Canadian national guidelines recommend Point of Care Ultrasound (PoCUS) image archiving for documentation, and to facilitate quality improvement and assurance – key components of driving great patient-centred care with ultrasound. The CAEP Emergency Ultrasound Committee, with representatives from urban, rural, academic, community, paediatric, and adult emergency departments established a minimum archiving standard for the basic PoCUS indications, as infrastructure allows. While this may be the minimum, additional images may be required to support a diagnosis depending on the clinical context and image quality.
 
Here are representative images you need to meet the standard for each of the basic PoCUS applications:

 

Abdominal Aortic Aneurysm

Modality: Still or Cineclip

Minimum Archiving Requirement:

  • If no AAA present, transverse images of the proximal, mid, distal and bifurcation of the aorta
  • If AAA present, single transverse image

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AAA present

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No AAA, Proximal Aorta

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No AAA, Mid Aorta

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No AAA, Aorta Distal Bifurcation

Cardiac Arrest

Modality: Cineclip

Minimum Archiving Requirement: Best possible view

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Cardiac Arrest

Left Ventricular Function

Modality: Cineclip

Minimum Archiving Requirement: Parasternal long axis view

LV Function

Right Ventricular Function

Modality: Cineclip

Minimum Archiving Requirement: Apical 4-chamber view

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RV function

Pericardial Effusion

Modality: Cineclip

Minimum Archiving Requirement: Best possible view, subxiphoid is the most common

Pericardial Effusion

Focused assessment with sonography for trauma (FAST)

Modality: Still or Cineclip

Minimum Archiving Requirement: Parasternal long axis view

  • Entire hepatorenal interface to the tip of the liver (Morison’s pouch)
  • Diaphragm-liver interface up to the 9 o’clock position (including R pleuraleffusion)
  • Entire splenorenal interface including the caudal spleen tip
  • Diaphragm-spleen interface up to the 9 o’clock position (including L pleural effusion)
  • Transverse view of the pelvis
  • Best possible cineclip to assess for pericardial effusion

RUQ

LUQ

Pelvis

Pneumothorax

Modality: Cineclip or M-Mode

Minimum Archiving Requirement: Bilateral sagittal scans at the mid-clavicular line, 3rd intercostal space

Left Lung (repeat on contralateral side)

Pulmonary Edema

Modality: Cineclip

Minimum Archiving Requirement: Minimum of 2 representative zones, bilaterally

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Pulmonary Edema

Modality: Cineclip

Minimum Archiving Requirement: Minimum of 2 representative zones, bilaterally

Pregnancy of Unknown Location

Modality: Still or Cineclip

Minimum Archiving Requirement:

  • Sagittal and transverse views of the uterus and bladder
  • Gestational sac in the uterus, if present
  • Fetal pole and yolk sac, if present
  • Myometrial mantle measurement if it appears abnormal
  • Fetal heart rate documentation, if present, using M-mode still or cine-clips

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Transverse

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Sagittal

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Myometrial Mantle

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Fetal Heart Rate

Cholelithiasis and Cholecystitis

Check out our gallbladder PoCUS learning module here

Modality: Still or Cineclip

Minimum Archiving Requirement:

  • Long axis view
  • Short axis view
  • In the context of cholecystitis, measure of the anterior wall of the gallbladder
     

Short Axis

Long Axis

Long Axis

Cholecystitis Measurement

Hydronephrosis

Modality: Still or Cineclip

Minimum Archiving Requirement:

  • Long axis view of bilateral kidneys
  • Transverse view of the bladder

Left Kidney

Pelvic

Above knee lower extremity Deep Venous Thrombosis

Modality: Cineclip with and without compression

Minimum Archiving Requirement:

  • Zone 1
    • Common femoral vein
    • Saphenous femoral junction
    • Femoral vein beyond the deep femoral branch
  • Zone 2
    • Distal femoral vein
    • Popliteal vein
    • Popliteal vein trifurcation
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Zone 1: Common Femoral Vein

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Zone 1: Saphenous Femoral Junction

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Zone 1: Femoral Vein

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Zone 2: Distal Femoral Vein

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Zone 2: Popliteal Vein

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Zone 2: Popliteal Zone Trifurcation

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Central Line Insertion

Modality: N/A

Minimum Archiving Requirement: No routine archiving necessary; if choosing to archive, a confirmatory image of wire in vein

 

Authors

  • Dr. Michael Wong is a FRCPC Emergency Physician with special interests in end-of-life communication, health literacy, and simulation. Michael also has a Point-of-Care Ultrasound Fellowship.

  • Dr. Pageau is an Emergency Physician at the Ottawa Hospital, and current present of the Canadian Association of Emergency Physicians. He has a special clinical interest in ultrasound, global health and protocolized care. His personal search of wellness involves; family, friends and time in the Gatineau hills.

  • Dr. Shahbaz Syed is a FRCPC Emergency Physician at the University of Ottawa, he is also the assistant director of Digital Scholarship and Knowledge Dissemination, and Co-Editor in Chief of the EMOttawa Blog.