<p begin="00:00:07.385" end="00:00:09.473" style="s2">- [Voiceover] A curved or<br />phased array transducer</p>
<p begin="00:00:09.473" end="00:00:12.170" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:12.170" end="00:00:14.744" style="s2">an aorta ultrasound exam.</p>
<p begin="00:00:14.744" end="00:00:16.791" style="s2">The entire length of the aorta from</p>
<p begin="00:00:16.791" end="00:00:18.015" style="s2">the level of the diaphragm</p>
<p begin="00:00:18.015" end="00:00:20.748" style="s2">to the bifurcation of the iliac arteries</p>
<p begin="00:00:20.748" end="00:00:23.480" style="s2">must be evaluated in two planes.</p>
<p begin="00:00:23.480" end="00:00:26.126" style="s2">The examination begins with the transducer</p>
<p begin="00:00:26.126" end="00:00:29.631" style="s2">placed transversely in<br />the epigastric mid line,</p>
<p begin="00:00:29.631" end="00:00:33.631" style="s2">with the marker directed<br />to the patient's right.</p>
<p begin="00:00:34.682" end="00:00:37.901" style="s2">The aorta is seen as a<br />round, pulsatile structure,</p>
<p begin="00:00:37.901" end="00:00:41.184" style="s2">anterior to the bright<br />reflection of the vertebrae.</p>
<p begin="00:00:41.184" end="00:00:43.074" style="s2">The vena cava is an oval structure</p>
<p begin="00:00:43.074" end="00:00:46.359" style="s2">immediately to the left of<br />the aorta on the screen,</p>
<p begin="00:00:46.359" end="00:00:48.639" style="s2">which changes in caliber with compression</p>
<p begin="00:00:48.639" end="00:00:50.751" style="s2">or deep inspiration.</p>
<p begin="00:00:50.751" end="00:00:53.234" style="s2">The abdominal aorta will course gradually,</p>
<p begin="00:00:53.234" end="00:00:56.523" style="s2">becoming more superficial<br />as it progresses distally.</p>
<p begin="00:00:56.523" end="00:00:58.935" style="s2">The transducer is slowly moved distally</p>
<p begin="00:00:58.935" end="00:01:01.352" style="s2">to identify the celiac trunk,</p>
<p begin="00:01:02.313" end="00:01:03.563" style="s2">renal arteries,</p>
<p begin="00:01:06.503" end="00:01:08.753" style="s2">superior mesenteric artery,</p>
<p begin="00:01:12.713" end="00:01:15.718" style="s2">and bifurcation to the iliac arteries.</p>
<p begin="00:01:15.718" end="00:01:18.027" style="s2">Note the location of any change in size</p>
<p begin="00:01:18.027" end="00:01:20.307" style="s2">of the aorta or iliac arteries,</p>
<p begin="00:01:20.307" end="00:01:23.021" style="s2">and measure in long and short axis views</p>
<p begin="00:01:23.021" end="00:01:25.054" style="s2">from outer wall to outer wall</p>
<p begin="00:01:25.054" end="00:01:27.444" style="s2">to determine the true diameter.</p>
<p begin="00:01:27.444" end="00:01:30.347" style="s2">The transducer is returned<br />to the epigastric area</p>
<p begin="00:01:30.347" end="00:01:32.963" style="s2">and rotated 90 degrees clockwise,</p>
<p begin="00:01:32.963" end="00:01:36.205" style="s2">with the orientation marker<br />to the patient's head.</p>
<p begin="00:01:36.205" end="00:01:38.466" style="s2">The transducer is swept side to side</p>
<p begin="00:01:38.466" end="00:01:41.870" style="s2">to identify the maximal<br />diameter of the aorta.</p>
<p begin="00:01:41.870" end="00:01:45.463" style="s2">The abdominal aorta will have<br />proximal to distal taper.</p>
<p begin="00:01:45.463" end="00:01:47.712" style="s2">The transducer is moved distally</p>
<p begin="00:01:47.712" end="00:01:49.767" style="s2">to evaluate the walls of the aorta</p>
<p begin="00:01:49.767" end="00:01:52.767" style="s2">for any change in the shape or size.</p>
<p begin="00:01:55.622" end="00:01:57.555" style="s2">If the aorta is difficult to visualize</p>
<p begin="00:01:57.555" end="00:02:01.245" style="s2">due to overlying bowel, gentle<br />downward transducer pressure</p>
<p begin="00:02:01.245" end="00:02:04.715" style="s2">may encourage peristalsis<br />of the overlying bowel.</p>
<p begin="00:02:04.715" end="00:02:06.950" style="s2">Alternatively, consider moving the patient</p>
<p begin="00:02:06.950" end="00:02:09.314" style="s2">into a left lateral decubitus position</p>
<p begin="00:02:09.314" end="00:02:13.481" style="s2">to re-position the bowel<br />away from the field of view.</p>

<p begin="00:00:09.529" end="00:00:11.032" style="s2">- In our other video we talked about</p>
<p begin="00:00:11.032" end="00:00:13.728" style="s2">patient position and<br />transducer orientation,</p>
