Tuesday, 18 August 2026

Murphy's Sign (Sweeney's Sign)

General Ultrasound • Gallbladder • Clinical Signs
Murphy's Sign (Sweeney's Sign)
Clinical Elicitation, Sonographic Correlation, and Significance in Gallbladder Disease
Hepatobiliary Ultrasound General Sonography Updated 2026 Educational Reference
Definition → Murphy's sign, also known as Sweeney's sign, is a clinical sign used primarily to assess for gallbladder inflammation, particularly acute cholecystitis. A positive sign occurs when palpation of the right upper quadrant during inspiration produces significant pain and causes the patient to abruptly stop or interrupt inspiration.
How is it Elicited? → The examiner places the fingers or hand beneath the right costal margin, usually near the midclavicular line, and asks the patient to take a deep breath. During inspiration, the diaphragm moves downward and the gallbladder descends toward the examiner's hand. If this maneuver produces marked pain and the patient suddenly stops inspiration, the test is considered positive.
Positive Murphy's Sign → A positive Murphy's sign is characterized by localized right upper quadrant tenderness associated with inspiratory arrest. The finding suggests gallbladder inflammation and may support the clinical diagnosis of acute cholecystitis, but it should always be interpreted together with the clinical presentation and imaging findings.
Sweeney's Sign → Sweeney's sign is used as a synonym for Murphy's sign. Therefore, a positive Sweeney's sign describes the same clinical response: right upper quadrant pain during inspiration with inspiratory arrest when the inflamed gallbladder comes into contact with the examiner's hand.
Ultrasound Murphy's Sign → During ultrasound examination, the transducer is positioned directly over the gallbladder and gentle pressure is applied. A sonographic Murphy's sign is considered positive when the patient experiences maximal tenderness directly beneath the ultrasound probe over the gallbladder. This finding is particularly useful when correlated with gallbladder wall thickening, distension, stones, sludge, or pericholecystic fluid.
Clinical Importance → Murphy's sign is an important bedside finding in patients with suspected acute cholecystitis. It helps localize symptoms to the gallbladder, but a positive or negative sign alone does not establish or exclude the diagnosis. Clinical examination, laboratory findings, and imaging should be considered together.
Sonographic Correlation → In suspected acute cholecystitis, ultrasound may demonstrate gallstones, gallbladder distension, wall thickening, pericholecystic fluid, sludge, hyperemia of the gallbladder wall, and a positive sonographic Murphy's sign. The combination of appropriate clinical findings and characteristic sonographic abnormalities increases diagnostic confidence.
Positive vs Negative → Positive Murphy's Sign → Right upper quadrant pain + inspiratory arrest.
Negative Murphy's Sign → Deep inspiration can be completed without characteristic gallbladder tenderness.
Sonographic Murphy's Sign → Maximal tenderness directly beneath the ultrasound transducer over the gallbladder.
Commonly Associated Conditions → Murphy's sign is most classically associated with acute cholecystitis. Similar right upper quadrant tenderness, however, may occur with other hepatobiliary or adjacent abdominal conditions, so the sign is not completely specific for acute cholecystitis.
Important Ultrasound Findings → Gallstones → Echogenic calculi with posterior acoustic shadowing.
Gallbladder Wall Thickening → May accompany inflammation but is nonspecific.
Gallbladder Distension → May occur with cystic duct obstruction.
Pericholecystic Fluid → Supports inflammatory change when appropriately interpreted.
Wall Hyperemia → May be demonstrated with Doppler in inflammation.
Sonographic Murphy's Sign → Maximal tenderness directly over the gallbladder.
Clinical Mechanism → During deep inspiration, the diaphragm descends and the gallbladder moves downward toward the examiner's hand or ultrasound transducer. When the gallbladder is inflamed, this contact can produce localized pain, causing the patient to interrupt inspiration.
Key Learning Point → Murphy's Sign = Sweeney's Sign
Positive Clinical Sign = RUQ pain + inspiratory arrest
Sonographic Murphy's Sign = Maximal tenderness directly beneath the probe over the gallbladder
Most Important Association = Acute cholecystitis
Did You Know? → John Benjamin Murphy's influence extended beyond the Murphy sign. He was an important figure in the development of modern American surgery, particularly through his emphasis on early intervention, clinical observation, surgical innovation, and practical teaching. The American College of Surgeons recognizes him as one of the important figures in its early history.
Historical Summary → John Benjamin Murphy → American surgeon
Born → December 21, 1857, Appleton, Wisconsin
Medical Degree → Rush Medical College, 1879
Major Surgical Center → Chicago
Chief of Surgery → Mercy Hospital, Chicago
Famous For → Murphy's sign + major surgical innovations
American Medical Association → President, 1911–1912
Died → August 11, 1916
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Systematic Measurement sequence of ultrasound

Ultrasound Measurement Techniques
Systematic Measurement Sequence
Standard Measurement Workflow, Anatomical Landmark Identification, Caliper Placement, Distance, Area, Volume, Documentation, and Reproducibility
8.5 Measurement Techniques General Sonography USG Measurement Educational Reference
Abdominal Ultrasound — Measurable Structures
Systematic Measurement sequence :
  • 1. USG Abdomen
  • 2. Obstetric & Fetal Sonography
  • 3. Transvaginal Sonography (TVS)
  • 4. Perineal & Groin Ultrasound
  • 5. Scrotal Ultrasound
  • 6. Penile Ultrasound
  • 7. Breast Ultrasound
  • 8. Dorsal Wall Ultrasound
  • 9. Neck Ultrasound
  • 10. Upper Limb Ultrasound
  • 11. Lower Limb Ultrasound
  • 12. Interventional Ultrasound
  • 13. Neonatal & Pediatric Ultrasound
  • 14. Ophthalmic Ultrasound
  • 15. Cheek / Buccal Ultrasound
  • 16. Nasal & Paranasal Sinus Ultrasound
  • 17. Spine Ultrasound
  • 18. Nerve Conduction Velocity (NCV) Study
  • 19. Contrast-Enhanced Ultrasound (CEUS)
  • 20. Elastography
  • 21. Three-Dimensional (3D) Ultrasound
  • 22. Four-Dimensional (4D) Ultrasound
  • 23. Microvascular Imaging (SMI / MV-Flow)
  • 24. Fusion Imaging
  • 25. High-Frequency Ultrasound (HFUS)
  • 26. Artificial Intelligence (AI)-Assisted Ultrasound
  • 27. Point-of-Care Ultrasound (POCUS)
  • 28. Interventional Ultrasound Procedures
  • 29. Endoscopic Ultrasound (EUS)
  • 30. Intravascular Ultrasound (IVUS)
  • 31. Transcranial Doppler (TCD)
  • 32. Lung/Thorax Ultrasound (LUS)
  • 33. Cardiac Ultrasound (Echocardiography / Echo)
  • 34. Quantitative Ultrasound (QUS)
    • Systematic Measurement sequence

    Systematic Measurement
    Workflow

    A structured approach to ultrasound measurement — covering preparation, imaging, documentation, and reporting.

    General Sonography Measurement Protocol Quality Assurance Reporting

    The MEASURE Workflow

    A systematic measurement workflow ensures accuracy, reproducibility, and consistency across every ultrasound examination. The sequence below — remembered by the mnemonic MEASURE — guides the sonographer from machine setup through final report generation. Each step builds on the previous one, so skipping or reordering compromises the quality of the measurement.

    M–E–A–S–U–R–E

    Machine → Ergonomics → Anatomy → Standardized planes → Uniform calipers → Recording → Evaluation

    Key Step Description & Key Points
    M Machine Preparation Select the appropriate transducer (frequency & footprint), set the organ-specific preset, and verify machine calibration.
    Curvilinear for abdomen, linear for superficial structures, endocavitary for TVS. Confirm thermal indices (TIB/TIS) within safe limits.
    E Ergonomics & Patient Position Position the patient correctly (supine, lateral, or Trendelenburg), ensure comfort and adequate exposure. Adjust bed height and monitor angle for operator ergonomics.
    Use positioning aids (pillows, wedges). Apply coupling gel adequately to eliminate air interfaces.
    A Anatomical Landmarks Identify standard anatomical landmarks and reference structures before attempting any measurement. Confirm orientation — head/feet, left/right.
    Use vessels, organs, and fascial planes as fixed references. Verify sagittal, transverse, and coronal planes.
    S Standardized Planes & Settings Acquire images in accepted standard planes. Optimize gain, depth, focus, and zoom so the structure fills the screen. Freeze the ideal frame before measuring.
    One measurement per frozen frame. Use outer-to-outer or inner-to-inner as per protocol (e.g., liver length = outer-to-outer).
    U Uniform Caliper Placement Place calipers precisely on the edges of the structure following established measurement conventions. Zoom in if needed for accuracy; avoid estimating.
    Leading-edge to leading-edge for wall thickness. Repeat 2–3 times and average for consistency.
    R Recording & Documentation Save annotated images with measurements displayed. Document all required views — at least two perpendicular planes for 3D structures.
    Include patient ID, date, and side marker. Store in PACS with proper labeling and recorded values.
    E Evaluation & Reporting Compare measurements with reference ranges / nomograms. Correlate with clinical history. Generate a structured report with findings, impressions, and recommendations.
    Flag abnormal values. Suggest follow-up or complementary imaging when appropriate.

    MEASURE — A systematic workflow for accurate, reproducible ultrasound measurements.

