ACR–AIUM–SPR–SRU PRACTICE PARAMETER FOR THE PERFORMANCE OF SCROTAL ULTRASOUND EXAMINATIONS

PREAMBLE

INTRODUCTION

II.

INDICATIONS

III.

QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL

IV.

SPECIFICATIONS OF THE EXAMINATION

DOCUMENTATION

VI.

EQUIPMENT SPECIFICATIONS

VII.

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

Writing Committee – members represent their societies in the initial and final revision of this practice parameter

ACR
Rebik, Kristin L DO, Chair
Amodio, John B MD
Itani, Malak MD
Middleton, William D MD

SRU
Bajaj, Sanjiv MD
Fordham, Lynn A MD

SPR
Linam, Leann MD
Squires, Judy H MD
Tutman, Jeffrey MD

AIUM
Mevorach, Robert A MD

Committee on Practice Parameters - Ultrasound

(ACR Committee responsible for sponsoring the draft through the process)

Gabriel, Helena MD, Chair	Adler, Cameron MD	Azadi, Javad MD	Bohm-Velez, Marcela MD
Burgan, Constantine MD	Carnahan, Molly MD	Fu-Yen Lin, Michael MD	Fung, Christopher MD
Gunabushanam, Gowthaman MBBS, MD	Itani, Malak MD	Melany, Michelle MD	Penna, Rupinder MD
Squires, Judy H MD

Committee on Practice Parameters and Technical Standards

(ACR Committee responsible for sponsoring the draft through the process)

Caplin, Drew M MD, Chair

Committee on Practice Parameters – Pediatric Imaging

(ACR Committee responsible for sponsoring the draft through the process)

Amodio, John B MD, Chair	Alizai, Hamza MD	Betz, Bradford W MD	Blumfield, Einat MD
Collard, Michael MD	Goldman-Yassen, Adam MD	Lai, Hollie A MD	Lala, Shailee V MD
Lasiecka, Zofia M MD, PhD	Laufer, Adina MD	Levin, Terry L MD	Li, Arleen MD
Maloney, John A MD	Noda, Sakura MD	Shah, Summit MD	Trout, Andrew T MD
Vatsky, Seth DO

Bulas, Dorothy I MD, Chair, Commission on Pediatric Radiology

Larson, David B MBA, MD, Chair, Commission on Quality and Safety

Nicola, Lauren MD, Chair, Commission on Ultrasound

Comments Reconciliation Committee

McAdams, Christopher MD - CSC, Co-Chair	Weissman, Ian DO - CSC, Chair	Amodio, John B MD	Bajaj, Sanjiv MD
Bulas, Dorothy I MD	Caplin, Drew M MD	Crummy, Timothy MD, MHA - CSC	Fordham, Lynn A MD
Gabriel, Helena MD	Itani, Malak MD	Larson, David B MBA, MD	Linam, Leann MD
Mevorach, Robert A MD	Middleton, William D MD	Nicola, Lauren MD	Rebik, Kristin L DO
Schoppe, Kurt MD - CSC	Squires, Judy H MD	Tutman, Jeffrey MD

