Denver Health Protocols

Aorta, IVC, and Iliac Duplex Ultrasound Protocol

1. Aorta- prox, mid, distal - Sag / Trans - ap and width, color, pw

2. Iliac Arteries - Sag / Trans - ap and width, color, pw

3. IVC - bw, Color and PW

Appendix Protocol

Scan:

1. Look for area of max pain - start here

• Take images with and without color and power Doppler, looking for hyperemia.

• Measure the compressed appendix at site of maximum diameter on transverse image, from outer to outer margins of wall.

• Cine: SAG and TRV

Document any secondary findings including:

- Evaluate for fecalith/appendicolith

- free fluid

- loculated fluid collections

- echogenic/hyperemic mesentery/inflammatory changes

ALSO CHECK:

1. Right lower quadrant,

2. left lower quadrant

3. inf right upper quadrant,

4. periumbilical area

5. pelvis

Ascites Protocol

Scan All four quadrants

and

midline upper and lower abdomen

Testicular Protocol

Protocol:

TESTICLES:

o Comparison of both testes in the same image with and without color doppler

o TRV and SAG images throughout the entirety of bilateral testes

o Color and Power doppler to evaluate flow

o SAG, AP, TRV measurements

o 2D, measurements, color/power doppler on any focal abnormality

EPIDIDYMIS:

o SAG views of epididymal head, body, and tail, bilaterally.

o Measure AP dimension of epididymal head

o Color doppler

o Document any spermatoceles/cysts/masses

INGUINAL CANAL:

o 2D images in TRV and SAG

o Cine bilat IGN canal with Valsalva

o Document any hernia with measurements, color, and compression

o Document any other focal abnormality

Ultrasound Abdomen Complete Includes

Aorta, IVC, pancreas, liver, gallbladder, ducts, kidneys, bladder, RLQ/LLQ, and spleen

AB Complete Protocol:

Protocol:

AORTA:

o SAG prox, mid, and distal Ao (measurement outer to outer)

o Color doppler for blood flow direction

o Document any AAA in three dimensions, 2D, and color Doppler

IVC:

o 2D Sag IVC

o Color doppler image

PANCREAS:

o TRV head, body and tail

o TRV head and porto-splenic confluence with color doppler

o Measure pancreatic duct if visible.

o If not well seen, take image of “Pancreas Area”

LIVER:

o Scan liver entirety SAG left to right and TRV from cephalad to caudad including major

anatomy and evaluating for focal or diffuse findings

o Liver length at the level of the right kidney. If possible, perform view comparing the

echogenicity of the liver to the right kidney

o 2D MPV measurement at porta hepatis for accurate diameter

o MPV evaluation with color and power doppler for patency and direction of flow

o Liver capsule surface image with linear transducer assessing nodularity, preferably the left lobe.

BILE DUCTS:

o SAG CBD measured inner to inner wall at porta hepatis. Color doppler used to distinguish ducts from vessels.

o If dilated, follow CBD as distal as possible to look for stones/mass and measure as distal

as possible as well.

o Document and measure any intrahepatic bile duct dilatation with 2D and color imaging

GALLBLADDER

o SAG and TRV images through gallbladder entirety. Get LLD GB when possible

o Measure GB wall most accurately represented, except along the posterior wall

o Document any abnormality seen, (stones, polyp, adenomyomatosis) Color and power doppler

when needed

o Evaluate for Murphy’s sign. if pain medication received or patient condition limits assessment,

document on worksheet

o Color doppler of GB wall for hypervascularity

KIDNEYS:

o SAG and TRV of kidney entirety (SAG medial, mid, and lateral and TRV upper, mid and lower)

o SAG and TRV measurements at mid kidneys.

o Document hydronephrosis or pelviectasis with color doppler at pelvis.

o Measure AP diameter of pelvis in transverse aspect.

SPLEEN:

o TRV and SAG of spleen

o SAG spleen length measurement

o Document the left pleural space if possible

o Color doppler for blood flow

BLADDER:

o SAG and TRV Urinary bladder

LOWER QUADRANTS:

o RLQ and LLQ for ascites

AB Limited/RUQ includes

pancreas, liver, gallbladder, ducts

Liver with Doppler includes

Liver with vascular evaluation including-

o MPV, LPV, UDPV, RAPV, RPPV, MHV, RHV, LHV, and Hepatic Artery

TVU protocol

Uterus

o Document vagina, cervix, and uterus

o Uterine length, height, width, and endometrium

o SAG images right of midline, midline and left of midline.

o TRV images from cervix to fundus.

Ovaries / Adnexa

o Ovarian length, height, and width.

o SAG and TRV images of each ovary

o Image bilateral adnexa

o Color and pulse wave doppler of each ovary

RUQ w. Doppler includes

• pancreas, liver, gallbladder, ducts

• vascular evaluation of –

  • MPV, LPV, UDPV, RAPV, RPPV, MHV, RHV, LHV, and Hepatic Artery

EARly OB protocol

1. Get LMP, EDD

2. Scan Uterus - position (retro/ante), Rt- Left, Length, AP x W

3. Gest. Sac in Uterus? - MSD, Yolk Sac Present, Embryo Present, CRL measurement, Cardiac activity HR

4. RT Ov / LT OV - L x H X W, CF, PW

5. Adnexas (Rt/Lf) - B&W, Color, Cine both sides

6. CDS - check for fluid

Questions for Thyroid scan patients

1. hx of Thyroid CA

2. Hx of Radiation

3. Hx of endocrine dz

4. Prior bx or surgery

5. Prior US

When scanning thyroid, what size nodules do they want you to measure and count?

any over 1 cm