    Abdominal Ultrasound — Measurable Structures

    1.Abdominal Ultrasound — Measurable Structures

    Gray Scale Measurements (Short Form)

    1. Solid Organs

    Liver

    • Span (MCL)
    • Portal vein dia.
    • Hepatic vein dia.
    • CBD dia.
    • Lesion: L × W × T

    Gallbladder

    • Length & width
    • Wall thickness
    • Stone size
    • Sludge/polyp size

    Pancreas

    • AP thickness (H, B, T)
    • Duct diameter
    • Lesion/pseudocyst

    Spleen

    • Length (long axis)
    • Width
    • Thickness
    • Lesion dimensions

    Kidneys (B/L)

    • Renal length
    • Renal width
    • Cortical thickness
    • Hydronephrosis grade
    • Echogenicity (subjective)
    2. Hollow Viscous Organs

    Urinary Bladder

    • Volume (L × W × H)
    • Wall thickness
    • Pre-void volume
    • Post-void volume

    Stomach / Bowel

    • Bowel wall thickness
    • Bowel diameter
    • Appendix diameter

    Gallbladder (wall/lumen)

    • Wall thickness
    • Lumen assessment
    3. Fluid-Filled Structures & Collections

    Ascites

    • Pocket depth

    Collections

    • Abscess dimensions
    • Volume estimation

    Cysts

    • Hepatic / Renal
    • Splenic / Mesenteric
    • Dimensions

    Hematoma

    • Dimensions
    4. Vascular Structures (Gray Scale)

    Aorta

    • AP diameter (multiple levels)

    IVC

    • Diameter
    • Collapsibility

    Portal Vein

    • Diameter

    Splenic Vein

    • Diameter

    SMV

    • Diameter

    Renal Vein

    • Diameter
    5. Lymph Nodes

    Lymph Nodes

    • Short axis diameter
    • L/S axis ratio
    • Hilum (subjective)
    6. Other

    Prostate

    • Volume (TA / TR)

    Uterus

    • Length
    • Width
    • Thickness

    Ovaries

    • Dimensions (L × W × T)

    Abdominal Wall

    • Muscular wall thickness
    Obstetric & Fetal Sonography — Measurable Structures

    2. Obstetric & Fetal Sonography — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Early Pregnancy (First Trimester)

    Gestational Sac (GS)

    • MSD (mean sac dia.)
    • GS volume
    • Position

    Yolk Sac

    • Diameter
    • No. / morphology

    CRL (Crown-Rump Length)

    • CRL (mm)
    • Embryonic HR

    NT (Nuchal Translucency)

    • NT thickness (mm)
    • NB (nasal bone)

    Subchorionic Hematoma

    • Size / volume
    • % circumferential
    2. Fetal Biometry (BPD, HC, FL, AC)

    BPD (Biparietal Diameter)

    • BPD (mm)
    • OFD (occipito-frontal dia.)
    • HC (head circumference)

    FL (Femur Length)

    • FL (mm)
    • Other long bones (HL, humerus)

    AC (Abdominal Circumference)

    • AC (mm)
    • Abdominal dia. (AP & trans.)
    • UV diameter

    EFW (Estimated Fetal Weight)

    • EFW (Hadlock / Shepard)
    • Percentile
    • AC/FL ratio

    Fetal Weight / Growth

    • EFW percentile
    • Growth curve plot
    • Interval growth
    3. Fetal Organs (Detailed / Anomaly Scan)

    Fetal Brain

    • LV width (atrial)
    • Cisterna magna
    • CM (posterior fossa)
    • Cerebellar dia.
    • TCD (trans. cerebellar dia.)

    Fetal Heart

    • Fetal HR (bpm)
    • Cardiac: thorax ratio
    • Aortic / pulmonary dia.

    Fetal Kidneys

    • Renal pelvis dia. (AP)
    • Cortical echogenicity
    • Renal length

    Fetal Abdomen

    • Stomach bubble size
    • Bowel dilatation dia.
    • Bladder volume

    Fetal Thorax

    • Chest circumference
    • Lung lesion volume
    • CVR (Chest Volume Ratio)

    Fetal Skeleton

    • Long bone lengths
    • Foot length
    • Nasal bone length
    4. Amniotic Fluid & Placenta

    Amniotic Fluid

    • AFI (4-quadrant sum)
    • Deepest pocket (cm)
    • Subjective assessment

    Placenta

    • Position (anterior/post.)
    • Grade (0-III)
    • Thickness (mm)
    • Placenta previa distance
    • Cord insertion site

    Umbilical Cord

    • No. of vessels (3 / 2)
    • Cord thickness / coiling index
    • SUAc/PUAc assessment
    5. Uterus & Cervix

    Cervix

    • Cervical length (mm)
    • Funneling
    • Internal os status

    Uterus

    • Wall thickness
    • Fibroid size/location
    • Scar thickness (LSCS)

    Adnexa

    • Corpus luteum size
    • Adnexal mass size
    • Ovary volume
    6. Doppler (Fetal & Maternal)

    Umbilical Artery (UA)

    • PSV, EDV
    • RI, PI
    • S/D ratio
    • End-diastolic flow (present/absent/reversed)

    MCA (Middle Cerebral Artery)

    • PSV (MoM)
    • RI, PI
    • Brain-sparing (MCA PI < UA PI)

    Uterine Arteries (B/L)

    • RI, PI
    • Notching (early diastolic)
    • Mean PI

    Ductus Venosus (DV)

    • Waveform (a-wave)
    • PI
    • Flow direction

    Fetal Heart Rate

    • FHR (bpm)
    • Rhythm (regular/irregular)

    Other Fetal Vessels

    • Aortic / pulmonary flow
    • UV flow (pulse)
    • Renal artery RI
    Transvaginal Sonography (TVS) — Measurable Structures

    3. Transvaginal Sonography (TVS) — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Uterus

    Uterine Body

    • Length (fundus to cervix)
    • AP thickness
    • Transverse width
    • Uterine volume

    Endometrium

    • Endometrial thickness (mm)
    • Pattern (trilaminar / homogeneous)
    • Endometrial stripe symmetry
    • Polyp / submucosal fibroid size

    Myometrium

    • Fibroid dia. (L × W × T)
    • Adenomyosis (JZ thickness)
    • Myometrial cysts
    • Wall asymmetry

    Cervix

    • Cervical length (mm)
    • Cervical canal width
    • Nabothian cyst size
    • Cervical polyp size
    2. Ovaries

    Ovary — Dimensions

    • Length (mm)
    • Width (mm)
    • Thickness (mm)
    • Ovarian volume (mL)

    Follicles

    • Dominant follicle dia. (mm)
    • AFC (antral follicle count)
    • Follicle growth rate/day
    • Mean follicular dia.

    Corpus Luteum

    • Size / dia.
    • Wall thickness
    • Internal echoes

    Ovarian Lesions

    • Cyst dia. & volume
    • Solid component size
    • Septation thickness
    • Papillary projection size

    PCOS Markers

    • Ovarian volume (>10 mL)
    • AFC (≥12 per ovary)
    • Stromal echogenicity
    • Stromal:total area ratio
    3. Fallopian Tubes

    Fallopian Tube

    • Diameter (normal ≤4 mm)
    • Hydrosalpinx dia.
    • Wall thickness
    • Tube length (if visible)

    Tubal Patency (SSG/HSG)

    • Free spill (B/L)
    • Contrast flow time
    • Tubal occlusion site
    4. Adnexa & Pelvic Structures

    Adnexal Masses

    • Dimensions (L × W × T)
    • Volume estimation
    • Solid / cystic / mixed
    • Wall & septa thickness

    Cul-de-sac (Pouch of Douglas)

    • Fluid depth (mm)
    • Collection volume
    • Debris / hematoma size

    Pelvic Floor

    • Levator ani thickness
    • Hiatal area
    • Descent measurement

    IUD Position

    • Fundus-to-IUD distance
    • IUD stem length
    • Migration / perforation
    5. Early Pregnancy (TVS)

    Gestational Sac

    • MSD (mm)
    • Sac shape & position
    • Decidual reaction

    Yolk Sac

    • Diameter (mm)
    • Morphology (regular/irregular)

    Embryo

    • CRL (mm)
    • Fetal heart rate (bpm)
    • Embryonic pole presence

    Subchorionic Hematoma

    • Size (L × W × T)
    • Volume
    • % sac circumference

    Ectopic Pregnancy

    • Adnexal mass size
    • Gestational sac presence
    • Hematosalpinx dia.
    • Pouch of Douglas fluid
    6. Doppler (Transvaginal)

    Uterine Artery (B/L)

    • PSV, EDV
    • RI, PI
    • S/D ratio
    • Early diastolic notching

    Ovarian Artery

    • PSV (dominant ovary)
    • RI, PI
    • Flow (low-resistance in CL)

    Endometrial / Sub-endometrial

    • Vessel count
    • PI, RI
    • Vascularization index (VI)
    • Flow pattern assessment

    Intra-lesional Flow

    • Fibroid vascularity
    • Polyp pedicle artery
    • Ovarian mass flow pattern
    • Low-resistance flow (suspicious)

    Corpus Luteum Flow

    • PSV (cm/s)
    • RI (low: 0.4–0.5)
    • Flow ring assessment

    Follicular / Stromal

    • Perifollicular flow
    • Stromal artery PSV
    • Stromal RI (PCOS)
    Perineal & Groin Ultrasound — Measurable Structures

