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1. ULTRA SOUNDS
basics of
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical Care/ER

2. --1-What is the Ultrasound imaging
--2-Why Ultrasound is required
--3-Common uses of Ultrasound
--4-Small History of Ultrasound
--5-Properties of Ultrasound
--6-Equipment required for Ultrasound
--7-How does this procedure work
--8-Benefits and risks of Ultrasound
-OUTLINE

3. --Ultra sound imaging. Also called “sonography”
It involves “Exposing part of the body to high
frequency sound waves” to produce pictures
of the inside of the body
--Ultrasound examinations do not use Ionizing
radiations (as used in X Rays)
--Because Ultrasound images are captured in real
time, they can show the structure and movement
of the body’s internal organs, as well as blood
flowing through blood vessels
-GENERAL ULTRASOUND IMAGING
What is that

4. --1-Ultrasound (US) is the “Most widely used imaging
technology world wide
--2-It is popular due to “availability, Speed, low cost,
Patient friendless (No Radiation)
--3-Applied in “Obstetrics, Cardiology, Inner Medicine
and Urology”
--4-Ongoing research to improve image quality speed
and new application areas such as intraoperative
Navigation, and Tumor Therapy..
-WHY ULTRASOUND
Should be requested

5. --1-Ultrasound examinations can help to diagnose
a variety of conditions and to asses Organs
damage following illness
--2-Ultrasound is used to help Physicians to evaluate
symptoms such as
a-Pain
b-Swelling
c-Infection and
d-Hematuria (blood in urine)
-SOME COMMON USES
of the procedure

6. ---Ultrasound is a useful way of examining many
of the body’s internal organs including but not
limited to the
-1-Heart and Blood vessels, including the abdominal
aorta and its major branches
-2-Liver
-3-Gall Bladder
-4- Spleen
-5-Pancreas
-6-Kindney
-7-Bladder
-8-Uterus, Ovaries, and unborn child (fetus) in pregnant
patients
-9-Eyes
-10-Thyroid and Parathyroid Glands
-11-Scrotum (testicles)
-12-Brain in infants
-13-Hips in infants
-SOME COMMON
USES
of the procedure
contd.

7. -ULTRASOUND
IS ALSO USED TO GUIDE
--1-Procedures such as Needle Biopsies
in which needles are used to Extract
sample cells from an abnormal area for
laboratory testing
--2-Image the Breasts and to guide Biopsy
of Breast cancer
--3-Diagnose a variety of Heart conditions
and to assess damage after a heart
attack or diagnose for Valvular
Heart disease

8. --1-Blockages to the blood flow (such as clots)
--2-Narrowing of vessels (which may be caused by a plaque)
--3-Tumors and congenital vascular malformations
IMPORTANT:-
With a knowledge about the speed and volume of blood flow
gained from a Doppler ultrasound image, the Physician can often
determine whether a patient is a good candidate for a procedure
like “Angioplasty”
DOPPLAR ULTRASOUND IMAGES CAN
HELP THE PHYSICIAN TO SEE AND EVALUATE

9. --Follow Fetal development
--Detect Pathologies
-APPLICATIONS IN OBSTETRICS
-Two Dimensional B Mode Ultrasound image of a fetus

10. -Three Dimensional image of the same fetus
5(Five) months after conception
-APPLICATIONS IN
OBSTETRICS

11. --1-Blood flow in vessels (Doppler US)
--2-Contraction, Rhythm
--3-Blood flow in the Heart (defects on
the wall muscle, valve defects
--4-Assessment of cardiac perfusion
-APPLICATIONS IN CARDIOLOGY

12. --1-Gallstone
--2-Perfusionn of Renal Transplant
-APPLICATIONS IN INNER MEDICINES
-Gallstone (Red arrow)within the Gallbladder
produces a bright surface ECHO and causes
a dark acoustic shadow (S)

13. -PERFUSION DOPPLAR IMAGE
OF A RENAL TRANSPLANT

14. --Visualization of Tendons, ligaments
--Investigations under movement is
possible
– simplifies the Detection of
RUPTURES, and OBSTRUCTIONS
-APPLICATIONS IN MUSCULOSKELETAL SYSTEM
The arrows show the large GAP of the
rupture of ACHILLES tendon

