Standards of the Polish Ultrasound Society – update. The liver, gallbladder and bile ducts examinations

Abstract

Ultrasonography, which usually constitutes an initial imaging method of the gallbladder, liver and bile ducts diseases, allows for final diagnosis or determines another diagnostic step. The continuously progressing technological advancement forces to broaden the indications for ultrasound diagnostics and enables easier and more precise imaging of the tested structures. Performing the examination in accordance with current standards allows for the optimization of the sensitivity and specificity parameters of ultrasound examinations in the diagnosis of the liver, gallbladder and bile ducts pathologies as well as minimizes the probability of error-making. This article presents a recommended liver, gallbladder and bile ducts ultrasound technique which indicates an optimal positioning of the patient for the exam as well as the sites of the ultrasound transducer application. Minimum technical parameters of the apparatus have been specified with respect to the requirements of modern ultrasound techniques which enable imaging with the use of contrast agents and elastography. Furthermore, the article proposes a standard exam description containing essential patient-related data and provides required ultrasound evaluation parameters for the tested organs. Attention has been drawn to the appropriate manner of preparing the patient for the examination and the features of the tested structures have been presented. The article also contains a brief description of the liver, gallbladder and bile ducts diseases which are most often diagnosed by ultrasound examinations. Moreover, the use of elastography as well as contrast-enhanced examinations in the diagnostics of fibrosis and focal changes in the liver have been discussed. This article has been prepared on the basis of the Ultrasound Examination Standards of the Polish Ultrasound Society (2011) and updated with reference to the latest findings in pertinent literature.

Bile Duct Strictures Caused by Solid Masses: MR in Differential Diagnosis and as a Prognostic Tool to Plan the Endoscopic Treatment

“…In 3D MRCP the use of water as a natural contrast in duodenum and evaluation of both (maximum intensity projection) MIP and source cholangiopancreatographic images are the simplest methods to decrease the number of misdiagnoses in these cases [ 16 , 18 ]. The influence of bile duct dilatation and presence of gas and fluid in the duodenum on sensitivity in the diagnosis of localization and cause of biliary duct pathologies are also common in ultrasonography performed in most cases prior to magnetic resonance [ 19 , 20 ].…”

Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Long Version) – General Aspects

“…Algorithms with predefined transducer positions have been published for almost all US applications, in particular for abdominal US 30 31 32 33 34 , thoracic US 35 36 , joint US 37 , thyroid US 38 39 , echocardiography 40 , vascular US 41 42 43 44 , and US-guided interventions 45 46 . If standard examination algorithms have not been published for a particular US application, the US practitioner should follow an institutional or at least an individual standardized examination scheme to ensure that it is retrospectively clear what was examined and how.…”

“…Algorithms with predefined transducer positions have been published for almost all US applications, in particular for abdominal US [30][31][32][33][34], thoracic US [35,36], joint US [37], thyroid US [38,39], echocardiography [40], vascular US [41][42][43][44], and US-guided ▶ Fig. 4 Clinical ultrasound room for ambulatory and bedridden patients with two patient changing rooms and two desks, suitable for complex interventions such as drainage procedures: approximately 45 m 2 (e. g. 7.5 × 6 m) are required for an examination couch, an additional patient bed, the ultrasound machine, one desk space for the person to write the report divided from the rest of the room at least by an office shelf, a second desk space for the assistant person with an open view of the patient, two patient changing rooms, two separate hand washing spaces for personnel and patients, a combined bench and cupboard for intervention preparation and material storage and additional space for sterile setup (including sterile instrument table ).…”

Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Short Version) – General Aspects

“…Algorithms with predefined transducer positions have been published for almost all US applications, in particular for abdominal US 25 26 27 28 29 , thoracic US 30 31 , joint US 32 , thyroid US 33 34 , echocardiography 35 , vascular US 36 37 38 39 , and US-guided interventions 40 41 . If standard examination algorithms have not been published for a particular US application, the US practitioner should follow an institutional or at least an individual standardized examination scheme to ensure that it is retrospectively clear what was examined and how.…”