Scrotum Protocol

Patient Setup- Have the patient perform the first 2 bullets in the room alone
 Place a rolled towel lengthwise between the upper thighs (as high as possible) under the scrotum
 Place a towel over the male genitalia not being examined and use a sheet to cover the patient’s legs and abdomen/pelvic
region. The scrotum should be the only area exposed for scanning.
Organ/ Scan Label Landmarks Identified
Order Plane
Transverse RT AND LT TESTICLE  RT Testicle
with Virtual  Median Raphe
convex  LT Testicle
 RT Testicle
RT and LT  Median Raphe
Testicle  LT Testicle
with  Color Doppler box covering both testicles
Median Transverse RT TESTICLE  RT Testicle only with Color Doppler
Raphe RT TESTICLE  RT Testicle with Color Doppler & Spectral Analysis (arterial flow)
RT TESTICLE  RT Testicle with Color Doppler & Spectral Analysis (venous flow)
LT TESTICLE  LT Testicle only with Color Doppler
LT TESTICLE  LT Testicle with color Doppler & Spectral Analysis (arterial flow)
LT TESTICLE  LT Testicle with color Doppler & Spectral Analysis (venous flow)
Transverse RT SPERM CORD  RT Spermatic Cord
RT EPID  RT Epididymal Head
RT TESTICLE SUP  RT Superior Testicle
RT TESTICLE MID  RT Mid Testicle
RT TESTICLE MID  RT Mid Testicle with width measurement
RT TESTICLE INF  RT Testicle Inferior
RT Testicle Sagittal RT EPID  RT Epididymal head, body, and tail
RT EPID  RT Epididymal Head with AP measurement
RT TESTICLE LAT  RT Lateral Testicle
RT TESTICLE MID  RT Mid Testicle
RT TESTICLE MID  RT Mid Testicle at mediastinum w/ length and AP measurements
RT TESTICLE MID  RT Mid Testicle at mediastinum w/ Color Doppler
 RT Epididymal head
RT TESTICLE MED  RT Testicle Medial
Transverse LT SPERM CORD  LT Spermatic Cord
LT EPID  LT Epididymal Head
LT TESTICLE SUP  LT Superior Testicle
LT TESTICLE MID  LT Mid Testicle
LT TESTICLE MID  LT Mid Testicle with width measurement
LT TESTICLE INF  LT Testicle Inferior
LT Testicle Sagittal LT EPID  LT Epididymal head, body, and tail
LT EPID  LT Epididymal Head with AP measurement
LT TESTICLE LAT  LT Lateral Testicle
LT TESTICLE MID  LT Mid Testicle
LT TESTICLE MID  LT Mid Testicle at mediastinum with length and AP measurements
LT TESTICLE MID  LT Mid Testicle at mediastinum w/ Color Doppler
 LT Epididymal head
LT TESTICLE MED  LT Testicle Medial
AK\backup\Abdomen II\protocols
Scrotum Protocol
 Use warm gel when performing the examination
Normal Measurement Ranges

Structure Area of Interest Plane Measurement Comments
 AP thickness
Scrotal Wall Thickness of Wall Transverse 2-8 mm  Use standoff pad or glob of gel to assist
with getting measurements
 Measurements represent
Head 10-12 mm
anterior/posterior dimensions
Epididymis Head, Body & Tail Sagittal Body 2-4 mm
 Body and tail measurements taken only if
Tail 2-5 mm
abnormalities are suspected
 Mid testicle superior to inferior
3-5 cm
Length Sagittal  Use virtual convex or dual screen if the
entire testicle cannot be seen
 Mid testicle anterior to posterior
Testicle Height (A/P  *Some physicians may want this
Sagittal 2-3 cm
thickness) measurement in the transverse plane
(Clarify before exam)
2-3 cm  Mid testicle medial to lateral
Width Transverse

Tips
 You must always evaluate the entire organ first before you store an image
 Use multiple focal zones
 Make sure you look above and below the testicle for pathology (the entire scrotal sac should be evaluated)
 Look for enlarged lymph nodes in the groin
 Look for varicoceles or hernias in the area of the spermatic cord

Color and Spectral Doppler
 Testes in general are low resistance—Low filter and low PRF- do not change settings once set
 Epididymi exhibit low to no flow in normal conditions
 Testicular, capsular centripetal and recurrent rami arteries
 Low resistance flow
 broad systolic peaks & high diastolic flow
 Cremasteric and deferential arteries
 High resistance flow
 narrow systolic peaks & low diastolic flow

Pathology -If pathology is present you must document the pathology in its entirety; images should include:
 Gray scale sagittal and transverse images
 Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
 Color Doppler image to document the presence of blood flow
 Spectral Doppler image to document the type and velocity of blood flow
 Special notes:
 If a varicocele is suspected, store images prior to, during and post Valsalva maneuver
 If a mass is suspected superiorly in the testicle, look for peristalsis---the mass may be herniated bowel
 If you are unable to locate testes within the scrotal sac, look in the lower pelvis for them
 If patient presents with infertility—add images of the seminal vesicles and vas deferens
AK\backup\Abdomen II\protocols