Ultrasound Scanning technique for Spleen

SONOACADEMY

CLINICAL ULTRASOUND

QUALITATIVE • QUANTITATIVE • INTERVENTIONAL ULTRASOUND

Scanning Sequence Patient Preparation Equipment Optimization Assessment Doppler Measurements Documentation Final Check

Spleen Ultrasound Scanning Technique

PATIENT PREPARATION • EQUIPMENT • IMAGE OPTIMIZATION • SYSTEMATIC SCANNING • SPLENIC VESSELS • DOCUMENTATION

ULTRASOUND SCANNING TECHNIQUE

SEARCH SPLEEN SCANNING TECHNIQUE

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SYSTEMATIC SCANNING PRINCIPLE: Use a consistent scanning sequence to evaluate the spleen in longitudinal, short-axis and oblique planes. Assess the splenic parenchyma, splenic hilum, accessory spleen, splenic vessels and relationship with the left kidney. Adapt patient position, respiration and probe approach according to visualization and clinical requirements.

The Longitudinal Scanning of the Spleen by the Left Intercostal Space

The Image of the Accessory Spleen (Splenules) in the Longitudinal Scan of the Spleen by the Left Intercostal

Short Axis Scanning of the Spleen

Oblique Scanning of the Left Kidney and Spleen by the Left Intercostal Space

The Longitudinal Scanning of the Splenic Vein by Left Upper Abdomen

The Blood Flow Waveform of the Splenic Artery

PRE-EXAMINATION PRINCIPLE

Follow the local examination protocol and clinical indication. Explain the examination to the patient and obtain relevant clinical history before scanning.

Confirm patient identity and examination indication.

Review relevant symptoms, clinical history and previous imaging when available.

Explain the splenic ultrasound examination to the patient.

Use appropriate fasting instructions according to local protocol and clinical circumstances.

Position the patient comfortably, usually supine initially.

Use right lateral decubitus or other positional adjustment when required for splenic visualization.

Ask the patient to cooperate with respiration and breath-holding when necessary.

Expose the left upper abdomen appropriately while maintaining patient privacy.

Apply adequate ultrasound gel to obtain consistent acoustic coupling.

Use respiratory and positional maneuvers when the spleen is poorly visualized.

Select an appropriate abdominal curvilinear transducer.

Use a suitable frequency range according to patient body habitus and required penetration.

Inspect the transducer surface and cable before use.

Confirm adequate acoustic coupling and apply sufficient gel.

Select an abdominal preset when available.

Confirm correct patient information on the ultrasound system.

Prepare Color Doppler when vascular assessment is required.

Prepare Spectral Doppler when splenic artery or venous flow assessment is required.

Ensure measurement and image-storage functions are available.

Optimize the system before acquiring final diagnostic images.

1. Probe Orientation

Maintain correct probe orientation for longitudinal, short-axis and oblique splenic views.

2. Depth Optimization

Adjust depth so the entire spleen and relevant adjacent structures are appropriately displayed.

3. Overall Gain

Adjust overall gain to provide balanced visualization of the splenic parenchyma and surrounding tissues.

4. TGC

Adjust time-gain compensation to maintain consistent image brightness throughout the splenic field.

5. Frequency

Select the highest practical frequency that provides adequate penetration and splenic visualization.

6. Dynamic Range

Adjust dynamic range and compression to obtain useful grayscale separation within the spleen.

7. Focal Zone

Position the focal zone near the region of interest when detailed assessment is required.

8. Zoom and Field of View

Magnify the splenic hilum, accessory spleen, focal lesion or vascular structure when required.

9. Respiratory Maneuver

Use appropriate inspiration or breath-holding maneuvers when they improve visualization of the spleen.

10. Patient Position

Modify patient position when required to improve the acoustic window and demonstrate the entire spleen.

11. Color Doppler

Optimize Color Doppler when evaluating splenic vessels or differentiating vascular structures.

