Rotation 1

Introduction to Machinery, Transducers, Color Doppler, Harmonics

Introduction to Basic Ultrasound Analysis, GB, Liver, Kidney, Free Fluid Abdomen/Pelvis, Normal Anatomy

Learn to analyze and diagnosis Hydronephrosis

Learn to analyze and Diagnose - Biliary Dilatation, Ascites, Pleural Effusion

Rotation 2

Review of work of Rotation 1 - further experience

Increased familiarity with machines and transducers

Introduction to basic OB/GYN analysis

Introduction to DVT analysis

Learn to analyze and diagnose IUP, Ectopic pregnancy, CNS fluid

Analyze and diagnose Pancreatic Mass, Liver Mass, Spleen Mass, Kidney Mass, Bladder Mass, and Ovarian Mass. Learn appropriate differential diagnoses and methods for further analysis.

Rotation 3

Review of work of Rotation 2 - further experience » mastery

Improvement in OB analysis

Improvement in DVT analysis

Learn to analyze and diagnose:

Normal OB exam and possible abnormalities

Normal lower extremity veins and rule out DVT analysis

Rotation 4

Review of work of Rotation 3 - Develop mastery, teach

Improvement in GYN, abdomen, OB ultrasound


Advanced vascular, neurosonography, prostate analysis

Be able to train junior level resident in basics


  1. Introduction to Ultrasound including techniques, transducers, and artifacts
  2. Obstetrics 1 - Early obstetrical pregnancy, measurements, findings and ectopic pregnancy
  3. Obstetrics 2 - 2nd and 3rd trimester fetus, normal and abnormal anatomy
  4. Obstetrics 3 - 2nd and 3rd Trimester placenta, cervix, growth measurements
  5. Liver and Gall Bladder - Gallstones, cholecystitis, biliary tree abnormalities, liver tumor, fatty liver, and liver transplant ultrasound
  6. Spleen, pancreas and retroperitoneum
  7. Kidney, Bladder
  8. Vascular ultrasound
  9. Pediatric hip ultrasound: synovitis, Dysplastic hips
  10. Neurosonography - Including spine
  11. Pediatric and adolescent gynecologic ultrasound
  12. Pediatric abdominal ultrasound, Hypertrophic pylorus stenosis, gastroesophageal reflux, pylorospasm, appendicitis, intussuception, mesenteric adenitis


Miscellaneous - Chest, pericardial, prostate, and renal transplant ultrasound

Pediatric renal, bladder and scrotal ultrasound

Diagnostic Ultrasound Curriculum

The following curriculum is based on one developed by the Curriculum Committee of the Society of Radiologists in Ultrasound and is intended as a guideline for the training of radiology residents in ultrasound. The resident should be familiar with this material as a result of hands-on clinical experience combined with formal teaching materials such as conferences, teaching files, books, etc. This material will be covered during dedicated ultrasound rotations, as well as in parts organ-based rotations and in the resident Physics coursework.

I.  Physicist Background/Technical Considerations [To Be Taught In Part By Medical Physics]:

  1. Physics
    Definitions of ultrasound, relationship of sound waves used in imaging to those of higher/lower frequency with other properties

    Working knowledge of frequency, sound speed, wavelength, intensities/decibels

    Interaction of sound waves with tissues: reflection, attenuation, scattering, refraction, absorption, acoustic impedance

    Generation/detection of ultrasound waves

    Doppler phenomenon

    Pulse-echo principles

    Beam formation/focusing

  2. Bioeffects/Safety
    Thermal/nonthermal effects on tissue

    Relative effects of gray scale, M-Mode, pulsed wave Doppler, color flow imaging, power imaging, harmonics

    Contrast agents

  3. Imaging Applicatlons/Equipment Operation
    Transducer choice frequency: gray scale/Doppler (understand tradeoff of penetration/resolution), optimal gray scale probe may not be the optimal Doppler probe shape: linear, sector, curved approach: external, endocavitary, translabial

