Urinary tract imaging: Urologic ultrasonography

Question 1

Fine internal echogenicity seen on utz (ie testis utz)

Answer 1

speckle

Question 2

what is being shown by arrows

Answer 2

Increased through transmissions (Distal enhancement) is observed when sound waves are less attenuated while passing through a given structure or tissue than by the surrounding tissues

Question 3

in patients with chronic medical renal diseases the renal cortex is _____, and isoechoic/hyperechoic with respect to the liver

Answer 3

thinned, hyperechoic

Question 4

distinction of measurement between the renal cortical and parenchymal thickness in utz

Answer 4

The distinction between renal cortical thickness and renal parenchymal thickness is that the renal parenchyma is measured from the central band of echoes to the renal capsule. The renal cortex is measured from the outer margin of the medullary pyramid to the renal capsule

Question 5

what is the measurement of bladder volume formula by ultrasound

Answer 5

Question 6

how to measure bladder wall thickness

Answer 6

Question 7

how to measure prostatic utz via utz

Answer 7

(A) Transabdominal ultrasound is extremely useful for measuring prostatic volume and evaluating prostatic morphology. The volume of the prostate can be calculated using this formula: prostate volume (mL) = width (cm) × height (cm) × length (cm) × 0.523.

Question 8

The cross-sectional BCM area is ___ related to the number of cytosine, adenine, guanine (CAG) repeats. The BCM area has also been shown to be directly related to total ____, ____ and ____ as measured by dual-energy x-ray absorptiometry (DEXA)

Answer 8

The cross-sectional BCM area (Fig. 4.43C) is inversely related to the number of cytosine, adenine, guanine (CAG) repeats. The BCM area has also been shown to be directly related to total testosterone, free testosterone, and bone density as measured by dual-energy x-ray absorptiometry (DEXA)

Question 9

The maximum excursion of a wave above and below the baseline is known as its: a. wavelength. b. frequency. c. period. d. cycle. e. amplitude

Answer 9

e. Amplitude. In ultrasound physics it is crucial to understand the concept of amplitude. The amplitude of an ultrasound wave represents its relative energy state, and it is the amplitude of the returning sound wave that determines the pixel brightness to be displayed on a monitor during real-time gray-scale imaging.

Question 10

The artifact that occurs when an ultrasound wave strikes an interface at a critical angle and is refracted with limited reflection is:

a. reverberation artifact. b. increased through-transmission artifact. c. edging artifact. d. comet-tail artifact. e. aliasing artifact.

Answer 10

c. Edging artifact. Echo reflection is the primary mechanism whereby sound waves are returned to a transducer. It is important to understand how the angle of insonation affects the reflection and refraction of sound waves. There is a critical angle at which waves will travel along an interface rather than being returned to the probe. When this angle is encountered, it provides a dark or hypoechoic “shadow” called an “edging artifact.” A reverberation artifact is one caused by multiple transits of a sound wave between the transducer and the reflecting object. Increased through transmission artifact is caused by decreased attenuation of sound waves as they travel through a fluid-filled structure. Comet-tail artifact is seen as the result of the interaction between sound waves and fluid and gas filled structures such as the bowel. Aliasing artifact is seen with Doppler ultrasonography.

Question 11

Which ultrasound mode allows for detection and characterization of the velocity and direction of motion? a. Harmonic scanning b. Color Doppler c. Power Doppler d. Spatial compounding e. Gray-scale ultrasonography

Answer 11

b. Color Doppler. Doppler ultrasonography is important for evaluating motion and flow. The critical difference between color Doppler and power Doppler is that color Doppler is able to evaluate both flow velocity and direction. Power Doppler evaluates integrated amplitude of the returning sound waves. Although grayscale ultrasonography does permit the evaluation of motion, it does not permit the characterization of velocity or direction. Harmonic scanning and spatial compounding are modes that allow the selective evaluation or combination of reflected frequencies in ways that improve image quality.

Question 12

The sonographic hallmark of testicular torsion is:

a. the “blue dot” sign. b. epididymal edema. c. paratesticular fluid. d. increased epididymal blood flow. e. absence of intratesticular blood flow.

Answer 12

e. Absence of intratesticular blood flow. The absence of intratesticular blood flow is the classic sonographic finding in testicular torsion. However, there are many documented cases of some preserved intratesticular blood flow even in cases with significant torsion. Therefore testicular torsion remains a clinical diagnosis. Epididymal edema, paratesticular fluid, and increased epididymal blood flow may be seen with testicular torsion but may also be seen with other clinical conditions. The blue dot sign is a classic physical finding in torsion of the appendix testis.

Question 13

Ultrasound waves are examples of: a. radio waves. b. mechanical waves. c. electromagnetic waves. d. ionizing radiation. e. light waves.

Answer 13

b. Mechanical waves: Mechanic104al waves are represented graphically as a sine wave alternating between a positive and negative direction from the baseline. Sound waves as they propagate through human tissue produce areas of returning compression and rarefaction.

