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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
Debra L. Krukowski, BS, ARDMS, ARRT(R)
Program Coordinator/Faculty
Diagnostic Medical Sonography Program
Triton Community College
River Grove, Illinois
Robert Lilly, MS, RDMS, RDCS
Program Director
Diagnostic Medical Sonography
Mountain State University
Beckley, West Virginia
Joyce A. Miller, EdD, RDMS
Lecturer
New York Methodist Hospital
School of Allied Health
Sonography Program
Brooklyn, New York
EDITORIAL REVIEW BOARD ix
Theresa L. Moore, RT, RDMS
Adjunct Faculty
Delaware Technical Community College
Wilmington, Delaware
Susanna Ovel, RT, RDMS, RVT
Senior Sonographer Instructor
Sutter Medical Foundation
Mint Medical Education
Sacramento, California
Catherine E. Rienzo, MS, RT(R), RDMS, FSDMS
Professor and Program Director
Diagnostic Medical Sonography Program
Northampton Community College
Bethlehem, Pennsylvania
Cheryl L. Zelinsky, MM, RT(R), RDMS
Chair, Diagnostic Medical Sonography Program
Sanford-Brown College
Portland, Oregon
Preface
Sonography Scanning: Principles and Protocols came about as a result of
my teaching, as well as practical scanning experience. During my 22
years as a sonographer—most of which I have spent as a clinical director and teaching in scanning labs as well as the hospital setting—I realized that sonographers needed a basic approach to the performance of
scans, a pattern as well as a benchmark for their work. My purpose in
writing this text is to provide a step-by-step method for scanning and
image documentation for physician diagnostic interpretation. I hope
this “how to” scanning approach takes the struggle out of scanning and
ensures thoroughness and accuracy. The enumeration of scanning steps
and required images for each examination promotes the establishment
of standards and improves examination quality. The structure of this
text should make it easy to read, simple to follow, and practical to use.
The text begins with an introductory chapter that includes topics such
as guidelines for the general use of the text, professional standards, clinical standards, case presentation, scanning prerequisites, image quality
and labeling, and methods by which sonographic findings are described.
planes and their anatomical interpretations and scanning methods,
followed by a chapter devoted to the evaluation, documentation, and
description of abnormal findings. Next, the scanning protocol chapters
offer scanning protocols for the major blood vessels and organs of the
abdomen (including full and limited studies), the male and female pelvic organs, and obstetrics. Scanning protocols for the scrotum, thyroid
gland, breast, and neonatal brain are also included. The protocol chapters conclude with scanning protocols for vascular and cardiac studies.
of the American Institute of Ultrasound in Medicine, which, along
with an abbreviation glossary, are included in the appendixes of
the text. The scanning protocol chapters selectively address organ,
vasculature, or fetal location, as well as anatomy, physiology,
sonographic appearance, and normal variations. In addition, patient
preparation, position, and breathing techniques are discussed. Steps
are specified for transducer placement, surveys, and required images.
Other features to assist the reader are illustrations for anatomy; patient
positions; the placement of, position of, and direction to move the
transducer; and illustrations of nearly all ultrasound images.
Subsequent sections cover technical parameters, including scanning
Applicable protocols are patterned after the scanning guidelines
What’s New
The fourth edition has been completely redesigned to enhance
x
readability by offering more images on each page and presenting the
information in an attractive, 2-color design. We added pedagogy to
each chapter, including learning objectives and key words as well
as updated end-of-chapter review questions, to aid the reader’s
understanding of the material. In addition, more than 300 new images
have been included to demonstrate superior quality scans from the
latest state-of-the-art ultrasound equipment. New transducer location
drawings on images help the reader understand exactly where on the
body to scan to produce a particular image. Also exclusive to this
edition is a new chapter covering musculoskeletal protocols for those
interested in this specialty.
Because the scanning methods under discussion are derived from
the authors’ professional experiences, most chapters highlight the
techniques that we have found to work best. However, the success of
scanning depends on the skill of the individual; thus finding one’s
personal approach to solving imaging problems is not only expected
but inevitable. Therefore, in addition to our personal way of doing
things, we discuss alternatives and encourage you to explore other
approaches.
