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Abdomen Or Retroperitoneum US

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Abdomen Or Retroperitoneum US 1990 (Res. 7) The American College of Radiology, with more than 30,000 Revised 1993 (Res. 4) members, is the principal organization of radiologists, radiation Revised 1997 (Res. 27) oncologists, and clinical medical physicists in the United Revised 2001 (Res. 36) States. The College is a nonprofit professional society whose Effective 1/1/02 primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the ACR STANDARD FOR THE socioeconomic aspects of the practice of radiology, and PERFORMANCE OF AN encourage continuing education for radiologists, radiation ULTRASOUND EXAMINATION OF Ultrasound oncologists, medical physicists, and persons practicing in allied THE ABDOMEN OR professional fields. RETROPERITONEUM The American College of Radiology will periodically define new standards for radiologic practice to help advance the I. INTRODUCTION science of radiology and to improve the quality of service to patients throughout the United States. Existing standards will The clinical aspects of this standard (Indications/ be reviewed for revision or renewal, as appropriate, on their Contraindications, Specifications of the Individual Examinations, fifth anniversary or sooner, if indicated. and Equipment Specifications) were developed collaboratively by the American College of Radiology (ACR), and the American Each standard, representing a policy statement by the College, Institute of Ultrasound in Medicine (AIUM). has undergone a thorough consensus process in which it has These standards and guidelines have been developed to provide been subjected to extensive review, requiring the approval of assistance to practitioners performing ultrasound studies of the the Commission on Standards and Accreditation as well as abdomen or retroperitoneum. Ultrasound examination is a proven the ACR Board of Chancellors, the ACR Council Steering and useful procedure for the evaluation of many structures within Committee, and the ACR Council. The standards recognize these anatomic areas. Depending on the clinical indications, an that the safe and effective use of diagnostic and therapeutic examination may include the entirety of the abdomen and retroperitoneum, a single organ, or several organs. A combination radiology requires specific training, skills, and techniques, as of structures may be imaged because of location (e.g., upper described in each document. abdominal scan, right upper quadrant organs) or function (e.g., biliary system [liver, gallbladder, and bile ducts], both kidneys). Reproduction or modification of the published standard by For some patients, more focused examinations may be appropriate those entities not providing these services is not authorized. for evaluation of 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 The standards of the American College of Radiology (ACR) using ultrasound examination of the abdomen and are not rules, but are guidelines that attempt to define principles retroperitoneum, adherence to the following standards will of practice that should generally produce high-quality maximize the probability of detecting abnormalities radiologic care. The physician and medical physicist may modify an existing standard as determined by the individual Throughout this standard, references to Doppler evaluation may patient and available resources. Adherence to ACR standards include spectral, color, or power Doppler individually or in any will not assure a successful outcome in every situation. The combination. Whenever a long axis view is indicated, this could standards should not be deemed inclusive of all proper methods be either a sagittal or coronal plane. of care or exclusive of other methods of care reasonably directed to obtaining the same results. The standards are not (For specific pediatric considerations, see sections IV.A.2., IV.A.5, intended to establish a legal standard of care or conduct, and IV. B.3, and VI.) deviation from a standard does not, in and of itself, indicate or imply that such medical practice is below an acceptable II. INDICATIONS/CONTRAINDICATIONS level of care. The ultimate judgment regarding the propriety of any specific procedure or course of conduct must be made Indications for ultrasound examination of the abdomen and by the physician and medical physicist in light of all retroperitoneum include, but are not limited to: circumstances presented by the individual situation. A. Abdominal, flank, and/or back pain. B. Pain that may be referred from the abdominal or retro- peritoneal regions. ACR STANDARDS Ultrasound of the Abdomen or Retroperitoneum / 597 C. Palpable abnormalities such as possible abdominal