Objectives: Patient preparation before abdominal ultrasound plays a major role to ensure improved visualization of internal organs and pathologies by minimizing artifacts. The aim of this study was to assess the effectiveness on abdominal ultrasound scan imaging quality by patient preparation and evaluate its associated factors. Method and Materials: This was a descriptive cross-sectional study on consenting medical patients who had undergone elective abdominal ultrasound scan examinations at the radiology department of tertiary care center, in Sri Lanka for a three months period. Blinded examiners examined the patient preparation and optimization of the scan image findings in related to the abdominal ultrasound scan. The univariate, bivariate analysis and the chi-squared test were used to check the relationship between two categorical variables as this study dataset comprises more than 50 observations, where 5% was used as the significance level. Results: The total 320 randomized patients were included in the primary analyses. The majority of this study participant (29.7%) age was above 60 years while considering gender prevalence both male and female had relatively an equal contribution 52.2% and 47.8% respectively. The greater number of study participants represented urban living places (53.1%) while there was 46.9% from rural places. The occupational category accounted for skilled workers 16.9%, menial jobs 27.8% and a larger proportion was jobless (55.3%). Conclusion: There are lack of research study on patient preparation and optimization of abdominal ultrasound imaging quality. However, our study contends that patient’s preparation improves the abdominal ultrasound scan imaging quality to some extent.