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UPPER ABDOMINAL ULTRASOUND SCANNING
Category: Diagnostic Radiology
Abstract : upper abdominal ultrasound scanning technique is not something that can be learnt from a book. There is absolutely no substitute for regular practical experience under the supervision of a qualified ultrasound practitioner. There are, however, some general approaches which help to get the best from the scanning procedure: ● Scan in a systematic way to ensure the whole of the upper ab
upper abdominal ultrasound scanning technique is not something that can be learnt from a book. There is absolutely no substitute for regular practical experience under the supervision of a qualified ultrasound practitioner. There are, however, some general approaches which help to get the best from the scanning procedure:
● Scan in a systematic way to ensure the whole of the upper abdomen has been thoroughly interrogated.
The use of a worksheet, which indicates the structures to be examined, is advisable when learning.
● Always scan any organ in at least two planes, preferably at right angles to each other. This reduces the risk of missing pathology and helps to differentiate artefact from true pathology.
● Where possible, scan in at least two patient positions. It is surprising how the available ultrasound information can be enhanced by turning your patient oblique, decubitus or erect. Inaccessible organs flop into better view and bowel moves away from the area of interest.
● Use a combination of sub- and intercostal scanning for all upper-abdominal scanning. The different angles of insonation can reveal pathology and eliminate artefact.
● Don’t limit yourself to longitudinal and transverse sections. Use a variety of planes and angulations. Trace ducts and vessels along their courses. Use the transducer like a pair of eyes.
● Deep inspiration is useful in a proportion of patients, but not all. Sometimes it can make matters worse by filling the stomach with air and obscuring large areas. An intercostal approach with the patient breathing gently often has far more success.
● Positioning patients supine, particularly if elderly or very ill, can make them breathless and uncomfortable. Raise the patient’s head as much as necessary; a comfortable patient is much easier to scan.
● Images are a useful record of the scan and how it has been performed, but don’t make these your primary task. Scan first, sweeping smoothly from one aspect of the organ to the other in two planes, then take the relevant images to support your findings.
● Make the most of your equipment. Increase the confidence level of your scan by fully utilizing all the available facilities, using Doppler, tissue harmonics, changing transducers and frequencies and manipulating the machine settings and processing options.
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