    4. Perineal & Groin Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Groin / Inguinal Region

    Inguinal Lymph Nodes

    • Short axis dia. (mm)
    • L/S axis ratio
    • Cortical thickness
    • Hilar fat preservation

    Inguinal Hernia

    • Neck width (mm)
    • Sac size (L × W)
    • Content (bowel / omentum)
    • Reducibility

    Femoral Canal

    • Canal width
    • Femoral hernia sac size
    • Fat pad thickness

    Fluid Collections

    • Seroma / hematoma size
    • Abscess dimensions
    • Volume estimation
    • Cyst / hydrocele dia.
    2. Perineal Soft Tissues

    Perineal Body

    • Thickness (AP)
    • Height
    • Echotexture

    Levator Ani

    • Muscle thickness (B/L)
    • Hiatal area
    • Levator hiatus (AP & trans.)
    • Avulsion assessment

    Anal Sphincter

    • IAS thickness (mm)
    • EAS thickness (mm)
    • Sphincter length
    • Defect / tear size

    Perineal Masses

    • Dimensions (L × W × T)
    • Solid / cystic / mixed
    • Depth of invasion
    • Relation to urethra/vagina

    Bartholin Gland

    • Cyst dia. & volume
    • Wall thickness
    • Abscess size
    • Internal echoes
    3. Urethra & Lower Urinary Tract

    Urethra

    • Urethral length
    • Wall thickness
    • Urethral diverticulum size
    • Rhabdosphincter thickness

    Bladder Neck

    • Position (rest / strain)
    • Descent (mm)
    • Funneling width
    • Mobility (Q-tip angle)

    Urethral Vessels

    • Vessel count
    • Flow pattern
    4. Vessels of Groin

    Femoral Artery (CFA)

    • Diameter (mm)
    • PSV, EDV
    • Plaque thickness & length
    • % stenosis

    Femoral Vein (CFV)

    • Diameter (mm)
    • Compressibility
    • Thrombus size / extent
    • Flow (spontaneous / phasic)

    Great Saphenous Vein

    • SFJ diameter
    • GSV trunk dia. (proximal/mid/distal)
    • Reflux time (sec)
    • Tributary dia.

    Saphenofemoral Junction

    • Junction width
    • Reflux duration
    • Terminal valve competence

    Perforators

    • Diameter (mm)
    • Location (thigh/leg)
    • Reflux (outward flow duration)

    Pseudoaneurysm

    • Sac size (L × W)
    • Neck width
    • To-and-fro flow
    • Compression therapy response
    5. Scrotal / Genital (Groin Extension)

    Spermatic Cord

    • Cord thickness
    • Varicocele vein dia.
    • Valsalva reflux duration

    Inguinal Canal

    • Canal width
    • Cord structures dia.
    • Hydrocele of cord size

    Testis (if scanned)

    • Volume (mL)
    • Length × width × thickness
    • Echo consistency
    6. Pelvic Floor Dynamics

    Levator Hiatus (Dynamic)

    • AP dia. at rest
    • AP dia. at Valsalva
    • Transverse dia. at rest
    • Transverse dia. at Valsalva
    • Hiatal area (rest / strain)

    Organ Descent

    • Bladder descent (mm)
    • Uterine descent (mm)
    • Rectal ampulla descent
    • Rectocele depth
    • Cystocele depth

    Anorectal Angle

    • Angle at rest
    • Angle at squeeze
    • Angle at Valsalva

    Puborectalis

    • Muscle thickness (B/L)
    • Symmetry
    • Avulsion
    7. Doppler (Perineal & Groin)

    Femoral Artery Flow

    • PSV, EDV
    • RI, PI
    • Acceleration time
    • Waveform (triphasic / monophasic)

    Femoral Vein Flow

    • Flow pattern (phasic / continuous)
    • Augmentation response
    • Valsalva reflux
    • Compressibility

    Varicocele Flow

    • Vessel diameter
    • Valsalva reflux (sec)
    • Retrograde flow
    • Grade (I–III)

    Lymph Node Flow

    • Hilar flow pattern
    • Peripheral flow (suspicious)
    • RI (if malignant suspected)

    Soft Tissue Lesion Flow

    • Internal vascularity
    • Vessel distribution
    • RI / PSV
    Scrotal Ultrasound — Measurable Structures

    5. Scrotal Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Testes (Bilateral)

    Testicular Dimensions

    • Length (mm)
    • Width (mm)
    • Thickness / AP (mm)
    • Volume (mL) — Lambert's formula

    Testicular Parenchyma

    • Echogenicity (B/L comparison)
    • Echotexture (homogeneous / heterogeneous)
    • Atrophy assessment
    • Microlithiasis count / distribution

    Intratesticular Lesions

    • Mass dimensions (L × W × T)
    • Volume
    • Echogenicity (iso/hypo/hyper/complex)
    • Boundary (well-defined / ill-defined)
    • % of testis replaced

    Tunica Layers

    • Tunica albuginea thickness
    • Tunica vaginalis fluid depth
    • Hydrocele volume estimation
    • Fibrin strands / septations

    Testicular Calcifications

    • Size & number
    • Distribution (focal / diffuse)
    • Associated mass
    2. Epididymis

    Epididymal Head

    • Size (L × W) (mm)
    • Echogenicity
    • Cyst / spermatocele dia.

    Epididymal Body & Tail

    • Thickness (mm)
    • Echogenicity
    • Enlargement / mass size

    Epididymal Lesions

    • Cyst dia. & volume
    • Solid mass dimensions
    • Adenomatoid tumor size
    • Tubular ectasia dia.

    Epididymal Wall

    • Wall thickness
    • Effusion depth
    • Internal echoes / debris
    3. Spermatic Cord & Vessels

    Spermatic Cord

    • Cord diameter (mm)
    • Cord thickness (B/L compare)
    • Mass / lipoma size

    Pampiniform Plexus

    • Vein diameter (mm)
    • No. of dilated veins
    • Valsalva reflux duration (sec)
    • Grade (I–III)

    Testicular Artery

    • PSV (cm/s)
    • EDV
    • RI (normal 0.5–0.7)
    • Flow (low-resistance)

    Cremasteric Artery

    • PSV, EDV
    • RI
    • Flow pattern

    Deferential Artery

    • PSV, EDV
    • RI
    4. Scrotal Sac & Collections

    Hydrocele

    • Fluid depth (mm)
    • Volume estimation
    • Septations / loculations
    • Internal echoes (hematocele/pyocele)

    Scrotal Wall

    • Wall thickness (mm)
    • Edema depth
    • Cellulitis / abscess size

    Spermatocele

    • Diameter (mm)
    • Volume
    • Internal echoes

    Inguinal Extension

    • Canal width
    • Hernia sac size
    • Content (bowel / omentum)

    Pyocele / Hematocele

    • Dimensions
    • Volume
    • Wall thickness
    • Internal debris / septations
    5. Appendages & Miscellaneous

    Appendix Testis

    • Size (mm)
    • Shape (ovoid / pedunculated)
    • Torsion assessment

    Appendix Epididymis

    • Size (mm)
    • Cystic dilation dia.
    • Pedunculated assessment

    Cysts (Intratesticular)

    • Diameter (mm)
    • Volume
    • Wall thickness
    • Septations

    Traumatic Injury

    • Fracture line length
    • Hematocele volume
    • % disruption of tunica albuginea

    Undescended Testis

    • Location (inguinal / abdominal)
    • Testis size & volume
    • Echogenicity
    • Atrophy assessment
    6. Doppler (Scrotal)

    Testicular Artery (Intratesticular)

    • PSV (cm/s)
    • EDV
    • RI (normal 0.5–0.7)
    • Flow presence (torsion rule-out)
    • B/L symmetry

    Capillary Flow (Color/Power)

    • Flow grade (0–3)
    • B/L comparison
    • Patchy / absent flow
    • Hyperemia assessment

    Varicocele Flow

    • Vessel dia. (mm)
    • Valsalva reflux (sec)
    • Retrograde flow duration
    • Grade: I (subclinical), II, III

    Epididymal Flow

    • Hyperemia (epididymitis)
    • RI (elevated in torsion)
    • Flow grade

    Spermatic Cord Flow

    • Cord vessel patency
    • Spiral / twist detection
    • Whirlpool sign
    • Flow distal to torsion site

    Lesion Vascularity

    • Intratumoral flow pattern
    • RI (malignant > 0.7)
    • Chaotic / disorganized vessels
    • Contrast enhancement pattern
    Penile Ultrasound — Measurable Structures

    6. Penile Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Penile Shaft — Corporal Structures

    Corpora Cavernosa (B/L)

    • AP diameter (mm)
    • Transverse dia. (mm)
    • Cross-sectional area (cm²)
    • Echogenicity (B/L comparison)
    • Asymmetry assessment

    Tunica Albuginea

    • Thickness (mm)
    • Integrity (disruption / tear)
    • Plaque size (L × W)
    • Plaque thickness
    • Calcification assessment

    Corpus Spongiosum

    • AP diameter (mm)
    • Transverse dia. (mm)
    • Echogenicity
    • Urethral compression

    Septum

    • Thickness (mm)
    • Integrity
    • Plaque extension

    Buck's Fascia

    • Thickness
    • Fluid collection depth
    • Hematoma size
    2. Urethra

    Penile Urethra

    • Diameter (mm)
    • Wall thickness
    • Stricture length
    • Stricture dia.
    • Diverticulum size

    Bulbar Urethra

    • Diameter
    • Wall thickness
    • Periurethral fibrosis

    Urethral Lesions

    • Stone size
    • Polyp / mass dimensions
    • Cyst / abscess dia.
    • Fistula tract length

    Spongioplasty Assessment

    • Spongiosal thickness
    • Fibrosis depth
    • Vascularization
    3. Glans & Prepuce

    Glans Penis

    • AP thickness (mm)
    • Echogenicity
    • Lesion / mass size
    • Cyst / abscess dia.

