Ultrasound Flashcards

1
Q

What is sound?

A

A pressure wave (a form of mechanical energy) that travels in a longitudinal wave.

A sound wave is created when a vibrating object sets molecules of a medium (air) into motion.

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2
Q

What is compression?

A

High pressure

(Peak)

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3
Q

What is rarefaction?

A

Low pressure

(Trough)

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4
Q

Where is pressure measured? (On a graph)

A

Y-axis

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5
Q

Where is time measured? On a graph

A

X axis

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6
Q

What does frequency measure?

A

Pitch

(How many cycles occur in a given period of time)

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7
Q

What is wavelength?

A

Distance b/t two identical points in adjacent cycles.

Inversely related to frequency.

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8
Q

What is amplitude?

A

A sound’s loudness. Determined by the degree of pressure fluctuations.

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9
Q

What is the sound velocity through air?

A

343 m/sec

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10
Q

What is the sound velocity through soft tissue?

A

1540 m/sec

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11
Q

What is the sound velocity through bone?

A

3,000-5,000 m/sec

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12
Q

What do modern transducers employ?

A

A piezoelectric material called zirconate titanate

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13
Q

What is a piezoelectric material?

A

Can transducer electrical energy to mechanical energy and vice versa

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14
Q

What determines the vertical placement of each dot in an ultrasound image?

A

Vertical placement = time delay (how long it takes the echo to return)

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15
Q

What determines the horizontal placement of each dot in a ultrasound image?

A

Determined by the particular crystal that receives the returned echo.

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16
Q

What is the brightness of each dot determined by?

A

Amplitude of the returning signal.

(Echogenicity describes a tissues ability to transmit or reflect sound waves)

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17
Q

What are hyperechoic structures?

A

Produce strong amplitude echos (these tissues have high impedance)

**BONE

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18
Q

What is a hypoechoic structure?

A

Darker shade of grey

Produce weak (low amplitude) echoes (these tissues have a lower impedance)

**solid organs, skin, adipose tissues, and cartilage

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19
Q

What is an anechoic structure?

A

Don’t produce an echo.

(Vascular structures, cysts, ascites)

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20
Q

How do nerves appear on ultrasound?

A

It depends on echogenicity of the surrounding structures. (Anechoic ~ Roots of the brachial plexus)

Or (hyperechoic ~ honeycomb appearance like distal nerves)

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21
Q

What is axial resolution?

A

Beam depth
The ability to differentiate structures that exist along the length of the ultrasound beam

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22
Q

What is lateral resolution?

A

(Beam width)
The ability to differentiate structures that exist in the width of the ultrasound beam.

Position the sonoanatomy of interest in the focal zone

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23
Q

What is elevational resolution?

A

Beam thickness

The ability to differentiate structures that exist in the thickness of the ultrasound beam.

(Fixed value)

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24
Q

What are the three zones of the ultrasound beam?

A

Focal zone: region where the beam is narrowest and thinnest

Near zone: the region b/t the transducer and the focal zone

Far zone: the region beyond the focal zone

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25
Q

Where is the image resolution the best?

A

Focal zone

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26
Q

What is attenuation?

A

Reduction in image quality d/t the natural decrease in a sound’s strength and the fact that some sound waves never return.

(Bone produces the greatest amount of attenuation)

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27
Q

Absorption?

A

Sound waves are lost to the body as heat.

It’s an important determinant of the depth of tissue penetration (high frequencies experience a greater degree of attenuation as a function of absorption)

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28
Q

What is reflection?

A

It is the process where a sound bounces off a tissue boundary of differing acoustic impedance.

Applying gel b/t the ultrasound transducer and the patients skin reduces reflection.

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29
Q

What is scatter?

A

Occurs when the ultrasound wave encounters an object smaller than the wave

This explains why fluid filled objects appear anechoic

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30
Q

What is refraction?

A

Bending of the ultrasound wave that encounters a tissue boundary at an oblique angle.

