Fundamental ultrasound 超音波入門
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1 Fundamental ultrasound 超音波入門 趙婉純國泰醫院
2 超音波 波動學 Ordinary sound:20-20khz Medical Ultrasound 醫用超音波 : 2-20MHz 超音波由探頭送入人體組織, 利用經過組織交界面產生的回音, 轉換成電子訊號放映在螢幕上 : Ultrasound Imaging
3 超音波原理 Ultrasound Pulse Echoes TISSUES TISSUES Diagnostic Ultrasound, 1993
4
5 超音波原理 反射 : 密度 (acoustic impedance of tissue) 直射 (angle of incidence) 衰減 : 自然衰減 ; 吸收衰減 音速誤差 : 位移 音響陰影 (Acoustic shadow)
6 Acoustic impedance Greater difference of medium, greater reflected Soft tissue - air: 99.9% Soft tissue -- bone :near 100% Incident sound Medium 1 Medium 2 Reflected sound Transmitted sound
7 Acoustic impedance Z = p v Z:acoustic impendence (Rayls) p:density (g/cm) v:velocity of sound (cm/sec)
8
9 Gas reflection Vgh-ks/pan
10 Bone reflection Vgh-ks/pan
11 interface reflection Vgh-ks/pan
12 Vgh-ks/pan
13 假影 (artifact) 多重反射假影 (Reverberation artifact) 旁向波 (Side lobe artifact ) 鏡面現象 (Mirror phenomenon) 透鏡效果 (Lens effect)
14 Reverberation artifact T Real Vgh-ks/pan 2 Reverberation 3 Reverberation
15 Side lobe artifact Vgh-ks/pan
16 Mirror phenomenon Vgh-ks/pan
17 Mirror phenomenon
18 Attenuation Vgh-ks/pan
19 Posterior enhancement Vgh-ks/pan
20 Acoustic shadow Vgh-ks/pan
21 操作 1. 準備事項 : 2. 探頭自不同視窗 (window) 進入 (approach) 觀察 3. 量像的調節 4. 熟知解剖學 5. understanding the normal variation
22 Liver Anatomy Cantile described main divisions along a main plane from GB fossa to IVC. Divides liver into equal halves. Couinaud developed 4 sectors and 8 segments, divided into vertical and oblique planes, defined by the 3 main hepatic veins and transverse plane thru right and left portal branches.
23 Liver Anatomy Hepatic veins lie between segments. Left hepatc vein divides left lobe into medial and lateral segments. Middle hepatic vein divides liver into left and right lobes.
24 Liver Anatomy Right hepatic vein divides right lobe into anterior and posterior segments. A horizontal line thru left and right main portal veins is used to divide lobes into inferior and superior segments. The 8 liver segments are numbers clockwise on the frontal view.
25 Liver Segments
26 Transverse anatomy of liver a transverse image through the superior liver segments, that are divided by the hepatic veins.
27 Young robuste Vgh-ks/pan
28 Transverse anatomy of liver a transverse image at the level of the left portal vein. At this level the left portal vein divides the left lobe of the liver into the superior segments (2 and 4A) and the inferior segments (3 and 4B). The left portal vein is at a higher level than the right portal vein.
29 Transverse anatomy of liver at the level of the right portal vein. At this level the right portal vein divides the right lobe of the liver into superior segments (7 and 8) and the inferior segments (5 and 6). The level of the right portal vein is inferior to the level of the left portal vein.
30 Transverse anatomy of liver At the level of the splenic vein, which is below the level of the right portal vein, only the inferior segments are seen (right image).
31 The points for reading solid organ Size Parenchymal lesion: Diffuse: echogenicity Space occupying lesion Ductal dilatation: level nature
32 The points for reading hollow organ Contour : smooth, distensible Wall : thickness, continue Space occupying lesions
33 Liver
34 Liver: focal sparing zones with decreased echogenicity, without welldefined outline. Similar picture is often in infections (chlamydiosis), blood diseases, subfebrile condition.
35 Biliary dilatation Too many tubes sign Double duct sign
36 Gall bldder Normal gallbladder Hypotonic gallbladder Chronic cholecystitis, exacerbated Compound anomaly gallbladder Semicircular septum of the middle third of the gallbladder. Cholelithiasis Gallbladder polyp
37 Bi-lole GB vgh-ks/pan
38 Adenomyomatosis with Comet tail artifact Vgh-ks/pan
39
40 Chronic cholecystitis, excerbated Double outline of the gallbladder wall
41
42 Pancreas
43 Pancreatic cyst an oval, echonegative formation with well-defined, even outline visualised within the pancreatic body projection.
44 Non-invasive intraductal papillary mucinous carcinoma Vgh-ks/pan
45 Pancreatic Ca
46 Chronic pancreatitis in phase of exacerbation. Note an uneven outline of the gland and heterogeneous structure of pancreatic tissue.
47 Tumour of the pancreatic head
48 Accessory spleen Pancreatic Ca vgh-ks/pan
49 Spleen numerous decreasedechogenicity patches. Similar structures are found in the liver. The picture is characteristic for infections caused, for instance, by Chlamydia.
50 Splenic infarction
51 Calcification
52 Normal kidney
53
54 Duplication of kidneys Incomplete duplication 1 and 2 mark hilum of each renal segment
55 Harmatoma Vgh-ks/pan
56 RCC Vgh-ks/pan
57 Hydronephrosis DD: Normal vessels Vgh-ks/pan
58
59 Hydronephrosis of both kidneys in the status of urinary bladder distension but improved after voiding Vgh-ks/pan
60 TCC Vgh-ks/pan
61 Vgh-ks/pan
62 Abdominal ileus
63 Pitfall of ultrasound in Smaller FOV Vascular enhancement Deeper area Gas block Artifacts & Variants Skill & Technique dependent
64
65 Columm of Bertin: Columnar hypertrophy (column : between pyramid) Vgh-ks/pan
66 Bil hydro with pelvic mass Actually: Blood clots in UB Vgh-ks/pan
67 The musculoskeletal system Ultrasound images are typically used to help diagnose: tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle abnormalities of the muscles, such as tears and softtissue masses bleeding or other fluid collections within the muscles, bursae and joints Limitations: Ultrasound has difficulty penetrating bone and therefore can only see the outer surface of bony structures and not what lies within.
68
69
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72 Breast Anatomic Relationships Skin: 2 mm thick Cooper s ligament Subcutaneous fat Parenchyma Pectoralis muscle ----
73
74 Sono guidance in 4 biopsy procedures fine needle aspiration (FNA), which uses a very small needle to extract fluid or cells from the abnormal area. core needle (CN) which uses a large hollow needle to remove one sample of breast tissue per insertion. vacuum-assisted device (VAD) which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion. wire localization, in which a guide wire is placed into the suspicious area to help the surgeon locate the lesion during surgical biopsy.
75
76
77 Summary Medical Ultrasound Acoustic impedance Artifacts Liver Anatomy The points for reading solid organ The musculoskeletal system Sono guidance
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