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DIS > Ultrasound > Flashcards

Ultrasound Flashcards

1
Q

What are the different probes and what are they used for?

A

Linear array – used for vascular work due to its flat surface

curvilinear - used for general and obstetric work the curved head allows for the beam to be angled – for example under the ribs

Transvaginal - Inside the vagina canal

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2
Q

Name different scan techniques?

A

Transfer vaginal
Transrectal

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3
Q

What can we examine in ultrasound?

A

Nearly all soft tissues
Foreign bodies x-rays can’t find
Abdomen
gynaecology
fertility
MSK
Hernia
Breast
Neonatal head
Baby hips
scrotum
obstetrics
vessels
biopsy guide

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4
Q

Why is ultrasound Used?

A

Good soft tissue images

Minimal preparation

No radiation

Inexpensive

Quick

Tolerable for patient

Portable

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5
Q

What is sound?

A

The transfer of energy from one place to another by series of collisions

(these collisions are between adjacent molecules in the medium through which the sound is passing)

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6
Q

What is ultrasound?

A

Ultrasound is The Sound above 20 KHZ

This is above the level of human hearing

It has the same behavioural properties of sound we can hear

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7
Q

How does sound travel best?

A

Solids are the most efficient due to the tightly packed molecules

The closer the molecules the faster than sound waves move through a medium.

(Like Chinese whispers)

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8
Q

What is attenuation?

A

A Sound travels through a medium:

It loses energy

All media absorbs some of the waves energy

The sound can also be reflected - bounces back in the form of an echo - which is what we want in ultrasound


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9
Q

How does ultrasound interact with tissue:

A

 Ultrasound is based on reflected – echo – rather than transmitted energy

When ultrasound interacts with a tissue the interactions are similar to the wave behaviour observed for light

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10
Q

What is acoustic impedance?

A

Acoustic impedance is how much the energy medium wants to take away (absorbs)

different interactions – different appearance

When the two media for me interface have very different values of acoustic impedance a large fraction of the original sound will be reflected

For example the difference of air to tissue - 99% would be reflected

Conversely if there acoustic impedance between two structures are similar sound will be readily transmitted

The change of Acoustic impedance allows the visualisation of soft tissue structures with an ultrasonic beam

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11
Q

How may ultrasonic beams interact with different tissues?

A

It may be:

absorbed

Passed through

Or reflected

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12
Q

Why is gel used in ultrasound?

A

Gel is used to ensure ultrasound goes into the body through a gradual acoustic impedance

If there was no gel the ultrasounds would not go into the body

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13
Q

The pulse Echo principle?

A

Distance = speed X time

Time interval between the generation of the original pulse of ultrasound and the detection of the returning echo - time

Knowledge of the speed of sound through the tissues - speed

These both allowers to estimate the total distance of the distance travelled by the pulse

  • Probe – body – ultrasound monitor
    The time to reflect back enables the monitor to know how close to the skin surface the structure is
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14
Q

Probe construction:

A

Acoustic lens

Acoustic matching layer

Piezo-electric element – transducer - PZT

Backing material

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15
Q

Piezoelectric effect

A

Transducer + Energy – vibration(sound wave) (of the required frequency)

Goes in as an ultrasound pulse and reflects as an echo pulse

The sound waves then enter through the gel into the body (sound waves) - reflected back to the probe/transducer (piezoelectric crystal) where is picked up as a pulse - amplified to determine the pulse-echo return time- and then converted to a digital image on the ultrasound monitor

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16
Q

Probe selection – frequency:

A

High-frequency – skinny:
- clear images but less penetration (loses energy)
– beam travels to shorter distance (superficial)

Low frequency – fat:
- poor image but can image deeper structures (doesn’t lose energy quickly)
– beam travels further (good penetration)
- not good detail (definition)
- absorbed by tissue - not good reflection

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17
Q

What is frequency?

A

Frequency - number of occurrences of repeating event per unit of time

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18
Q

Ultrasound artefact:

A

Acoustic enhancement – bright up
- fluid - less absorbed - goes straight through

Acoustic shadowing 
- all reflected

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19
Q

What affects the image?

A

Patient size

Patient preparation

Probe and frequency

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20
Q

Patient preparation?

A

 Full bladder for pelvic contents - Acts as a acoustic window - pushes bowel to the side and pushes uterus posteriorly

Fasted for a liver/gallbladder – allows gallbladder to fill with a bottle enabling visualisation of gallbladder wall and contents

Gas – beam is reflected – fast to prevent gas – can obstruct pancreas, duodenum, intestines

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21
Q

What effect does the operator have on the ultrasound

A

Ultrasound is highly operator dependent

Qualification/experience – very vital as well as equipment knowledge

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22
Q

Image interpretation in ultrasound:

A

What’s normal - very vital to know

Looking at size, shape, texture and Echogenicity - diagnosis

Organs should be imaged in two planes that are right angles to each other

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23
Q

Image interpretation what should it look like normal?

A

For example liver parenchyma - Slightly more bright the cortex – too bright – fatty

Black – fluid

White – gas/bone/organ edge – reflective

Great – soft tissue

24
Q

Obstetrics

First trimester?

A

Conception to 12 weeks

Can do transvaginal 6 to 7 weeks

You get a 12 week scan

25
Q

What is the purpose of a 12 week scan in obstetrics?

A

To determine viability

Exclude ectopic pregnancy

Exclude multiple pregnancy - twins triplets

Confirm gestation

Exclude certain abnormalities - anencephaly

Rule out ovarian pathology – large cyst

Exclude uterine abnormalities – fibroids

26
Q

What can be seen in the first trimester – abnormalities?

