Table 1.

Sonographic protocol for suspected testicular torsion

1	Transducer - Use the linear high-frequency 6- to 15-MHz probe. The linear 9-MHz probe can be used to obtain greater depth. In infants, the hockey-stick probe can be used. Start the examination by asking where it hurts.
2	First obtain a midline gray-scale transverse view to document lie of both testes.
3	Take transverse static color Doppler image of both testes.
4	While holding the probe still (do not sweep) in midline transverse mid-testis position, take a 3-s color cine clip of both testes side-by-side to show real-time intrinsic flow.
5	Take gray-scale longitudinal images in central, medial and lateral aspect of each testis.
6	Take gray-scale transverse images at superior, mid and inferior portions of each testis.
7	Document testis volume on each side.
8	Start with asymptomatic side in order to optimize color Doppler parameters, and then move to the affected side. Perform color Doppler of each testis.
9	Color Doppler exam with pulsed Doppler tracing of arterial and venous flow (angle correct if possible, and use power Doppler if flow is difficult to document). Try to measure testicular arterial resistive index.
10	Take gray-scale and color images of the epididymis in longitudinal and transverse planes.
11	Take gray-scale and color images of the spermatic cord in longitudinal plane. Follow the cord meticulously in its entire extent in the sac and through the inguinal canal till the internal ring.
12	Take cine sweeps of each testis in longitudinal and transverse planes.
13	Take cine sweep of each spermatic cord in longitudinal plane.
14	In case of any pathology, save images as needed.