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Modalities > Ultrasound > Flashcards

Ultrasound Flashcards

1
Q

what is the orientation of the image when transducer is in transverse plane with patient lying supine

A

anterior (skin surface)
posterior
right
left

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2
Q

what is the orientation of the image when transducer is in longitudinal/sagittal plane with patient lying supine

A

anterior (skin surface)
posterior
superior (head)
inferior (feet)

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3
Q

what is the orientation of the image when transducer is in transverse plane when patient is in right lateral decubitus position

A

lateral (skin surface)
medial
anterior
posterior

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4
Q

where should the transducer be placed to scan the liver

A

intercostal
- transducer placed in between ribs following orientation of the ribs
- useful when scanning high riding liver

subcostal
- transducer is angled superiorly just beneath the ICM

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5
Q

name the 6 transducer manipulation

A

sliding
rocking
sweep
rotate
compression
fan

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6
Q

describe what is does the depth knob control

A
  • important for image quality and presentation
  • if depth is too deep, anatomy will appear small at the top of image
  • if depth is too shallow, important information at the bottom will be lost
  • frame rate is also affected, as each line of information takes longer to return
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7
Q

describe the gain knob

A
  • gain amplifies the overall reflected signals
  • increasing gain increases both signals and noise
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8
Q

describe time gain compensation (TGC)

A
  • selectively amplifies signals from deeper structures or suppress signals from superficial tissue
  • resulting image would be balanced and uniformed
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9
Q

what is auto optimatization

A
  • automatically adjust TGC and overall gain
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10
Q

what is the focus knob

A
  • focal zone is the point at which the beam is the narrowest with maximum resolution
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11
Q

what is dynamic range (compression)

A
  • determines the number of shades of gray (dB)
  • wide range - smoother image
  • narrow range - higher contrast
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12
Q

what is harmonic imaging

A
  • reduce noise and clutter
  • narrower beam-width
  • improve spatial resolution
  • reduces noise from side lobes
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13
Q

terms to describe echogenicity

A
  • anechoic: free of echos (describe fluid/liquid)
  • echogenic: bright echos
  • hyperechoic: brighter than surrounding echoes
  • hypoechoic: darker than surrounding echoes
  • isoechoic: similar to surrounding echoes
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14
Q

interaction with tissues results in physical effects which can:

A
  • interfere with normal functioning of cells of tissue
  • cause structural damage
  • result in cell necrosis
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15
Q

type and severity of any physical effect depend on which 2 variables

A
  • mechanism of interaction with tissue
  • parameters of exposure
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16
Q

how are the mechanism of interaction categorised

A
  • thermal (heating)
  • mechanical
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17
Q

what does the heating effect depend on

A
  • output power
  • frequency
  • exposure time
  • focal zone position
  • FOV
  • low perfusion
  • scanning mode
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18
Q

what are the mechanical effects

A

bioeffects induced not related to heating
- effects related to cavitation
- effects resulting from radiation force associated with US beam
- effects caused by microstreaming

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19
Q

causes of work related MSK symptoms

A
  • excessive use
  • increase freq of repetitive motion
  • duration of load on muscles and tendons
  • level of muscular effort
  • insufficient recovery time due to tight schedule
  • habitual arm abduction
  • forceful gripping of transducer
  • forceful pressure of transducer
  • habitual rotation of upper spine
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20
Q

tips to scan safely

A
  • neutral wrist: <15deg ulnar/radial deviation; <15deg flexion/extension
  • position patient and equipment as close as possible to prevent arm abduction and trunk bending
  • work within ‘reach’ zone: 30cm from body with 30cm range
  • proper height of chair and bed
  • avoid bending or twisting of trunk
  • neck in neutral position: <20deg flexion
  • proper seating
  • reposition/adjust equipment and monitor (top of monitor to eye level)
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21
Q

name all the small superficial parts for ultrasound

A

thyroid
breast
scrotum
penile
eyes
lump/bumps
foreign body
lymph node
salivary gland
lungs

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22
Q

which probe should be used for small parts

A

high frequency linear probe
- wide near field
- excellent resolution
- excellent colour doppler

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23
Q

normal size of thyroid

A

length = 30-70mm
AP diameter = 12-18mm
transverse diameter = 20-25mm
isthmus diameter = 4-6mm
volume = 18.6ml

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24
Q

probe used for thyroid

A

high resolution linear probe (7-15MHz)
sector/curve linear probe with small footprint (5-8MHz) for enlarged thyroid lobes

