dasar ultrasound
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Introduction to Ultrasound
Scanning
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Diagnostic Ultrasound
Disadvantages- Use is limited in the evaluation of dense
structures, air filled structures or thegastrointestinal tract
- Doesnt provide any information aboutorgan function
- Can not distinguish between benign andmalignant tissue
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Information Provided from
Ultrasound Ultrasound provides information
concerning size, shape, echo pattern and
position of organs and other structures-The ultrasound professional must know the normalpatterns of all organs, including shape, contour,texture, internal architecture, and relative position
-Any disruption of normal patterns suggests an anomalyor abnormality
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Essentials for a good
sonographic examClinical considerations include:
Patient positions for specific examsTransducer selection
Scanning techniques
Patient breathing techniques
These are the things you will learn in this class!!!
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Labeling Sonographic Images
Ultrasound images are labeled as transverseor
longitudinalfor specific organs (ex: Long. Liver)
Patient position should be included (ex: Rt. Decub)
**Labeling protocols will vary slightly from office to office**
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Scan Planes
2 basic scan planes are used in abdominalultrasound scanning. Sagittal / LongitudinalPatients body/organ
is divided in into unequal right and left halves TransversePatients body/organ is divided
into unequal top and bottom halves
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Longitudinal/Sagittal Scan Plane
Transducer placement for longitudinal scan
plane
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Long./Sagittal Monitor Correlation
In the longitudinal scan plane with patient supine:
the top of the U/S monitor corresponds to theanterior anatomy of the patient
the bottom of the U/S monitor corresponds to theposterior anatomy of the patient
the left side of the screen corresponds to theanatomy closest to the patients head
the right side of the screen corresponds to theanatomy closest to the patients feet
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Transverse Scan Plane
Transducer position forthe transverse scan
plane
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Transverse Monitor Correlation
In the transverse scan plane with thepatient supine:
The top of the U/S monitorcorresponds to the anterioranatomy of the patient
The bottom of the U/S monitorcorresponds to the posterioranatomy of the patient
The left side of the U/S monitorcorresponds to the patients rightside
The right side of the U/S monitorcorresponds to the patients left
side
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Prone Patient
At times it is necessary to image a patient prone
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Prone Patient Monitor Correlation In the longitudinal plane with the patient prone:
The top of the U/S monitor corresponds to the posterior anatomy of thepatient
The bottom of the U/S monitor corresponds to the anterior anatomy ofthe patient
The left side of the screen corresponds to anatomy closest to thepatients head
The right side of the screen corresponds to the anatomy closest to thepatients feet
Note: The only thing that
changes when imaging
in the longitudinal plane
when the patient is prone
is the anteriorand
posterioranatomy (top
and bottom of the
screen)
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Prone Patient Monitor Correlation
In the transverse plane with the patientprone:
The top of the U/S monitor correlates with theposterior anatomy of the patient
The bottom of the U/S monitor correlates withthe anterior anatomy of the patient
The right side of the screen correlates withthe anatomy on the patients right side
The left side of the screen correlates with theanatomy on the patients left side
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Sonographic Definitions
Echoes are the bright spots that make upan ultrasound image.
Echoes are the reflections of the sound beam
Echoes represent the anatomy beingevaluated with ultrasound
Echoes vary in brightness giving valuableinformation about the organ
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Sonographic Definitions
If a structure has a lot of echoes within it,it is called echogenic/hyperechoic
Echogenic/hyperechoic an echoproducing structure; reflects sound
with a brighter intensity
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Sonographic Definitions
Structures/organs that contain echoes that areexaggerated and extremely bright are referred to
as hyperechoic
This usually suggests a very solid or densestructure or echo enhancement resulting from
the sound beam passing through a fluid
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Sonographic Definitions
The liver can bedescribed as
hyperechoic ormoderately echogenic
liver
RtKid
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Sonographic Definitions
Hyperechoic liver lesion
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Sonographic Definitions
Hyperechoic area posterior to gallbladder
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Sonographic Definitions
Hypoechoic Low level echoes within a
structure
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Sonographic Definitions
Hypoechoic liver lesion
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Sonographic Definitions
Hypoechoic renal cyst
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Sonographic Definitions
The terms hypoechoic and hyperechoicare also used to compare different organs
echogenicities. If one organ appears brighter or contains
more echoes than another organ then thatorgan is said to be hyperechoic or moreechogenic than the other
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Sonographic Definitions
In this image, the livercan be described asbeing hyperechoic to the
Rt. Kidney or moreechogenic than the Rt.Kidney
The liver contains more
and brighter echoesthan the kidney
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Sonographic Definitions
The terms hypoechoic and hyperechoicare also used to compare different organs
echogenicities. If one organ appears less bright or contains
fewer echoes than another organ that organis said to be less echogenic or hypoechoic tothe other organ.
