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Clin D III > Ultrasound > Flashcards

Ultrasound Flashcards

(73 cards)

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1
Q

The Medical Sonographer

RDMS- registered diagnostic medical sonographer

A

Typical 2 year education program
Now typically tied to Bachelor’s degree
Didactic and Clinical

Other routes, i.e. on the job (OTJ) cross training
National boards
Different specialties

Ultrasound physics as additional part of certification

Ultrasound Provider- UP
Mid level provider for ultrasound department
Has not “taken off” except in echo

Masters Degree

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2
Q

OB/GYNE

TAS

A

transabdominal approach
Full urinary bladder
Later pregnancy (very late may not need full bladder), ovaries, uterus

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3
Q

OB/GYNE

EVS

A

endovaginal sonography
Empty bladder
Early pregnancy, ovaries, uterus
Frequencies of 5-10 MHz
Limited FOV (Field of View)

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4
Q

First Trimester Studies
indications

A

Ectopic pregnancy

Threatened Ab
Cervix open vs closed
Fetal viability/death
Anembryonic pregnancy (blighted ovum)

Sonographic dates
Gestational sac size (see Figure)
Crown Rump length (see Figure)

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5
Q

gesttional sac size

A

measure the size of the ovum when the fetus isnt big enough to measure

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6
Q
A

crown to rump size

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7
Q

2nd and 3rd trimesters
fetal measurements (4)

A

Fetal measurements
BPD- biparietal diameter
HC- head circumference
AC- abdominal circumference
FL/HL- femoral length to humeral length ratio

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8
Q

obgyn

IUGR- intrauterine growth retardation

A

baby isnt growing at proper rate

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9
Q

OBGYN

PROM- premature rupture of membranes

A
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10
Q
A

As seen in “Volume” ultrasound mode
3D look

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11
Q

Biophysical Profile

A

Level II US (See table)

Fetal assessment
Number, position, lie
Breathing, movements, tone, reactive heart rate

Fetal Data
Measurements BPD, FL, AC
Systematic organ review

Placenta, amniotic fluid amount
Cord

measurements taken to grade the baby, this is done if there are concerns for baby.

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12
Q

US Guided OB Procedures

Amniocentesis

Chorionic Villus sampling (CVS)

A

Amneocentesis
AFP level abnormal
Fetal lung maturity check
Level of fluid

CVS can help identify certain genetic diseases, including problems with chromosomes. These cell structures hold fetal DNA.

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13
Q

Gyne Exams

A
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14
Q

Transducers

A

Change one form of energy into another

Piezoelectric crystals (created a voltage when mechanically deformed) –>The active component of transducer
Emits ultrasound frequency waves

Conductivity gel is needed to make an image

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15
Q

frequency

A

Numbers of cycles per second
Hertz or Hz
Hearing 30-20,000 Hz
US uses >20,000
Clinical imaging 2MHz –10 MHz

Determined by sound source
Transducer named for main frequency

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16
Q

Beam Anatomy

A

Beam starts as size of transducer

Converges to focal point
Focal length
Diverges in the far zone
Larger diameters have further focal length

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17
Q

Ultrasound transducer beam

A

Sound waves in transducers don’t diffract
Most energy transmitted along main central beam

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18
Q

Resolution

A

Lateral resolution
2 points distinguishable when side by side

Depth resolution
2 pts distinguishable when “front to back”

Wavelength influences resolution
Higher frequency, higher resolution (less penetration)

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19
Q

Pulsed Waves

A

Collection of number of cycles that travel together
On time- transducer sending
Off time- receiving
Capturing return trip information

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20
Q

Receiver

A

As image depth increases, the pulse repetition frequency decreases (number of pulses per second) so more listening time

Operator determines maximum imaging depth

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21
Q

Acoustic Propagation Properties

A

Effects of medium upon sound wave
Propagation speed

Attenuation
Absorption
Reflection
Scattering

Impedance

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22
Q

Propagation speed

A

Determined by density and stiffness of medium

All sound travels at the same speed through same medium
Soft tissue (st)- 1.54 km/s (1.54 mm/s)
Lung< fat < soft tissue < bone
0.5, 1.45, 1.54, 3.0 km/sec respectively
Speed m/s = frequency (Hz) x wavelength (m)

know that fat and soft tissue are similar speed, but fat is slightly fas

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23
Q

Attenuation

A

Decrease in intensity and amplification in soft tissue

Greater frequency, greater attenuation

Limits maximum depth from which can obtain images

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24
Q

Absorption

A

Energy imparted to cell is lost by conversion to another form such as heat or vibration of intracellular particles

