Scan Lab Final 2024 Flashcards
What does “TIPS” stand for?
Transjugular intrahepatic portosystemic shunts
What two vessels does the tips usually connect?
Right hepatic vein and right portal vein
True/False
You only measure the velocity at the mid portion of the TIPS to determine if it is completely patent
False
What is the most common reason a patient gets a TIPS?
Portal hypertension
What is the most common complication in a TIPS?
Stenosis within the TIPS
Which characteristics best describe flow in the main portal vein?
Low velocity and hepatopedal flow
The flow in the left portal vein should be ______________ in a patient with a TIPS:
Hepatofugal
A _______ velocity change from previous exams denotes possible malfunction within a TIPS. (in cm/s)
> 50cm/s
In the setting of chronic cirrhosis, flow in the hepatic artery will be ______ resistance
Low resistance
What does RAR stand for?
Renal Aortic velocity ratio
When performing a renal artery stenosis exam, which two vessels do you use a sample gate with the angle correct on?
Renal artery and Aorta
another name for a dominant follicle is a _________ follicle
Graafian follicle
For ovarian Doppler, you should expect to decrease your ________ when evaluating for torsion
PRF
With an LMP, you need to know the ______ day of the last menstrual cycle.
First
Ovarian torsion causes the ovary to become edematous giving the ovarian a _________ echogenecity
HypOechoic
What two vessels supply oxygenated blood to the ovaries?
Uterine artery and ovarian artery
The left ovarian vein travels superiorly into what vessel?
Left renal vein
Term for the surgical removal of the ovary:
Oophorectomy
Color flow is a _____________ type of measurement.
Qualitative
With a properly placed ________, you will get a more accurate evaluation
Sample gate
To ensure accuracy, your angle correct should be set at _____ degrees or less.
60 degrees
_________ ultrasound is a vital component in evaluating the female pelvis
Doppler
Ovarian veins are known to _________ during pregnancy
Dilate
Once ruptured, the follicle turns into a ___________________
Corpus luteum
The ___________ sign represents the twisting of the ovaries, vascular pedicle
Whirlpool sign
Where does the ovarian artery originate?
Aorta
Normal parenchymal ovarian artery flow has ______ velocities
Low
List the vessels imaged for the mesenteric Doppler protocol:
Ao (prox, mid, distal)
Celiac axis
Hepatic artery
Splenic artery
SMA (prox, mid, distal)
IMA
Celiac and hepatic artery will have _______ resistance
Low
SMA while fasting needs to be ______ (____ resistance) with a brief period of flow reversal, and little to no flow in diastole
Triphasic, high resistance
IMA is going to have ______ flow characteristic as the SMA
The same
After the patient consumes approximately 16 to 20 fluid ounces of ________, Then you wait ______ minutes to go back and reevaluate the same vessels with color and pulse wave.
-a high calorie drink (such as boost or ensure)
-Wait 20 minutes
What we are looking for in the post prandial exam is a(n) _____ in the PSV and EDV in the _______
an
INCREASE
in PSV and EDV in the
SMA
There are only guidelines per the PSV/EDV for the ______ and the ______
SMA and Celiac axis
Renal artery is slightly __________ to the renal vein
Anterior
Sample gates on the Renal artery Doppler protocol must have the correct…
Size, placement, and angle correct (AO & renal artery only) in the direction of blood flow
Color Doppler can be fine tuned with _______
Scale
(Sensitivity = good)
Purpose of Renal artery stenosis evaluation:
-To evaluate the kidneys when the patient presents with sudden onset hypertension and/or fluctuating blood pressures
-To identify renal stenosis before renal failure occurs
What is the primary imaging modality for Renal artery stenosis in possible surgical and non-surgical situations?
-u/s if the first choice for typical evaluation of the kidney
-CT is the first choice in cases of possible surgical situations
Most common reason for a renal artery stenosis examination?
Any uncontrolled or sudden blood pressure issues and/or hypertension
What type of flow occurs right before a stenosis in the renal artery
Laminar flow
Flow directly after stenosis in the renal artery is __________
Turbulent
Where in location of a stenosis in the renal artery do you check for blood flow?
Before, during, and after the stenosis.
Renal Doppler protocol:
• Full Kidney protocol
• Doppler the arcuate arteries at upper, mid, & lower poles
• Doppler the renal vein
• Renal artery Doppler @ prox, mid, & dist ANGLE CORRECT
• Gray scale, color, and pulse wave of the mid aorta ANGLE CORRECT
Why do you also evaluate the vein during a RAS exam?
To rule out thrombus (looks like slow flow in the vein)
*
Formula for End Diastolic Ratio (EDR):
EDV / PSV = EDR
What is a normal EDR?
