US Gallbladder

Always ask when the patient last ate (at least 4 hours of fasting is best)
Have the patient supine or try left lateral decubitus for a better sonographic window
Have the patient take varying levels of inspiration, especially if the GB is under the rib cage
Use the ABD preset on the GE machine
Start with 5 MHz curvilinear transducer
Don't be shy! really press down with the transducer and use lots of gel
One of the reasons the Sonographers get better images is that they press down harder than us
If you can't find the common bile duct, use a cine and scan throughout the gb slowly. To get a cine, hit the record image button without pausing. This will record the past few seconds of scanning
When in doubt, don’t hesitate to recommend a HIDA

CBD < 6mm (+1 mm for each decade after 60)
Most common reason for an inadequate study on call is no CBD
Use color to differentiate vessels from ducts in the porta hepatis (both the CBD and hepatic artery have echogenic walls)

If the patient's body habitus allows, use the 9 MHz linear to measure anterior wall thickness in transverse
Should be 1-3 mm thick
"Double wall" sign may be GB wall edema