    Frenulum

    • Length
    • Thickness
    • Shortness assessment

    Prepuce (Foreskin)

    • Thickness (mm)
    • Retractability
    • Phimosis grade
    • Fibrotic band width

    Preputial Lesions

    • Cyst dia.
    • Mass dimensions
    • Calcification size
    4. Peyronie's Disease Assessment

    Plaque

    • No. of plaques
    • Size (L × W × T)
    • Location (dorsal / ventral / lateral)
    • Echogenicity (hypo / hyper / calcified)
    • % calcification

    Penile Curvature

    • Angle (degrees)
    • Direction (dorsal / lateral / ventral)
    • Hinge effect
    • Waist / narrowing deformity

    Erection Quality

    • Erection hardness score (EHS)
    • Corporeal distension
    • Septal straightening
    • Dynamic response

    Hour-glass Deformity

    • Narrowing dia. (mm)
    • Proximal & distal dia.
    • Indentation depth
    5. Penile Masses & Trauma

    Penile Masses

    • Dimensions (L × W × T)
    • Location (glans / shaft / root)
    • Solid / cystic / mixed
    • Layer of origin
    • Depth of invasion

    Cysts

    • Diameter (mm)
    • Volume
    • Wall thickness
    • Internal echoes

    Penile Fracture

    • Tunica albuginea tear (mm)
    • Hematoma size (L × W)
    • Site of injury
    • Corporeal disruption
    • Urethral injury assessment

    Foreign Body

    • Size & shape
    • Location / depth
    • Surrounding collection

    Penile Abscess

    • Dimensions
    • Volume
    • Wall thickness
    • Extent of spread
    6. Arterial Doppler

    Dorsal Penile Artery (B/L)

    • PSV (cm/s)
    • EDV
    • RI
    • Flow (continuous / intermittent)
    • Post-ICI PSV (>25 cm/s normal)

    Cavernosal Artery (B/L)

    • Diameter (mm)
    • PSV (cm/s)
    • EDV
    • RI (normal < 0.75 post-ICI)
    • Acceleration time (ms)

    Bulbar / Urethral Artery

    • PSV, EDV
    • RI
    • Flow pattern

    Helicine Arteries

    • Vessel count
    • Branching pattern
    • Flow visibility (flaccid / erect)

    Dynamic (Post-ICI) Assessment

    • Peak PSV (both arteries)
    • End-diastolic flow (EDV)
    • RI / PI
    • Veno-occlusive function
    • Erection response grade
    7. Venous Doppler & Erectile Dysfunction

    Dorsal Penile Vein

    • Diameter (mm)
    • Flow velocity
    • Persisting flow (post-ICI)
    • RI (venous leak: EDV > 5 cm/s)

    Cavernosal Veins

    • Vessel dia.
    • Flow presence (post-ICI)
    • Veno-occlusive dysfunction

    Crural / Deep Veins

    • Diameter
    • Flow pattern
    • Reflux assessment

    ED Diagnostic Indices

    • PSV < 25 cm/s — arterial insufficiency
    • EDV > 5 cm/s — venous leak
    • RI < 0.75 — venogenic ED
    • Acceleration time > 110 ms — arterial

    Plaque Vascularity

    • Internal flow
    • Peripheral flow
    • RI (active inflammation)
    8. Penile Length & Morphology

    Penile Dimensions

    • Flaccid length (cm)
    • Stretched length (cm)
    • Erectile length (post-ICI)
    • Shaft circumference (cm)
    • Glans diameter (mm)

    Morphology

    • Curvature angle (degrees)
    • Torsion (degrees)
    • Shape (straight / bent / hourglass)
    • Shortening assessment

    Post-Surgical Assessment

    • Implant position
    • Cylinder dimensions
    • Fluid leak / collection
    • Erection / detumescence
    Breast Ultrasound — Measurable Structures

    7. Breast Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Breast Parenchyma

    Glandular Tissue

    • Total breast thickness (mm)
    • Glandular layer thickness
    • Echogenicity (homogeneous / heterogeneous)
    • Pattern (fatty / fibroglandular / dense)

    Cooper's Ligaments

    • Thickness (mm)
    • Disruption / retraction
    • Asymmetry (B/L)

    Fibroglandular Band

    • AP thickness (mm)
    • Distribution (focal / diffuse)
    • Asymmetry vs. contralateral

    Subcutaneous Fat

    • Thickness (mm)
    • Echogenicity
    • Edema / infiltration depth

    Retromammary Fat

    • Thickness
    • Fluid collection depth
    • Mass involvement
    2. Ductal System

    Lactiferous Ducts

    • Diameter (mm) — normal ≤2 mm
    • Duct ectasia dia. (>3 mm)
    • Wall thickness
    • Intraluminal echoes (debris / plug)
    • No. of dilated ducts

    Terminal Ducts

    • Dia. (mm)
    • Wall irregularity
    • Intraductal mass size

    Intraductal Lesions

    • Papilloma size (mm)
    • Location (central / peripheral)
    • Duct extension length
    • Solid component size

    Nipple-Areolar Complex

    • Nipple thickness
    • Areolar width
    • Retroareolar duct dia.
    • Skin thickness over nipple
    3. Solid Lesions (BIRADS Assessment)

    Fibroadenoma

    • Dimensions (L × W × T)
    • Volume (mL)
    • Echogenicity (iso / hypo)
    • Shape (oval / round)
    • Orientation (parallel / not parallel)

    Malignant Mass

    • Dimensions (L × W × T)
    • Volume
    • Shape (irregular / spiculated)
    • Orientation (not parallel)
    • Boundary (abrupt / echogenic halo)

    BI-RADS Descriptors

    • Shape, margin, orientation
    • Echo pattern
    • Posterior features (enhance / shadow)
    • Calcifications (size / distribution)
    • BI-RADS category (0–6)

    Lymph Nodes (Axillary)

    • Cortical thickness (mm)
    • Short axis dia.
    • L/S ratio
    • Hilar fat preservation
    • Fatty hilum thickness

    Phyllodes Tumor

    • Dimensions (L × W × T)
    • Volume
    • Rapid growth rate
    • Internal cystic spaces
    4. Cystic Lesions & Collections

    Simple Cyst

    • Dimensions (L × W × T)
    • Volume (mL)
    • Wall thickness (thin / thickened)
    • Internal echoes (anechoic)
    • Posterior enhancement

    Complicated Cyst

    • Dimensions
    • Debris thickness
    • Fluid-debris level depth
    • Wall irregularity

    Complex Cyst (Mural)

    • Mural nodule size (mm)
    • Septation thickness
    • No. of septations
    • Solid component %
    • Wall thickness

    Abscess / Inflammation

    • Dimensions & volume
    • Wall thickness
    • Internal debris depth
    • Skin thickness (edema)
    • Surrounding hyperemia depth

    Hematoma / Seroma

    • Dimensions (L × W × T)
    • Volume (mL)
    • Internal echoes
    • Septations
    • Resolution rate
    5. Skin & Subcutaneous Tissue

    Skin Thickness

    • Skin layer (mm) — normal ≤2 mm
    • Focal thickening size
    • Edema assessment
    • Peau d'orange depth

    Subcutaneous Lesions

    • Lipoma dimensions (L × W × T)
    • Sebaceous cyst dia.
    • Mass depth from skin
    • Wall thickness (cyst)

    Skin Lesions

    • Lesion dimensions
    • Depth of invasion
    • Extension to parenchyma

    Post-Surgical Scar

    • Scar thickness (mm)
    • Length
    • Architectural distortion
    • Fluid collection size
    6. Implant Assessment

    Implant Dimensions

    • Base dia. (mm)
    • Projection / height (mm)
    • Volume (cc)
    • Profile (low / mod / high)

    Implant Shell

    • Shell thickness
    • Folds / wrinkles size
    • Rupture site
    • Stepladder sign

    Peri-implant Fluid

    • Collection depth (mm)
    • Volume estimation
    • Seroma vs. abscess
    • B/L comparison

    Capsule

    • Capsule thickness
    • Contracture grade (Baker I–IV)
    • Calcification
    7. Doppler (Breast & Axilla)

    Lesion Vascularity

    • Internal flow (present / absent)
    • Vessel count & distribution
    • Peripheral vs. central flow
    • RI (malignant > 0.7)
    • PSV (cm/s)

    Lymph Node Doppler

    • Hilar flow (present / absent)
    • Peripheral flow (suspicious)
    • Vessel displacement
    • RI (malignant pattern)

    Arterial Flow (Breast)

    • Internal mammary artery PSV
    • Lateral thoracic artery PSV
    • RI

    Abscess / Inflammation

    • Hyperemia grade (0–3)
    • Vessel density
    • Surrounding tissue flow
    • RI (low in inflammation)

    Cyst Wall Flow

    • Wall vascularity (present / absent)
    • Mural nodule flow
    • RI

    Implant Capsule Flow

    • Peri-implant hyperemia
    • Contracture-related flow
    • Abscess flow within capsule
    8. Supplementary Measurements

