Week 2: Anatomy Review, Probe, Positioning, Protocols Flashcards
Ergonomics
______of sonographers report having some degree of pain due to physical stresses related to scanning
> 80%
Ergonomics
Approximately_____ of sonographers are forced to leave the field due to musculoskeletal injury
20-25%
Ergonomics
WRMSD stands for
Work Related Musculoskeletal Disorders (WRMSD)
Most common WRMSD amongst sonographers
carpal/cubital tunnel
epicondylitis of the elbow
shoulder capsulitis and tendonitis
neck and back strain
Carotid Scanning: Positioning
patient position
supine
flat head extended
head turned slightly away from the side being examined or could keep the head straight
Carotid Scanning: Positioning
sonographer position
behind the patient’s head
or
to the patient”s right side
sit or stand
get close to the patient
_________ Arteries- All arteries that carry blood from the heart up to the base of the skull (outside the skull)
Extracranial
extracranial arteries (3)
LCC, L subclavian
Innominate (brachiocephalic)
Aorta- Begins at the aortic valve of the heart ends at the bifurcation of the iliac arteries
- Thoracic Aorta: from aortic valve to_______
- Abdominal Aorta: from _______to bifurcation of the________
diaphragm
diaphragm
common iliac
name of the vessel?
innominate
Innominate artery-1st branch off the aortic arch
-Begins @ _____and ends @___________
the aortic arch
the bifurcation into the right common carotid and right subclavian arteries
2: name of the vessel?
LCC
Left common carotidartery-2nd branch off the aortic arch
-Begins @______ and ends @__________
the aortic arch
the carotid bifurcation
3: name of the blood vessel?
L subclavian
Left subclavian artery-3rd branch off the aortic arch
-Beings @_____ and ends at the________
the aortic arch
thoracic outlet
*isthmus - The aortic isthmus is the segment of aorta located between the origin of the left subclavian artery and the connection of the ductus arteriosus to the descending aorta.
CCA
-
No branches
• Divides into the ____ & _____
• Widens at the level of the _____ to form the_______
ICA and ECA
bifurcation
carotid bulb
The carotid circulation is considered _____circulation
anterior
*The anterior circulation derives blood from the bilateral internal carotid arteries (ICA) and supplies blood to the majority of the cerebral hemispheres, including the frontal lobes, parietal lobes, lateral temporal lobes and anterior part of deep cerebral hemispheres
Common carotid artery relationship to the internal jugular vein (IJV)
- CCA is______ to the IJV (TRV plane)
medial
A normal IJV will ______with transducer pressure
compress
ICA vs. ECA
ICA
- location of the vessel in relation to ECA? (in approx. 90%)
- branches: yes or no? (*extracranially)
- width in relation to ECA?
- waveform?
- 1st branch off ICA?
- posterolateral
- no
- (usually) wider
- low resistive waveform
- opthalmic artery
*Note:
High-Resistance and Low-Resistance Doppler Spectrum. A. A high-resistance waveform is characterized by rapid systolic upstroke (straight arrow), low flow velocities, or no flow, during diastole (curved arrow), and, commonly, reversal of flow direction (arrowhead) in early diastole. This Doppler spectrum was obtained from the common femoral artery. B. A low-resistance waveform is characterized by relatively high flow velocities throughout diastole (curved arrow). The narrow spectrum and clean systolic window (straight arrow) is characteristic of laminar blood flow. This Doppler spectrum was obtained from the internal carotid artery.
ICA vs. ECA
ECA : supply blood to face
- location of the vessel in relation to ICA? (in approx. 90%)
- branches: yes or no? (*extracranially)usu
- width in relation to ICA?
- waveform?
- 1st branch off ECA?
- a tip to differentiate ECA from ICA?
- anterior vessel
- yes
- usually narrower
- high resistive waveform
- superior thyroid artery
- use temporal tap
Used to differentiate the ICA from the ECA
Tap the temportal artery, an ECA branch (runs in front of the upper part of the ear)
Causes changes in the ECA flow during diastole
Has little/no effect on the ICA
*very light touch
Vertebral Artery
- First branch of the___________
- Left vertebral artery is _____ than the right
- Right and left join at the posterior skull and form the______
- subclavian artery
- longer
- basilar artery
The vertebral arteries and basilar artery are considered___________
posterior circulation
- Vertebral vein: ______ to the vertebral aratery
- Vertebral artery courses between the ____________
- anterior
- transvers foramina of the cervical spine
- _________ - All arteries that carry blood from the heart up into the skull (inside the skull)
- Requires ________ to evaluate
- Intracranial Arteries
- transcranial scan (TCD)
__________is the joining area of several arteries at the bottom (inferior) side of the brain. At this point, the internal carotid arteries branch into smaller arteries that supply oxygenated blood to over 80% of the cerebrum.
