1 | Area of Interest | Normal Measurement |
---|---|---|
2 | General Ultrasound | |
3 | Speed of sound (soft tissue) | 1540 m/s |
4 | Speed of sound (bone) | 4080 m/s |
5 | Speed of sound (fat) | 1450 m/s |
6 | Speed of sound (water) | 1484 m/s |
7 | ||
8 | Aorta | |
9 | Aorta | <3 cm or 1.5x proximal |
10 | Iliac | <1.5 cm |
11 | Aortic root | <3.8 cm |
12 | ||
13 | Cardiac | |
14 | Small pericardial effusion | <1 cm |
15 | Pericardial volume | < 50 ml |
16 | Chronic wall thinning | <7 mm or >30% decrease |
17 | RV End-diastolic diameter | 21 +/- 1 mm |
18 | TV Regurg | <2 m/s |
19 | LV End-diastolic diameter | <6 cm |
20 | LV wall thickness | 0.6-1.2 cm |
21 | EPSS (see terms) | 8-10 mm |
22 | Apical 4 view RV:LV ratio | <0.5 |
23 | ||
24 | FAST | |
25 | Pleural fluid | >20 ml detection limit |
26 | Peritoneal fluid | >200 ml detection limit |
27 | ||
28 | Hepatobiliary | |
29 | GB wall | <3 mm (Anterior wall) |
30 | Common bile duct | <7 mm (inner to inner) |
31 | CBD (age criteria) | < 1/10th age |
32 | CBD (after cholecystectomy) | 1 cm (all ages) |
33 | Mid-hepatic line | 12.8 cm |
34 | Spleen length | 12-14 cm |
35 | ||
36 | Musculoskeletal | |
37 | Synovial bursa | ~4 ml |
38 | ||
39 | Ocular | |
40 | Globe | 23.5 mm (vert), 24 mm (AP) |
41 | Optic Sheath Measurement | 3 mm posterior to globe |
42 | Optic Sheath | 4 (<1y), 4.5 (1-15y), 5 mm (adult) |
43 | ||
44 | Normal Pregnancy | |
45 | Uterus | 8 cm x 5 cm x 3 cm |
46 | Ovaries | 4 cm x 3 cm x 2 cm |
47 | Fallopian tubes | 10 cm long |
48 | Intradecidual sign | 25 days (4 wks - not definitive) |
49 | Definitive pregnancy | By 5 weeks (transvag) |
50 | Fetal heartbeat | 6 weeks |
51 | Fetal pole | 6 weeks |
52 | Head and ext | 7 weeks |
53 | Pathologic Pregnancy | |
54 | Gestational sac | >10 mm without yolk sac |
55 | Gestational sac | >18 without fetal pole |
56 | Collapsed gestation sac | |
57 | No FHR | with CRL > 5mm |
58 | Fetal pole with | FHR <90 |
59 | ||
60 | Renal | |
61 | Length | 9-12 cm |
62 | Width | 4-5 cm |
63 | ||
64 | Surgical Application | |
65 | Appendix | <6 mm (compressible) |
66 | Pyloris | Muscle <3 mm, length <15 mm |
67 | ||
68 | Testicle | |
69 | Testicle | 2-3 cm wide, 3-5 cm long |
70 | Epididymus | 6-7 cm long |
1 | IVC (cm) | Respiratory Change | CVP (cm) |
---|---|---|---|
2 | <1.5 | Total collapse | 0-5 |
3 | 1.5-2.5 | >50% change | 5 to 10 |
4 | 1.5-2.5 | <50% change | 11 to 15 |
5 | >2.5 | <50% change | 16 to 20 |
6 | >2.5 | No change | >20 |
7 | |||
8 | |||
9 | |||
10 | per paper | ||
11 | |||
12 | <2.1cm | >50% | 5 |
13 | >2.1cm | <50% | 15 |
1 | Terms | Meaning |
---|---|---|
2 | Artifacts | |
3 | Shadowing | Think gallstone, kidney stone, bone |
4 | Posterior enhancement | Increased sound speed through low density material (i.e cystic fluid) |
5 | Side lobe | Caused by lower intensity angulated beams generated by probe |
6 | Edge shadowing | Caused by refraction around the edges of an object |
7 | Mirror artifact | Caused by angular reflection of sound. Think diaphram |
8 | Ring down | Series of parallel bands radiating away from small crystals or air bubbles |
9 | Reverberation | Sounds bouncing back and forth between two layers before travelling back to probe. |
10 | Comet tails | Produced by front and back reflection of strong reflector. Narrow and organized into a small band |
11 | ||
12 | Cardiac | |
13 | E point | M-mode through MV in parasternal long axis view, first peak - passive LV filling |
14 | A point | M-mode through MV in parasternal long axis view, second peak - atrial contraction |
15 | Double peak | M-mode through MV, two peaks indicate normal sinus rhythm |
16 | EPSS | E-point septal separation - distance from E point to septal wall - large is abnormal = LV systolic dysfunction |