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25
Q

scanning protocol for thyroid

A
  1. isthmus measurement (~3mm)
  2. colour doppler of both sides
  3. longitudinal scans through each lobe
  4. axial scans of the whole gland
  5. identify focal lesions
  6. evaluate vascular flow
  7. document enlarged LN/ thrombosed jugular vein
  8. repeat for left lobe
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26
Q

how does a normal thyroid look like on US

A
  • well circumcised
  • echogenic thyroid capsule
  • smooth and homogenous echotexture
  • hyperechoic to the adjacent muscle
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27
Q

4 types of variant of a thyroid

A
  • broad base
  • parallel
  • bulge
  • stand alone
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28
Q

what is included in a TIRADS

A
  • composition
  • echogenicity
  • margins
  • presence and type of calcification
  • shape
  • vascularity
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29
Q

when should FNA be considered

A

nodule >1cm +/- microcalcification/ coarse calcifications

30
Q

anatomy of parathyroid

A
  • inferior and superior pair of glands
  • posteriomedial surface of the capsule of the thyroid
31
Q

function of parathyroid

A

makes PTH in response to level of calcium in the blood
- calcium in blood decreases = make more PTH = bones to release calcium into blood

32
Q

how does a parathyroid look like on US

A
  • usually not seen
  • homogeneously hypoechoic
  • echogenic thyroid capsule separating the thyroid from the parathyroid
  • doppler US –> feeding vessel; internal vascularity seen in a peripheral distribution
33
Q

how many levels of cervical lymph nodes are there

A

5

34
Q

how does cervical lymph node look like on US

A

on gray-scale:
- hypoechoic compared with adjacent muscles
- oval shape
- presence of nan echogenic hilum

on colour and power doppler
- hilar vascularity

35
Q

anatomy of breast

A
  • paired organs
  • mammary glands
  • glands are anchored to pec muscles by suspensory ligaments/ Cooper’s ligaments
  • areola: pigmented area surrounding the nipple; made up of sweat and subaceous glands (montgomery gland)
  • nipple: centre of areola; where milk exits from Montgomery glands
36
Q

blood supply of the breast

A
  1. axillary artery
  2. internal thoracic artery
  3. anterior intercostal arteries
37
Q

lymphatic drainage of the breast

A
  • anterior axillary nodes and pectoral nodes draining the lateral quadrant
  • internal thoracic nodes draining the medial quadrant
  • posterior intercostal nodes draining the posterior portion
  • lymphatic vessel of opposite breast
  • anterior abdo lymph vessels
38
Q

how does nipple appear on US

A
  • hypoechoic structure at the skin surface that occasionally produce an intense acoustic shadow
  • presence of retroareolar ducts and blood vessels
39
Q

how does normal lymph node look within the axillary tail in US

A

hypoechoic cortex and hyperechoic fat hilum

40
Q

differences in breast in different aged women shown in US

A

young female:
- very little fat in subcutaneous or glandular layer
- appears as homogenously dense or hyperechoic

middle aged women:
- tissue comprises of dense glandular tissue with some fatty replacement
- appears as hyperechoic areas with some hypoechoic area between

older women:
- tissue undergone glandular atrophy and fatty degeneration
- appears mainly hypoechoic
- mammo preferred

during pregnancy and lactation
- breast becomes enlarged and dilated milk ducts can appear as cystic spaces within the breast

41
Q

what type of probe should be used for breast US

A

high resolution linear probes
7-17MHz

curvilinear probes
2-9MHz

42
Q

scanning protocol for breast

A
  • scanned in a systematic way from quadrant to quadrant to ensure that all parts of the breast are scanned (including axilla and all the breast margin)
  • both breast should be scanned in this way to compare each other
  • record any palpable lump or area of focal thickening
  • use dual technique

concerned lesions should be imaged in 2 planes with 3D measurement and described by:
- position on the clockface
- distance from nipple
- distance from skin surface
- distance from pec muscle

