How do I learn ultrasonography (USG) of the abdomen?

How to Learn Ultrasonography (USG) of the Abdomen

To effectively learn abdominal ultrasonography, follow a structured approach that combines theoretical knowledge with hands-on practice, focusing on mastering the basic skills recommended by the European Society of Intensive Care Medicine. 1

Basic Abdominal USG Skills to Master

Fundamental Techniques

• Learn to perform the Focused Assessment with Sonography for Trauma (FAST) examination, which is considered a basic skill for identifying free fluid in the pericardial sac, pleural space, and peritoneum 1
• Master the detection of hypo/anechoic free fluid in the peritoneal cavity, which is essential for identifying free peritoneal fluid in non-traumatic acute abdomen 1
• Practice serial FAST exams to visualize the development of previously undetectable free fluids in response to changes in patient condition 1
• Learn to evaluate the presence of additional internal echoes within effusions, which suggests the presence of complicated effusions 1

Systematic Scanning Approach

• Adopt a systematic examination procedure with longitudinal, cross-sectional, and oblique scans to view all abdominal organs 2
• Begin scanning in the epigastric region, then proceed to the right upper quadrant, left upper quadrant, both iliac fossae, and finally the hypogastric region 2
• Practice B-mode ultrasound evaluation of both kidneys and bladder in short and long axis views to assess for hydronephrosis and bladder overdistention 1

Learning Pathway

Theoretical Foundation

• Start with understanding the basic physics of ultrasound and how to interpret the images 3
• Learn normal abdominal anatomy and measurements of different organs to accurately identify pathology 2
• Study the integration of clinical assessment with abdominal US findings, which is considered a basic skill for ruling out non-traumatic acute abdomen 1

Practical Training

• Engage in regular, distributed hands-on learning sessions throughout your training period 4
• Practice holding the ultrasound probe correctly and generating clear images, as this is a learned skill 4
• Master ultrasound-guided procedures such as determining the indication and location for abdominal drainage, monitoring procedure effectiveness, and ruling out drainage complications 1

Advanced Applications

• Learn ultrasound scanning of vessels to detect size, position, and patency using compression ultrasonography (CUS) 1
• Practice continuous visualization of the needle tip during its trajectory using both in-plane and out-of-plane techniques for vascular access 1
• Master compression techniques from the common femoral vein at the groin to the popliteal vein for diagnosing deep venous thrombosis 1

Important Limitations to Understand

• Recognize that abdominal US should not be used alone to identify the cause of a surgical abdomen, as it doesn't reliably characterize different etiologies such as infectious colitis, small bowel obstruction, or perforation 1
• Understand that functional assessment of bowel using ultrasound is not considered a basic skill due to the vast variety of parameters that could be assessed 1
• Be aware that detection of intramural gas in the bowel wall is not recommended as a basic skill for diagnosing non-traumatic acute abdomen 1

Common Pitfalls to Avoid

• Avoid relying solely on ultrasound for diagnosing complex abdominal conditions without clinical correlation 1
• Don't attempt to use Doppler resistive index of the interlobar arteries in hemodynamically stable polytrauma patients, as this is not recommended for detecting signs of decompensation 1
• Recognize the steep initial learning curve for US-guided procedures and interventions, which can be challenging for beginners 5