DMST 202: Ultrasound Scanning Fundamentals - Great Vessels (Vocabulary Flashcards)

Abdominal Aorta

Patient Preparation

• Fasting

Location

• Just left of midline

• Sits anterior to vertebral column

• Proximal portion of aorta more posterior in the body

• Distal portion of aorta more anterior in the body

• Courses superior to inferior in the body

Sonographic Appearance

• Tubular structure

• Tapers from cranial to caudal end

• Contains smooth bright walls

• Lumen appears anechoic (echo free)

• Non-compressible

Scanning Windows and Breathing Techniques

• Probe placed in the midline of the abdomen from the xiphisternum to the umbilicus

• Deep breath in and/or normal breathing for proximal aorta

• Normal breathing for distal aorta

Indications for an Aortic Sonogram

• Pulsatile abdominal mass

• Abdominal pain

Normal Measurements for the Aorta

• Anteroposterior measurement is less than or equal to 3\,\text{cm}

• Measurement occurs at the distal end of the aorta (follows spine curvature)

Abdominal Aorta Landmarks and Images

Anatomy and Landmark Requirements

• Aorta appears as an anechoic circle

• True axis (transverse)

• Focus below the deepest portion of the aorta

• Depth - should have enough to see behind the area of interest

• Gains not too bright or too dark

• TGC's even throughout the image

• Vertebral body may be visible in the background

Common Iliac Vessels (CIA) Landmarks

• Common Iliac Vessels appear as anechoic circle directly anterior to the spine

• True transverse axis

• Focus below the deepest portion of the aorta

• Depth - should have enough to see behind the area of interest

• Gains not too bright or too dark

• TGC's even throughout the image

Visual Reference Terms

• Vertebra

• TRX AO DIST

• TRX AO BIF

• CIA

Inferior Vena Cava

Patient Preparation

• Fasting

Location

• Just right of midline

• Sits anterior to vertebral column

Sonographic Appearance

• Tubular structure

• Contains thin walls

• Lumen appears anechoic (echo free)

• Compressible

Scanning Windows and Breathing Techniques

• Probe placed in the midline of the abdomen from xiphisternum to umbilicus

• Deep breath in and/or normal breathing for proximal IVC

• Normal breathing for distal IVC

Indications for an IVC Sonogram

• Abdominal pain

• Heart Disease

Inferior Vena Cava Landmarks and Images

Scanning Protocol: Great Vessels

Professionalism

• Introduce yourself as a SAIT student

• Confirm patient first and last name

• Confirm patient birthday

• Explain the examination to the patient

• Ask to begin the examination

Ultrasound Machine Setup

• Enter patient ID – student’s first and last name, student’s SAIT ID number and scanner’s initials

• Select the ABD SAIT Preset

• Select the 5\,\text{MHz} curvilinear transducer

TGC Setup

• Place a small amount of gel just below the xiphoid process (xiphisternal window)

• Place the probe in the sagittal plane in this window and have your patient take a deep breath in and hold it

• Angle the probe towards the patient’s right side and a large segment of the liver will appear

• Adjust your depth to ensure the entire liver is on the screen and not cut off at the bottom

• Place your focus posterior to the liver

• Check and adjust your TGC to ensure proper penetration of the echoes to the deepest portion of the liver

• Check and adjust your gains to an appropriate level – vessels should appear echo free

• Remember to let your patient breathe out

Adjusting the Machine for the Abdominal Aorta/IVC

• Move transducer back to the xiphisternal window in the sagittal plane

• Ask patient to take a deep breath in and hold it

• Adjust the depth so that the proximal aorta/IVC is in the centre of your screen

• Let your patient breathe out

Sagittal Interrogations of the Abdominal Aorta – “Sweeping”

• With the probe in the xiphisternal window in the sagittal plane, have the patient take deep/small breath in and hold it – (quiet breathing may optimize the Aorta as well)

• Identify the heart and diaphragm and ensure that they are on the left side of your screen

• Locate the aorta based on knowledge of its sonographic appearance and location in the body

• Place your focus posterior to the aorta

• Elongate the proximal/mid aorta – use transducer manipulation (rotation/angling) to achieve this

• Slide the transducer down the patient’s abdomen, keeping the long length of the aorta on the screen

• Once you have made it down half way or the liver window has disappeared, allow your patient to breathe (usually about the level of the SMA)

