Sonography instruments

Mr. IHTISHAM SAHIL
(BS RADIOLOGY)
HAFEEZ INSTITUTE OF MEDICAL SCIENCE PESHAWARHAFEEZ INSTITUTE OF MEDICAL SCIENCE PESHAWAR

SONOGRAPICAL INSTRUMENTSSONOGRAPICAL INSTRUMENTS

OBJECTIVESOBJECTIVES
• Types of Ultrasound Display (A-Mode, B-
Mode, M-Mode, B-Scan, Real Time, B-Scan)
• Real Time Imaging
• Transducers
• Gel
• Specialized Ultrasound Systems

Types of Ultrasound Display
• MODE:MODE:
A mode is an operational state that a system has beenA mode is an operational state that a system has been
switched to. A normal mode occurs when all parts of aswitched to. A normal mode occurs when all parts of a
system oscillate with the same frequency. Forsystem oscillate with the same frequency. For
ultrasound imaging, different modes are used toultrasound imaging, different modes are used to
examine the arterial/venous system, heart, pancreas,examine the arterial/venous system, heart, pancreas,
urinary system, ovaries, spinal cord, joints, and more.urinary system, ovaries, spinal cord, joints, and more.
The different types of modes can be controlled by theThe different types of modes can be controlled by the
operator or tech.operator or tech.

A- MODE (A- MODE (Amplitude ModulationAmplitude Modulation))
• A-Mode, or Amplitude Modulation, is theA-Mode, or Amplitude Modulation, is the
display of amplitude spikes of different heights.display of amplitude spikes of different heights.
It is used for ophthalmology studies to detectIt is used for ophthalmology studies to detect
finding in the optic nerve. A-Mode consists of afinding in the optic nerve. A-Mode consists of a
x and y axis, where x represents the depth and yx and y axis, where x represents the depth and y
represents the Amplitude. The following imagesrepresents the Amplitude. The following images
shows an example of A-Mode display.shows an example of A-Mode display.

B-MODE( Brightness mode)B-MODE( Brightness mode)
• B-Mode, or Brightness Modulation, is the display of 2DB-Mode, or Brightness Modulation, is the display of 2D
map of B-Mode data, and is the most common form ofmap of B-Mode data, and is the most common form of
ultrasound imaging. Unlike A-Mode, B-Mode is based onultrasound imaging. Unlike A-Mode, B-Mode is based on
brightness with the absence of vertical spikes. Therefore,brightness with the absence of vertical spikes. Therefore,
the brightness depends upon the amplitude or intensity ofthe brightness depends upon the amplitude or intensity of
the echo. There is no y axis on B-Mode, instead, there is a zthe echo. There is no y axis on B-Mode, instead, there is a z
axis, which represents the echo intensity or amplitude, andaxis, which represents the echo intensity or amplitude, and
a x axis, which represents depth. B-Mode will display ana x axis, which represents depth. B-Mode will display an
image of large and small dots, which represent strong andimage of large and small dots, which represent strong and
weak echoes, respectively. Below is an example of B-Modeweak echoes, respectively. Below is an example of B-Mode
imaging of an acrogenic mass in a particular organ.imaging of an acrogenic mass in a particular organ.

M-MODE (Motion mode)M-MODE (Motion mode)
• M-Mode, or Motion Mode (also called Time MotionM-Mode, or Motion Mode (also called Time Motion
or TM-Mode), is the display of a one-dimensionalor TM-Mode), is the display of a one-dimensional
image that is used for analyzing moving body partsimage that is used for analyzing moving body parts
commonly in cardiac and fetal cardiac imaging. Thiscommonly in cardiac and fetal cardiac imaging. This
can be accomplished by recording the amplitude andcan be accomplished by recording the amplitude and
rate of motion in real time by repeatedly measuringrate of motion in real time by repeatedly measuring
the distance of the object from the single transducerthe distance of the object from the single transducer
at a given moment. The single sound beam isat a given moment. The single sound beam is
transmitted and the reflected echoes are displayed astransmitted and the reflected echoes are displayed as
dots of varying intensities thus creating lines acrossdots of varying intensities thus creating lines across
the screen. Below is an TM-Mode one dimensionalthe screen. Below is an TM-Mode one dimensional
imaging in a pt with moderate mitral stenosisimaging in a pt with moderate mitral stenosis
(calcific) that shows evidence of multiple echoes of(calcific) that shows evidence of multiple echoes of
the anterior mitral leaflet.the anterior mitral leaflet.

