Basic of Ultrasound Physics E FAST & Renal Examination. Dr Muhammad Umer Ihsan MBBS,MD, DCH CCPU,DDU1,FACEM
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1 Basic of Ultrasound Physics E FAST & Renal Examination Dr Muhammad Umer Ihsan MBBS,MD, DCH CCPU,DDU1,FACEM
2 What is Sound? Sound is Mechanical pressure waves
3 What is Ultrasound? Ultrasounds are sound waves with a frequency exceeding the upper limit of human hearing, which is 20 to 20 khz. Medical Ultrasound 2MHz to 12MHz
4 Speed of Sound Density of medium Propagation Speed Air = 330 m/s Bone = 4080 m/s
5 Speed of Sound Speed of sound though soft tissues ranges from 1450 m/s (adipose) to 1580m/s (muscle) Most ultrasound systems assume a default speed of sound of 1540 m/s for "tissue" m/s
6 Ultrasound Physics Wavelength Frequency
7 Acoustic Impedance MegaRayls (Z) Air: Z Bone 7.8 Z Adipose = 1.34 Z
8 Attenuation Reflection Refraction Scattering Absorption
9 Mode of Ultrasound A Mode B Mode (Gray sacle) M Mode (Motion)
10 Doppler Effect Moving object will change the frequency of reflected echoes
11 Colour Doppler BA RT
12 Power Doppler Displays the strength of the Doppler signal in colour, rather than the speed and direction information. 3 times more sensative
13 Spectral Doppler Two Types PW stands for pulsed wave Doppler. CW for continuous wave Doppler. Gate
14 ULTRASOUND How is it produced?
15 Ultrasound Wave Production. Transducer contains piezoelectric crystals which produce the ultrasound pulses (transmit 1% of the time & listen 99%). These elements convert electrical energy into a mechanical ultrasound wave called as Pulses. Returning sound waves from the tissues are converted into electric energy called as Echoes
16 How It Works? The sound waves travel into the body at different speed in different tissues until they hit a boundary between tissues (e.g. between fluid and soft tissue or soft tissue and bone). Some of the sound waves reflect back (Reflected Echoes) to the probe, while some travel on further until they reach another boundary and then reflected back to the probe. The differential between reflected echoes are detected,analyzed and then relayed to the machine.
17 Resolution Quality of the ultrasound image Depends on frequency and type of probe
18 Lateral Resolution
19 Axial Resolution
20 Relationship between Frequency & Resolution The frequency affects the QUALITY of the ultrasound image. The HIGHER the frequency, the BETTER the resolution. The LOWER the frequency, the LESS the resolution.
21 Relationship between Frequency & Penetration The frequency also determines the penetration of the ultrasound wave. A 12 MHz transducer has very good resolution, but cannot penetrate very deep into the body. A 3 MHz transducer can penetrate deep into the body, but the resolution is not as good as the 12MHz.
22 Appearance of Reflected sound waves (Echoes) on the machine. Strong Reflections = White dots Diaphragm, tendons, bone Hyperechoic
23 Reflected Echoes No Reflections = Black dots Fluid within a cyst, urine, blood Hypoechoic or echo free
24 Reflected Echoes Weaker Reflections = Grey dots Most solid organs, thick fluid isoechoic
25 Reflected Echoes
26 Echogenicity
27 Echotexture Smooth Coarse
28 Artifacts Sounds travels in a straight line Sound speed is uniform Single pulse from probe and return Attenuation is uniform Signals only from main beam
29 Shadowing
30 Post Cystic Enhancement
31 Lateral Cystic shadowing
32 Mirror Artifact
33 Reverberation Artifact
34 Transducer Types Many different types of Transducer available
35 Curvilinear
36 Linear
37 Phased Array
38 Endocavity
39 Probe Orientation
40 Body Imaging Planes
41 Organ Orientation Axial ( Long Axis ) Transverse (Short axis)
42 Organ Orientation
43 Organ Orientation
44 FAST& E FAST FAST = Focused Assessment with Sonography in Trauma. Extended FAST include sonography of the anterior thorax to rule out haemo-pneumothorax.
45 FAST is now an extension of physical examination of the trauma patient-(part of Circulation). used to identify intraperitoneal or pericardial fluid. efast identify haemo and pneumothoraces.
46 FAST ACEM Guidelines Following areas of the abdomen are scanned in FAST assessment. Perihepatic (Morrison's Pouch) Perisplenic (Lenorenal Space) Pelvis Pericardium (Subxiphoid view)
47 Equipment
48 Probe (2-5Mhz) Curvilinear low frequency
49 Perihepatic view
50
51 Perisplenic view
52 Perisplenic view
53
54 Subxiphoid view
55
56 Pelvic view
57 Longitudinal View
58 Longitudinal View
59 Transverse View
60 Ant Thorax
61
62
63 Strengths Rapid, bedside test Non invasive Reduced time to diagnosis Can be repeated Sensitivities 69-95% Specificities %
64 Limitations Can not identify cause of fluid Operator dependent Difficult in obese pt or increase bowel gas Cannot evaluate retroperitonium
65 Renal Scanning
66 Approach to Scanning LIVER STOMACH Right kidney scanning approach: anterior, lateral, posterior Liver is the acoustic window K IVC I AORTA S K Left kidney: requires a posterior approach, through the spleen Air-filled bowel impedes anterior scanning
67 Anatomy 9-12 cm long, 4-5 cm wide, 3-4 cm thick Gerota s fascia encloses kidney, capsule, perinephric fat Sinus Hilum: vessels, nerves, lymphatics, ureter Pelvis: major and minor calyces Parenchyma surrounds the sinus Cortex: site of urine formation, contains nephrons Medulla: contains pyramids that pass urine to minor calyces. Columns of Bertin separate pyramids
68 Ultrasound Anatomy
69 Right Kidney Long Axis Anterior Superior Liver Inferio Sinus Cortex Diaphragm Posterior
70 Right Kidney Short Axis Anterior Right GB Liver Left IVC R Kidney Vertebral Body Aorta Renal a. Posterior
71 Left Kidney Long Axis Anterior Super ior Inferior Rib Shadow Kidn Posterior ey Spleen
72 Left Kidney Short Axis Anterior Right Liver Left Spleen L Kidney Posterior
73 Range of Hydronephrosis Normal Mild Moderate Severe
74 Mild Hydronephrosis GB Kidney Liver
75 Moderate - Severe Hydronephrosis GB Kidney Liver Dilated pelvis
76 Renal Cysts Liver Scatter 2 0 Cyst Bowel Kidney
77 Questions?
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