PART I

GENERAL PRINCIPLES

1

Clinical Guidelines   Betty Bates Tempkin

How to Use this Text

3

Professional and Clinical Standards to Follow

5

Proper Use of Ultrasound Equipment/Ergonomics

5

Imaging Criteria

6

Image Documentation Criteria

7

Case Presentation

7

Describing Sonographic Findings

8

Review Questions

9

2

Scanning Planes and Scanning Methods   Betty Bates Tempkin

Purpose

11

Scanning Planes Defined

11

Scanning Planes Interpreted

12

How to Use the Transducer

17

How to Take Accurate Measurements

19

Patient Positions

20

Surface Landmarks

23

Review Questions

24

PART II

PATHOLOGY

3

Scanning Protocol for Abnormal Findings   Betty Bates Tempkin

Purpose

27

Criteria for Evaluating Abnormal Findings

27

Criteria for Documenting Abnormal Findings

30

Criteria for Describing Abnormal Findings

31

Required Images for Abnormal Findings

37

Review Questions

38

PART III

ABDOMINAL SCANNING PROTOCOLS

4

Abdominal Aorta Scanning Protocol   Betty Bates Tempkin

Location

43

Anatomy

43

Physiology

43

Sonographic Appearance

44

Patient Prep

45

Transducer

45

Breathing Technique

45

Patient Position

45

Abdominal Aorta Survey

46

Abdominal Aorta Required Images

51

Required Images When the Abdominal Aorta Is Part of Another Study

57

Review Questions

58

5

Inferior Vena Cava Scanning Protocol   Betty Bates Tempkin

Location

61

Anatomy

61

Physiology

63

Sonographic Appearance

63

Patient Prep

65

Transducer

65

Breathing Technique

65

Patient Position

65

Inferior Vena Cava Survey

66

Inferior Vena Cava Required Images

72

Required Images When the IFC Is Part of Another Study

76

Review Questions

77

6

Liver Scanning Protocol   Betty Bates Tempkin

Location

81

Anatomy

81

Physiology

87

Sonographic Appearance

88

Normal Variants

89

Patient Prep

89

Transducer

89

Breathing Technique

89

Patient Position

89

Liver Survey

90

Liver Survey

94

Liver Required Images

97

Required Images When the Liver Is Part of Another Study

102

Review Questions

103

7

Gallbladder and Biliary Tract   Scanning Protocol

Betty Bates Tempkin Location

105

Anatomy

105

Physiology

106

Sonographic Appearance

107

Normal Variants

109

Patient Prep

109

Transducer

110

Breathing Technique

110

Patient Position

110

Gallbladder and Biliary Tract Survey

111

Gallbladder and Biliary Tract Required Images

117

Required Images When the Gallbladder and Biliary Tract are Part of Another Study

123

Review Questions

126

8

Pancreas Scanning Protocol   Betty Bates Tempkin

Location

129

Anatomy

129

Physiology

130

Sonographic Appearance

131

Normal Variants

136

Patient Prep

136

Transducer

137

Breathing Technique

137

Patient Position

137

Pancreas Survey

138

Pancreas Required Images

145

Required Images When the Pancreas is Part of Another Study

149

Review Questions

151

9

Renal Scanning Protocol   Betty Bates Tempkin

Location

153

Anatomy

153

Physiology

154

Sonographic Appearance

154

Normal Variants

155

Patient Prep

156

Transducer

156

Breathing Technique

156

Patient Position

156

Renal Survey

157

Renal Required Images

166

Required Images When the Kidneys are Part of Another Study

178

Review Questions

180

10

Spleen Scanning Protocol   Betty Bates Tempkin

Location

183

Anatomy

183

Physiology

184

Sonographic Appearance

184

Normal Variants

185

Patient Prep

185

Transducer

185

Breathing Technique

185

Patient Position

185

Spleen Survey

186

Spleen Required Images

189

Required Images When the Spleen is Part of Another Study

192

Review Questions

192

11

Image Protocol for Full and Limited Studies of the Abdomen   Betty Bates Tempkin

How to Use this Chapter

198

Liver Study with Full Abdomen

200

Aorta Study with Full Abdomen

203

Inferior Vena Cava Study with Full Abdomen

207

Gallbladder and Biliary Tract Study with Full Abdomen

210

Pancreas Study with Full Abdomen

213

Renal Study with Full Abdomen

216

Spleen Study with Full Abdomen

221

Aorta Limited Study

225

Inferior Vena Cava Limited Study

227

Right Upper Quadrant Limited Study

228

Gallbladder and Biliary Tract Limited Study

231

Pancreas Limited Study

234

Renal Limited Study

237

Spleen Limited Study

239

PART IV

PELVIC SCANNING PROTOCOLS

12

Female Pelvis Scanning Protocol   Betty Bates

Tempkin Anatomy

243

Physiology

250

Sonographic Appearance

252

Normal Variants

256

Patient Prep

256

Transducer

256

Breathing Technique

256

Patient Position

256

Female Pelvis Survey

257

Ovaries Survey

262

Female Pelvis Required Images

265

Review Questions

275

13

Trans vaginal Sonography   Betty Bates Ternpkin

Patient Prep

277

Patient Position

277

Transducer

278

Image Orientation

278

Transvaginal Female Pelvis Survey

282

Transvaginal Female Pelvis Required Images

286

Review Questions

293

14

Obstetrics Scanning Protocol for First, Second, and Third Trimesters   Betty Bates Tempkin

Maternal Anatomy

297

First Trimester

298

Early First Trimester Anatomy and Sonographic Appearance

298

Determining Gestational Age during the First Half of the First Trimester

299

Development and Sonographic Appearance during the First Half of the First Trimester