B-SCAN (Static scan)B-SCAN (Static scan)
• The B scan uses a series of B mode images to build a 2DThe B scan uses a series of B mode images to build a 2D
view of the tissue. The probe is attached to an articulatedview of the tissue. The probe is attached to an articulated
arm, which provide the U system with information onarm, which provide the U system with information on
transducer position and orientation. This type of imagestransducer position and orientation. This type of images
is not use in modern equipment because of theis not use in modern equipment because of the
drawbacks.drawbacks.
• Scanning motion and planes are limitedScanning motion and planes are limited
• Lengthy exam,Lengthy exam,
• A high level of operator skill is requiredA high level of operator skill is required
• Movement can not be displayed.Movement can not be displayed.
• Equipment is large and unwieldy. A portableEquipment is large and unwieldy. A portable
examination can not be performed.examination can not be performed.

Real-time, B-ModeReal-time, B-Mode
• Real-time systems provide a cinematic view ofReal-time systems provide a cinematic view of
the area being evaluated by displaying a rapidthe area being evaluated by displaying a rapid
series of images sequentially.series of images sequentially.
AdvantagesAdvantages
1.1. SScanning planes that demonstrate the area ofcanning planes that demonstrate the area of
interest can be found easily.interest can be found easily.
2.2. A rapid examination can be performed.A rapid examination can be performed.
3.3. Extended structure such as vessels can beExtended structure such as vessels can be
followed, allowing them to be traced to theirfollowed, allowing them to be traced to their
origin .origin .

4. Movement observation may aid in organ4. Movement observation may aid in organ
identification (eg, mass vs. bowel)identification (eg, mass vs. bowel)
5. Infant, children, and uncooperative patients can5. Infant, children, and uncooperative patients can
be examined easilybe examined easily
6. Pulsed and color-flow Doppler can be6. Pulsed and color-flow Doppler can be
performed coincident with the real timeperformed coincident with the real time
examinationexamination

REAL—TIME IMAGINGREAL—TIME IMAGING
• All modern imaging systems use a real time approach.All modern imaging systems use a real time approach.
Real time B mode U system use a probe, which containReal time B mode U system use a probe, which contain
a crystal that can convert u impulses into electricala crystal that can convert u impulses into electrical
impulses. These signals are integrated by a computer,impulses. These signals are integrated by a computer,
called a scan converter .called a scan converter .
Scan converter:Scan converter:
It is the portion of the imaging system in which the imageIt is the portion of the imaging system in which the image
data are stored and converted for display .data are stored and converted for display .

Digital scan converters, now found in all newDigital scan converters, now found in all new
systems, use computer memory to digitize thesystems, use computer memory to digitize the
image and transfer it to the display monitor.image and transfer it to the display monitor.
Preprocessing and post processing of the imagePreprocessing and post processing of the image
information occurs in the scan converter.information occurs in the scan converter.

TransducerTransducer
Its assembly consist of five main componentsIts assembly consist of five main components
• The transducer crystalThe transducer crystal
• The matching layerThe matching layer
• Damping materialDamping material
• The transducer caseThe transducer case
• The electrical cableThe electrical cable

The transducer crystalThe transducer crystal
• It is composed of piezoelectric material, mostIt is composed of piezoelectric material, most
commonly lead zirconate titnate. It convert thecommonly lead zirconate titnate. It convert the
electrical voltage into acoustic energy uponelectrical voltage into acoustic energy upon
transmission, and acoustic energy upontransmission, and acoustic energy upon
reception.reception.

The matching layerThe matching layer
• The matching layers lie in front of the probeThe matching layers lie in front of the probe
element and provide an acoustic connectionelement and provide an acoustic connection
between the probe and skin and to protectbetween the probe and skin and to protect
surface of the crystal.surface of the crystal.

Damping materialDamping material
• D material such as rubber is attached to the backD material such as rubber is attached to the back
of the probe to decrease secondary reverberationof the probe to decrease secondary reverberation
of the crystal with returning signals. Decreasingof the crystal with returning signals. Decreasing
the ring time results in an increase in depththe ring time results in an increase in depth
(axial) resolution.(axial) resolution.

