A checklist for comprehensively imaging abdominal organs, accurately documenting technical limitations, and structuring adult complete abdominal ultrasound reports around the...
RadPhrases Editorial Team6 min read
A checklist for comprehensively imaging abdominal organs, accurately documenting technical limitations, and structuring adult complete abdominal ultrasound reports around the clinical question.
Scope This content is a basic checklist for general adult abdominal and retroperitoneal ultrasound. Obstetric/pelvic, Doppler, transplant, pediatric, contrast-enhanced ultrasound, and detailed organ-specific examinations require separate protocols.
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A good ultrasound report states what was seen and which areas could not be adequately assessed. The word “normal” should imply that the organ was examined in appropriate planes with adequate technique.
This checklist was prepared to standardize the scanning sequence and ensure that limitations such as bowel gas, obesity, or limited patient cooperation are accurately reflected in the report.
1. Preparation and clinical question
☐ Read the indication. Pain location, jaundice, infection, impaired renal function, and follow-up purpose alter the focus of the examination.
☐ Assess patient preparation. Fasting affects evaluation of the gallbladder and upper abdomen; bladder filling should be planned according to the required regions.
☐ Review prior imaging. Prior ultrasound, CT, or MRI is important for comparing a known cyst, calculus, mass, or organ size.
☐ Recognize technical limitations early. Document limitations from bowel gas, body habitus, pain, dressings, or cooperation throughout the examination.
☐ Optimize the transducer and settings. Adjust depth, focus, gain, and frequency for each organ; do not complete the entire examination using a single setting.
2. Liver
☐ Size and contour. If a craniocaudal measurement is required, obtain it in the plane defined by institutional practice and assess surface irregularity.
☐ Parenchymal echogenicity and homogeneity. Compare with the renal cortex while considering technical factors.
☐ Focal lesion. When appropriate, describe location, size, margins, echogenicity, posterior acoustic features, and vascularity.
☐ Hepatic and portal veins. Diameter, patency, and direction or character of flow should be reported only when an appropriate Doppler assessment has been performed.
☐ Intrahepatic bile ducts. Is there dilatation or another sign of obstruction?
3. Gallbladder and extrahepatic bile ducts
☐ Gallbladder distention and wall. Consider fasting status and the effect of contraction.
☐ Calculi and sludge. Assess mobility, acoustic shadowing, and location at the neck or duct using different patient positions.
☐ Pericholecystic findings. Fluid, hyperemia, and a sonographic Murphy sign should be interpreted only under appropriate clinical and technical conditions.
☐ Common bile duct. Measure the visible portion and consider the measurement site, age, and factors such as prior surgery.
☐ Level of obstruction. If the duct is dilated, assess its proximal and distal course and the visible cause as far as possible.
4. Pancreas
☐ Head, body, and tail. Assess the degree of visualization of each part separately; do not report a segment obscured by gas as normal.
☐ Size, contour, and echogenicity. Consider variation related to age and body habitus.
☐ Pancreatic duct. Is there dilatation or irregularity?
☐ Surrounding regions. Assess peripancreatic fluid and visible vascular structures according to the clinical question.
☐ Technical limitation. Use anatomically specific wording, such as “The pancreatic tail could not be assessed because of overlying bowel gas.”
5. Spleen
☐ Size. Obtain a long-axis measurement in the plane defined by institutional practice.
☐ Parenchyma. Assess homogeneity and look for focal lesions, infarction, or traumatic injury.
☐ Hilum and surrounding region. Note visible findings such as varices, an accessory spleen, or perisplenic fluid.
6. Kidneys and urinary tract
☐ Size and contour of both kidneys. Long-axis measurements should use the same technique, and asymmetry should be compared with prior imaging.
☐ Cortical thickness and echogenicity. Comparison with the liver or spleen should be made within clinical and technical limitations.
☐ Collecting system. Assess the degree of hydronephrosis, appearance of the calyces and pelvis, and relationship to bladder filling.
☐ Calculus. Assess an echogenic focus together with shadowing and twinkle artifact; do not rely on artifact alone.
☐ Cyst or mass. Describe size, location, internal architecture, wall or septa, and vascularity as appropriate.
