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Normal Ultrasound Protocol and Procedure – Thyroid
Patient Preparation
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All clothing and jewellery from around the neck area should be removed and hair tied back
where possible. A gown to change into should be given to any patients with high necklines
on their clothing.
Wipes should be place around the collar of the top if the patient is wearing their own
clothing to reduce any gel spillage.
The patient is placed in the prone position with a pillow placed below the shoulders to
elongate the neck.
Care should be taken with elderly patients or those who suffer from vertigo. Move the pillow
further up the patient or place a small sponge beneath the occiput to decrease head tilt if
necessary.
A bluey is placed below the head catch any further spillage.
The following image demonstrates room set up.
Appropriate space for patient’s head to rest
Bluey to catch any drip
Pillow at shoulder height to allow for appropriate head tilt
Image 1: Bed Setup
Jewellery removed
Clothing around removed
Protective wipes around collars
Image 2 and 3: Patient Preparation
Equipment Setup
In our practice either use a Toshiba Aplio 500 or an IU22 is used for small parts examinations. Both
an 18Mhz and 12Mhz linear transducer should be made available, attached or in reach if possible. In
some practices both transducers may not be available.
For imaging of the thyroid it is best to use the highest frequency transducer possible. In many cases
the 18Mhz transducer will be appropriate however for larger thyroids a longer foot print may be
needed. In these cases I will often conduct the majority of the examination using the 18Mhz
transducer changing to the 12Mhz transducer for length measurements and deep retrosternal
extension.
Thick US gel is more appropriate for examination of the thyroid. This area is not as sensitive as the
breast or testes may be. It also prevents the gel from running off the neck and into the patient’s hair
or onto their clothing. Appropriate towels or wipes should be within reach during the examination
for final clean up but also if any gel spills do occur.
Standard Ultrasound Protocol
The following is the standard ultrasound protocol for examination of the thyroid gland as it appears
in the training manual for my practice.
Scout scan of both lobes to assess the extent of any pathology
Right Lobe and Left Lobe
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Transverse Images
o Superior
o Mid with trans measurement
o Mid with colour to show normal flow
o Inferior
Longitudinal Images
o CCA
o Lateral aspect
o Mid with long and AP measurements
o Medial aspect
o Superior aspect
o Inferior aspect
Isthmus
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Trans image with AP measurement
Comparison
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Trans image with both lobes for comparison
Right and Left Neck
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Check for cervical lymphadenopathy, measure the largest lymph node seen.
Pathology
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In the presence of pathology two images at 90 degrees are needed with measurements
Doppler imaging is needed to assess vascularity of any suspicious nodules
Ultrasound Imaging
The following is a series of images demonstrating the standard protocol series.
Image 1 and 2 – Images of the right lobe in the transvers plane displaying the heterogenous nature
of this particular patient’s gland
Image 3 and 4 – Images of the right lobe at the mid portion. Image 3 displays the measurement
across the thickest portion of the gland. Image 4 is a Colour Doppler Image of at the same level as
Image 3.
Image 5 and 6 – Images of the lower portion of the right lobe. Callipers indicate the transverse
measurements of thyroid nodules.
Images 7 and 8 – Longitudinal images of the right lobe of the thyroid. Image 7 shows the CCA in the
longitudinal plane. Image 8 again demonstrates the use of callipers to measure thyroid nodules.
Image 9 and 10 – Image 9 demonstrates the use of Colour Doppler to interrogate the thyroid in the
lateral plane. Image 10 Demonstrates the use of the “trapezoid” or “wide screen” function to allow
for measurement of the gland while maintaining high resolution.
Images 11 and 12: These images show the interrogation of the anterior triangle as per department
protocol. Note the use of the extended FOV to allow for a more global view of the neck structure.
Considerations during the Examination
It is important to be considerate of the patient during the examination. Though the neck is not as
sensitive an area as the scrotum or breast there are things to consider to make the experience less
uncomfortable for the patient. The following is a brief description of the considerations I make to
ensure a more pleasant experience for my patients while improving image quality.
Points of Practice
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Give the patient a clear explanation of the examination and results delivery.
o This makes the patient aware of what you are going to do before you do and also
gives the patient to ask any question.
Make it clear to the patient that they may breathe and swallow normally through the
examination but kindly ask them to refrain from talking while you are acquiring images.
o I find that explaining that talking decreases the image quality is the most simply and
effective way to ensure that they do not talk throughout the scan.
Be aware of patient position and comfort level throughout the scan.
o The position described previously is very good for imaging but is not always
comfortable for you patient. I find it easiest to explain why we need the patient in
the position but also to check with them that they are comfortable before starting
the scan
Be mindful or probe pressure.
o Always be aware that you are on the patient’s neck especially when doing
comparison imaging as images along the midline are often the most uncomfortable.
Be very careful when sitting the patient up at the end of the examination.
o At the conclusion of the examination gently sit the patient up. I find it best to have
lowered the bed so that the patient can immediately place the feet on the ground.
This allows the patient a chance to sit and ensure that they are not dizzy after lying
down with the neck extended.