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Acknowledgment

This workbook is intended for physicians, technicians, and medical students who are new to sonography and wish to familiarize themselves with the technique of sonographic image formation and the interpretation of sonographic images. It also takes into consideration the fact that many novices generally have a limited budget for purchasing textbooks on their chosen field.

I therefore thank everybody who contributed to the workbook and strived for a low production cost. The members of Georg Thieme Verlag accommodated all our special requests and wishes concerning the layout of the material, and accompanied and supported the progress of the workbook at all times. Owing to the exceptional engagement and support of Dr. Lüthje, Dr. Bergman, and Mr. Lehnert, the third German edition and the English translation, with Dr. Winter as translator, could be completed in a very short period of time. The Department of Science and Research of North Rhine-West-phalia and Toshiba contributed to the printing costs, making the affordable price a reality.

This interactive workbook is based on the experience I have gathered since 1992 in Düsseldorf as head of the pilot project on medical didactics "Anatomy of Imaging Modalities." The pilot project is gratefully supported by the program "Quality in Teaching" conducted by the Department of Science and Research of North Rhine-Westphalia. The con cept of teaching sonography combined with practical exercises in small groups could not have been achieved without the feedback and constructive criticism of the students and pyhsicians in our program and without the continuous cooperation of numerous instructors taken from the ranks of our students. I wish to thank Jörg Kambergs, Andreas Saleh, Ghazaleh Tabatabai, and Jochen Türk, who supported my work for many years and offered valuable suggestions. Furthermore, I wish to mention the willing support of the models Simone Katzwinkel, Wolfgang Bongers, Joana and Würmchen Hofer for the photographs illustrating the positioning of the probe.

I am obliged to Prof. U. Mödder, Prof. H.-G. Hartwig, and Dr. Tanja Reihs for their counsel and for providing several cases. A special note of gratitude goes to my wife Stefanie, who advised me during the planning stage, helped train our assistants, and reviewed the manuscript.

I thank the graphic artists Mrs. Susanne Kniest, and Mrs. Sabine Zarges for their valuable help in drawing all sketches and diagrams, and Mr. Markus Pietrek for the professional photographic displays that demonstrate the handling of the transducer.

Düsseldorf, fall 1998 Matthias Hofer

Normal Measurements

The normal values listed here are subject to individual variations and should be considered only as guidelines. Different tables apply for children. These representative values were taken from the literature and apply only to measurements in

Abdominal aorta luminal diameter:

< 1.0 cm (width of an individual limb)

Aortomesenteric angle

< 30°

Aortovertebral distance

< 0.5 cm

< 0.6 cm (if gallbladder is present)

< 0.9 cm (status post cholecystectomy) intrahepatic:

< 0.4 cm

Cervical subcutaneous tissue

width (in prenatal measurements): < 3.0 mm (if more: "nuchal edema" or "posterior cervical edema")

< 15.0 mm (premenopausal)

< 8.0 mm (postmenopausal)

< 11.0 cm longitudinal (preprandial) maximal diameter:

< 4.0 cm transverse (preprandial)

< 0.6 cm (distal to the last confluence before the inferior vena cava) > 0.6 cm => right cardiac insufficiency

(with collapse during forced expiration!) > 2.5 cm without expiration collapse => suspicious of right cardiac insufficiency

IUD-fundus distance

< 20.0 mm (if increased: dislodged)

IUD-endometrium distance

< 5.0 mm (refer to p. 59)

10.0-12.0 cm (lengthwise) 4.0-6.0 cm (transverse) respiratory mobility:

3.0-7.0 cm parenchymal width:

1.3-2.5 cm Parenchyma-pyelon index: ^ 1.6:1 (under 30 years)

1.2:1-1.6:1 (31-60 years) ^ 1.1:1 (above 60 years)

< 13.0 cm (craniocaudal)

< 15.0 cm (depending on body habitus) marginal angle:

< 45° (right hepatic lobe, caudal)

Lymph nodes

maximal diameter: < 1.0 cm

the stated standard sections. For vessels, the inner diameter of the vascular lumen is given, without consideration of the vascular wall.

Ovaries

Pancreas

Portal vein

Prostate gland

Spleen

Splenic vein

Superior mesenteric artery

Thyroid gland

Urinary bladder volume:

5.5-10.0 cm3 (each ovary premenopausal) 2.5-3.5 cm3 (each ovary postmenopausal)

size of the head:

< 2.5 cm luminal diameter of the duct:

< 3.0 cm (anteroposterior, sagittal) volume:

< 25 ml maximal size:

< 4.0 cm (depth, measured between splenic hilum and surface)

luminal width:

> 1.2 cm => portal hypertension or splenomegaly luminal diameter: < 0.5 cm size:

4.0-7.0 cm (craniocaudal) 1.0-3.0 cm (transverse) 1.0-2.0 cm (sagittal) volume (both lobes combined):

wall thickness:

postvoid residual:

Uterus maximal size:

5.0-8.0 cm longitudinal (nullipara) 1.5-3.0 cm width

Volume calculation

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