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MEDICAL ULTRASONOGRAPHY

CHAPTER 13

Introduction
Ultrasonography is a noninvasive technique that uses a skin probe emitting sound waves (ultrasound) . Thus, visual images of the internal organs, e.g., the urinary tract, can be obtained for the purpose of assessing its position .

Audible Sound
Humans can hear only a limited range of frequencies that are called the audible spectrum. The frequncy range of audible sound is appropriately 20 Hz to 20 kHz

Ultrasound
Frequncies higher than the 20KHz are called ultraound. Ultrasound is sound with a frequency greater than the upper limit of human hearing, approximately 20 kilohertz/20,000 Hertz. Some animals, such as dogs, dolphins, bats, and mice have an upper limit that is greater than that of the human ear and thus can hear ultrasound.

Sonography
Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize internal organs, their size, structure and any pathological lesions.

Working
Ultrasonography (sonography) uses a probe containing one or more acoustic transducers to send pulses of sound into a material. Whenever a sound wave encounters a material with a different acoustical impedance, part of the sound wave is reflected, which the probe detects as an echo.

Working
The time it takes for the echo to travel back to the probe is measured and used to calculate the depth of the tissue interface causing the echo. The greater the difference between acoustic impedences, the larger the echo is. The difference between gases and solids is so great that most of the acoustic energy is reflected, and so imaging of objects beyond that region is not possible.

To generate a 2D-image
The probe is swivelled, either mechanically or electronically through a phased array of acoustic transducers. The data is analyzed by computer and used to construct the image. In a similar way, 3D images can be generated by computer using a specialised probe.

Display mode
A- mode B- mode M- Mode

A mode :

B MODE
The B mode stands for brightness. Shifting the position of ultrasound transmision & reception results in scanning. Echo signals received undergo intensity modulation, so that a cross sectional image can be diaplyed on the CRT. Using this display method, we can see internal structures in patient safety .

M MODE
M mode stands for motion. This display mode is useful for studying moving tragets such as the anterior mitral valves. The transducer position remain fixed when using this mode while the display moves across the monitor screen ina movemt called scroling. Scrolling allows movement of a vale to be displayed as an image

ULTRASOUND EQUIPMENT

PRINCIPLES OF ULTRASOUND EQUIPMENT

Ultrasound Diagnostic equipment uses a pulse reflection system. The pulse generation circuit generates high volatge pulses. Then the T delay line circuit applies appropiate delay time for each transmitted pulse for electronic focussing for the ultrasound beam. When the ultarsound probe touches the patients skin surface, ultrsound waves are transmittable to the patinet.

PRINCIPLES OF ULTRASOUND EQUIPMENT

The delayed high volateg pulses are applied to the piezo electric transducer elements They produce the ultarsound waves, which will enter to the patiinet & will be reflected back by internal structures. The reflected echo signals are received by the same probe. Then theay are input the R delay line circuit to compensate for the trasnmission delay factor of the pulses & mix the echo signals

PRINCIPLES OF ULTRASOUND EQUIPMENT

Then the receiver circuits ampliier the mixed echo signasl from R delay line In new equipment, the echo signals are produced using a digital scan converter so that tehimage data is stored into the frame memory & read sequentilaly out in a format for display on the TV monitor. The result is real time imaging .

DOPPLER SONOGRAPHY Ultrasonography can be enhanced with Doppler measurements, which employ the Doppler effect to assess whether structures (usually blood) are moving towards or away from the probe, and its relative velocity. By calculating the frequency shift of a particular sample volume, for example a jet of blood flow over a heart valve, its speed and direction can be determined and visualised.

DOPPLER SONOGRAPHY This is particularly useful in cardiovascular studies (ultrasonography of the vasculature and heart) and essential in many areas such as determining reverse blood flow in the liver vasculature in portal hypertension. The Doppler information is displayed graphically using spectral Doppler, or as an image using colour Doppler or power Doppler. It is often presented audibly using stereo speakers: this
produces a very distinctive, although synthetic, sound.

APPLICATIONS:
It images muscle and soft tissue very well and is particularly useful for delineating the interfaces between solid and fluidfilled spaces. It renders "live" images, where the operator can dynamically select the most useful section for diagnosing and documenting changes, often enabling rapid diagnoses. It shows the structure as well as some aspects of the function of organs. It has no known long-term side effects and rarely causes any discomfort to the patient.

APPLICATIONS:
Equipment is widely available and comparatively flexible. Small, easily carried scanners are available; examinations can be performed at the bedside. Relatively inexpensive compared to other modes of investigation (e.g. computed X-ray tomography, DEXA or magnetic resonance imaging).

DISADVANTAGES
Classical ultrasound devices have trouble penetrating bone but current research on ultrasound bone imaging will make it possible with dedicated devices in the future. Ultrasound performs very poorly when there is a gas between the scan head and the organ of interest, due to the extreme differences in acoustical impedance .

DISADVANTAGES
Even in the absence of bone or air, the depth penetration of ultrasound is limited, making it difficult to image structures that are far removed from the body surface, especially in obese patients. The method is operator-dependent. A high level of skill and experience is needed to acquire good-quality images and make accurate diagnoses.

MAINTENANCE
Make sure to check the system daily before starting to examine patinets Daily check will help dicover a malfunction at the earliest possible stage. Before deciding on the malfucntion , check whethr the power is turned ON, whether the chracters are displaying. Etc. If charcaters are diaplyed & no ultrasound image then set the gain knob t themaximum positions. If this operation do not correct the problem, confirm that the probe is connected correctly.