finding?

heterogenous, solid mass in the upper pole of right kidney with irregular borders. echogenic structure within the central lumen of the inferior vena cava at the level of the right renal vein which may reflect non-occlusive thrombus versus abutting or invading mass

The color doppler can be used for what?

to look for vascularity internally

What are findings that require immediate notification and do not let the patient leave

DVT, severe carotid findings, ectopic, fetal demise, appendicitis, air in the portal system

Step 1 of Sonographic Examination

assessment of relevant documentation

step 2 of sonographic examination

examining reports and images

step 3 of sonographic examination

preparing the exam room and protocol review

step 4 of sonographic examination

introducing yourself

step 5 of sonographic examination

gathering clinical history

Anything the patient or family member tells you regarding their history (EX: “I’m having epigastric pain and back pain”)

subjective information

information the sonographer can clearly see, hear, feel, or read. it is factual and concrete (EX: lab values in patient chart confirm that patient amylase and lipase levels are elevated)

objective information

step 6 of sonographic examination

patient education

step 7 of sonographic examination

conducting the sonogram

step 8 of sonographic examination

completing the sonography report

step 9 of sonographic examination

sonographer interaction with interpreting physician

step 10 of sonographic examination

discharging the patient (ensure they don’t have any additional exams, tests, or imaging studies before letting them go)

What is the placement of the liver?

extends from RT hypochondrium across the epigastric area into LT hypochondrium

What is the fibrous connective tissue with nerves and blood vessels that covers the liver?

glisson’s capsule

What is the measurement that is considered hepatomegaly in the liver?

more than 15-17 cm

Riedel’s lobe

right lobe of liver extends below inferior pole of right kidney

What is helpful in visualization of pancreas?

elongated left tip of liver

Where the main portal vein and hepatic artery enter the liver and common bile duct exits the liver

porta hepatis

What are the 3 fossa?

gallbladder, porta hepatis, and IVC

The pancreas is what to the liver?

inferior to the LT lobe

The duodenum is what to the liver?

adjacent and medial to RT lobe

The gallbladder is what to the liver?

posterior

What is the smallest lobe of the liver?

caudate

What is the largest lobe of the liver?

right

Hepatic veins, portal veins, ligaments, and fissures

what divides the lobes of the liver

What forms upper border and attaches to diaphragm, separates RT from LT lobes?

falciform ligament

What does the right lobe border?

anterolateral abdominal wall

Where does the right lobe lay?

right lateral undersurface of diaphragm

The right lobe is divided into anterior and posterior segments by what?

right portal vein and right hepatic vein

What separates the right lobe from the left lobe?

middle hepatic vein and main portal vein

What divides right from left lobes?

main lobar fissure

Where does the left lobe lay?

undersurface of diaphragm

The left lobe is what to the pancreas?

anterior (anatomy dependent)

transverse left lobe

The left lobe is divided into medial and lateral segments by what?

ligament of teres, left hepatic vein, and left portal vein

What separates the left lobe from caudate?

ligament venosum

What are all the anatomy that separates RT lobe from LT lobe?

falciform ligament, main lobar fissure, middle hepatic vein, and main portal vein

Where does the caudate lobe lay?

posterior liver

What is the anterior border of the caudate that separates it from the left lobe?

ligament venosum

What forms the posterior border of the caudate lobe?

inferior vena cava

The caudate lobe can be enlarged with pathology such as…

cirrhosis

what’s the arrow pointing at

caudate lobe

what is the image showing?

hepatic veins

What meets the falciform to connect liver to diaphragm (usually do not see)?

coronary ligament

what is the arrow pointing to?

falciform ligament

What has anterior and posterior branch

right portal vein

what enters the liver anterior to IVC and posterior to hepatic artery

main portal vein

what has lateral and medial branch

left portal vein

How to designate MPV and RPV

mpv is outside of liver, rpv inside liver

rpv/lpv confluence

oxygen-rich blood flows into the liver through what?

hepatic artery

nutrient-rich blood coming from the bowel flows into the liver through the what?

portal vein

bile flows out of the liver through what?

bile duct

blood flows out of the liver through 3 hepatic veins into a big vein called the what?

inferior vena cava

What is the large duct at the porta hepatis that drains bile?

common bile duct

all scan should begin with what?

a survey

sagittal liver left lobe protocol

1. lateral margin

2. aorta

3. caudate lobe

4. ivc

5. ivc with color

transverse liver left lobe protocol

1. lateral margin/dome

2. left hepatic vein

3. caudate lobe

4. left portal vein

sagittal liver right protocol

1. ivc

2. gallbladder

3. 2 mids

4. dome

5. kidney

6. measurement

transverse liver right protocol

1. hepatic veins

2. portal rt/lt confluence

3. kidney

4. dome

5. mpv

sagittal liver left lateral margin

sagittal liver left with aorta

sagittal liver left with caudate

sagittal liver left with ivc

transverse liver left dome

transverse liver left with hepatic vein

transverse liver left with left portal vein

sagittal liver right with gallbladder