WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

 Liver measurement may be performed on longitudinal images. LIVER LONGITUDINAL

 Parenchyma should be evaluated for focal and/or diffuse

abnormalities.

 Echogenicity of the liver should be compared with that of the

right kidney.

 The liver surface may be imaged with a high-frequency

transducer to evaluate possible surface nodularity in patients at
risk for cirrhosis.

 For vascular examinations, Doppler evaluation should be used to

document blood flow characteristics and the direction.

In addition, the following should be imaged:

HEPATIC VEINS AND INFERIOR VENA CAVA

MAIN PORTAL VEIN BRANCHES OF PORTAL VEIN

In addition, the following should be imaged:

RIGHT LOBE AND DIAPHRAGM LEFT LOBE

WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

LONGITUDINAL - CAUDATE LOBE TRANSVERSE

 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

LONGITUDINAL - GALLBLADDER

 Adequately distended gallbladder.

 Long-axis and transverse views obtained in the supine

position.

 Decubitus imaging should be performed when feasible.

 If the patient presents with pain, tenderness to transducer

compression over the gallbladder should be assessed.

RIGHT HEMIDIAPHRAGM

Right Lobe Liver and Intrahepatic Vessels

 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

TRANSVERSE - WALL THICKNESS

 Most commonly the measurement of GB wall is made

on the long axis view of the gallbladder.

 It is best carried out on the anterior wall where it abuts TRANSVERSE

the liver, resulting in better intrinsic contrast.

COMMON BILE DUCT

 Doppler imaging
-> differentiate hepatic arteries and portal veins
from bile ducts.
.

• Bile duct in the porta hepatis should be measured and

documented.
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

LONGITUDINAL

HEAD AND NECK

 All portions of the pancreas should be identified

 When visualized, the distal common bile duct in the
o head,
pancreatic head should be evaluated.
o uncinate process
TRANSVERSE
o body
o tail
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

BODY AND TAIL

 TIPS in better visualization of the pancreas:

o Orally administered water or a contrast agent
o Changes in patient positioning such as upright and
right decubitus positions

LONGITUDINAL

 All portions of the pancreas should be identified

o head,
o uncinate process
o body MEASUREMENT
o tail
TRANSVERSE

BODY

HEAD
TAIL

TRANSVERSE
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

 TIPS in better visualization of the pancreas:

o Orally administered water or a contrast agent
o Changes in patient positioning such as upright and
right decubitus positions

MEASUREMENT
RIGHT KIDNEY

BODY

HEAD
TAIL

SAGITTAL LEFT KIDNEY SAGITTAL

 Shows kidney in longest

and widest dimension Mirror image of the
with central echo
right kidney.
complex, its pelvis and
preferably with
ureteropelvic junction.

RIGHT KIDNEY AXIAL LEFT KIDNEY AXIAL

 Taken through the renal

pelvis demonstrates
kidney thickness.
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

RIGHT UPPER QUADRANT (RUQ) SAGITTAL LUQ SAGITTAL

Liver Spleen

 Demonstrates renal
cortical echogenicity vs
Liver and Spleen

R kidney L kidney
OPTIONAL: e.g. Investigation of hypertension or renalupper
perfusion
pole upper pole
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

COLOR FLOW DOPPLER

LONGITUDINAL

 When performing a complete ultrasound evaluation of the

urinary tract, transverse and longitudinal images of the
distended urinary bladder.

TRANSVERSE

 Bladder lumen or wall abnormalities should be noted.

 UB wall thickness is measured in its anterior wall.

LEFT URETERAL JET

 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

 The acquisition of ureteral jets with color Doppler imaging

may be helpful when evaluating hydroureteronephrosis
to evaluate for the presence of obstruction.

 When possible, long-axis and transverse images of the

adrenal glands in the newborn or young infant may be
obtained.
LIVER
 Represented by a thin echogenic core (arrow) surrounded
by an echopoor rim.
o Length -> maximum cephalocaudal dimension
(between cursors)
o Width -> maximum dimension perpendicular to
the length of one of the wings.

REPRESENTATIVE IMAGE OF AORTA

LONGITUDINAL TRANSVERSE

AORTA
LONGITUDINAL IVC TRANSVERSE
AORTA

IVC
IVC
REPRESENTATIVE IMAGE OF INFERIOR VENA CAVA
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

BOWEL

 Bowel wall thickening, dilatation, muscular hypertrophy, masses, vascularity, and other
abnormalities.

 Sonography of the pylorus and surrounding structures -> evaluation of the vomiting
infant.

 Graded compression sonography -> visualization of the appendix and other bowel loops.

 Measurements -> bowel wall thickening.

 Color or power Doppler imaging -> hypervascularity.

PERITONEAL FLUID

 Free or loculated peritoneal fluid -> extent and location

 Trauma -> FAST (Focused Abdominal Sonography for Trauma)

o Objective: screen the abdomen for free fluid
o Longitudinal and transverse plane images:
 Hepatorenal area (RUQ)
 Splenorenal area (LUQ)
 Right and left paracolic gutters
 Pelvis

Note: Some books and articles include “pericardial view”

An extended FAST or "eFAST" scan is now standard of care, and is performed by incorporating
two views assessing the anterior thorax, “anterior pleural views”.

ABDOMINAL WALL

 Signs or symptoms referable to the abdominal wall -> Ultrasound.

 Images of the abdominal wall in the location of symptoms or signs.

 The relationship of any identified mass with the peritoneum.

 Any defect -> presence or absence of bowel, fluid, or other tissue contained.