The transducer caseThe transducer case
• Its provides a housing for the crystal, a dampingIts provides a housing for the crystal, a damping
material layer, and insulation from interferencematerial layer, and insulation from interference
by electrical noise.by electrical noise.

The electrical cableThe electrical cable
• It contain the bundle of electrical wires used toIt contain the bundle of electrical wires used to
excite the probe elements and to receive theexcite the probe elements and to receive the
returned the electrical impulses. There must bereturned the electrical impulses. There must be
an individual wire for excitation and foran individual wire for excitation and for
reception of each individual probe element.reception of each individual probe element.

Types of TransducerTypes of Transducer
1. 4DC7-3/40 Convex 4D1. 4DC7-3/40 Convex 4D
SpecificationsSpecifications
• Application: Abdominal, Gynecology, PediatricApplication: Abdominal, Gynecology, Pediatric
• Frequency Range: 7 - 3 MHzFrequency Range: 7 - 3 MHz
• Focal Range: 5 - 24 cmFocal Range: 5 - 24 cm
• Image Field : 79°Image Field : 79°

2.2. 4DEC9-5/10 Endovaginal Microvonvex 4D4DEC9-5/10 Endovaginal Microvonvex 4D
• Applications: GynecologyApplications: Gynecology
• Focal Range : 5 - 16 cmFocal Range : 5 - 16 cm
• Image Field : 124°Image Field : 124°

3.3. 4DL14-5/38 Linear 4D4DL14-5/38 Linear 4D
• Applications: Abdominal, Musculoskeletal,Applications: Abdominal, Musculoskeletal,
Pediatric, Small PartsPediatric, Small Parts
• Frequency Range: 14 -5 MHzFrequency Range: 14 -5 MHz
• Image Field: 28mmImage Field: 28mm

4.4. BPC8-4/10 & BPL9-5/55 TransrectalBPC8-4/10 & BPL9-5/55 Transrectal
Bi- planeBi- plane
• Frequency Range: 8 - 4 MHz & 9 - 5 MHzFrequency Range: 8 - 4 MHz & 9 - 5 MHz
• Focal Rang: 3 - 12 cm & 2 - 9 cmFocal Rang: 3 - 12 cm & 2 - 9 cm
• Image Field: 149°Image Field: 149°

5.5. C5-2/60 GPS ConvexC5-2/60 GPS Convex
• Applications: Abdominal, Gynecology, PediatricApplications: Abdominal, Gynecology, Pediatric

6.6. EC9-5/10 EndovaginalEC9-5/10 Endovaginal
MicroconvexMicroconvex
• Applications: GynecologyApplications: Gynecology

7.7. HST15-8/20 LinearHST15-8/20 Linear
• Applications: Musculoskeletal, Pediatric,Applications: Musculoskeletal, Pediatric,
Peripheral VascularPeripheral Vascular
• Image Field:16mmImage Field:16mm

8.8. L14-5W/60 LinearL14-5W/60 Linear
• Applications: Abdominal, Musculoskeletal,Applications: Abdominal, Musculoskeletal,
Pediatric, Small PartsPediatric, Small Parts

9. L40-8/12 Linear9. L40-8/12 Linear
• Applications: Musculoskeletal, Pediatric,Applications: Musculoskeletal, Pediatric,
Peripheral Vascular, Small PartsPeripheral Vascular, Small Parts
• Focal Range: 0.2 - 3 cmFocal Range: 0.2 - 3 cm

10. SA4-2/24 Phased Array10. SA4-2/24 Phased Array
• Applications: Abdominal, Cardiac, Pediatric,Applications: Abdominal, Cardiac, Pediatric,
TranscranialTranscranial
• Frequency Rang: 3 - 2 MHzFrequency Rang: 3 - 2 MHz

11. 4-Way Laparoscopic 8666-RF11. 4-Way Laparoscopic 8666-RF
• Applications: Intraoperative:Applications: Intraoperative:
• Frequency Range: 10 - 4.3 MHzFrequency Range: 10 - 4.3 MHz
• Contact Surface: 30 x 5 mmContact Surface: 30 x 5 mm
• Scanning Modes: B, M, Doppler, CFM, TissueScanning Modes: B, M, Doppler, CFM, Tissue
Harmonic ImagingHarmonic Imaging
• Dimension: 302 x 178 mmDimension: 302 x 178 mm
• Weight: 475 gWeight: 475 g

