Ultrasonography, also known as sonography, involves exposing the body to high frequency sound waves to produce images of internal organs and structures. It has a variety of clinical applications for diagnosing conditions in many areas of the body. Ultrasonography is noninvasive, does not use ionizing radiation, and can provide real-time images to evaluate moving structures like the heart or fetus. While it has limitations in penetration depth and can be operator dependent, technological advances are expanding its capabilities for diagnostic and therapeutic applications.

1. Ultrasonography
Presented by:-
Suman Adhikari (3)
Kushal Singh Basnet (9)
Avantika Joshi (27)

2. Contents
01. Introduction
 Definition
 Principe
 Procedure
 Types
02. Clinical Applications
 Diagnostic
 Therapeutic
03. Pros and Cons 04. Indication and
Contraindication
05. Recent Advances

3. Introduction
• MEDICAL IMAGING
• The technique used to create image of internal as well as external
organs of human body for clinical purpose
• Medical imaging is done to:
• Provide pictorial status of particular organ which is to be treated
• Make surgical targets more clear and precise

4. ULTRASOUND
• Also called sonography
• It involves exposing part of body to high frequency sound
waves to produce pictures of the inside of the body
• As the waves sent into the body are reflected at the interface
between tissue, the returning time tells us of the depth of the
reflecting surfaces and can show real time movements and
structure of internal organs
• Frequency ranges used are 2-15 MHz

5. HISTORY
• First practical application, 1912 unsuccessful search for titanic
• World War II brought massive military research- SONAR (SOund
Navigation And Ranging)
• Mid century used for non destructive testing of materials
• First used as diagnostic tool in 1942 for localizing brain tumors
• 1950’s 2D grey scale images
• 1965 real time imaging
• 1970 various doppler scans
• 1980s 3D ultrasound

7. MECHANISM
• Ultrasound imaging is done using two basic principles
• Propagation of waves in tissue:
• When the sound waves interact with the tissues in the body they are either
reflected, transmitted, attenuated or scattered.
• Piezoelectric effect
• Conversion of one form of energy to another by applying pressure to the crystal.

18. TYPES

24. Terminologies
Echogenicity:- The ability to reflect or transmit
echoes in the context of surrounding tissue.
Hyperechoic:- Bright ; many echoes
Hypoechoic:- Dark ; few echoes
Anechoic:- Black ; no echoes
Shadowing:- a signal void behind structures that
strongly absorb or reflect ultrasonic waves

25. Uses of USG
Can be broadly divided into 2 subtopics: -
 Diagnostic
 Therapeutic
Diagnosis of diseases of different systems: -
i. Cardiology
ii. Emergency Medicine
iii. Gastroenterology and Hepatobiliary
iv. Neonatology
v. Neurology
vi. Urology
vii. Vascular
viii. Obstetrics

26. USG uses in different systems
Emergency Medicine : - Used generally in
FAST (Focal Assessment with Sonography for
Trauma) and patients with right upper quadrant
abdominal pain to aid rapid decision making
1. Pericardiac
2. Perihepatic
3. Perisplenic
4. Peripelvic Space
Fig: - FAST detects minimal amount of fluid in the abdomen by 200 -
650 ml for mainly haemoperitoneum.

27. USG uses in different systems
Cardiology : - Echocardiography for diagnosis
of Cardiac diseases
Musculoskeletal: - Tendons, muscles, nerves,
ligaments, soft tissue masses, and bone surfaces
Figure of lipoma
Fig: - 2D
transthoracic
echocardiography
demonstrates a
myxomatous mitral
valve and prolapse
of posterior mitral
leaflet (arrow) with
severe MR.

