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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.

Other Department Resources

     BLUE NIPPV      Protocol

Congratulations to our first

Ultrasound division

Golden Probe Award Winner!

Connie yu, m.d.

Yale university ultrasound fellowship

The Golden Probe Award is given to graduating 3rd year resident who exemplifies the qualities of both an excellent clinician and sonographer, and will continue to be a role model for future sonographers
connie yu, m.d.
the Golden Gel Award is given to 1st and 2nd year residents who strive to be excellent clinicians & sonographers by exemplifying educational leadership and sono ability
PGY1 Alex Bracey, M.D.
pgy2 Kartik shah, M.D.
Stony Brook

(631) 444-3880


101 Nicolls Road,

Stony Brook, NY 11794

Copyright 2018 Designed by Lindsay Reardon, MD

Photography by Mike Beck, MD & Lindsay Reardon, MD