 Hernias -> Valsalva maneuvers and upright positioning may be helpful.

 Doppler examination -> define the relationship of blood vessels to a detected mass.
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

AIUM Practice Parameter

• Parameter developed in conjunction with the American College of Radiology (ACR), the
Society for Pediatric Radiology (SPR), and the Society of Radiologists in Ultrasound
(SRU).
• This practice parameter has been revised to assist practitioners performing ultrasound
studies of the abdomen and/or retroperitoneum.
• Adherence to the following practice parameter will maximize the probability of
detecting abnormalities.

Indications/Contraindications
A. Abdominal, flank, and/or back pain.
B. Signs or symptoms that may be referred from the abdominal and/or retroperitoneal
regions, such as jaundice or hematuria.
C. Palpable abnormalities such as an abdominal mass or organomegaly.
D. Abnormal laboratory values or abnormal findings on other imaging examinations
suggestive of abdominal and/or retroperitoneal pathology.
E. Follow-up of known or suspected abnormalities in the abdomen and/or
retroperitoneum.
F. Search for metastatic disease or an occult primary neoplasm.
G. Evaluation of cirrhosis, portal hypertension, and transjugular intrahepatic portosystemic
shunt (TIPS) stents; screening for hepatoma; and evaluation of the liver in conjunction
with liver elastography.
H. Abdominal trauma.
I. Evaluation of urinary tract infection and hydronephrosis.
J. Evaluation of uncontrolled hypertension and suspected renal artery stenosis.
K. Search for the presence of free or loculated peritoneal and/or retroperitoneal fluid.
L. Evaluation of suspected congenital abnormalities.
M. Evaluation of suspected hypertrophic pyloric stenosis, intussusception, necrotizing
enterocolitis, or any other bowel abnormalities.
N. Pretransplantation and posttransplantation evaluation.
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

O. Planning for and guiding an invasive procedure.

 An abdominal and/or retroperitoneal ultrasound examination should be performed

when there is a valid medical reason.

 There are NO absolute contraindications.

Written Request for the Examination

 It should provide sufficient information to allow for the appropriate performance and
interpretation of the examination.

Specifications for Individual Examinations

 Spectral, color, and power Doppler imaging -> vascular from nonvascular structures
 Measurements -> abnormal area.
 Cine clips -> particularly when screening for malignancy.
 Contrast may have applications in abdominal and retroperitoneal ultrasound.

Documentation

 Essential for high-quality patient care.

 Permanent record of the ultrasound examination and its interpretation.
 Images of all appropriate areas, both normal and abnormal, should be recorded.
 Variations from normal size should be accompanied by measurements.
 Images -> labeled with the patient identification, facility identification, examination
date, and side (right or left) of the anatomic site imaged.
 An official interpretation (final report) of the ultrasound findings should be included in
the patient’s medical record.
 Retention of the ultrasound examination should be consistent both with clinical needs
and with relevant legal and local health care facility requirements.

Equipment Specification

 Abdominal and/or retroperitoneal sonographic studies

o conducted with real-time scanners, preferably using curved sector or linear
transducers.
 The equipment should be adjusted to operate at the highest clinically appropriate
frequency, realizing that there is a trade-off between resolution and beam penetration.
 Preadolescent pediatric patients, mean frequencies of 5 MHz or greater.
 Neonates and small infants, a higher-frequency transducer.
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

 Adults, mean frequencies between 4 and 6 MHz.

 Higher frequencies are often used and needed when evaluating the abdominal wall,
liver surface, and bowel.
 Color and power Doppler imaging should be used to characterize vascular structures
and masses.

Quality Control and Improvement, Safety, Infection Control, and Patient Education

 Policies and procedures related to quality control, patient education, infection control,
and safety should be developed and implemented in accordance with the AIUM S
tandards and Guidelines for the Accreditation of Ultrasound Practices.

 Equipment performance monitoring should be in accordance with the AIUM Standards

and Guidelines for the Accreditation of Ultrasound Practices.

ALARA (As Low As Reasonably Achievable) Principle

 The potential benefits and risks of each examination should be considered.

 This principle should be observed when adjusting controls that affect the acoustic
output and by considering transducer dwell times.

REFERENCES:
 WHOLE ABDOMEN ULTRASOUND MINIMUM IMAGE ACQUISITION PROTOCOL

MAIN reference: American Institute of Ultrasound in Medicine (n.d.). Retrieved March 20,
2021, from https://www.aium.org/resources/guidelines.aspx
OTHERS:
• Ba, T. B. B. (2007). Pocket Protocols for Ultrasound Scanning, 2nd Edition (2nd ed.).
Saunders.
• Curry, R. A., & Tempkin, B. B. (2016). Sonography: Introduction to normal structure and
function (4th ed.). St. Louis, MO: Elsevier.
• K. J. M., Md, E. V. N., Md, W. B. E., & Md, C. H. A. (2018b). Brant and Helms’
Fundamentals of Diagnostic Radiology (Fifth ed.). LWW.
• Rahmouni A, Bargoin R, Herment A, Bargoin N, Vasile N (1996) Color Doppler twinkling
artifact in hyperechoic regions. Radiology 199:269–271
• Rumack, C.M., Levine, D. (2017). Diagnostic Ultrasound (5th ed). Elsevier Health
Sciences.
• Sidhu, P. S., Chong, W. K., & Satchithananda, K. (2017). Measurement in ultrasound: A
practical handbook (2nd ed.). CRC Press.
• Themes, U. (2017, September 30). Renal Ultrasound. Radiology Key.
https://radiologykey.com/renal-ultrasound/