    Lesion Distance

    • Distance from nipple (mm)
    • Distance from skin (mm)
    • Distance from chest wall (mm)
    • Clock position (o'clock)

    Chest Wall

    • Pectoralis muscle thickness
    • Mass invasion depth
    • Ribs / intercostal spaces

    Elastography (if available)

    • Strain ratio
    • TSI (tissue stiffness index)
    • SWV (m/s) — shear wave velocity
    • kPa value
    • Elasticity score (1–5)

    Interval Growth

    • Size change (mm / %)
    • Volume doubling time
    • Growth rate comparison
    Dorsal Wall Ultrasound — Measurable Structures

    8. Dorsal Wall Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Skin & Subcutaneous Tissue

    Skin

    • Thickness (mm) — normal ≤2 mm
    • Focal thickening size
    • Edema depth
    • Induration assessment

    Subcutaneous Fat

    • Thickness (mm)
    • Echogenicity
    • Mass / nodule size
    • Fluid collection depth

    Lipoma

    • Dimensions (L × W × T)
    • Volume
    • Depth from skin
    • Multiple / solitary

    Sebaceous / Epidermal Cyst

    • Diameter (mm)
    • Wall thickness
    • Internal echoes / debris
    • Rupture assessment
    2. Musculature (Paraspinal)

    Erector Spinae

    • Thickness (mm) — B/L
    • Cross-sectional area (cm²)
    • Echogenicity
    • Asymmetry (B/L comparison)
    • Fatty infiltration %

    Multifidus

    • Thickness (mm)
    • Cross-sectional area
    • Atrophy assessment
    • Echogenicity

    Latissimus Dorsi

    • Thickness (mm)
    • Echogenicity
    • Tear / defect size
    • Mass / hematoma

    Trapezius

    • Thickness (mm)
    • Echogenicity
    • Asymmetry

    Rhomboids

    • Thickness
    • Echogenicity
    • Atrophy assessment
    3. Thoracolumbar Fascia

    Thoracolumbar Fascia

    • Thickness (mm) — B/L
    • Echogenicity
    • Asymmetry
    • Discontinuity / defect size

    Fascial Layers

    • Anterior layer thickness
    • Middle layer thickness
    • Posterior layer thickness
    • Fascial cleft fluid

    Fascial Lesions

    • Lipoma size
    • Fibroma / nodule dia.
    • Calcification size
    4. Bony & Osseous Structures

    Spinous Process

    • Interspinous distance (mm)
    • Step-off / spondylolisthesis
    • Bony irregularity
    • Fracture gap (mm)

    Lamina & Facet Joints

    • Facet joint effusion depth
    • Capsule thickness
    • Osteophyte size
    • Joint space width

    Vertebral Body

    • Cortical break / step
    • Wedge compression depth
    • Loss of height (mm)
    • % height loss

    Sacrum & SI Joint

    • SI joint space width
    • Erosion depth
    • Sacral hiatus depth
    • Effusion assessment

    Ribs & Intercostal Space

    • Cortical step / fracture
    • Callus size
    • Intercostal space width
    • Intercostal mass size
    5. Interspinous & Ligamentous Structures

    Interspinous Ligament

    • Thickness (mm)
    • Echogenicity
    • Tear / defect size
    • Fluid in interspinous cleft

    Supraspinous Ligament

    • Thickness
    • Discontinuity
    • Calcification size

    Ligamentum Flavum

    • Thickness (mm)
    • Hypertrophy assessment
    • Dural sac distance

    Interspinous Bursa

    • Bursa depth / effusion (mm)
    • Wall thickness
    • Bursitis assessment
    6. Spinal Canal & Nerve Structures

    Epidural Space

    • Anterior epidural space (mm)
    • Posterior epidural space
    • Epidural fat thickness
    • Hematoma / collection depth

    Dural Sac

    • Sagittal dia. (mm)
    • Transverse dia.
    • Spinal canal stenosis grade
    • CSF space assessment

    Nerve Roots

    • Diameter (mm)
    • Swelling / enlargement
    • Root exit zone assessment
    • Compression site

    Intervertebral Disc

    • Disc height (mm)
    • Bulge / protrusion dia.
    • Extrusion size (L × W)
    • Disc-nerve contact distance
    • Annular tear width

    Conus Medullaris

    • Position (vertebral level)
    • Sagittal dia.
    • Lesion / cyst size
    7. Collections & Masses

    Fluid Collections

    • Seroma / hematoma dimensions
    • Volume estimation
    • Depth & extent
    • Wall thickness

    Abscess

    • Dimensions (L × W × T)
    • Volume
    • Wall thickness
    • Track / sinus length
    • Depth from skin

    Soft Tissue Mass

    • Dimensions (L × W × T)
    • Volume
    • Layer of origin
    • Depth of invasion
    • Bony contact assessment

    Post-Surgical

    • Scar thickness
    • Seroma / collection dia.
    • Laminectomy defect size
    • Meningocele / pseudomeningocele
    8. Doppler (Dorsal Wall)

    Paraspinal Muscle Flow

    • Vessel count
    • Flow pattern
    • Hyperemia (inflammation)
    • Atrophy-related flow

    Mass / Lesion Vascularity

    • Internal flow (present / absent)
    • Vessel distribution (central / peripheral)
    • RI (malignant > 0.7)
    • PSV (cm/s)

    Abscess / Infection

    • Hyperemia grade (0–3)
    • Peripheral hyperemia
    • Internal flow (absent in pus)

    Nerve Root Flow

    • Perineural flow
    • Hyperemia (compression)
    • RI elevation

    Facet Joint / Bursa

    • Synovial flow
    • Inflammatory hyperemia
    • RI assessment

    Post-Surgical Flow

    • Scar vascularity
    • Recurrence flow pattern
    • Hematoma organization flow
    Neck Ultrasound — Measurable Structures

    9. Neck Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Thyroid Gland

    Thyroid Lobes (B/L)

    • Length (mm)
    • AP thickness (mm)
    • Transverse width (mm)
    • Lobar volume (mL)
    • Total gland volume (mL)

    Isthmus

    • AP thickness (mm) — normal ≤3 mm
    • Transverse width
    • Echogenicity

    Thyroid Parenchyma

    • Echogenicity (normal / hypo / heterogeneous)
    • Echotexture (homogeneous / coarse)
    • Colloid cyst count
    • Calcification distribution

    Thyroid Nodule

    • Dimensions (L × W × T)
    • Volume (mL)
    • TIRADS assessment
    • Composition (solid / cystic / spongiform)
    • Echogenicity & shape (taller-than-wide)
    • Margin (smooth / irregular / lobulated)
    • Calcifications (micro / macro / rim)

    Diffuse Disease

    • Gland volume
    • Lobular enlargement
    • Vascularity (Hashimoto / Graves)
    • Echogenicity grade
    • PI/RI (graves: high flow)
    2. Parathyroid Glands

    Parathyroid Adenoma

    • Dimensions (L × W × T)
    • Volume (mL)
    • Location (superior / inferior)
    • Shape (oval / teardrop)
    • Echogenicity (hypoechoic)
    • Number of glands seen

    Parathyroid Hyperplasia

    • Gland size (all four)
    • Volume (B/L comparison)
    • Echogenicity

    Parathyroid Carcinoma

    • Dimensions (L × W × T)
    • Irregular margins
    • Depth of invasion
    • Lymph node involvement

    Post-Parathyroidectomy

    • Residual gland size
    • Recurrence / reimplant size
    • Fluorescence / PTH assessment
    3. Cervical Lymph Nodes

    Lymph Node Size

    • Short axis dia. (mm)
    • Long axis dia.
    • L/S ratio (<2 suspicious)
    • Cortical thickness
    • Hilar fat thickness
    • Volume estimation

    Morphology

    • Shape (oval / round)
    • Hilum (present / absent / replaced)
    • Cortical echogenicity
    • Eccentric cortical widening
    • Necrosis (cystic / coagulative)

    Levels I–VI Mapping

    • Level (I–VI location)
    • Side (left / right / bilateral)
    • No. of abnormal nodes
    • Largest node dia.
    • Cluster / matting assessment

    Tuberculous / Necrotic Nodes

    • Necrotic area dia.
    • Matting extent
    • Surrounding soft tissue edema
    • Abscess / cold abscess size

    Post-Treatment Nodes

    • Size change (mm / %)
    • Cystic degeneration
    • Calcification assessment
    • Fatty replacement
    4. Salivary Glands

    Parotid Gland

    • Dimensions (L × W × T)
    • Volume (mL)
    • Echogenicity
    • Superficial / deep lobe size
    • Mass / tumor dimensions
    • Stone size & duct dia.