The Circle of Willis
*Essentialforcirculationof flow in events of occlusions or emboli to create collateral routes
- _________ deliver blood to the brain in the event of stenosis or occlusion
- ________ can develop both extracranially and intracranially
- Develop slowly
- Develop because they must (blood always takes the path of ________)
- Ability to develop ______ is variable among individuals
- Only ______ & _______ (collaterals) can be assessed by ultrasound
- Collateral pathways
- Collaterals
- ollaterals
- least resistance
- opthalamic artery and circle of Willis
collateral pathway is _____ flow
reterograde flow
- In the presence of severe ICA disease, branches of ____ can act as important collateral pathways, example:
- It communicates with the _________ then the flow will come into the ICA via the ______ and continue to feel the intracranial portion
- ECA (facial artery)
- ophthalmic artery *creates retrograde flow in the ophthalmic
- ophthalmic
*Note: ECAs do not normally supply blood to the brain
Tortuous Vessels
- __Can make wide curves, tight kinks, or even 360-degree loops
- Tortuosity can _____ the velocity within the vessel without stenosis
increase
Anterior Circulation
name the vessels 1-4
- CCA
- ICA
- ACA - anterior cerebral artery
- MCA - middle cerebral artery
Posterior Circulation
name the blood vessel 1-4
- vertebral artery
- basilar artery
- posterior cerebral artery (PCA)
- posterior communicating artery * connects posterior and anterior circulation)
Protocol
Approach
- Important to attempt to image the carotid system, especially the CCA and ICA, using all three approaches: _____, _____, and _______
- _______ approach places the vessel out of the near field and allows for visualization of the bifurcation more frequentl
- anterior, lateral posterior
- posterior
ICA vs. ECA
- Differentiating the ICA from ECA takes time- listen
- When scanning the CCA and moving distally, should see area of vessel widening (bulb area or bifurcation region)
- From this point a slight ________ of the transducer will allow visualization of the ECA
- Once visualization of the ECA is achieved, a slight ________ or angulation _______ should enable the ICA to be seen
- anterior rocking
4. posterior rocking , posteriorly
name 1-9 blood vessels
- e: CCA
- g: DAO
- d: vertebral artery
- h: ICA
- c: AAO
- a: AO arch
- i: inniminate
- f: ECA
- b: left subclavian
name the blood vessels 1-8
- b: Celiac trunk
- g: left renal artery
- a: abdominal aorta
- e: SMA
- f: right renal artery
- d: splenic artery
- c: hepatic artery
- h: left renal vein
Name the blood vessels 1-8
- Subclavian artery
- Axillary artery
- Brachial artery
- Radial artery
- Ulnar artery
- Deep palmer arch
- Superficial palmer arch
- Digital artery
Name the blood vessels 1-6
- Subclavian vein
- Axillary vein
- Brachial vein
- Basilic vein
- Cephalic vein
- Median cubital vein
Name the blood vessels 1-12
- Abdominal aorta
- Common iliac artery
- External iliac artery
- Internal iliac artery
- Common femoral artery
- Deep femoral artery
- Superficial femoral artery
- Popliteal artery
- Tibioperoneal artery
- Anterior tibial artery
- Peroneal artery
- Posterior tibial artery
Name the vessels 1-10
- Common femoral vein
- Great (greater or long) saphenous vein
- Deep femoral vein
- Femoral (superficial) vein
- Popliteal vein
- Small (lesser) saphenous vein
- Anterior tibial vein
- Tibioperoneal trunk veins
- Peroneal vein
- Posterior vein
*peroneal - relating to or situated in the outer side of the calf of the leg
chapter 3 question
- the proximal limit of these two arteries is the distal to innominate artery
RCC & R subclavian arteries
- The first 3 main arteries off the aortic arch, in order from proximal to distal
- innominate
- LCC
- subclavian
- this segment the carotid system had no branches until it enters the skull
ICA
- the internal jugular vein is _____ to the CCA
lateral
name the blood vessels 1-9
- ACoA (anterior communicating artery)
- opthalmic
- MCA (middle cerebral artery
- PCoA (posterior communicating artery)
- PCA (posterior cerebral artery)
- VA (vertebral artery)
- BA (basilar artery)
- ICA internal carotid artery)
- ACA (anterior cerebral artery)
Name the blood vessels 1-12
- CCA
- ICA
- ECA
- distal ICA (carotid siphon)
- opthalmic artery
- facial artery
- maxillary artery
- superficial temporal artery
- infraorbital artery
- nasal artery
- supraorbital artery
- frontal artery
______ begins at the innominate bifurcation and ends at the carotid bifurcation. The thyroid gland is medial to it proximally.
