Scan Artist Files – Navigating the Ultrasound Probe

Throughout the years, FOAMfrat has put on quite a few ultrasound workshops. One of the most interesting aspects of watching someone pick up the ultrasound probe for the first time is how they grip it. How the brain wants to hold something new is influenced by how you have gripped something similar. Most parents can relate to watching their children learn how to use utensils. And just like with utensils, how you hold the probe can either help or hinder your precision.

I watched my daughter play Operation the other day and noticed that how she held the tweezers was almost identical to how I grip the ultrasound probe in about 95% of my scans. I took a picture and annotated why the specific components of this grip are ideal for the skill she is trying to perform.

The windows we use in ultrasound are the clearest when the probe is positioned perpendicular to the target. For example, this illustration of a parasternal long view illustrated below.

One of the most common mistakes I see when teaching ultrasound is people gripping the probe high, like a joystick. This may feel intuitive, but it complicates fine motor control. It introduces unnecessary movement that may land your probe in a non-perpendicular position in relation to the target window you are trying to obtain.

Instead, try this:

• Use your dominant hand

• Maintain a low grip near the footprint of the probe

• Keep a point of contact with the patient using your hand or fingers

 There are some views where your grip will need to adjust, such as the subxiphoid.

When you're focused on the screen and using a generous amount of gel, it's easy to lose track of where you are on the patient. Resting part of your hand on the patient gives you stability and orientation, reducing drift and increasing confidence in your landmarking.

Understanding Probe Marker Orientation

The probe marker is a small notch or bump on the probe. It corresponds to one side of the image on your screen. One of the easiest ways to explain this is to tap on the corner of the probe and see which side of the screen you see the tapping on. Correlating what you see on the screen to the probe's position can be confusing. It also does not help that the screen probe indicator switches when you enter cardiac mode. Check out this clip from our Scan Artist Series.

In most modes, like abdominal, the probe marker appears on the screen's left side.

In cardiac mode, it shifts to the right side of the screen.

Why the difference? It comes down to historical context:

Radiology-based imaging (like CT) views the patient from the feet looking up toward the head. This is the standard for abdominal ultrasound, which keeps the right side of the body on the left side of the screen.

Cardiology developed its standards to optimize cardiac windows, particularly in the parasternal long-axis. They flipped the image, placing the probe marker on the right side of the screen so that as they move from parasternal long-axis to apical four-chamber views and then subxiphoid, it maintains screen orientation consistency (RV on the left, LV on the right), making it easier to interpret moving structures and maintain anatomic continuity. So if your ultrasound image feels “backwards,” check your mode. It’s likely a matter of probe marker orientation.

Movement Terms: Navigating with Intention

As an instructor, you can occasionally be tempted to grab the student's hand and position the probe if they are having trouble obtaining a specific view. While this can be helpful a few times to emphasize how much pressure is needed, it ultimately is better to call out directional terms and have them build the muscle memory of finding it themselves. A solid understanding of the maneuvers below will help you guide the learner instead of physically co-piloting the probe.

1. Rocking

Tilting the probe along its long axis is similar to nodding. This is helpful when you’re aligned with a structure but need to bring one end of it into view, such as visualizing both the aortic valve and left atrium in a parasternal long-axis view.

2. Fanning

Tilting the probe across its short axis, sweeping left and right while keeping your pivot point fixed. This helps scan across structures or detect pathology like fluid collections or effusions.

3. Rotating

Twisting the probe while keeping the footprint stationary changes your view from long to short axes (or vice versa). For example, you can rotate from a parasternal long-axis view of the heart to a parasternal short-axis view.

4. Sliding

Physically moving the probe across the skin. Often used to locate the best window or trace anatomy along its course. For instance, sliding along the chest wall until the papillary muscles are visible in a parasternal short view.

In addition to these navigational terms, you may hear the words transverse and sagittal to describe probe orientation. The sagittal plane has the probe marker pointed up towards the head and is commonly used for looking at things like the IVC and bladder in the long axis. Rotating the probe marker towards the patient's right side will provide a transverse view (short-axis) of the same structures.

Practice Without a Probe

You can still practice the mechanics even if you don’t have an ultrasound machine at home. A simple remote control, like a Roku, can act as a stand-in for a probe. Use the volume button side as your probe marker. Practice different grips, rocking, fanning, rotating, and sliding on your forearm or a tabletop. Focus on maintaining control and orientation through small, deliberate movements

Check out this class as part of the Scan Artist Series in Studio.

References

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