Minimal Image Criteria for Acceptable Scans

AORTA: (5 views with measurements): 25 exams

Measure outer-wall to outer wall in the anterior-posterior diameter

  • Transverse: Proximal, Middle, Distal (Normal < 3 cm)
  • Transverse Iliac Bifurcation (normal <1.5cm)
  • Longitudinal/Sagittal (normal <3cm)

BILIARY: 25 exams

  • Longitudinal gallbladder                
  • Transverse gallbladder
  • Demonstrate relationship to portal vein
  • Liver Sweep                   
  • Measure: Anterior Gallbladder Wall thickness (normal <4mm) 
    • Common Bile Duct Inner to Inner Wall (Normal < 6mm + 1 mm for every decade over age 60)         

CARDIAC (2 of 4 views): 25 exams

Show a clear pericardium-myocardium interface

  • Subxiphoid (SX)
  • Parasternal Long-Axis (PLA)
  • Parasternal Short-Axis (PSA)
  • Apical 4 Chamber (A4)

DEEP VENOUS THROMBOSIS (4 views): 25 exams

  • Show either complete or incomplete compressibility of the vessel
  • Show contralateral side for comparison when positive
  • Areas of Compression:
    • Common femoral vein
    • Sapheno-femoral junction
    • Confluence of the superficial and deep femoral veins
    • Popliteal vein
    • +/- Popliteal Trifurcation

Extended FAST: 25 exams

  • Show superior and inferior poles of kidney; clear interface between organs
    • Hepatorenal space (Morrison’s Pouch) on the right + Pleural Base
    • Subxiphoid View
    • Sub-phrenic space and splenorenal space on the left + Pleural Base
    • Pelvic (sagittal and transverse)
    • Assess anterior chest wall lung sliding (right and left)

LUNG: 25 exams

  • Three areas per hemithorax (Document in M-mode or with video clip)
    • Anterior lung (rib-intercostal space-rib) 2nd or 3rd intercostal space, midclavicular line
    • Lateral lung axillary region
    • Lung bases inferior region

RENAL: 25 exams

  • Longitudinal of each kidney + Measure Length (Normal < 9-12cm)
  • Transverse of each kidney
  • Sagittal and transverse of the bladder

OB-GYN: 25 exams each of transabdominal + transvaginal

  • Show a clear posterior cul de sac
    • Sagittal uterus (TA), coronal uterus (TV)
    • Transverse uterus
    • Measure endo-myometrial mantle at its minimal thickness (≤ 7 mm is concerning) up to 20 weeks
      • Document fetal heart rate in M-mode
      • Show adnexa in trans-vaginal scans

VASCULAR ACCESS: 3 venous access exams, 2/3 central access

  • Show video clip of compressible vessel, still of guidewire, or flush of saline in vein

SOFT TISSUE: 10 exams (5 positive cellulitis, 5 positive abscess)

  • Show in 2 planes
  • Measure collection if present and evaluate color flow
  • Show contralateral side for comparison

INFERIOR VENA CAVA: 5 exams

  • Clip 1 cm distal to the hepatic vein confluence during inspiration or leg raise

BLADDER VOLUME: 1 exam

  • Bladder sagittal and transverse
  • Measure width, height and depth in cm
  • Calculate the bladder volume: (W x H x D x 0.7 = volume in ml)

OCULAR: 5 exams, (FB, retinal detachment, vitreous hemorrhage, lens dislocation)

  • Clip of globe in 2 planes
  • Measure optic nerve sheath diameter, 3mm posterior to the retina
  • Show contralateral side for comparison

PROCEDURAL GUIDANCE

Show the area in two planes (Static or Dynamic) to evaluate surrounding structures

  • Thoracentesis
  • Pericardiocentesis
  • Paracentesis
  • Nerve Block
  • Abscess drainage
  • Foreign body localization

PEDIATRICS

APPENDICITIS: 5 exams

  • Image of RLQ: iliac vessels next to psoas muscle
  • Demonstrate blind ended, non-compressible tube, aperistaltic tubular structure connecting to cecum
  • Inflamed > 6 mm (appendsix)

INTUSSUSCEPTION: 5 exams

  • Scan across belly starting in RLQ in sweeping motions across abdomen in clockwise fashion
  • Transverse + Longitudinal images
  • Donut/Target Sign, Usually > 3 cm, Include flow to demonstrate reduced flow

PYLORIC STENOSIS: 5 exams

  • Find gastric outlet near medial liver margin, feed baby during exam
  • Each wall > 3 mm, Length > 14-17 mm (pi-Loric Stenosis)

Updated August 2020