Gastrointestinal Physiology 

  Online Videos:
      UCI Lecture #3 

      Optional videos: 
      Ultrasound podcast: Gallbladder 
      Biliary Lecture 
      Small Bowel Obstruction 

Trace the liver as it lies under the skin. Appreciate the gallbladder in its position within the main interlobar fissure of the liver. Understand the anatomy of the portal triad and utilize color Doppler to enhance visualization. Trace the spleen in its location under the skin. View the proximal esophagus adjacent to the trachea and observe saliva and air during swallowing. Perform "mowing the lawn" compression technique to observe intestinal loops. 

Hepatobiliary System 
 1. Choose the correct transducer to assess the hepatobiliary system. 
 2. Place the patient in the correct position to assess the hepatobiliary system. 
 3. Demonstrate the gallbladder in long and short axis using both approaches:
        a. Subcostal Sweep. 
        b. X minus 7. 
 4. Demonstrate the portal vein, hepatic veins, and IVC. 
 5. Measure the common bile duct. 
 6. Measure the long and short axis of the spleen. 

Intestinal system
 7. Choose the correct transducer to assess the intestinal system. 
 8. Demonstrate the esophagus and observe saliva being swallowed (*Not Covered in Podcast but easy to do). 
 9. Demonstrate compression of the abdominal wall musculature down to psoas muscle in an effort to visualize the appendix. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were adequate measurements taken? 

Cardiovascular 2

  Online video: 
      UCI Podcast #7 

      Optional/Advanced: 
      Diastology part 1 
      Diastology part 2 
      EPSS 

Using the parasternal long axis, measure the diameter of the left ventricular outflow tract. Using the apical 5-chamber view, maneuver the pulsed-wave Doppler gate over the aortic valve and operate the software to trace the velocity-time interval and calculate the cardiac output. Visualize color Doppler in the carotid arteries and note the intima-media thickness. Visualize the abdominal aorta from the celiac axis past the superior mesenteric artery and down to the bifurcation. 

Parasternal Long Axis (PSL) 
 1. Activate the cardiac software setting. 
 2. Choose the correct transducer to image the heart in the parasternal long axis. 
 3. Place the patient in the correct position to obtain a PSL view. 
 4. Aim the indicator in the correct direction. 
 5. Demonstrate the RV, LV, LA, mitral and aortic valves. 
 6. Appreciate the contractility of the LV and measure the LVOT diameter (save it). 
 7. Verify how the anterior septal leaflet of the mitral valve contacts the septum. 
 8. Measure the Left Ventricular Outflow Tract Diameter (LVOTD). 
 9. Save this value using the ultrasound machine software. 

Apical Four Chamber (A4C) 
 10. Aim the indicator to the correct position to obtain A4C. 
 11. Trace the LV, RV, LA, and RA and identify the septum. 
 12. Appreciate the chamber size differences (RV 2/3 of LV). 
 13. Apply colorflow Doppler over the tricuspid and mitral valves and observe the lack of a blue jet flowing backwards into the atria. 

Apical “Fifth” Chamber (A5C) 
 14. From A4C, tilt the transducer anteriorly to obtain A5C. 
 15. Activate pulsed wave Doppler over the aortic valve and note the cardiac output. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were the correct measurements taken? 
-Were the correct applications used? 

Respiratory

  Online Videos: 
      UCI Lung Ultrasound – Lecture #8 
      Pneumothorax lecture 

      Optional: 
      Ultrasound of the Dyspneic Patient 
      Lung Ultrasound with Vicki Noble Part 1 
      Lung Ultrasound with Vicki Noble Part 2 
      Lung Ultrasound with Mike Stone Part 1 
      Lung Ultrasound with Mike Stone Part 2 

Demonstrate the windows necessary to view the lung fields in their entirety. Identify the pleural line in its location between each rib level. Appreciate the diaphragmatic excursion using coronal planes. Locate the cupula of the lung and the proximity to the subclavian vein.

Pneumothorax 
 1. Choose the correct transducer to assess for pneumothorax. 
 2. Place the patient in the correct position to assess for pneumothorax. 
 3. Identify bilateral lung sliding in 2D and M-Mode. 
        a. What is the VPPI? 
        b. Describe “ants marching” and “sky-ocean-beach”.     
 4. Demonstrate M-Mode tracing. 

