Required Views

Because we want residents to be able to meaningfully participate in ultrasound studies performed, note that a maximum of 2 residents may receive credit for any given study. In most cases, clips are preferred over still images.

* = required view to get "credit" for credentialing

1. E-FAST (minimum 4 images)

Focused questions: (1) Hemoperitoneum? (2) Hemothorax? (3) Hemopericardium? (4) Pneumothorax?

• RUQ* - including Morison’s pouch, liver tip, and above/below diaphragm
• LUQ* including splenorenal, left pericolic gutter (inferior to liver/spleen), and above/below diaphragm
• Pelvic* including bladder, uterus/bowel or prostate/bowel
• Pericardial* (either subxiphoid or PSLA)
• Bilateral superior/anterior chest views for pneumothorax (either M-mode or clip)
• Bilateral inferolateral views for hemothorax evaluation (may be included in the RUQ/LUQ views)

2. Cardiac (minimum 4 images - clips preferred)

Focused questions: (1) Pericardial effusion or tamponade? (2) Global LV contractility? (3) R heart strain? (4) Volume status?

You need 4 main views (if you are not able to obtain all on all patients, please write a comment into the comment section to explain circumstances).

• PSLA*
• PSSA*
• Apical*
• Subxiphoid*
• IVC

Any 2-, 3-, or other outflow tract views and Doppler images are also welcome!

4. Aorta (minimum 5 images)

Focused questions: (1) AAA? (2) Iliac aneurysm?

• Three transverse views of abdominal aorta, with outer wall-to-outer wall measurements, including:
  • Proximal* (includes landmarks of celiac trunk or SMA)
  • Mid*
  • Distal* (just proximal to aortic bifurcation)
• Aortic bifurcation with measurements to evaluate for iliac aneurysm
• Two long axis view of the upper* and lower* aorta

5. Gallbladder (minimum 3 images)

Focused questions: (1) Gallstones? (2) Evidence of cholecystitis (GB wall thickening, pericholecystic fluid, sonographic Murphy sign? (3) CBD dilation suggestion choledocholithiasis/biliary obstruction

• Gallbladder in longitudinal* and transverse* axis. Measure the anterior GB wall in transverse view.
• CBD* with inner wall-to-inner wall measurement -- ideally, you should have an image that shows the entire portal triad (portal vein, CBD, and hepatic artery) with color Doppler to demonstrate lack of flow in the CBD.

6. Kidney (minimum 6 images)

Focused questions: (1) Obstructive uropathy - hydronephrosis/hydroureter? (2) Bladder distension?

• L kidney in longitudinal* and transverse* axis
• R kidney in longitudinal* and transverse* axis
• Bladder in with long* and transverse* axi

Ureteral jets can be documented to evaluate for blockages in ureteral flow

Bladder volume calculations are also welcome

7a. Transabdominal OB/GYN (minimum 2 images)

Focused questions: (1) IUP present? (2) Evidence of ectopic pregnancy - adnexal mass or pelvic FF?

• Longitudinal* and transverse* views of the uterus
• Bilateral adnexa views

Estimate gestational age using gestational sac, CRL, or BPD measurements.

Use only M-mode to calculate FHR. Do not use Doppler (color or pulsed wave) as it is a higher energy modality, and the principle of ALARA (as low as reasonably achievable) should be observed.

7b. Transvaginal OB/GYN (minimum 1 image @ PP, minimum 2 images in the ED)

• Longitudinal* and transverse* views of the uterus
• Bilateral adnexa views

Estimate gestational age using gestational sac, CRL, or BPD measurements.

Use only M-mode to calculate FHR. Do not use Doppler (color or pulsed wave) as it is a higher energy modality, and the principle of ALARA (as low as reasonably achievable) should be observed.

8. DVT (minimum 3 views - w/wo compression)

Focused questions: (1) DVT present?

• Common femoral vein (CFV) at level of great saphenous vein (GSV) - compressed* and uncompressed*
• Femoral vein aka superficial femoral vein (FV or SFV) - compressed* and uncompressed*
• Popliteal vein (PV) - compressed* and uncompressed*

9. Ocular (minimum 2 views)

Focused questions: (1) Presence of pathology - RD, PVD, vitreous hemorrhage, lens dislocation, FB? (2) ONSD dilated >5mm?

• Globe in transverse* and longitudinal*
• Should include measurements of optic nerve sheath diameter in one or both planes

10. Soft Tissue / MSK (minimum of 2 views)

Focused questions: (1) Presence of pathology - e.g. fluid collection, FB, air, tendon rupture, fracture, joint effusion?

• 2 orthogonal views (transverse* and longitudinal*) of the structure of interest -- e.g. abscess, cellulitis, ruptured tendons, muscles, fracture, joint dislocation, joint effusions

11. Bowel (minimum of 2 views)

Focused questions: (1) Presence of pathology - e.g. appendicitis, SBO, diverticulitis, hernia?

• 2 orthogonal views of the structure or area of interest -- e.g. appendix, small bowel obstruction, diverticulitis, hernia

12a. Vascular Access (minimum 1 image)

Focused questions: Where is the target vein, is it patent, and is it safe for cannulation?

• At least one image (either transverse or longitudinal) of the vessel* with catheter or guidewire in the vessel. Once a minimum of 5 studies have been submitted to Qpath and QA'd, simply an image of the vessel to be cannulated with an attestation that the IV was placed successfully via aspiration of blood is sufficient for credit.

(Please also write a .POCUSVASCACCESS procedure note in Epic for all US-guided IVs)

12b. Procedures (minimum 1-2 images)

Focused questions: Where is the target structure, and how do I safely get there with a needle/scalpel?

• 1-2 orthogonal views (transverse* and longitudinal*) of the structure of interest -- e.g. abscess I&D, paracentesis, thoracentesis, pericardiocentesis, arthrocentesis, ultrasound guided nerve blocks