28. USG uses in different systems
Gastroenterology and Hepatobiliary : - Imaging of
solid organs like pancreas, aorta, IVC, Liver, Gall-
bladder, bile-ducts, kidneys, spleen

29. USG uses in different systems
Normal Liver has same echogenicity as renal
parenchyma.

30. USG uses in different systems
Neonatology : - Assessment of intra-cerebral
structure abnormality, bleeds, hydrocephalus
Neurology : - Blood flow and stenosis of carotid
arteries and big intra cerebral arteries
Fig: - Normal (Choroid Plexus filling the entire lumen of atrium) and
Ventriculomegaly (Anterior displacement of shrunken choroid plexus that is
detached from medial wall of ventricle)
Fig: - Carotid Doppler effect

31. USG uses in different systems
Urology: - Determination of amount of fluid
retained in the patient's bladder. It can also give
significant information about kidneys, uterus,
ovaries, prostrate, testis.

32. USG uses in Renal system

33. USG uses in different systems
Vascular System: - For assessment of patency
and possible obstruction of arteries. Helpful in
diagnosis of DVT.
In valvular system, the vein are easily compressible but if veins are not compressed, then it is gold standard sign of DVT.

34. USG uses in different systems
Obstetrics: - Used to check the development of
the fetus

35. USG in Obstetrics
1st Trimester 2nd Trimester 3rd Trimester
Confirmation of Pregnancy and viability Fetal presentation and position Cardiac activity
Intra-uterine localization of gestational
sac
Cardiac activity Fetal size
Detection of signs of early pregnancy
failure
Fetal number Fetal presentation and lie
Single or Multiple Pregnancy Fetal age/size and anatomy Fetal anatomy
Assessment of gestational age Amniotic Fluid Assessment Amniotic Fluid Assessment
Assessment of normal embryo and normal
gestational sac before 10 weeks
Placental appearance and location Placental appearance and location
Assessment of basic anatomy after 11
weeks
Assessment of adnexa Assessment of adnexa

36. In non pregnant case,
Used to detect : -
 Leiomyoma
 Ovarian cyst
 Dermoid cyst
 Polyp
 Carcinoma

37. USG uses in different systems
Breast : - To differentiate different kind of breast
tumors
Smooth, solid mass (fibroadenoma)
hypoechoic, homogeneous echogenicity.
Malignant mass
well-circumscribed mass
containing area of
increased density. Slight
marginal irregularity is seen
(arrows)

38. Therapeutic Uses of Ultrasonography
i. Guidance for Local Anesthetic
ii. Effect on blood flow
iii. Pain control
iv. Effect on wound healing
v. Effect on fracture healing

39. Therapeutic Uses of Ultrasonography
Anesthesiology : - Injection guidance while
placing local anesthesia solution near nerves
Fig: - The RN at the elbow. The small
unlabelled arrows indicate the block needle;
the block needle shows a bayonet artifact
and reverberations posteriorly. LA, pool of
local anaesthetic; RN, radial nerve.

40. Therapeutic Uses of Ultrasonography
 Effect on blood flow: - Continuous USG can increase blood
flow up to 45 mins
 Pain control: - Decreases pain by increasing pain threshold,
decreasing transmission of pain impulse along nerve and via
gate theory for pain inhibition.
 Effect on wound healing: - Pulsed ultrasound at low intensity
enhance healing of wound by collagen production, increases
intracellular calcium ion level and stimulates the myofibroblast
to contract giving rapid initial wound strength
 Fracture healing: - Very low intensity US waves if pulsed for
20 mins can stimulate wound healing

41. ULTRASONOGRAPHY:
Pros, cons and Future
Suman Adhikari
Roll no. 3

42. Pros
• Cheap
• Portable
• Non-invasive
• Non-ionizing
• Flexible
• Real-time Image Rendering

43. Cons/Limitations
• Penetration
• Artefacts
• Operator-dependent

44. Advancements/Breakthroughs
• Acoustic Radiation Force Impulse (ARFI) Imaging
• Miniaturized Ultrasound Device
• Histotripsy
• Tumor detection
• Photoacoustic imaging
• Super resolution Ultrasound imaging
• High-Intensity Focussed Ultrasound (HIFU)
• Intravascular Ultrasound

45. Acoustic Radiation Force Impulse
ARFI
• Analysis of Tissue deformatios due to Ultrasound
waves
• Hard tissues have less deformation
• Uses: