Ultrasound Training to Assist DMS Programs

Upper Uterine Segment
• Step 1: Select the Upper Uterine Segment window. Scan through the uterus in both sagittal and transverse planes.
• Step 2: Acquire an image of the uterus in the mid-sagittal plane. Annotate “Uterus Mid-Sagittal” and save.
• Step 3: Measure the length of the uterus. Annotate “Uterus Mid-Sagittal Length” and save.
• Step 4: Measure the anteroposterior portion of the uterus. Annotate “Uterus Mid-Sagittal Height” and save.
• Step 5: Measure the anteroposterior portion of the endometrial stripe. Annotate “Endometrial Echo” and save.
• Step 6: Acquire an image of the uterus in the transverse plane. Annotate “Uterus Transverse” and save.
• Step 7: Measure the width of the uterus at the widest diameter. Annotate “Uterus Transverse Width” and save.

Right Adnexa - Transabdominal
• Step 1: Select the Right Adnexa window. Scan through the right adnexa in both sagittal and transverse planes.
• Step 2: Acquire an image of the right iliac vessels in the mid-sagittal plane. Annotate “RT Adnexa Mid-Sagittal” and save.
• Step 3: Evaluate the right adnexa in the mid-sagittal plane with color Doppler.
• Step 4: Acquire an image of the right iliac vessels in the transverse plane. Annotate “RT Adnexa Transverse” and save.
• Step 5: Evaluate the right adnexa in the transverse plane with color Doppler.
• Step 6: Evaluate the right adnexa for cystic or solid masses.
• Step 7: Evaluate the right adnexa for free fluid.
• Step 8: Measure the length, width, and height of identified abnormalities.

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Right Proximal Common Carotid Artery
• Step 1: Select the Right Proximal Common Carotid Artery window. Scan through in both sagittal and transverse planes.
• Step 2: Along a sagittal plane, obtain a single best greyscale image of the right proximal common carotid artery capturing the full length of the vessel. Annotate “Sagittal Rt Prox Comm Carotid” and save.
• Step 3: Along a transverse plane, obtain a single best greyscale image of the right proximal common carotid artery. Annotate “Transverse Rt Prox Comm Carotid” and save.
• Step 4: Along a sagittal plane, obtain a single best image of the right proximal common carotid artery with color Doppler demonstrating wall-to-wall color flow. Annotate “Sagittal Rt Prox Comm Carotid with Color Doppler” and save.
• Step 5: Along a sagittal plane, obtain a single best image of the right proximal common carotid artery with pulsed-wave Doppler. Annotate “Sagittal Rt Prox Comm Carotid, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s” and save.

Right Mid Common Carotid Artery
• Step 1: Select the Right Mid Common Carotid Artery window. Scan through in both sagittal and transverse planes.
• Step 2: Along a sagittal plane, obtain a single best greyscale image of the right mid common carotid artery capturing the full length of the vessel. Annotate “Sagittal Rt Mid Comm Carotid” and save.
• Step 3: Along a transverse plane, obtain a single best greyscale image of the right mid common carotid artery. Annotate “Transverse Rt Mid Comm Carotid” and save.
• Step 4: Along a sagittal plane, obtain a single best image of the right mid common carotid artery with color Doppler demonstrating wall-to-wall color flow. Annotate “Sagittal Rt Mid Comm Carotid with Color Doppler” and save.
• Step 5: Along a sagittal plane, obtain a single best image of the right mid common carotid artery with pulsed-wave Doppler. Annotate “Sagittal Rt Mid Comm Carotid, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s” and save.
• Step 6: Along a sagittal plane, obtain a single best image of the right mid common carotid artery capturing the intima-media thickness. Annotate “Sagittal Rt Mid Comm Carotid, IMT = [enter measurement] cm” and save.

