PROTOCOLS

THYROID:

  1. Transverse Thyroid (comparison)

    1. Grayscale

    2. Color

  2. Transverse Isthmus

    1. Grayscale (decrease depth)

    2. Measure AP

  3. Transverse Thyroid Right Lobe Superior in Grayscale

  4. Transverse Thyroid Right Lobe Mid

    1. Grayscale

    2. Measure width and AP

    3. Color

  5. Transverse Thyroid Right Lobe Inferior in Grayscale

  6. Long Thyroid Right Lobe Lateral in Grayscale

  7. Long Thyroid Right Lobe Mid

    1. Grayscale

    2. Measure length and AP

    3. Color

  8. Long Thyroid Right Lobe Medial in Grayscale

  9. Long Right Lateral Neck in Grayscale

  10. Transverse Thyroid Left Lobe Superior in Grayscale

  11. Transverse Thyroid Left Lobe Mid

    1. Grayscale

    2. Measure width and AP

    3. Color

  12. Transverse Thyroid Left Lobe Inferior in Grayscale

  13. Long Thyroid Left Lobe Lateral in Grayscale

  14. Long Thyroid Left Lobe Mid

    1. Grayscale

    2. Measure length and AP

    3. Color

  15. Long Thyroid Left Lobe Medial in Grayscale

  16. Long Left Lateral Neck in Grayscale

THYROID NOTES:

  • RUSH radiologist prefers for mid to be split screen with long mid and transverse mid

  • Split screen should include measurements for BOTH planes

SCROTUM:

  1. Transverse Scrotum (comparison)

    1. Grayscale

    2. Color

  2. Transverse Right Testicle Superior in Grayscale

  3. Transverse Right Testicle Mid

    1. Grayscale

    2. Measure width

    3. Color

  4. Transverse Right Testicle Inferior in Grayscale

  5. Long Right Sac

  6. Long Right Testicle Lateral in Grayscale

  7. Long Right Testicle Mid

    1. Grayscale

    2. Measure length and AP

    3. Color

    4. PW

  8. Long Right Testicle Medial in Grayscale

  9. Transverse Right Epi Head

    1. Grayscale

    2. Measure width

  10. Long Right Epi Head

    1. Grayscale

    2. Measure length and AP

    3. Color

  11. Transverse Left Testicle Superior in Grayscale

  12. Transverse Left Testicle Mid

    1. Grayscale

    2. Measure width

    3. Color

  13. Transverse Left Testicle Inferior in Grayscale

  14. Long Left Sac

  15. Long Left Testicle Lateral in Grayscale

  16. Long Left Testicle Mid

    1. Grayscale

    2. Measure length and AP

    3. Color

    4. PW

  17. Long Left Testicle Medial in Grayscale

  18. Transverse Left Epi Head

    1. Grayscale

    2. Measure width

  19. Long Left Epi Head

    1. Grayscale

    2. Measure length and AP

    3. Color

SCROTUM NOTES:

  • Valsalva maneuver is used to identify enlarged veins or a varicocele and is performed by asking a patient to

    • Take a breath

    • Pinch nose and close mouth

    • Forcefully exhale while bearing down

    • Hold

  • Varicocele is identified if vessel measures larger than 3 mm and is a normal finding


BREAST:

  1. Anti-Radial

    1. Grayscale with chest wall

    2. Grayscale with decreased depth focused on mass

    3. Measure width of mass

    4. Color

  2. Radial

    1. Grayscale

    2. Measure length and height of mass

    3. Color

RUQ:

  1. Transverse Pancreas (1-2 images) showing as much pancreas as possible

    1. Grayscale

    2. Color

  2. Long Left Liver in Grayscale (3-4 images) sweeping through including landmarks

    1. Dorito

    2. Aorta

    3. IVC

    4. Caudate

  3. Transverse Left Liver in Grayscale (3-4 images) sweeping through stopping at pancreas

  4. Long Right Liver in Grayscale (6-8 images)

    1. Liver and Right Kidney Interface

    2. Measure length

    3. Color and PW of MPV

  5. Transverse Right Liver in Grayscale (6-8 images) starting at dome and ending at kidney

    1. Color of Hepatic Veins

  6. CBD

    1. Grayscale

    2. Measure inner to inner

    3. Color

  7. Long GB in Grayscale (3-4 images)

  8. Transverse GB in Grayscale (3-4 images

  9. Long GB LLD in Grayscale (3-4 images)

  10. Transverse GB LLD in Grayscale (3-4 images)

    1. Measure GB wall

  11. Long Right Kidney Lateral in Grayscale

  12. Long Right Kidney Mid

    1. Grayscale

    2. Measure length

    3. Color

  13. Long Right Kidney Medial in Grayscale

  14. Transverse Right Kidney Superior in Grayscale

  15. Transverse Right Kidney Mid

    1. Grayscale

    2. Measure height and width

    3. Color

  16. Transverse Right Kidney Inferior in Grayscale

COMPLETE ABDOMEN:

  1. Long Aorta Proximal

    1. Grayscale

    2. Measure outer to outer

  2. Long Aorta Mid in Grayscale

    1. Grayscale

    2. Measure outer to outer

    3. Color

    4. PW

  3. Long Aorta Distal in Grayscale

    1. Grayscale

    2. Measure outer to outer

  4. Long IVC

    1. Grayscale

    2. Color

  5. Transverse Pancreas (1-2 images)

    1. Grayscale

    2. Color

  6. Long Left Liver in Grayscale (3-4 images) sweeping through including landmarks

    1. Dorito

    2. Aorta

    3. IVC

    4. Caudate

  7. Transverse Left Liver in Grayscale (3-4 images) sweeping through stopping at pancreas

  8. Long Right Liver in Grayscale (6-8 images)

    1. Liver and Right Kidney Interface

    2. Measure length

    3. Color and PW of MPV

  9. Transverse Right Liver in Grayscale (6-8 images) starting at dome and ending at kidney

    1. Color of Hepatic Veins

    2. Make sure to include and label each hepatic vein in color

      1. RHV

      2. MHV

      3. LHV

  10. Patients with HCC on indication: SWITCH TO LINEAR TRANSDUCER Right Liver Surface

  11. Patients with HCC on indication: SWITCH TO LINEAR TRANSDUCER Left Liver Surface

  12. Long Right Kidney Lateral in Grayscale

  13. Long Right Kidney Mid

    1. Grayscale

    2. Measure length

    3. Color

  14. Long Right Kidney Medial in Grayscale

  15. Transverse Right Kidney Superior in Grayscale

  16. Transverse Right Kidney Mid

    1. Grayscale

    2. Measure height and width

    3. Color

  17. Transverse Right Kidney Inferior in Grayscale

  18. Long GB in Grayscale (3-4 images)

  19. Transverse GB in Grayscale (3-4 images)

    1. Measure GB wall

  20. Long GB LLD in Grayscale (3-4 images)

  21. Transverse GB LLD in Grayscale (3-4 images)

  22. CBD

    1. Grayscale

    2. Measure inner to inner

    3. Color

  23. Long Left Kidney Lateral in Grayscale

  24. Long Left Kidney Mid

    1. Grayscale

    2. Measure length

    3. Color

  25. Long Left Kidney Medial in Grayscale

  26. Transverse Left Kidney Superior in Grayscale

  27. Transverse Left Kidney Mid

    1. Grayscale

    2. Measure height and width

    3. Color

  28. Transverse Left Kidney Inferior in Grayscale

  29. Long Spleen

    1. Spleen and Left Kidney Interface

    2. Grayscale

    3. Measure

    4. Color

  30. Transverse Spleen

    1. Grayscale

    2. Color

COMPLETE ABDOMEN NOTES:

  • RUSH does not PW on MPV unless specified by order

  • RUSH does not measure kidneys in transverse

ABDOMINAL DOPPLER:

  1. Aorta

    1. Grayscale

    2. Measure

    3. Color

    4. PW

  2. Celiac Artery

    1. Grayscale

    2. Color

    3. PW

  3. Superior Mesenteric Artery (SMA)

    1. Grayscale

    2. Color

    3. PW

  4. Hepatic Artery

    1. Grayscale

    2. Color

    3. PW

  5. Splenic Artery

    1. Grayscale

    2. Color

    3. PW

  6. Hepatic Veins including Right, Middle, and Left

    1. Grayscale

    2. Color

    3. PW

  7. Portal Veins including Right, Left, and Main

    1. Grayscale

    2. Color

    3. PW

RENAL:

  1. Long Right Kidney L-M (sweep) in Grayscale

  2. Long Right Kidney Mid

    1. Grayscale

    2. Measure length

    3. Color

  3. Transverse Right Kidney S-I (sweep) in Grayscale

  4. Transverse Right Kidney Mid

    1. Grayscale

    2. Measure height and width

    3. Color

  5. Long Left Kidney L-M (sweep) in Grayscale

  6. Long Left Kidney Mid

    1. Grayscale

    2. Measure length

    3. Color

  7. Transverse Left Kidney S-I (sweep) in Grayscale

  8. Transverse Left Kidney Mid

    1. Grayscale

    2. Measure height and width

    3. Color

  9. Transverse Bladder S-I (sweep) in Grayscale

  10. Transverse Bladder Mid

    1. Grayscale

    2. Measure

  11. Transverse Bladder Jets in Color

  12. Long Bladder ML-RT (sweep) in Grayscale

  13. Long Bladder ML-LT (sweep) in Grayscale

  14. Pre-Void Bladder SPLIT SCREEN

    1. Transverse bladder: Measure width

    2. Long bladder: Measure length and height

  15. Post-Void Bladder SPLIT SCREEN

    1. Transverse bladder: Measure width

    2. Long bladder: Measure length and height

RENAL DOPPLER (RUSH PROTOCOL):

  1. Aorta

    1. Grayscale

    2. Color

    3. PW

  2. Renal Artery Origin

    1. Grayscale

    2. Color

    3. PW

  3. Renal Artery Proximal

    1. Grayscale

    2. Color

    3. PW

  4. Renal Artery Mid

    1. Grayscale

    2. Color

    3. PW

  5. Renal Artery Distal/Hilum

    1. Grayscale

    2. Color

    3. PW

  6. Renal Vein at Kidney Hilum or Origin

    1. Grayscale

    2. Color

    3. PW

  7. Arcuate Artery Superior

    1. Grayscale

    2. Color

    3. PW

  8. Arcuate Artery Mid

    1. Grayscale

    2. Color

    3. PW

  9. Arcuate Artery Inferior

    1. Grayscale

    2. Color

    3. PW

  10. Repeat on other kidney

RENAL DOPPLER NOTES:

  • Native kidneys: More concerned with peak systole (PS)

    • PS > 180 cm/sec = STENOSIS

  • Transplant kidneys: More concerned with resistive index (RI)

    • RI > 0.7 = STENOSIS

APPENDIX (RUSH PROTOCOL):

  1. Linear probe: SPLIT SCREEN of Transverse RLQ & W/CMP (with compression)

    1. Physically move transducer from iliacs (lateral) to belly-button or bladder (medial)

    2. Image at each new location in Grayscale

    3. Color on iliacs

    4. Measure appendix width IF visible

    5. Color appendix IF visible

  2. Linear probe: SPLIT SCREEN of Long RLQ & W/CMP (with compression)

    1. Physically move transducer from iliacs (lateral) to belly-button or bladder (medial)

    2. Image at each new location in Grayscale

    3. Color on iliacs

    4. Measure appendix length and AP IF visible

    5. Color appendix IF visible

  3. Curved probe: Long RUQ to check for fluid near liver

  4. Curved probe: Transverse RUQ to check for fluid near kidneys

    1. Image kidneys in grayscale to check for hydronephrosis

    2. Image kidneys in color to check for stones

APPENDIX NOTES:

