Category: 2. Ultrasound Probe Movements and Manipulation

Compression with the ultrasound probe involves putting downward pressure on the probe to evaluate the compressibility of a structure or organ of interest. The most common use is to evaluate for deep vein thrombosis, differentiate between artery versus vein, and evaluation for appendicitis (non-compressible).

Here is an example of compression used to compress the brachial artery and vein:

Rocking the ultrasound probe involves “rocking” the ultrasound probe either towards or away from the probe indicator along the long-axis.

Rocking allows you to help center the area of interest. This is also referred to as “in-plane” motion because the image is kept in-plane throughout the manipulation.

Here is an example of rocking the ultrasound probe:

Rotating the ultrasound probe involves turning the transducer in a clockwise or counterclockwise direction along its central axis. Rotation is most commonly used to switch between the long and short axis of a specific structure such as a vessel, the heart, the kidney, etc.

In the example below, we are going from a short axis to the long axis of the brachial artery by rotating clockwise 90 degrees:

Tilting the ultrasound probe involves moving the transducer from side to side along the short axis of the probe. It is commonly also called “Fanning” as well. Tilting will allow visualization of multiple cross-sectional images of a structure of interest. You can apply this technique to structures such as the heart, kidney, bladder, vessels, etc.

Sliding involves moving the entire probe in a specific direction to find a better imaging window. This is usually used to find the best window, move to different areas of the body, or to follow a specific structure (such as a vessel).

(Note: There is some more recent literature that suggests that the term “sliding” should indicate motion along the long axis of the probe and “sweeping” involves motion along the short axis of the probe. However, I have found this confuses learners more than just the general term sliding to encompass any movement of the probe from the original position. Also sometimes when you are sliding you are not just going along the short or long axis of the probe but a combination. However, I wanted to mention this distinction in case you encounter it)

Handling the ultrasound probe and proper movement is essential to obtaining optimal ultrasound images. There are traditionally 4 basic movements that are performed when scanning with ultrasound they are Slide, Rock, Tilt(Fan), Rotate. Another technique that could be considered a “5th” cardinal movement is Compression.

It is very important that you master each of these ultrasound transducer manipulation/movement techniques. Most experienced sonographers think what manipulation or combination of movements will give them the desired image. In their minds, they know how each transducer manipulation should change their image. With deliberate practice, you will be able to do this too!