Basic physics of US

Sound is a mechanical wave,it is a series of pressure

waves propagating through a medium. Audible range of sound frequency for humans is 20 Hz to 20 kHz , so ultrasound By Definition is greater than 20 kHz Medical ultrasound is performed in the range of 2 20 MHz

Basic physics of US
Sound waves are expressed as sine waves with the

following properties: 1- Wavelength () 2- Frequency (f) :The higher the frequency, the better the resolution and the lower the penetration. 3- Propagation Velocity (v) :expressed by the Wave Equation v
= f In soft tissue propagation velocity is relatively constant at 1540 m/sec. Hence wavelength is inversely proportional to frequency

Basic physics of US
4- Amplitude :is the height above the baseline and represents maximal compression. It is expressed in decibels.

Transducer
Curve linear probe
Crystals are placed in a curve line transducer face is curved produces pie-shaped image Typically used in abdominal applications

Linear probe
crystals are placed parallel transducer face is flat produces rectangular image For superficial organs .

USAModes mode :
a display of ultrasonic

echoes in which the horizontal axis of the cathode ray tube display represents the time required for the return of the echo and the vertical axis represents the strength of the echo. The mode is used in echoencephalography

US Modes
M Mode : M-mode stands for

motion mode. It captures returning echoes in only one line of the B-mode image but displays them over a time axis. Movement of structures positioned in that line can now be visualized. Often Mmode and B-mode are displayed together on the ultrasound monitor

US modes
B Modes : B-mode stands for

brightness mode and provides structural information utilizing different shades of gray (or different brightness) in a two-dimensional image

US modes
Doppler Mode :
the Doppler mode examines the

characteristics of direction and speed of tissue motion and blood flow and presents it in audible, color or spectral displays

Pulsed (spectral) doppler

US modes
Color doppler mode
Direction and velocity of

tissue motion and blood flow are color coded and superimposed on the corresponding B-mode image

US modes
Power doppler Non directional More sensitive for

measure blood flow

US modes
Duplex and triplex

Interaction with matter

Absorption, reflection,

refraction. Scatter

Abdomen US
Pt. prepration
Fasting 6 hrs to reduce bowel gases and gallbladder

shown distended . Transducer : Curve linear , 3-5 MHz Use aqueous gel as coupling material to minimize reflection of US Mostly use B mode .

Abdomen US
General points for imaging upper abdomen :
1-Always scan any organ in at least two planes,

to reduces the risk of missing pathology and helps to differentiate artifact from true pathology. 2- Use a combination of sub- and intercostal . 3- never limit the scan to longitudinal and transverse sections. 4- Deep inspiration can be useful.

Liver
Normal appearance

- The liver is a homogeneous, mid-grey organ on ultrasound. It has the same, or slightly increased echogenicity when compared to the cortex of the right kidney and less echogenicity than pancreas and spleen . - Size of the liver up to 16 cm ,longitudinal scan at midclaviclar line . - Portal vein appear hypoechoic with hyperechoic fibrous sheath.( margin)

Liver

liver pathology

Simple cyst

Liver pathology

Liver cirrhosis

Gallbladder
The normal gallbladder is best

visualized after fasting for around six hours, it should be distended with bile into an elongated pear-shaped sac. It should have a hyperechoic, thin wall and contain anechoic bile Wall thickness of gallbladder not more than 3 mm.(GB wall is measured at the most narrow point of the anterior wall in the short-axis) GB diameter 4- 5 cm and the long axis from 8-12 cm

Gallbladder
If the gallbladder cannot be found
Check for previous surgery; a cholecystectomy Check the patient has fasted an ectopic gallbladder, for example positioned low in the

pelvis. A contracted, stone-filled gallbladder, producing heavy shadowing, can be difficult to identify due to the lack of any contrasting fluid in the lumen * Sonographic Murphys sign is positive when the point of maximal tenderness is identified in the right upper quadrant while the gallbladder is identified on the ultrasound monitor

Gallbladder
Duodenum mimicking gallbladder pathology
The close proximity of the duodenum to the

posterior gallbladder wall often causes it to invaginate the gallbladder turn the patient to cause the duodenal contents to move.

Gallbladder

GB pathology

GB pathology

Pathology

acute cholecystitis

Contracted GB

Common bile duct

The internal diameter of the common duct is reported to

be In adults, the average diameter o 4 mm. less than 6 mm is considered to be normal, 6 to 7 mm is equivocal, and more than 7 mm is dilated. may be more than 8 mm in eldery pt . Patients with a cholecystectomy CBD is dilated, but nonobstructed 10 mm . CBD dilated if there obstruction due to formation of stones in the duct.

CBD

CBD

CBD

pathology

Stone in CBD

Pancreas
The most useful technique is to start by scanning the

epigastrium in transverse plane, using the left lobe of the liver as an acoustic window. In adult , the pancreas is hyperechoic compared to normal liver. The normal stomach or duodenum can mimic pancreatic pathology if the patient is insufficiently fasted , Giving the patient a drink of water usually differentiates the gastrointestinal tract from a collection.

Pancreas

Spleen
The normal spleen has a fine, homogeneous with

smooth margins and a pointed inferior edge. It has similar echogenicity to the liver but may be slightly hypo- or hyperechoic . A splenic length of below 12 cm is generally considered normal .

Spleen

Kidneys
The right kidney is readily demonstrated through the

right lobe of the liver The left kidney is not usually demonstrable sagittally because it lies posterior to the stomach and splenic flexure. The spleen can be used as an acoustic window to the upper pole by scanning coronally, from the patients left side, with the patient supine or decubitus (left side raised) . Normal ultrasound appearances of the kidneys The cortex of the normal kidney is slightly hypoechoic when compared to the adjacent liver parenchym

kidneys
There is good

differentiation of the renal capsule ,cortex, medulla, and renal sinus complex. The longitudinal plane.

kidneys
Normal renal value :
Renal length: 9-12 cm Renal width :4-6 cm

Cortex width : 1.3-2.5 cm

pathology

Renal cyst

pathology

Renal stone

pathology

Moderate HN
Mild HN

Severe HN

Urinary bladder
Pt. preparation :
Full bladder . To show bladder outline ,window for prostate and

uterus . When the bladder is distended with urine, the walls are thin, regular and hyperechoic. The walls may appear thickened if the bladder is insufficiently distended, making it impossible to exclude a bladder lesion.

Urinary bladder
Hypoechoic with smooth outline. The wall thickness of 4 to 6

mm three perpendicular measurements and multiplying by 0.56: Bladder volume (ml) = length * width * anteroposterior diameter (cm) * 0.56 post micturition residue of less than 20 cc in an adult is regarded as normal

patholgy

Vascular US
R/O DVT
No preparation Linear transducer 7-10 MHZ Popilital and femoral vein Spectral ( pulsed ) doppler used to differentiate artery

and vein differences between artery and vein : Pulsation and compressepility

DVT

DVT

3D /4D US