Manual for working with ultrasound equipment. Levels of competence
Ultrasound imaging, also called ultrasound scanning or sonography, is the impact of organs and structures with high-frequency sound waves in order to reproduce images of the internal structure of the body. An ultrasound does not use ionizing radiation (as an X-ray does). Ultrasound images are obtained in real time and can be used to show the structure and movement of the internal organs, as well as the blood flowing in the vascular structures.
Ultrasound examination is a non-invasive medical test that helps doctors in diagnosis and therapeutic behavior.
Abdominal ultrasound provides images of the organs and other structures in the upper abdominal cavity.
Doppler ultrasound may be part of the abdominal examination.
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Doppler ultrasound is a special ultrasound technique that images the blood flow through the vessels, including the large arterial vessels and veins in the abdomen, upper and lower extremities, and the neck.
What is an ultrasound machine?
The ultrasound scanner consists of a main console containing a computer and electronic elements, a television monitor (display) and a transducer or transducers through which the body and vascular structures are scanned.
The transducer is the most important part of the system - a small device that is comfortable to hold in the hand and connected by a cable to the scanner. The transducer emits high-frequency ultrasound waves to the body and then receives the echo signals reflected from the body's structures. The principle is the same as with echo sounders on ships and submarines.
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The ultrasound image is instantly displayed on the video monitor, which looks more like a computer screen or television monitor. The image is based on the amplitude (deviation), frequency and time it takes for the sound signal to travel from the patient to the transducer, which is also dependent on the type of structures it passes through.
How is the ultrasound examination performed?
Ultrasound imaging is based on the same operating principles of sonar used by bats, ships and fishermen. When the sound wave collides with an object, it is reflected back - the so-called echo. By measuring these echo waves, it is possible to determine how far the object is and what its size, shape, and consistency are (whether it is solid, liquid-filled, or both).
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In medicine, ultrasound is used to detect changes in organs, tissues, and vessels, or to visualize abnormal masses, such as tumors.
In the ultrasound examination, the transducer simultaneously sends out ultrasound waves and records the echo waves. When the transducer adheres to the skin surface, it directs tiny pulses of high-frequency sound waves into the body. When ultrasound waves collide with internal organs, fluids and tissues, the transducer's sensitive microphone records subtle changes in sound amplitudes and direction.
These waves are measured instantly and presented to the computer, which forms the real-time picture on the monitor. One or more frames are represented by the moving picture.
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Doppler ultrasound is a special application of ultrasound, it measures the direction and speed of blood cells as they move through the vessels. The changes in the blood cells cause a change in the peak of the reflected ultrasound waves (called the Doppler effect). The computer collects and processes the sound waves and presents a graph or color image representing the flow of blood through blood vessels.
Short story
In 1794, Spallazanni, during experiments with bats, found that when their ears were blocked, they lost orientation in the environment. This is how ultrasound was discovered in nature. It is currently accepted that all sound waves with a frequency above 20,000 Hz are called ultrasound.
The Curie brothers in 1830 discovered the effect of the piezoelectric crystal and for the first time received ultrasound in laboratory conditions. Initially, this effect was applied in the field of underwater research. One of the first echo sounders was used to search for the sunken hull of the Titanic.
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Much later, Dusik made an attempt to introduce ultrasound into medicine, but failed to interest the public. A decade later, in 1952, it went to D. Howry and W. Bliss. They were the first to publish data on the property of ultrasound to reflect differently, passing through organs, tissues and body fluids with distinct acoustic densities.
The actual introduction of ultrasound into clinical practice dates back to the early 1970s. Founders of abdominal ultrasound diagnostics on a global scale are JH Holmes, B. Braun, R. Gunther, WB Schwerk, Donald, K. Tanaka, R. Ushida and on a national scale - Gr. Mechkov, Zh. Vasileva, N. Grigorov and others.
In Bulgaria about 30 years ago, there were very few doctors from various specialties trained in the field of ultrasound tomography. Ultrasound machines were only available in large clinical centers. Translated editions were lacking, and novice sonographers used first-hand knowledge from courses or from the few textbooks by foreign authors in English, German, and French that they sometimes found in libraries.
