Disclaimer

• All protocols that follow adhere to the practice parameters established by the American College of Radiology, American Institute of Ultrasound in Medicine, and Society for Vascular Ultrasound (ACR–AIUM–SVU). Throughout this manual, this group will be referred to by the abbreviated form ACR–AIUM–SVU. Chapters 7–10 follow the current ACR and AIUM practice parameters for the performance of abdominal, pelvic, superficial, and vascular ultrasound examinations.
• The AIUM provides great image examples for many examination types, including obstetrics, which is not covered in this text; these resources are available on their website under Practice Parameters (American Institute of Ultrasound in Medicine, n.d.).
• There are some examples of documenting pathology in pancreas, liver, renal, female pelvis, scrotal, thyroid, and mesenteric Doppler. Some images are pictures taken of the machine’s screen at the time the pathology was seen—years and years ago. The quality is poor, but the pathology is mine or my husband’s and is ours to share with you. Some of the areas were challenging for even professionals to see, and therefore, serve as valuable learning examples.

Recommendations for Every Scan

1. Always survey, even when practicing.
2. Always scan at the highest frequency possible. Zoom in before measuring when possible.
3. Try different windows. Think of your area of interest as a potato in a cup. Your sound beam is a toothpick. You can hit that potato from all different sides. Don’t get stuck.
4. If you’re really struggling on something, stop trying so hard. Let go. Lift the probe, take a breath, shake it out, add more gel. Take what you can get, move on. You can always come back and try again for better. It’s so often in the moment as soon as we stop trying that the ideal image falls right onto our screen (this is the moment that the student doesn’t even see, that I as the instructor reach up, hit freeze, cine back, and we both laugh. But I promise you, this is going to happen to you too—whether you see these moments or not. That image you are chasing is there, and it will find you).
5. Your lab time is your time to practice the skills and techniques necessary to acquire the images quickly. You will always be balancing obtaining as good an image as possible with obtaining the images as quickly as possible. The more you practice the how to obtain as good as possible, the quicker you become. If you just took five minutes to get the perfect fill on the main portal vein, lift the probe and do it again, now faster. Repetition, repetition, repetition.
6. Speckle reduction imaging dramatically reduces noise, reduces echoes in fluid-filled areas (vessels, gallbladder, etc.), and makes borders significantly easier to see. Find this function on your machine and play with this setting to your liking.
7. You don’t have to turn on CF only when you’re about to take a CF image. Color is your friend! Remember you can also “drop a dirty Dop” to check vessel waveforms and check where you are.
8. Remember the elevational plane: check your probe handle height from patient body up into the air as you scan: is the probe straight up and down, perpendicular to the patient (or the area of interest within the patient), or do you need to tilt the top and see how moving through that plane changes your image on the screen?
9. Pressure makes an immense difference. I’m not talking about a lot of pressure either—just a little added gentle push gets you that much closer to the area of interest and makes everything better. You do NOT have to push the whole time! Do NOT hurt yourself! Want that ovary to pop in a little better for measurements? Give that little extra oomph. Want that PW recording to be a little more crisp? Give that little extra oomph. Before you know you’re doing this, you will be doing this push in, relax, push in as needed while you scan without thinking about doing so.
10. Get comfortable! Have fun! My scanning dramatically improved when I started playing music while I scanned (i.e., I relaxed). Also, I have Ehlers Danlos Syndrome, postural orthostatic tachycardia syndrome (POTS), blood pooling, and deep vein reflux. Standing is often more ergonomic than sitting; however, I personally feel significantly better sitting when I scan. Find what works best for your mind and your body and implement what you can to bolster your learning experience.