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Introduction to Ultrasound
Knobology
The study of knobs --- how to use an ultrasound machine
DR.HAMISI MKINDI,MD.
TO DOWNLOAD CONTACT ME: hermyc@live.com
Knobology Topics
• Physics of Ultrasound – What is it? How does it work?
• Types of Machines
• Modes and Settings
• Echogenicity – How structures appear in an image
• Picking a transducer (probe)
• Image orientation
• Attenuation
• Artifacts
Handheld devices
What is Ultrasound?
• Safe, non-invasive, portable, and affordable imaging technique
• Transducer emits high-frequency sound waves which reflect off of
internal structures (tendons, muscles, vessels, organs)
• Machine records how long it takes these sound waves to return to
the transducer and uses this to generate an image
Butterfly IQ transducer
uses semiconductor
chips instead of crystals
to generate sound
waves of many different
frequencies
Why use gel? It’s a liquid
medium.
• Sound travels better through LIQUID than air.
• Gel allows for sound waves to travel through liquid
between the probe and the patient, resulting in a better
image.
Tissues absorb higher frequency sound waves more easily, but higher
frequency sound waves will produce a clearer image
• Higher frequency waves = sharper images, but do not penetrate as
deep
• Lower frequency waves = reduced image sharpness, but penetrate
at a greater depth
Higher resolution,
shallower max depth
Lower resolution,
greater max depth
Frequency vs. image sharpness
Interpreting Depth from an Image
Superficial (closest to skin)
Deep (furthest from probe)
indicator
• The longer it takes for sound waves to return to the probe after reflecting off of a structure,
the further it is from the probe, and the deeper it is
• Structures that are close to the probe (superficial) are shown at the TOP of the image
• Structures that are further from the probe (deep) are shown at the BOTTOM of the
image
Liquid
Review Questions
What do we use to create that medium?
Gel
In what medium are sound waves
most efficiently transmitted?
Important Modes and
Settings
• Modes
• 2D or B Mode
• Color Flow Doppler
• M-Mode
• Settings
• Depth
• Gain
• Presets used in course
• Cardiac
• Abdominal
• OB/GYN
2D Mode
• Regular scanning
mode
• Where you will spend
most of your time
• Press 2D to reset all
your settings back to
normal!
M-Mode = Motion Mode
• Able to see
movement of a fixed
part of the screen
over time
• Commonly used for
the pulmonary exam
(seeing lung slide
back and forth) and
cardiac exam (seeing
valves open and
close)
Color Flow Doppler Mode
• Doppler measures direction of blood flow
• BART: Blue Away, Red Towards
• If probe is at a 90° angle from the direction of motion, there
will be NO color
Another example:
distinguishing bile
duct (no color)
from portal vein
(color depending
on angle)
Depth
• The most important setting in ultrasound!
• You should try to maximize the space on the screen
• Put the structure you’re looking at in the middle of the
screen, and make it as big as you can!
Too Much Depth
Wasted
Space
Perfect Depth
Less
Wasted
Space—
Much
Better!
Gain
• Gain: the strength of the sound waves coming back to the probe
• Changing the gain changes the brightness of the screen
• Increasing gain makes the image brighter
• Decreasing gain makes the image darker
Under-Gained
Too Dark
Over-gained
Too Bright
Perfect Gain
Just Right
Review Question!
•What button can you press to reset the machine?
2D or B
mode
Echogenicity
• How much a structure reflects sound waves
• More reflection = more echogenic = brighter
• Hyperechoic
• Less reflection = less echogenic = darker
• Hypoechoic
• No reflection at all = not echogenic = black
• Anechoic
Echogenicity - Hyperechoic
• Hyperechoic = white
• More echogenic than
surrounding tissue
• Dense, hard structures
(example: bone, muscle,
tendons, nerves)
Echogenicity - Hypoechoic
• Hypoechoic = gray
• Less echogenic than
surrounding tissue
Echogenicity - Anechoic
• Anechoic = completely black
• Devoid of echoes
• Example: Fluid
Outline of bone
What Is an example of a structure
that would appear hyperechoic?
Increasing frequency =
better resolution but
lower penetration
Intracavitary
or
Endovaginal
Curvilinear or
Convex Linear
Phased
Array or
Cardiac
LINEAR = HIGHEST FREQUENCY
Transducer Basics
• Convex Array (Curvalinear)
C60
To see abdomen, aorta,
kidney, bladder, pelvis…
Transducer Basics
• Phased Array
P21
Good for heart
and lungs!
Transducer Basics
• Linear
• Good for SUPERFICIAL
structures
• Highest frequency probe
L38
Increase frequency = BETTER resolution,
but WORSE penetration
How does increasing frequency
affect resolution (image sharpness)
and penetration?
How to hold the transducer:
Like a pencil, pinky on the patient
Keep in mind: some scans require applying some pressure
Changing your view:
Sweeping vs Fanning
● Sweeping: Moving the location of the probe on the
patient’s body.
