Imaging Protocol Overview
Cranial Ultrasound Protocol
Billing codes
| Exam | Code |
|---|---|
| Brain limited | 76506 |
| TCD limited | 93888 |
Equipment settings
Transducers
| Setting | Phased array probe | Linear probe |
|---|---|---|
| Preset | Abdomen | Abdomen |
| Depth / focal point | 15 cm depth, focal point at 7-8 cm | 4 cm depth, focal point at 2 cm |
| Frequency | 3 MHz | 6 MHz or harmonic for clarity |
| Gain | Turn gain way up | Turn gain up some |
| Optimize for | Visibility of midline and contralateral structures | Visibility of subdural and cortical structures |
Imaging modes
- B-mode (grayscale)
Optional imaging mode
- Color/Power Doppler — if evaluating vascular anatomy
Imaging windows
Anterior and posterior burr holes
Identify an extra cranial structure, such as ear canal or TMJ to use as distance trajectory. Notate this structure in the report using the most perpendicular position possible.
Typical viewable anatomy
- Lateral ventricles
- Cavum septum pellucidum/vergae
- Third ventricle
- Thalamus
- Falx Cerebri
- Sylvia Fissure
- Choroid plexus
- Cortical surface
- Cortical and dural vessels
- Posterior aspect of lateral ventricles
- Corpus callosum
- Cerebellum
- Fourth ventricle
Coronal plane (notch facing up)
- Sweep anterior to posterior to identify the edges and middle of the plate
- Fan anterior to posterior to identify the optimal view of target structures
Annotate on the image: laterality of burr hole, midline, Ventricular size, hemorrhage, midline shift, structure echogenicity
Save 2-3 images for measurements to midline and/or contralateral
Sagittal plane (notch facing nose)
- Sweep superior and inferiorly to identify the edges and middle of the plate
- Fan superior and inferiorly to identify optimal view of structures
Annotate: Ventricular size, midline shift, structure echogenicity
Save 2-3 images for measurements to midline and/or contralateral
Reporting
Measurements
- Plate outer surface to midline
- Plate outer surface to cortical surface
- Ventricular size
Echogenicity
- Targeted anatomical structures
- Structural anomalies
Doppler findings (if performed)
- Direction of flow
- Velocity