12.T-Shaped Intraoperative I14C5t12.T-Shaped Intraoperative I14C5t
• Applications: Abdominal, IntraoperativeApplications: Abdominal, Intraoperative
• Focal Range: 10 - 80 mmFocal Range: 10 - 80 mm
harmonic Imaging, Contrast Imaging, Elastrographyharmonic Imaging, Contrast Imaging, Elastrography
• Weight:55 gWeight:55 g

13:Intraoperative Biplane 882413:Intraoperative Biplane 8824
• Application: IntraoperativeApplication: Intraoperative
• Frequency Range: 10 - 3.75 MHzFrequency Range: 10 - 3.75 MHz
Harmonic ImagingHarmonic Imaging
• Dimensions: 1.4 x 3.3 x 5.1 cmDimensions: 1.4 x 3.3 x 5.1 cm
• Weight: 45 gWeight: 45 g

14:High Frequency Curved N13C514:High Frequency Curved N13C5
• Application: Intraoperative, Neonatal Cephalic,Application: Intraoperative, Neonatal Cephalic,
Neurosurgery, PediatricNeurosurgery, Pediatric
• Frequency Range: 13-5Frequency Range: 13-5
• Scanning Modes: B, M, CFM, Doppler, TissueScanning Modes: B, M, CFM, Doppler, Tissue
Harmonic Imaging, ElastographyHarmonic Imaging, Elastography

15:Endfire Curved E14C415:Endfire Curved E14C4
• Applications: Interventional Procedures,Applications: Interventional Procedures,
Transrectal, TransvaginalTransrectal, Transvaginal
• Contact Surface: 5 x 23.5Contact Surface: 5 x 23.5
• Scanning Modes: B, M, CFM, Doppler, TissueScanning Modes: B, M, CFM, Doppler, Tissue
Harmonic Imaging, ElastographyHarmonic Imaging, Elastography

Ultrasound GelUltrasound Gel
• Ultrasounds don’t hurt a bit, but the gooey gel they useUltrasounds don’t hurt a bit, but the gooey gel they use
during the procedure can be cold, sticky and really,during the procedure can be cold, sticky and really,
really messy. So why in the world would they use it andreally messy. So why in the world would they use it and
can you do without out it? Unfortunately, they have tocan you do without out it? Unfortunately, they have to
use it and you can’t do without it. Ultrasound gel is ause it and you can’t do without it. Ultrasound gel is a
type of conductive medium that enables a tight bondtype of conductive medium that enables a tight bond
between the skin and the probe or transducer, lettingbetween the skin and the probe or transducer, letting
the waves transmit directly to the tissues beneath and tothe waves transmit directly to the tissues beneath and to
the parts that need to be imaged. It is formulated to actthe parts that need to be imaged. It is formulated to act
as a coupling agent and reduce static. In fact, the moreas a coupling agent and reduce static. In fact, the more
gel, the better – thus why many radiologists giving thegel, the better – thus why many radiologists giving the
exam pile it on.exam pile it on.

Besides ultrasounds themselves, the gel is alsoBesides ultrasounds themselves, the gel is also
used with a fetal Doppler, which can beused with a fetal Doppler, which can be
employed to allow parents and doctors to listenemployed to allow parents and doctors to listen
to the heart beat of an unborn child.to the heart beat of an unborn child.
• Ultrasonic gel is usually composed of propyleneUltrasonic gel is usually composed of propylene
glycol, water and occasionally a dye. The dye isglycol, water and occasionally a dye. The dye is
more for looks than making it work better. It ismore for looks than making it work better. It is
usually clear and thick, and a little bit sticky.usually clear and thick, and a little bit sticky.
That way, when it is applied to the skin itThat way, when it is applied to the skin it
doesn’t drip or run off. At the end of thedoesn’t drip or run off. At the end of the
procedure it can be wiped off easily.procedure it can be wiped off easily.