17 | ||
18 | Thoraxic | |
19 | Seashore sign | M-mode thorax - positive lung sliding |
20 | Stratosphere sign | M-mode with reverberation artifact in setting of PTX with no lung sliding |
21 | B-lines | Comet tails - horizontal lines extends from pleura to botton of screen, moves with lung sliding. Excludes PTX. Think edema vs infiltrate |
22 | Air bronchograms | Hyperechoic foci that may represent consoludation (PNA, infarct, atelectasis) |
23 | ||
24 | Heptaobiliary | |
25 | Mickey Mouse sign | Portal triad - Portal vein, common bile duct, hepatic artery. Largest = PV |
26 | Sonographic murphy | Maximum tenderness at point with identified GB |
27 | Wall echo shadow sign | GB is contracted around many stones - bright wall --> black bile line --> bright stone line --> posterior acoustic shadow |
28 | Parallel channel sign | Dilated CBD adjacent to PV |
29 | Antler sign | Dilated intrahepatic ducts from biliary obstruction |
30 | OIive Sandwich Sign | Hepatic artery between a dilated CBD and PV |
31 | Phrygian Cap | Folds of the GB fundus |
32 | Liver hemangioma | Hyperechoic liver mass |
33 | Spiral Valves of Heister | Valves located in GB neck |
34 | ||
35 | Ocular | |
36 | 30 degree test | Ocular ultrasound - check optic nerve sheath at primary gaze and shifted 30 degrees. Increased ICP will have no change in diameter. Normal = smaller |
37 | ||
38 | Pregnancy | |
39 | Intradecidual sac sign | IDSS - consists of an region of echogenicity within the thickened decidua representing the implanted blastocyts |
40 | Pseudogestational sac | Endometrial breakdown in presence of ectopic - lacks thick chorionic ring |
41 | Ring of Fire Sign | Increased blood supply of gestation sac in ectopic |
42 | Interstitial pregnancy | Eccentric GS locations |
43 | Discriminatory Zone | Serum beta 1000-2000 should correlate to viable IUP on TV ultrasound |
44 | Sliding sign | Sliding of the gestational sac in the cervix |
45 | ||
46 | Musculoskeletal | |
47 | Anisotropy | The property of being directionally dependent - i.e view nerves and tendon perpendicular to them or they will become less visible |
48 | ||
49 | Surgical Applications | |
50 | Keyboard sign | Small bowel obstruction - prominent valvulae pattern in a dilated, fixed loop |
51 | Target sign | Intussusception, appendicitis, pyloric stenosis |
52 | Antral nipple sign | Refers to redundant pyloric mucosa protruding into the gastric antrum |
53 | Cervix sign | Pyloric stenosis |
1 | |||||||
---|---|---|---|---|---|---|---|
2 | |||||||
3 | |||||||
4 | |||||||
5 | |||||||
6 | |||||||
7 | |||||||
8 | |||||||
9 | |||||||
10 | |||||||
11 | |||||||
12 | |||||||
13 | |||||||
14 | |||||||
15 | |||||||
16 | |||||||
17 | |||||||
18 | |||||||
19 | |||||||
20 | |||||||
21 | |||||||
22 | |||||||
23 | |||||||
24 | |||||||
25 | |||||||
26 | |||||||
27 | |||||||
28 | |||||||
29 | |||||||
30 | |||||||
31 | |||||||
32 | |||||||
33 | |||||||
34 | |||||||
35 | |||||||
36 | |||||||
37 | |||||||
38 | |||||||
39 | |||||||
40 | |||||||
41 |
1 | Sonogames Tips | |
---|---|---|
2 | Clicker | Make sure it works! Check the serial number. |
3 | Click Early | Put your first instinct in early. Lock in an answer. Can be changed but detrimental to time factor. |
4 | Seating | Get there early and sit closer. Lighting stinks, better visualization closer. |
5 | Scoring | 30, 40, and 50 point questions. Progressively hard. Watch for trick questions in the 50s>40s questions. |
6 | Orientation | Know the orientation of images, especially coronal and cardiac views |
7 | Numbers | Know numbers noted on this page. Watch for numbers on images - frequency, depth, etc. Count heart beats, breaths, ribs, etc.. |
8 | ||
9 | Hard Questions | |
