Ultra sound imaging general presentation
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Tutorial for beginners

Tutorial for beginners

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    Ultra sound imaging general presentation Ultra sound imaging general presentation Presentation Transcript

    • Ultra sound imaging A basic imaging modality Dr Rekha Khare MD Radiology
    • Why U/S is day to day imaging modality?
      • Quick
      • Cheap compare to other imaging
      • Strict patient prep. not required
      • Patient position is flexible
      • Bedside imaging possible
      • Repeat/ review possible
      • No radiation hazard
    • Ultrasound in emergency
      • It is focused in YES or NO question
      • eg. Is there ruptured entopic?
      • Is there cardiac tamponade?
      • Is there abdominal aortic aneurysm?
      • etc. etc.
    • Indication in emergency
      • Trauma
      • Cardiac
      • Bleeding in pregnancy
      • Acute abdominal pain
      • Torsion of testis
    • Trauma
      • Focussed abdominal sonography for trauma……….FAST
    • What is FAST?
      • Detection of free intra abdominal fluid in blunt abdominal trauma
      • Quite reliable and sensitive
    • FAST IN 4 views
      • Check fluid in_ 1. Morrison’s pouch
      • 2.Perisplenic view
      • 3.Pelvic view
      • (rectovesical/ cul de sac__ less than 250ml. fluid is detectable)
      • 4.Pericardium
    • Cardiac
      • To detect cardiac activity if pulse less electrical activity
      • To detect pericardial effusion
      • if yes, Is patient in cardiac tamponade?
      • ( thumping on right cardiac chamber)
    • Bleeding in pregnancy
      • Whatever is the gestational period
      • It could be_ ectopic pregnancy
      • threatened abortion
      • placenta praevia
      • any other
    • Acute abdominal colic/pain
      • Few eg._ acute cholelithiasis
      • acute choledocholithiasis
      • acute pancreatitis
      • acute nephrolithiasis
      • acute torsion of ovary
      • ruptured aortic aneurysm
    • Torsion of testes
      • Use of Doppler to assess vascular supply
    • U/S is not diagnostic for
      • Intestinal obstruction
      • Perforation
      • Plain X-ray supine/ erect or lateral decubitus is the first line of imaging modality
    • Indications other than emergency
      • Abdominal
      • Cardiac
      • Vascular
      • Pelvic
    • Contd.
      • Eye
      • Neck
      • Breast
      • Neonatal head/ brain
      • Any other in consultation with clinician
    • Abdominal problems
      • Ascitis_ to know the underlying cause
      • hepatic - chr. liver disease
      • renal - renal failure
      • cardiac - cardiac failure
      • extra pulmonary tubercular
      • malignancy
    • Contd.
      • Jaundice_ Is it?
      • extrahepatic or intrahepatic
      • and then
      • to see the cause for it
    • Mass in abdomen
      • To assess the size, shape and texture
      • Origin of mass
      • Extent of mass
      • Adjoining vessels/ viscera
      • Associated lesion( ascitis/ pl.effusion/ PE)
    • Fever of unknown origion
      • Sub clinical/ occult malignancy
      • Abdominal tuberculosis
      • HIV ( immunosuppression) related complication eg. abscess
    • Cardiac problem
      • All cardiac lesion (except conduction defect or arrhythmia)
      • like_ cardio-megaly on X-ray chest
      • valvular lesion
      • congenital defects
    • Vascular problem
      • Any pulsatile swelling- aneurysm
      • Arterial thrombus
      • Deep vein thrombosis
      • Varicosity
      • Peripheral vessel disease( limited help)
    • Pelvic problems
      • Gynaecological_
      • infertility
      • bleeding disorder
      • mass in pelvic cavity
      • pelvic pain
      • lost IUCD
    • Trans/endo vaginal scanning
      • Pregnancy less than 6 wks.
      • Ectopic pregnancy
      • Post menopausal bleeding
      • Follicular study
    • Obstetric ultrasound
      • To ascertain pregnancy_
      • size/ gestational age
      • site( IU/ ectopic)
      • viability( cardiac activity )
      • number
      • position/ lie
    • Contd.
      • Placental localization
      • Amniotic fluid ( normal AFI- 10)
      • Umbilical cord
      • Any congenital anomaly
    • Doppler U/S in Obs.
      • To assess IUGR
      • ( though the specificity is low )
      • Fetal distress
      • Commonly umbilical, middle cerebral, uterine artery are examined for systolic/ diastolic peak to assess RI/ PI
    • Eye problem
      • Proptosis
      • Trauma/ foreign body
      • Retinal detachment/ tear/ haemorrhage
      • Vitrous haemorrhage/ collapse
    • Contd.
      • Ocular mass
      • Cataract
      • Retrobulbar mass
      • Optic nerve( gross lesion )
      • Whenever funduscopy is inconclusive
    • Neck problem
      • Enlarged thyroid
      • Submandibular swelling
      • Cervical lymphadenopathy
      • Carotid artery plaque/ thrombosis(doppler)
    • Breast problem
      • Enlarged breast eg. Fibrocystic disease
      • Mass in breast
      • Bleeding from nipple
      • U/S guided FNAC or cyst aspiration
    • Neonatal head/ brain
      • Enlarged head- ? hydrocephalus
      • Neonatal fits- hypoxia
      • haemorrhage
      • Congenital anomaly
      • Birth trauma- ? subdural hematoma
    • Last but not least
      • Any problem in consultation with clinician where ultrasound can help directly or by way of exclusion.
    • Eur.J.emergency.Med 2009 Jul4 Epub
      • Imaging studies performed by technologist and then reviewed by radiologist with no patient contact are better quality studies.
      • This para digm of imaging misses the point of clinicians performed U/S
      • Clinician performed sonography in emergency has better accuracy
    • Request from clinicians
      • Accurate clinical picture is really helpful for correct interpretation of U/S image
    • Recent advances in U/S imaging
      • Despite developments other imaging techniques, the role of U/S continues to expand.
      • Its unrivalled ability to show events in the body in real time with continuing technological advances will