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Registered Abdominal Ultrasound Specialist

RAUS - Registered Abdominal Ultrasound Specialist

RAUS-Registered Abdominal Ultrasound Specialist is a healthcare professional that evaluates and describes sonographic appearance of the abdominal cavity in the radiology field. Our certification exam both clinical and theory competencies, follow suggested but not limited protocols from standard institutions who present guidelines for the performance of these studies. 

These protocols are an educational tool designed to assist abdominal ultrasound graduates and practitioners in providing appropriate abdominal protocol for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal protocol standard of scanning. For these reasons and those set forth below, the American College of Radiology cautions against the use of these protocols in litigation in which the clinical decisions of a practitioner are called into question.


The practice of medicine involves nor only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these protocols will not assure an accurate diagnosis or a successful outcome. All that should be expected is that the graduate and/or practitioner will follow a reasonable course of action based on current knowledge, available resources.


The clinical and theoretical aspects of exams contained in the clinical protocols that we comprehend (Introduction, Indications, Specifications of the Examination, and Equipment Specifications) were developed under guidelines by the American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), the Society for Pediatric Radiology (SPR), and the Society of Radiologists in Ultrasound (SRU).


The protocols have been developed to assist ultrasound graduates and practitioners performing ultrasound studies of the abdomen. Sonography is a procedure which can be used as a  invasive and non invasive procedure proven and useful for evaluating the many structures within these anatomic areas. Depending on clinical indications, an examination may include the entirety of the abdomen, single organ or several organs. A combination of structures may be imaged because of location (e.g., upper abdominal scan, right upper quadrant organs) or function (e.g., biliary system [liver, gallbladder, and bile ducts], both kidneys). For some patients, more focused examinations may be appropriate for evaluating specific clinical indications or to follow up a known abnormality. In some cases, additional and/or specialized examinations may be necessary (e.g., spectral, color, and/or power Doppler). While it is not possible to detect every abnormality using ultrasound examination of the abdomen, adherence to the following protocol will maximize the probability of detecting abnormalities.


Focused Specifications for Individual Clinical Abdominal Examination Protocols

 

Liver
The examination of the liver should include axis and transverse views. The liver parenchyma should be evaluated for focal and/or diffuse abnormalities. If possible, the echogenicity of the liver should be compared with that of the right kidney. In addition, the following should be imaged:
a. The major hepatic and perihepatic vessels, including the inferior vena cava (IVC), the hepatic veins, the main portal vein, and, if possible, the right and left branches of the portal vein.
b. The hepatic lobes (right, left, and caudate) and, if possible, the righthemidiaphragm and the adjacent pleural space.

 

Gallbladder
Routine gallbladder examination should be conducted on an adequately distended gallbladder whenever possible. In most cases, fasting prior to elective examination will permit adequate distension of a normally functioning gallbladder evaluation should include long-axis and transverse views obtained in the supine position. Other positions such as left lateral decubitus, erect, or prone may be helpful to evaluate the gallbladder and its surrounding areas completely. Measurements may aid in determining gallbladder wall thickening. If the patient presents with pain, tenderness to transducer compression should be assessed.
The intrahepatic ducts can be evaluated by obtaining views of the liver demonstrating the right and left branches of the portal vein. Doppler may be used to differentiate hepatic arteries and portal veins from bile ducts. The intrahepatic and extrahepatic bile ducts should be evaluated for dilatation, wall thickening, intraluminal findings, and other abnormalities. The bile duct in the porta hepatis should be measured and documented. When visualized, the distal common bile duct in the pancreatic head should be evaluated.

 

Pancreas
Whenever possible, all portions of the pancreas – head, uncinated process, body, and tail – should be identified. Orally administered water or contrast agent may afford better visualization of the pancreas. The following should be assessed in the examination of the pancreas:
a. Parenchymal abnormalities
b. The distal common bile duct in the region of the pancreatic head
c. The pancreatic duct for dilatation and any other abnormalities, with dilatation confirmed by measurement
d. The peripancreatic region for adenopathy and/or fluid

 

Spleen
Representative views of the spleen in long-axis and transverse projections should be obtained. Splenic length measurement may be helpful in assessing enlargement. Echogenicity of the left kidney should be compared to splenic echogenicity when possible. An attempt should be made to demonstrate the left hemidiaphragm and the adjacent pleural space.

 

Bowel
The bowel may be evaluated for wall thickening, dilatation, muscular hypertrophy, masses, vascularity, and other abnormalities. Sonography of the pylorus and surrounding structures may be indicated in the evaluation of the vomiting infant. Graded compression Sonography aids in the visualization of the appendix and other bowel loops. Measurements may aid in determining bowel wall thickening.

 

Abdominal wall
The examination should include images of the abdominal wall in the location of symptoms or signs. The relationship of any identified mass to the peritoneum should be demonstrated. Any defect in the peritoneum and abdominal wall musculature should be documented. The presence or absence of bowel, fluid, or other tissue contained within any abdominal wall defect should be noted. Images obtained in upright position and/or with use of the Valsalva maneuver may be helpful. Doppler examination may be useful to define the relationship of blood vessels to a detected mass.

 

Kidneys
The examination of native or transplanted kidneys should include long-axis and transverse views of the kidneys. The cortices and renal pelves should be assessed. A maximum measurement of renal length should be recorded for both kidneys. Decubitus, prone, or upright positioning may provide better images of the native kidneys. When possible, renal echogenicity should be compared to the adjacent liver or spleen. The kidneys are perirenal regions be assessed for abnormalities.

 

Urinary bladder and adjacent structures
When performing a complete ultrasound evaluation of the urinary tract, transverse and longitudinal images of the distended urinary bladder and its wall should be included, if possible. Bladder lumen or wall abnormalities should be noted. Dilatation or other distal ureteral abnormalities should be documented. Transverse and longitudinal scans may be used to demonstrate any postvoid residual, which may be quantitated and reported.

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