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Welcome to your Ultrasound Block!
Exam Specific Image Guidelines
Required Study Elements for Credentialing
record 25 Studies & complete Worksheets
6 ACEP core exam types:
1) E-FAST • Morison’s Pouch (Hepatorenal space) • Diaphragm, Liver and Kidney. You must include a view of the inferior pole of the right kidney and liver tip • Left Upper Quadrant (Diaphragm, Spleen and Kidney) • Cardiac View (Subxiphoid or Parasternal long) • Bladder (Both Transverse and Longitudinal views) • Bilateral lung sliding
2) Pelvic (Transabdominal or transvaginal OB/GYN applications) • Sagittal view (must include uterus, bladder, and posterior cul-de-sac) • Transverse or Coronal View o Attempt to find the adnexa should be included. If trans-vaginal US is performed, need to see entire uterus as well as both adnexa in two orthogonal planes.
3) Cardiac• Parasternal long axis • Parasternal short axis • Apical 4 chamber • Subxiphoid • IVC Single view acceptable for ruling out pericardial effusion IF stated. Grade level 3 One of the views needs be a clip to demonstrate cardiac function. StonyBrookSono January 2017 2
4) Aorta • Transverse view at level of diaphragm (proximal aorta) • Transverse view at level of mid-abdominal aorta • Transverse view at bifurcation – with clip • Longitudinal view (with measurement)
5) Biliary • Longitudinal view of gallbladder • Transverse view of gallbladder • GB wall measurement (anterior) • Presence or absence of pericholecystic fluid, and sonographic murphy’s sign Attempt common bile duct: • Clip with COLOR through portal triad • CBD measured longitudinally anterior to portal vein • Needed in order to give a grade level of 4 or 5 – not necessary for credentialing
6) Renal• Transverse views of each kidney • Longitudinal views of each kidney • Longitudinal and transverse view of bladder • Ureteral jets if present (extra credit: to achieve level 4+)
Other exam types: Need 25 to become credentialed in application.
Thoracic: Need a minimum of 4 images or clips for a “Full Thoracic” study
Right & Left views • Anterior (longitudinal views) • Lateral • Posterior (unless pt cannot sit up or roll – indicate) • RUQ or LUQ views evaluating for pleural effusion (similar to FAST views)
Optional: M-mode still image or clip demonstrating sliding or no sliding when looking for pneumothorax
Limited Compression (2-Point) DVT:
• Transverse view of common femoral vein at level of saphenous vein (enters medially)
• Transverse view of femoral vein (to 10 cm below groin crease)
• Transverse view of popliteal vein
Need compressed and non-compressed image of vessel. Usually a clip of compression of each segment will suffice.
Procedures: (Please document these for billing purposes. Document both the procedure and ultrasound in the same note).
• Vascular Access *Record a single still image of the vessel*
OPTIONAL: demonstrate needle or guidewire in vessel
• Paracentesis or Thoracentesis: Still image of location where needle is going to be inserted.
• Regional anesthesia: Still image of structure to block
Prefer image/clip of anesthesia infiltration
Soft Tissue: Please label which part of the body we are viewing.
Please make comment as to whether notice cobblestoning (cellulitis) and/or presence/absence of a fluid collection (abscess)
Musculoskeletal: Please label structure being viewed. Need to determine presence or absence of fracture, tendon injury, or fluid collection (effusion)
Ocular: Need to clip through the entire eye. If determining optic nerve sheath diameter (ONSD), need a transverse measurement 3mm from retina over the optic nerve. Need to mention the presence or absence of VH: vitreous hemorrhage; or RD: retinal detachment; or any other pathology you are concerned for.
Grading made simple
[Scans will not be graded if there are no patient names/MRNs or no operator name recorded!]
Grading on QPath is on a 1-5 scale.
1- US faculty has no clue what we are looking at.
2-US doesn’t have all the necessary views (missing bladder for a renal scan), no interpretation on the final image or Qpath worksheet; and cannot interpret what images were performed.
3- US shows all necessary views or shows most views with the sonographer mentioning which views were not obtainable or interpretable; and faculty can discern and interpret/concur with US findings.
4-All ultrasound images are obtained and easily interpretable by US faculty and by another provider. Often see more advanced images and measurements.
5-All images obtained and structures are easily identifiable and can be used for a lecture or research project. (aka. Your patient could easily identify and interpret too).
A grade of 3 or higher is counted toward credentialing.