● Fanning: Keeping the probe where it is, but changing
the angle side to side.
Anatomic planes
Orientation:
Transducer Indicator
Sagittal
Sagittal
Head Foot
Right Left
Transverse
Coronal
Transverse!
In which probe orientation is the indicator
pointing to the patient’s right?
Attenuation
● Attenuation: decreasing force of a wave as it travels
● High Attenuating Structure: appears hyperechoic, leaves a shadow
behind it. (Example: BONE)
● Low Attenuating Structure: appears hypoechoic, makes the posterior
structure hyperechoic (Example: BLADDER)
High Attenuating Structure
Gallstone
Posterior
Shadow
• When sound
encounters high
attenuating tissue,
echoes are
diminished
posteriorly and an
acoustic shadow
results
Low Attenuating Structures
• When sound
encounters low
attenuating tissue,
echoes are enhanced
posteriorly
• May be used as a
“window” to visualize
anatomy
Posterior Acoustic
Enhancement
• Sound travels to and is reflected
off of the hyperechoic
diaphragm, and heads back
toward the probe
• Some of this sound will be
reflected by liver tissue, and
head back down toward the
diaphragm again, before being
once more sent back toward
the probe
• Machine interprets this as liver
on the other side of (deep to)
the diaphragm
Mirror
Liver
Diaphragm
Artifacts: Mirror Image
This is an important
NORMAL finding
Artifacts: Mirror Image
Mirror
Liver
Diaphragm
Liver and Its Mirror Image
Artifacts: Reverb
• Appears as
many bright
arcs at specific
intervals from
the transducer
This is a NORMAL finding in the lungs
Artifacts: Gas Scatter
• When Sound
encounters air,
the signal is lost
to “scatter” so
anatomy can’t be
seen behind air.
Gas
Happens often in the abdomen when we
try to look at intestines
Mirror Image of the Liver!
Which artifact can be seen in a normal
patient across the diaphragm near the liver?
Benefits of Ultrasound
• Non-invasive
• Diagnostic tool
• Portable
• Dependent on proficiency of handler
• NOT harmful to the handler or the
patient
Summary
• Ultrasound uses sound waves to create images
• Sound travels better in liquid so we use gel between skin and the
probe
• 2D or B Mode is the only mode that allows for resetting the machine
• M Mode measures motion against time
• Doppler allows visualization of red blood cell movement, BART
• Gain = brightness, Resolution = clarity, Penetration = how far waves
are going in the body
• Different transducers and settings used for different systems being
visualized
• Sagittal, Coronal, and Transverse views
• Artifacts can help diagnose certain conditions
• Ultrasound benefits are dependent on your skills!
Learning Ultrasound
It’s confusing at first, and that’s okay!!

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Ultrasound Basics-Knobology Hamisi Mkindi2.pptx

  • 1. Introduction to Ultrasound Knobology The study of knobs --- how to use an ultrasound machine DR.HAMISI MKINDI,MD. TO DOWNLOAD CONTACT ME: hermyc@live.com
  • 2. Knobology Topics • Physics of Ultrasound – What is it? How does it work? • Types of Machines • Modes and Settings • Echogenicity – How structures appear in an image • Picking a transducer (probe) • Image orientation • Attenuation • Artifacts
  • 4.
  • 5. What is Ultrasound? • Safe, non-invasive, portable, and affordable imaging technique • Transducer emits high-frequency sound waves which reflect off of internal structures (tendons, muscles, vessels, organs) • Machine records how long it takes these sound waves to return to the transducer and uses this to generate an image
  • 6.
  • 7.
  • 8.
  • 9. Butterfly IQ transducer uses semiconductor chips instead of crystals to generate sound waves of many different frequencies
  • 10. Why use gel? It’s a liquid medium. • Sound travels better through LIQUID than air. • Gel allows for sound waves to travel through liquid between the probe and the patient, resulting in a better image.
  • 11. Tissues absorb higher frequency sound waves more easily, but higher frequency sound waves will produce a clearer image • Higher frequency waves = sharper images, but do not penetrate as deep • Lower frequency waves = reduced image sharpness, but penetrate at a greater depth Higher resolution, shallower max depth Lower resolution, greater max depth Frequency vs. image sharpness
  • 12. Interpreting Depth from an Image Superficial (closest to skin) Deep (furthest from probe) indicator • The longer it takes for sound waves to return to the probe after reflecting off of a structure, the further it is from the probe, and the deeper it is • Structures that are close to the probe (superficial) are shown at the TOP of the image • Structures that are further from the probe (deep) are shown at the BOTTOM of the image
  • 13. Liquid Review Questions What do we use to create that medium? Gel In what medium are sound waves most efficiently transmitted?
  • 14. Important Modes and Settings • Modes • 2D or B Mode • Color Flow Doppler • M-Mode • Settings • Depth • Gain • Presets used in course • Cardiac • Abdominal • OB/GYN
  • 15. 2D Mode • Regular scanning mode • Where you will spend most of your time • Press 2D to reset all your settings back to normal!