    Submandibular Gland

    • Dimensions (L × W × T)
    • Volume (mL)
    • Echogenicity
    • Duct diameter (Wharton's)
    • Stone size & location

    Sublingual Glands

    • Size (mm)
    • Echogenicity
    • Ranula / cyst size

    Minor Salivary Glands

    • Size (mm)
    • Echogenicity (labial)
    • Nodule / mass dimensions
    5. Neck Vessels (Gray Scale)

    Common Carotid Artery (CCA)

    • Diameter (mm)
    • IMT (intima-media thickness)
    • Plaque size (L × W × height)
    • % stenosis
    • Wall irregularity

    Internal Carotid Artery (ICA)

    • Diameter (mm)
    • IMT
    • Plaque size & morphology
    • % stenosis (NASCET)
    • Distal lumen patency

    External Carotid Artery (ECA)

    • Diameter (mm)
    • Plaque assessment
    • Branch patency

    Carotid Bulb

    • Diameter (mm)
    • Plaque volume
    • % stenosis
    • Ulceration depth

    Vertebral Artery

    • Diameter (mm)
    • Course (normal / tortuous)
    • Patency (V0–V4 segments)
    • Subclavian steal assessment

    Jugular Veins (IJV)

    • Diameter (mm)
    • Compressibility
    • Thrombus size / extent
    • Collateral vessel dia.
    6. Larynx & Pharynx

    Vocal Cords

    • Length (mm)
    • Thickness
    • Mobility (B/L assessment)
    • Mass / nodule size
    • Asymmetry assessment

    Thyroid Cartilage

    • Thickness
    • Calcification
    • Fracture / defect size

    Cricoarytenoid Joint

    • Joint space
    • Asymmetry
    • Effusion depth

    Laryngeal Mass

    • Dimensions (L × W × T)
    • Depth of invasion
    • Cord fixation
    • Cartilage invasion

    Pyroid Sinuses

    • Depth
    • Mass / fluid assessment
    • Asymmetry
    7. Neck Masses & Collections

    Thyroglossal Duct Cyst

    • Diameter (mm)
    • Volume
    • Location (suprahyoid / infrahyoid)
    • Wall thickness
    • Internal echoes

    Branchial Cleft Cyst

    • Dimensions (L × W × T)
    • Volume
    • Level (I–V)
    • Wall thickness
    • Septations / internal echoes

    Cystic Hygroma / Lymphangioma

    • Dimensions
    • Volume
    • Multi-locular extent
    • Septation thickness
    • Deep extension

    Abscess / Neck Collection

    • Dimensions (L × W × T)
    • Volume
    • Wall thickness
    • Track / sinus length
    • Deep space extension

    Dermoid / Epidermoid Cyst

    • Diameter
    • Wall thickness
    • Internal echoes
    • Depth from skin

    Solid Neck Mass

    • Dimensions (L × W × T)
    • Layer of origin
    • Depth of invasion
    • Relation to vessels
    • Bony / cartilage involvement
    8. Doppler (Neck)

    Carotid Doppler (CCA / ICA / ECA)

    • PSV (cm/s)
    • EDV
    • RI, PI
    • S/D ratio
    • % stenosis (PSV criteria)
    • Plaque morphology (uniform / heterogeneous)

    Vertebral Artery Doppler

    • PSV, EDV
    • Flow direction (antegrade / retrograde)
    • RI, PI
    • Subclavian steal (pre-steal / latent / manifest)
    • B/L comparison

    Thyroid Doppler

    • PSV (cm/s) — normal / Graves
    • RI, PI
    • Vascular pattern (normal / hypervascular)
    • Intranodular flow (suspicious)
    • Perinodular flow

    Parathyroid Doppler

    • Intratumoral flow (present / absent)
    • Polar vessel sign
    • PSV, RI
    • Differential from thyroid nodule

    Lymph Node Doppler

    • Hilar flow (present / absent)
    • Peripheral / mixed flow (suspicious)
    • RI (malignant > 0.8)
    • PSV
    • Vessel displacement / encasement

    Jugular Vein Doppler

    • Flow pattern (spontaneous / phasic)
    • Valsalva augmentation
    • Thrombus (partial / complete)
    • Collateral flow assessment

    Salivary Gland Doppler

    • Mass vascularity pattern
    • RI (malignant parotid masses)
    • Facial artery flow
    • Intraglandular vessel displacement

    Soft Tissue / Abscess

    • Hyperemia grade (0–3)
    • Peripheral hyperemia
    • Internal flow (absent in pus)
    • RI assessment
    Upper Limb Ultrasound — Measurable Structures

    10. Upper Limb Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Shoulder Joint

    Rotator Cuff — Supraspinatus

    • Tendon thickness (mm)
    • Tear width & retraction (mm)
    • Partial vs. full-thickness
    • Muscle belly atrophy (Goutallier grade)

    Rotator Cuff — Infraspinatus / Teres Minor

    • Tendon thickness
    • Tear size
    • Muscle atrophy assessment

    Rotator Cuff — Subscapularis

    • Tendon thickness
    • Tear size
    • LHBT subluxation

    Long Head of Biceps (LHBT)

    • Tendon diameter (mm)
    • Tendon sheath effusion depth
    • Subluxation / dislocation
    • Tear / split size

    Acromioclavicular (AC) Joint

    • Joint space width (mm)
    • Step-off deformity
    • Capsule thickness
    • Effusion depth

    Glenohumeral Joint

    • Effusion depth (posterior recess)
    • Synovial thickness
    • Labral tear / cyst size
    • Cartilage thickness

    Subacromial-Subdeltoid Bursa

    • Bursal thickness (mm)
    • Effusion depth
    • Bursal reaction
    2. Elbow Joint

    Common Extensor Tendon

    • Thickness (mm)
    • Tear size
    • Calcification size
    • Echogenicity

    Common Flexor Tendon

    • Thickness (mm)
    • Tear size
    • Epicondyle irregularity

    Ulnar Collateral Ligament (UCL)

    • Thickness (mm)
    • Laxity / tear
    • Effusion

    Olecranon Bursa

    • Bursal wall thickness
    • Effusion depth
    • Internal debris / tophi

    Elbow Joint Recess

    • Anterior / posterior effusion
    • Synovial hypertrophy
    • Loose body size
    • Cartilage assessment

    Ulnar Nerve

    • Cross-sectional area (mm²)
    • Thickness at cubital tunnel
    • Subluxation assessment
    • B/L comparison
    3. Wrist & Hand

    Median Nerve

    • Cross-sectional area (mm²) at carpal tunnel
    • Thickness (AP × transverse)
    • Notch sign / flattening ratio
    • B/L comparison

    Flexor Tendons

    • Tendon diameter (mm)
    • Tear size / %
    • Tenosynovitis effusion
    • Retraction

    Extensor Tendons

    • Tendon thickness
    • Tear / split size
    • Sheath effusion

    Joint Synovitis (Wrist / MCP / PIP)

    • Synovial thickness (mm)
    • Effusion depth
    • Erosion size
    • Cartilage thickness

    TFCC (Triangular Fibrocartilage)

    • Thickness (mm)
    • Tear size
    • DRUJ effusion

    Scapholunate Ligament

    • Gap width (mm)
    • Dorsal ligament thickness
    • Dynamic instability

    Ganglion Cyst

    • Dimensions (L × W)
    • Neck width
    • Depth from skin
    • Relation to joint / tendon

    A2 / A4 Pulleys

    • Thickness (mm)
    • Rupture / tear
    • Bowstringing distance
    4. Muscles

    Muscle Tear

    • Defect size (L × W × D)
    • % muscle involvement
    • Hematoma size
    • Retraction distance
    • Grade (I–III)

    Myositis / Calcification

    • Calcific deposit size
    • Echogenicity
    • Edema depth
    • Fluid collection

    Intramuscular Cyst / Hematoma

    • Dimensions
    • Volume
    • Wall thickness
    • Internal echoes

    Compartment Syndrome

    • Muscle thickness / swelling
    • Echogenicity change
    • Fascial bulging
    • B/L comparison
    5. Nerves (Upper Limb)

    Median Nerve

    • CSA (mm²) at wrist / forearm
    • Wrist-to-forearm ratio
    • Flattening ratio
    • B/L comparison

    Ulnar Nerve

    • CSA (mm²) at cubital tunnel
    • CSA at Guyon's canal
    • Subluxation
    • B/L comparison

    Radial Nerve

    • CSA (mm²)
    • Thickness at spiral groove
    • B/L comparison

    Brachial Plexus

    • Trunk CSA (mm²)
    • Root diameter
    • Avulsion / neuroma size
    • B/L comparison

    Nerve Sheath Tumor

    • Dimensions (L × W × T)
    • Volume
    • Echogenicity
    • Continuity with nerve
    • Vascularity pattern
    6. Vessels (Arterial & Venous)

    Subclavian / Axillary Artery

    • Diameter (mm)
    • PSV, EDV
    • Plaque size
    • % stenosis
    • Waveform (triphasic / monophasic)

    Brachial / Radial / Ulnar Artery

    • Diameter (mm)
    • PSV, EDV
    • RI, PI
    • Plaque / thrombus
    • % stenosis

    Deep & Superficial Veins

    • Diameter (mm)
    • Compressibility
    • Thrombus size / extent
    • Flow (spontaneous / phasic)
    • Valsalva reflux duration

    AV Fistula (Dialysis)

    • Afferent artery dia. & flow
    • Efferent vein dia. & flow
    • Anastomosis size
    • Volume flow (mL/min)
    • Stenosis / thrombosis

    Pseudoaneurysm

    • Sac size (L × W)
    • Neck width
    • To-and-fro flow
    • Thrombus within sac

    Raynaud / Digital Arteries

    • Digital artery dia.
    • PSV at rest / cold provocation
    • Flow pattern
    • B/L comparison
    7. Soft Tissue & Bones

    Soft Tissue Mass

    • Dimensions (L × W × T)
    • Volume
    • Layer of origin
    • Echogenicity
    • Depth from skin
    • Relation to neurovascular bundle

    Lipoma

    • Dimensions (L × W × T)
    • Volume
    • Depth from skin
    • Multiple / solitary

    Foreign Body

    • Size & shape
    • Depth from skin
    • Surrounding collection / granuloma
    • Relation to tendon / vessel

