On the ultrasound report, this section will show:
√ The patient’s symptoms.
√ Medical history.
√ The issue that the ultrasound is meant to assess.
While not every sonographer may be keen to include this section for routine scans, it can be helpful as a reference for future scans, especially for specialized ultrasounds.
Generally, the section indicates the area of the body that is scanned, the techniques used, plus patient handling.
The details and procedure section can show:
√ The ultrasound method (transabdominal, transrectal, transvaginal, transcutaneous, etc.)
√ The type of ultrasound machine used.
√ The ultrasound machine settings.
√ Patient position during the scan (lateral or supine).
√ Area of body scanned and the maneuvers.
The findings section is the heart of a scan report. It details everything the sonographer finds from the ultrasound scan, including the following:
√ Organ structure
The sonographer lists the specific organs or structures examined (heart, uterus, liver, etc.), including their shape, size, and appearance.
The findings on the structures are indicated accordingly, specifying their echotexture (If they appear normal, brighter, darker, or have features such as swelling or scarring).
√ Normal and abnormal observations
The radiographer notes if the structures are normal or if there are abnormalities and specifies the particular anatomical location, image form, and measurements.
For example, depending on the organ scanned, the sonographer may indicate that the liver is “normal, no parenchymal lesions noted”, or “the right ovary has a 5cm cyst”, or that the “gallbladder contains gallstones ranging from 2.3mm to 6.6mm.”
√ Measurements & Calculations
The ultrasound technician indicates the measurements of organs and any calculations during the scan, then specifies if they are normal or abnormal.
Measurements can show the dimensions of organs in length, width, and depth, and the volume of fluids where applicable. They also show blood flow velocity for Doppler scans and fetal measurements in pregnancy ultrasounds.
Usually, the sonographer indicates measurements or volume in a consistent unit of measure.
√ Test variations
If the radiologist has reason to diversify the request of the referring note, they will indicate it in this section.
Variations in the ultrasound request can be due to unexpected findings early in the ultrasound examination. For example, the sonographer may not examine the cervix if s/he notices an early pregnancy.
√ Ultrasound result comparison
Especially when the ultrasound scan is a follow-up test to check for change (or absence of change) in a patient’s condition, a comparison note is included in this section.
Sonographers generally use the terms impressions, summary, or conclusion rather than diagnosis.
In this section, the ultrasound technician includes comments on the overall findings and an interpretation of the results. They may also include relevant recommendations based on the findings and show any additional actions taken after the findings.
The most significant findings of an ultrasound are listed first.
This is the penultimate part of the written ultrasound report. It shows the names and designations of those involved in the ultrasound procedure, and may include the sonographer, an assisting trainee, nurse, or consulted radiologist.
Listing the examining personnel is crucial in case the patient or referring physician needs clarification.
While this is not a compulsory section, some sonographers include it as a reference to support the criteria or guidelines used to interpret the ultrasound. It is especially useful for the referring physician.
Sonographers write ultrasound reports based on the ultrasound images. As such, attaching the scan images is a key part of the report.
If comparisons have been made to past ultrasounds, the report and images from those may also be attached.
While sonographers are advised to keep ultrasound language formal but easily understandable, your ultrasound report can have information or medical terms that are unfamiliar to you.
Here are some of the common medical terms you might see on an ultrasound report:
So, with the ultrasound anatomy and the medical terms in mind, it is obvious that you’d want to know which parts of the ultrasound report you should focus most on.
When reading an ultrasound report, pay particular attention to the Findings section. This area details what is in the normal range and highlights any abnormal observations on the scan. The sonographer also underlines any issues of concern in this area.
You should also focus on the Impressions or conclusion section, which is a summary of the sonographer’s overall evaluation of the findings. Additionally, it shows recommendations for further follow-up when required.
For expectant parents, information on the findings section of a pregnancy scan report can be complex. As such, it’s enough to focus on the Summary area. Here, the sonographer highlights aspects such as:
Your sonographer may recommend follow-up in the following cases:
Often, expectant mothers and other patients give special focus to the ultrasound scan image, which is even harder to read. So, what should you focus on when looking at your ultrasound image?
When you look at an ultrasound image, you notice a series of numbers at the top of the ultrasound (the smaller part of the cone-shaped image). These numbers may not mean anything to you at first sight.
And while it’s true that you need not pay particular attention to these numbers, knowing what they mean is no harm.
The numbers at the top of the ultrasound usually refer to details on the patient (name & reference number) and the ultrasound machine settings.
However, especially on pregnancy ultrasounds, you may also notice some abbreviations alongside the patient’s info. We’ll explain some of those later in the article.
While most of the numbers and abbreviations occur at the top of the ultrasound image, some sonographers may also utilize space at the bottom corners of the image.
So, what about the colors on the ultrasound image?
Understanding the black and gray, and sometimes red and blue, shades on an ultrasound seems to be the hardest task when reading an ultrasound image. But it really isn’t rocket science.
What you should know is that different body tissues react to the sound waves from an ultrasound probe differently. Body liquids absorb the sound waves while denser tissues reflect them. The denser the tissue, the better it reflects the sound waves.
So, here’s the general rule you should remember when reading the colors on an ultrasound scan.
Black appears in areas with fluid, such as amniotic fluid.
Gray is for soft tissues and organs made of such tissue.
White is for the densest tissue, like bones.
Let’s demonstrate that in a diagram.