<p begin="00:00:13.728" end="00:00:15.992" style="s2">and in this video I'd like to talk about</p>
<p begin="00:00:15.992" end="00:00:19.265" style="s2">inputting information into<br />the ultrasound machine</p>
<p begin="00:00:19.265" end="00:00:22.440" style="s2">and how to go about<br />acquiring a measurement.</p>
<p begin="00:00:22.440" end="00:00:25.072" style="s2">So, on the ultrasound machine,</p>
<p begin="00:00:25.072" end="00:00:28.023" style="s2">one of the things that's<br />different about IMT as</p>
<p begin="00:00:28.023" end="00:00:30.631" style="s2">compared to some of<br />the other examinations,</p>
<p begin="00:00:30.631" end="00:00:32.464" style="s2">is that there is some information that</p>
<p begin="00:00:32.464" end="00:00:34.713" style="s2">you really need to have<br />input into the system.</p>
<p begin="00:00:34.713" end="00:00:38.440" style="s2">It's very important to have<br />the patient gender input</p>
<p begin="00:00:38.440" end="00:00:41.513" style="s2">into the system because<br />the restratification</p>
<p begin="00:00:41.513" end="00:00:44.841" style="s2">gets applied according to male or female,</p>
<p begin="00:00:44.841" end="00:00:46.423" style="s2">and the date of birth,</p>
<p begin="00:00:46.423" end="00:00:49.216" style="s2">that's information that<br />is very important as well.</p>
<p begin="00:00:49.216" end="00:00:52.871" style="s2">Ethnicity is an option<br />that's offered for IMT only,</p>
<p begin="00:00:52.871" end="00:00:55.639" style="s2">and that's relative to<br />the restratification,</p>
<p begin="00:00:55.639" end="00:00:58.378" style="s2">so you always wanna have<br />that information selected.</p>
<p begin="00:00:58.378" end="00:01:01.945" style="s2">You also wanna be sure you<br />have the IMT exam selected.</p>
<p begin="00:01:01.945" end="00:01:05.202" style="s2">Once you get all that information input</p>
<p begin="00:01:05.202" end="00:01:06.993" style="s2">you can begin with your<br />study and know that</p>
<p begin="00:01:06.993" end="00:01:08.689" style="s2">when the study is completed,</p>
<p begin="00:01:08.689" end="00:01:11.153" style="s2">that information will<br />automatically be populated</p>
<p begin="00:01:11.153" end="00:01:14.236" style="s2">into the patient report for SonoCalc.</p>
<p begin="00:01:15.234" end="00:01:17.249" style="s2">You wanna take your measurements<br />from the distal portion</p>
<p begin="00:01:17.249" end="00:01:21.641" style="s2">of the common carotid artery<br />just before the bifurcation.</p>
<p begin="00:01:21.641" end="00:01:23.395" style="s2">So, when you're acquiring<br />your measurements,</p>
<p begin="00:01:23.395" end="00:01:27.386" style="s2">you will always be scanning<br />in the longitudinal plane.</p>
<p begin="00:01:27.386" end="00:01:30.654" style="s2">You'll have the artery in long,</p>
<p begin="00:01:30.654" end="00:01:34.772" style="s2">and you wanna get a nice image of the IMT.</p>
<p begin="00:01:34.772" end="00:01:39.140" style="s2">You don't wanna take your<br />measurement within the bulb.</p>
<p begin="00:01:39.140" end="00:01:40.467" style="s2">Depending on your protocol,</p>
<p begin="00:01:40.467" end="00:01:43.692" style="s2">you'll take measurements<br />from the near wall</p>
<p begin="00:01:43.692" end="00:01:45.109" style="s2">and the far wall.</p>
<p begin="00:01:46.564" end="00:01:50.727" style="s2">So, when you have a good image of the IMT</p>
<p begin="00:01:50.727" end="00:01:53.308" style="s2">you'll freeze the image,</p>
<p begin="00:01:53.308" end="00:01:55.331" style="s2">select the calcs,</p>
<p begin="00:01:55.331" end="00:01:58.499" style="s2">then you wanna select<br />the IMT measurement tool,</p>
<p begin="00:01:58.499" end="00:02:00.437" style="s2">and you'll get this drop<br />down menu that gives you</p>
<p begin="00:02:00.437" end="00:02:04.180" style="s2">options of which angle<br />are you scanning from,</p>
<p begin="00:02:04.180" end="00:02:07.894" style="s2">and when you select the<br />label, the tool will come up.</p>
<p begin="00:02:07.894" end="00:02:09.860" style="s2">And you just select the direction that</p>
<p begin="00:02:09.860" end="00:02:11.820" style="s2">you need to move the tool,</p>
<p begin="00:02:11.820" end="00:02:13.996" style="s2">whether it's left and right,</p>
<p begin="00:02:13.996" end="00:02:15.246" style="s2">or up and down.</p>
<p begin="00:02:16.835" end="00:02:20.035" style="s2">And you bring the tool<br />down and it should attach</p>
