STANDARD OPERATING PROCEDURE (SOP) FOR ULTRASOUND

FOR USE AT SCOTTISH LIVINGSTONE HOSPITAL

RADIOLOGY DEPARTMENT 2009

INTRODUCTION

This SOP relates to ultrasounography performed by Radiographers and Radiography

Officers at the Radiology Department in Scottish Livingstone Hospital.
It is based on *AIUM and protocols from other sources coupled with practical
experience.
At the time of preparing this SOP the Radiology Dept had no Radiologist or physician
carrying out Ultrasound scanning.
There are two categories of Radiography cadres practicing ultrasound:
- Cadres formally trained and certified by an institution
- Cadres who have acquired practical hands-on scanning skills on the job.

PURPOSE

To provide a practical guidelines with simplified and standardized scanning

protocol

To provide a scanning protocol that requires thoroughness

To provide a scanning protocol that requires appropriate images for diagnosis

To promote professionalism

PROFESSIONALISM

Practice courteous and respectful interaction with patients and staff.

Introduce yourself to patients

Conversations with patients should be appropriate and professional

Dress appropriately

Do not give patients a diagnosis.

CLINICAL SKILLS

 Make sure you have the correct patient

- Check patient identification
- Check patient ID, Request form and Treatment chart.
 Assist patients to and from the exam area.
 Briefly explain the examination and instruct the patient appropriately.
 Drape patient properly.
 Handle medical equipment attached to the patient in a safe manner.
BOOKINGS AND REGISTRATION

Patients appointments should be recorded in the Ultrasound Bookings Diary and

appointments kept to a maximum of two working days

Patients should be registered at the reception on first come first served basis and
attended to as such unless in an emergence.

Request form (MH 2013 or any other form) should be properly filled in with the
following information:
- Health Facility
- Date
- Ward/Department
- Name of Medical Officer requesting
- Patient’s full name
- Age
- Gender
- Type of Scan requested
- Clinical history or provisional diagnosis or reason for scan
- Requesting M.O. ‘s signature
- Register number eg.1218/2009

PATIENT DATA FIELDS ENTRIES

The following data should be entered in their appropriate fields:
 Patient’s ID number (Omang no. or Passport no.)
 Patient’s full name (starting with surname)
 Date of Birth or Age
 Gender (male or female)
 Series Number (Register number eg.1218/2009)
 Reason for Scan (clinical history)
 Name of Referring physician
 Name of person scanning

EQUIPMENT
Select the proper transducer for the examination
The following conditions should be optimal:

Field size

Near gain

Far gain

Homogeneous technique from near to far field

Contrast

Well-defined borders

No areas of fade-outs

Low power setting with adjusted slope (TGC)

Overall interpretable images
CARE OF EQUIPMENT
A protective sheath may be used to cover a Transabdominal probe depending on skin
surface condition of the patient. At the end of the examination the sheath should be
disposed and probe cleaned in antimicrobial solution recommended by manufacturers.

STANDARDS SCANNING

 Use 3.5MHz or higher, Sector or Curved linear transducers

 Complete scanning survey of the Abdomen or Pelvis is important to determine the
following:
- Correct technique
- Presence or lack of pathology
- Normal variants
- Image Sequence
 Surveys include:
- Entire abdomen for abdominal organ examination no single organ- exams.
- Entire pelvis
- Single vessels
- Individual small part organs
 All film images should be taken in two scanning planes.

FILM LABELLING

Film labeling should be confined to the margins surrounding the image

Never label over an part of the image unless you include the same image without the
labels.
The following information should be appear on the scan image print out

Patient’s name.

Patient’s ID number

Gender and Age

Area of Interest
- Broad and specific (e.g. uterus –broad & cervical Os – specific)

Scanning Plane
- Sagittal.
- Transverse.
- Coronal

Patient position.
- Supine
- Prone
- Sitting erect/semi erect
- Right Lateral Decubitus (RLD)
- Left lateral Decubitus (LLD)
- Right Lateral Oblique (RPO)
- Left Posterior Oblique (LPO)
DOCUMENTATION

Permanent record of the ultrasound examination and its interpretation

Images of appropriate areas, both normal and abnormal should be recorded in
storage format

Variation from normal should be accompanied by measurements

A Report of the ultrasound findings should written on the request form

The report and image printouts are attached to the patient’s medical chart

Duplicate carbon copy Reports are filed in the Files Room

The Findings of the scan should be recorded in the Findings Book

GUIDELINES FOR THE ABDOMEN AND RETROPERITONEUM

ULTRASOUND EXAMINATION

The following guidelines describe the examination to be performed for each organ and
anatomical region.
A complete exam include all organs
A limited exam would include one or more but not all of them.

LIVER SURVEY
The following should be imaged
o Long axis (coronal or sagittal)
o Transverse views
o Views comparing the echogenicity of the liver to the right kidney
o Major vessels (aorta/inferior vena cava) in the region of the liver
o Position of the IVC where it passes through the liver
o Regions of the ligamentum teres on the left
o Regions of the dome of the right lobe with right hemi diaphragm
o Right pleural space
o Main lobar fissure
o Visualization of hepatic veins in right and left lobes
o Right and left branches of the portal vein
o Intrahepatic bile ducts should be evaluated for possible dilatation.
o Measurements:
GALLBLADDER AND BILIARY TRACT
The gallbladder evaluation should include the following obtained in Supine position:
o Long axis (coronal or Sagittal)
o Transverse Views
o Left Lateral Decubitus ( left side down), erect or prone
o Intrahepatic ducts as described under the liver
o Size of extrahepatic ducts and intrahepatic ducts should be assessed
o Common Bile Duct in pancreatic head should visualized

PANCREAS
When possible the following should be identified in transverse and long axis projections :
o Pancreatic head
o Uncinate process
o Body
o Pancreatic tail
o Pancreatic duct
o Peripancreatic region assessed for adenopathy

SPLEEN
The following views should be performed:
o Either Sagittal or coronal
o Transverse and when possible
o Long axis (coronal or sagittal) projections
o Left pleural space
o Comparison echogenicity of upper pole of left kidney to that of the spleen

KIDNEYS
The views of each kidney should be obtained
o Long axis (coronal or sagittal)
o Visualization of the cortex and renal pelvis
o Transverse views which include upper pole, middle section at the renal pelvis, and
lower pole
o Comparison of renal echogenicity with adjacent Liver and spleen
o Perirenal regions for possible abnormality.

AORTA AND INFERIOR VENA CAVA

The IVC should be imaged;
o Long axis (sagittal or coronal)
o Transverse planes
o From diaphragm to bifurcation usually at level of umbilicus
o Images of adjacent common iliac vessels,
o Abnormalities should be assessed and
o Surrounding soft tissues evaluated for adenopathy.