Scan Quality Best Practices

“Every scan is a step forward — practice, upload, learn, repeat.”

Which Scans to Upload

• Only de-identified files (no patient name or information)
• A combination of still images and videos, with multiple files per exam
• Make sure your images tell your story; submit a variety of scans, annotated if possible
• Include the minimum criteria needed to answer the sonographic questions for primary- care scan types
• Submit your best-quality images — or deliberately submit a subpar image with a comment such as “I only got a partial view of the gallbladder in image #2; how do I improve my technique?”

General Best Practices

• Optimize first: adjust depth, gain, and focus before recording; keep anatomical landmarks visible
• Clips + stills: clips (3–6 s) for motion, compression, physiology; stills for measurements and pathology
• Label clearly: view + side + scan type (e.g., “RUQ FAST – Right Kidney Long Axis”)
• Scan systematically: upload all standard required views; if incomplete, upload anyway and note what you struggled with
• Normal & abnormal: every scan helps learning; prioritize abnormal findings, technically challenging scans, or those you want feedback on
• Give the clinical scenario: e.g., “Patient with swollen, painful leg → rule out proximal

DVT”

• Ask focused questions: e.g., “Is this artifact or pathology?”
• Upload often and iteratively: mentors expect progress, not perfection — use feedback to improve subsequent scans
• Know your machine: see Part 6 for machine-specific capture and export tips

Obtaining Images

• Time: bring an ultrasound on hospital rounds; ask your medical assistant to room the ultrasound with a patient; start the POCUS exam while collecting history
• Confidence: practice what you’ll say to patients — they’re more receptive than you may think
• See GUSI’s blog post on overcoming barriers to scanning , or discuss with your fellowship mentor or group leader

Scan-Specific Upload Checklists

See the Minimum Image Criteria document (available to all GUSI POCUS Fellows) for detailed view requirements per scan type.

DVT

• Views: CFV, GSV confluence, FV/DFV bifurcation, and PV/trifurcation
• Clip vs still: clips for compression; stills optional
• Doppler: can help assess flow if compression is equivocal
• Pitfalls: mistaking artery for vein; not compressing enough
• Best practice: label structures (R/L, CFV, GSV, FV, DFV, PV)

FAST

• Views: RUQ, LUQ, pelvis both planes, subxiphoid
• Clip vs still: clips beneficial; stills optional
• Pitfalls: missing windows; missing inferior pole of right kidney; gain too high in suprapubic view
• Best practice: always fan through the entire recess

AAA

• Views: long & short axis, sweep to bifurcation
• Measure: outer-to-outer wall
• Clip vs still: still for diameter measurement; clip to show continuity proximal → distal
• Doppler: helps identify structures
• Pitfalls: mistaking IVC for aorta; not applying enough pressure
• Best practice: identify celiac trunk, hepatic/splenic artery, SMA, and renal arteries

Gallbladder

• Views: long & short axis, neck, CBD; patient in multiple positions
• Measure: wall thickness; CBD inner-to-inner
• Clip vs still: clip for stone rolling, wall edema, CBD identification; still for wall thickness and CBD measurements
• Doppler: to identify structures required for CBD
• Pitfalls: mistaking duodenum for gallbladder; inadequate fasting → contracted GB
• Best practice: zoom in when measuring wall thickness and CBD

Echo

• Views: PLAX, PSAX, A4C, subxiphoid (aim for at least three), and IVC
• Clip vs still: clip always for contractility; still for effusion or EPSS measurement
• Measure: M-mode for EPSS
• Doppler: for valves, regurgitation, or insufficiency
• Pitfalls: foreshortening LV; wrong orientation
• Best practice: heart fills ~⅔ of screen; chambers anechoic

MSK

• Views: long & short axis; dynamic motion; contralateral comparison
• Clip vs still: clip for dynamic tendon movement; still for measurements
• Doppler: power/color for increased flow
• Pitfalls: anisotropy (tendon looks hypoechoic if probe not perpendicular)
• Best practice: label structures; compare contralateral side

Lung

• Zones: anterior, lateral, posterior
• Clip vs still: clip for sliding and B-lines; still for M-mode
• Pitfalls: artifacts won’t appear if probe isn’t perpendicular to pleura
• Best practice: label; overgain for better artifacts

GI (Appendix)

• Target: appendix → compressibility, blind end
• Measure: diameter (>6 mm abnormal)
• Clip vs still: clip to show peristalsis; still for diameter measurement
• Doppler: power/color to assess increased flow
• Pitfalls: small bowel loop mistaken for appendix

Renal

• Views: both kidneys + bladder, long & short axis
• Measure: bladder volume
• Clip vs still: clip through the whole kidney; still for length and hydronephrosis grading
• Doppler: differentiate vessels vs hydronephrosis; twinkle artifact; ureter jets
• Pitfalls: not fanning through the entire kidney; always check both kidneys
• Best practice: fan through entire kidney and bladder, anterior-posterior and superior- inferior

Soft Tissue

• Views: long & short axis
• Measure: size and depth
• Clip vs still: clip to show swirling (pus); still for depth measurement
• Doppler: assess vascularity
• Pitfalls: not enough gel (compresses the lesion)
• Best practice: measure volume of abscesses

OB – 1st Trimester

• Views: uterus sagittal + transverse, adnexa
• Landmarks: gestational sac, yolk sac, embryo with heartbeat
• Measure: CRL, MSD, FHR (M-mode only)
• Clip vs still: clip required; still for CRL and FHR
• Pitfalls: scanning with an empty bladder
• Best practice: do not use any Doppler modality during the 1st trimester

OB – 2nd & 3rd Trimester

• Views: BPD, HC, AC, FL; placenta; AFI/MVP
• Measure: biometrics, amniotic fluid, FHR
• Clip vs still: stills for biometry; clips for fetal lie, placental edge, and fetal wellbeing
• Pitfalls: incomplete views; not using Doppler when measuring AFI or MVP
• Best practice: have the LMP and assess fetal weight

Common Pitfalls Across All Scans

• Uploading only stills — reviewers prefer clips for motion/compression (stills-only is appropriate where connectivity is poor)
• Clips longer than 6 seconds — harder to review, wastes storage
• Missing key views (e.g., only RUQ in FAST, only long axis in AAA)
• Unlabeled clips — reviewers can’t confirm anatomy (especially MSK)
• No measurements where required (AAA, OB, renal)

Maximizing Feedback Value

• Upload both normal and abnormal examples when possible
• Ask 1–3 focused questions (e.g., “Is this a B-line artifact vs a true B-line?”)
• After feedback arrives, revisit the original scan, compare comments to your images, then rescan and re-upload with improvements

Final Checklist Before Upload

• Cine loop ≤6 s recorded
• Still images saved for measurements
• Labels complete (view, side, scan type)
• Measurements included (AAA, OB, renal, GB, etc.)
• Clinical notes/questions written
• Exam submitted & synced in ScanHub

If you require further assistance or discovered an error in our support documentation, please contact us by emailing support@globalultrasoundinstitute.com