The document discusses ultrasound technology and its applications. It describes how ultrasound uses sound waves with frequencies above human hearing to produce images. Smartphones can now be used for basic ultrasound exams. The document outlines ultrasound physics concepts like transducer design and knobology. It shows how ultrasound is used to image internal organs and detect medical conditions by techniques such as B-mode, Doppler, and contrast enhanced ultrasound. Artefacts that can occur on ultrasound images and how to recognize them are also summarized. Ultrasound is highlighted as a convenient, non-invasive and low-cost imaging method.

3. Worlds smallest ultrasound equipment
Your smartphone!

4. Faroe Islands

5. Christian P Nolsøe MD PhD
WFUMB President
Dep of Surgical Gastroenterology
Ultrasound Section
Herlev Hospital, Denmark
Faroe Islands
The island “Nolsoy” (Nolsø)
The capitol “Tórshavn”
Ultrasound physcis, techniques and knobology
very basic aspects

6. - and 100.000 sheep with
no respect for cars !

7. Millions of puffins

9. Up in the air
Basic aspects of ultrasound
Physics & Knobology

10. Bats hunt at night with
ultrasound around 200 kHz
Giant bats – Katamandu, 2010

11. Porpoises use ultrasound up to 160 kHz
Kauai 2010

13. SONAR - SOund NAvigation and Ranging

14. SONAR - SOund NAvigation and Ranging
Fishfinder 
Salmon, 9 kg,
Baltic Sea

15. ULTRASOUND
Natures own imaging
Completely safe!!!

16. Approximately 10 % thought that
US utilized radiation !

17. ”Green” imaging by ALL measures

19. What is Ultrasound?
• Audible Sound: 20 Hz - 20 KHz
• Diagnostic US: 2 – 20 MHz
• Abdominal US: 2 – 5 MHz
• Small Part US: 7 – 15 MHz
• Lower frequencies: Better penetration
• Higher frequencies: Better resolution

20. The Piezo-Electric Transducer
Transducing
between
Electrical and Kinetic (Sound) Energy

21. From single crystal to
Array transducer
Up to 256 crystals in one array

22. Ultrasound Transducer – schematic model

25. By courtesy of Peter Coombs

26. Focused Assessment with Sonography in Trauma FAST

27. Intervention

28. B-mode
(B for Brigthness)

29. Doppler mode
Color Doppler

30. Continuous wave, Doptone
Spectral Doppler analysis
Acoustic

31. B-mode + Spectral analysis
“DUPLEX”

32. Celiac Trunc and Superior Mesenteric Artery
B-mode + Spectral analysis + color Doppler
“TRIPLEX”

33. Power Doppler

34. Focal liver lesions ?
Contrast mode - CEUS
(Contrast Enhanced UltraSound)

35. Knobology – Transducer and application

36. Knobology
Gain (Volume/brigthness)

37. Huge livercyst

38. Gain

39. Knobology
Slope/TGC/DGC
Slope/TGC/DGC

40. Importance of Slope

41. Knobology
Slope/TGC/DGC
Depth – image magnification

42. Depth/Size – image enlargement

43. Importance of
Focal zone
If you miss the shadow artifact
You miss the diagnosis

44. Pixels in the US-image
A 1 2 3 4 5 6 7 8 9 10 11
B
C
D
E
F
G
H
I
J

52. Artefacts
• Principles
• Recognition
• Pitt-falls
• Utilization
Ghost lesion

53. Attenuation Artefacts
B: Enhancement
C: Shadow from stone
D: Heterogeneous proces
A: Reference
A B C D

54. Attenuation Artefacts
Enhancement
Shadow from stone

55. Attenuation Artefacts
Shadow from calcification
behind cyst

56. Cholecystolithiasis

57. Artefacts
• Principles
• Recognition
• Pitt-falls
• Utilization
Clean shadow = stone
Dirty shadow = gas in bowel
???

58. Artefacts
Clean shadow = stone
Dirty shadow = gas in bowel may show ”comet tail”

59. Importance of
Focal zone

60. Ultrasound Artefacts
Pathway artefacts

61. Mirror artifact

62. Reverberation Artefacts
• Ringning
TR

63. Reverberation
TR

64. Biopsy needles; different angles

65. Reveberations & Grating Lobes

66. Doppler Artifacts
Ringing gallstones – Twinkling artifact

67. Cholecystitis – twinkling artifact

68. M .biceps
long.
Anisotropic artefact

69. Names !

70. Ghost lesion
Reverberation
Sidelobes
Enhancement

71. Things are not always what they
appear to be
Diagnosis, please !
Two pills in duodenum !

72. ULTRASOUND
• Convenient
• Rapid
• Real time
• Organ function independent
• No radiation
• Mobile equipment/portable
• Pt can stay in bed
• Inexpensive

73. US NOT for Staging !!!
Need wholebody
Imaging
CECT/CEMRI

75. Ghost artifact

77. Grating lobes artifact

78. Grating Lobes