  • 16. M-Mode = Motion Mode • Able to see movement of a fixed part of the screen over time • Commonly used for the pulmonary exam (seeing lung slide back and forth) and cardiac exam (seeing valves open and close)
  • 17. Color Flow Doppler Mode • Doppler measures direction of blood flow • BART: Blue Away, Red Towards • If probe is at a 90° angle from the direction of motion, there will be NO color Another example: distinguishing bile duct (no color) from portal vein (color depending on angle)
  • 18. Depth • The most important setting in ultrasound! • You should try to maximize the space on the screen • Put the structure you’re looking at in the middle of the screen, and make it as big as you can!
  • 21. Gain • Gain: the strength of the sound waves coming back to the probe • Changing the gain changes the brightness of the screen • Increasing gain makes the image brighter • Decreasing gain makes the image darker
  • 25. Review Question! •What button can you press to reset the machine? 2D or B mode
  • 26. Echogenicity • How much a structure reflects sound waves • More reflection = more echogenic = brighter • Hyperechoic • Less reflection = less echogenic = darker • Hypoechoic • No reflection at all = not echogenic = black • Anechoic
  • 27. Echogenicity - Hyperechoic • Hyperechoic = white • More echogenic than surrounding tissue • Dense, hard structures (example: bone, muscle, tendons, nerves)
  • 28. Echogenicity - Hypoechoic • Hypoechoic = gray • Less echogenic than surrounding tissue
  • 29. Echogenicity - Anechoic • Anechoic = completely black • Devoid of echoes • Example: Fluid
  • 30. Outline of bone What Is an example of a structure that would appear hyperechoic?
  • 31. Increasing frequency = better resolution but lower penetration Intracavitary or Endovaginal Curvilinear or Convex Linear Phased Array or Cardiac LINEAR = HIGHEST FREQUENCY
  • 32. Transducer Basics • Convex Array (Curvalinear) C60 To see abdomen, aorta, kidney, bladder, pelvis…
  • 33. Transducer Basics • Phased Array P21 Good for heart and lungs!
  • 34. Transducer Basics • Linear • Good for SUPERFICIAL structures • Highest frequency probe L38
  • 35. Increase frequency = BETTER resolution, but WORSE penetration How does increasing frequency affect resolution (image sharpness) and penetration?
  • 36. How to hold the transducer: Like a pencil, pinky on the patient Keep in mind: some scans require applying some pressure
  • 37. Changing your view: Sweeping vs Fanning ● Sweeping: Moving the location of the probe on the patient’s body. ● Fanning: Keeping the probe where it is, but changing the angle side to side.
  • 44. Transverse! In which probe orientation is the indicator pointing to the patient’s right?
  • 45. Attenuation ● Attenuation: decreasing force of a wave as it travels ● High Attenuating Structure: appears hyperechoic, leaves a shadow behind it. (Example: BONE) ● Low Attenuating Structure: appears hypoechoic, makes the posterior structure hyperechoic (Example: BLADDER)
  • 46. High Attenuating Structure Gallstone Posterior Shadow • When sound encounters high attenuating tissue, echoes are diminished posteriorly and an acoustic shadow results
  • 47. Low Attenuating Structures • When sound encounters low attenuating tissue, echoes are enhanced posteriorly • May be used as a “window” to visualize anatomy Posterior Acoustic Enhancement
  • 48. • Sound travels to and is reflected off of the hyperechoic diaphragm, and heads back toward the probe • Some of this sound will be reflected by liver tissue, and head back down toward the diaphragm again, before being once more sent back toward the probe • Machine interprets this as liver on the other side of (deep to) the diaphragm Mirror Liver Diaphragm Artifacts: Mirror Image This is an important NORMAL finding
  • 50. Artifacts: Reverb • Appears as many bright arcs at specific intervals from the transducer This is a NORMAL finding in the lungs
  • 51. Artifacts: Gas Scatter • When Sound encounters air, the signal is lost to “scatter” so anatomy can’t be seen behind air. Gas Happens often in the abdomen when we try to look at intestines
  • 52. Mirror Image of the Liver! Which artifact can be seen in a normal patient across the diaphragm near the liver?
  • 53. Benefits of Ultrasound • Non-invasive • Diagnostic tool • Portable • Dependent on proficiency of handler • NOT harmful to the handler or the patient
  • 54. Summary • Ultrasound uses sound waves to create images • Sound travels better in liquid so we use gel between skin and the probe • 2D or B Mode is the only mode that allows for resetting the machine • M Mode measures motion against time • Doppler allows visualization of red blood cell movement, BART • Gain = brightness, Resolution = clarity, Penetration = how far waves are going in the body • Different transducers and settings used for different systems being visualized • Sagittal, Coronal, and Transverse views • Artifacts can help diagnose certain conditions • Ultrasound benefits are dependent on your skills!
  • 55. Learning Ultrasound It’s confusing at first, and that’s okay!!