positions, may be necessary to evaluate the gallbladder mass or organomegaly. and its surrounding area completely, particularly when D. Abnormal laboratory values suggestive of abdominal or stones and/or sludge are observed. Wall measurements retroperitoneal pathology. may aid in the determination of thickening. Tenderness E. Follow-up of known or suspected abnormalities in the to transducer compression may be assessed. abdomen or retroperitoneum. F. Search for metastatic disease or occult primary. The intrahepatic ducts can be evaluated by obtaining G. Evaluation of suspected congenital abnormalities. views of the liver demonstrating the right and left H. Abdominal trauma. branches of the portal vein. Doppler may be used to I. Pre- and post-transplantation evaluation. differentiate hepatic arteries and portal veins from bile ducts. The intrahepatic and extrahepatic bile ducts should Abdominal or retroperitoneal ultrasound should be performed be evaluated for dilatation, wall thickening, filling when there is a valid medical reason. There are no absolute defects, and other abnormalities. The size of the bile duct contraindications. in the porta hepatis should be documented. When visualized, the distal common bile duct in the pancreatic III. QUALIFICATIONS AND RESPONSIBILITIES OF head should be evaluated. THE PHYSICIAN Routine gallbladder examination should be conducted See the ACR Standard for Performing and Interpreting Diagnostic on a filled gallbladder. Fasting for 8 hours prior to Ultrasound Examinations. examinations will permit adequate distension of a normally functioning gallbladder in adults and children. IV. SPECIFICATIONS FOR INDIVIDUAL In infants and some adults adequate distention may be EXAMINATIONS achieved in less time. A. Abdomen 3. Pancreas 1. Liver Whenever possible, all portions of the pancreas – head, uncinate process, body, and tail – should be identified The examination of the liver should include long axis in long-axis and transverse projections. Orally and transverse views. The liver parenchyma should be administered water or contrast agent may afford better evaluated for focal and/or diffuse abnormalities. If visualization of the pancreas. The following should be possible, the echogenicity of the liver should be assessed in the examination of the pancreas: compared with that of the right kidney. In addition, the following should be imaged: a. Parenchymal abnormalities. b. The distal common bile duct in the region of the a. The major vessels in the region of the liver, including pancreatic head. the IVC, the hepatic veins, and the main, right, and c. The pancreatic duct for dilatation and any other left branches of the portal vein. abnormalities, with dilatation confirmed by b. The hepatic lobes (right, left, and caudate) and, if measurement. possible, the hepatic fissures, the right d. The peripancreatic region for adenopathy and/or hemidiaphragm, and the adjacent pleural space. fluid. Doppler may be used to differentiate vascular from Doppler may be used to differentiate vascular from nonvascular structures. nonvascular structures. Note: For vascular examinations of the native or 4. Spleen transplanted liver, in addition to the evaluation above, Doppler should be used to document blood flow Representative views of the spleen in long-axis and characteristics and blood flow direction in the hepatic transverse projections should be obtained. Doppler may artery, hepatic veins, portal veins, and intrahepatic be used to determine the presence and direction of flow portion of the IVC, as well as to identify collateral venous in the splenic vein and artery. Suspicion of splenic pathways if present. enlargement should be documented by measurement. Echogenicity of the left kidney should be compared to 2. Gallbladder and biliary tract splenic echogenicity when possible. An attempt should be made to demonstrate the left hemidiaphragm and the The gallbladder evaluation should include long-axis and adjacent pleural space. transverse views obtained in the supine position; other positions, such as left lateral decubitus, erect, or prone 598 / Ultrasound of the Abdomen or Retroperitoneum ACR STANDARDS 5. Bowel 3. Adrenal glands The bowel may be evaluated for wall thickening, When possible, usually in the newborn or young infant, dilatation, muscular hypertrophy, masses, and other long-axis and transverse images of the adrenal glands abnormalities. Sonography of the pylorus and can be obtained. The adrenal glands are infrequently seen surrounding structures may be indicated in the evaluation in adults. When visualized, the shape and size of the of the vomiting infant. Compression sonography may gland should be documented as well as the presence
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