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transducers convert: Electricity into sound = pulse Sound into electricity = echo
waves propagating through a medium. y Audible range of sound frequency for humans is 20 Hz to 20 kHz , so ultrasound By Definition is greater than 20 kHz y Medical ultrasound is performed in the range of 2 20 MHz
following properties: 1- Wavelength (P) : The distance between consecutive cycles of sound. ( f : P ) 2- Frequency (f) : Number of complete cycles per unit of time (Hz)
-The higher the frequency, the better the resolution and the lower the penetration.( f : resolution : penetration )
Attenuation
y Definition: The reduction in power and intensity as
y Must be adjusted manually for each tissue type examined and may be manipulated throughout an exam to optimize the image
Transducer
Curve linear probe Crystals are placed in a curve line transducer face is curved produces pie-shaped image Typically used in abdominal applications Linear probe crystals are placed parallel transducer face is flat produces rectangular image For superficial organs .
Sector
Linear
Artifacts
y Portions of the display which are not a true
the two artifacts that provide the most useful diagnostic information
Acoustic Shadowing
Diminished sound or loss of sound posterior to a
strongly reflecting or strongly attenuating structure -stones, large calcification, bone, .etc.
Acoustic Enhancement
Increased through transmission of the sound
wave posterior to a weakly attenuating structure. Occurs posterior to simple cysts or weakly attenuating masses
US Modes
A mode : y a display of ultrasonic echoes in which the horizontal axis of the cathode ray tube display the time required for the return of the echo and the vertical axis represents the strength of the echo. The mode is used in echoencephalography(used in the past to localize echoproducing interfaces such as midline structures in the brain)
US modes
B Modes : B-mode stands for
brightness mode and provides structural information utilizing different shades of gray (or different brightness ) in a two-dimensional image
US Modes
M Mode : M-mode stands for motion mode. It captures returning echoes in only one line of the B-mode image but displays them over a time axis. Movement of structures positioned in that line can now be visualized. Often Mmode and B-mode are displayed together on the ultrasound monitor
US modes
y Doppler Mode :
y the Doppler mode examines the
characteristics of direction and speed of tissue motion and blood flow and presents it in audible, color or spectral displays
US modes
y Color doppler mode y Direction and velocity of
tissue motion and blood flow are color coded and superimposed on the corresponding B-mode image
US modes
y Power doppler y Non directional y More sensitive for
US modes
y Duplex and triplex
refraction. Scatter
Abdomen US
y Pt. prepration y Fasting 6 hrs to reduce bowel gases and gallbladder
shown distended . y Transducer : Curve linear , 3-5 MHz y Use aqueous gel as coupling material to minimize reflection of US y Mostly use B mode .
Abdomen US
General points for imaging upper abdomen :
1- Always scan any organ in at least two planes, to reduces the risk of missing pathology and helps to differentiate artifact from true pathology. 2- Use a combination of sub- and intercostal . 3- never limit the scan to longitudinal and transverse sections. 4- Deep inspiration can be useful.
Liver
Normal appearance
- The liver is a homogeneous, mid-grey organ on ultrasound. It has the same, or slightly increased echogenicity when compared to the cortex of the right kidney and less echogenicity than pancreas and spleen . - Size of the liver up to 16 cm ,longitudinal scan at midclaviclar line . - Portal vein appear hypoechoic with hyperechoic fibrous sheath.( margin)
Liver
liver pathology
Simple cyst
Liver pathology
Liver cirrhosis
Gallbladder
y The normal gallbladder is best
visualized after fasting for around six hours, it should be distended with bile into an elongated pear-shaped sac. y It should have a hyperechoic, thin wall and contain anechoic bile y Wall thickness of gallbladder not more than 3 mm.(GB wall is measured at the most narrow point of the anterior wall in the short-axis) y GB diameter 4- 5 cm and the long axis from 8-12 cm
Gallbladder
y If the gallbladder cannot be found y Check for previous surgery; a cholecystectomy y Check the patient has fasted y an ectopic gallbladder, for example positioned low in the pelvis. y Congenital absence. y A contracted, stone-filled gallbladder, producing heavy shadowing, can be difficult to identify due to the lack of any contrasting fluid in the lumen y * Sonographic Murphy s sign is positive when the point of maximal tenderness is identified in the right upper quadrant while the gallbladder is identified on the ultrasound monitor
Gallbladder
Duodenum mimicking gallbladder pathology The close proximity of the duodenum to the
posterior gallbladder wall often causes it to invaginate the gallbladder, turn the patient to cause the duodenal contents to move.
Pathology
acute cholecystitis
Contracted GB
CBD
CBD
CBD
pathology
Stone in CBD
Pancreas
y The most useful technique is to start by scanning the epigastrium in transverse plane, using the left lobe of the liver as an acoustic window. In adult , the pancreas is hyperechoic compared to normal liver. y The normal stomach or duodenum can mimic pancreatic pathology if the patient is insufficiently fasted , Giving the patient a drink of water usually differentiates the gastrointestinal tract from a collection.
Pancreas
Spleen
y The normal spleen has a fine, homogeneous with
smooth margins and a pointed inferior edge. It has similar echogenicity to the liver but may be slightly hypo- or hyperechoic . y A splenic length of below 12 cm is generally considered normal .
Spleen
Kidneys
The right kidney is readily demonstrated through the right lobe of the liver The left kidney is not usually demonstrable sagittally because it lies posterior to the stomach and splenic flexure. The spleen can be used as an acoustic window to the upper pole by scanning coronally, from the patient s left side, with the patient supine or decubitus (left side raised) . Normal ultrasound appearances of the kidneys The cortex of the normal kidney is slightly hypoechoic when compared to the adjacent liver parenchym
kidneys
y There is good
differentiation of the renal capsule ,cortex, medulla, and renal sinus complex. The longitudinal plane.
kidneys
y Normal renal value : y Renal length: 9-12 cm y Renal width :4-6 cm y Cortex width : 1.3-2.5 cm
pathology
Renal cyst
pathology
Renal stone
pathology
Moderate HN Mild HN
Severe HN
Urinary bladder
Pt. preparation : Full bladder . To show bladder outline ,window for prostate and
uterus . When the bladder is distended with urine, the walls are thin, regular and hyperechoic. The walls may appear thickened if the bladder is insufficiently distended, making it impossible to exclude a bladder lesion.
Urinary bladder
y Hypoechoic with smooth outline. y The wall thickness of 4 to 6
mm y three perpendicular measurements and multiplying by 0.56: y Bladder volume (ml) = length * width * anteroposterior diameter (cm) * 0.56 y post micturition residue of less than 20 cc in an adult is regarded as normal
patholgy
Vascular US
y R/O DVT y No preparation y Linear transducer 7-10 MHZ y Popilital and femoral vein y Spectral ( pulsed ) doppler used to differentiate artery
and vein y differences between artery and vein : Pulsation and compressepility
DVT
DVT
3D /4D US