10 | McKenney Hemoperitonium Score: Right subphrenic space and subhepatic space; the left upper quadrant, including the left subphrenic space and perisplenic area; and pelvis (5 spaces). Largest vertical distance in any space + 1 point for each space with fluid. If >3, then will need laparotomy. | |
11 | ||
12 | Bladder diameter | Gave 3 dimensions but in two views had repeated a same measurement. Answer = needed more information |
13 | Identify CFV | Vein medial (watch for dot orientation). For image, answer = left CFV |
14 | Identify pacer wire | |
15 | Identify intraoccular lens | |
16 | Identify and do finger ultrasound using water bath | |
17 | Identify SBO | Answer = treat with NGT. Look up keyboard sign. |
18 | Pneumothorax | Partial lung sliding with lung point. Answer = chest tube. |
19 | SBO | Showed 4 images, all with SBO. The most OMINOUS sign was the image where there is peristalsis one direction and then regurgitation in other direction |
20 | Hertz of probes | Know what Hertz probes are (mega, milli, 2-5, million, thousand, etc.) |
21 | ||
22 | Hands-on | 5 stations. Scored based on how well you do compared to others. 20 minutes each station. |
23 | Procedural skill | We had to do an LP with u/s assistance - find space in two views, mark, and go. As fast as possible. Once u/s marked - perform normal LP. |
24 | Find objects | 8 objects in a silicone gel. Use linear probe to find it. Work as a team. Break off gel into 3 segments - be meticulous. |
25 | Metal - will have reverberation artifact | |
26 | Wood - will have shadow (toothpick) | |
27 | Cystic structure was actually a bullet - doesn't have to be a perfect cylinder because of artifact | |
28 | Mission Impossible | Taboo, blind folded ultrasounds |
29 | Teacher tells the operator what study to do and how to adjust but can't use specific words | |
30 | Operator is blind-folded, can talk (I think) | |
31 | Machinist is not blind folded but can't talk. Adjusts knobs. Gives the probe to the operator. | |
32 | Rotates every round | |
33 | Cases | Tell the proctor which probe and where for different cases then answer clinical questions. Work as fast as possible |
34 | Recreate images | Will have sample image. Need to use an ultrasound to recreate given images exactly. |
35 | First question was to create a patient entry form | |
36 | Know how to switch probes | |
37 | Used water bath for finger ultrasound | |
38 | Look at the hints! We missed one because they wanted a coronal IVC with right atrium but we did AP... | |
39 | Central line insertion | One person could look at screen. One operated probe. One placed line then guidewire. Had to capture image of guidewire in vessel. There were 6 caveats (i.e., during one caveat, the person placing the central line had to wear handcuffs. during another, the probe operator had to wear earphones, etc.) |
40 | Stump the chump | You are given an image to obtain and you have to beat an ultrasound expert. You are given a 5 second head start. |
41 | ||
42 | Final Round | |
43 | Question round | Take turns answering questions - can steal if other team misses. Was based solely on the 4 articles they give you ahead of time last year so read them. |
44 | Lightning round | Each team takes turns answering as many questions as possible. They did not have this the second year |
45 | Buzzer round | Look at image. Image goes away. Get asked an obscure questions: They did not have this the second year |
46 | - how many ribs were scanned through | |
47 | - how many heart beats in the clip | |
48 | - what was the charge of the battery | |
49 | Imaging round | Completely subjective. You obtain an image on a dummy patient and then the opposite team does. Audience and 2 judges determine which image is better |