y Definition: The principle of converting energy by
applying pressure to a crystal.
y The reverse of the piezoelectric effect converts the
energy back to its original form.
Piezoelectric Effect and Ultrasound Transducers
y A transducer converts one type of energy into another. y Based upon the pulse-echo principle Ultrasound
transducers convert: Electricity into sound = pulse Sound into electricity = echo
Physical Principles of Ultrasound
y Sound is a mechanical wave,it is a series of pressure
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
Physical Principles of Ultrasound
y Sound waves are expressed as sine waves with the
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 )
3- Propagation Velocity (v) :expressed by the Wave Equation
(v = Pf ) In soft tissue propagation velocity is relatively constant at 1540 m/sec. Hence wavelength is inversely proportional to frequency
Physical Principles of Ultrasound
y 4- Amplitude :is the height above the baseline and represents maximal compression. It is expressed in decibels.
y Definition: The reduction in power and intensity as
sound travels through a medium. Transducer frequency Depth of penetration
y Higher frequencies attenuate, or are absorbed, faster
than lower frequencies
Time Gain Compensation (TGC)
y Operator controlled adjustment to compensate for the attenuation of sound as it travels into the tissue
y Must be adjusted manually for each tissue type examined and may be manipulated throughout an exam to optimize the image
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 .
y Portions of the display which are not a true
representation of the tissue imaged
y Medical Diagnostic Ultrasound imaging utilizes
certain artifacts to characterize tissue
y Acoustic Shadowing and Acoustic Enhancement are
the two artifacts that provide the most useful diagnostic information
Diminished sound or loss of sound posterior to a
strongly reflecting or strongly attenuating structure -stones, large calcification, bone, .etc.
Increased through transmission of the sound
wave posterior to a weakly attenuating structure. Occurs posterior to simple cysts or weakly attenuating masses
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)
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
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
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
y Pulsed (spectral) doppler
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
y Power doppler y Non directional y More sensitive for
measure blood flow
y Duplex and triplex
Interaction with matter
y Absorption, reflection,
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 .
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.
- 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)
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
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
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.
Common bile duct
y The internal diameter of the common duct is reported to be in adults, the average diameter 4 mm. less than 6 mm is considered to be normal, 6 to 7 mm is equivocal, and more than 7 mm is dilated. may be more than 8 mm in eldery pt (increases with age). y Patients with a cholecystectomy CBD is dilated, but nonobstructed 10 mm . y CBD dilated if there obstruction due to formation of stones in the duct.
Stone in CBD
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.
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 .
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
y There is good
differentiation of the renal capsule ,cortex, medulla, and renal sinus complex. The longitudinal plane.
y Normal renal value : y Renal length: 9-12 cm y Renal width :4-6 cm y Cortex width : 1.3-2.5 cm
Moderate HN Mild HN
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.
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
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
3D /4D US