Exam / Additional Images over protocol / Additional Cine loops over protocol / Reporting
OB 2nd and 3rd trimester Initial Scan /
  • Nuchal fold up to 22 weeks
  • Humeral length up to 22 weeks
  • Label left/ right on extremities and annotate with body part
  • Color flow over cervix to R/O vasa previa
  • Placental cord insertion gray scale and color
  • Document fetal movement on OLF
/
  • 4ch heart
  • Situs with label (L) over fetal left side and annotating position as breech/ transverse or vertex
  • LVOT
  • RVOT
  • Diaphragm sagittal/ coronal
  • Placental cord insertion
  • Cine sweeps of fetal face
/
  • Humeral length on biometry
  • Placental cord insertion
  • Macro Polyclinic OB initial

OB 2nd and 3rd trimester Limited / Follow-up Scan /
  • Lateral ventricle
  • Cisterna Magna
  • TCD up to 30 weeks
  • Identify normal anatomy: 4 CH heart, LVOT and RVOT
  • Stomach
  • Kidneys
  • Bladder
  • Diaphragm
  • Document fetal movement on OLF
  • Please only get cervix length up to 32 weeks TA only unless requested to do TV.
/
  • Diaphragm sagittal/ coronal
  • Situs with label (L) over fetal left side and annotating position as breech/ transverse or vertex
/
  • Macro Ob limited > 32 weeks or OB limited < 32 weeks.
  • Macro Polyclinic OB follow-up

Nuchal translucency /
  • Done between CRL= 45-84 mm.
  • Early anatomy to include: CP, extremities, nasal bone, situs where possible, CI, bladder and stomach.
  • When documenting first trimester for dates need Uterus, ovaries and adnexa in addition to CRL, YS etc.
/
  • Report impression should include CRL in mm corresponding to # of weeks/ days and NT in mm.
  • Nuchal translucency + first trimester OB for dating: US OB + NT
  • Nuchal translucency alone
  • US NT

OB Special considerations /
  • Funneling of LUS document cervix length on TV on any 2nd up to 28 weeks
  • When Biometry/ AC lagging by at least 2 weeks or when EFW < 10% do cord and MCA Doppler
  • On patients with hypertension in pregnancy do Cord Doppler
  • Variation with Cord insertion:
Marginal:< 2cm from placental edge.
Velamentous:inserting into membranes.
Central: (-90%): normal situation Eccentric:lateral insertion of the umbilical cord at > 2 cm of the placental margin
  • Cervix does not need to be imaged TV or TA after 32 weeks
  • Document fetal movement on OLF for OB complete & OB Follow up.
/
  • Add Transvaginal exam in header and procedure line and document TV done in report
  • MCA and Cord Doppler Macros

Renal /
  • Renal volumes
  • Renal cortical thickness on requests for chronic renal disease or when patient GFR < 60 ml/min.
  • For indications: recurrent UTIs, urinary frequency, BPH and concerns about residual volume please do pre and post void volumes.
  • Pre and post void bladder for indications: Incontinence, frequency, recurrent urinary tract infection and enlarged prostate/ BPH.
/
  • Renal cortical thickness
    (normal > 8mm)
  • Report renal volumes
  • Report residuals volume and % residual.

Renal Transplant /
  • Resistive indices at interlobar arteries upper, mid and lower poles angle 0, instead angle transducer
  • Main renal artery PSV @ anastomosis, mid and hilum PSV
/
  • Report RIs for interlobar arteries at upper, mid and lower pole
(Normal <0.7)
Liver Doppler /
  • PHA, LHA and RHA RIs
  • RPV, MPV, LPV, splenic vein waveforms and direction
  • RHV, LHV, MHV, IVC, waveform and direction
/
  • Report RIs for arteries
(Normal <0.8)
Macro: Abdominal Doppler or Liver Doppler depending on whether complete abdomen or limited abdomen done.
Testicular or Ovarian Doppler /
  • Document arterial and venous flow BOTH (complete)
  • Document one side OR just artery alone or vein alone (limited)
/
  • Add Doppler Macro

When to call MD to check

Abnormal US cases:

When you see an abnormality such as acute cholecystitis, ovarian mass or things that require the attention of a radiologist because we might ask for Doppler or extra images, please call and check BEFORE you send the patient away.

Gynecologic Emergencies:

  1. For clinical indication of R/O torsion in acute pelvic pain. If you see a mass and patient is in acute pain: always ask referring to request and do Doppler to document BOTH venous outflow and arterial inflow to the ovaries. Limited charge applies if only 1 ovary or only arterial flow done.
  2. Ectopic pregnancy.
  3. When a complex pelvic fluid collection is identified as this can be an abscess or related to PID/TOA.
  4. Ovarian Hyperstimulation syndrome: i.e. when a patient is taking clomid, pergonal or other fertility treatments to conceive and comes in with acute pain.

Obstetrical Emergencies:

  1. Pregnant patient with tenderness over fibroid may be undergoing necrosis and can be at risk for abscess, premature labor etc.
  2. Oligohydramnios.
  3. Hydrops.
  4. Note that the normal placental thickness is 1mm per week of pregnancy and if placenta is unusually thick, this can be an early sign.
  5. If hydrops is present: look for causes such as:
  6. Signs of anemia: obtain MCA peak systolic velocity
  7. Arrhythmias: M mode.
  8. If SVT HR usually between 220-230 bpm.
  9. If complete heart block, HR usually between 65-90 bpm.
  10. Any bradycardia defined as sustained HR < 100 bpm.
  11. Infection: most common cause is parvovirus B19
  12. Fetal masses: CPAM, CDH, tracheal atresia, sequestration.
  13. Any ABNORMAL pregnancy: molar, fetal aneuploidy or demise.
  14. Cord prolapse
  15. Nuchal cord which involves 2+ loops around the fetal neck.
  16. Twins: oligo/poly sequence of TTS, lack of distension of stomach or bladder.
  17. Vasa Previa: fetal vessels are fixed in front of the os seen when:
  18. Cord insertion into placenta is Velamentous—therefore always look at the placental cord insertion site
  19. Succenturiate lobe is present.
  20. Accreta: when there is a history of prior C-section and you have a placenta previa please look for:
  21. Loss of retroplacental hypoechoic zone
  22. Myometrial thinning less than 3mm
  23. Placental venous lakes.
  24. Placental abruption. This is seen with maternal hypertension, trauma and IVDA especially with cocaine.
  25. Postpartum excessive blood loss:
  26. Uterine rupture
  27. In patients who have had a prior myomectomy with pain or blood loss post delivery—worry about uterine dehiscence.

Updated 2016.