15. --Ultrasound Elastography is
often used to classify
Tumors and
--Malignant Tumors are
10 to 100 time stiffer
then the normal
tissue around
-APPLICATIONS OF
ULTRASOUND ELASTOGRAPHY

16. -The BAT use Ultrasound for navigation
-HISTORY

17. -Development of the B – mode Ultrasound image quality
-HISTORY

18. --1-Although Ultrasound is better known for its
diagnostic capabilities it was initially used
for therapy rather than diagnosis
--2-In the 1940’s Ultrasound was used to
perform services similar to that of radiation
or chemotherapy now
--3-Ultrasonic waves emit heat that can create
disruptive effects on animal tissue and
destroy malignant tissue.
-HISTORY contd.

19. -Common sound frequencies and frequency ranges
-COMMON SOUND
FREQUENCIES
Sound Frequency
Adultaudiblerange 15– 20’000Hz
Rangeforchildren'shearing Upto40’000Hz
Malespeakingvoice 100– 1’500Hz
Femalespeakingvoice 150‘2’500Hz
Standardpitch(ConcertA) 440Hz
Bat 50’000– 200’000Hz
MedicalUltrasound 2.5– 40MHz
Maximumsoundfrequency 600MHz

20. ---Longitudinal mechanical waves
--Needs elastic medium
-Transducer needs to be in
contact with skin
--Component Resolution
-3 MHZ - > 1.1 mm
-10 MHZ - > 0.3 mm
--Wave velocity
-Fat - > 1450 m/s
-Muscle - > 1580 ms
-PHYSICS OF THE METHOD

21. -PRINCIPLES OF ULTRASOUND
-Its components
-Operations
-Applications

22. -ULRASOUND PARTS

23. -The basic Ultrasound Machine has the following parts
-ULTRASOUND MACINE
--1-Transducer Probe:-Probe that sends and receives the sound waves
--2-Central processing unit (CPU) :-Computer that does all of the calculations and
contains the electric power supplies for itself and the transducer probe
--3-Transducer Pulse Controls:-Changes the amplitude, frequency and duration of
the pulses emitted from the transducer probe
--4-Display:-Display the image from the Ultrasound data processed by the CPU
--5-Keyboard/Cursor:-Inputs data and takes measurements from the display
--6-Disc storage device(Hard, Floppy, CD) stores the acquired images
--7-Printer:-Prints the image from the displaced data

24. --1-Ultrasound scanners consist of a console
containing a computer and electronics
a video display screen and a transducer
that is used to do the scanning
--2-The transducer is a small hand – held
device that resembles a microphone
attached to the scanner by a cord
--3-The transducer sends out inaudible
high frequency sound waves into the
body and then listens for the returning
echoes from the tissues in the body
--4-The principles are similar to sonar
used by boats and submarines
-EQUIPMENT

25. --5-The Ultrasound image is immediately
visible on a video display screen that
looks like a computer or television screen
--6-The image is created based on the
amplitude (Strength) Frequency and
time it takes for the sound signal to
return from the area of the patient
being examined to the transducer and
the type of body structure the sound
travels through
-EQUIPMENT contd.

26. --1-Ultrasound imaging is based on the same
principles involved in the sonar used by Bats,
ships, Fishermen and the weather service.
--2-When a sound wave strikes an object, it
bounces back or Echoes
--3-By measuring these Echo waves, it is possible
to determine how far away the object is, its
shape, size and consistence (whether the object
Is solid, filled with fluid or both)
--4-In medicine, the Ultrasound is used to detect
changes in appearance of organs, tissues, and
vessels or detect abnormal masses such as
tumors
-HOW DOES THIS
PROCEEDURE WORK

27. --5-In an Ultrasound examination, a
Transducer both sends the sound
waves and receives/records the
Echoing waves
--6-When the transducer is pressed
against the skin, it directs small
pulses of inaudible, high frequency
sound waves into the body
--7-As the sound wave bounce off of
internal organ, fluids and tissues
the sensitive microphone in the
transducer records tiny Changes in
the sound’s pitch and direction
-HOW DOES THIS
PROCEEDURE WORK contd.