• So why does it always seem so cold? (That’s theSo why does it always seem so cold? (That’s the
most common complaint) Well it doesn’t havemost common complaint) Well it doesn’t have
to be. Many medical facilities use specialto be. Many medical facilities use special
warmers to make their gel a more comfortablewarmers to make their gel a more comfortable
temperature before applying it. Ask for thattemperature before applying it. Ask for that
before you go – most good places should havebefore you go – most good places should have
no problem providing that request.no problem providing that request.

Specialized Ultrasound Systems
There are many types of U systems used in ourThere are many types of U systems used in our
daily routine examinations. Here they aredaily routine examinations. Here they are
mentioned below.mentioned below.
1.Endocavity ultrasound systems1.Endocavity ultrasound systems
2.Operative systems2.Operative systems
3.3D imaging systems3.3D imaging systems
etcetc

1.Endocavity ultrasound systems1.Endocavity ultrasound systems
Its means that how a procedure of endocavityIts means that how a procedure of endocavity
done. The transducer array, which can be adone. The transducer array, which can be a
linear, curved, or phased array scanner is placedlinear, curved, or phased array scanner is placed
at the end of transducer shift this transducerat the end of transducer shift this transducer
shaft is inserted into the rectum or vigina. Useshaft is inserted into the rectum or vigina. Use
of ultrasound (US) to obtain intravenous accessof ultrasound (US) to obtain intravenous access
is usually accomplished with a 7.5-MHz linearis usually accomplished with a 7.5-MHz linear
US probe.US probe.

This paper describes the use of an endocavity USThis paper describes the use of an endocavity US
probe to obtain vascular access. Since bothprobe to obtain vascular access. Since both
probes use US of the same megahertz values, theprobes use US of the same megahertz values, the
picture quality with the two is no different.picture quality with the two is no different.
Because the equipment used for each type ofBecause the equipment used for each type of
probe costs thousands of dollars, the economicprobe costs thousands of dollars, the economic
value of having to purchase one less probe mayvalue of having to purchase one less probe may
be significant.be significant.

2.Operative systems2.Operative systems
Standard US are modified so they can be used inStandard US are modified so they can be used in
sterile fashion in the operating room. Specialsterile fashion in the operating room. Special
high frequency U probes are used for thathigh frequency U probes are used for that
purposes. Intraoperative probes are design withpurposes. Intraoperative probes are design with
a size shape to allow easy handling anda size shape to allow easy handling and
positioning during intraoperative procedures.positioning during intraoperative procedures.

• A procedure that uses ultrasound (high-energyA procedure that uses ultrasound (high-energy
sound waves that are bounced off internalsound waves that are bounced off internal
tissues and organs) during surgery. Sonogramstissues and organs) during surgery. Sonograms
(pictures made by ultrasound) of the inside of(pictures made by ultrasound) of the inside of
the body are viewed on a computer to help athe body are viewed on a computer to help a
surgeon find tumors or other problems duringsurgeon find tumors or other problems during
the operation. Also called IOUS.the operation. Also called IOUS.

3. 3D imaging systems3. 3D imaging systems
• 3D ultrasound3D ultrasound is a medical ultrasound is a medical ultrasound
technique, often used in fetal, cardiac, trans-technique, often used in fetal, cardiac, trans-
rectal and intra-vascular applications. 3D rectal and intra-vascular applications. 3D
ultrasound refers specifically to the volume ultrasound refers specifically to the volume
rendering of ultrasound data and is also rendering of ultrasound data and is also
referred to as 4D (3-spatial dimensions plus 1-referred to as 4D (3-spatial dimensions plus 1-
time dimension) when it involves a series of time dimension) when it involves a series of
3D volumes collected over time.3D volumes collected over time.

• When generating a 3D volume the ultrasoundWhen generating a 3D volume the ultrasound
data can be collected in 4 common ways.data can be collected in 4 common ways.
1.1. Freehand :which involves tilting the probe andFreehand :which involves tilting the probe and
capturing a series of ultrasound images andcapturing a series of ultrasound images and
recording the transducer orientation for eachrecording the transducer orientation for each
slice.slice.
2.2. Mechanically :where the internal linear probeMechanically :where the internal linear probe
tilt is handled by a motor inside the probe. tilt is handled by a motor inside the probe.

