Medical Ultrasound Imaging
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Ultrasound Machine
Ultrasound machines, widely used in medical imaging, are essential tools in the field of diagnostic ultrasound. These devices utilize high-frequency sound waves to create real-time images of internal body structures. Ultrasound machines consist of several key components that work together to generate diagnostic images. These include:
The transducer is a handheld device that emits and receives sound waves. It converts electrical energy into sound waves and captures the returning echoes to create images.
The control panel houses the interface where the sonographer adjusts imaging parameters such as depth, frequency, and gain. It allows for customization of imaging settings based on the clinical requirements. The transducer pulse controls change the amplitude, frequency and duration of the pulses emitted from the transducer probe.
The central processing unit (CPU) serves as the brain of the ultrasound machine, processing the acquired data and transforming it into images. It handles complex calculations, image optimization, data storage and contains the electrical power supplies for itself and the transducer probe.
The display monitor (oscilloscope, tablet, computer monitor, etc.) showcases the real-time ultrasound images produced by the machine. It provides visual feedback to the sonographer, aiding in the interpretation and analysis of anatomical structures. Handheld ultrasound devices and mobile ultrasound probes can be connected wirelessly to a smartphone or tablet via Bluetooth or WiFi. These end device serves then as the ultrasound monitor.
Data input and measurements are done with the keyboard cursor (trackball). Ultrasound devices used for handheld point of care ultrasound (HPOCUS) are operated via the touch screen of the control panel.
Images are captured, reviewed, stored and transmitted digitally, using a standard format for digital imaging and communications in medicine (DICOM). Disk storage devices (FDD, HDD, CD, DVD) are outdated, but may be used in older machines to store the acquired images if no picture archiving and communication system (PACS) connection is possible.
The displayed ultrasound pictures are usually digitally stored in a PACS. The images from portable ultrasound machines can be stored and conveniently managed on the end device itself, the inserted memory card or in the cloud. With a QR scanner, the images can be accessed via the Internet in the cloud. Often there is also the possibility to get a picture of a baby sonography as a printout.

B-mode machines represent the vast majority of machines used in echocardiology, obstetrical scans, abdominal scans, gynecological scans, etc. B-mode ultrasound machines usually produce the sector (or pie segment-shaped) scans. These ultrasound scans require either a mechanical scanner transducer (the transducer moves to produce the sector scan), or a linear array transducer operated as a phased array.


Ultrasound machines come in different types, each catering to specific clinical needs. The two primary types are stationary and portable ultrasound machines:

Stationary units are typically larger in size and are installed in dedicated imaging rooms. These machines offer advanced imaging capabilities and a wide range of specialized features. They are commonly found in hospitals, clinics, and university medical centers where comprehensive imaging services are provided.
Portable units (see Portable Ultrasound Machine), as the name suggests, are compact and lightweight, designed for on-the-go imaging. These machines are highly versatile and offer excellent mobility, allowing healthcare professionals to bring the ultrasound system directly to the patient's bedside. Portable ultrasound machines are particularly useful in emergency settings, rural healthcare facilities, and point-of-care applications.