Pleural Effusion 
 5. Choose the correct transducer to assess for pleural effusion. 
 6. Place the patient in the correct position to assess for pleural effusion. 
 7. Identify the diaphragm and the mirror image artifact. 
        a. Right chest 
        b. Left chest 

Pulmonary Edema 
 8. Choose the correct transducer to assess for pulmonary edema. 
 9. Demonstrate the 8 locations (4 per chest). 
        a. Identify A-lines in these locations. 

Pneumonia 
 10. Choose the correct transducer to assess for pneumonia. 
 11. Place the patient in the correct position. 
 12. Identify the locations where the transducer is needed to assess for pneumonia. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were the correct measurements taken? 
-Were the correct applications used? 


Musculoskeletal

  Online Videos: 
      UCI podcast #9 

      Optional Videos:
      Radius Fx 
      Hip Ultrasound 

Differentiate the various soft tissue types such as muscle, bone, tendon, vasculature, nerve, and fat. Appreciate the joint spaces, musculature, and tendons during passive range of motion. Bones of the shoulder, knee, and hand should be identified. Utilize the water bath and gel standoff pads to view structures in the hand.

Hands-on Objectives: 

Shoulder 
 1. Identify the biceps tendon between the subscapularis and supraspinatus in rotator cuff interval in both short and long axes. 
 2. Identify the subscapularis tendon in two planes. 
 3. Identify the coraco-acromial ligament. 
 4. Identify the supraspinatus and infraspinatus muscles. 
 5. Identify the posterior gleno-humeral joint. 
 6. Identify the supraspinatous tendon. 

Leg 
 7. Demonstrate the quadriceps tendon with attachment to the patella. 
 8. Identify the patellar tendon with attachment to the tibial tuberosity. 
 9. Identify the medial collateral ligament. 
 10. Identify the gastrocnemius and soleus muscles with the Achilles tendon in both long and short axes. 

Hand 
 11. Demonstrate the median nerve as separate from flexor tendons. 
 12. In the long axis of the wrist identify the distal radius, lunate, and capitate bones. 
 13. Identify the pulley system of the digits and observe their function under the long axis. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were the correct measurements taken? 
-Were the correct applications used? 

Genitourinary

  Online Videos: 
      UCI podcast #2 
      Renal Lecture 

      Optional Videos:
      Ultrasound Podcast Renal Ultrasound 

Appreciate anatomical position of the kidneys by demonstrating the long and short axes. Differentiate the renal pyramids from the renal cortex and renal pelvis. Demonstrate the position of the prostate in relation to the bladder. Estimate the bladder volume by taking the height, width, and length measurements. Apply power Doppler to the bladder to demonstrate the urine jets entering the trigone of the bladder. 

Renal
 1. Choose the correct transducer to assess the kidneys. 
 2. Demonstrate a long axis and short axis of each kidney. 
        a. Differentiate the renal capsule, cortex, and pelvis. 

Bladder
 3. Choose the correct transducer to assess the bladder. 
 4. Measure the three planes of the bladder and estimate the bladder volume. 
 5. If time permits, use power flow Doppler with a very low pulse repetition frequency to assess for bladder jets. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were adequate measurements taken? 


Head and Neck

  Online Videos:
      UCI Podcast #10 

Examine the thyroid including the isthmus in longitudinal and transverse planes. Demonstrate the anterior neck musculature and attachment points along the clavicle. Outline the jugular veins and note the change in diameter during valsalva and body inclination and how the jugular vein abruptly tapers on sagittal view. Demonstrate the anterior and posterior chambers of the eye and outline the optic nerve sheath. 


Hands-on Objectives:

1. Demonstrate each lobe of the thyroid in the transverse plane. 
2. Demonstrate each lobe of the thyroid in the longitudinal plane. 
3. Demonstrate the musculature of zone 2 of the neck. 
4. Demonstrate the jugular vein with and without body inclination. 
5. Demonstrate the anterior segment of the eye, differentiating the lens from the iris. 
6. Demonstrate the posterior segment of the eye, locating the optic nerve sheath. 

All image acquisition will be evaluated based on the following criteria:
-Can the organ and anatomy of interest be identified? 
-Is the proper transducer being used with the correct indicator orientation? 
-Was the image obtained at the proper depth, gain, and frequency? 
-Were the correct measurements taken? 
-Were the correct applications used?