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CARDIAC ULTRASOUND PROTOCOLS

Cardiac ultrasound protocols and in-person sonographer training were provided by local cardiologist Dr. Katie Nadolny DVM, DACVIM - Cardiology

STANDARD DOG PROTOCOL


  • RIGHT SIDE
    • 4-chamber long axis

-LV volumetric

-LA volumetric (in some circumstances)

  • 5-chamber long axis
  • Color Doppler mitral valve
  • Color Doppler aortic valve
  • Color Doppler tricuspid valve
  • Short axis LV
  • Short axis mitral valve
  • M-mode LV

-LV study

  • M-mode mitral valve
  • Short axis LA/Ao

-LA/Ao

  • Color Doppler aorta
  • Color Doppler tricuspid valve
  • Pulmonary valve
  • Color Doppler pulmonary valve
  • Pulsed-wave Doppler pulmonary valve
  • Right pulmonary artery
  • LEFT SIDE
    • 4-chamber long axis
    • Color Doppler mitral valve
    • Mitral regurgitation CW Doppler
    • Mitral inflows (PW Doppler)
    • Mitral TDI
    • Color Doppler tricuspid valve
    • Tricuspid regurgitation CW Doppler
    • TAPSE
    • 5-chamber long axis
    • Color Doppler aortic valve
    • Pulsed-wave Doppler aortic valve
    • Right auricle
    • Pulmonary valve (if possible)


Pulmonary hypertension / right-sided disease

  • As above plus:
    • Tricuspid inflows
    • Tricuspid TDI
    • Pulmonary valve regurgitation velocity
    • AFAST/TFAST
    • RPAD


 STANDARD CAT PROTOCOL


  • RIGHT SIDE
    • 4-chamber long axis

-LV volumetric (RARELY)

-LA volumetric (in some circumstances)

-LV study

-LA diameter

  • 5-chamber long axis
  • M-mode mitral valve
  • Color Doppler mitral valve
  • Color Doppler aortic valve
  • Color Doppler tricuspid valve
  • Short axis LV
  • Short axis mitral valve
  • M-mode LV

-LV study

  • M-mode mitral valve
  • Short axis LA/Ao

-LA/Ao

  • Color Doppler aorta
  • Color Doppler tricuspid valve
  • Pulmonary valve
  • Color Doppler pulmonary valve
  • Pulsed-wave Doppler pulmonary valve
  • Color / PW Doppler of the RVOT
  • Right pulmonary artery
  • LEFT SIDE
    • 4-chamber long axis
    • Color Doppler mitral valve
    • Mitral regurgitation CW Doppler
    • Mitral inflows (PW Doppler)
    • Mitral TDI 
    • Color Doppler tricuspid valve
    • Tricuspid regurgitation CW Doppler
    • 5-chamber long axis
    • Color Doppler aortic valve
    • Pulsed-wave Doppler aortic valve
    • IVRT (PW Doppler)
    • Pulmonary valve (if possible)

ABDOMINAL SCANNING PROTOCOL

 Still images   Video clips

Table 1: Recommended image documentation of the hepatobiliary system. 


1 Representative longitudinal and transverse images of the liver parenchyma and vasculature 

2 Liver and spleen comparison (if needed with split screen image). Liver and falciform fat comparison in cats 

3 Parenchymal liver lesions with measurements in two planes (largest and most representative, if many) 

4 Gallbladder wall and contents with wall thickness measurement if abnormal    

5 Common bile duct with measurement of intraluminal diameter and wall thickness if visible  

6 Hepatic lymph nodes with thickness measurement if visible    

7 Portal vein and aorta diameter at portal vein entrance into the liver if a portosystemic shunt is suspected  


Table 2: Recommended image documentation of the spleen. 


1 Representative areas of the dorsal and ventral splenic extremities and body 

2 Splenic hilus with measurements in a longitudinal plane    

3 Splenic lesions with measurements    

Table 3: Recommended image documentation of the gastrointestinal system 


1 Gastric fundus, body, antral and pyloroduodenal locations in at least one or both planes, if possible, with wall thickness measurement 

2 Duodenum (descending portion) in at least one or both planes if possible, including wall thickness measurement 

3 Representative jejunal segment (multiple if not uniform in appearance) in at least one or both planes if possible, including wall thickness measurement 

4 Ileocecocolic junction in cats, and if visible in dogs in at least one or both planes if possible 

5 Representative large intestinal segment (multiple if not uniform in appearance) in at least one or both planes if possible, including wall thickness measurement    


Table 4: Recommended image documentation of the pancreas. 

1 Left and right lobes (if visible) and body of the pancreas in at least one or both planes if possible 

2 Pancreatic duct with measurements if visible   

  

Table 5: Recommended image documentation of the urinary system. 

1 Left and right kidney in longitudinal and transverse 

2 Left and right renal length measurement 

3 Renal pelvis in transverse with measurement if distended 

    Tracing the ureters from origin to insertion or as far as possible if abnormal

4 Urinary bladder apex and/or body depending on indication, and trigone with measurement of wall thickness if abnormal 


Table 6: Recommended image documentation of the adrenal glands. 


1 Both adrenal glands in longitudinal with maximal thickness measurement 

2 Adrenal nodules/masses in longitudinal, and if feasible transverse with measurement 

        Video: For adrenal masses Color or Power Doppler examination of adjacent vasculature


Table 7: Recommended image documentation of the genital system. 


Female

1 Left and right ovaries in intact female dogs and cats at maximal dimension. 

2 Uterine horns (left and right), uterine body, cervix and pre-pubic aspects of the vagina 

        Tracing each mammary chain in transverse if abnormalities are present

3 Representative gestational sacs and fetuses in pregnant dogs and cats. 

         Fetuses documenting heartbeat if present

4 Fetal heart rate using M mode with calipers documenting heart rate calculation 

5 Focal abnormalities of the mammary chain in at least one image plane   


Male

1 Longitudinal and transverse images of the prostate with measurements 

2 Both testes in at least one image plane at the points of maximal dimension to include the median raphe or mediastinum testis.     


Table 8: Recommended image documentation of the lymph nodes, mesentery and omentum, great vessels, peritoneal and retroperitoneal space. 


1 Medial iliac and jejunal lymph nodes in longitudinal 

1 If discrete medial iliac lymph nodes are not identified then a video clip in longitudinal and transverse of the region of the lymph nodes including both the left lateral aspect of the aorta and right lateral aspect of the caudal vena cava at the level of the aortic trifurcation between the deep circumflex and external iliac arteries should be acquired

2 Any abnormal lymph nodes in longitudinal with measurements 

      Region of the jejunal lymph nodes along the cranial mesenteric artery and vein. 

3 Abnormalities of the peritoneal and retroperitoneal fat/space including free fluid and gas 

      Abnormal portions of the abdominal fat with anatomical landmarks      

4 Abnormalities of the abdominal vasculature  

     Abnormalities of the peritoneal and retroperitoneal space with anatomical landmarks

5 Abnormalities of the abdominal vasculature


Any abdominal lesion is thoroughly documented with still and video loops. 

This protocol was adapted by our interpreting radiologist from the 2022 ACVR protocol

 Seiler, GS,  Cohen, EB,  d'Anjou, M-A, et al.  ACVR and ECVDI consensus statement for the standardization of the abdominal ultrasound examination. Vet Radiol Ultrasound.  2022; 63: 661– 674. https://doi.org/10.1111/vru.13151 

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