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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
Preparation, 233
Patient Prep, 233
Transducer, 233
Breathing Technique, 234
Patient Position, 234
Female Pelvis Survey, 234
Vagina, Uterus, and Pelvic Cavity Survey Steps, 234
Vagina, Uterus, and Pelvic Cavity • Longitudinal Survey, 234
SAGITTAL PLANE • ANTERIOR APPROACH, 234
Vagina, Uterus, and Pelvic Cavity • Axial Survey, 236
TRANSVERSE PLANE • ANTERIOR APPROACH, 236
Ovaries Survey Steps, 238
Right Ovary • Longitudinal Survey, 238
SAGITTAL PLANE • ANTERIOR APPROACH, 238
Right Ovary • Axial Survey, 240
TRANSVERSE PLANE • ANTERIOR APPROACH, 240
Left Ovary • Longitudinal and Axial Surveys, 240
Female Pelvis Required Images, 240
Vagina, Uterus, and Pelvic Cavity • Longitudinal Images, 241
SAGITTAL PLANE • ANTERIOR APPROACH, 241
Vagina, Uterus, and Pelvic Cavity • Axial Images, 244
TRANSVERSE PLANE • ANTERIOR APPROACH, 244
Right Ovary • Longitudinal Images, 247
SAGITTAL PLANE • ANTERIOR APPROACH, 247
Right Ovary • Axial Images, 248
TRANSVERSE PLANE • ANTERIOR APPROACH, 248
Left Ovary • Longitudinal Images, 249
SAGITTAL PLANE • ANTERIOR APPROACH, 249
Left Ovary • Axial Images, 250
TRANSVERSE PLANE • ANTERIOR APPROACH, 250
Review Questions, 251
CONTENTS xix
12 Transvaginal Scanning Protocol for the Female Pelvis
Betty Bates Tempkin
Overview, 255
Preparation, 256
Patient Prep, 256
Patient Position, 256
Transducer, 256
Image Orientation, 256
Transvaginal Female Pelvis Survey, 259
Uterus and Adnexa • Longitudinal Survey, 259
SAGITTAL PLANE • INFERIOR APPROACH, 259
Uterus and Adnexa • Axial Survey, 260
CORONAL PLANE • INFERIOR APPROACH, 260
Right Ovary • Axial Survey, 260
CORONAL PLANE • INFERIOR APPROACH, 260
Right Ovary • Longitudinal Survey, 261
SAGITTAL PLANE • INFERIOR APPROACH, 261
Left Ovary • Axial Survey, 261
CORONAL PLANE • INFERIOR APPROACH, 261
Left Ovary • Longitudinal Survey, 262
SAGITTAL PLANE • INFERIOR APPROACH, 262
xx CONTENTS
Transvaginal Scanning Protocol for the Female Pelvis Required Images, 262
Uterus and Adnexa • Transvaginal Longitudinal Images, 262
SAGITTAL PLANE • INFERIOR APPROACH, 262
Uterus and Adnexa • Transvaginal Axial Images, 265
CORONAL PLANE • INFERIOR APPROACH, 265
Right Ovary • Transvaginal Axial Images, 267
CORONAL PLANE • INFERIOR APPROACH, 267
Right Ovary • Transvaginal Longitudinal Images, 268
SAGITTAL PLANE • INFERIOR APPROACH, 268
Left Ovary • Transvaginal Axial Images, 269
CORONAL PLANE • INFERIOR APPROACH, 269
Left Ovary • Transvaginal Longitudinal Images, 270
SAGITTAL PLANE • INFERIOR APPROACH, 270
Review Questions, 271
13 Obstetrical Scanning Protocol for First, Second,
and Third Trimesters
Betty Bates Tempkin
Overview, 276
Maternal Anatomy and Physiology, 276
First Trimester, 276
Anatomy and Sonographic Appearance During Early First Trimester, 277
GESTATIONAL SAC, 277
Determining Gestational Age During the First Half of the First Trimester, 278
MEAN SAC DIAMETER, 278
Sonographic Appearance and Development During the First Half of the First
Trimester, 278
DOUBLE SAC SIGN, 278
YOLK SAC, 279
DOUBLE BLEB SIGN, 280