    Display: gray scale, M-Mode, pulsed wave Doppler, color/power imaging, 3-D

    Image orientation: standard images in different planes

    Image optimization: power output, gain, time gain compensation

    Image recording options - electronic, film, paper, videocassette

    Endocavitary imaging - vaginal, rectal, endoscopic techniques

    Interventional techniques

  4. Artifacts
    Underlying principles (straight narrow sound beams, simple reflection, constant sound speed)

    Beamwidth artifacts, sidelobes, slice thickness

    Multiple reflection artifacts - mirror image/reverberations

    Tissue characteristics - shadowing/enhancement

    Refractive artifacts

    Doppler artifacts - pulse wave, color imaging (includes aliasing)

  5. Quality Assurance
    Equipment QA Program

    Phantoms - spatial/ contrast resolution

    Sonographer/physician based QA


  1. General Considerations

    Examination protocols - protocols for each routine examination should be understood. Published protocols from the American Institute of Ultrasound in Medicine (AlUM) or the American College of Radiology (ACR) with or without local modification are acceptable frames of reference.

    Basic cross sectional/ultrasound anatomy/range of normal sonographic findings as related to age and sex for each of the anatomic areas included below.

    General diagnostic criteria used to evaluate tissue characteristics and distinguish normal from abnormal, cystic from solid, etc.

    General knowledge of clinical uses/limitations of ultrasound and use of other imaging studies to complement ultrasound.

    Techniques for ultrasound guided invasive procedures - aspiration (of tissue masses, fluid collections), biopsy, catheter placement (into pleural, peritoneal, other fluid collections), amniocentesis.

    Reporting skills/requirements

  2. Specific Applications
    Neonatal head: hemorrhage, hydrocephalus, shunt evaluation, periventricular leukomalacia, congenital malformations

    Neonatal spine: lipoma, tethered cord, sacral skin dimple, normal anatomy, diastematomyelia

    Neurosurgical: guidance for intracranial fluid aspiration, mass localization

    Thyroid: size, shape, multinodular goiter, benign/malignant neoplasm, associated adenopathy, localization of parathyroid mass, biopsy of thyroid/parathyroid mass or adenopathy thyroglossal duct cyst

    Vascular exams: carotid duplex exam (with Doppler spectrum analysis including normal appearance, arterial occlusion, stenosis, plaque, subclavian steal, jugular thrombosis

    Pleural fluid (simple vs. loculated/complex) or mass, aspiration/catheter drainage of fluid

    Vascular: subclavian vein thrombosis

    Breast: cystic vs. solid mass, malignancy, abscess, ultrasound guided needle localization/biopsy/cyst aspiration [to be taught by breast imaging group]

    Cardiac: pericardial effusion

    Liver: normal size, shape, echotexture, Doppler and color imaging of hepatic arteries, veins, and portal veins, diffuse disease, focal mass (cyst, hemangioma, hepatocellular carcinoma, metastatic lesions), cirrhosis/portal hypertension, varices, transplant evaluation, intrahepatic porto-systemic shunt Doppler evaluation

    Gallbladder /Bile Ducts: normal gallbladder intra- and extra-hepatic duct size, gallstones, acute cholecystitis (calculus/acalculus), hyperplastic cholecystoses, sludge, polyps, carcinoma, HIV related biliary disease, biliary obstruction/dilatation, duct stones

    Pancreas: normal anatomy/size, duct size, chronic pancreatitis, pseudocyst, calcifications, cysts, masses (benign/malignant)

    Spleen: normal anatomy/size, focal lesions (cystic vs. solid), trauma, splenic varices

    Kidneys/Ureters: normal anatomy/size, cysts (simple/complex), cystic diseases, renal cell carcinoma, angiomyolipoma, hydronephrosis /hydroureter, calculi, abscess / pyeloneophritis, perinephric fluid, renal arterial Doppler (including use of resistive index), renal transplant evaluation (include Doppler)

    Adrenal Glands: focal lesion (cyst/solid), neonatal hemorrhage, normal

    Peritoneal Cavity: localization/ quantification/ aspiration of fluid (free/loculated) - including abscess, blood, omental mass, free air

    Gastroinestinal Tract: normal appearance, appendicitis, pyloric stenosis intussusception mass, inflammatory bowel disease

    Retroperitoneum/Vesse1s: adenopathy, aorta (normal/ aneurysm, including proximal and distal extent), inferior vena cava (normal I thrombosis), aortic aneurysm

    PELVIS (excluding pregnancy)
    Urinary Bladder: mass, calculi, obstruction, infection, diverticula, ureterocele, color flow imaging of ureteral jets

    Uterus: normal size, shape, echogenicity.