Knowing this, it would be easy to tell which part of this fetal ultrasound image has fluid, which soft tissue, and which bone. We’ve done it for you!
But what about the blue and red, and sometimes, green and orange?
Red color on an ultrasound indicates an arterial blood flow, meaning blood flowing in the direction of the ultrasound probe.
Blue indicates a venous blood flow, or blood flowing in the opposite direction, away from the ultrasound transducer.
So, if you see red, you are looking at the blood in your arteries that is sending blood to the target organ from the heart. Instead, blue shows you blood flowing from the organ back to the heart.
A pregnancy is divided into 3 trimesters:
In each trimester, an ultrasound can be performed for different purposes. Here’s what a fetal ultrasound schedule looks like during the three trimesters.
Note that your OB/GYN specialist may also request an ultrasound scan in the period around 6-13 weeks for the following purposes:
Additional ultrasounds may also be performed during the other trimesters for mothers with high-risk pregnancies or when your doctor detects any issues that require monitoring.
So, how do you read your fetal ultrasound?
Ultrasound labels show the correct positioning of the transducer on the mother’s body. Notice the Sagittal plane (SAG), which is the long side view, vs the Transverse plane (TRANS), or the cross-sectional view.
The slimmer side of the cone-shaped image is the top of the image that is closer to the probe. The wider bottom has the uterus view.
The gray oval shape inside the wider cone marks the uterus outline. For a transabdominal scan, you also notice the bladder in a dark shade sitting in front of the uterus.
Identify the head, abdomen, and spine to get your bearings. Refer to the color codes in the earlier section on “Understanding Ultrasound Colors” (black=fluid, gray=soft tissue, white=bone).
Depending on the period of pregnancy, the fetus may present in transverse position (back down and face up) in the early months of pregnancy, in posterior position (head down and back to the mother’s back) in the later months, and in the anterior position (face down and back to the mothers belly) before birth.
The transverse or posterior position is what you are most likely to see, depending on the pregnancy stage.
The pregnancy features you will notice on your fetal ultrasound depend on the trimester.
For example:
In the early weeks (5-10), you will notice the embryo that may look like a tadpole by week 5 and has the organs already clearly defined by week 10. You also see the gestational sac presenting as a black circle, the yolk sac as a small white ring before the placenta forms, and the heartbeat as a flicker.
In the Motion Mode, you can see the heart motion is noticeable, or you may see the label FHR (Fetal Heart Rate), which ranges around 110-160bpm. If the ultrasound is in the Doppler mode, you may see the red and blue colors of blood flow.
The placenta appears as a grainy area attached to the uterine wall. While it may not be obvious to you, your doctor will tell if the placenta is normal or if there are issues.
You can check if there is more than one fetus by noticing the dividing membrane and if there are two placentas. This is defined by the term chorionicity (number of placentas) on the ultrasound report.
If you are in the third trimester, the sonographer may measure the length of the cervix or how close the placenta is to the cervix, especially in the weeks before delivery. A 2cm distance is considered standard for a safe vaginal delivery.
Read the ultrasound report for a summary of the fetal ultrasound image. The “impressions” or “conclusion” section should be enough to tell you what you need to know.
This video is an excellent visual representation to help you understand your fetal ultrasound:
On your fetal ultrasound report, you will also notice some abbreviations for different measurements apart from the ones already mentioned.
A fetal ultrasound has several measurements taken and represented in abbreviations. These measurements give details on your baby’s development at different gestational stages.
Below are the most common abbreviations you will see on the ultrasound and the report:
All these measurements are key for monitoring fetal growth and development at the different stages of gestation.
But what about the baby’s gender?
During the ultrasound of the second trimester (weeks 18-20), your sonographer can make out the gender of your baby. Some advanced ultrasound equipment can show it earlier.
Ultrasonographers look for special lines on the image that are gender-specific to determine if there’s a penis or labia.
When looking at an ultrasound, the sonographer identifies a female by noticing the lines of the labia lips.
In the sagittal plane (longitudinal), the ultrasound technician may look for a small projection at the end of the spine, also called the caudal notch or nub. In a girl, the nub faces downwards at a 10-degree angle.
A male fetus is easier to identify as it can sometimes be clearly visible by week 18-20. Rarely, an upward flow of urine may also be spotted, suggesting it is a boy.
From the nub theory, the nub in a male fetus points upward at an over 30-degree angle when observed in a sagittal plane.
This video shows the identification of male and female fetuses at different stages of growth:
Ultrasound gender prediction accuracy may not always be 100%. That can depend on the position of the fetus, the type of ultrasound machine, and the expertise of the ultrasound technician. However, today’s cutting-edge ultrasound equipment, including portable ultrasound machines, has made it a lot easier and precise.
See this example of female fetal identification using the Clarius handheld ultrasound scanner:
With all the knowledge you have so far on how to read an ultrasound image, you might still want to know if all that is safe for your unborn baby.
Reading an ultrasound can feel overwhelming. But learning the basics in this A-Z guide can help you easily understand what you see on your ultrasound image and what you read on the ultrasound report.
Whether you are curious about a recent fetal ultrasound or excited about an upcoming one, you can now confidently say you have an idea of how to read an ultrasound report and image.
However, keep in mind that only a professional sonographer can confirm findings and make diagnoses. But your knowledge of how to read ultrasound pictures can help you ask valuable questions to your doctor.
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