Liver lecture for Quiz 1

Question 1

What is the order of annotation?

Answer 1

Organ, scan plane, left/right (except Kid/OV), special notations

Question 2

How should you feature the anatomy on U/S?

Answer 2

Center the anatomy or area of interest and zoom

Question 3

In abdominal studies, what should rarely happen with the patient?

Answer 3

Supine as the only position

Question 4

What are three ways to move the patient?

Answer 4

LLD/RLD, sitting, LPO/RPO

Question 5

What 12 things do you consider with optimizing an image?

Answer 5

Presets, transducer selection, frequency (high/low, multi Hz, harmonics) depth, focus, gain (overall, TGC) sector size, zoom, compression/dynamic range, B-color colorization, post-processing, sweep/video clip

Question 6

When selecting a transducer, what two things do you consider?

Answer 6

Axial resolution w/higher frequencies (smaller SPL, better front to back resolution), Depth for low frequencies

Question 7

What do you consider with frequency selection?

Answer 7

Penetration and resolution needs, harmonics

Question 8

What five things do you consider when dealing with depth?

Answer 8

Shallow vs. deep, two fingers from bottom, don’t cut anatomy off, don’t waste far field, if you change depth also adjust focus tool

Question 9

What produces best reflection with B-scan?

Answer 9

90 degrees to the wall

Question 10

What 5 things do you consider with lateral resolution?

Answer 10

Beam width, focus, better used with non-moving structures, enhancing image in a specific region, position at level or just below ROI

Question 11

How do you optimize beam width?

Answer 11

Use focus (narrowest part of sound beam)

Question 12

When should you use multi-focus?

Answer 12

It is better used with non-moving structures (use at the sake of temporal resolution which slows down the frame rate)

Question 13

What 3 things occur with sector size?

Answer 13

Narrowing sector size will get rid of unnecessary information/improve overall resolution of the image, zoom, enlarges the ROI without loss of quality

Question 14

What 3 things do you consider with dynamic range or compression?

Answer 14

DR (range of grays between smallest and largest signals), compressions (varying shades of gray due to compressed signals), contrast vs gray scale

Question 15

What 2 things do you consider with B-color or image colorization?

Answer 15

Substitution of the basic grayscale image w/hue other than gray to improve visual perception of images, can be helpful w/doppler spectrum

Question 16

What does the ligamentum teres also act as?

Answer 16

Collateral flow with portal hypertension

Question 17

What is another term for ligamentum teres?

Answer 17

Round ligament

Question 18

What conditions do we need to determine when scanning liver?

Answer 18

Hepatomagaly, splenomegaly, renal impairment and abdominal aortic aneurysm

Question 19

Why does liver measurements need to be consistent?

Answer 19

To be able to compare sizes over time

Question 20

What should be used ideally with positioning in a follow-up assessment?

Answer 20

The calipers need to be positioned in the same position and ideally the same sonographer used

Question 21

Where does the upper border of liver lie?

Answer 21

Right midclavicular line at the 5th intercostal space

Question 22

What do most people have in terms of the lower border of the liver?

Answer 22

It extends to the lower costal margin

Question 23

Where do you measure liver?

Answer 23

The posterior diaphragm to the lower anterior edge

Question 24

How does liver size increase over time?

Answer 24

Gender, age, height, weight and body surface area

Question 25

When is liver measurement less than 13 cm?

Answer 25

If the measurement is made from the anterior diaphragm to the lower edge of the liver in the midclavicular line

Question 26

What technique do you do first when scanning liver?

Answer 26

A full sweep through

Question 27

What do you look for when sweeping liver?

Answer 27

Homogeneous V’s attenuative (fatty), smooth V’s coarse echotexture

Question 28

Where should inferior border of liver for measurement lie?

Answer 28

Halfway down the kidney

Question 29

In B mode, how will an enlarged liver look?

Answer 29

It will have rounded borders

Question 30

What is Segment I?

Answer 30

Caudate lobe

Question 31

What is Segment II?

Answer 31

Lateral segment of the left lobe (superior)

Question 32

What is Segment III?

Answer 32

Lateral segment of the left lobe (inferior)

Question 33

What is Segment IV?

Answer 33

Quadrate lobe

Question 34

What is Segment V?

Answer 34

Anterior segment of the right lobe (inferior)

Question 35

What is Segment VI?

Answer 35

Posterior segment of the right lobe (inferior)

Question 36

What is Segment VII?

Answer 36

Posterior segment of the right lobe (superior)

Question 37

What is the Segment VIII?

Answer 37

Anterior Segment of the right lobe (superior)

Question 38

What are you assessing when you scan liver?

Answer 38

Size, capsular contour, parenchymal echogenicity, vascularity, biliary tree, masses/collections

Question 39

What limitations are there when scanning liver with the patient?

Answer 39

Obesity and severe cases of metabolic disorders (haemochromatosis/fatty infiltration) reducing detail and the diagnostic yield of the scan

Question 40

How many hours should the patient fast?

Answer 40

6 hours to reduce gas and prevent GB contraction

Question 41

Which transducer is best for liver?

Answer 41

Curved linear array 2 - 6 MHz

Question 42

What transducer should you use if there is nodularity of the liver border?

Answer 42

Linear array 7 - 12 MHz for good color, power, doppler when assessing vessels or vascularity

Question 43

What should you be prepared to do when scanning liver?

Answer 43

Changing focal zone position and frequency output of probe to adequately assess superficial and deeper structures