ESSAY
The examination that will be discussed in this paper is protocol for a complete abdominal ultrasound. This consist of visualizing the following organs and/or structures in the body: pancreas, aorta, liver, gallbladder, common bile duct, right kidney, left kidney, and spleen. Each type of organ and/or structure will be mentioned and what exact pictures of each that will be taken. Patient preparation and indications will also be mentioned.
Each clinical site has their own protocols for exam. And some of the radiologist ask certain way to take image for the exam and how to write things. Sonographers are eyes of the radiologist. Ultrasound image can provide valuable information for diagnosis and treating a variety of diseases and condition. so it is very important for sonographer to take good image and follow the protocol so radiologist can read the image clearly and write report for the exam.
My clinical site is premier at Brentwood, and they do not have protocol books. but my CI made her own protocol scan assistance to follow it as a guideline to complete this paper.
For the abdominal complete exam patient role to obtain good quality image for the exam, Patients should be NPO for at least 6-8 hours before the exam to help dispel bowel gas and ensure proper dilation of the gallbladder and biliary tract.
Most common indications for a abdominal complete ultrasound are pain on RUQ, LUQ, RLQ, LLQ area or palpable mass or et cetera. Abdomen complete scan includes aorta, pancreas, liver, gallbladder, right and left kidney and spleen. When they come into the exam room, we ask the patients for their name and birthday to make sure we have right patient and right chart pull up. And we ask if patient had any prior surgeries on his abdomen such as cholecystectomy and what’s the reason for the visit today such as pain they are having. So we know when we scan we don’t get confuse
And all the gather information we put it on our computer system and worksheet then we begin scanning. Once we done with exam, we will fill out an exam worksheet and we can write measurements, echotexture, echogenicity, and any abnormalities for the radiologist to see and scan the worksheet into the PACS system.
We start patients with supine position. first imaging we can is pancreas. We take three transverse pancreas images and one image for sagittal pancreas. When we image the transverse pancreas, we make sure we show head, neck, body and tail if its visualized.
Next, we scan the patient’s aorta. Patient should remain in supine position. When we scan, we starting with two picture each for aorta proximal sagittal and transverse with and without the measurement and picture two picture for mid sagittal and transverse with and without the measurement and two picture for distal sagittal and transverse with and without the measurement. And two picture for bifurcation with and without the color flow.
And one picture for IVC
Next, we move on to the liver. Patient remaining on supine position also It may be necessary for the patient to take a deep breath and hold it to improve visualized of liver. We take fifteen image for sagittal and eighteen image for transverse. Sagittal image must include the borders of the lateral, medial lobes, and left portal vein. Transverse image must include border of the lateral and medial lobe and the “steer head” sign. Other images in sagittal plane mid of the liver should include all the three lobes with caudate lobe and ligamentum venosum and IVC. When we take liver image we sweep through and take the image while we are taking liver image, we also take gallbladder image. We take three sagittal image of gallbladders with and without the measurement and three transverse image of gallbladders with and without the measurement.
And when we can ask patient to move to LLD position to get better image. This will help to see if there is any gallstone or abnormalities in the Gallbladder. And we take image for Common bile duct with the measurement and one image with color flow to verify the absence of blood within the vessels.
And we ask patient to return to the supine position, we scan the right renal. We take three sagittal mid image with and without measurement and color flow. And one sagittal lateral image and one right transverse superior and transverse mid image with measurement and one transverse inferior.
For the left renal, we have to ask patient to be in RLD position. We take three sagittal mid image with and without measurement and color flow. And one sagittal image for lateral. For the transverse image we take one for superior and one mid with measurement and one inferior image.
Last organ we scan is spleen. Patient still in RLD position. We take two transverse images with and without measurement and three sagittal images with and without measurement.
Ultrasound tech is eye of the radiologist so it is important to take images of any abnormalities such as pathology, stone, masses, or cyst, so if we see anything we can always add more image. When we take image, we must measure and put color flow. After the exam is finished, ultrasound technologist will wipe the gel off and explain how patient will receive their results for our clinic radiologist will read it on site and write the report and send it to the patients doctor in two days max. after patient leave, we clean the room for next patient. Make sure we dispose of dirty linen in the linen basket put new linen in the bed and wipe down the ultrasound transducer and exam bed. Then we will fill out an exam worksheet and we can write measurements, echotexture, echogenicity, and any abnormalities and we scan the worksheet into the PACS system and make sure our in-house radiologist mark as reading our exam. Once we done, we go back and marked as end exam and marked completed for the radiologist to be able to read it.
References
Premier Radiology at Brentwood: Abdomen Protocol scan assistance. Premier Radiology at Brentwood