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Sonographic Definitions In this image the liver can be described as being
hypoechoic to the pancreas or less echogenic than thepancreas
Liver
panc
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Sonographic Definitiosn
The term anechoic/sonolucent (withoutechoes) is used to describe anatomy or
structures that contain no echoesAnechoic structures are represented on
ultrasound as black
Usually an anechoic structure is a fluid filledstructure
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Sonographic Terms
The normal gallbladder is an anechoic organ
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Sonographic Definitions
Normal anechoicurinary bladder
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Sonographic Definitions Anechoic renal cyst
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Sonographic Definitions
Two structures that have the sameechogenicity are referred to as beingisoechoic to each other
Isoechoic is also used to describe anorgan when normal parenchymalechogenicity pattern exists
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Sonographic Definitions
In this image the liverand the lymph nodes
present are isoechoicor isosonic
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Sonographic Definitions
This liver can bedescribed as being
isoechoic since itexhibits a normal liver
echo pattern
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Sonographic Definitions
The terms homogeneous andinhomogeneous/heterogeneous are usedto describe the texture of the anatomy
being evaluated with ultrasound Homogeneous describes smooth uniform
texture throughout a structure
Normal structures without pathology presentwill have a homogeneous texture
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Sonographic Definitions
The normal liver should appear homogeneous
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Sonographic Definitions
Heterogeneous / Inhomogeneousdescribes texture that is not uniform or
smooth throughoutAn organ or anatomy with a heterogeneous
texture would indicate pathology orabnormality
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Sonographic Definitions
This diseased liver would be described as
inhomogeneous or heterogeneous
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Sonographic Definitions
Once you become familiar with normalanatomy you will easily be able to spot
abnormalities
You may not know immediately what thespecific pathology is, but you will knowthat something is wrong!
Your mission in this class is to get to knownormal sonographic anatomy!!!
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Introduction to Scanning
Transducer Formats:
The format of an image is determined by thetype of transducer being used
There are three primary image shapes:
Sector
Linear Array
Curved Linear
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Introduction to Scanning Sector
Displayed as a pie shaped wedge.
Advantage : the sector transducerhas a smaller face, or footprint,
which allows for scanning in small ortight spaces (i.e. between ribs orunder xiphoid)
Disadvantage : skin contact area is
small and the image produced has alimited field of view of structuresnear the skin surface
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Introduction to Scanning
Image produced witha sector transducer
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Introduction to Scanning
Linear Array
Rectangular format
Advantage : allows for imaging awider field of view
Disadvantage : large footprint noteasily used in small areas
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Introduction to Scanning
Image produced with a lineararray transducer
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Introduction to Scanning
Curved Linear Array
Also referred to as Convex Array
Displayed as a blunted pie shaped wedge
The curved linear array is a good compromisebetween the sector and linear transducers
The footprint is smaller than the linear transducerand the curve allows for better contact in small
spaces It still allows for a wider field of imaging
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Introduction to Scanning
Curved Linear Array
Also referred to asConvex Array
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Introduction to Scanning
Image produced with acurved linear array
transducer
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Introduction to ScanningAcoustic Window
Any medium or structure which transmits soundwell
During an upper abdomen ultrasound exam the livermakes and excellent window for imaging the otherabdominal structures
The sonographer can take several images by simply
sweeping the sound through the window, changingonly the tilt or angle of the transducer
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Introduction to Scanning
Transducer Manipulation
Sliding
Rocking Tilting
Rotating
Compression
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Introduction to Scanning
Sliding refers to grossmovement of the transducerfrom one location to another
and can be from or to anydirection
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Introduction to Scanning
Rocking the transducer towards a point ofreference or away from it enables thesonographer to center the point on
interest or extend the field of view in onedirection or another.