    Bone Surface

    • Cortical step / fracture
    • Callus size
    • Erosion depth
    • Periosteal reaction thickness

    Abscess / Collection

    • Dimensions (L × W × T)
    • Volume
    • Wall thickness
    • Track / sinus length
    • Depth from skin

    Lymph Nodes (Epitrochlear / Axillary)

    • Short axis dia.
    • Cortical thickness
    • L/S ratio
    • Hilum preservation
    8. Doppler (Upper Limb)

    Arterial Flow

    • PSV, EDV (each segment)
    • RI, PI
    • Acceleration time
    • Waveform (triphasic / biphasic / monophasic)
    • B/L comparison

    Venous Flow

    • Compressibility (present / absent)
    • Flow pattern (spontaneous / phasic)
    • Augmentation response
    • Valsalva reflux duration
    • Thrombus (acute / chronic)

    Joint / Tendon Hyperemia

    • Synovial vascularity grade (0–3)
    • Tendon sheath flow
    • Enthesitis flow
    • Fracture site hyperemia

    Nerve Hyperemia

    • Intraneural flow (present / absent)
    • Perineural hyperemia
    • CSA vs. flow correlation

    Mass Vascularity

    • Internal flow (present / absent)
    • Vessel distribution
    • RI (malignant > 0.7)
    • PSV

    AV Fistula Assessment

    • Brachial artery flow volume (mL/min)
    • RI (low in AVF)
    • Stenosis PSV ratio
    • Recirculation flow
    • Cardiac output impact
    Lower Limb Ultrasound — Measurable Structures

    11. Lower Limb Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Hip Joint

    Hip Joint

    • Effusion depth (anterior recess, mm)
    • Synovial thickness
    • Joint space width
    • Cartilage thickness
    • Labral tear / cyst size

    Developmental Dysplasia (DDH)

    • Alpha angle (°)
    • Beta angle (°)
    • Femoral head coverage (%)
    • Graf type (I–IV)
    • Femoral head position (located / dislocated)

    Iliopsoas Bursa

    • Bursal distension depth (mm)
    • Wall thickness
    • Communication with hip joint

    Gluteal / Trochanteric Bursa

    • Bursal thickness (mm)
    • Effusion depth
    • Tendinopathy assessment

    Gluteal Tendons (Med/Min)

    • Tendon thickness (mm)
    • Tear size
    • Calcification
    • Atrophy
    2. Knee Joint

    Quadriceps Tendon

    • Thickness (mm)
    • Tear size / gap
    • Calcification
    • Echogenicity

    Patellar Tendon

    • Thickness (mm)
    • Tear size
    • Calcification / enthesopathy
    • Hoffa's fat pad herniation

    Medial Collateral Ligament (MCL)

    • Thickness (mm)
    • Tear grade (I–III)
    • Effusion depth

    Lateral Collateral Ligament (LCL)

    • Thickness
    • Tear / laxity

    Menisci (Medial / Lateral)

    • Extrusion (mm)
    • Tear / cleft width
    • Cyst size (parameniscal)

    Joint Recess (Suprapatellar)

    • Effusion depth (mm)
    • Synovial hypertrophy
    • Loose body size
    • Cartilage thickness

    Baker's Cyst (Popliteal)

    • Dimensions (L × W × T)
    • Volume
    • Neck width
    • Rupture assessment
    • Internal debris / clot

    Iliotibial Band

    • Thickness (mm)
    • Bursal effusion depth
    • Lateral femoral condyle gap
    3. Ankle & Foot

    Achilles Tendon

    • Thickness (AP, mm) — normal ≤6 mm
    • Tear size / gap (mm)
    • Retraction distance
    • Calcification / enthesophyte
    • Retrocalcaneal bursa depth

    Posterior Tibial Tendon

    • Thickness (mm)
    • Tear size / split
    • Tenosynovitis effusion
    • Subluxation

    Peroneal Tendons (L/B)

    • Thickness
    • Tear / split
    • Tenosynovitis
    • SPR tear / subluxation

    Anterior Tibial / Extensor Tendons

    • Thickness
    • Tear / tenosynovitis
    • Effusion depth

    Deltoid Ligament (Medial)

    • Thickness
    • Tear
    • Effusion

    ATFL / CFL / PTFL (Lateral Ligaments)

    • Thickness
    • Tear / laxity
    • Anterior drawer assessment

    Plantar Fascia

    • Thickness (mm) — normal ≤4 mm
    • Echogenicity
    • Calcification
    • Fascial cleft fluid

    MTP Joints / Morton's Neuroma

    • Synovial thickness
    • Effusion / erosion
    • Neuroma size (mm)
    • Intermetatarsal bursa depth
    4. Muscles

    Muscle Tear (Calf / Thigh)

    • Defect size (L × W × D)
    • % muscle involvement
    • Hematoma size
    • Retraction distance
    • Grade (I–III)

    Tennis Leg (Medial Gastrocnemius)

    • Tear gap (mm)
    • Hematoma depth
    • Soleus involvement

    Myositis / Calcification

    • Calcific deposit size
    • Echogenicity
    • Edema / fluid collection

    Compartment Syndrome

    • Muscle thickness / swelling
    • Echogenicity change
    • Fascial bulging
    • B/L comparison
    5. Nerves (Lower Limb)

    Common Peroneal Nerve

    • CSA (mm²) at fibular neck
    • Thickness
    • Subluxation
    • B/L comparison

    Tibial Nerve

    • CSA (mm²) at ankle / tarsal tunnel
    • Thickness
    • B/L comparison

    Sural Nerve

    • CSA (mm²)
    • Thickness
    • B/L comparison

    Saphenous Nerve

    • CSA (mm²)
    • Thickness
    • B/L comparison

    Morton's Neuroma

    • Size (mm)
    • Location (2nd / 3rd webspace)
    • B/L comparison

    Tarsal Tunnel Syndrome

    • Tibial nerve CSA (mm²)
    • Medial / lateral plantar branch CSA
    • Flexor retinaculum thickness
    6. Vessels (Arterial & Venous)

    Femoral / Popliteal Artery

    • Diameter (mm)
    • PSV, EDV
    • Plaque size
    • % stenosis
    • ABI correlation

    Anterior / Posterior Tibial / Peroneal

    • Diameter (mm)
    • PSV, EDV
    • RI
    • Waveform (triphasic / monophasic)
    • % stenosis

    Deep Veins (Femoral / Popliteal / Calf)

    • Diameter (mm)
    • Compressibility
    • Thrombus size / extent
    • Flow (spontaneous / phasic)
    • Acute vs. chronic

    Superficial Veins (GSV / SSV)

    • SFJ / SPJ diameter
    • Trunk dia. (proximal / mid / distal)
    • Reflux duration (sec)
    • Tributary dia.
    • Varix size

    Perforators

    • Diameter (mm)
    • Location (thigh / leg)
    • Outward reflux duration (sec)

    Pseudoaneurysm

    • Sac size (L × W)
    • Neck width
    • To-and-fro flow
    • Thrombus within sac

    AV Malformation / Fistula

    • Nidus size
    • Afferent / efferent vessel dia.
    • Volume flow (mL/min)
    • Low-resistance flow

    Bypass Graft Assessment

    • Graft diameter
    • Flow velocity
    • Stenosis PSV ratio
    • Aneurysm at anastomosis
    7. Soft Tissue & Bones

    Soft Tissue Mass

    • Dimensions (L × W × T)
    • Volume
    • Layer of origin
    • Echogenicity
    • Depth from skin
    • Relation to neurovascular bundle

    Lipoma

    • Dimensions (L × W × T)
    • Volume
    • Depth from skin
    • Multiple / solitary

    Foreign Body

    • Size & shape
    • Depth from skin
    • Surrounding granuloma / collection
    • Relation to tendon / vessel

    Bone Surface

    • Cortical step / fracture
    • Callus size
    • Erosion depth
    • Periosteal reaction thickness
    • Stress fracture cortex thickening

    Abscess / Collection

    • Dimensions (L × W × T)
    • Volume
    • Wall thickness
    • Track / sinus length
    • Depth from skin

    Inguinal / Popliteal Lymph Nodes

    • Short axis dia.
    • Cortical thickness
    • L/S ratio
    • Hilum preservation

    Gout / Tophi

    • Tophus size (mm)
    • Erosion depth
    • Double contour sign
    • Joint effusion

    Rheumatoid / Synovitis

    • Synovial thickness (mm)
    • Effusion depth
    • Erosion size
    • Cartilage thickness
    • Joint space narrowing
    8. Doppler (Lower Limb)

    Arterial Flow (Segmental)

    • PSV, EDV (each segment)
    • RI, PI
    • Acceleration time
    • Waveform (triphasic / biphasic / monophasic)
    • B/L comparison
    • ABI (ankle-brachial index)

    Venous Flow

    • Compressibility (present / absent)
    • Flow pattern (spontaneous / phasic)
    • Augmentation response
    • Valsalva reflux duration
    • Thrombus (acute / chronic)

    Joint / Tendon Hyperemia

    • Synovial vascularity grade (0–3)
    • Tendon sheath flow
    • Enthesitis flow
    • Fracture site hyperemia

    Nerve Hyperemia

    • Intraneural flow (present / absent)
    • Perineural hyperemia
    • CSA vs. flow correlation

    Mass Vascularity

    • Internal flow (present / absent)
    • Vessel distribution
    • RI (malignant > 0.7)
    • PSV

