From a sonopath member, Dr. Damian: I found in the case (03_00165 Ruby K Hepatocellular carcinoma) (If you just paste the case number into the pathology search box the case comes up) that they mention some numbers based on where are they scanning the liver e.g. 4/6 and then another 10-27. I want to ask Eric what does that mean and if it is a particular technique to determine which area of the liver is scanned. But I dont know if this should go in the forum? Could you guide me please?

EL: These numbers represent the dates of the sonogram in order to compare size of and location of the lesion. The way I distinguish a liver lesion as resectable or not is if we can keep the cbd, pv, cvc and aorta and if 30% of liver volume (that of a normal liver) can be kept surgically in order to maintain metabolic need then the lesion is resectable. This isnt written up anywhere its just the rule i go by as does my team and tends to pan out with outcomes. Hence a left sided tumor…cut it out…one that involves only the GB and not the cbd and other vital structures>>>take the GB with it. If the diaphragm is involved then seeding may be an issue. I scan first under the xyphoid and point to the right shoulder to get the GB and cbd and pv then drop the probe tail that gives me the left liver, raising the probe tail gives me the right liver. Deep right liver lesion (like in the case Dr. Damian cited) cant take it out but caudal right and caudate lesion>> yes if the cbd, pv, and cvc are not affected. I ensure i know my right from left in the liver by confirm right liver and Gb status with right interocstal approaches and left intercostal approaches for the left. These approaches are demonstrated in the latest normals dvd as efficiency clips. 

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I hope this helps,