• Elongate the mid/distal aorta and continue sliding distally through the remainder of the aorta until it tapers

• Adjust your focus as you are sliding down the aorta keeping it at or below the aorta

• Repeat the above steps so that two interrogations of the aorta occur

• Note: in Scanning Fundamentals it is not necessary to adjust your depth as you sweep; this may be mandatory in future courses

• Refer to video labelled SAG AO SWEEP

Transverse Interrogations of the Aorta – “Sweeping”

• With the probe in the xiphisternal window in the transverse plane, have the patient take in a deep breath

• Tilt the transducer superiorly towards the patient’s head and look for the heart pulsating (starting point for the transverse sweeps)

• In one motion begin tilting your probe inferiorly in an arc and begin sliding down the aorta

• Identify the celiac trunk and SMA

• When SMA and celiac trunk are identified, let the patient breath out

• With the probe perpendicular to the patient’s skin slide the probe inferiorly towards the patient’s umbilicus

• Follow the aorta down to bifurcation

• Adjust your focus as you are sliding down the aorta keeping it at or below the aorta

• Adjust your depth as you are sliding down the aorta to ensure that the aorta is at all times in the middle of your screen

• Repeat the above steps so that two interrogations of the aorta occur

• Note: depth adjustment during sweeping is not mandatory in Scanning Fundamentals but will be in future courses

• Refer to video labelled TRX AO SWEEP

Sagittal Interrogations of the IVC – “Sweeping”

• With the probe in the xiphisternal window in the sagittal plane, have the patient take in a deep/small breath and hold it – (quiet breathing may optimize the IVC as well)

• Identify the heart and diaphragm and ensure that they are on the left side of your screen

• Locate the IVC based on knowledge of its sonographic appearance and location in the body

• Place your focus posterior to the IVC

• Elongate the proximal/mid IVC – use transducer manipulation (rotations/angling) to achieve this

• Slide down the patient’s abdomen keeping the long length of the IVC on your screen

• Don’t use a lot of pressure as the IVC is compressible

• Often, the distal portion of the IVC is obscured with gas and not seen

• We should always be able to interrogate the IVC from the diaphragm to the level of the right renal vein

• Adjust your focus as you are sliding down the IVC keeping it at or below the IVC

• Repeat the above steps so that two interrogations of the IVC occur

• Note: depth adjustment during sweeping is not mandatory in Scanning Fundamentals but will be in future courses

• Refer to video labelled SAG IVC SWEEP

Required Imaging of the Abdominal Aorta and IVC

• Once the interrogations are complete, freeze and store the required images below.

• Optimize your technical factors and correctly annotate each image (see below).

• Labels:

  • TRX AO DIST (Transverse plane)

  • TRX AO BIF

  • SAG IVC

  • SAGITTAL PLANE

  • SAG AO PROX

  • SAG AO DIST

Image Labeling and Reference Notes

• Example image labels used in the protocol:

  • SAG AO PROX

  • SAG AO DIST

  • TRX AO DIST

  • TRX AO BIF

  • SAG IVC

  • ABD SAIT

• Preset and settings references seen in practice sheets (e.g., ABD SAIT, C5-2, 20Hz, 12am, 20, etc.)

• Planes and annotations correspond to the required imaging list above

References

• Curry, R., & Prince, M. (2021). Sonography: Introduction to Normal Structure and Function (5th ed.). St. Louis, Missouri: Elsevier.

Notes on Ethics, Practicalities, and Real-World Relevance

• Professionalism emphasizes patient introduction, identity verification, consent, and explanation of the exam.

• Ergonomics are emphasized to prevent operator fatigue and injury during prolonged scanning sessions.

• Proper communication and attire are highlighted as part of professional behavior in a clinical training environment.

• Breathing techniques and positioning are crucial for optimal visualization of vascular structures and to reduce motion artifacts.

• Knowledge of normal anatomy and landmarks is essential for accurate interpretation and for identifying pathologies in a real-world setting.

• The protocol includes standardized image acquisition with defined planes and annotations to ensure consistency across exams and proficiency assessment.

• Ethical implications include maintaining patient comfort, privacy, and data handling when saving and annotating images.
  LaTeX formatting reminders used in this document: all numerical thresholds and units are formatted for clarity, for example: \text{AP} \le 3\,\text{cm} and 5\,\text{MHz}.