    Endometrium - normal thickness (premenopausal, postmenopausal, effect of hormone replacement), physiologic variation, carcinoma, hyperplasia, polyps, endometritis, pyometra.

    Myometrium - leiomyomata, adenomyosis.

    Cervix - mass, stenosis, obstruction. Saline hysterosonography

    Ovary: normal size, shape, echogenicity, physiologic variation (follicles, corpus lutem). Torsion, infection, abscess, cystic/solid mass cystadenoma/ carcinoma, hemorrhagic cyst, dermoid, endometrioma

    Fallopian Tube: hydrosalpinx, pyosalpinx

    Prostate: normal size, shape, echogenicity, cystic/solid mass, carcinoma, abscess, biopsy

    Scrotum: normal size, shape, echogenicity of testis and epididymis, cystic/solid testicular or extratesticular mass. Testicular carcinoma, torsion, epididymitis/orchitis, varicocele, hydrocele, spermatocele, trauma, appendiceal torsion

    Vascular: venous thrombosis evaluation (upper and lower extremity) with compression/Doppler/color imaging, venous insufficiency, aneurysm, pseudoaneurysm/compression, arteriovenous fistula

    Musculoskeletal: mass (cystic/solid), tendon (tear, inflammation), neonatal dysplasia hip effusion, foreign body

    Normal findings: gestational sac appearance, size, growth, yolk sac, embryo, cardiac activity, amnion, chorion, embryology, normal early fetal anatomy/growth, crown rump measurement, multiple gestations, correlation with hCG levels

    Abnormal findings: spontaneous abortion, embryonic death, blighted ovum, bleeding/hematoma, ectopic pregnancy, gestational trophoblastic disease, gross embryonic structural abnormalities

    2nd /3rd TRIMESTER
    Normal findings: fetal anatomy/development, placenta, biometry, amniotic: fluid, multiple gestations, umbilical cord Doppler, alphafetoprotein testing, perform complete exam according to the AIUM/ACR guidelines. Amniocentesis, chorionic villous sampling guidance

    Nonfetal abnormalities: oligohydramnios, polyhydramnios, placenta previa, placental abruption, placental masses, 2 vessel umbilical cord, cord masses, cervical shortening/ dilatation (including translabial imaging)

    Fetal abnormalities: intrauterine growth retardation, chromosomal abnormalities/ associated syndromes, hydrops, congenital infections, neural tube defects, hydrocephalus, hydranecephaly, chest masses, cardiac malformations and arrhythmias, diaphragmatic hernia, abdominal wall defects, abdominal masses, GI tract obstructions, urinary tract obstruction/cystic abnormalities, renal agenesis, ascites, limb shortening abnormalities, cleft lip/palate, twin/twin transfusion syndrome.

    Understand significance of borderline findings: choroid plexus cyst, echogenic focus in heart, echogenic bowel, borderline hydrocephalus

    PEDIATRICS [found also in earlier parts of this document]
    Brain and Spine - intraventricular hemorrhage (various grades), periventricular leukomalacia, anomalies

    Neck - thyroglososal duct cyst, branchial cleft cyst

    Chest - pleural effusion, pericardial effusion, pneumonia

    Abdominal - Non-luminal- kidney - obstruction, duplication, tumor, liver spleen, pancreas, abdomen, biliary tree, choledochal cyst, hepatocellular carcinoma, adrenal tumor.

    Abdominal - Luminal - hypertrophic pyloric stenosis, pylorospasm

    Pelvis - posterior uretheral valves, uterus, ovary, normal, anomalies, bicornuate uterus, PID, hemorrhagic cyst, TOA, ovarian cyst/follicles

    Vascular - carotid arteries, DVT, jugular vein, renal vessels, hepatic vessels, tumor or clot in vessels

    Miscellaneous/Musculoskeletal - lymph nodes, developmental hip dysplasia, hip effusion