Determining Gestational Age During the Second Half of the First
Trimester, 280
CROWN RUMP LENGTH, 280
Sonographic Appearance and Development During the Second Half of the
First Trimester, 281
AMNIOTIC SAC, 281
EMBRYONIC HEART, 281
SKELETAL SYSTEM, 281
UMBILICAL CORD, 281
TENTH WEEK, 282
END OF THE FIRST TRIMESTER, 282
Second and Third Trimesters, 282
Sonographic Appearance and Development During the Second and Third
Trimesters, 282
PLACENTA, 283
PLACENTAL GRADING, 283
PLACENTAL PREVIA, 283
UMBILICAL CORD, 285
UMBILICAL CORD INSERTION, 286
Sonographic Appearance of Fetal Anatomy, 286
SKELETAL SYSTEM, 287
CARDIOVASCULAR SYSTEM, 288
CONTENTS xxi
RESPIRATORY SYSTEM, 289
GASTROINTESTINAL SYSTEM, 289
GENITOURINARY SYSTEM, 291
INTRACRANIAL ANATOMY, 293
Determining GA During the Second and Third Trimesters, 295
BIPARIETAL DIAMETER MEASUREMENT, 296
HEAD CIRCUMFERENCE, 297
ABDOMINAL CIRCUMFERENCE, 297
LONG BONE MEASUREMENTS, 297
Preparation, 298
Patient Prep, 298
PATIENT PREP FOR TRANSABDOMINAL APPROACH, 298
PATIENT PREP FOR TRANSVAGINAL APPROACH, 298
Transducer, 298
TRANSDUCER FOR TRANSABDOMINAL APPROACH, 298
TRANSDUCER FOR TRANSVAGINAL APPROACH, 298
Patient Position, 299
PATIENT POSITION FOR TRANSABDOMINAL APPROACH, 299
PATIENT POSITION FOR TRANSVAGINAL APPROACH, 299
Obstetrics Survey, 299
Female Pelvis Survey, 299
Vagina • Uterus • Adnexa, 299
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 299
TRANSVERSE PLANE • TRANSABDOMINAL APPROACH, 301
First Trimester Survey, 303
Gestational Sac • Yolk Sac • Embryo, 303
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 303
TRANSVERSE PLANE • TRANSABDOMINAL APPROACH, 303
Second and Third Trimester Survey (The Fetus), 304
Determining Fetal Position/Presentation, 304
Thoracic Cavity • Abdominopelvic Cavity • Fetal Limbs • Fetal Spine • Fetal
Cranium, 304
FETAL LONG AXIS • TRANSABDOMINAL APPROACH, 304
Required Images for Obstetrics, 306
Early First Trimester, 306
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 306
SCANNING PLANE DETERMINED BY POSITION OF ANATOMY •
TRANSABDOMINAL APPROACH, 307
Later First Trimester, 310
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 310
SCANNING PLANE DETERMINED BY POSITION OF ANATOMY •
TRANSABDOMINAL APPROACH, 311
Second and Third Trimester, 313
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 313
SCANNING PLANE DETERMINED BY POSITION OF ANATOMY •
TRANSABDOMINAL APPROACH, 314
SAGITTAL PLANE • TRANSABDOMINAL APPROACH, 314
SCANNING PLANE DETERMINED BY POSITION OF ANATOMY •
TRANSABDOMINAL APPROACH, 315
Multiple Gestations, 333
ADDITIONAL REQUIRED IMAGES, 333
xxii CONTENTS
The Biophysical Profile, 334
Required Images for a Biophysical Profile, 335
Review Questions, 338
14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis
Betty Bates Tempkin
Overview, 344
Anatomy, 344
PROSTATE GLAND AND SEMINAL VESICLES, 344
SCROTUM AND TESTICLES, 345
PENIS, 347
Physiology, 347
Sonographic Appearance, 349
PROSTATE GLAND AND SEMINAL VESICLES, 349
SCROTUM AND TESTICLES, 349
PENIS, 352
Preparation, 353
Patient Prep, 353
PROSTATE GLAND, 353
SCROTUM, 353
PENIS, 354
Transducer, 355
PROSTATE GLAND, 355
SCROTUM, 355
PENIS, 356