REFERENCES

1. [23768892] Appelbaum L, Gaitini D, Dogra VS. Scrotal ultrasound in adults. Seminars in Ultrasound, CT & MR. 34(3):257-73, 2013 Jun.
2. [22498445] Mirochnik B, Bhargava P, Dighe MK, Kanth N. Ultrasound evaluation of scrotal pathology. [Review]. Radiologic Clinics of North America. 50(2):317-32, vi, 2012 Mar.
3. [15136021] Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am 2004;42:349-63.
4. [16632779] Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006;25(5):563-574.
5. [17374858] Deurdulian C, Mittelstaedt CA, Chong WK, Fielding JR. US of acute scrotal trauma: optimal technique, imaging findings, and management. [Review] [27 refs]. Radiographics. 27(2):357-69, 2007 Mar-Apr.
6. [22025740] Philips S, Nagar A, Dighe M, Vikram R, Sunnapwar A, Prasad S. Benign non-cystic scrotal tumors and pseudotumors. [Review]. Acta Radiol. 53(1):102-11, 2012 Feb 01.
7. [22528888] Sung EK, Setty BN, Castro-Aragon I. Sonography of the pediatric scrotum: emphasis on the Ts--torsion, trauma, and tumors. [Review]. AJR. American Journal of Roentgenology. 198(5):996-1003, 2012 May.
8. [23617512] Liang T, Metcalfe P, Sevcik W, Noga M. Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum. AJR Am J Roentgenol. 200(5):W444-9, 2013 May.
9. [24432171] Yusuf GT, Sidhu PS. A review of ultrasound imaging in scrotal emergencies. [Review]. Journal of Ultrasound. 16(4):171-8, 2013 Sep 04.
10. [29468365] Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. [Review]. Pediatric Radiology. 48(5):735-744, 2018 05.
11. [30928082] Rebik K, Wagner JM, Middleton W. Scrotal Ultrasound. [Review]. Radiologic Clinics of North America. 57(3):635-648, 2019 May.
12. [22710430] Richenberg J, Brejt N. Testicular microlithiasis: is there a need for surveillance in the absence of other risk factors?. Eur Radiol. 2012 Nov;22(11):2540-6.
13. [23143112] Wasnik AP, Maturen KE, Shah S, Pandya A, Rubin JM, Platt JF. Scrotal pearls and pitfalls: ultrasound findings of benign scrotal lesions. [Review]. Ultrasound Quarterly. 28(4):281-91, 2012 Dec.
14. [24475810] Cooper ML, Kaefer M, Fan R, Rink RC, Jennings SG, Karmazyn B. Testicular microlithiasis in children and associated testicular cancer. Radiology. 270(3):857-63, 2014 Mar.
15. [30724874] Gupta A, Bhatt S. Ultrasound Findings of Benign Scrotal Lesions: A Pictorial Review. Ultrasound Quarterly. 2019 Feb 04.
16. [21404205] Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. [Review]. Urology Journal. 8(1):60-5, 2011Winter.
17. [15076274] Rubenstein RA, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. J Urol. 2004 May;171(5):1765-72.
18. [16291306] Beddy P, Geoghegan T, Browne RF, Torreggiani WC. Testicular varicoceles. Clin Radiol. 2005 Dec;60(12):1248-55.
19. [30386652] Balawender K, Orkisz S, Wisz P. Testicular microlithiasis: what urologists should know. A review of the current literature. Cent European J Urol. 2018;71(3):310-314.
20. [23122043] Aganovic L, Cassidy F. Imaging of the scrotum. [Review]. Radiologic Clinics of North America. 50(6):1145-65, 2012 Nov.
21. [27058778] Winter TC, Kim B, Lowrance WT, Middleton WD. Testicular Microlithiasis: What Should You Recommend?. AJR Am J Roentgenol. 2016 Jun;206(6):1164-9.
22. [22215782] AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. J Ultrasound Med. 2012 Jan;31(1):133-44.
23. [11863093] Scholz M, Zehender M, Thalmann GN, Borner M, Thöni H, Studer UE. Extragonadal retroperitoneal germ cell tumor: evidence of origin in the testis. Ann Oncol. 2002 Jan;13(1):121-4.
24. [19793379] Stoehr B, Zangerl F, Steiner E, et al. Routine scrotal ultrasonography during the follow-up of patients with testicular cancer leads to earlier detection of asynchronous tumours and a high rate of organ preservation. BJU Int. 2010 Apr;105(8):1118-20.
25. [33718059] Corcioni B, Renzulli M, Marasco G, et al. Prevalence and ultrasound patterns of testicular adrenal rest tumors in adults with congenital adrenal hyperplasia. Translational Andrology & Urology. 10(2):562-573, 2021 Feb.
26. [15937973] Pires CR, De Moura Poli AH, Zanforlin Filho SM, Mattar R, Moron AF, Debs Diniz AL. True hermaphroditism-the importance of ultrasonic assessment. Ultrasound Obstet Gynecol. 2005 Jul;26(1):86-8.
27. [-3149692] American College of Radiology. ACR–SPR–SRU Practice Parameter for Performing and Interpreting Diagnostic Ultrasound Examinations. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=24+&releaseId=2
28. [17270639] Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007 Jan;69(1):152-7.
29. [9880639] Baud C, Veyrac C, Couture A, Ferran JL. Spiral twist of the spermatic cord: a reliable sign of testicular torsion. Pediatr Radiol 1998;28:950-4.
30. [34032502] Punjani N, Wald G, Al-Hussein Alawamlh O, Dudley V, Goldstein M. Standing Ultrasound Adds Clinical Utility for the Diagnosis of Varicoceles. Journal of Urology. 206(4):1001-1008, 2021 10.
31. [35129151] Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q. 2022 Sep 01;38(3):224-236.
32. [-3197621] American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=74+&releaseId=2
33. [-3197641] American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Real Time Ultrasound Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=118+&releaseId=2