Ultrasound Overview and Workflow Guide

Ultrasound Overview and Workflow Guide

Top and center

·       Tissue Composition – Optional and site or radiologist dependent. Click on to view tissue composition options.

            Note: Categories b and c have optional subcategory choices

o   a) homogenous fatty

o   b) homogeneous fibroglandular



o   c)  heterogenous




·       Optional sub-categories for b) and c)


·       Need Priors – Clicking this button will create a tracking tickler and adds “Previous exam(s) should be sought for comparison and, if obtained, an addendum issued” into the recommendations section of the report.



·       Add Location or Laterality Selector – Clicking on one of the blue breast options will drop that laterality (Bilateral, Right, or Left) into the column below to add findings and/or Bi-RADS. Note: If the exam is scheduled as a unilateral you will only be able to add findings/Bi-RADS to that laterality, but you are able to add multiple findings by clicking on the laterality selector again.



      The left side of your screen

·       Selections for Simple Cyst, Complicated Cyst, Complex Lesion, Duct, and Skin

·       Elastography for both Shear and Strain Wave (side tab and can be dictated simultaneously)

·       Fremitus (side tab)

·       Motion (multiple options for simple cyst, complicated, complex, and duct options)

·       Multiple


The right side of your screen

·       Selections for Mass, Cyst versus Solid, Lymph Node, Post-op or Trauma, and Special Cases (such as gynecomastia, foreign body, galactocele, lipoma, hamartoma fluid collection, free silicone, Mondor’s thrombosis, hemangioma, venous malformation, AVM/AVF, pseudo-aneurysm and architectural distortions with and without shadow.

·       Elastography for both Shear and Strain Wave (side tab and can be dictated simultaneously)

·       Fremitus (side tab)

·       Motion (compressible and/or rotatable features for Mass and Cyst versus Solid options)

·       Multiple



Images with blue arrows

·       Blue arrow – Left click hold over the image opens optional variations that can be added to the finding. Note: gynecomastia option only available when the patient is male


Under each left and right findings section

·       Options that can be added or associated with the highlighted finding above them. These are not “standalone” options.



·       Correlate – Does the finding correlate, yes or no, to prior imaging, clinical concern, biopsy/surgical site, incidental, and/or with underlying surface “marker”

·       Change – Is the area new, increased, the same/unchanged, decreased, or gone

·       Features – Associated features that will be linked to the highlighted finding above this button


Lower screen

·       BI-RADS Bar



·       Workup +/- – Such as negative/benign findings regarding prior imaging and/or clinical concern per patient and/or MD, No Change on Comparison, No Axillary Adenopathy, Benign fibrocystic changes. Note: Options for BI-RADS 0, 1, 2, and 3

·       Marker – Can add biopsy marker(s) with the option to add the shape

·       Implant – Options for placement, type, condition, and miscellaneous

·       Follow Up – Opens recommendation options for location/laterality, the modality or follow-up, the next visit date, and an additional section for specific requests. Note: Bi-RADS are given default recommendations, but they can be customized and/or new ones added by clicking on the “Follow Up” button

·       Report – Takes you to the report screen (can also click “Report” option on the navigation bar)

Follow Up/Recommendations Button Example:



Diagnostic Workflow Example

      ·       When a patient returns for a diagnostic workup the marked location(s) will carry forward from the previous exam (see the links in the example below). Note: The location(s) can be changed/updated in “Location” found on the navigation bar

·       A laterality/location must be Highlighted (purple) in order to add findings and/or


·       In the example below the “FA Findings” (optional feature) was highlighted which automatically highlights the 5 most reported fibroadenoma findings. You do have the option to deselect enhancement if it is not seen. This will add report text, “this is consistent with a Fibroadenoma,” and if “Multiple” is also added, “these are consistent with fibroadenomas”


·       Highlighted the next location, added simple cyst and gave this location a BI-RADS 2


·       To add a new finding, click on the blue “Laterality/Location Selector” (also available in “Location”) which will drop a new laterality into the column to add finding(s) with the option to then locate and/or add another Bi-RADS


To Add or update a Location

·       Click “Location” on the navigation bar

·       Highlight the finding/location and click on the diagram. Can hold and drag the target to update

·       Can add centimeter from nipple (cfn)

·       Option to report as quadrant

·       Can add measurements

·       To add another location, click on the blue Add Location/Laterality Selector and locate


Additional Options from the Findings and/or the Location screens

·       When a laterality/location is highlighted there will be a white chevron in the corner. Clicking on this will open options to add Custom Finding, Clear Findings (that location), Reset Exam (erase everything and start the exam over), or to Delete (that location/finding).


·       Clicking on “Custom Finding” opens a box to add text and/or pick from a scrollable list of already created macros. If applicable, you can save your custom finding for future use by clicking on Save as Custom Macro, create a short title and save.  Note: The list of macros is also found on the report screen under the “Findings” section

·      If you do not wish to save your custom finding for future use just click “Save” to close this box


Review the report and make any changes prior to signing

·       There are custom macro sections to the right of the report. Note: Any custom comments added from these selections are not tracked within Ikonopedia.

·       “Pre-Sign” button allows time to make corrections and the time limit is site-dependent. Once the time limit has been reached the system will automatically “Sign” the report. Once signed any corrections would be made by adding an addendum (separate addendum workflow guide)


Note: Academic sites with Residents will use the Pre-Sign button which the Attending will “Cancel Pre-Sign” if they need to edit the report.


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