I work for several different hospitals in my region with a collective agreement on US appendix protocol. Yes, aim for the visualilzation of a normal appendix. Also we will include images of Rt/Lt adnexa, and RUQ/LUQ as well as RLQ mesentery for any lymph node enlargements. Depending on the age of the patient, gender, amount of free fluid (if any) and the experience level of the sonographer, if the appendix is not identified with confidence, a CT may be warranted.
We have been doing more and more appendix evaluations with u/s in my facility and it took quite awhile to get confident in doing them. The ER docs are pretty confident if we don't see an appendix and the pt. doesn't completely meet criteria that it isn't appendicitis. If they are showing clinically w/ what appears to be appendicitis and we can't give them a definate answer, they will order a CT appendix protocol.
This is rather a late reply. But the best way to sonographically diagnose appendicitis is to interorogate the point of maximal tenderness, and perform a graded compression study. If there is an inflammation in the RIF, there should be some structural changes and the "blind-ending" vermiform structure may be apparent. I think a "pink appendicitis" or one dampened by prior antibiotic and NSAID therapy may not be classical in appearance. If do not visualize the appendix with a good graded compression to frive away bowel gas, then appendicular inflammation is unlikely. This does not apply to a retrocecal appendix, whose tip may be located upper in the right flank.
Sometimes there is no Pin-point site of tenderness, like this one below, with caption....