Based on snell’s law.

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31
Q

What is short-axis view?

A

Cross section

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32
Q

What is long axis view?

A

Looks at a structure along its length

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33
Q

Which frequencies allow us to see deeper inside the body, but with a loss of resolution?

A

Lower-frequencies

34
Q

Which frequencies produce the best resolution at the expense of being unable to visualize deep structures?

A

High-frequencies

35
Q

What is the frequency (MHz) of high frequency transducers? What depth? And what is this good for?

A

> 10 Hz
For depths <3 cms below skin
For: interscalene, supraclavicular, axillary, wrist, ankle, femoral, superficial blood vessels

36
Q

What is the frequency (Hz) of medium frequency transducers? What depth? What is it best used for?

A

Freq: 5-10 Hz
Depth: 3-6 cms
For: popliteal, sciatic, deeper blood vessels

37
Q

What is the frequency (Hz) of low frequency transducers? What depth? What is it best used for?

A

Hz: < 5
Depth: > 6cm
For: lumbar plexus, celiac plexus, neuraxial, high BMIs

38
Q

How is a linear array transducer configured?

A

Piezoelectric crystals are arranged in parallel

Operate in a high frequency

39
Q

How is a curvilinear array transducer configured?

A

Convex footprint ~ piezoelectric crystals follow suit ~ fanlike image

Lower freq

40
Q

How is a phased array transducer configured?

A

Very narrow in the near field and fans out with increasing depth

Best for small acoustic windows at a deeper level (I.e. looking b/t ribs)

Typically operate on low freq

41
Q

What does gain adjust in the ultrasound?

A

The strength of the returning echoes

42
Q

What does depth on a ultrasound determine?

A

How dee you can see into the body

43
Q

What does the B-mode on the ultrasound machine mean?

A

Stands for the brightness of the pixels on the screen. Produces real-time imagery of the sonoanatomy.

44
Q

What does the M-Mode on the ultrasound machine stand for?

A

Stands for motion. It’s a time lapse photo that illustrates the relative movement of the structures over time.

Used frequently in echocardiography (also useful in fluid responsiveness or diagnosing a pneumo)

45
Q

Where should you focus your image?

A

Adjust the focus so the target sonoanatomy resides in the focal zone.

46
Q

What does the y axis of the m-mode represent?

A

Degree of movement

47
Q

What does the x-axis in m-mode represent?

A

Time

48
Q

What is the Doppler effect?

A

Describes the change in the perceived frequency of a sound wave when there’s relative motion between the sound’s source and an observer.

If the sound source becomes closer to the observer ~ decrease in wavelength and increase in frequency (POSITIVE Doppler shift)

If the sound source becomes farther away from the observer ~ increase in wavelength and a decrease in frequency (NEGATIVE Doppler shift)

49
Q

What are the three things that determine the degree of Doppler shift?

A

Frequency of the ultrasound beam
Blood flow velocity
Angle of insinuation
(Shift is greatest is beam is parallel)
(Shift is zero if US beam is perpendicular to flow)

50
Q

What are the three factors that determine the degree of Doppler shift?

A

Frequency
Angle of Insonation
Blood flow velocity

51
Q

What is the degree of insonation when the ultrasound beam is perpendicular to blood flow?

A

Zero. The cosine of 90 degrees = 0

52
Q

According to the standard convention, the orientation marker on the ultrasound probe should point towards the patient’s what?

A

Right (usually in short axis view ~I.e arterial line)

head (long axis view)

53
Q

What is the correct way to hold a transducer?

A

Like a pencil

54
Q

Which technique improves image resolution by reducing the distance b/t the transducer and your anatomical target?

A

Compression

55
Q

What does tilting the transducer do?

A

Helps orient the ultrasound beam perpendicular to an underlying structure ~ improves image quality by reducing signal loss.

Changes the angle of incidence

56
Q

What does rocking on the transducer do?