Patient Position, 356
PROSTATE GLAND, 356
SCROTUM, 356
PENIS, 356
Prostate Gland Survey, 356
Prostate • Axial Survey, 357
TRANSVERSE PLANE • RECTAL APPROACH, 357
Prostate • Longitudinal Survey, 357
SAGITTAL PLANE • RECTAL APPROACH, 358
Prostate Gland Required Images, 358
Prostate • Axial Images, 359
TRANSVERSE PLANE • RECTAL APPROACH, 359
Prostate • Longitudinal Images, 362
SAGITTAL PLANE • RECTAL APPROACH, 362
Scrotum Survey, 363
Scrotum • Longitudinal Survey, 363
SAGITTAL PLANE • ANTERIOR APPROACH, 363
Scrotum • Axial Survey, 366
TRANSVERSE PLANE • ANTERIOR APPROACH, 366
Scrotum Required Images, 369
Scrotum • Right Hemiscrotum • Longitudinal Images, 369
SAGITTAL PLANE • ANTERIOR APPROACH, 369
Scrotum • Right Hemiscrotum • Axial Images, 376
TRANSVERSE PLANE • ANTERIOR APPROACH, 376
Scrotum • Left Hemiscrotum • Longitudinal Images, 381
SAGITTAL PLANE • ANTERIOR APPROACH, 381
Scrotum • Left Hemiscrotum • Axial Images, 387
TRANSVERSE PLANE • ANTERIOR APPROACH, 387
CONTENTS xxiii
Penis Survey, 392
Penis • Longitudinal Survey, 392
SAGITTAL PLANE • ANTERIOR APPROACH, 392
Penis • Axial Survey, 392
TRANSVERSE PLANE • ANTERIOR APPROACH, 392
Penis Required Images, 393
Penis • Longitudinal Images, 394
SAGITTAL PLANE • ANTERIOR APPROACH, 394
Penis • Axial Images, 394
TRANSVERSE PLANE • ANTERIOR APPROACH, 394
Review Questions, 395
PART V SMALL PARTS SCANNING PROTOCOLS
15 Musculoskeletal Scanning Protocol for Rotator Cuff, Carpal Tunnel,
and Achilles Tendon
Amy T. Dela Cruz
Rotator Cuff Scanning Protocol Overview, 401
Location, 401
Anatomy, 402
Physiology, 402
Sonographic Appearance, 403
Preparation, 403
Patient Prep, 403
Transducer, 403
Patient Position, 403
Breathing Technique, 403
Rotator Cuff Survey and Required Images, 403
Biceps Tendon, 403
Subscapularis, 405
Supraspinatus, 406
Infraspinatus, 407
Teres Minor, 408
Carpal Tunnel Scanning Protocol Overview, 409
Location, 409
Anatomy, 409
Physiology, 410
Sonographic Appearance, 410
Preparation, 411
Patient Prep, 411
Transducer, 411
Patient Position, 411
Breathing Technique, 411
Carpal Tunnel Survey, 411
Transverse Plane, 411
Sagittal Plane, 413
Carpal Tunnel Required Images, 413
Transverse Images, 413
Sagittal Images, 414
Achilles Tendon Scanning Protocol Overview, 415
Location, 415
Anatomy, 415
xxiv CONTENTS
Physiology, 415
Sonographic Appearance, 415
Preparation, 416
Patient Prep, 416
Transducer, 416
Breathing Technique, 416
Patient Position, 416
Achilles Tendon Survey, 416
Longitudinal Survey, 416
Transverse Survey, 416
Achilles Tendon Required Images, 417
Longitudinal Images, 417
Transverse Images, 418
Review Questions, 419
16 Thyroid and Parathyroid Glands Scanning Protocol
Wayne C. Leonhardt
Overview, 425
Location, 425
THYROID GLAND, 425
PARATHYROID GLANDS, 426
Anatomy, 426
THYROID GLAND, 426
PARATHYROID GLANDS, 426
Physiology, 427
THYROID GLAND, 427
PARATHYROID GLANDS, 427
Sonographic Appearance, 427
THYROID GLAND, 427
PARATHYROID GLANDS, 429
Color Flow Doppler Characteristics, 429
Normal Variants, 429
THYROID GLAND, 429
PARATHYROID GLANDS, 430
Preparation, 430
Patient Prep, 430
Transducer, 430
Breathing Technique, 430
