Standardization of ultrasound exams

Check the position of the CBR Ultrasound Commission on the subject The versatility and high efficiency of ultrasound as a diagnostic method in daily medical practice constitute the great strength of this method, but at the same time, impose an enormous difficulty in standardizing conducts both in terms of the execution of ultrasound examinations by the imaging specialist, regarding the request of the exams to be performed. Some aspects deserve special consideration: · The multiplicity of possible designations to refer to some regions that can be studied by ultrasound. · The extent of disease across different organs or structures nearby, but often not exactly within the requested field of study. · The need to adapt the terminology used in the assistant physician's request to the codes available at CBHPM or to other reference tables, depending on the contracted party with health insurance plans. · Any mistaken request in the medical order regarding the structure that you would really like to see evaluated or the dissociation of the requested structure and the informed medical indication. · The increase in lawsuits regarding both the included and missing content of the medical report. The situations mentioned above are examples that demonstrate the importance of standardizing the denomination of the ultrasound study by region and the real scope of each exam according to this denomination, making the communication and integration between the assistant physician and the specialist in imaging diagnosis more efficient, as well as how clearer the interaction of the imaging service with the patient and health plans. In this first version, we tried to list the main points of interest and doubts that arose from the practice of the specialists involved in this Commission, as well as from the consultations carried out to the CBR through its official vehicles, based on the denominations of ultrasound exams used in the codes available in the CBHPM 2016. Just as medical practice itself is dynamic and changeable, new versions of this standardization should be prepared when technological evolution, norms or laws or even when any question or doubt of greater interest makes reinterpretation or further clarification necessary. ultrasound of Upper Abdomen Includes assessment of the Liver, Bile ducts, Gallbladder, Spleen and Pancreas. It does not include the evaluation of the Kidneys, Abdominal Aorta, Inferior Vena Cava and other retroperitoneal structures. The study with Doppler is not included in this type of exam, and the desired organ must be specifically requested in the medical order when it is necessary (there are even specific codes for some organs and structures). Assessment of abdominal wall structures is not included in this type of examination. ultrasound of Total Abdomen Includes assessment of the Liver, Bile ducts, Gallbladder, Spleen, Pancreas, Kidneys and Bladder. The B-mode study (without Doppler) of the Abdominal Aorta and the Inferior Vena Cava and other retroperitoneal structures is also included in this type of exam. When necessary, the Doppler evaluation of any of these structures or other abdominal organs must be specifically requested and charged in addition to the baseline exam (there are specific codes). Intestinal loops, cecal appendix, adrenals and other abdominal structures should be mentioned if pathology is detected by the method during the examination. Assessment of pelvic organs (uterus, ovaries and appendages, prostate and seminal vesicles) is not included in this assessment. The performance of a post-voiding bladder evaluation is not routinely performed, and may be included at the discretion of the performing physician or when explicitly requested in the medical order. Assessment of abdominal wall structures is not included in this type of examination. ultrasound of Kidneys and Urinary Tracts It includes the evaluation of the Kidneys and Bladder. The ureters and adrenal glands are mentioned only if any pathology is detected by the method, and are not necessarily included in the exam report in the absence of findings or when these organs are not detected in the ultrasound exam. The performance of a post-voiding bladder assessment may be included at the discretion of the performing physician, in compliance with the clinical indication or, when explicitly requested in the medical request. Assessment of pelvic organs (uterus, ovaries and appendages, prostate and seminal vesicles) is not included in this assessment. The Doppler study is not included in this type of exam and must be specifically requested in the medical order and charged in addition to the base exam when necessary. ultrasound of Abdominal Wall It includes the evaluation of the integrity of the muscle groups of the abdominal wall, as well as the search for hernias, subcutaneous lesions in the anterior abdominal wall (including in the umbilical region). The study is often carried out directed to the region of the patient's complaint or to the region indicated in the medical order. The evaluation of the inguinal regions (including the search for hernias, masses, collections or lymph node enlargement in these regions) is not included in this type of examination, and must be requested separately when necessary (unilateral or bilateral). It does not include the evaluation of the intra-abdominal organs and the pelvis, the study of which, when necessary by the attending physician, must be requested separately. ultrasound of Inguinal Region It includes the search for hernias, masses, collections or lymph node enlargement in the inguinal regions. It can be a unilateral or bilateral evaluation, depending on the medical request, which must specify the indication for the study and the laterality of the desired investigation. ultrasound of Prostate (Abdominal route) or da Male Pelvis (Lower abdomen) Includes transabdominal assessment of the Bladder, Prostate (volumetry and weight estimation), Seminal vesicles and measurement of post-voiding bladder residue. ultrasound of Prostate (Transrectal) It does not include the transabdominal assessment of the Bladder or the measurement of post-voiding bladder residue. ultrasound of Female Pelvis (Lower Abdomen) Includes transabdominal assessment of the Bladder, Uterus, Ovaries and Adnexal Regions. The performance of a post-voiding bladder evaluation is not routinely performed, but it may be included at the discretion of the performing physician, in compliance with the clinical indication or, when explicitly requested in the medical request. ultrasound transvaginal Includes endovaginal evaluation of the Uterus, Ovaries and Adnexal Regions. The vagina is mentioned only if any pathology is detected by the method, and is not necessarily included in the examination report in the absence of alterations. The performance of a transabdominal evaluation complementary to the endocavity study is not routinely performed. The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. ultrasound of Thyroid It includes thyroid evaluation (Volumetry, Evaluation of its echotexture, Research and Characterization of Nodules or other Focal Lesions). Does not include assessment of cervical lymph nodes. The Doppler of the Thyroid and its focal lesions (including nodules) is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. Thyroid Doppler does not include the evaluation of cervical vessels (carotid and jugular) which has its own code and whose evaluation must be specifically requested in the medical order when it is necessary to perform it. ultrasound of Cervical Region It includes evaluation of the cervical lymph nodes in all their compartments (central and lateral), as well as the thyroid bed (exclusively in case of previous total thyroidectomy), the parathyroid stores and the main cervical muscle groups. Parathyroid glands and muscle groups are specified in the medical report only in case of pathology detected by the method, it is not necessary to report these structures if they are not individualized or if they do not present alterations. It does not include the assessment of Thyroid and Salivary Glands, which have specific codes and must be specified separately in the medical order. The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. The examination of the Cervical Region with Doppler does not include the evaluation of cervical vessels (carotid and jugular) which have their own code and whose evaluation must be specifically requested in the medical order when necessary. ultrasound of Salivary glands Includes evaluation of the Submandibular, Parotid and Sublingual Glands bilaterally. The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. Does not include assessment of Thyroid and Cervical Region. ultrasound of Transfontanella skull The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. ultrasound of boobs It includes evaluation of the Mammary Glands (Evaluation of its echotexture, Research and Characterization of Nodules or other Focal Lesions). It does not include the study of the axillary regions, which must be specifically requested in the medical order (including laterality). The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. ultrasound of Armpit Evaluation of the soft tissues of the right or left armpit according to the physician's request, including the search for atypical lymph nodes at levels I, II and III. The study with Doppler is not included in this type of exam, and must be specifically requested in the medical order when it is necessary. CBR's National Commission on Ultrasound will revise the standardizations described above when necessary and timely, remaining available to resolve any additional questions that may be sent to us. Exams not mentioned in this document will be standardized in subsequent publications. Click here and download this opinion in PDF