3. Using an endoprobe: which generates the volume by3. Using an endoprobe: which generates the volume by
inserting a probe and then removing the transducer ininserting a probe and then removing the transducer in
a controlled manner. a controlled manner.
4.Matrix array transducer: uses beamsteering to sample4.Matrix array transducer: uses beamsteering to sample
points throughout a pyramid shaped volume.points throughout a pyramid shaped volume.
• A 3D ultrasound of a human fetus aged 20 weeksA 3D ultrasound of a human fetus aged 20 weeks

GE Refurbished Ultrasound SystemsGE Refurbished Ultrasound Systems
Vivid 3 Pro / Expert (2003)Vivid 3 Pro / Expert (2003)
• Application/OptionApplication/Option
Cardiac / Vascular / OB-Gyn / Small Parts /Cardiac / Vascular / OB-Gyn / Small Parts /
Pediatrics / Abdominal IntraoperativePediatrics / Abdominal Intraoperative
MonitoringMonitoring
• Available ProbeAvailable Probe
3S Cardiac / 5S Cardiac / 7S Cardiac /3S Cardiac / 5S Cardiac / 7S Cardiac /

Voluson 730 Pro / Expert(2004)Voluson 730 Pro / Expert(2004)
Abdominal / Obstetrical / Gynecologigal / Breast /Abdominal / Obstetrical / Gynecologigal / Breast /
Small Parts / Cardiac / VascularSmall Parts / Cardiac / Vascular
• Available Probe:Available Probe:
AB2-5 Convex / AB2-7 Convex / IC5-9 Endo-Cavity /AB2-5 Convex / AB2-7 Convex / IC5-9 Endo-Cavity /
PA2-5P Phased Array / PA6-8 Phased Array / RAB2-5PA2-5P Phased Array / PA6-8 Phased Array / RAB2-5
3D Volume Convex / RAB4-8P 3D Convex / RIC5-93D Volume Convex / RAB4-8P 3D Convex / RIC5-9
3D Endo-Cavity / RSP6-12 3D Volume Linear / SP10-3D Endo-Cavity / RSP6-12 3D Volume Linear / SP10-
16 Linear / SP4-10 Linear / SP6-12 Linear16 Linear / SP4-10 Linear / SP6-12 Linear

Logiq 200 Pro(2006)Logiq 200 Pro(2006)
Abdominal / Obstetrics / Gynecological /Abdominal / Obstetrics / Gynecological /
Urological / Small Parts / Neonatal /Urological / Small Parts / Neonatal /
Pediatric / Orthopedic.Pediatric / Orthopedic.
CBF Linear / CAE Convex / MTZ Linear / LHCBF Linear / CAE Convex / MTZ Linear / LH
Linear /10L LinearLinear /10L Linear

Logiqbook XP Enhanced (2009)Logiqbook XP Enhanced (2009)
Abdominal / Cardiac / Obstetrical / Gynecological /Abdominal / Cardiac / Obstetrical / Gynecological /
Musculoskeletal / Vascular / Urological / Small PartsMusculoskeletal / Vascular / Urological / Small Parts
& Superficial / Pediatric & Neonatal / Intraoperative& Superficial / Pediatric & Neonatal / Intraoperative
8L-RS Linear / 3S-RS Cardiac / 3C-RS Convex / E8C-8L-RS Linear / 3S-RS Cardiac / 3C-RS Convex / E8C-
RS Endo-Cavity / 8C-RS Micro-Convex / i12LRS Endo-Cavity / 8C-RS Micro-Convex / i12L
Linear / i739L-RS Linear / T739L-RS LinearLinear / i739L-RS Linear / T739L-RS Linear

REFERENCEREFERENCE
•
http://www.two-views.com/ultrasounds/gel-goo.html#sthash.GnIJivhttp://www.two-views.com/ultrasounds/gel-goo.html#sthash.GnIJiv
• https://https://bkultrasound.combkultrasound.com//
• Clinical Sonography, A Practical Guide by Roger C.Sanders
• http://sonohouse.co.kr/ReconditionedSystems.htm
• http://www3.gehealthcare.com/en/products/categories/ultrasound
• http://www.usedultrasound.com/ultrasound-applications/tee-
ultrasound/
• http://www.kpiultrasound.com/medical-equipment/ultrasound-scannhttp://www.kpiultrasound.com/medical-equipment/ultrasound-scann

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