300

Determining Gestational Age During the Second Half of the First Trimester

301

Development and Sonographic Appearance during the Second Half of the First Trimester

302

Second and Third Trimesters

304

Development and Sonographic Appearance during the Second and Third Trimesters

304

Sonographic Appearance of Fetal Anatomy

307

Skeletal System

307

Cardiovascular System

308

Respiratory System

308

Gastrointestinal System

309

Genitourinary System

310

Intracranial Anatomy

311

Determining Gestational Age during the Second and Third Trimesters

314

Patient Prep

316

Transducer

317

Patient Position

317

Obstetrics Survey

318

Female Pelvis Survey

318

Female Pelvis Survey

320

First Trimester Survey

323

First Trimester Survey

324

Second and Third Trimester Survey

325

Required Images for Obstetrics

328

Early First Trimester Images

328

Later First Trimester Images

333

Second and Third Trimester Images

337

Multiple Gestations

358

The Biophysical Profile

360

Required Images for a Biophysical Profile

361

Review Questions

364

15

Male Pelvis Scanning Protocol for the Prostate   Gland Scrotum, and Penis Betty Bates Tempkin

Anatomy

367

Physiology

372

Sonographic Appearance

572

Patient Prep

377

Transducer

379

Patient Position

380

Prostate Gland Survey

381

Prostate Gland Required Images

384

Scrotum Survey

389

Scrotum Required Images

396

Penis Survey

421

Penis Required Images

422

Review Questions

424

PART V

SMALL PARTS SCANNING PROTOCOLS

16

Thyroid and Parathyroid Glands Scanning, Protocol   Betty Bates Tempkin and Wayne C. Leonhardt

Location

429

Anatomy

429

Normal Variants

430

Physiology

430

Sonographic Appearance

430

Color Doppler Flow Characteristics

432

Patient Prep

433

Transducer

433

Breathing Technique

433

Patient Position

433

Thyroid Gland Survey

434

Thyroid Gland Required Images

439

Review Questions

445

17

Breast Scanning Protocol   Betty Bates Tempkin

Clinical Reasoning

447

Anatomy

447

Physiology

448

Sonographic Appearance

448

Patient Prep

451

Transducer

451

Patient Position

451

Breast Lesion Survey Steps

452

Required Images for Breast Legion

453

Whole Breast Survey

455

Whole Breast Required Images

456

Review Questions

457

18

Neonatal Brain Scanning Protocol   Kristin Dykstra-Downey

Cranial Vault Anatomy and Sonographic Appearance

459

Patient Prep

461

Transducer

461

Patient Position

461

Neonatal Brain Survey

462

Neonatal Brain Required Images

464

Review Questions

471

PART VI

VASCULAR SCANNING PROTOCOLS

19

Abdominal Doppler and Color Flow   Marsha M. Neumyer

Basic Principles

475

Purpose of Abdominal Doppler and/or Color Flow Imaging

483

Examination Protocol

483

Patient Prep

484

Transducer

484

Patient Position

484

Arterial Flow

484

Mesenteric Arterial Examination

488

Renal Arterial Examination

490

Venous Flow

492

Scanning Tips

494

Gynecological Studies

495

Obstetrical Studies

496

Breast Sonography

497

Scrotal Sonography

497

Review Questions

498

20

Cerebrovascular Duplex Scanning Protocol   Marsha M. Neumyer

Location

501

Anatomy

501

Physiology

501

Sonographic Appearance

503

Patient Prep

504

Pulsed Doppler Transducers

504

Patient Position

504

Cerebrovascular Duplex Survey

505

Cerebrovascular Duplex Required Images

510

Review Questions

514

21

Peripheral Arterial and Venous Duplex Scanning Protocols   Marsha M. Neumyer

Lower Extremity Venous Duplex Ultrasonography

517

Anatomy

517

Patient Prep

518

Transducer

518

Patient Position

519

Normal Sonographic Findings

519

Lower Extremity Peripheral Venous Duplex Exam Protocol and Required Images

521

Pathology

526

Lower Extremity Peripheral Arterial Duplex Ultrasonography

528

Patient Prep

529

Transducer

529

Necessary Equipment

529

Lower Extremity Peripheral Arterial Duplex Exam Protocol and Required Images

530

Data Documentation

536

Review Questions

539

PART VII

ECHOCARDIOGRAPHY

22

Adult Echocardiography Scanning Protocol   Maureen E. McDonald

Location

543

Anatomy

543

Physiology

546

Sonographic Appearance

547

Patient Prep

547

Patient Position

547

Transducer

547

Breathing Techniques

547

Transducer Orientation

548

Adult Heart Survey

549

Adult Heart Required Images

556

M-Mode Evaluation

562

Doppler Evaluation

567

Review Questions

572

23

Pediatric Echocardiography Scanning Protocol   Maureen E. McDonald

Anatomy and Physiology

575

Sonographic Appearance

575

Patient Prep

575

Transducer

575

Patient Position

576

Breathing Techniques

576

Transducer Orientation

576

Pediatric Heart Survey

577

Pediatric Heart Required Images

584

Required M-Mode Images

593

Review Questions

595

Abbreviation Glossary

597

Answers to Review Questions

599

APPENDICES

A

Guidelines for Performance of the Abdominal and Retroperitoneal Ultrasound Examination

603

B

Guidelines for Performance of the Scrotal Ultrasound Examination

607

C

Guidelines for Performance of the Antepartum Obstetrical Ultrasound Examination

609

D

Guidelines for Performance of the Ultrasound Examination of the Female Pelvis

613

E

Guidelines for Performance of the Ultrasound Examination of the Prostate (and Surrounding Structures)

617

Illustration Credits Page

621