Urinary Protocol (Renal or Kidney

)

 This protocol includes images of the kidneys and bladder
 You must always evaluate the entire organ first before you store an image
 You should understand completely why you stored the image and identify everything in
the image
 Multiple breathing techniques may be required

Organ/ Scan Label Key Landmarks Identified
Order Plane
RT KID SAG  Renal parenchyma and capsule
LAT
RT KID SAG  Renal parenchyma and capsule
MID  Renal sinus
Sagittal
 Renal parenchyma and capsule
plane of
 Renal sinus
the RT KID SAG
 Measurement
kidney MID
RT o Length measurement from superior to inferior
Kidney pole
RT KID SAG  Renal parenchyma and capsule
MED  Renal sinus at hilum
 Renal parenchyma and capsule
RT KID TX
 Renal sinus
Transver SUP
 Liver
se plane
RT KID TX  Renal parenchyma and capsule
of the
MID  Renal sinus at hilum to include renal vessels
kidney
RT KID TX  Renal parenchyma and capsule
INF  Renal sinus
LT KID SAG  Renal parenchyma and capsule
LAT
LT KID SAG  Renal parenchyma and capsule
MID  Renal Sinus
Sagittal
 Renal parenchyma and capsule
plane of
 Renal Sinus
the LT KID SAG
 Measurement
LT kidney MID
o Length measurement from superior to inferior
Kidney
pole
LT KID SAG  Renal parenchyma and capsule
MED  Renal sinus at hilum
LT KID TX  Renal parenchyma and capsule
Transver SUP  Renal sinus
se plane LT KID TX  Renal parenchyma and capsule
of the MID  Renal sinus at hilum to include renal vessels
kidney LT KID TX  Renal parenchyma and capsule
INF  Renal sinus
BLADDER  Mid and bladder wall
Sagittal
SAG
Bladder
Transver  Mid and bladder wall
BLADDER TX
se
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Urinary Protocol

Anatomical/ Image Correlation

Lateral
Superior

Later Medial
Mid

Mid

Media Inferior

Sagittal Rt. Kidney with Transverse locations
Sagittal
lateral, mid and medial for superior, mid and
sonographic
imaging planes inferior images Transverse
appearance. Mid
shows length sonographic
measurement appearance

Normal Measurement Ranges

Structure Area of Plane Measuremen Comments
Interest t
Kidney Mid Sagittal Length 10-12  Measure from superior pole to
cm inferior pole through the
kidney
Kidney Mid Sagittal AP 2-3 cm  This is site specific – only
taken if 3 measurements are
required:
o Measure anterior to
posterior
Kidney Mid Transverse Width 5-7.5  This is site specific – only
cm taken if 3 measurements are
required:
o Measure in a transverse
plane though the mid
kidney

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Bladder Wall Area of Transverse 3-6 mm  This is an AP measurement for
thickening a distended bladder wall
o Only performed if
abnormalities are
suspected

Common Laboratory Values to be Reviewed prior to Examination

Lab Value Organ Level Indication or Association
Blood urea nitrogen  Kidneys Increased  Renal failure or renal disease
(BUN)
Creatinine  Kidneys Increased  Renal failure or renal disease
White blood cell  Kidneys Increased  Indicates infection
count (WBC)  Bladder

Urinary Protocol

Tips

 Roll the patient up LLD and RLD, if necessary, to see kidneys better
o Use the liver on the right as a window
o Use the spleen on the left as a window
 If urinary obstruction is a concern, use color Doppler to look for bladder jets to verify open
ureter
 If patient has a Foley catheter and the bladder is of concern, ask the patient’s nurse for
permission to clamp the bag shut at the beginning of the study so the bladder will fill while
you scan - REMEMBER TO UNCLAMP WHEN STUDY IS COMPLETE

 Coronal Scanning
o Sometimes, especially on the left, the kidney can be seen best scanning coronally.
Anterior and posterior images can be obtained from the coronal scan plane.
 The medial and lateral images cannot be obtained from this plane.
 Therefore, anterior, mid, and posterior images in coronal should documented.
 The renal parenchyma, sinus, and capsule will be seen in each image
 Label Coronal - Anterior, Mid, or Posterior
 Pathology Seen
o Gray scale sagittal and transverse images
o Gray scale sagittal and transverse images with 3 measurements (length, width, and
height)
o Color Doppler image to document the presence of blood flow
o Spectral Doppler image to document type and velocity of blood flow
o For hydronephrosis, demonstrate connection of the dilated pyramids to the renal pelvis
and include ureter images if the ureter is dilated.
o For renal calculi, move the focal zone to the level of the calculus to aid in
demonstrating posterior shadowing

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o If a pathology is seen in the bladder, roll the patient onto their side to determine if the
pathology is mobile or attached to the bladder wall.

Image
Image 21
Liver
Liver SagTXMPV

RightAnterior liver with
lobe sagittal with main
diaphragm
portal vein

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