43
Q

reporting guidelines for thyroid imaging is called

A

TIRADS

44
Q

reporting guidelines for breast imaging is called

A

BIRADS

45
Q

anatomy of scrotum

A
  • sack of skin divided into 2 parts by the perineal raphe
  • each side usually consist of:
    1. testicle
    2. epididymis
    3. spermatic cord
    4. cremaster muscle
46
Q

anatomy of testes

A
  • ovoid shaped gland measuring approx 4x3x3cm
  • divided into more than 250 conical lobules containing the seminiferous tubules
  • rete testis formed by the anastomosis of these tubules in the mediastinum
  • connected to the head of the epididymis through the efferent duct
47
Q

anatomy of the scrotum

A
  • each testicle and epididymis enclosed by a fibrous capsule - tunica albuginea
  • tunica albuginea covered by tunica vaginalis
  • tunica vaginalis = sac of peritoneum consisting 2 layers - parietal and visceral layer
  • visceral layer lines tunica albuginea
  • parietal layer lines the inner aspect of the scrotal wall by a small amount of fluid-containing space
  • tunica albuginea extends into the posteromedial testis to form mediastinum testis which contains ducts, nerves and blood vessels
48
Q

how does the epididymis look on US

A
  • 6-7cm long structure located posterolateral to the testis
  • divided into a head, body, tail
  • head is adjacent to the upper pole of the testis
  • body of epididymis is much smaller than the head, courses along the posterolateral aspect of the testis from the upper to the lower pole
  • small hypoechoic structure containing numerous echogenic linear structures, which represent the coiled epididymal tube
  • tail of epididymis is slightly larger and is located posterior to the lower pole of the testis
49
Q

where does the scrotum start descending from

A
  1. abdominal area to inguinoscrotal area
  2. from inguinoscrotal to final location in scrotum
50
Q

scanning protocol of testis

A
  1. comparison of right and left testis
  2. colour doppler of the comparison view
  3. dimension of right testis - longitudinal and transverse
  4. right epididymal head, body and tail
  5. pampiniform plexus - with Valsalva
  6. image pathologies seen
  7. repeat 3-6 for left testis
51
Q

what transducer is used for abdominal US

A

low frequency curvilinear
1-5MHz to look at deep organs

high frequency linear probe
5-17MHz for superficial scanning

52
Q

scanning protocol of abdominal US

A
  • systematic approach to evaluate the whole liver, gallbladder and biliary tree
  • scan in several planes (longitudinal, transverse and oblique)
  • arrested deep inspiration
  1. left lobe of liver (TS and LS plane) - check patency of left portal vein
  2. right lobe of liver (TS and LS) - check patency of right portal vein
  3. gallbladder and biliary system (LS)
  4. right and left kidneys (TS and LS)
  5. speen (LS)
  6. pancreas (TS and LS)
53
Q

3 lobes of liver

A
  • right
  • left
  • caudate
54
Q

blood supply of liver

A

portal vein - 75%
hepatic artery - 25%

55
Q

venous drainage of liver

A

hepatic veins (right, middle, left)

56
Q

how does normal liver appear on US

A
  • paranchyma appears homogenous
  • portal vein and branches seen as tubular structure with echogenic walls
  • hepatic vein walls are non reflective
57
Q

normal gallbladder size

A

8-10cm long
2-5cm wide
with < 3mm thin walls

58
Q

what is included in portal triad

A

bile duct
hepatic artery
portal vein

59
Q

how does normal gallbladder look like in US

A
  • thin wall, well distended, pear-shaped
  • fundus - rounded inferior portion
  • body - mid portion
  • neck - tapering superior portion
  • about 8-10cm long and 2-5cm wide
60
Q

normal CBD diameter

A
  • grows 1mm for each decade of life
61
Q

type of transducer used for kidney US

A

3.5-5MHz curvi linear broadband transducer

62
Q

how does a normal kidney look on US

A

size: 9-12cm
shape: bean-shaped
echoes:
- parenchyma appears homogenous and hypoechoic to the liver and spleen
- medullary pyramids appear hypoechoic to the cortex
- renal sinus appears hyperechoic as it contains adipose tissue, intrarenal vessels and renal pelvis

63
Q

kidney variant

A
  • horse shoe
  • fetal lobulation
  • double collecting system
  • ectopic
  • cross fused ectopia
64
Q

how does normal bladder look like on US

A
  • anechoic
  • ovoid shape with smooth wall
65
Q

variant of spleen

A

accessory spleen: splenunculus
- splenic tissue outside of spleen
- mostly found around the splenic hilum
- looks like normal splenic tissue
- single or multiple

66
Q

what is the normal spleen size

A

< 12cm

67
Q

transducer used for spleen US

A

3-5MHz curve linear

68
Q

how does a normal spleen look like on US

A

shape: half moon
echoes: medium level echoes

69
Q

how does a normal pancreas look on US

A
  • homogenous, medium level echogenicity
  • becomes more echogenic with age
  • even or increased echogenicity compared to the liver
70
Q

normal size of pancreas

A

head - 2.5-3cm
neck - 1-2.5cm
body - 2.5cm max
tail - 2.5cm max

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