> 0.2
- Formula for acceleration time (AT):
What is a normal acceleration time (AT)?
<100 milliseconds
How is renal artery stenosis most often treated?
With angioplasty and/or stunting
Where are the calipers placed for acceleration time?
End diastolic pattern to early systolic peak
Renal Aortic Ratio (RAR) formula:
Highest Renal Artery PSV / Aorta PSV
Normal value for RAR:
<3.5
Formula for resistive index (RI):
(PSV - EDV) / PSV
Normal value for RI:
<0.8
When there is torsion in the ovaries, you will image it in….
B-mode (grayscale), color Doppler, and power Doppler.
Ovaries have what type of waveform?
Low resistance (10-35 cm/s)
Arterial spectral waveform for an ovarian Doppler has an alternating _____ uptake and systolic peak and has _____ diastolic flow.
Quick uptake
Lower diastolic flow
Left ovarian vein drains into the…
Left renal vein
Right ovarian vein drains…
Directly into the IVC
Venous spectral waveform on an ovarian Doppler has what type of flow in diastole?
continuous, low resistance recurring flow
Venous spectral waveform on an ovarian doppler has what type of flow in systole?
Reduced flow signal
What is used to detect the presence of blood flow in a select area at a known depth with a given sample gate?
Pulsed wave Doppler
What is used along with PW doppler that allow for a more concise evaluation of a given vessel?
Sample gate
When the waveform is above the baseline, flow is traveling…
Toward the transducer
When the waveform is below the baseline, the flow is moving…
Away from the transducer
What information does color Doppler provide?
Directional information and relative velocity of flow
What is color Doppler dependent on?
Optimization of angles, the flow that is being interrogated, and the transducer
Higher/faster velocities appear ______ in color
Brighter
Slower velocities appear _______ in color
Darker
What type of Doppler is used when more sensitivity is needed for subtle flow and is not dependent on specific Doppler angles?
Power Doppler
What displays blood flow movement with no directional information
Power Doppler
Ovarian flow patterns vary depending on…
The degree of torsion and duration
While doing an ovarian Doppler examination, non-existent vascular flow is indicative of…
An oophorectomy
List the classic sonographic signs of ovarian torsion:
- Unilateral enlarged edematous with small peripheral follicles
-Little to no vascular flow
-Free fluid in the cul-de-sac
Clinical/Physical symptoms of ovarian torsion:
lower abdominal pain
Fever
Nausea/vomiting
Peritoneal irritation
Important patient history to get prior to ovarian Doppler exam:
-LMP
-G/P
-Surgical history
-Age
What is the purpose of ultrasound for a TIPS procedure?
To examine the abdomen and determine the presence and amount of ascites.
What is being assessed during a TIPs ultrasound examination?
-ascites
-any hepatic hematoma,
-biliary obstruction,
-debris in the GB or CBD.
-the shunt
What is the usual placement of the shunt for a TIPS procedure?
between the right portal and right hepatic veins.
(TIPS)
What is the normal appearance of the stent via ultrasound?
The stent is echogenic and looks like two parallel curvilinear lines.
(TIPS)
During a Doppler interrogation, what is being sampled?
Velocity, flow direction and waveforms patterns are sampled
(TIPS)
Velocity, flow direction and waveform patterns are sampled at the:
MPV
Portal vein end of shunt
Mid shunt
Hepatic vein end of shunt
Left portal vein
Hepatic artery
Flow in a normal TIPS progresses (blank) the transducer, then will appear to be (blank) for a short segment (d/t the flow being perpendicular to the beam).
Progresses towards the transducer then appears absent for a short segment
(TIPS)
As the shunt curves away from the probe, the color is…
displayed in a different hue.
(TIPS)
In the MPV, flow will be (blank) before the shunt
hepatopedal
(TIPS)
Flow will be (blank) at the Hepatic vein
Hepatofugal
(TIPS)
Once at the mid of the shunt, flow is…
Hepatofugal
After a TIPS placement, flow in the left portal vein is…
Hepatofugal
(TIPS)
Velocities will vary widely throughout the shunt, usually increasing from the (blank) to the (blank)
portal venous end to the hepatic venous end
(TIPS)
Velocities in the shunt range from…
50-190cm/sec.
(TIPS)
What is the best means of documenting any changes within the shunt and will act as an early indicator of shunt compromise?
Serial evaluations
When / how often is a patient scanned for a TIPS procedure?
The patient is usually scanned pre procedure, post procedure, 3 months post procedure, and then every 6 months to a year. This should be done at the same clinic or records