Patient Position, 430
Thyroid Gland Survey Steps, 430
Lobes: Axial Survey Isthmus • Longitudinal Survey, 431
TRANSVERSE PLANE • ANTERIOR APPROACH, 431
Lobes: Longitudinal Survey, 433
SAGITTAL PLANE • ANTERIOR APPROACH, 433
Thyroid Gland Required Images, 435
Thyroid • Right Lobe • Axial Images, 435
TRANSVERSE PLANE • ANTERIOR APPROACH, 435
Thyroid • Right Lobe • Longitudinal Images, 437
SAGITTAL PLANE • ANTERIOR APPROACH, 437
Thyroid • Left Lobe • Axial Images, 438
TRANSVERSE PLANE • ANTERIOR APPROACH, 438
Thyroid • Left Lobe • Longitudinal Images, 439
SAGITTAL PLANE • ANTERIOR APPROACH, 439
Review Questions, 440
17 Breast Scanning Protocol
Betty Bates Tempkin
Clinical Reasoning, 445
Overview, 446
Anatomy, 446
Physiology, 446
Sonographic Appearance, 446
Normal Variants, 448
Preparation, 448
Patient Prep, 448
Transducer, 448
Patient Position, 448
PATIENT POSITION FOR BREAST LESION SCANNING, 448
PATIENT POSITION FOR WHOLE BREAST SCANNING, 448
Breast Lesion Survey Steps, 449
Longitudinal Survey, 449
SCANNING PLANE DETERMINED BY LESION SHAPE AND LIE • APPROACH
DETERMINED BY LESION LOCATION, 449
Axial Survey, 449
SCANNING PLANE DETERMINED BY LESION SHAPE AND LIE • APPROACH
DETERMINED BY LESION LOCATION, 449
Required Images for Breast Lesion, 449
Breast Lesion • Right Breast or Left Breast • Longitudinal Images, 450
SCANNING PLANE DETERMINED BY LESION SHAPE AND LIE • APPROACH
DETERMINED BY LOCATION, 450
Breast Lesion • Right Breast or Left Breast • Axial Images, 450
SCANNING PLANE DETERMINED BY LESION SHAPE AND LIE • APPROACH
DETERMINED BY LOCATION, 450
Breast Lesion • Right Breast or Left Breast • Longitudinal and Axial
High and Low Gain Images, 450
SCANNING PLANE DETERMINED BY LESION SHAPE AND LIE • APPROACH
DETERMINED BY LOCATION, 450
Whole Breast Survey, 451
Whole Breast Survey • Right Breast or Left Breast, 451
Whole Breast Required Images, 451
Whole Breast Images • Right Breast or Left Breast, 451
Review Questions, 452
CONTENTS xxv
18 Neonatal Brain Scanning Protocol
Kristin Dykstra Downey; Betty Bates Tempkin
Overview, 456
Cranial Vault Anatomy and Sonographic Appearance, 456
Preparation, 459
Patient Prep, 459
Transducer, 459
Patient Position, 459
Neonatal Brain Survey, 460
Coronal Survey, 460
CORONAL PLANE • ANTERIOR FONTANELLE APPROACH, 460
Sagittal Survey, 461
SAGITTAL PLANE • ANTERIOR FONTANELLE APPROACH, 461
xxvi CONTENTS
Neonatal Brain Required Images, 462
Coronal Images, 462
CORONAL PLANE • ANTERIOR FONTANELLE APPROACH, 462
Sagittal Images, 466
SAGITTAL PLANE • ANTERIOR FONTANELLE APPROACH, 466
Review Questions, 469
PART VI VASCULAR SCANNING PROTOCOLS
19 Abdominal Doppler and Color Flow Imaging
Marsha M. Neumyer
Basic Principles, 474
The Doppler Equation, 474
General Information, 474
FREQUENCY RANGE, 474
DOPPLER GAIN, 476
MOST FREQUENTLY USED DOPPLER CONTROLS, 477
Doppler Instrumentation, 477
Doppler Analysis, 479
AUDIBLE SOUND, 479
SPECTRAL ANALYSIS, 480
COLOR DOPPLER ANALYSIS, 480
Doppler Pitfalls, 480
ALIASING, 480
DOPPLER MIRROR IMAGE, 481
COLOR IMAGING PITFALLS, 482
Biologic Effects, 482
Preparation, 483
Examination Protocol for Abdominal Doppler and Color Flow
Imaging, 483