  • Those with appendicitis will have REBOUND PAIN

    • Normal patients: Pain upon compression or pressing down

    • Appendicitis: Pain after relieving compression or stopping pressure

  • Report: MUST STATE THAT APPENDIX IS NOT VISUALIZED, NOT THAT PATIENT IS NEGATIVE FOR APPENDICITIS

    • Appendix not visualized due to overlying bowel gas

    • No free fluid in abdomen

AORTA/IVC:

  1. Long Aorta Proximal (Supraclavicular)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

    4. PW (calipers on PS and ED)

  2. Transverse Aorta Proximal (Supraclavicular)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

  3. Long Aorta Mid (Juxtarenal)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

    4. PW (calipers on PS)

  4. Transverse Aorta Mid (Juxtarenal)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

  5. Long Aorta Distal (Infrarenal)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

    4. PW (calipers on PS)

  6. Transverse Aorta Distal (Infrarenal)

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

  7. Bifurcation

    1. Grayscale

    2. Color

    3. PW

  8. Long Right Common Iliac

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

    4. PW (calipers on PS)

  9. Transverse Right Common Iliac

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

  10. Long Left Common Iliac

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

    4. PW (calipers on PS)

  11. Transverse Left Common Iliac

    1. Grayscale

    2. Measure (outer to outer)

    3. Color

FEMALE ABDOMINAL PELVIS:

  1. Long Midline (ML) Uterus that includes endometrium, uterus, cervix

    1. Grayscale

    2. Measure length and AP

    3. Color

  2. Long Midline Endometrium

    1. Grayscale

    2. Measure

  3. Long Right Uterus that includes uterus, cervix in Grayscale

  4. Right Midline (ML) Sweep or Right Lateral Pelvis in Grayscale

  5. Long Left Uterus that includes uterus, cervix in Grayscale

  6. Left Midline (ML) Sweep or Left Lateral Pelvis in Grayscale

  7. Transverse vagina (inferior to cervix) in Grayscale

  8. Transverse cervix in Grayscale

  9. Transverse Inferior Uterus in Grayscale

  10. Transverse Mid Uterus

    1. Grayscale

    2. Measure width

  11. Transverse Superior Uterus in Grayscale

  12. Transverse Superior Pelvis that includes bladder in Grayscale

  13. Transverse Right Ovary

    1. Grayscale

    2. Measure length and width

    3. Color

    4. Arterial PW

    5. Venous PW

  14. Long Right Ovary

    1. Grayscale

    2. Measure AP

    3. Color

    4. Arterial PW

    5. Venous PW

  15. Transverse Right Adnexa that includes right side of uterus, ovary, pelvis, in Grayscale

  16. Long Right Adnexa that DOES NOT include right side of uterus, ovary in Grayscale

  17. Transverse Left Ovary

    1. Grayscale

    2. Measure length and width

    3. Color

    4. Arterial PW

    5. Venous PW

  18. Long Left Ovary

    1. Grayscale

    2. Measure AP

    3. Color

    4. Arterial PW

    5. Venous PW

  19. Transverse Left Adnexa that includes left side of uterus, ovary, pelvis in Grayscale

  20. Long Left Adnexa that DOES NOT include left side of uterus, ovary in Grayscale

PARACENTESIS:

  1. 1-2 images in grayscale RUQ

  2. 1-2 images in grayscale RLQ

  3. 1-2 images in grayscale LUQ

  4. 1-2 images in grayscale LLQ

PARACENTESIS NOTES:

  1. Normal lab values include

    1. Platelet count > 50

    2. INR/PT (prothrombin time) < 1.5