Question 14

The most important determinant of axial resolution is: a. impedance. b. speed of propagation. c. acoustic power. d. frequency. e. number of foci

Answer 14

d. Frequency: Axial resolution is directly dependent on the frequency of sound waves. The higher the sound wave’s frequency is, the better the axial resolution.

Question 15

The optimal ultrasound image requires tradeoffs between resolution and depth of penetration. ____________-frequency transducers of_____ MHz may be used to image structures near the surface of the body (e.g., testis, pediatric kidney) with excellent resolution. However, deeper structures (e.g., right kidney, bladder) require _____ frequencies of ___ MHz to penetrate. Such images will have poorer ____________

Answer 15

d. Depth of penetration: The optimal ultrasound image requires tradeoffs between resolution and depth of penetration. Highfrequency transducers of 6 to 10 MHz may be used to image structures near the surface of the body (e.g., testis, pediatric kidney) with excellent resolution. However, deeper structures (e.g., right kidney, bladder) require lower frequencies of 3.5 to 5 MHz to penetrate. Such images will have poorer axial resolution

Question 16

When sound waves encounter the interface between two tissues with large differences in impedance, the waves are: a. increased in frequency. b. decreased in frequency. c. reflected. d. refracted. e. reverberated.

Answer 16

. c. Reflected: The shape and size of the object and the angle at which the advancing wave strikes the object are critical determinants of the amount of energy reflected. The amount of energy reflected from an interface is also influenced by the impedance of the two tissues at the interface. Impedance is a property that is influenced by tissue stiffness and density. It is the difference in impedance that allows an appreciation of interfaces between different types of tissue

Question 17

When a tissue appears darker than the surrounding tissue on ultrasound it is said to be relatively: a. hypoechoic. b. hyperechoic. c. hypodense. d. isoechoic e. anechoic.

Answer 17

. a. Hypoechoic: The liver is usually used as a benchmark for echogenicity. A hypoechoic area is described as “darker” on Bmode ultrasound.

Question 18

The focal zone represents the area of best: a. lateral resolution. b. axial resolution. c. echogenicity. d. blood flow. e. tissue penetration

Answer 18

a. Lateral resolution: Lateral resolution refers to the ability to identify separately objects that are equidistant from the transducer. Lateral resolution is a function of the focused width of the ultrasound beam and is a characteristic of the transducer. The location of the narrowest beam width can be adjusted by the user. The more focused the beam is, the better the lateral resolution at that location. Thus image quality can be enhanced by locating the narrowest beam width (focus or focal zone) at the depth of the object or tissue of interest

Question 19

Increasing the gain has the effect of: a. increasing amplitude of the sound waves. b. increasing acoustic power. c. increasing thermal index. d. increasing mechanical index. e. increasing transducer sensitivity

Answer 19

e. Increasing transducer sensitivity: The gain control on the console of the ultrasound machine permits the user to increase or decrease the sensitivity of the transducer to reflected sound waves.

Question 20

One way to improve the visualization of deep structures is to: a. increase the frequency. b. decrease the frequency. c. increase the wave velocity. d. decrease the gain. e. employ Doppler flow.

Answer 20

b. Decrease the frequency: The optimal ultrasound image requires trade-offs between resolution and depth of penetration. Highfrequency transducers of 6 to 10 MHz may be used to image structures near the surface of the body (e.g., testis, pediatric kidney), with excellent resolution. However, deeper structures (e.g., right kidney, bladder) require lower frequencies of 3.5 to 5 MHz to penetrate. Such images will have poorer axial resolution.

Question 21

The best frequency for performing external renal ultrasound in most adults is:

a. 3.5 to 5 MHz. b. 6 to 7 MHz. c. 7.5 to 8.4 MHz. d. 8.5 to 9.9 MHz. e. None of the above

Answer 21

a. 3.5 to 5 MHz: Deeper structures (e.g., right kidney, bladder) require lower frequencies of 3.5 to 5 MHz to penetrate

Question 22

A simple cyst of the kidney would not display which of the following characteristics? a. Bright back wall b. Increased through transmission c. Anechoic interior d. Edging artifact e. Hyperechoic internal nodule

Answer 22

e. Hyperechoic internal nodule: A simple cyst is an example of a structure that is well circumscribed, with an anechoic interior and through transmission.

Question 23

Which of the following is correct? a. Measuring bladder volume requires three-dimensional scanning. b. A nearly empty bladder is desirable for bladder scanning. c. A curved array transducer is preferred for bladder ultrasound in most patients. d. Ureteroceles are usually poorly visualized because the membrane is thin. e. Bladder ultrasound is a sensitive screening exam for suspected bladder tumors.

Answer 23

c. A curved array transducer is preferred for bladder ultrasound in most patients: A curved array transducer is of lower frequency (3.5–6 MHz) and provides greater depth of penetration but with less axial resolution. It is most often the transducer of choice for imaging the kidney and urinary bladder

Question 24

Which of the following are evaluable by transabdominal bladder ultrasound? a. Urine volume b. Bladder wall characteristics c. Stones or diverticulum d. Dilated ureters e. All of the above

Answer 24

e. All of the above: Urine volume, bladder wall characteristics, the presence of calculi or diverticulum, and the presence of dilated ureters just outside the bladder are all evaluable by transabdominal bladder ultrasound.