Patient Prep, 483
Transducer, 483
Patient Position, 483
Arterial Flow Patterns, 483
EXAMPLES OF ABDOMINAL ARTERIAL FLOW, 484
Mesenteric Arterial Duplex Protocol and Required Images, 487
Renal Arterial Duplex Protocol and Required Images, 491
Abdominal Venous Blood Flow Patterns and Duplex Protocols, 496
Required Diagnostic Data, 497
Scanning Tips, 498
Gynecological Studies, 498
Vascular Anatomy, 499
Blood Flow Patterns, 499
Obstetric Studies, 501
Breast Sonography, 501
Vascular Anatomy, 501
Scrotal Sonography, 502
Vascular Anatomy, 502
Blood Flow Patterns, 502
Pathology, 502
Review Questions, 504
CONTENTS xxvii
20 Cerebrovascular Duplex Scanning Protocol
Marsha M. Neumyer
Overview, 507
Location, 507
Anatomy, 507
Physiology, 508
Sonographic Appearance, 509
Preparation, 509
Patient Prep, 509
Pulsed Doppler Transducers, 510
Patient Position, 510
Cerebrovascular Duplex Survey, 510
Cerebrovascular Duplex Required Images, 519
Data Documentation, 526
Review Questions, 527
21 Peripheral Arterial and Venous Duplex Scanning Protocols
Marsha M. Neumyer
Lower Extremity Arterial Duplex Ultrasonography Overview, 531
Location, 531
Anatomy, 532
Physiology, 533
Sonographic Appearance, 533
Preparation, 533
Patient Prep, 533
Pulsed Doppler Transducers, 533
Patient Position, 533
Lower Extremity Arterial Duplex Survey, 534
Lower Limb Arterial Duplex Required Images, 540
Data Documentation, 551
Using Blood Pressures, 551
Doppler Waveform Morphology, 552
Normal Lower Extremity Arterial Velocities, 552
Classification of Disease Severity Based on Doppler Waveform
Morphology, 553
Lower Extremity Peripheral Venous Duplex Sonography Overview, 556
Anatomy, 556
Normal Sonographic Findings, 558
Preparation, 560
Patient Prep, 560
Transducer, 560
Patient Position, 560
Lower Extremity Venous Duplex Survey, 560
Lower Limb Venous Duplex Required Images, 564
Data Documentation, 570
Normal Examination, 570
Abnormal Examination, 570
Review Questions, 572
xxviii CONTENTS
PART VII ECHOCARDIOGRAPHY
22 Adult Echocardiography Scanning Protocol
Maureen E. McDonald
Overview, 578
Location, 578
Anatomy, 578
Physiology, 581
Sonographic Appearance, 582
Preparation, 582
Patient Prep, 582
Patient Position, 582
Transducer, 582
Breathing Techniques, 582
Transducer Orientation, 582
Adult Heart Survey
• 2D Examination, 584
Parasternal Views, 584
Apical Views, 586
Subxiphoid Views, 588
Suprasternal View, 589
Adult Heart Required Images, 590
M-Mode Evaluation, 596
Aortic Valve Level, 596
Mitral Valve Level, 597
Left Ventricular Level, 599
Tricuspid and Pulmonic Valves, 600
Doppler Evaluation, 601
Normal Valve Profiles, 601
MITRAL VALVE, 601
TRICUSPID VALVE, 601
AORTIC VALVE, 602
PULMONIC VALVE, 602
LEFT VENTRICULAR OUTFLOW TRACT, 603
Valve Survey, 603
COLOR DOPPLER SURVEY, 603
CONTINUOUS-WAVE DOPPLER SURVEY, 604
PULSED-WAVE DOPPLER SURVEY, 604
Review Questions, 605
23 Pediatric Echocardiography Scanning Protocol
Maureen E. McDonald
Overview, 609
Anatomy and Physiology, 609
Sonographic Appearance, 609
Preparation, 609
Patient Prep, 609
Transducer, 610
Patient Position, 610
Breathing Techniques, 610
Transducer Orientation, 610