The text reflects the assumption that the reader has thorough
knowledge of gross and sectional anatomy. An in-depth course in
normal anatomy and sectional anatomy are key prerequisites for comprehending scanning techniques. As an overview, gross anatomy and
reference illustrations are at the beginning of most protocol chapters.
The sonographer’s role in medicine is unique among those of other
allied health professionals specializing in imaging modalities because
sonographic image accuracy depends on the skill of the operator, not
just the technical aspects of the machine. That single reason is sufficient to support the premise that scanning skills must equal the level
of importance attached to a sonographer’s knowledge of physics,
physiology, pathology, and anatomy. Currently, practical considerations prevent the American Registry of Diagnostic Medical Sonography from evaluating scanning ability. Therefore, feedback from
sonography educators and sonologists and comparison of films with
established guidelines and scanning protocols are vital to mastering
the art of ultrasound scanning.
When performed at the highest level, the collective factors that
define “sonographer” become an integral part of patient evaluation. It is my hope that this text provides the tools to facilitate scanning and documenting studies and, as a result, directly contributes
to the achievement of excellence in the daily practice of ultrasound
scanning.
PREFACE xi
Betty Bates Tempkin, BA, RT(R), RDMS
Acknowledgments
Many thanks to Developmental Editors Beth LoGiudice and John
Tomedi of Spring Hollow Press, my Project Manager Mary Stueck at
Elsevier, and Lois Schubert at Top Graphics. Their coordinated efforts
and individual expertise make this a great new edition and they were
a pleasure to work with.
I am always inspired and motivated by the feedback I receive
from other sonographers, students, instructors, physicians, and peer
reviews. I love hearing from you, and try to incorporate your suggestions in each new edition.
A special thank you to the American Institute of Ultrasound in
Medicine (AIUM) for agreeing to include applicable AIUM guidelines
in the book. This collaboration greatly benefits the reader and ultimately the ultrasound community.
Finally, to those who touch my heart—David, Max, and my closest
friends—sincere thanks for your continued support and interest!
Betty Bates Tempkin, BA, RT(R), RDMS
xii
PART I GENERAL PRINCIPLES
1 Guidelines
Betty Bates Tempkin
How To Use This Text, 3
Professional Standards, 4
Clinical Standards, 6
Ergonomics and Proper Use of Ultrasound Equipment, 8
Imaging Criteria, 8
Image Documentation Criteria, 9
Case Presentation, 10
Describing Sonographic Findings, 10
Review Questions, 11
2 Scanning Planes and Scanning Methods
Betty Bates Tempkin
Scanning Planes Defined, 15
Scanning Planes Interpreted, 16
Sagittal Scanning Plane, 16
Transverse Scanning Plane, 18
Coronal Scanning Plane, 20
Scanning Methods, 21
Transducers, 21
How to Use the Transducer, 22
How to Take Accurate Images and Measurements, 23
Surface Landmarks, 26
Review Questions, 27
Contents
PART II PATHOLOGY
3 Scanning Protocol for Abnormal Findings/Pathology
Betty Bates Tempkin
Criteria for Evaluating Abnormal Findings/Pathology, 31
Criteria for Documenting Abnormal Findings/Pathology, 33
Criteria for Describing the Sonographic Appearance of Abnormal
Findings/Pathology, 36
Required Images for Abnormal Findings/Pathology, 42
Review Questions, 43
PART III ABDOMINAL SCANNING PROTOCOLS
4 Abdominal Aorta Scanning Protocol
Betty Bates Tempkin
Overview, 51
Location, 51
Anatomy, 52
Physiology, 52
Sonographic Appearance, 52
Normal Variants, 54
xiii
xiv CONTENTS
Preparation, 54
Patient Prep, 54
Transducer, 54
Breathing Technique, 54
Patient Position, 54
Abdominal Aorta Survey Steps, 55
Abdominal Aorta • Longitudinal Survey, 55
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 55