12. Spectral Doppler

Optimize scale, wall filter, gain, sample gate and sweep speed when obtaining splenic arterial or venous waveforms.

Structure / Assessment	Technique Focus
Spleen — Longitudinal	Use the left intercostal approach to obtain a longitudinal image and assess the splenic parenchyma and overall contour.
Accessory Spleen / Splenule	Inspect the region around the splenic hilum and adjacent tissues for an accessory splenic structure when visualized.
Spleen — Short Axis	Obtain short-axis views to assess the spleen in a complementary plane.
Spleen and Left Kidney	Use the left intercostal approach to demonstrate the relationship between the spleen and left kidney.
Splenic Vein	Use the left upper abdominal approach to obtain a longitudinal view of the splenic vein when adequately visualized.
Splenic Artery	Use Doppler assessment when indicated to obtain the splenic arterial blood-flow waveform.

SPLEEN ASSESSMENT NOTE:

Assess the spleen in multiple planes and use appropriate patient positioning and respiratory maneuvers when required. Document technically adequate representative images according to the clinical indication and local examination protocol.

Vessel / Assessment	Technique Focus
Splenic Artery	Identify the splenic artery using an appropriate imaging approach and optimize Color and Spectral Doppler when arterial flow assessment is required.
Splenic Artery Waveform	Acquire a technically adequate blood-flow waveform using an appropriate sample volume and Doppler settings according to the examination protocol.
Splenic Vein	Assess the splenic vein using an appropriate left upper abdominal approach and Color Doppler when required.
Color Doppler	Adjust color scale, gain, wall filter and box size to demonstrate vascular flow without excessive background noise.
Spectral Doppler	Optimize sample gate, scale, baseline, wall filter, gain and sweep speed for the required spectral tracing.

DOPPLER NOTE:

Use Doppler settings and measurements required by the clinical indication and local laboratory protocol. When velocity measurement is required, use appropriate angle correction according to the examination protocol.

Select the appropriate anatomical plane before placing calipers.

Obtain an adequately magnified image when required.

Place calipers precisely on the intended anatomical margins.

Use an appropriate standardized imaging plane for the measurement.

Avoid unnecessary obliquity when a standardized plane is required.

Record measurements using the correct units.

Repeat measurements when the first acquisition is technically suboptimal.

Document the anatomical reference and imaging plane when appropriate.

Use consistent technique for follow-up examinations whenever possible.

Document relevant splenic measurements according to local protocol.

Document a representative longitudinal image of the spleen.

Document a representative short-axis image of the spleen.

Document the splenic hilum when adequately visualized.

Document an accessory spleen/splenule when identified.

Document the spleen and left kidney relationship when obtained.

Document the splenic vein when adequately visualized.

Document the splenic artery when assessed.

Save the splenic arterial Doppler waveform when required.

Save appropriate Color Doppler images when vascular assessment is performed.

Save measurement images with visible calipers and labels.

Use appropriate anatomical labels and patient identifiers according to local protocol.

Ensure stored images are technically adequate before completing the examination.

SPLEEN SCAN COMPLETION CHECKLIST

Confirm that the required splenic regions, scanning planes, vascular structures, measurements and representative images have been completed according to the clinical indication and local examination protocol.

Longitudinal spleen view obtained.

Short-axis spleen view obtained.

Splenic hilum assessed where required.

Accessory spleen/splenule assessed when indicated.

Left kidney and spleen relationship assessed.

Splenic vein assessed where required.

Splenic artery assessed where required.

Splenic arterial Doppler waveform obtained when indicated.

Appropriate left intercostal approach completed.

Left upper abdominal approach completed where required.

Required measurements completed.

Required representative images saved.

Color Doppler used when indicated.

Final images reviewed for technical quality.

SONOACADEMY • CLINICAL ULTRASOUND

Spleen Ultrasound Scanning Technique • Systematic • Practical • Diagnostic