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This protocol includes images of several organs and structures. It has been divided into
sections to assist in determining diagnostic images that should be stored for the physician
o Midline structures (Pancreas, Aorta, and IVC)
o Liver
o Gallbladder and Common Bile Duct
o Kidneys and Spleen
Physicians may request a full examination of all abdominal organs or only specific
abdominal organs
o Students will be provided separate protocols for organs in addition to this full
examination protocol
You must always evaluate the entire organ first before you store an image
You should understand completely why you stored the image and identify everything in
the image
Multiple breathing techniques and patient positions will be required
AK\backup\Abdomen I\Protocols
LIVER SAG Right lobe superior
SUP Right hemidiaphragm
Sagittal Right pleural space
The transducer LIVER SAG Right lobe mid
LIVER
is placed MID Main portal vein
Sagittal
sagittal and LIVER SAG Right lobe inferior
lateral on the INF o Demonstrating largest superior to inferior
patients body area
o Measure liver length from superior to inferior
Right kidney
Transverse Left lobe
LIVER TX
Caudate lobe
The transducer
IVC
is placed
LIVER transverse in the
Right lobe
Transver mid portion of LIVER TX Left lobe
se the patients HV Right hepatic vein
body Left hepatic vein
Middle hepatic vein
Angulation of the
probe is used for LIVER TX Right lobe - most anterior portion
right lobe images Diaphragm
LIVER TX Right lobe superior
SUP Right hemidiaphragm
Right pleural space
LIVER TX Right lobe mid
MPV Main portal vein
Transverse
LIVER TX Right lobe mid
LIVER The transducer MPV Main portal vein with color Doppler
Transver is placed
se transverse and
lateral on the Right lobe mid
LIVER TX
patients body Main portal vein with color & spectral Doppler
MPV
o Normal waveform will demonstrate slight
phasic flow toward the liver
LIVER TX Right lobe - inferior
INF Right kidney
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o measure anterior wall thickness
GB LLD SAG Gallbladder body
Gallblad Sagittal
Gallbladder fundus
der plane of
GB LLD SAG Gallbladder body
the GB
Gallbladder neck
Patient in Transvers Gallbladder mid body
Left lateral
e
decubitus GB LLD TX
position plane of
the GB
Gallblad GB RLD Gallbladder body
Sagittal
der SAG Gallbladder fundus
plane of
GB RLD Gallbladder body
the GB
Patient in SAG Gallbladder neck
Right lateral Transvers Gallbladder mid body
decubitus e plane of GB RLD TX
position the GB
Transvers Portal vein
e plane of CBD TX CBD
the CBD Hepatic artery
Portal vein
Common CBD SAG
CBD
Bile Duct Enlarged image
CBD SAG Portal vein
level of the Sagittal
CBD
porta plane of
hepatis Enlarged image
the CBD
Portal vein
CBD SAG CBD
Measurement
o Internal AP diameter
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INF Renal sinus
LT KID SAG Renal parenchyma and capsule
LAT
LT KID SAG Renal parenchyma and capsule
LT Sagittal MID Renal Sinus
Kidney plane of Renal parenchyma and capsule
the LT KID SAG Renal Sinus
kidney MID Measurement
o Length measurement from superior to inferior pole
LT KID SAG Renal parenchyma and capsule
MED Renal sinus at hilum
AK\backup\Abdomen I\Protocols
LT KID TX Renal parenchyma and capsule
Transver SUP Renal sinus
se plane LT KID TX Renal parenchyma and capsule
of the MID Renal sinus at hilum to include renal vessels
kidney LT KID TX Renal parenchyma and capsule
INF Renal sinus
Spleen mid
SPLEEN SAG Left hemidiaphragm
Sagittal Left pleural space
plane of Left kidney (if not seen, may require extra image)
the Spleen mid with splenic hilum
spleen Left hemidiaphragm
SPLEEN SAG
Spleen Left pleural space
Measurement
o Length measurement from superior to inferior
Transver Spleen mid
se plane
SPLEEN TX
of the
spleen
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o Follow CBD to pancreatic head
If GB removed, CBD may be
enlarged (up to 11 mm)
Gallbladder Anterior Wall Transver <3 mm Calipers are placed outside to
wall se inside of the anterior wall
Liver RT Lobe Sagittal 15-17 cm Measure superior to inferior
Inferior through the liver
Main Portal Porta Hepatis Transver Normal AP Internal AP diameter where MPV
Vein se plane measurement crosses the IVC
on the is <13mm o Only performed if abnormalities
body/ are suspected
long axis Normal flow Flow should be phasic and toward
on the velocity is 20- the liver
vessel 40 cm/s
Kidneys Mid Sagittal 10-12 cm Measure from superior pole to
inferior pole through the kidney
Spleen Mid Sagittal 8-13 cm Measure superior to inferior
through the spleen
Hilum should be demonstrated
Tips
Patient should be NPO for this study to reduce the amount of gas present and to prevent
contraction of the GB
AK\backup\Abdomen I\Protocols
Have patient poke out their abdomen or take in a deep breath if having trouble seeing the
pancreas
Pancreatic tail may be evaluated using the spleen as a window
Sit the patient erect for scanning if suspicious for stones stuck in the neck that werent
confirmed in LLD or RLD
Watch your gain settings:
o Making the GB lumen too dark with TGC can mask pathology
o Using too much gain can give the appearance of pathology
If the GB appears to have artifacts, change to a higher frequency, use harmonics, use a
different window, or have the patient poke out their abdomen
If the GB is enlarged make sure to evaluate the ducts for signs of stones. These can
obstruct the ducts
To find the CBD:
o Scan from the GB in transverse and follow it to the neck and cystic duct, you will
see CBD
o Follow the portal vein from the portal confluence. The CBD will be anterior to the
vein
If the GB has been surgically removed (postcholecystectomy), document a GB FOSSA
image (main lobar fissure near porta hepatis) instead of the gallbladder images
Roll the patient up LLD and RLD, if necessary, to see kidneys better
o Use the liver on the right as a window
o Use the spleen on the left as a window
If urinary obstruction is a concern, use color Doppler to look for bladder jets to verify open
ureter
Coronal Scanning
o Sometimes, especially on the left, the kidney can be seen best scanning coronally.
Anterior and posterior images can be obtained from the coronal scan plane.
The medial and lateral images cannot be obtained from this plane.
Therefore, anterior, mid, and posterior images in coronal should documented.
The renal parenchyma, sinus, and capsule will be seen in each image
Label Coronal - Anterior, Mid, or Posterior
Pathology Seen
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Use color and spectral Doppler to document true and false lumens
o If the GB wall measures greater than 3 mm, color Doppler can be used to confirm
increased flow in the wall due to cholecystitis.
o If the patient has gallstones and/or gallbladder wall thickening, they should be
evaluated for a positive Murphys sign (extreme tenderness upon transducer or manual
pressure in the RUQ). This needs to be reported to the interpreting physician as it
indicates acute cholecystitis.
o Must attempt to demonstrate movement of any pathology seen in the GB sludge and
stones will move masses will not!!
o If the CBD is enlarged at the porta hepatis, it should be followed to the pancreatic head
to evaluate for stones or an obstructive lesion
o For hydronephrosis, demonstrate connection of the dilated pyramids to the renal pelvis
and include ureter images if the ureter is dilated.
o For renal calculi, move the focal zone to the level of the calculus to aid in
demonstrating posterior shadowing
AK\backup\Abdomen I\Protocols