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 POCKET PROTOCOLS FOR

Sonography Scanning
This page intentionally left blank

     
 POCKET PROTOCOLS FOR

Sonography Scanning
FOU RTH E DI T I O N

Adapted from:
Sonography Scanning: Principles and Protocols,
F O U RT H E D I T I O N

BETTY BATES TEMPKIN, BA, RT(R), RDMS

Ultrasound Consultant
Formerly Clinical Director of the Diagnostic Medical Sonography Program
Hillsborough Community College, Tampa, Florida
3251 Riverport Lane
St. Louis, Missouri 63043

Pocket Protocols for Sonography Scanning, Fourth Edition   ISBN: 978-1-4557-7322-0

Copyright © 2015, 2009, 1999, 1993 by Saunders, an imprint of Elsevier Inc.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any in-
formation storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s
permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manu-
facturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
The Publisher

Executive Content Strategist: Sonya Seigafuse

Content Development Specialist: Laurie Gower
Content Coordinator: John Tomedi
Marketing Manager: Jamie Augustine
Publishing Services Manager: Jeff Patterson
Project Manager: Mary G. Stueck
Text Designer: Renée Duenow

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1
 Acknowledgments

Peggy Ann Malzi Bizjak, MBA, RDMS, Wayne C. Leonhardt, BA, RT(R), RVT,
RT(R)(M), CRA RDMS
Radiology Manager–Ultrasound Faculty
Radiology and Medical Imaging Department Foothill College of Ultrasound
University of Virginia Health System; Los Altos, California;
Adjunct Faculty Staff Sonographer, Technical Director, and
Diagnostic Medical Sonography Program Continuing Education Director
Piedmont Virginia Community College Summit Medical Center
Charlottesville, Virginia Oakland, California

Amy T. Dela Cruz, MS, RDMS, RVT

Medical Sonography Program Director
South Piedmont Community College
Monroe, North Carolina

v
 Acknowledgments n vi

Maureen E. McDonald, BS, RDMS, RDCS Marsha M. Neumyer, BS, RVT, FSVU,
Staff Echocardiographer FAIUM, ASDMS
Adult Echocardiography Instructor and Lecturer International Director
Thomas Jefferson University Hospital Vascular Diagnostic Educational Services
Philadelphia, Pennsylvania Vascular Resource Associates
Harrisburg, Pennsylvania
 Contents

PART I 
Introduction: Purpose and Use, 1 Renal Study With Full Abdomen, 131
Spleen Study With Full Abdomen, 162
PART II 
Image Protocol for Abnormal
Sonographic Findings, 3 SECTION TWO n Image Protocols for Limited
Sonographic Studies of the Abdomen, 186
PART III 
The Abdomen, 8 Aorta Study With Limited Abdomen, 188
Inferior Vena Cava Study With Limited
SECTION ONE n Image Protocols for Full Abdomen, 196
Sonographic Studies of the Abdomen, 8 Right Upper Quadrant Study With Limited
Liver Study With Full Abdomen, 11 Abdomen, 200
Aorta Study With Full Abdomen, 33 Gallbladder and Biliary Tract Study With
Inferior Vena Cava Study With Full Abdomen, 59 Limited Abdomen, 220
Gallbladder and Biliary Tract Study With Full Pancreas Study With Limited Abdomen, 237
Abdomen, 82 Renal Study With Limited Abdomen, 253
Pancreas Study With Full Abdomen, 107 Spleen Study With Limited Abdomen, 267

vii
 Contents n viii

PART IV 
The Pelvis, 273 SECTION TWO n Image Protocol for the
Sonographic Study of the Late First Trimester, 352
SECTION ONE n Image Protocol for the
Late First Trimester Study, 354
Transabdominal Sonographic Study of the
Female Pelvis, 273 SECTION THREE n Image Protocol for the
Transabdominal Female Pelvis Study, 275 Sonographic Study of the Second and
Third Trimesters, 359
SECTION TWO n Image Protocol for the Transvaginal
Second and Third Trimesters Study, 361
Sonographic Study of the Female Pelvis, 291
Transvaginal Female Pelvis Study, 293 SECTION FOUR n Image Protocol for the
Sonographic Study of Multiple Gestations, 392
SECTION THREE n Image Protocols for Sonographic
Multiple Gestations Study, 394
Studies of the Male Pelvis, 307
The Biophysical Profile, 397
Transrectal Prostate Gland Study, 309
Scrotum Study, 315 PART VI 
Small Parts, 405
Penis Study, 340
SECTION ONE n Image Protocol for the
PART V 
Obstetrics, 344 Sonographic Study of the Musculoskeletal
System, 405
SECTION ONE n Image Protocol for the
Musculoskeletal Study (Rotator Cuff, Carpal
Sonographic Study of the Early First Trimester, 344
Tunnel, and Achilles Tendon), 407
Early First Trimester Study, 346
SECTION TWO n Image Protocol for the SECTION TWO n Image Protocol
Sonographic Study of the Thyroid Gland, 419 for Cerebrovascular Duplex Scanning, 467
Thyroid Gland Study, 421 Cerebrovascular Study, 469