Question 25

18. Scrotal ultrasound for the evaluation of possible testicular torsion may include all of the following but must include: a. B-mode ultrasound. b. multiple scrotal views. c. Doppler flow studies. d. simultaneous bilateral views. e. harmonic scanning

Answer 25

c. Doppler flow studies: Caution should be used when interpreting Doppler flow studies in the evaluation of suspected testicular torsion. The hallmark of testicular torsion is the absence of intratesticular blood flow. Paratesticular flow in epididymal collaterals may appear within hours of torsion. Comparison with the contralateral testis should be performed to ensure that the technical attributes of the study are adequate to demonstrate intratesticular blood flow.

Question 26

19. The most important limitation of ultrasound in attempting to characterize complex renal cysts as benign or malignant is: a. refraction. b. inability to evaluate enhancement. c. lack of axial resolution. d. increased through-transmission with artifact. e. reverberation artifact.

Answer 26

b. Inability to evaluate enhancement: Unlike computed tomography (CT), currently ultrasound cannot evaluate enhancement. Once it is approved by the US Food and Drug Administration (FDA) for this purpose, contrast-enhanced ultrasound will allow the detection of enhancement of renal masses by ultrasound.

Question 27

A complete transrectal ultrasound of the prostate should include an evaluation of: a. rectal wall. b. seminal vesicles and ejaculatory ducts. c. bladder. d. prostate. e. all of the above.

Answer 27

e. All of the above: When evaluating the prostate, surrounding structures need to be assessed. Rectal lesions (including cancer), dilated seminal vesicles, and/or ejaculatory ducts as well as bladder pathology should all be evaluated for a complete examination.

Question 28

Which of the following would not typically be visible in a sagittal midline prostate ultrasound? a. Middle lobe of the prostate b. Central zone c. Ejaculatory duct d. Tip of right seminal vesicle e. Apex of the prostate

Answer 28

d. Tip of right seminal vesicle: In a midline sagittal view the tips of the seminal vesicles are not normally visualized on ultrasound. An axial projection needs to be obtained to be able to measure the length of each seminal vesicle.

Question 29

Characteristics of prostate cancer as demonstrated on transrectal ultrasound of the prostate may include:

a. hypoechogenicity. b. hyperechogenicity. c. prostate asymmetry. d. increased vascularity. e. all of the above

Answer 29

. e. All of the above: Although excellent resolution and tissue characteristics is possible with transrectal ultrasound a diagnosis of prostate cancer is not often able to be made with ultrasound alone.

Question 30

The single most important determinant of patient safety in ultrasound utilization is: a. multifrequency probes. b. good documentation. c. an informed operator. d. periodic equipment inspection

Answer 30

c. An informed operator: The ALARA (as low as reasonably achievable) principle is intended to limit the total energy imparted to the patient during an examination. This can be accomplished by (1) keeping power outputs low, (2) using appropriate scanning modes, (3) limiting examination times, (4) adjusting focus and frequency, and (5) using the cine function during documentation. All of these are dependent upon an informed sonographer.

Question 31

The disinfection level protocol required for transrectal ultrasound probes following needle biopsy is: a. low. b. moderate. c. high. d. critical. e. none of the above

Answer 31

d. Critical: Any time body fluids or tissues come in contact with an ultrasound transducer, critical or high-level disinfection protocols must be strictly adhered to.

Question 32

For patient safety it is preferable to maximize and limit: a. acoustic power, exam duration. b. acoustic power, gain. c. gain, acoustic power. d. gain, use of cine function. e. images, description.

Answer 32

C. Gain, acoustic power: Unlike gain, which refers to amplification of the acoustic signal returning to the transducer, acoustic power is the amount of acoustic energy applied to the tissue. The biologic effects of ultrasound in terms of power are in the milliwatt range. High levels generate heat and cavitation, which might result in tissue damage.

Question 33

___ is the peak velocity minus the end-diastolic velocity over the peek systolic velocity. This is measured using the color flow Doppler with spectral display and is used to characterize renal artery stenosis, ureteral obstruction, and penile arterial insufficiency.

Answer 33

Resistive index is the peak velocity minus the end-diastolic velocity over the peek systolic velocity. This is measured using the color flow Doppler with spectral display and is used to characterize renal artery stenosis, ureteral obstruction, and penile arterial insufficiency.

Question 34

By convention, the ___ is used as a benchmark for echogenicity. By convention, the ____ aspect of the structure is to the left of the image.

Answer 34

By convention, the liver is used as a benchmark for echogenicity. By convention, the cephalad aspect of the structure is to the left of the image.

Question 35

Ultrasonography may produce injury due to mechanical effects caused by ___or by ___

Answer 35

Ultrasonography may produce injury due to mechanical effects caused by cavitation or by heat generation