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25
Reflection
Some of propagating acoustic energy is redirected back toward transducer Smooth reflector (i.e. mirror) is specular reflector (e.g. diaphragm)
26
Specular reflector is the line around the kidney in this image, it disappears where the reflection doesnt bounce back to the transducer. the inside of the kidney that is hyperechoic (lighter) is due to the collectiong ducts.
27
Scattering
If boundary between 2 media has irregularities, with a size similar to pulses’ wavelength, the wavelength can be redirected into many directions Backscatter to transducer Rayleigh scatter- dont need to know this name
28
Impedance
Acoustic resistance to sound as travels through medium Intensity increases with decrease density and with increased propagation speed
29
Difficult to Image Media
Bone Great reflector Backscatter/reflection High propagation speed Increased impedance Increased attenuation Lung Great scatter Low propagation speed
30
Artifact Sources
Machine malfunctioning Poor engineering Acoustic artifacts Operator error Interpreter error- Anatomic artifact/pitfall
31
Acoustic Artifact Types
Reverberation Shadowing Enhancement Reflectors Propagation speed Resolution
32
# Acoustic Artifact Types Reverberation
Multiple echos or reflection equally spaced May occur when 2 strong reflectors lie in line of US beam
33
# Acoustic Artifact Types Shadowing
US cannot pass through first structure either highly reflective or high attenuation or highly scattered sound does not penetrate, so acoustic shadow as useful artifact: **renal calculi cholelithiasis**
34
# Acoustic Artifact Types Enhancement
Appears higher than normal echo amplitude after sound passes through **fluid** **increased “ease”** of sound transmission through fluid **less impedence, faster speed** May have fill in artifact | "opposite fo shadowing"
35
# Acoustic Artifact Types Curved and Oblique reflectors
Image not present or understated (see previous renal film/specular reflector)
36
# Acoustic Artifact Types Propagation speed errors
If tissue is not 1.54 KM/sec, incorrect depth of image
37
# Acoustic Artifact Types Resolution
Appears as 1, if closer than resolution of machine Try to image in different plane to confirm Note: any abnormal finding in any imaging discipline tries to see same in another orientation to “confirm”
38
Quality Assurance
Tissue equivalent phantom Cysts Solids Resolution lateral and vertical
39
Biological Effects & Safety Measures
Very high US intensity can cause damage Thermal injury Exams that cause <1 degree Centigrade elevation of temperature are considered safe Exams that cause >41 degrees Centigrade temperature are harmful to fetus
40
Safety issues
Cavitation Bodies of gas, bubbles, cavities may be excited by US May vibrate, shrink, expand Could lead to tissue injury Minimal evidence that this really occurs, but could in theory Can at lithotripsy levels Do not perform a scan without reason Do not prolong a scan without reason Use minimal output power to produce images
41
Orientation to transabdominal approach films
Typical “outer” approach Longitudinal Head on L Foot on R Transverse R L Cavity approach changes orientation
42
Echogenicity
Presented white on black More white, more echogenic (Denser matter) black, less echogenic (Fluid) Imaging choice for cystic vs. solid
43
Cyst
“Black” fluid filled Enhancement
44
Abdominal studies
Transabdominal sonography (TAS) Usually NPO Decreases bowel gas GB should be “full” Same technique in chest wall cavity when looking for fluid Pleural effusion US guided tap Common Abdominal Studies GB and Biliary system Pancreas- should not be visible, if it is its too mig Kidneys Spleen Retroperitoneum
45
Cholelithiasis
45
GB and Biliary system
Liver, GB, CHD, CD, HA, PV Cholecystitis Cholelithiasis Choledocholithiasis GB polyps Echogenic Bile
46
Choledocholithiasis
47
Cholecystitis-thick shaggy GB wall
48
Pancreas | what can you see w US