SECTION THREE n Image Protocols for the SECTION THREE n Image Protocols for Peripheral
Sonographic Study of the Breast, 427 Arterial and Venous Duplex Scanning, 480
Breast Lesion Characterization, 430 Lower Limb Arterial Duplex Study, 482
Whole Breast Study, 433 Lower Limb Venous Duplex Study, 498

SECTION FOUR n Image Protocol for the PART VIII Echocardiography, 508
Sonographic Study of the Neonatal Brain, 435
Neonatal Brain Study, 437 SECTION ONE n Image Protocol for the
Sonographic Study of the Adult Heart, 508
PART VII 
Vascular System, 446 Adult Heart Study, 509

SECTION ONE n Image Protocols for Abdominal SECTION TWO n Image Protocol for the
Doppler and Color Flow Studies, 446 Sonographic Study of the Pediatric Heart, 540
Mesenteric Arterial Study, 448 Pediatric Heart Study, 541
Renal Arterial Study, 453
Examples of Various Venous Blood Flow PART IX 
Abbreviation Glossary, 556
Patterns and Duplex Protocols, 460
Image Examples of Various Studies, 464

Contents n ix
This page intentionally left blank
     
 PART I

INTRODUCTION:
PURPOSE AND USE
Pocket Protocols is a response to the need for a practical imaging reference to use during
ultrasound examinations.
The majority of the image protocols follow the American Institute of Ultrasound in
Medicine’s (AIUM) imaging guidelines. Any other image protocols are patterned after
the AIUM’s suggestions and the authors’ collective experiences.
Pocket Protocols is a reference devoted to documenting technically accurate and
thorough ultrasound image studies for diagnostic interpretation by the physician.
These comprehensive imaging protocols include image and labeling examples for
abdominal, pelvic, obstetric, small parts, vascular, and echocardiography studies.
Images are presented in a logical manner and specify the scanning plane and area
of interest.
 Introduction: Purpose and Use n 2

These reference materials are just that. They do not include or endorse the exclusion
of the necessary prerequisites for accomplished scanning skills.
I hope Pocket Protocols serve as a practical reference and imaging standard that helps
sonographers obtain comprehensive, consistent, and technically accurate image repre-
sentations of ultrasound studies.

Betty Bates Tempkin, BA, RT(R), RDMS

 PART II

IMAGE PROTOCOL FOR ABNORMAL

SONOGRAPHIC FINDINGS
This section describes a universal imaging protocol for documenting pathology,
regardless of the type. All pathology visualized by ultrasound in some way disrupts the
normal sonographic pattern of the organ or structure involved and may alter its shape,
size, contour, position, or textural appearance. Although familiarity with specific dis-
eases and abnormalities is not necessary to document them accurately for physician
interpretation, an understanding of pathological processes and the ways in which they
affect interdependent body systems can be beneficial.
 Image Protocol for Abnormal Sonographic Findings n 4

Criteria for Documenting Abnormal Sonographic Findings

• Survey of the abnormality in at least 2 scanning planes following the survey of the
primary area(s) of interest. (This is not to say that the abnormality is not evaluated
as the area of interest is evaluated, but it ensures that a total evaluation is made of
a structure, not just its abnormal part.)
• Volume measurement of the abnormality.
• High- and low-gain technical setting images of the abnormality in at least 2
­scanning planes.
Required Images
1. Longitudinal image of the abnormality with measurement from the most superior to
most inferior margin.
  
Labeled: “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”

SCANNING TIP: Required images of abnormal findings follow the study’s required
images of the area(s) of interest.

SCANNING TIP: In cases where the origin of an abnormality cannot be determined,

Part II
adjacent structures must be noted for a site location. Look for bright, echogenic
interfaces where fat separates adjacent structures.

2. Same image as number 1, without measurement calipers.

  
Labeled: “ORGAN or STRUCTURE” or “SITE LOCATION” and “SCANNING PLANE”
  

Image Protocol for Abnormal Sonographic Findings n 5

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