28. --8-These signature waves are instantly measured and
displayed by a computer, which in tern creates a
real – time picture on the monitor
--9-One or more frames of the moving pictures are
typically captured as still images
--10-Small loops of the moving “real time” images
may also be saved
--11-Dopplar Ultrasound, a special application of
Ultrasound, measures The direction and speed
of blood cells as they move through vessels
--12-The movement of blood cells causes a change
in pitch of the reflected sound waves
(called the Doppler effect)
--13-A computer collects and processes the sounds and
creates graphs or colour pictures that represent the
flow of blood through the blood vessels
-HOW DOES THIS
PROCEEDURE WORK contd

29. --1-For the most Ultrasound Examinations, the patient is
positioned lying Face – up on an examination table that
can be titled or moved
--2-A clear water – based gel is applied to the area of the
body being studied to help the transducer make secure
contact with the body and eliminate air pockets
between the transducer and the skin that can block the
sound waves from passing into your body
--3-The sonographer (Ultrasound technologist) or radiologist
then presses the transducer firmly against the skin in
various locations, sweeping over the area of interest or
angling the sound beam from a further location to better
see an area of concern
-HOW IS THE
PROCEDURE PERFORMED

30. --1-Dopplar sonography is performed using the same
transducer
--2-When the examination is complete, the patient may
be asked to dress and wait while the Ultrasound images
are reviewed
--3-In some Ultrasound studies, the transducer is attached
to a probe and inserted into a natural opening in the body.
These Examinations include:-
a-Trans-Esophageal-Echocardiogram:-The transducer is
inserted into the esophagus to obtain images of the Heart
b-Trans-Rectal-Ultrasound:-The transducer is inserted into a
man’s rectum to view the prostate
c-Trans-Vaginal Ultrasound:-The transducer is inserted into
a women’s vagina to view the Uterus and Ovaries
--4-Most Ultrasound examinations are completed within 30
minutes to an hours
-HOW IS THE PROCEDURE
PERFORMED contd.

31. BENEFITS
--1-Most Ultrasound scanning is non invasive ( no needles
or injections are required) and is usually painless
--2-Ultrasound is widely available, easy-to-use and less
expensive than other imaging methods
--3-Ultrasound imaging does not use any ionizing radiation
--4-Ultrasound imaging gives a clear picture of soft tissue
that do not show up well on X Ray images
--5-Ultrasound is the preferred imaging Modality for the
diagnosis and monitoring of pregnant women and their
unborn babies
--6-Ultrasound provides real time imaging, making it a good
tool for guiding Minimally invasive procedures such as
-Needle Biopsies and
-Needle Aspiration
RISKS
--1-For slandered diagnostic Ultrasound there are no known
harmful effects on humans (contd.)
-WHAT ARE THE
BENEFITS VS RISKS

32. --2-Unlike X Rays, Ultrasound involves only
sound waves
--3-There is no Radiation Danger
--4-However, sound waves can increase
body temperature
-This is known as cavitation
-Significant only for long exposures
time
-WHAT ARE THE BENEFITS
VS RISKS contd.

33. -WHAT ARE THE BENEFITS
VS RISKS contd.
--1-Many studies have been conducted
to determine the physiological effects
of Ultrasound cavitation
--2-No direct co-Relation have been found
between Ultrasound imaging and
cancer, low birth weight, dyslexia or
delayed speed of development
--3-Reliable data from Ultrasound
techniques is hard to come by
--4-Additional studies are ongoing
--5-Biggest risk is Misdiagnosis

34. --1-Improved clarity for use
in cancer diagnosis
--2-Increased therapeutic use
to correct blood clots and
kidney stones
--3-Portability and veterinary
use
--4-Joint and muscle treatment
through cavitation
-FUTURE OF ULTRASOUND

35. --1-Ultrasound waves are disrupted by air or gas: therefore
ultrasound is not an ideal imaging technique for air-filled
bowel or organs obscured by the bowel. In most cases,
-Barium exams(studies)
-CT Scanning and
-MRI
are the methods of choice in this setting
--2-Large patients are more difficult to image by Ultrasound
because greater amounts of tissue attenuates (weakens)
the sound waves as they pass deeper into the body
--3-Ultrasound has difficulty penetrating bone and, therefore,
can only see the outer surface of bony structures and not
what lies within (except in infants) For visualizing internal
structure of bones or certain joints, other imaging
Modalities such as MRI are typically used
-WHAT ARE THE
LIMITATIONS
OF GENERAL
ULTRASOUND
IMAGING