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Mid Subclavian Artery
• Step 1: Select the Mid subclavian artery window. Scan through in both sagittal and transverse planes.
• Step 2: Along a sagittal plane, obtain a single best greyscale image of the mid subclavian artery capturing the full length of the vessel. Annotate “Sagittal Rt Mid Subclavian” and save.
• Step 3: Along a transverse plane, obtain a single best greyscale image of the mid subclavian artery. Annotate “Transverse Rt Mid Subclavian” and save.
• Step 4: Along a sagittal plane, obtain a single best image of the mid subclavian artery with color Doppler demonstrating wallto-wall color flow. Annotate “Sagittal Rt Mid Subclavian with Color Doppler” and save.
• Step 5: Along a sagittal plane, obtain a single best image of the mid subclavian artery with pulsed-wave Doppler taking note of the velocity measurements and waveform characteristics. Annotate “Sagittal Rt Mid Subclavian, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s, [Tri/Bi/Mono] Waveform” and save

Mid Axillary Artery
• Step 1: Select the Mid axillary artery window. Scan through in both sagittal and transverse planes.
• Step 2: Along a sagittal plane, obtain a single best greyscale image of the mid axillary artery capturing the full length of the vessel. Annotate “Sagittal Rt Mid Axillary” and save.
• Step 3: Along a transverse plane, obtain a single best greyscale image of the mid axillary artery. Annotate “Transverse Rt Mid Axillary” and save.
• Step 4: Along a sagittal plane, obtain a single best image of the mid axillary artery with color Doppler demonstrating wall-towall color flow. Annotate “Sagittal Rt Mid Axillary with Color Doppler” and save.
• Step 5: Along a sagittal plane, obtain a single best image of the mid axillary artery with pulsed-wave Doppler taking note of the velocity measurements and waveform characteristics. Annotate “Sagittal Rt Mid Axillary, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s, [Tri/Bi/Mono] Waveform” and save.

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Radial Artery at Distal Wrist
• Step 1: Select the Radial artery at distal wrist window. Scan through in both short- and long-axis views. Screen for physiologic findings supportive of sclerosis or calcification in the arterial system.
• Step 2: Along a long-axis view, obtain a single best greyscale image of the radial artery at the distal wrist capturing the full length of the vessel. Annotate “Long Axis Lt Radial at Dist Wrist” and save.
• Step 3: Along a short-axis view, obtain a single best greyscale image of the radial artery at the distal wrist. Annotate “Short Axis Lt Radial at Dist Wrist” and save.
• Step 4: Along a long-axis view, obtain a single best image of the radial artery at the distal wrist with color Doppler demonstrating wall-to-wall color flow. Annotate “Long Axis Lt Radial at Dist Wrist with Color Doppler” and save.
• Step 5: Along a long-axis view, obtain a single best image of the radial artery at the distal wrist with pulsed-wave Doppler taking note of the velocity measurements and waveform characteristics. Annotate “Long Axis Lt Radial at Dist Wrist, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s, [Tri/Bi/Mono] Waveform” and save.
• Step 6: Along a short-axis view, obtain a single best image of the radial artery at the distal wrist and utilize the ‘Caliper’ feature to measure the skin to vessel distance. Annotate “Short Axis Lt Radial at Dist Wrist Depth = [enter measurement] cm” and save.
• Step 7: Along a short-axis view, obtain a single best image of the radial artery at the distal wrist and utilize the ‘Caliper’ feature to measure the maximal arterial diameter. Annotate “Short Axis Lt Radial at Dist Wrist = [enter measurement] cm” and save.

Radial Artery at Proximal Wrist
• Step 1: Select the Radial artery at proximal wrist window. Scan through in both short- and long-axis views. Screen for physiologic findings supportive of sclerosis or calcification in the arterial system.
• Step 2: Along a long-axis view, obtain a single best greyscale image of the radial artery at the proximal wrist capturing the full length of the vessel. Annotate “Long Axis Lt Radial at Prox Wrist” and save.
• Step 3: Along a short-axis view, obtain a single best greyscale image of the radial artery at the proximal wrist. Annotate “Short Axis Lt Radial at Prox Wrist” and save.
• Step 4: Along a long-axis view, obtain a single best image of the radial artery at the proximal wrist with color Doppler demonstrating wall-to-wall color flow. Annotate “Long Axis Lt Radial at Prox Wrist with Color Doppler” and save.
• Step 5: Along a long-axis view, obtain a single best image of the radial artery at the proximal wrist with pulsed-wave Doppler taking note of the velocity measurements and waveform characteristics. Annotate “Long Axis Lt Radial at Prox Wrist, PSV = [enter measurement] cm/s, EDV = [enter measurement] cm/s, [Tri/Bi/Mono] Waveform” and save.
• Step 6: Along a short-axis view, obtain a single best image of the radial artery at the proximal wrist and utilize the ‘Caliper’ feature to measure the skin to vessel distance. Annotate “Short Axis Lt Radial at Prox Wrist Depth = [enter measurement] cm” and save.
• Step 7: Along a short-axis view, obtain a single best image of the radial artery at the proximal wrist and utilize the ‘Caliper’ feature to measure the maximal arterial diameter. Annotate “Short Axis Lt Radial at Prox Wrist = [enter measurement] cm” and save