See also Handheld Ultrasound, Ultrasound System Performance, Equipment Preparation, Coaxial Cable, and Microbubble Scanner Modification, Environmental Protection and Ultrasound Accessories and Supplies.
Portable Ultrasound Machine
Ultrasound technology has evolved significantly, providing sonographers with a wide range of ultrasound machines. As technology has advanced, portable ultrasound equipment, including handheld ultrasound systems, have emerged in the field of medical imaging. However, these devices may have limited imaging capabilities and reduced image quality compared to larger systems.
Types of ultrasound systems compiled according to their portability:
Handheld Ultrasound Devices:
Handheld ultrasound devices are compact, lightweight, and easily maneuverable. They offer convenience and point-of-care imaging capabilities, making them ideal for emergency medicine, primary care, and remote settings. Pros include portability, rapid assessments, and ease of use. However, these devices may have limited imaging capabilities and reduced image quality compared to larger systems.
Laptop-Based Ultrasound Scanner:
Laptop-based ultrasound machines combine portability with a larger display and enhanced imaging capabilities. They are versatile and suitable for various applications, including primary care, obstetrics, and musculoskeletal imaging. These machines provide good image quality, a user-friendly interface, and improved storage capacity. However, they may still be bulkier and less portable than handheld devices.
Console-Based Ultrasound Systems: Console-based ultrasound machines are larger, stationary systems commonly found in hospitals and specialized imaging centers. They offer comprehensive imaging capabilities, advanced features, and excellent image quality. These machines are suitable for a wide range of specialties and can perform complex examinations. Pros include high image resolution, advanced imaging modes, and comprehensive data management. However, they lack the portability and immediate accessibility of handheld or laptop-based devices.
Cart-Based Ultrasound Machines:
Cart-based ultrasound machines strike a balance between portability and advanced imaging capabilities. They consist of a console unit mounted on a mobile cart. These machines are commonly used in hospitals, clinics, and larger healthcare facilities. They provide excellent image quality, a wide range of imaging options, and ergonomic considerations. While less portable than handheld or laptop-based devices, cart-based machines offer enhanced functionality and versatility.


In summary, pros and cons of portable ultrasound machines:
Pros:
Compact portable ultrasound machines eliminate transfers and reduce wait times, improving patient comfort. Scans at the bedside minimize discomfort and anxiety while optimizing workflow efficiency. Sonographers can quickly assess patients and detect abnormalities. Real-time examinations provide immediate visualization, procedural guidance, and support for critical decision-making especially in emergency, critical care, and resource-limited settings.
Cons:
Portable ultrasound machines may have restricted features and imaging modes compared to larger systems, potentially affecting diagnostic quality and detail. The compact size can lead to compromises in image resolution and overall quality due to factors like lower power output and smaller transducers.The small displays and simplified controls of portable systems may pose challenges for sonographers, potentially impacting workflow efficiency and user fatigue. Portable ultrasound machines often come with a higher price tag, requiring careful evaluation of cost versus expected benefits and specific practice needs.

See also Ultrasound Accessories and Supplies, Environmental Protection, Sonographer, Ultrasound Technology and Equipment Preparation.
Ultrasound System Performance
Ultrasound machines, with their various components and types, have revolutionized the field of medical imaging. These devices enable healthcare professionals to visualize internal structures, assess conditions, and guide interventions with real-time imaging capabilities. Today, medical ultrasound systems are complex signal processing machines. Assessing the performance of an ultrasound system requires understanding the relationships between the characteristics of the system, such as the point spread function, temporal resolution, and the quality of images. Image quality aspects include the detail resolution, contrast resolution and penetration. Systems with microbubble scanner modification are particularly suitable for contrast enhanced ultrasound.

Low-performance systems constitute approximately 20% of the world ultrasound market. These ultrasound machines are characterized by basic black and white imaging and are primarily used for basic OB/GYN applications and fetal development monitoring. They are often purchased by private office practitioners and small hospitals, with a unit cost below $50,000. These scanners commonly come equipped with a transvaginal probe.
Mid-performance sonography systems also hold around 20% market share. These machines are basic gray scale imaging, color and spectral Doppler and are used for routine examinations and reporting. They typically utilize a minimum number of scanheads and find applications in radiology, cardiology, and OB/GYN. The cost of these systems ranges between $50,000 and $100,000. Refurbished advanced and high-performance ultrasound machines with fewer optional features can also be found in this price range.
High-performance ultrasound systems generally provide high-resolution gray scale imaging, advanced color power and spectral Doppler capabilities. They usually include advanced measurement and analysis software, image review capabilities, and a variety of probes. These high-performance sonography devices have a market share of approximately 40% and cost between $100,000 and $150,000.
The remaining 20% of the market consists of premium or advanced performance ultrasound systems, typically sold for over $150,000. Premium performance systems offer high-resolution gray scale imaging, advanced color flow, power Doppler, and spectral Doppler, as well as features like tissue harmonic imaging, image acquisition storage, display and review capabilities, advanced automation, and more. Premium systems are equipped with a wide assortment of transducer scanheads.