RCA
_____ begins at the innominate bifurcation and ends at the thoracic outlet, passing over the first rib
R clavian artery
______ runs down the lateral neck (often visible in singers who are straining too hard) and joins the subclavian vein. This vein drains the face and scalp
external jugular vein
*The external jugular vein is a superficial vein of the neck that drains blood from the parotid gland, most of the scalp, and side of the face, then back to the heart. It also assists with blood flow down from the head when other major veins, like the internal jugular vein, are compressed or blocked.
_______ runs down the neck from the base of the skull along the lateral side of the internal carotid and common carotid arateries and joins the innominate vein at its junction with the subclavian vein.
internal jugular vein
*The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. Internal jugular vein. The fascia and middle thyroid veins.
carotid bifurcations can occur very proximally or very distally; occasionally the external and internal carotid arteries arise from the aortic arch separately.
Vertebral arteries can arise directly from the arch as well, or even take off from a contralateral artery and cross over
Each collateral is mainly a way to keep the circle of Willis and especially the ______ perfused when the ICA is obstructed; picture that as the destination and work your way to it.
MCA (middle cerebral artery
Collaterals
- collaterals develop slowly over time
- collateral flow evolves in response to the slowly changing pressure gradients caused by the obstruction
- As the lesion reduces pressure distally, blood flows the paths of ______ by flowing gradually more through the alternate routes
least resistance
The phenomenon, ____________ caused by the obstruction of left subclavian artery (*the left subclavian is more likely than the right to become obstructed), the pressure becomes more and more reduced in the arteries to the left arm till the point at there will be less pressure in the arm than in the cerebral end of the verttebral artery, causing flow to travel retrograde down the vertebral artery on that side. This may cause posterior-circulation cerebrovascular symptoms as blood flow is taken from the vertebrobasilar system to perfuse the arm.
subclavian steal
*athe point is that collaterals develop in response to abnormal pressure gradients caused by arterial obstruction; the flow has to fo where it does
It is estimated that roughly half the population has an incomplete circle of Willis.
T or F ?
T
What are the 3 major pathways (collaterals)?
- contralateral hemiisphere
- posterior to anterior
- ECA to ICA branches
Contralateral Hemisphere
*case scenario: total occulusion of right ICA - objective is to provide enough perfusion to right MCA
The key artery in this pathway is ____1___. Blood flow travels from the left anterior cerebral artery (AA) across the ____1___ and retrograde down to the right ACA to the right MCA.
The complete pathway looks like this: aorta - _2__ - __3__ - __4__ - _5_ - __6__ - _7__
- ACoA: anterior communicating artery
- left CCA
- left ICA
- left ACA
- ACoA
- right ACA
- right MCA: middle cerebral artery
Posterior to Anterior
*case scenario: total occulusion of right ICA - objective is to provide enough perfusion to right MCA
In this case, flow travels from the vertebrobasilar circulation via the __1__ and __2__.
The complete pathway looks like this: innominate - _3__ - __4__ - __5__ - __6__ - __7__ - __6__ - __7__
- PCA (posterior cerebral artery)
- PCoA (posterior communicating artery
- subclavian
- vertebral
- basilar
- right PCA
- right PCoA
- distal ICA
- right MCA
ECA brancheds to opthalmic branches
*case scenario: total occulusion of right ICA - objective is to provide enough perfusion to right MCA
If the right ICA becomes occluded, the pressure in the distal ICA will be quite low. This causes flow in ECA branches to travel retrograde along the branches of the opthalmic artery, thereby reconstituting flow in the distal ICA.
The retrograde flow in the opthalmic artery reconstitutes flow in the distal ICA at the __1__ (this is where the ICA turns anterior and then posterior again just before reaching the circle of Willis). The ICA bifurcates into the MCA and ACA branches of the circle of Willis, and flow is thus provided to the right MCA.
The complete pathways: aorta - innominate - _2_ - _3_ - _4_ - _5_ - _6_ - _7_ - _8_
- carotid siphon
- right CCA
- right ECA
- ECA branches (superficial temporal, facial and maxillary)
- opthalmic artery branches (supraorbital, frontal, and nasal)
- right opthalmic artery
- distal ICA (siphon)
- MCA
