美国医学超声学会乳腺超声检查实践指南
2010-03-22 17:44:06   来源：丁香园   作者：  评论：0 点击：

AIUM Practice Guideline for the Performance of a Breast Ultrasound Examination
美国医学超声学会乳腺超声检查实践指南

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary
association dedicated to advancing the safe and effective use of ultrasound in
medicine through professional and public education, research, development
of guidelines, and accreditation. To promote this mission, the AIUM is pleased
to publish, in collaboration with the American Society of Breast Surgeons
(ASBS), this updated AIUM Practice Guideline for the Performance of a
Breast Ultrasound Examination. We are indebted to the many volunteers
who contributed their time, knowledge, and energy to bringing this docu-
ment to completion.
美国医学超声学会是一个通过对指南的专业的大众宣传、研究和发展及资格认证，致力于推进超声在医学领域的安全、有效地应用的跨学科的组织。为了推进这个目标，我们很高兴与美国乳腺外科医生学会合作，使美国医学超声学会乳腺超声检查实践指南得以更新。感谢许多为这个文件的完成献出时间、知识和精力的志愿者们。
The AIUM represents the entire range of clinical and basic science interests in
medical diagnostic ultrasound, and, with hundreds of volunteers, the AIUM
has promoted the safe and effective use of ultrasound in clinical medicine for
more than 50 years. This document and others like it will continue to advance
this mission.
美国医学超声学会展示临床和基础医学感兴趣的超声诊断的全部范围，同时在数以百计的志愿者的努力下，美国医学超声学会已经使超声在临床得以安全、有效应用50多年。这份指南及其它指南将会继续推进这个目标。
Practice guidelines of the AIUM are intended to provide the medical ultra-
sound community with guidelines for the performance and recording of
high-quality ultrasound examinations. The guidelines reflect what the AIUM
considers the minimum criteria for a complete examination in each area
but are not intended to establish a legal standard of care. AIUM-accredited
practices are expected to generally follow the guidelines with recognition
that deviations from these guidelines will be needed in some cases, depending
on patient needs and available equipment. Practices are encouraged to go
beyond the guidelines to provide additional service and information as needed
by their referring physicians and patients.
美国医学超声学会的实践指南旨在为医学超声团体提供完成和记录高质量超声检查的指导方针。指导方针反应美国医学超声学会考虑到的在每个区域检查中需要的最低条件，而不是试图设立一个法定的注意标准。美国医学超声学会认可的做法是，在通常情况下遵循指南，并承认在某些情况下需要违背指南，这取决于病人的需要和设备条件。鼓励进行超过指南的实践，提供相关医生和病人需要的额外的服务和信息。

I. Introduction简介
This guideline has been developed to provide assistance to practitioners performing sonographic examinations of the breast. When sonography is used as guidance for interventional procedures or biopsy, guidelines that address those specific situations should be consulted.
这个指南已经改进了，为乳腺超声检查的操作者提供帮助。随着超声检查被用于介入操作和活组织检查的引导，服务于这些特殊情况的指南就应该被商讨。

II. Indications适应症
Appropriate indications for breast sonography include:
1. Identification and characterization of palpable abnormalities and further evaluation of clinical and imaging findings.
2. Guidance for interventional procedures.
3. Evaluation of problems associated with breast implants.
4. Treatment planning for therapy.
Breast sonography is the initial imaging technique for evaluating palpable masses in women younger than 30 years and in lactating and pregnant women.
Although the efficacy of sonography as a screening study for occult masses is an area for research, at this time sonography is not considered a primary screening modality in other populations.
乳腺超声检查的适应症包括：
1、  确认及描述明显的异常，进一步评估临床和图像所见。
2、  介入操作的引导。
3、  乳房植入物相关问题的评估。
4、  治疗计划的制定。
乳腺超声检查是评估小于30岁的女性、哺乳期女性及孕妇的可见包块的首选影像技术。虽然超声检查作为隐性包块的筛查术的功效是研究的一个领域，但是目前超声检查在其它人群并不被认为是主要筛查形式。

III. Qualifications and Responsibilities of Personnel相关人员的任职要求及职责
See the AIUM Official Statement Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Ultrasound Examinations and the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.
详见美国医学超声学会内科医生培训指南官方声明，其中评估及解释了诊断超声检查及美国医学超声学会对超声实践的认证标准和指导方针。

