Five Top Tips on Head and Neck Scanning
Catherine Kirkpatrick, Consultant Sonographer and Clinical Lead from United Lincolnshire Hospitals NHS Trust shares her 5 top tips on head and neck scanning
1. Methodology and Technique. The ‘7 sweep’ scanning technique allows a methodical approach to head and neck scanning which is reproducible (therefore excellent for teaching), a reliable way of creating standards (which can be used alongside the BMUS peer review audit tool) and ensures all the major structures in the neck are adequately assessed along with the lymph node chains. Having a standard set of images produced in a methodical manner will also allow repetition for non-radiology members of the multidisciplinary team (MDT) to understand ultrasound anatomy in meetings and make discussion easier.
2. Physics and Equipment. Don’t recoil! It’s just a reminder that it matters! The choice of frequency or transducer used is sometimes the difference between spotting pathology or missing it. Be acutely aware of the anatomy your looking at and whether the frequency or transducer needs adjusting, for example the deep parotid gland; I invariably start the 7 sweep scan on a very high frequency but only make it to sweep 3, the parotid gland, before the frequency has to be reduced to ensure I’m not missing anything. It has also become my standard practice now when I have not detected a ? parathyroid adenoma with a high frequency transducer to switch to the 5 MHz curvilinear transducer……. and sometimes it’s like turning the light on…..ping it’s there!
3. Know Your Anatomy. Ok standard top tip for any scanning! But it’s so so important in the head and neck. Understanding your anatomy is an essential way of reducing your list of differential diagnoses. It also goes back to Tip 1, if you scan methodically in sweeps, you can narrow down pathologies to those which most commonly occur in each sweep.
4. Are You Sure? A crucial piece of knowledge that was given to me by an expert head and neck radiologist from Wales was to ask: when is a cyst not a cyst?…..when it’s a solid! When is a solid not a solid?…..when it’s a cyst! Clear as mud?! The point being there are lots of mimics in the head and neck scan so just take a moment and ask yourself – are you sure? Hypoechoic lymphoma lymphadenopathy can often appear pseudocystic (also goes back to Tip 2, make sure your machine settings are optimal for what you are looking at); cystic papillary carcinoma lymph node metastasis can lead to confusion and not to mention solid appearances of a thyroglossal duct cyst!
5. Use Your MDT. The knowledge out of the ultrasound sphere is invaluable to scanning, ability to communicate with the patient and the members of the MDT effectively. Even so far as to say, gaining knowledge in this way improves the ultrasound report, providing all the necessary information that can be given from a scan for the referrer – which without MDT input may not have been obvious. If you perform FNAs or are looking to, your first port of call should be a visit to your friendly head and neck pathologist. Vital tips on slide/sample preparation can be obtained, what you can do for them to ensure the best possibility of an adequate sample and some may even go through some cases to demonstrate pathologies so the end point of an FNA can be appreciated. Always good to embark on the full journey!