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Anterior Fontanelle - Coronal
• Step 1: Scan through the anterior fontanelle in the coronal plane. Acquire an image of the frontal lobes anterior to the frontal horns of the lateral ventricles with the orbits visualized deep to the skull base. Annotate “Coronal Frontal Lobes” and save.
• Step 2: In the coronal plane, acquire an image of the frontal horns or the bodies of the lateral ventricles and the interhemispheric fissure. Annotate “Coronal Frontal Horns” and save.
• Step 3: In the coronal plane, acquire an image of the lateral ventricles at the level of the foramina of Monro (outlining the course of the choroid plexus from the lateral ventricle into the third ventricle), interhemispheric fissure, cingulate sulcus (if developed), corpus callosum, septum pellucidum or cavum septi pellucidi, caudate nuclei, putamina, globi pallidi, and Sylvian fissures. Annotate “Coronal Third Ventricles” and save.
• Step 4: In the coronal plane, acquire an image of the lateral ventricles slightly posterior to the foramina of Monro (the point at which the lateral and third ventricles communicate). Include the pons and medulla, thalami, and choroid plexus in the roof of the third ventricle and in the caudothalamic grooves. Annotate “Coronal Lateral Ventricles” and save.
• Step 5: Measure the ventricular index bilaterally. Annotate “Ventricular Index” and save.
• Step 6: In the coronal plane, acquire an image at the level of the quadrigeminal plate cistern and cerebellum. Include the cerebellar vermis and cisterna magna. Annotate “Coronal Cerebellum and Quadrigeminal Plate” and save.
• Step 7: In the coronal plane, acquire an image of the echogenic glomi of choroid plexuses at the posterior aspect of the lateral ventricles at the level of trigones. Include the splenium of the corpus callosum at the divergence of the lateral ventricle and periventricular white matter lateral to the posterior horns of the lateral ventricles. Annotate “Coronal Choroid Plexus at Lateral Ventricle Atrium” and save.
• Step 8: In the coronal plane, acquire an image posterior to the occipital horns of the lateral ventricles. Include parietal and occipital lobes and the posterior interhemispheric fissure. Annotate “Coronal Parietal and Occipital Lobes” and save.

Anterior Fontanelle - Sagittal
• Step 1: Scan through the anterior fontanelle in the sagittal midline plane. Acquire an image in a midline sagittal view to include the corpus callosum, cavum septi pellucidi, cavum vergae, third and fourth ventricles (if present), aqueduct of Sylvius, brainstem, cerebellar vermis, cisterna magna, and sulci (if present). Annotate “Sagittal Midline” and save.
• Step 2: In the parasagittal plane, acquire an image of the right lateral ventricle, including the caudothalamic groove and the choroid plexus. Annotate “Parasagittal Right Caudothalamic Groove” and save.
• Step 3: In the parasagittal plane, acquire an image of the right Sylvian fissure and the periventricular region. Annotate “Parasagittal Right Sylvian Fissure and Temporal Lobe” and save.
• Step 4: In the parasagittal plane, acquire an image of the left lateral ventricle, including the caudothalamic groove and the choroid plexus. Annotate “Parasagittal Left Caudothalamic Groove” and save.
• Step 5: Scan through the anterior fontanelle in the parasagittal plane. Acquire an image of the left Sylvian fissure and the periventricular region. Annotate “Parasagittal Left Sylvian Fissure and Temporal Lobe” and save.

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