A

 Normal – gestation sack which is the first sign of pregnancy

Yolk sac - what are baby feeds off

Seven week gestation – diamond ring sign

An embryonic pregnancy

Nuchal translucency

Exomphalos

Gastroschisis

Ancephaly



27
Q

Twins – first trimester?

A

Twin to twin syndrome – too much or too little
it is an increased risk for identical twins or twins that share an Placenta

Twins are scanned every two weeks

28
Q

What is An embryonic pregnancy?

A

– pregnancy continues to develop despite the absence of a fetus

29
Q

What is Nuchal translucency?

A

fluid at the back of neck – measure to determine risk of Down’s syndrome

30
Q

What is Examphalos?

A

weakness of babies abdominal wall where umbilical cord joins – chromosome problem – contents potrude outside
The bigger it is the worse the prognosis

31
Q

What is Gastroschisis?

A

defective abdominal wall - intestines are outside of the body

32
Q

What is Ancephaly?

A

– malformation of large part of the brain/school/scalp is absent – incompatible with life

33
Q

Second trimester:

A

13 to 26 weeks

Detailed anomaly scan at 20 weeks

34
Q

The purpose of the details scanned 20 weeks:

A

To confirm growth

Reconfirm viability

Determine structural abnormalities

Boy or a girl

Check the 4 chambers of the heart - valves, aorta, vessels

Check the bread and cerebellum

Check the feet - soft tissue markers – combination of symptoms - club feet

Cleft lip – 4D image to help prepare patient – surgery to correct

Spina bifida
lack of folic acid
Spine nerves are exposed
Skin defect
Paralysis



35
Q

Third trimester:

A

Checking for:

Growth – small/large for dates

placenta site

Presentation – position

Follow-up of abnormalities

Amniotic fluid volume

Doppler umbilical artery

36
Q

what is placenta previa?

A

Cannot be fully digested till the third trimester

Vaginal delivery not possible

Placenta partially or completely covers the cervical opening

37
Q

Umbilical artery Doppler:

A

Uteroplacental insufficiency - not enough oxygen

Intra-uterine growth resection

38
Q

The liver:

A

Produces blood clotting stuff

Filters

Breaks down old or damaged blood cells And fat > energy 

Metabolic processes – creates energy

39
Q

Liver – healthy versus damaged:

appearance

A

Healthy smooth

Fat deposits – bright

Fibrosis scar tissue

Cirrhosis - hard, lumpy, Chucky, unable to work
-Fluid around due to breakdown of cells

40
Q

Lesions and mets:

A

All different some harder to find a pick up

41
Q

Contrast enhanced ultrasound:
why?
what can it find
cost

A

To check vessels – blood flow pattern
- Normal that middle - out - cartwheels
- No storage cells – go straight out

Nodular hyperplasia
Liver lesions

It’s cheap – £60 per patient - US
CT – £300 per patient

42
Q

Possible hepatic system problems

A

Blockage of flow of bile - biliary colic and obstructive jaundice

Stones come form in the system leading to biliary colic

The gallbladder can become inflamed – cholecysitis

Tumours or other obstructions at the level of the head of the pancreas can obstruct the flow of bile

43
Q

Vascular issues:

A

Thrombosis – Blockage/deep vein thrombosis

– abdominal aneurysm- measure - size and location is very important

May contain calcification or atheroma

DVT – compress it to ensure the pain is compressible that means there is no thrombosis

Veins at supposed to be black
grey = thrombosis

Varicose veins


44
Q

Doppler ultrasound?

A

Red - flowing towards the probe

Blue – flowing away from the probe

45
Q

Kidney cancer clinic –

A

50% of cancer is bilateral

Work out what the next stage is

stage one and two is contained

stage three spread to Renal vein

In clinic scan from renal vein - IVEC- nodes - liver - continue to find out extent

46
Q

Urinary bladder scanner

A

Check for the smooth

Early – easy – straight to fluoroscopy - remove tumour

Tumour can eat into bladder wall

Roll the patient if it doesn’t move it’s not stones

47
Q

Gynaecology scanning:

A

ICUD – coils - ensure it’s in the uterine cavity
Pregnancy- Ensure it has not perforated muscle

Endo polyp - Heavy bleeding between period

MSG - lining of cavity – guide to takeaway – nine out of 10 times it’s benign
Ovarian mass

Ovaries - they move around
you need to know the patients stage of cycle to determine the pathology
1-7 no dominant follicles
10-13 follicles grow until they pop and egg comes out

48
Q

Fertility treatment:

A

Stimulate horrible to produce more focals

Suction needle that to pop focals there should be eggs and they are then take it out

49
Q

Portable ultrasounds:

A

Renal, liver, DVT in ward

 covid lung

50
Q

ECMO

What is it and what does it stand for?

A

Extra Corporeal membrane oxygenation
Outside the body – membrane oxygenator is a piece of equipment which delivers oxygen into the body

Post ECMO - Hi risk of DVT

51
Q

Ultrasound MSK:

A

Commonly used in rheumatology and sports medicine

Steroid injections can be given under ultrasound control

52
Q

Breast ultrasound:

A

For under 35-year-olds ultrasound is better

Simple cyst - acoustic enhancement

53
Q

Testes and epididymi

A

Tumour hunting

54
Q

Hernia

A

Weakness of war

Valsalva manoeuvre – used to increase pressure inside

55
Q

Neonatal radio:

A

Used to assess intracranial haemorrhage and hydrocephalus

56
Q

Baby hip ultrasound:

A
57
Q

FAST scan:

A

A and E to exclude internal bleeding

Look for fluid between liver and kidney an spleen

Less of a risk – better management CT for intestinal a journey - who needs it more

DIS (17 decks)

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