IV. Written Request for the Examination检查申请的书写
The written or electronic request for a sonogram should provide sufficient information to allow for appropriate performance and interpretation of the examination. The request for the examination must be originated by a physician or other appropriately licensed health care provider or under their direction. The accompanying clinical information should be provided by a physician or other appropriate health care provider familiar with the patient’s clinical situation and should be consistent with the relevant legal and local health care facility requirements.
手写的或电子的超声检查申请应当提供充分的信息以规定检查的合适表现和解释。检查申请必须出自于内科医生或被恰当地许可的医疗工作者，或者在他们的指导下（完成）。相关临床信息应该由内科医生或其他恰当的熟悉患者临床情况的医疗工作者，同时应当符合相关法律及当地的医疗设备条件。

V. Specifications of the Examination技术规范

A. Lesion Characterization and Technical Factors病变描述和技术因素
1. The breast sonogram should be correlated with mammographic and other appropriate breast imaging studies as well as with a physical examination directed to the area in question. If sonography has been performed previously, the current examination should be compared with prior sonograms, as appropriate. A lesion or any area of the breast being studied should be viewed in 2 perpendicular projections; 1 view is insufficient.
乳腺声像图应当与乳腺摄影、其他乳腺成像结果及可以指示问题区域的体格检查相结合。如果（患者）以前进行过超声检查，那么这次检查应该适当地和以前的检查进行对比。病变或其它检查区域应当分别在两个垂直切面进行观察，一个切面是不够的。
2. At least 1 set of images of a lesion should be obtained without calipers. The maximal dimensions of a mass should be recorded in at least 2 dimensions.
一个病变至少应该采集一张没有测径器的图像。肿块的最大尺寸应当测量两次。
3. The images should be labeled as to the right or left breast, the lesion’s location, and the orientation of the transducer with respect to the breast (eg, transverse or longitudinal and radial or antiradial). The location of the lesion should be recorded; the quadrant should be specified, or the location can be indicated by using clock notation and distance from the nipple or shown on a diagram of the breast. Several sonographic features may be helpful in characterizing breast masses. These features should be noted: size, shape, echogenicity, margin features, orientation, and attenuation (eg, shadowing or enhancement). Features may also be described using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon.
图像应表明左乳或右乳、病变的位置和探头相对于乳房的方位（例如：横切或纵切及径向切面或者非径向切面）。病变的位置应当被描述：应该指明（病变）所在象限，或者可以用时钟表示法指示病变位置，说明至乳头的距离或者在乳房示意图上标明。许多超声特征可能会有助于对乳腺肿块的认识。这些特征应该被记录：大小、形状、回声反射性、边界、方位和衰减（例如：减弱或增强）。可应用美国放射学会的乳腺影响报告和数据系统的专业词汇对特征进行描述。
4. Mass characterization with sonography is highly dependent on technical factors.
Proper depth, gain, and focal zone settings should be optimized to obtain high-quality images. The patient should be positioned to minimize the thickness of the portion of the breast being evaluated. For evaluation of superficial lesions, a standoff device or use of a thick layer of gel may be helpful.
超声成像对肿块的认识很大程度上取决于技术因素。应将深度、增益和增益设置到最佳以得到高质量的图像。病人的体位应使被观察部分的厚度最小。观察表浅的病变时，支架设备或一层厚的凝胶可能会有帮助。
B. Guidance of Interventional Procedures介入操作的引导
1. Interventional procedures that can be performed with sonographic guidance include but are not limited to cyst aspirations, presurgical needle hook wire localization, therapeutic procedures, and fine-needle, core, or vacuum-assisted biopsy.
介入可以在超声引导下进行的包括但不限于以下方面：囊肿穿刺，术前针钩线定位、治疗过程，细针、带芯或真空负压细针穿刺活检。
2. A full sonographic examination of the area of interest should be completed before the procedure.
应该在（介入）操作之前对感兴趣区进行一次全面的超声检查。
3. There is no single correct method for accomplishing interventional procedures with sonographic guidance. Both a freehand technique and the use of a transducer with a needle guide are suitable for breast interventions. The type of equipment on hand and the experience of the physician performing the procedure will determine the technique.
在超声引导下完成介入操作没有唯一正确的方法。手法和带引导针的探头的应用适于乳腺介入术。仪器的类型和进行（介入）操作的医生的经验将会决定技术水平。
4. High-frequency transducers with a center frequency of 7.0 MHz or higher used for imaging the breast are suitable for guiding interventional procedures. With these transducers, continuous visualization of the device path is possible. Depending on the transducer configuration, the geometry of the acoustic beam, and the route of device entry, either a small portion of the device may be visible as an echogenic focus, or, if the device entry is aligned with the acoustic beam and nearly perpendicular to it, the entire device may be visible.
中心频率7.0 MHz或更高频率的高频探头对乳腺的成像适用于介入操作的引导。在探头作用下，设备路径的连续可见变为可能。装置的一个小部分可能发生回波聚焦而可见，或者当装置的进入（方向）与声束平行或几乎垂直时，整个装置都可见，这取决于探头的结构、声波的几何学特性和装置的进入（方向）。
5.  Sonographic guidance can be used to aid in infiltration of anesthetics around the mass.
超声引导可被用于引导肿块周围的浸润麻醉。

