Ultrasound Card Requirements

STANFORD ED ULTRASOUND APPLICATIONS:
REQUIREMENT FOR CREDENTIALING

Must have YOUR INITIALS, Patient MR#, INTERPRETATION
Click "PATIENT" - Type initials of Sonographer and Supervisor
(First initials set denotes the one who performed study)
ALL MUST BE CLIPS, unless measurement/interpretation/M Mode
(If more than one person performed the US study, type this with your
interpretation (and indicate initials). Multiple saved images required.)

AORTA: 2 Clips: Transverse and longitudinal - SX to iliacs. If stills
only: must show prox/mid/distal aorta with measurement.
Normal < 3cm outer wall to outer wall. If dilation or if diameter > 3cm,
look for clot. Save transverse still with measurement if > 3cm.

ECHO: Clips: 3 out of 4 views (below). Eval for effusion/tamponade,
contractility; CARDIAC or ABDOMINAL settings on US.
- Subxyphoid 4 chamber: Flatten probe under xiphoid process
- Parasternal long: Left ant chest wall; also evals aortic root/desc aorta
- Parasternal short: Left ant chest wall; evals LV contractility
- Apical 4 chamber: at PMI; eval RV size in relation to LV (PE eval)

FAST: 4 Views: 4 Clips: RUQ, LUQ, SUBX (or PSL), PELVIS:
- View entire kidney; view entire heart; view above diaphragm
- Fanning thru diaphragm-liver-kidney/spleen-kidney/pelvis space

E-FAST: 6 Views: Clips: as above + bilateral clips of lung sliding
- Bilateral views with M Mode (pneumothorax) (optional)

GALLBLADDER: 2 clips: Transverse and longitudinal of GB;
adjust depth as needed
- Eval for stones, pericholecystic fluid, ant wall thickening, CBD
- Normal GB: length 7-10cm/width 2-3cm
- Normal GB anterior wall: 3mm; CBD: 6mm
(+1mm for each decade over 50)

TRANSABDOMINAL PELVIS: 2+ Clips (fanning thru structure)
Uterus: Sagittal & transverse + bilateral ovaries attempt
Live IUP: ID gestational sac (5.5 weeks), yolk sac, fetal pole - 
Cardiac activity/rate (with M Mode - DO NOT USE DOPPLER);
Gest age: GS, CRL, BPD, FL (optional) - Do FAST with ectopic eval

ABDOMEN (SPECIAL): Clips of anatomy with both transverse &
longitudinal views (pyloric stenosis, intussusceptions, etc)

BLADDER VOLUME: Clips preferred/stills OK: Suprapubic
transverse (2 measurements) and sagittal view (1 measurement) - 3
measurements and calculation of volume (0.7 x L x W x D)

CHEST/THORAX: Clips: Bilateral views; M-mode OK if eval ptx.
If eval for CHF/PNA/ARDS: Multiple B lines on multiple views on 
each side of the chest (8 total chest quadrants evaluated)

DVT: Clips preferred/stills OK if split screen of non-compressed vs
compressed region - compress every 1cm for the length of 5cm in 
both the femoral and popliteal (up to trifurcation) regions

IVC: Clips preferred: subxyphoid view (longitudinal) showing IVC
entering RA with respiratory variations; visualize IVC size; try to
show sniff test (make sure it is NOT the aorta). Normal 1.5-2.5cm

MSK: Clip of relevant findings in multiple (at least 2) views
- Look for fracture, cellulitis, abscess, joint eff, LN, foreign body

ORBITAL: Clips: bilateral orbits in transverse and longitudinal;
linear probe; fanning thru orbit;
- shows optic nerve, retina, vitreous, lens, anterior chamber, pupil
muscle contraction: ONSD measured 3mm from retina; norm < 5mm

PROCEDURAL: Clips preferred/stills OK - Procedure in progress
Vascular access: must show needle in vein; Fluid localization: must
show are of fluid for US guidance

RENAL: 3 views: clips: transverse and long kidney PLUS bladder
- Normal kidney length 9-12cm; left lower than right
- Eval for cysts, masses, hydronephrosis, stones

RLQ (Appendicitis): Linear probe at area of pain; Clips of
compression/incompressibility/evidence of free fluid - views with
Color encouraged

TESTICULAR: Clips: Transverse and longitudinal of each testicles
- with and without Color Doppler

MISC: Give at least 2 (transverse, long) views; interpret image

GUIDELINES