Knobology

Shagufta Batool
Knobology
● Knobology is a terminology that describes
the manipulation of ultrasound knobs and
system controls in order to obtain the
best image possible from diagnostic
ultrasound.
● The inadequate use of knobology variables
may impair image quality and can result in
misdiagnosis.
Image Optimization:
Adjust the following in order;
● Depth
● Focus
● TGC
● Zoom
● Gain
● Dynamic range (contrast)
Preset:
● Preset button or the exam button is
perhaps one of the most important
buttons in an ultrasound system.
● Selecting the right preset for that
particular region of the body makes
scanning much easier.
● Built-in software assists not only with
labeling and measurement but will make
the video image much clearer.
Preset:
● For example, if you were scanning a
pregnant patient in the second trimester
and did not select the obstetrical preset
for the second trimester, you will not be
able to calculate the gestational age using
the fetal parameters such as BPD, FL, or
AC if you were scanning the patient using
abdominal settings. Also note that the
acoustic output of the probe may be
higher than is recommended for fetal
ultrasound.
Depth:
● The depth setting must be adjusted so
that the structures of interest fall within
the field of view.
● The objective is to set the depth to just
below the desired target.
● Start with higher “Depth”
● Decrease “Depth” to put area of interest
at ¾ depth of screen
● Leave a small area behind to observe
useful artifacts e.g.,shadowing,
enhancement.
 Depth
Too much! Too little!

Just
right!
Focus:
● Ensure that the structure of interest is
in the focal zone.

● Allows to adjust the focal zone to various

depths in the field.

● By positioning the focus at the same level

as the target of interest, the amount of
beam divergence can be limited and
lateral resolution maximized accordingly.
Out Focus! Good Focus
Gain:
● This is the most important control for
image optimization.
● The gain controls usually measured in dB.
● It is an arbitrary measurement of sound
amplitude.
● It Dictates how bright (hyperechoic) or
dark (hypoechoic) the image appears.
● Care must be taken with the use of gain.
Too much overall gain can fill artifactual
echoes into fluid-filled structures,
whereas as too little gain can negate real
echoes information.
Gain:
● Increasing the gain amplifies the
electrical signal produced by all returning
echoes which in turn increases the
brightness of the entire image, including
background noise.
 Gain
Too much! Too little!

Just
right!
Time Gain Compensation
(TGC):
● Also called as depth gain compensation
(DGC).
● Similar to the gain dial.
● Adjust TGC to obtain a smooth grey scale
picture.
● TGC differs by allowing the operator to
adjust the brightness independently at
specific depths in the field.
● It is used to compensate the acoustic loss
by absorption, scattering and reflection.
Time Gain Compensation
(TGC):
● And to show the structures of the same
acoustic strength with the same
brightness, no matter what the depth is.
● Individual controls for the small
segments of the display, known as slide
pots, are available from most
manufacturers.
● The DGC/TGC and gain controls should be
used together to provide a uniform image.
.
 Zoom:
● Zoom in to magnify point of interest.
● It allows the image magnification by increasing
the pixel size, although this change results in
image degradation.
● Read - zoom: only magnification.
● Write - zoom:
■Improve image quality.
■With write zoom, a box is placed on the
screen and the area seen within the box can
be expanded to fill the screen. The number
of scan lines remains the same and the lines
are reallocated so that the image is w true
magnification of the area under examination.
Zoom:
● Useful in the:
○ Measurement of CBD
○ M-mode documentation of fetal
pulsation.
Zoom
Dynamic range:
● Also called as log compression.
● It is the range of the intensities from
the largest to the smallest echo that a
system can be display.
● Changing the log compression does not
affect the number of gray shades in the
image; instead, it varies the display of
the gray shades.
● For Example, a signal will appear more
sonolucent at a lower log compression
than the same amplitude signal at a
high-log compression setting.
Dynamic Range:
● The log compression may be used to
remove reverberation artifacts from
cystic structures or to enhance the
display of low level echoes such as
gallbladder sludge or soft plaque.

● How white is white? And how black is black?

● Adjust dynamic range give the contrast.
● High “Dynamic Range”
● = Low “Contrast”
Dynamic Range:
Too low! Too high
Calipers:
● Calipers markers are available to measure
distances.
● The ellipsoid measurement is an added
feature in most units.
● A dotted line can be created around the
outline of a structure to calculate either
the circumference or the area.
Freeze:
● Modern ultrasound systems are always
recording and dumping data as they
record new data.
● So, at any point in time when you press
the freeze button, the user can scroll
back through the previous few frames on
the internal memory of the device.
● Once you unfreeze, the data from the
previous scan is deleted unless
specifically saved by the user.
Freeze:
● The amount of data that is stored while
scanning can be adjusted by the user by
logging into the system configuration or
system settings.
● Small pocket ultrasound devices may not
allow you to manipulate such settings
THANK YOU…