ECP 5 Flashcards
Ultrasound what does it allow you to see, and what is the specificity and safety
- Allows evaluation of the internal structure of organs
- Dynamic ultrasound evaluation can allow evaluation of function
- Often has low specificity for identifying specific diseases - don’t know what it is
Cytology and histopathology may be required for lumps
No confirmed adverse biological reactions
What is involved with preparing the patient for ultrasound and echocardiology
- sedate, clip, alcohol and gel - don’t need to clip or sedate horses if temperament allows
- Ultrasound gel - improve transmission of sound and allow probe to glide over skin
○ Need to clip a fair amount of hair up under the rib cage - Fast animals prior - doesn’t penetrate through dense tissue/food or gas filled spaces - morning generally less gas
- Echocardiography -> Can be performed without sedation, using an echocardiography table
What are 3 important reasons to sedate during ultrasound
- Reduce stress and anxiety
- Reduce panting
- Relaxed abdominal wall - US probe can be pushed into tricky places
What are the 3 types of ultrasound
1) B-mode imaging - most common - provides a real time cross-sectional 2D image
2) M-mode imaging - provides a graphical trace of motion over time and is used in echocardiography
3) doppler mode - provides information on blood flow
Doppler mode what does it provide information on, how to interpret and the 2 types
- Provides information on blood flow -> is it moving in the right direction, regurgitation
- BART - blue away red toward, green in the middle (can reflect turbulence)
Types
○ Colour doppler superimposes direction and velocity of blood flow over the B-mode image
○ Spectral doppler allows quantification of velocity -> degree of stenosis, larger stenosis faster velocity
§ Pulsed wave doppler -> measures the velocity within a well-defined area, trace overtime of velocity of blood flow
Continuous wave doppler -> accurate for high velocity flow
How are ultrasound images made
- Images are formed one scan line at a time, based on the pulse echo principle
§ Each line sends out sound that is reflected as an echo which is then detected then move across etc.
what determines the depth and brightness of displayed echo
- The travel time of pulse to echo determines the depth of the displayed echo
○ Higher travel time arise from deeper tissues
○ Velocity of sound in tissue 1540m/sec - assumed so can place the spot on the - ALL TISSUES THE SAME - The amplitude of a returning echo determines the brightness of the displayed pixel
○ Stronger reflector higher amplitude brighter pixel
○ Weak reflector lower amplitude echo darker pixel
What are the 3 interactions of sound with tissue
- Transmission - moves through
○ Occurs when tissues have similar density and velocity of sound in that tissue
○ Acoustic impedance (Z) = velocity (v) x tissue density (p) - Refraction -
○ Bending as energy passes from medium of one density to a medium of another density
○ Ultrasound probe can detect echoes that are reflected through an angle of <3degrees
○ Mostly ignores the refraction lines - Attenuation - tissue heating
A reduction in amplitude of sound due to absorption, scattering and reflection
What are the 2 things that influence the rate of sound attenuation
- Distance -> greater distance, greater depth = more attenuation
- Frequency -> higher frequency = more attenuation
Acoustic impedance mismatch what is it and what are the 2 main structures involved
- Ultrasound can’t penetrate through bone or lung due to this - use radiograph instead
- Bone: most sound is absorbed so high acoustic impedance -> casts a distal acoustic shadow -> cannot see internal structure of bone
- Lung: most sound is reflected so low acoustic impedance -> bounces between lung and detector -> thinks it’s an echo back -> reverberation artefact
What does the ultrasound transudcer do and what are the 3 types
- Converts electrical energy to ultrasound, and coverts echoes into electrical signals
- Operator selects main frequency band used which changes based on:
Types - leads to different footprints (shape of field of view)
1. Linear array-> most common in larger animals and more dense, produces rectangular field
2. Curved array -> most common in small animal, produces trapezoid-shaped sector
3. Phased array -> tend to be specific for echocardiology - B-mode with colour doppler - triangular with narrow top
Ultrasound transducer what should you consider
When selecting a transducer, consider the frequency and the footprint of the transducer.