Also called In-plane motion because it
allows for visualization of more anatomy inthe original plane slice
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Introduction to Scanning
Rocking
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Introduction to Scanning
Illustration showing the change in the soundbeam along the same plane when rocking
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Introduction to Scanning Tilting involves angling the transducer from side to
side
Also called cross-plane motion because it allows for
visualization in other planes in the same axis
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Introduction to Scanning
Illustration showing thechange in planes of the
sound beam when tilting
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Artifacts
In most imaging fields artifacts usuallydegrade an image and are considered
undesirable.
In ultrasound artifacts can be useful in
identifying anatomy and pathology.
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Artifacts
Posterior enhancement
seen behind the twocysts located in the
testicle
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Artifacts Shadowing opposite of posterior
enhancement. Area behind the structureis hypoechoic or may even be anechoic.
Produced when the sound beam iscompletely reflected or absorbed by thestructure being imaged.
Usually indicates a solid structure.
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Artifacts
Shadow producedby gallstones
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Artifacts
Gas or air-filled structures can reflectsounds and produce shadows.
Shadowing produced by an air-filledstructure is described as a dirty shadow.
The shadow behind a stone or a rib
is sharply defined or described as a cleanshadow.
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Artifacts
Dirty shadow produced by air in bowel
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Artifacts
Refraction Shadowing resulting frombending of the sound beam.
If an echo is not received by thetransducer because of refraction, it isnot displayed on the image.
This often occurs at the edge of cysts. This is also referred to as edge shadowing
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Artifacts
Reverberation result due to the soundsignal bouncing off a strong reflectiveinterface.
Frequently seen when a fluid-filled structureis in close proximity to the transducer(anterior region of the bladder during a
pelvic scan)
Appear as soft specular echoes in theanterior portion of the fluid structure.
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Artifacts
Reverberation seen
anterior bladder
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Artifacts
Ring down artifact seen in this transverseview of the thyroid. It occurs due to the air
within the trachea.
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Artifacts
Mirror artifact Occurs when the soundbeam hits a curved structure, which
focuses the sound beam like a mirror.
A mirror image is seen immediately behindthe original reflector.
Occurs frequently when scanning thediaphragm.
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Artifacts
Mirror image artifact
due to the diaphragm
There appears to beliver tissue in the lungs
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Artifacts
Mirror image artifactdue to the diaphragm
The liver cyst isduplicated superior
to diaphragm
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Artifacts
Mirror image artifactdue to the bladder wall
The bladder tumor and partof the bladder is duplicatedoutside of the bladder wall
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Artifacts
Mirror image artifactdue to the bladder wall
The bladder is duplicatedoutside of the bladder wall
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Artifacts
Propogation Velocity Artifact Causes amisregistration of information resultingfrom the change in sound velocity as itpasses through different densities.
If the sound is delayed, it is recorded
as being positioned deeper than it actuallyis.
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Artifacts
Propogation velocityartifact causes this
diaphragm to lookfractured
The sound travels slower through the livertumor so the echoes posterior to the tumorare misplaced to appear deeper than they
actually are
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Artifacts
Movement artifactseen due to patient
inspiration andexpiration
The diaphragm is distorted
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Assignments
There will be a quiz over todays materialnext Wednesday
Read Chapter 5 on the Vascular System.Pg 101-122
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References
Textbook of Diagnostic Ultrasonogaphy 6thedition Hagen-Ansert
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