Medical Ultrasound Imaging
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Ultrasonic Heating
Due to the absorption of ultrasound, heating of tissue (including bone) can occur. For this reason, the sonographer should follow the ALARA principle to minimize the potential for ultrasonic heating of tissue during for example M-mode ultrasound. The thermal effect of Doppler ultrasound flow examinations is significantly greater.

See also Thermal Index and Ultrasonic Power.
Ultrasound Accessories and Supplies
Common ultrasound supplies that are often used in conjunction with ultrasound imaging:
Ultrasound Gel:
A water-based gel used as a coupling agent between the transducer and the patient's skin. It helps eliminate air pockets and ensures good sound wave transmission.
Probe Covers:
Disposable covers designed to maintain hygiene and prevent cross-contamination. These covers are placed over the transducer before each examination.
Cleaning Wipes:
Alcohol-based or disinfectant wipes used for cleaning and disinfecting the transducer and other equipment surfaces. Specific cleaning solutions are recommended by the ultrasound equipment manufacturer for thorough cleaning of transducers.
Gel Warmers:
Devices used to warm ultrasound gel, providing patient comfort during the examination.
Needle Guides:
Attachments or brackets that assist in accurate needle placement during ultrasound-guided procedures such as biopsies or injections.
Positioning Aids:
Cushions, wedges, or straps designed to help position patients correctly and comfortably during ultrasound exams.

Common ultrasound accessories that are often used in conjunction with ultrasound imaging:
Transducer Storage Rack:
A dedicated rack or holder to store transducers safely when not in use, helping to prevent damage.
Storage and Archiving Solutions:
External hard drives, network storage, or cloud-based systems for long-term storage and backup of ultrasound images and reports. Possibly specialized printers that produce hard copies of ultrasound images for immediate documentation and patient records.
Power Supply and Transducer Cable Extenders:
Extension cables used to increase the length of transducer cables for more flexibility during examinations. Adequate power sources or uninterrupted power supply (UPS) to ensure continuous operation of the ultrasound machine during power outages or fluctuations.
Reporting Templates and Software:
Customizable reporting templates and software solutions that facilitate efficient and standardized reporting of ultrasound findings.
Phantom Devices:
Artificial tissue-like structures or phantoms used for training, calibration, and quality assurance purposes to evaluate image quality and system performance.

Consult with ultrasound equipment vendors or professionals in the field to determine the specific accessories and supplies that best suit your imaging needs and specialty. See also Equipment Preparation, Environmental Protection, Portable Ultrasound Machine, Ultrasound Technology, Ultrasound System Performance and Sonographer.
Ultrasound Elastography
Ultrasound elastography is a specialized imaging technique that provides information about tissue elasticity or stiffness. It is used to assess the mechanical properties of tissues, helping to differentiate between normal and abnormal tissue conditions.
The basic principle behind ultrasound elastography involves the application of mechanical stress to the tissue and measuring its resulting deformation. This is typically achieved by using either external compression or shear waves generated by the ultrasound transducer.
There are two main types of ultrasound elastography:
Strain Elastography: In strain elastography, the tissue is mechanically compressed using the ultrasound transducer, causing deformation. The transducer then captures images before and after compression, and the software analyzes the displacement or strain between these images. Softer tissues tend to deform more than stiffer tissues, and this information is used to generate a color-coded map or elastogram, where softer areas appear in different colors compared to stiffer regions.
Shear Wave Elastography: Shear wave elastography involves the generation of shear waves within the tissue using focused ultrasound beams. These shear waves propagate through the tissue, and their velocity is measured using the ultrasound transducer. The speed of shear wave propagation is directly related to tissue stiffness: stiffer tissues transmit shear waves faster than softer tissues. By calculating the shear wave velocity, an elastogram is generated, providing a quantitative assessment of tissue stiffness.

Both strain elastography and shear wave elastography offer valuable insights into tissue characteristics and can assist in the diagnosis and characterization of various conditions. In clinical practice, ultrasound elastography is particularly useful for evaluating liver fibrosis, breast lesions, thyroid nodules, prostate abnormalities, and musculoskeletal conditions. By providing additional information about tissue stiffness, ultrasound elastography enhances the diagnostic capabilities of traditional ultrasound imaging. It allows for non-invasive assessment, improves the accuracy of tissue characterization, and aids in treatment planning and monitoring of various medical conditions.
See also Ultrasound Accessories and Supplies, Sonographer and Ultrasound Technology.
Ultrasound Imaging Modes
Ultrasound imaging is excellent for diagnosing cysts and other fluids in soft tissue. For ultrasound imaging or ultrasonography, different modes are used to examine the arterial/venous system, heart, pancreas, urinary system, ovaries, spinal cord, joints and more.
Power levels, frequencies used, amplification, and beamforming determine the clarity of the image. These things are controlled by the sonographer, interacting with the properties of the ultrasound machine.

Various imaging modes:
Ultrasound Technology
Ultrasound technology with its advancements is vital for delivering high-quality patient care. Innovations including high-frequency ultrasound, 3D//4D imaging, contrast enhanced ultrasound, elastography, and point-of-care ultrasound, have expanded the capabilities of ultrasound imaging and improved diagnostic accuracy.
B-Mode imaging, also known as brightness mode, is the fundamental technique in ultrasound imaging. It produces two-dimensional images based on the echoes received from tissues and organs. Understanding the principles of B-Mode imaging, such as gain adjustment, depth control, and image optimization, is crucial for obtaining diagnostically valuable images. M-Mode imaging, on the other hand, allows for the visualization of motion over time, enabling assessment of cardiac structures and function, as well as fetal heart rate.
High-frequency ultrasound refers to the use of ultrasound waves with frequencies greater than 10 MHz. This technology enables improved resolution, allowing for detailed imaging of superficial structures like skin, tendons, and small organs. High-frequency ultrasound has found applications in dermatology, ophthalmology, and musculoskeletal imaging.
Traditional 2D ultrasound has been augmented by the advent of 3D ultrasound technology. By acquiring multiple 2D images from different angles, this technique construct a volumetric representation of the imaged area. The addition of 4D ultrasound in real-time motion adds further value by capturing dynamic processes.
Doppler imaging employs the Doppler effect to evaluate blood flow within vessels and assess hemodynamics. Color Doppler assigns color to different blood flow velocities, providing a visual representation of blood flow direction and speed. Spectral Doppler displays blood flow velocities as a waveform, allowing for detailed analysis of flow patterns, resistance, and stenosis.
Contrast enhanced ultrasound employs microbubble contrast agents to enhance the visualization of blood flow and tissue perfusion. By injecting these agents intravenously, sonographers can differentiate between vascular structures and lesions. Elastography is a technique that measures tissue elasticity or stiffness. It assists in differentiating between normal and abnormal tissues, aiding in the diagnosis of various conditions such as liver fibrosis, breast lesions, and thyroid nodules.
Fusion imaging combines ultrasound with other imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). By overlaying or merging ultrasound images with those obtained from other modalities, the user can precisely locate and characterize abnormalities, guide interventions, and improve diagnostic accuracy. Fusion imaging has proven particularly useful in areas such as interventional radiology, oncology, and urology.
See also Equipment Preparation, Environmental Protection, Handheld Ultrasound, Portable Ultrasound and Ultrasound Accessories and Supplies.
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