A

Moves from side to side (while staying in the long axis)

Promotes better contact b/t the patient and the transducer ~ helpful for imagining inside a narrow acoustic window.

57
Q

What is sliding the transducer?

A

Moving the short axis of the transducer up or down while maintaining the same angle of incidence

58
Q

What does rotation on the transducer do?

A

Moving the transducer in a clockwise or counterclockwise direction.

Useful when going from short to long axis or vice versa

59
Q

What is air artifact?

A

It happens when part of the transducer’s footprint fails to contact the skin, air pockets develops

Solved by applying more gel or applying more pressure

60
Q

What is shadow artifact?

A

This happens when acoustic energy encounters a medium which doesn’t allow penetration( I.e bone)

Because of this, you’ll observe an acoustic shadow deep to the hyperechoic border

61
Q

What is acoustic enhancement?

A

Opposite of shadow artifact

When the ultrasound wave reaches the interface of a fluid-filled structure (femoral artery) and the underlying tissue, the difference in acoustic impedance accentuates the brightness in this region

62
Q

Wha this mirror image?

A

Occurs when the ultrasound beam gets trapped between two highly reflective tissue ~ this causes a time delay in some of the returning echoes

63
Q

What is reverberation?

A

Similar to mirror image. Occurs when sound waves bounce between two strong parallel reflecting surfaces

**occurs during imaging of the pleura or an attenuating wide-bore needle

64
Q

What is bayoneting?

A

The needles appears to bend as it penetrates a tissue boundary.

This occurs when the needle passes through adjective tissues of different acoustic impedance.

65
Q

What are the three standard imaging windows?

A

Parasternal
Apical
Subcostal

66
Q

What can you see in the Parasternal-Long Axis (PLAX)

A

Structures: LA, LV, MV, AV, aorta, pericardium

Interpretation: LV fx, mitral/aortic lesions, effusion

67
Q

What can you see in the Parasternal-short axis (PSAX)

A

Structures: LV, papillary musc, RV, pericardium
(Looking from the apex up)

Interpretation: RV and LV fx, effusion

68
Q

What can you see in the Apical 4-chamber (A4CH)

A

Structures: RA, RV, LA, LV, mV, AV, pericardium

Interpretation: LV and RV fx, AV lesions, pericardial effusion

69
Q

What is the subcostal 4 chamber?

A

Structures: RA, RV, LA, LV l, MV, AV, pericardium

Interpretation: RV function/ pericardial effusion

70
Q

What is the Subcostal IVC view?

A

Structures: Liver, RA, IVC

Interpretation: volume status

71
Q

What do we assess to determine whether a patient is a full stomach?

A

Gastric antrum

72
Q

What does the absence of lung sliding suggest?

A

Pneumo or endobronchial lntubation

73
Q

What are a lines on a pulmonary ultrasound?

A

Horizontal lines from reverberation artifact

74
Q

What are b lines on a pulmonary ultrasound?

A

Vertical lines (can be normal or pulmonary edema)

75
Q

What position to do you place your patient for a gastric ultrasound?

A

Right lateral decubitus position

This allows air to rise and gastric contents to fall in the direction of the antrum

76
Q

What does an empty stomach look like on ultrasound?

A

Target or a “bull’s eye”

77
Q

What do clear liquids look like on gastric ultrasound?

A

Round and distended with an anechoic center.

78
Q

What does particular matter look like in ultrasound?

A

Stomach will look round and distended

Fluids or food will appear grainy or as bright particular matter (more solid foods)

79
Q

How do we calculate the volume of clear gastric fluid?

A

Gastric volume (mL) = 27 + 14.6 x CSA - [1.28 x age(years)]

80
Q

What is considered a low risk gastric volume?

A

Volume < 1.5 mL/kg (GRADE 1)

81
Q

What is considered a high risk gastric volume?

A

Volume > 1.5 mL/kg (GRADE 2)