Pseudocysts Pancreatitis Acute vs chronic Tumors Pancreas tricky to visualize when normal Note classic structures Aorta round- thicker wall IVC “collapsed”-thinner wall Fat around Superior Mesenteric Artery (SMA) Splenic Vein (SV) courses opposite Acute pancreatitis, swollen large, less echogenic Chronic pancreatitis, increased echogenic damaged areas
49
50
Kidneys
Hydronephrosis Parenchymal changes CFR- small kidneys, more echogenic Masses Cysts Congenital deformities Adrenals- not usually visualized Homogeneous parenchyma Center is echogenic collecting system NOT medulla vs cortex, its the parynchema vs collecting ducts Usually less echogenic than liver Liver aids visualization of Right Spleen aids visualization of Left But spleen normally smaller
51
Hydronephrosis
Dilated collecting system in renal pelvis Can have hydroureter as well
52
Spleen
Enlargement Infections Hematopoietic disorders WBC disorders Rupture Sickle cell Neoplasms spleen is Normally homogeneous
53
Retroperitoneum
Enlarged lymph nodes Masses Aorta Abscess
54
AAA
Lumen walls Lumen that blood flows through/clot
55
High Resolution of Superficial Structures
Thyroid Scrotum and Testes Breast
56
Thyroid
Normally homogeneous True cysts Malignant lesions Multinodular goiter Developmental cysts **Parathyroids are NOT usually visualized**
57
Scrotum and Testes
Normally homogeneous Edema Hydrocele Orchitis and Epididymitis Carcinoma Seminoma Varicocele
58
Hydrocele
F= Fluid in scrotal sac
59
Breast
Breast parenchyma fairly homogeneous Masses Cysts Abscess
60
Pelvic studies
Full urinary bladder for acoustic window Urinary bladder Pre and post void for volume/residual volume
61
Prostate studies
Echogenicity usually homogeneous Transrectal approach Size Masses
62
Neonatal brain
Acousic window Cartilage, not bone Fontanelles Why is this test not for an adult brain?
63
Doppler shift
Change in frequency of sound as result of motion between sound and receiver RBCs bouncing Hz Doppler shifts of -10 KHz to +10 KHz in Doppler studies negative is away from transducer, dec frequency positive is toward transducer, increased frequency
64
Doppler
0 or 180 degrees - there is no image as the sound beam and motion are parallel 90 degrees, the velocity is 0, good for imaging Motion mode for flow- graphic
65
Aliasing
Artifact when flow appears negative but really positive the deeper the sample volume (chosen by sonographer) the more likely aliasing higher frequency, more likely aliasing lower frequencies used more often
66
Duplex studies
Images and Doppler in same study
67
Color flow Doppler
Color is related to direction of flow in relation to transducer (positive/negative) Many times this may correspond to venous vs. arterial flow structures imaged B&W Color added to vessels for flow/fxn A pulsed US technique Provides a range of resolution at expense of aliasing
68
Echocardiography
Heart Imaging motion mode and imaging modes valvular abnormalities wall motion analysis ejection fraction pericardial effusion Need to image through “cardiac window” Between bones
69
Echo frequencies
highest frequency but smallest diameter transducers Peds 3.5, 5.0, 7.5 MHz diameters 3-6 mm Adults 3.5, 2.25, 1.6 MHz also a range of diameters (transesophageal approach for even better resolution)
70
FAST Ultrasound
Focused assessment with sonography for trauma (FAST) 4 areas: (1) hepatorenal recess (Morison pouch) (2) perisplenic area (3) subxiphoid pericardial window (4) suprapubic window (Douglas pouch) https://www.ncbi.nlm.nih.gov/books/NBK470479/
71
E-FAST US
extended FAST (E-FAST) add: (1) bilateral hemithoraces (2) upper anterior chest wall https://emedicine.medscape.com/article/104363-overview#a2 https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m3-curriculum/bedside-ultrasonagraphy/fast-exam
72
US Take Home Points
Anatomical imagine, some function applications Acoustic properties guide what “tissues” look like so don’t “see” same things as other imaging modalities Sounds waves, not radiation, theoretical safety issues

Clin D III (11 decks)

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