- Low frequency transducers are used to image deep structures BUT LOW SPATIAL RESOLUTION
Spartial resolution in terms of ultrasound what are the 2 types and what makes better resolution
- Best is achieved with high frequency transducers and when imaging within the focal zone
1) Axial resolution - distinguishing 2 objects parallel to the direction of the ultrasound beam
§ Depends on the wavelength
§ High frequency transducers have short wavelength and good axial resolution
2) Lateral resolution - distinguishing 2 objects perpendicular to the direct of the ultrasound beam
§ Depends on ultrasound beam diameters
§ Narrowest with high frequency transducers and within the focal zone
Contrast resolution in terms of ultrasound what is it and what are the 2 things its controlled by
ability to display differences in echogenicity (greyness) of objects
1) Controlled by dynamic range
○ Use a low dynamic range for echocardiography
§ Difference between parenchyma and lumen
○ Use high dynamic range for abdominal ultrasound
§ Want to see all the shades of grey
2) Also our ability to perceive the different echogenicity
○ Best seen in low gain setting and in darkened conditions
Define echogenicity, anechoic, hypoechoic, hyperechoic and isoechoic
- Echogenicity - relates to the relative brightness of a structure
- Anechoic - have no echoes within them and appear back -> urine filled bladder
- Hypoechoic - darker structure when two structures are compared
- Hyperechoic - lighter structure when two structures are compared
- Isoechoic - if two structures have the same echogenicity
Nuclear scintigrapy what does it do and the 3 molecules involved
- images the distribution of a radiopharmaceutical within the body, using a gamma camera resulting in structure and function ○ Make the body radioactive 1) Radionuclide 2) Radioactivity 3) Radiopharmaceutical
What is a radionuclide, radioactivity and radiopharmaceutical
1) Radionuclide
○ radioactive atom with an unstable nucleus
○ undergoes radioactive decay and emits the excess energy as radiation
2) Radioactivity [Bq]
○ rate of radioactive decay of a radionuclide with spontaneous emission of radiation
○ Half-life = time taken for radioactivity to reduce by half
3) Radiopharmaceutical
○ chemical containing a radionuclide, suitable for in vivo use to diagnose or treat disease
What is radioactivity dosage and radiation dose
Radioactivity dosage - amount of radioactivity administered to a patient
Radiation dose - amount of radiation absorbed by the body tissues
In terms of nuclear scintigraphy what does the radiopharmaceutical do, what is it made up of and example
radiopharmaceutical = radionuclide + ligand
- radiopharmaceutical allows the radionuclide to target the area of interest
○ Ligand - determines the physiologic distribution
Ligand eg - ○ 99mTc-MDP = Technetium Methylene Diphosphonate
§ bone scintigraphy
How does technetium work in terms of nuclear scintigraphy and what is the half life
Technetium starts as Mo and undergoes beta decay -> Tc which emits gamma rays as transitions from metastable to stable state (we get Tc at the metastable state)
HALF LIFE of 6 hours from metastable to stable state -> want to order the day before doing the study as doesn’t last as long
Generally at background levels within 24 hours
What are the 2 types of nuclear scintigraphy and what information do they provide
1) static acquisition - anatomic information - common to localise lameness in horses
2) dynamic acquisition - provides functional information - get multiple reading over time so see the movement of the radiopharmaceutical
Static acquisition nuclear scintigraphy what information does it provide and what used for
- Static acquisition anatomic information - common to localise lameness in horses
○ Bone scan -> able to see an increase in uptake of radiopharmaceutical in areas of active bone turnover -> problem area
Dynamic acquisition nuclear acquisition what information does it provide and the 2 main types
Dynamic acquisition provides functional information -> get multiple reading over time so see the movement of the radiopharmaceutical
1) Renal scintigraphy to measure GFR -> much more common in cats but still not as common
§ may be important to see when removing a kidney that the other kidney is functioning and won’t lead to kidney failure
§ Time activity curves allow you to quantify the GFR
2) Portal scintigraphy to diagnose portosystemic shunt - not as common anymore mainly just for laboratory testing
§ With a shunt over time the peak of radiopharmaceutical the peak occurs in the heart first and then liver or sometimes no peak in the liver -> BOTH SENSITIVE AND SPECIFIC FOR THIS DIAGNOSIS
Dynamic acquisition what are the main advantages and disadvantages
Advantages
- Provides functional information
- May be very sensitive -> sensitive at detecting physiologic processes
Disadvantages
- Poor anatomic resolution
- May have poor to moderate specificity
○ May be a “Hot spot” in the right shoulder = increased bone turnover but is it neoplasia, osteomyelitis, fracture
○ THEREFORE scintigraphy is usually followed up with other images modalities and/or biopsy
- The patient emits gamma radiation
○ Technetium is excreted by urine, faeces and saliva