Provider General Ultrasound Ordering Guide

• Structures/Organs Evaluated: Entire aorta, IVC, pancreas, liver, gallbladder, spleen, both kidneys.
  *Lower abdomen is not evaluated because this area consists of mostly bowel, and ultrasound cannot see through air/gas, so ultrasound is not an appropriate modality for imaging the lower abdomen (unless it is for a focal/palpable soft tissue evaluation).
• Prep Instructions: No food or drink for at least 6 hours, including no chewing gum or smoking

• Structures/Organs Evaluated: Proximal aorta only, IVC, pancreas, liver, gallbladder, right kidney
• Prep Instructions: No food or drink for at least 6 hours, including no chewing gum or smoking

• Structures/Organs Evaluated: This is usually used to perform a fluid check to evaluate for ascites. Can also be used to evaluate a focal area of abdomen. Since order is vague, include comments regarding exactly what needs to be evaluated.

• Structures/Organs Evaluated: Appendix

• Structures/Organs Evaluated: Evaluates liver vasculature, including portal veins, hepatic veins, hepatic artery, superior mesenteric vein and splenic vein.
• Prep Instructions: No food or drink for at least 6 hours, including no chewing gum or smoking

• Structures/Organs Evaluated: Spleen

• Structures/Organs Evaluated: Measures aorta from proximal to distal, as well as proximal common iliac arteries. Blood flow is not evaluated, just measurements of the arteries are obtained.
• If blood flow evaluation is desired, especially in the case of a patient with history of aneurysm repair, an Aorta Duplex must be ordered (this exam is performed in the vascular lab department).
• Prep Instructions: No food or drink for at least 6 hours, including no chewing gum or smoking

• Structures/Organs Evaluated: This is a Medicare screening exam. Only one can be performed in a lifetime. Includes measurements of aorta. Patient must meet certain criteria for exam to be covered: family history of AAA, male between age of 65-75 with history of tobacco use.
• Prep Instructions: No food or drink for at least 6 hours, including no chewing gum or smoking

• Structures/Organs Evaluated: Bilateral kidneys and urinary bladder, we can also evaluate transplanted kidney for parenchymal abnormalities.
• If blood flow evaluation of native and/or transplant kidneys is desired for renal artery stenosis, for example, then a Renal Artery Duplex or Renal Transplant Doppler must be ordered (this exam is performed in the Vascular Lab department).
• Prep Instructions: No prep for renal ultrasound. Renal artery duplex/renal transplant doppler patient must be NPO for at least 6 hours, including no chewing gum or smoking.

• Structures/Organs Evaluated: Urinary bladder only with pre- and post-void images.

• Structures/Organs Evaluated: Uterus, ovaries, bilateral adnexa (this is performed transabdominally only).
• Prep Instructions: Drink 32 oz. of water 1 hour prior to exam and hold bladder.

• Structures/Organs Evaluated: Uterus, ovaries, bilateral adnexa (this is performed both transabdominally and endovaginally). If endovaginal exam is desired, make sure this is the exam that is ordered.
• We do not perform endovaginal if the patient declines this part of the test and/or if they are virginal status.
• Prep Instructions: Drink 32 oz. of water 1 hour prior to exam and hold bladder.

In our department, we only perform 1st trimester OB ultrasounds up to gestational age of 13 weeks 6 days. Once fetus measures 14 weeks, 0 days, patient must be referred to Maternal-Fetal Medicine for ultrasound.

• Structures/Organs Evaluated: Uterus, ovaries, gestational sac, fetus, yolk sac, bilateral adnexa (this is performed transabdominally only).
• Prep Instructions: Drink 32 oz. of water 1 hour prior to exam and hold bladder.

In our department, we only perform 1st trimester OB ultrasounds up to gestational age of 13 weeks 6 days. Once fetus measures 14 weeks, 0 days, patient must be referred to Maternal-Fetal Medicine for ultrasound.

• Structures/Organs Evaluated: Uterus, Ovaries, gestational sac, fetus, yolk sac, bilateral adnexa (this is performed both transabdominally and endovaginally). If endovaginal exam is desired, make sure this is the exam that is ordered.
• Prep Instructions: Drink 32 oz. of water 1 hour prior to exam and hold bladder.

• Structures/Organs Evaluated: Scrotum, testicles, epididymis

• Structures/Organs Evaluated: Thyroid gland

• Structures/Organs Evaluated: Parathyroid glands

• Structures/Organs Evaluated: Parotid glands

To evaluate for breast abscess only. Imaging does not perform diagnostic breast ultrasounds for mass, etc. Those patients must be referred to Bearden-Josey Center for Breast Health.

Neonatal head ultrasound to evaluate brain anatomy. Can only be performed while anterior fontanelle is open. As infant gets older and fontanelle is smaller, exam is more limited.

• Neonatal spine ultrasound to evaluate for spine abnormalities.
• Can only be performed on infant with incompletely ossified spine. Once spine is ossified, exam cannot be performed (3 - 6 months).
• Common indications include sacral dimple, skin tag, hair tuft.

We do not perform exams with manipulation in our department

• Evaluates angle of femoral head in acetabulum.
• Should not be performed past age 6 months, as bones become more ossified after this, and image quality is compromised.
• Common indications include breech position in utero, hip click.

• Structures/Organs Evaluated: Evaluates for pyloric stenosis in infants. Usually occurs between 6 - 12 weeks of age but can occur anytime between birth and 6 months.
• Common indications: projectile vomiting, infant failing to thrive
• Prep Instructions: No food or drink for 4 hours

Area Evaluated: Head, neck, supraclavicular

Area Evaluated: Upper back

Area Evaluated: Lower Back

Area Evaluated: Chest wall

Area Evaluated: Abdominal wall (this includes evaluation for abdominal hernia or any other soft tissue evaluation of abdomen)

Area Evaluated: Pelvic wall, buttock, perineum, penis

(Penis is evaluated for soft tissue evaluation only, such as abscess or palpable lump/bump area. We do not evaluate for erectile dysfunction; this is typically done in a urology office.)

Area Evaluated: Upper arm

Area Evaluated: Lower arm

Area Evaluated: Wrist

Area Evaluated: Hand/finger

Area Evaluated: Inguinal/groin area and thigh/upper leg (this includes evaluation for inguinal hernia or any other soft tissue evaluation in inguinal/groin and thigh area)

Area Evaluated: Knee - soft tissue evaluation only (Baker’s cyst, for example). We do not evaluate joints.

Area Evaluated: Lower leg/calf

Area Evaluated: Ankle

Area Evaluated: Foot/toes