Abdominal Aorta • Axial Survey, 58
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 58
Abdominal Aorta Required Images, 59
Abdominal Aorta • Longitudinal Images, 59
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 59
Abdominal Aorta • Axial Images, 62
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 62
Required Images When the Abdominal Aorta is Part of Another Study, 66
Review Questions, 67
5 Inferior Vena Cava Scanning Protocol
Betty Bates Tempkin
Overview, 71
Location, 71
Anatomy, 72
Physiology, 72
Sonographic Appearance, 72
Normal Variants, 74
Preparation, 74
Patient Prep, 74
Transducer, 74
Breathing Technique, 74
Patient Position, 74
Inferior Vena Cava Survey Steps, 75
Inferior Vena Cava • Longitudinal Survey, 75
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 75
Inferior Vena Cava • Axial Survey, 79
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 79
Inferior Vena Cava Required Images, 80
Inferior Vena Cava • Longitudinal Images, 80
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 80
Inferior Vena Cava • Axial Images, 83
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 83
Required Images When the Inferior Vena Cava is Part of Another Study, 85
Review Questions, 86
6 Liver Scanning Protocol
Betty Bates Tempkin
Overview, 94
Location, 94
Anatomy, 94
LIVER LOBES, 95
LIVER SEGMENTS, 95
LIVER SURFACES, 96
LIVER LIGAMENTS, 97
CONTENTS xv
LIVER FISSURES, 98
LIVER VESSELS AND DUCTS, 98
Physiology, 100
Sonographic Appearance, 101
Normal Variants, 103
Preparation, 103
Patient Prep, 103
Transducer, 103
Breathing Technique, 103
Patient Position, 103
Liver Survey Steps, 104
Liver • Longitudinal Survey, 104
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 104
Liver • Axial Survey, 107
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 107
Liver Required Images, 110
Liver • Longitudinal Images, 110
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 110
Liver • Axial Images, 113
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 113
Required Images When the Liver is Part of Another Study, 116
Review Questions, 116
7 Gallbladder and Biliary Tract Scanning Protocol
Betty Bates Tempkin
Overview, 121
Location, 121
Anatomy, 122
Physiology, 123
Sonographic Appearance, 124
Normal Variants, 126
GALLBLADDER, 126
BILIARY TRACT, 126
Preparation, 127
Patient Prep, 127
Transducer, 127
Breathing Technique, 127
Patient Position, 127
Gallbladder and Biliary Tract Survey Steps, 128
Gallbladder • Longitudinal Survey, 128
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION, 128
Gallbladder • Axial Survey, 130
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION, 130
Biliary Tract • Longitudinal Survey, 131
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION, 131
Biliary Tract • Axial Survey, 132
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION, 132
xvi CONTENTS
Gallbladder and Biliary Tract Required Images, 133
Required Images When the Gallbladder and Biliary Tract are Part of
Review Questions, 143
Gallbladder • Longitudinal Survey, 133
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • SECOND
PATIENT POSITION, 133
Gallbladder • Longitudinal Images, 133
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION/SUPINE, 133
Gallbladder • Axial Images, 135
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION/SUPINE, 135
Biliary Tract • Longitudinal Images, 137
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • FIRST
PATIENT POSITION, 137
Gallbladder • Longitudinal Image, 139
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH • SECOND
PATIENT POSITION/LEFT LATERAL DECUBITUS, 139
Gallbladder • Axial Image, 139
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH •
SECOND PATIENT POSITION/LEFT LATERAL DECUBITUS, 139
Another Study, 140
Gallbladder • Longitudinal Image, 140
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 140
Gallbladder • Axial Image, 140