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In recent years, a real explosion has occurred in our country in the field of conventional and interventional ultrasound. Even the smallest polyclinics and rural health services have modern ultrasound machines. The army of sonographers has been replenished with new ambitious specialists. The number of people wishing to specialize in the field of ultrasound diagnostics has grown tremendously. Recently, specialized publications have been filled with publications presenting a variety of issues in the various aspects of ultrasound.
While initially the interest of doctors was directed in the field of abdominal ultrasound, now the maxillofacial area, neck (thyroid gland, parathyroid glands and processes outside them), mammary glands, scrotum, male and female pelvis are becoming attractive for examination. This has led to a situation in which experienced sonographers find themselves beginners in the study of the mentioned new areas. There was a great demand for information on the problems of surface structures, diseases of the pelvic organs and the diagnosis of hollow abdominal organs.
Ultrasound-guided needle biopsy, applied to obtain material for cytological and histological examination, entered clinical practice in the early 1970s. With the introduction of fine needles, safer, ultrasound-guided access to deep-seated foci of interest has been achieved. Therapeutic echo-controlled fine-needle manipulations aimed at liquid and dense foci - evacuation of contents and application of medications (alcohol, antibiotics, cytostatics) - entered the practice.
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Later, diagnostic-therapeutic manipulations were added as follows: contrast studies (ultrasound-radiological), drainage techniques (including nephrostomy) and dilatational minilaparotomy under ultrasound control. This wide range of echo-guided invasive manipulations led to the emergence of the "Interventional Ultrasound" section.
Intraoperative ultrasound entered clinical practice, which, according to some authors, should be considered a subsection of interventional ultrasound, and according to others, it should occupy an independent section.
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Content
Introduction
Level I - Fundamentals of ultrasound diagnostics
1. Fundamentals of ultrasound
2. Ultrasound terminology
3. Determining the directions of the ultrasound image
4. Basic scanning technique
5. Brief ultrasound anatomy and topography of the upper abdomen
II level – Ultrasound images of the most common pathological processes involving the organs of the upper abdomen
1. General principles of US examination of the upper abdomen
Liver - presentation on US examination
Gallbladder
2. Gallbladder and biliary tree pathology
3. Focal and diffuse liver pathology
4. Pancreas
Congenital anomalies of the pancreas
Pancreatitis
Benign focal pancreatic lesions
Malignant pancreatic diseases
Cystic pancreatic lesions: pseudocysts and cystic neoplasms
6. Slezka
7. Kidneys
Congenital anomalies
Diffuse renal processes
Focal renal processes
8. Adrenal glands
9. Ultrasound image of some pathological processes involving the abdominal wall, abdominal cavity and hollow abdominal organs
Abdominal wall
Retroperitoneal findings
Blood vessels
Intraperitoneal findings
Radiographic Imaging and Exposure,…
Level III – Surface organs and structures
Minimal scanning technique
Maxillofacial region
Thyroid and parathyroid glands
Mammary glands
Scrotum
Penis
Superficial lymph nodes
Brief anatomy and topography
Thyroid
Parathyroid glands
Mammary glands
Scrotum
Penis
Superficial lymph nodes
Ultrasound images of pathological processes involving superficial organs and structures
Thyroid
Parathyroid glands
Mammary glands
Scrotum
Penis
Lymph nodes
IV level – pelvic ultrasound (male and female)
Brief ultrasound anatomy and topography
Ultrasound of the female reproductive system
Ultrasound for men
Bladder
Prostate gland
Uterus
Ovaries
Fallopian tubes
Ultrasound image of the most common pathological processes involving the organs of the small pelvis
Level V – Interventional Ultrasound
1. History and development of interventional ultrasound
2. Diagnostic applications
Fine needle biopsy
Large-bore needle biopsies (CNB)
Contrast-enhanced ultrasound and biopsy guidance
3. Therapeutic applications under ultrasound control
Drainage of liquid collections
Drainage of pleural and pericardial effusion
Percutaneous drainage of abscesses
Tubulation of various organs
Tissue ablation
4. Integrated ultrasound – combining it with images from other interventional procedures
5. General behavior during Ultrasound-guided intervention
6. Cases of percutaneous drainage of abdominal and pleural fluid collections
Liver abscess
Pleural drainage
Postcholecystectomy collection