<p begin="00:02:20.035" end="00:02:22.084" style="s2">onto the arterial wall,</p>
<p begin="00:02:22.084" end="00:02:24.319" style="s2">and the measurement will<br />automatically be displayed</p>
<p begin="00:02:24.319" end="00:02:26.231" style="s2">on the bottom of the screen.</p>
<p begin="00:02:26.231" end="00:02:28.000" style="s2">This is a far wall measurement.</p>
<p begin="00:02:28.000" end="00:02:30.999" style="s2">Now I'll show you how to<br />acquire a near wall measurement.</p>
<p begin="00:02:30.999" end="00:02:32.327" style="s2">Near wall measurement is, again,</p>
<p begin="00:02:32.327" end="00:02:34.879" style="s2">taken at the distal portion<br />of the common carotid artery</p>
<p begin="00:02:34.879" end="00:02:37.379" style="s2">just prior to the bifurcation.</p>
<p begin="00:02:39.031" end="00:02:41.167" style="s2">You wanna select the calcs.</p>
<p begin="00:02:41.167" end="00:02:42.663" style="s2">And when you select your label,</p>
<p begin="00:02:42.663" end="00:02:44.431" style="s2">you wanna select a label that has N</p>
<p begin="00:02:44.431" end="00:02:46.622" style="s2">for near wall measurement.</p>
<p begin="00:02:46.622" end="00:02:48.705" style="s2">When the tool comes up...</p>
<p begin="00:02:51.110" end="00:02:53.121" style="s2">You can bring it down.</p>
<p begin="00:02:53.121" end="00:02:54.895" style="s2">Move it left to right.</p>
<p begin="00:02:54.895" end="00:02:57.783" style="s2">If you need to make an<br />adjustment of the measurements,</p>
<p begin="00:02:57.783" end="00:03:00.566" style="s2">we're gonna here adjust the lumen line,</p>
<p begin="00:03:00.566" end="00:03:02.528" style="s2">select the lumen,</p>
<p begin="00:03:02.528" end="00:03:04.624" style="s2">turn the dial and make the adjustment,</p>
<p begin="00:03:04.624" end="00:03:06.553" style="s2">and again, across the bottom of the screen</p>
<p begin="00:03:06.553" end="00:03:09.111" style="s2">the measurement results are displayed.</p>
<p begin="00:03:09.111" end="00:03:11.802" style="s2">The right side, lateral, and you have N,</p>
<p begin="00:03:11.802" end="00:03:15.560" style="s2">indicating that this is<br />a near wall measurement.</p>
<p begin="00:03:15.560" end="00:03:17.408" style="s2">So, when you're looking at the measurement</p>
<p begin="00:03:17.408" end="00:03:19.220" style="s2">you will notice a little portion</p>
<p begin="00:03:19.220" end="00:03:22.191" style="s2">of the measurement line is blue.</p>
<p begin="00:03:22.191" end="00:03:26.034" style="s2">That's identifying the thickest<br />portion of the measurement.</p>
<p begin="00:03:26.034" end="00:03:29.758" style="s2">The max region correlates<br />to this little blue line.</p>
<p begin="00:03:29.758" end="00:03:33.168" style="s2">The maximal thickness of this measurement.</p>
<p begin="00:03:33.168" end="00:03:34.655" style="s2">When you acquire your measurements,</p>
<p begin="00:03:34.655" end="00:03:36.776" style="s2">it's important to remember<br />to hit the save key</p>
<p begin="00:03:36.776" end="00:03:38.702" style="s2">so that those measurements<br />will be populated</p>
<p begin="00:03:38.702" end="00:03:40.285" style="s2">in the report page.</p>
<p begin="00:03:41.599" end="00:03:44.897" style="s2">To view your report at the end of an exam</p>
<p begin="00:03:44.897" end="00:03:47.564" style="s2">select the more key, and report.</p>
<p begin="00:03:50.000" end="00:03:51.839" style="s2">And all measurements that have been saved</p>
<p begin="00:03:51.839" end="00:03:53.672" style="s2">will be populated in the report.</p>
<p begin="00:03:53.672" end="00:03:56.439" style="s2">The individual measurement<br />results can be displayed,</p>
<p begin="00:03:56.439" end="00:04:00.092" style="s2">as well as the summary<br />averaging all measurements</p>
<p begin="00:04:00.092" end="00:04:02.670" style="s2">that have been acquired.</p>
<p begin="00:04:02.670" end="00:04:06.420" style="s2">In summary, the IMT exam<br />is done bilaterally,</p>
<p begin="00:04:07.381" end="00:04:10.951" style="s2">and you want to make sure<br />that you image the patient</p>
<p begin="00:04:10.951" end="00:04:13.421" style="s2">from all recommended angles,</p>
<p begin="00:04:13.421" end="00:04:16.101" style="s2">anterior, lateral, and posterior.</p>
<p begin="00:04:16.101" end="00:04:18.644" style="s2">And remember, according to your protocol,</p>
<p begin="00:04:18.644" end="00:04:22.811" style="s2">you can evaluate the near<br />wall as well as the far wall.</p>