Ultrasound Scanning technique for Pancreas

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CLINICAL ULTRASOUND

QUALITATIVE • QUANTITATIVE • INTERVENTIONAL ULTRASOUND

Scanning Sequence Patient Preparation Equipment Optimization Assessment Measurements Documentation Final Check

Pancreas Ultrasound Scanning Technique

PATIENT PREPARATION • EQUIPMENT • IMAGE OPTIMIZATION • SYSTEMATIC SCANNING • PANCREATIC ASSESSMENT • DOCUMENTATION

ULTRASOUND SCANNING TECHNIQUE

SEARCH PANCREAS SCANNING TECHNIQUE

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SYSTEMATIC SCANNING PRINCIPLE: Use a consistent scanning sequence to evaluate the pancreatic head, neck, body and tail in multiple planes. Adapt probe position, angulation, pressure, respiration and patient position according to visualization, body habitus and clinical requirements.

Transverse Scanning of the Pancreas by Subxiphoid

Transverse Scanning of the Upper Portion of the Pancreatic Head by the Right Subcostal

Transverse Scanning of the Lower Port of the Pancreatic Head by Subxiphoid

Sagittal Scanning of the Pancreatic Head by the Right Upper Abdomen

Sagittal Scanning of the Pancreatic Body by the Subxiphoid

Oblique Scanning of the Pancreatic Tail by the Left Upper Abdomen

Oblique Scanning of the Left Kidney, Spleen and Pancreatic Tail by the Left Intercostal Space

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 pancreatic ultrasound examination to the patient.

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

Position the patient comfortably, usually supine initially.

Be prepared to use additional positioning when pancreatic visualization is limited.

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

Expose the upper abdomen appropriately while maintaining patient privacy.

Apply adequate ultrasound gel to obtain consistent acoustic coupling.

Use graded probe pressure or positional adjustment when bowel gas limits visualization.

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 or pancreatic preset when available.

Confirm correct patient information on the ultrasound system.

Prepare Color Doppler when vascular anatomy or flow differentiation is required.

Ensure measurement and image-storage functions are available.

Select an appropriate monitor display and examination environment.

Optimize the system before acquiring final diagnostic images.

1. Probe Orientation

Maintain correct probe orientation and use appropriate transverse, sagittal and oblique approaches for the pancreatic region being examined.

2. Depth Optimization

Adjust depth so the pancreas and relevant surrounding anatomy are appropriately displayed without excessive unused field of view.

3. Overall Gain

Adjust overall gain to provide balanced grayscale visualization of pancreatic parenchyma and surrounding structures.

4. TGC

Adjust time-gain compensation to maintain appropriate brightness throughout the depth of the image.

5. Frequency Optimization

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

6. Dynamic Range

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

7. Focal Zone

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

8. Zoom and Field of View

Magnify the pancreatic head, body or tail when detailed assessment or measurement is required.

9. Harmonic Imaging

Use available harmonic or other image-processing modes when they improve visualization without obscuring relevant findings.

10. Respiratory Maneuver

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

11. Probe Pressure

Use appropriate graded pressure when necessary to reduce bowel-gas interference and improve the acoustic window.

12. Color Doppler

Optimize Color Doppler when differentiation of vessels, ducts or other structures is required.

Structure / Assessment	Technique Focus
Pancreas — Transverse View	Obtain a transverse subxiphoid view of the pancreas and assess the pancreatic region in a systematic fashion.
Upper Pancreatic Head	Use the right subcostal approach to obtain the transverse view of the upper portion of the pancreatic head.
Lower Pancreatic Head	Use the subxiphoid approach to assess the lower portion of the pancreatic head.
Pancreatic Head — Sagittal	Use the right upper abdominal approach to obtain a sagittal view of the pancreatic head.
Pancreatic Body	Use the subxiphoid approach to obtain a sagittal view of the pancreatic body.
Pancreatic Tail	Use the left upper abdominal approach for oblique assessment of the pancreatic tail.
Pancreatic Tail / Spleen / Left Kidney	Use the left intercostal approach to assess the relationship of the pancreatic tail with the spleen and left kidney.
Color Doppler	Use Color Doppler when vascular structures need to be identified or differentiated from adjacent pancreatic or ductal structures.

PANCREATIC ASSESSMENT NOTE:

Assess the pancreas using multiple planes and approaches. Adapt probe position, patient position and respiratory maneuvers according to visualization and clinical requirements. Document technically adequate representative images according to local examination protocol.

Select the appropriate anatomical plane before placing calipers.

Magnify the pancreatic region when necessary.

Place calipers precisely on the intended anatomical margins.

Use a standardized imaging plane appropriate 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 pancreatic measurements according to local protocol.

Document a representative transverse image of the pancreas.

Document the upper portion of the pancreatic head.

Document the lower portion of the pancreatic head.

Document a sagittal image of the pancreatic head.

Document a sagittal image of the pancreatic body.

Document the pancreatic tail when adequately visualized.

Document the pancreatic tail with spleen and left kidney when obtained.

Save appropriate Color Doppler images when vascular differentiation is required.

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.

Document relevant adjacent structures when they contribute to interpretation.

PANCREAS SCAN COMPLETION CHECKLIST

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

Transverse pancreas view obtained.

Upper pancreatic head assessed.

Lower pancreatic head assessed.

Sagittal pancreatic head assessed.

Sagittal pancreatic body assessed.

Pancreatic tail assessed where technically possible.

Left kidney and spleen relationship with pancreatic tail assessed where required.

Appropriate subxiphoid approach completed.

Right upper abdominal approach completed where required.

Left intercostal 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

Pancreas Ultrasound Scanning Technique • Systematic • Practical • Diagnostic