VI. Documentation文件材料
Images of all important findings, including in the case of interventional procedures the relationship of the device to the lesion, should be recorded on a retrievable and reviewable image storage format.
所有重要发现的图像，包括在介入操作时装置和病变的关系，应被记录为可修复及可读的图片格式。
A. Official documentation for the ultrasound images should include but is not limited to the following: 正式的超声影像文件材料应包括但不限于以下（方面）：
1. Patient’s name and other identifying information.病人的姓名和其它识别信息。
2. Facility’s identifying information.仪器识别信息。
3. Date of sonographic examination.超声检查时间。
4. Image orientation when appropriate.适当的图像说明。

B. The physician’s report of the sonographic findings should be placed in the patient’s medical record.
医生的超声所见报告应当放入病人的病历。
C. Retention of the breast sonograms should be consistent with the policies for retention of mammograms in compliance with federal and state regulations, local health care facility procedures, and clinical needs.
对乳腺超声影像的留存应与乳腺X线照片的留存政策一致，遵照联邦政府或州的规章、地方性医疗设备规程和临床需要。
D. Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an Ultrasound Examination.
报告应当符合美国医学超声学会关于超声检查文件材料的指南。

VII. Equipment Specifications设备规格
Breast sonography should be performed with a highfrequency linear array transducer operating at a center frequency of at least 7 MHz. Equipment permitting electronic adjustment of focal zone is recommended. In general, the highest frequency capable of adequate penetration to the depth of interest should be used. For evaluation of superficial lesions, a standoff device or use of additional gel may be helpful.
乳腺超声检查需要在中心频率至少7 MHz的高频线阵探头下进行。推荐使用允许电动调节聚焦区域的设备。总的来说，应该应用足够到达感兴趣区深度的最高频率。对于浅表病变的观察，支架设备或附加凝胶的应用可能会有帮助。

VIII. Quality Control and Improvement,质量控制和改善
Safety, Infection Control, and Patient Education Concerns Policies and procedures related to quality, patient education, infection control, and safety should be developed and implemented in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices. Equipment performance monitoring should be in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.
安全性、感染控制和病人教育相关策略和过程与（检查）质量相关，应当制定和实施与美国医学超声学会的标准和关于超声实践认证指南符合的病人教育、感染控制和安全性（规定）。
Acknowledgments 鸣谢
This guideline was developed by the American Institute of Ultrasound in Medicine (AIUM) in collaboration with the American Society of Breast Surgeons (ASBS).
这个指南是美国医学超声学会与美国乳腺外科医生学会合作完成的。
Collaborative Subcommittees 合作的小组委员会成员
AIUM美国医学超声学会
Gary Whitman, MD, Chair
Cindy Rapp, BS, RDMS, RDCS
Cathy Piccoli, MD
ASBS美国乳腺外科医生学会
Mark Gittleman, MD
Howard Snider, MD
Eric Whitacre, MD
AIUM Clinical Standards Committee
David Paushter, MD, Chair
Teresita Angtuaco, MD, Vice Chair
Susan Ackerman, MD
Jude Crino, MD
Marie De Lange, BS, RDMS, RDCS, RT
Lennard Greenbaum, MD
Kimberly Gregory, MD, MPH
Barbara Hertzberg, MDStephen Hoffenberg, MD
Charles Hyde, MD
Richard Jaffe, MD
Alfred Kurtz, MD
Joan Mastrobattista, MD
Jon Meilstrup, MD
William Middleton, MD
Cindy Rapp, BS, RDMS, RDCS
Michelle Robbin, MD
Henrietta Kotlus Rosenberg, MD
Joseph Wax, MD
Lami Yeo, MD

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