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 140
Biliary Tract • Longitudinal Images, 141
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 141
8 Pancreas Scanning Protocol
Betty Bates Tempkin
Overview, 147
Location, 147
Anatomy, 148
Physiology, 149
Sonographic Appearance, 149
Normal Variants, 155
Preparation, 155
Patient Prep, 155
Transducer, 156
Breathing Technique, 156
Patient Position, 156
Pancreas Survey Steps, 156
Pancreas • Longitudinal Survey, 156
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 156
Pancreas • Axial Survey, 160
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 160
Pancreas Required Images, 162
Pancreas • Longitudinal Images, 162
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 162
Pancreas • Axial Images, 164
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 164
Required Images When the Pancreas is Part of Another Study, 166
Pancreas • Longitudinal Images, 166
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 166
Pancreas • Axial Image, 167
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 167
Review Questions, 168
9 Renal Scanning Protocol
Betty Bates Tempkin
Overview, 171
Location, 171
Anatomy, 172
Physiology, 173
Sonographic Appearance, 173
Normal Variants, 176
Preparation, 176
Patient Prep, 176
Transducer, 176
Breathing Technique, 176
Patient Position, 176
RIGHT KIDNEY, 176
LEFT KIDNEY, 177
Renal Survey Steps, 177
Right Kidney • Longitudinal Survey, 177
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 177
Right Kidney • Axial Survey, 179
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 179
Left Kidney • Longitudinal Survey, 181
CORONAL PLANE • LEFT LATERAL APPROACH, 181
Left Kidney • Axial Survey, 183
TRANSVERSE PLANE • LEFT LATERAL APPROACH, 183
Kidneys Required Images, 185
Right Kidney • Longitudinal Images, 185
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 185
Right Kidney • Axial Images, 189
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 189
Left Kidney • Longitudinal Images, 191
CORONAL PLANE • LEFT LATERAL APPROACH, 191
Left Kidney • Axial Images, 195
TRANSVERSE PLANE • LEFT LATERAL APPROACH, 195
Required Images When the Kidneys are Part of Another Study, 197
Right Kidney • Longitudinal Images, 197
SAGITTAL PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 197
Right Kidney • Axial Image, 197
TRANSVERSE PLANE • TRANSABDOMINAL ANTERIOR APPROACH, 197
Left Kidney • Longitudinal Image(s), 198
CORONAL PLANE • LEFT LATERAL APPROACH, 198
Left Kidney • Axial Image, 198
TRANSVERSE PLANE • LEFT LATERAL APPROACH, 198
Review Questions, 199
CONTENTS xvii
xviii CONTENTS
10 Spleen Scanning Protocol
Betty Bates Tempkin
Overview, 203
Location, 203
Anatomy, 204
Physiology, 205
Sonographic Appearance, 205
Normal Variants, 206
Preparation, 207
Patient Prep, 207
Transducer, 207
Breathing Technique, 207
Patient Position, 207
Spleen Survey Steps, 207
Spleen • Longitudinal Survey, 207
CORONAL PLANE • LEFT LATERAL APPROACH, 207
Spleen • Axial Survey, 209
TRANSVERSE PLANE • LEFT LATERAL APPROACH, 209
Spleen Required Images, 210
Spleen • Longitudinal Images, 210
CORONAL PLANE • LEFT LATERAL APPROACH, 210
Spleen • Axial Images, 211
TRANSVERSE PLANE • LEFT LATERAL APPROACH, 211
Required Images When the Spleen is Part of Another Study, 213
Review Questions, 213
PART IV PELVIC SCANNING PROTOCOLS
11 Female Pelvis Scanning Protocol
Betty Bates Tempkin
Overview, 220
Anatomy, 220
TRUE PELVIS AND FALSE PELVIS, 220
PELVIC REGIONS, 220
VAGINA, 221
UTERUS, 221
UTERINE TUBES (FALLOPIAN TUBES OR OVIDUCTS), 223
OVARIES, 224
URINARY BLADDER, 225
URETERS, 225
COLON, 225
MUSCULATURE, 225
LIGAMENTS, 226
PELVIC SPACES, 227
Physiology, 227
FEMALE REPRODUCTIVE SYSTEM, 227
Sonographic Appearance, 228
VAGINA, UTERUS, UTERINE TUBES, OVARIES, URINARY BLADDER,
URETERS, SIGMOID COLON, RECTUM, PELVIC MUSCULATURE, BROAD
LIGAMENTS, AND PELVIC PERITONEAL SPACES, 228
Normal Variants, 232