☐ Ureters. They are usually not fully visualized; if dilated, assess visible proximal and distal portions and ureteric jets as clinically indicated.
7. Aorta, IVC, and retroperitoneum
☐ Abdominal aorta. Image the proximal, mid, and distal segments when possible and use the institutional standard measurement method.
☐ Iliac bifurcation. Assess the proximal iliac arteries according to the indication.
☐ IVC. Comment on caliber and patency only when image quality is adequate.
☐ Retroperitoneum. Assess visible regions for an obvious mass or lymphadenopathy while respecting the limitations of ultrasound.
8. Bladder, pelvis, and free fluid
☐ Bladder. Assess filling, wall, intraluminal calculi or debris, and ureteric jets according to the clinical question.
☐ Scope of pelvic organ assessment. Clarify whether the uterus/adnexa or prostate is included according to the local definition of a “complete abdomen” examination.
☐ Free fluid. Assess the presence, amount, and complexity of fluid in the perihepatic, perisplenic, and pelvic regions.
☐ Pleural spaces. Note fluid in the visible costophrenic regions during the upper abdominal examination.
9. Documenting technical limitations correctly
Instead of a general statement such as “the examination is limited,” specify which part of which organ could not be assessed and why.
Do not assume that a nonvisualized structure is normal.
If a limitation prevents the clinical question from being answered, make it visible in the impression.
When needed, relate a recommendation for an alternative modality to the clinical context and patient safety.
Avoid false precision when a measurement is unreliable.
10. Impression
Place the main finding that answers the clinical question first.
In a negative examination, state this clearly and simply when the region relevant to the clinical question has been adequately assessed.
Repeat an important technical limitation in the impression.
For a lesion that cannot be characterized, describe the sonographic finding and recommend appropriate further assessment according to context rather than assigning a definitive diagnosis.
Follow the institution's critical results communication policy for urgent findings.
Communication of critical findings
Time-sensitive ultrasound findings An abdominal aortic aneurysm at risk of rupture, serious findings associated with acute biliary obstruction, suspected organ torsion, an urgent clinical situation with substantial hydronephrosis, or other critical results should be communicated directly and documented. Critical thresholds should be defined by the institutional protocol.
11. Commonly overlooked or incompletely reported areas
Degree of visualization of the pancreatic tail
Measurement site of the common bile duct
Separate long-axis measurement of both kidneys
Relationship between hydronephrosis and bladder distention
Distal aorta and bifurcation
Perihepatic and perisplenic free fluid
Anatomically specifying nonvisualized regions
Measurable change from prior imaging
12. Example report framework
INDICATION: [Clinical question] TECHNIQUE: Complete abdominal ultrasound using grayscale and, when required, color/spectral Doppler. [Technical limitation]. COMPARISON: Examination dated [date]. FINDINGS: - Liver and hepatic/portal vascular structures: [...] - Gallbladder and bile ducts: [...] - Pancreas: [...] / [nonvisualized segment and reason] - Spleen: [...] - Right kidney: [...] - Left kidney: [...] - Aorta/IVC: [...] - Bladder/pelvis: [according to scope] - Free fluid: [...] IMPRESSION: 1. [Primary sonographic finding / answer to the clinical question.] 2. [Technical limitation or finding requiring further assessment, if present.]
References
ACR Practice Parameter for Communication of Diagnostic Imaging Findings, Revised 2025. Report components and principles for nonroutine/urgent communication. Source (opens in a new tab)
AIUM Practice Parameter: Abdomen or Retroperitoneum, 2021. Minimum framework for a high-quality and complete abdominal/retroperitoneal ultrasound examination. Source (opens in a new tab)
AIUM Ultrasound Practice Parameters. Scope and intended use of ultrasound practice parameters. Source (opens in a new tab)
Clinical use note
This content is educational and is not patient-specific medical advice. Every phrase, template, classification result, and recommendation must be verified and adapted by a physician using the complete examination, clinical context, current guidelines, and institutional protocol.
Turn the checklist into a report template
Use this sequence as an editable RadPhrases template and verify it against the images in every case.
