siamak bakhtiari consultant in emergency medicine · 2019. 2. 23. · objectives physics - how does...
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Siamak BakhtiariConsultant in Emergency Medicine
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Objectives
� Physics - how does an ultrasound machine work
� Turning on & setting up USS machines
� Knobology and use of ultrasound controls
� Obtaining basic images and maximising quality
� The boundaries and pitfall in USS
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History
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How does it work
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Structure of the machine
� Transducer to produce, transmit and receive ultrasound waves
� Computer for interpretation and storage of the acquired data
� Monitor to display the image
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Sound waves
� Ultrasound is > 20 KHz
� Ultrasound machines work in megahertz range – mostly 2 to 20 MHz
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Transducer
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Transducer
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Sound waves
� The speed of sound varies in different body tissues
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Transducer
� High frequency� Superficial penetration� High resolution
� Low frequency� Deep penetration� Low resolution
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What happens to the sound waves in the body?
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Reflection
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Refraction
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Scatter
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Absorption
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Attenuation
The combined effect of scattering and absorption is called attenuation.
Ultrasonic attenuation is the decay rate of the wave as it propagates through material.
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Echogenicity
� Hyperechoic: more echogenic than surrounding tissue
� Hypoechoic: less echogenic than surrounding tissue
� Isoechoic: same echogenicity as surrounding tissue
� Anechoic: absence of echoes
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Setting up the machine
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� Patient’s information
� Information governance
� Occupational health issues
� Appropriate environment
� Cleaning the machine
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Knobology and use of ultrasound controls
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Ultrasound modes
� A mode: Amplitude modulation
� B mode: Brightness modulation
� M mode: Motion mode
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A mode
� Amplitude Modulation
� Display of amplitude spikes of different heights
� Still in use - Ophtalmology
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B mode
� Display of 2D map of data
� The most common form of ultrasound imaging
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B mode
� Doppler
� Power Doppler
� Colour Doppler
� Spectral Doppler (pulse wave)
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Power Doppler
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Colour Doppler
� Toward the probe = RED
� Away from the probe = BLUE
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Spectral Doppler
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M mode
� Display of a one-dimensional image that
is used for analysing moving body parts
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Obtaining basic images
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Transvers plan
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Sagittal plan
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Coronal plan
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Depth
� Depth of field of view
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Time Gain Compensation - TGC
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Gain
� Overall brightness of the image
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Time Gain Compensation - TGC
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Probe markers
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Probe markers
Typeequationhere.
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Probe orientation
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Probe orientation
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How to hold the probe
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Probe movements
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Black & White
� Structures like Bones and stones appears as white and called hyperechoic
� Fluid allows most sound waves through and appears as black and called hypoechoic
� Air is the enemy
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Artefacts
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Practitioner
� Probe position
� Control settings
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Patient
� Motion
� Gas
� Anatomy
� Shadowing
� Enhancement
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Acoustic shadow
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Acoustic or Posterior enhancement
� Increased echoes deep to structures that transmit sound exceptionally well
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Image mirroring
� Seen when there is a highly reflective
surface in the path of the primary beam
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Reverberation
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