In summary, ultrasound machines have diverse performance levels and corresponding price ranges, catering to various medical imaging needs. From low-performance systems with basic imaging capabilities to high-performance and premium systems with advanced features, ultrasound technology continues to advance healthcare imaging capabilities.
See also Ultrasound Physics, Handheld Ultrasound, Environmental Protection, Equipment Preparation.
Equipment Preparation
Equipment Preparation is an essential step in ensuring optimal ultrasound imaging quality and maintaining a safe and hygienic scanning environment. The following considerations should be taken into account:
Ultrasound Machine Warm-Up:
The ultrasound scanner should be turned on and allowed to warm up for at least 5 minutes before initiating the examination. This allows the system to stabilize and ensures consistent performance.
Transducer Selection:
The appropriate pobe should be selected based on the type of examination required, as well as the patient's body size, weight, and habitus. Different transducer offer varying frequencies, field of view, and imaging capabilities, allowing for tailored imaging based on the specific clinical needs.
Power Settings and Techniques:
Prior to beginning the examination, it is crucial to verify and adjust the power settings and imaging techniques according to the examination protocol. This ensures that the ultrasound machine is optimized for the specific diagnostic requirements
Acoustic Couplant Application:
An adequate amount of acoustic couplant, such as warmed ultrasound gel, should be applied to the patient's skin or the transducer surface. This gel serves as a medium that promotes maximum transmission of the sound beam by eliminating air interfaces, leading to improved image quality.
Transducer Cleaning and Probe Covers:
All transducers should be cleaned and readily available for use with each patient. While endocavitary ultrasound probes are often protected by single-use disposable probe covers, it is important to maintain proper hygiene by performing a high-level disinfection of the probe between each use. Additionally, using a probe cover as an additional measure can help keep the probe clean and minimize the risk of cross-contamination.

By following these equipment preparation guidelines, healthcare professionals can ensure accurate and safe ultrasound examinations while promoting infection control measures and maintaining a hygienic environment for both patients and staff.
See also Environmental Protection, Portable Ultrasound Machine, Ultrasound Accessories and Supplies, and Ultrasound System Performance.
Handheld Ultrasound
Handheld ultrasound systems are portable devices for smartphone or tablet and are increasingly common in emergency, intensive care and veterinary medicine, but also in the pocket of the stationary doctor. This type of ultrasound machine enables immediate diagnoses directly on site (handheld point-of-care-ultrasound / HPOCUS) and quickly provide information regarding the patient's further care. Handheld ultrasound machines fit into a single-use plastic cover and can be easily disinfected, making them particularly useful in infectious environments.
The most striking advantage of handheld POCUS devices is the small footprint. The design is very compact, lightweight (approx. 200 g/0,44 lbs. - 500 g/1,1 lbs) and flexible. Due to this compactness and the necessary technical compression, the quality of the imaging is still limited compared to 'high-end devices', but sufficient to the extent that handheld ultrasound devices are already successfully used in many medical disciplines.
Depending on the model, handheld ultrasound systems run on Android, iOS, Windows or proprietary operating systems. They are connected to the end device via USB cable or wirelessly via Bluetooth or WiFi. The respective end device is used as an ultrasound monitor to display the ultrasound images. The associated app is operated via touchscreen, although some devices have a few buttons, e.g. for recording ultrasound images or freeze images. The images can be stored and managed on the end device itself, the inserted memory card or in the cloud. Theoretically, also a private smartphone can be connected, but this can lead to complications with reimbursement.
See also Portable Ultrasound Machine, Ultrasound Technology, Environmental Protection, Ultrasound Accessories and Supplies and Sonographer.
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