    Varicose Vein Mapping

    • SFJ / SPJ diameter
    • GSV / SSV trunk dia.
    • Reflux duration (sec)
    • Perforator dia. & reflux
    • Tributary mapping

    Bypass Graft Doppler

    • Graft flow velocity
    • Stenosis PSV ratio
    • Low-flow / occlusion assessment
    • Anastomotic flow
    Interventional Ultrasound — Measurable Structures

    12. Interventional Ultrasound — Measurable Structures

    Gray Scale & Doppler Measurements (Short Form)

    1. Needle & Probe Guidance

    Needle Tracking

    • Needle gauge (G)
    • Needle tip-to-lesion distance (mm)
    • Angle of approach (°)
    • Depth of target (mm)
    • Beam-to-needle angle

    Probe-to-Target Distance

    • Skin-to-target depth (mm)
    • Probe-to-skin contact
    • Stand-off pad thickness

    Biopsy Path

    • Trajectory length (mm)
    • Vessel avoidance distance
    • Nerve avoidance distance
    • Pleura / bowel avoidance

    Fusion / Navigation

    • Registration error (mm)
    • Tracker accuracy
    • CT/MRI overlay offset
    • EM tracking deviation
    2. Biopsy Targets

    Solid Organ Biopsy

    • Liver lesion size (L × W × T)
    • Renal mass dimensions
    • Spleen lesion size
    • Pancreatic mass dimensions
    • Prostate volume & zones

    Lymph Node Biopsy

    • Short axis dia.
    • Cortical thickness
    • Hilar displacement
    • Distance from vessels

    Soft Tissue Mass

    • Dimensions (L × W × T)
    • Volume (mL)
    • Necrotic area dia.
    • Solid component %
    • Depth from skin

    Thyroid Nodule

    • Dimensions (L × W × T)
    • Volume (mL)
    • Solid component size
    • TIRADS score
    • Distance from carotid / trachea

    Breast Lesion

    • Dimensions (L × W × T)
    • BI-RADS category
    • Distance from nipple / skin
    • Chest wall involvement
    3. Fluid Drainage

    Abscess Drainage

    • Collection dimensions (L × W × T)
    • Volume (mL)
    • Depth from skin (mm)
    • Catheter gauge & length
    • Post-drain residual volume

    Cyst Aspiration / Sclerotherapy

    • Cyst dimensions & volume
    • Sclerosant volume (mL)
    • Dwell time (min)
    • Post-procedure residual
    • Recurrence size

    Ascites / Pleural Tap

    • Pocket depth (mm)
    • Estimated volume (mL)
    • Bowel / organ interposition
    • Post-tap residual

    Hematoma Drainage

    • Dimensions & volume
    • Liquid vs. organized %
    • Depth from skin
    • Catheter size

    Pericardial / Pleural Effusion

    • Effusion depth (mm)
    • Volume estimation
    • Distance from chest wall
    • Lung / cardiac clearance
    4. Vascular Access

    Central Line (IJV)

    • IJV diameter (mm) — transverse
    • IJV depth from skin (mm)
    • Carotid-IJV overlap (%)
    • Catheter diameter (Fr)
    • Tip-to-cava distance

    Subclavian / Femoral Access

    • Vessel diameter (mm)
    • Depth from skin
    • Artery distance
    • Catheter gauge

    PICC Line

    • Vein diameter (basilic / brachial)
    • Depth from skin
    • Catheter size (Fr)
    • Tip position
    • Vein patency assessment

    AV Fistula Creation

    • Artery diameter (mm)
    • Vein diameter (mm)
    • Wall thickness
    • Flow (PSV)
    • Branch / bifurcation distance

    Port / Chemo Port

    • Vein diameter
    • Depth from skin
    • Catheter length
    • Tip position
    5. Tumor Ablation

    RFA / MWA Target

    • Tumor dimensions (L × W × T)
    • Volume (mL)
    • Depth from skin (mm)
    • Distance from vessels / ducts
    • Distance from capsule / pleura

    Ablation Zone

    • Probe gauge & active tip (mm)
    • No. of probes / electrodes
    • Spacing between probes (mm)
    • Ablation zone dia. (cm)
    • Margin thickness (mm)

    Post-Ablation Assessment

    • Ablation zone size (L × W × T)
    • Residual tumor size
    • Necrosis volume (mL)
    • Margin adequacy (≥5 mm)
    • Complication collection size

    Cryoablation

    • Ice ball dimensions (mm)
    • Probe tip temperature (°C)
    • Freeze-thaw cycles
    • Margin coverage

    HIFU / Focused Ultrasound

    • Focal depth (mm)
    • Lesion size at focus
    • Acoustic window width
    • Skin-to-target distance
    • Temperature rise (°C)
    6. Anesthetic / Nerve Blocks

    Brachial Plexus Block

    • Trunk / division CSA (mm²)
    • Depth from skin (mm)
    • Needle-to-nerve distance
    • Local anesthetic spread (mm)
    • Vessel avoidance distance

    Femoral / Sciatic Nerve Block

    • Nerve CSA (mm²)
    • Depth (mm)
    • Needle tip position
    • Injectate volume (mL)
    • Perineural spread (U-shape)

    Epidural / Facet Joint

    • Lamina-to-dura distance (mm)
    • Epidural space depth
    • Facet joint depth
    • Injectate volume
    • Needle gauge

    Peripheral Nerve Block

    • Nerve CSA (mm²)
    • Depth from skin
    • Injectate spread
    • Surrounding vessel distance

    Trigger Point / Musculoskeletal

    • Target muscle thickness
    • Depth of injection
    • Injectate volume (mL)
    • Tendon sheath distension
    7. Joint Interventions

    Joint Aspiration / Injection

    • Joint effusion depth (mm)
    • Joint recess distension
    • Needle-to-recess distance
    • Cartilage thickness
    • Injectate volume (mL)

    Barbotage (Calcific Tendinitis)

    • Calcific deposit size (mm)
    • Deposit depth from skin
    • Aspirate volume (mL)
    • Post-barbotage residual
    • Subacromial bursal injection

    Synovial Biopsy

    • Synovial thickness (mm)
    • Erosion depth
    • Biopsy needle gauge
    • Depth from skin

    Tendon Sheath Injection

    • Sheath effusion depth
    • Tendon diameter
    • Injectate volume
    • Needle-to-tendon distance

    Bursal Injection

    • Bursal distension depth
    • Wall thickness
    • Injectate volume (mL)
    • Bursal-to-vessel distance
    8. Catheter / Tube Placement

    Nephrostomy (PCN)

    • Pelvicalyceal dilation (mm)
    • Cortex thickness (mm)
    • Skin-to-calyx distance (mm)
    • Catheter size (Fr)
    • Post-PCN drainage assessment

    Cholecystostomy

    • Gallbladder dimensions
    • Wall thickness
    • Skin-to-GB distance
    • Liver parenchyma traverse (mm)
    • Catheter size (Fr)

    Drain Placement

    • Collection dimensions
    • Volume (mL)
    • Catheter-to-collection ratio
    • Post-drain residual
    • Catheter size & type

    Suprapubic Catheter

    • Bladder depth from skin (mm)
    • Bladder volume (mL)
    • Bowel interposition
    • Catheter size (Fr)

    Gastrostomy (PEG)

    • Stomach wall thickness
    • Stomach-to-skin distance
    • Liver / bowel interposition
    • Tube size (Fr)
    9. Post-Procedure Assessment & Complications

    Bleeding / Hematoma

    • Hematoma dimensions (L × W × T)
    • Volume (mL)
    • Depth / extent
    • Active bleeding source

    Pseudoaneurysm

    • Sac size (L × W)
    • Neck width (mm)
    • To-and-fro flow
    • Thrombin injection volume
    • Post-thrombin occlusion

    AV Fistula (Iatrogenic)

    • Artery & vein dia.
    • Flow volume (mL/min)
    • RI (low)
    • Compression therapy response

    Residual / Recurrence

    • Residual collection size
    • Residual volume (mL)
    • Recurrence dimensions
    • Time to recurrence

    Track Seeding

    • Nodule size along track
    • Distance from skin entry
    • No. of nodules

    Infection / Abscess

    • Abscess dimensions
    • Wall thickness
    • Depth from skin
    • Catheter / drain assessment

    Pneumothorax

    • Pleural separation depth (mm)
    • Volume estimation
    • Midline shift
    • Chest tube size (Fr)
    10. Doppler (Interventional)

    Vessel Patency (Pre/Post)

    • PSV, EDV pre-procedure
    • PSV, EDV post-procedure
    • Flow restoration
    • RI change
    • Thrombus resolution

    Lesion Vascularity (Pre/Post-Ablation)

    • Internal flow before ablation
    • Flow absence post-ablation
    • Peripheral residual flow
    • RI change

    Target Vessel (Biopsy Path)

    • Vessel PSV
    • Interposition distance
    • Color flow avoidance
    • Post-biopsy vessel integrity

    Catheter Flow Assessment

    • Catheter patency flow
    • Pericatheter leak
    • Vein patency (post-line)
    • Tip flow confirmation

    AV Fistula Maturation

    • Brachial artery flow (mL/min)
    • Vein dia. & flow
    • RI (low-resistance)
    • Maturation assessment
    • Stenosis site PSV

    Contrast-Enhanced (CEUS) Guidance

    • Lesion enhancement pattern
    • Necrotic vs. viable area
    • Wash-in time (sec)
    • Wash-out time (sec)
    • Post-ablation enhancement
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