BASIC US SHORT NOES

• Ultrasonic waves cannot move in a vacuum.
  
• Ultrasonic waves constitute high-frequency, short-wavelength sound waves.
  
• These waves travel at the same velocity as sound in a particular medium.
  
• Throughout homogenous media, their velocity remains constant
  
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• Does ultrasound use radiation?
  
  Because ultrasound images are captured in real-time, they can also show movement of the body's internal organs as well as blood flowing through the blood vessels. Unlike X-ray imaging, there is no ionizing radiation exposure associated with ultrasound imaging.Sep 28, 2020
  
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• What are the limitations of ultrasound?
  
  Ultrasound is a valuable tool, but it has limitations. Sound waves don't travel well through air or bone, so ultrasound isn't effective at imaging body parts that have gas in them or are hidden by bone, such as the lungs or head. Ultrasound may also be unable to see objects that are located very deep in the human body.Apr 30, 2022
  
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• Linear Probe. Linear probes have a flat array and appearance. ...
  
• Convex Probe. ...
  
• Endocavitary Probe. ...
  
• Phased Array/Cardiac Probe. ...
  
• Transesophageal (TEE) Probe (trans esophageal echocardiography). ...
  
• 3D/4D Probe.
  
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• What is C mode ultrasound?
  
  C-Mode functions similarly to B-Mode, although it has not been been as developed to full potential. Using data and a range of depth from A-Mode, the transducer then moves to B-Mode (or 2D mode) and examines the whole region at the depth originally employed in two dimensional imagery
  
• .
  

• A-mode: A-mode is the simplest type of ultrasound. ...
  
• B-mode: In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen.
  
• M-mode: M stands for motion.
  

• Having sex.
  
• An infection.
  
• Implantation. ...
  
• Hormone changes. ...
  
• Changes in your cervix. ...
  
• Certain types of testing during pregnancy like an amniocentesis or Chorionic villus sampling (CVS). ...
  
• Problems related to smoking.
  
• ...............................................
  
• Miscarriage is the sudden loss of a pregnancy before the 24th week. About 10% to 20% of known pregnancies end in miscarriage. But the actual number is likely higher. This is because many miscarriages happen early on, before people realize they're pregnant
  
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• How is a miscarriage confirmed?
  An ultrasound scan diagnoses most miscarriages. It may also diagnose miscarriages where some of the pregnancy remains in your womb. You might not be referred for an ultrasound if you: take a pregnancy test which gives a negative result
  
• ...............................................
  
• You can ovulate and become pregnant as soon as two weeks after a miscarriage. Once you feel emotionally and physically ready for pregnancy after miscarriage, ask your health care provider for guidance. After one miscarriage, there might be no need to wait to conceive
  
• ..............................................
  
• The symptoms of miscarriage can include:
  Bleeding from the vagina with or without pain, including light bleeding called spotting.
  Pain or cramping in the pelvic area or lower back.
  Fluid or tissue passing from the vagina.
  Fast heartbeat
  

• Threatened miscarriage. When your body is showing signs that you might miscarry, that is called a 'threatened miscarriage'. ...
  
• Inevitable miscarriage. ...
  
• Complete miscarriage. ...
  
• Incomplete miscarriage. ...
  
• Missed miscarriage. ...
  
• Recurrent miscarriage. ...
  
• Expectant or natural management. ...
  
• Medical management.
  

• INTRAUTERINE PREGNANCY (NORMAL PREGNANCY) A normal pregnancy develops favorably when the embryo correctly implants into the lining of the uterus. ...
  
• MULTIPLE PREGNANCY. ...
  
• ECTOPIC PREGNANCY (EXTRAUTERINE) ...
  
• MOLAR PREGNANCY.
  
• .............................................................
  
• What is the difference between abortion miscarriage and stillbirth?
  
  The U.S. medical community most often defines miscarriage (also called spontaneous abortion) as the spontaneous loss of a nonviable, intrauterine pregnancy before 20 weeks gestational age (GA), while stillbirth (also called fetal death and intrauterine fetal demise) describes this event at ≥ 20 weeks GA.Dec 4, 2019
  
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• What is the difference between a missed abortion and an incomplete abortion?
  
  The gestation would be termed a missed abortion only if the diagnosis of incomplete abortion or inevitable abortion was excluded. The condition may present as an anembryonic gestation (empty sac or blighted ovum) or as fetal demise prior to 20 weeks gestation
  
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• What is the difference between a threatened miscarriage and a miscarriage?
  
  A threatened miscarriage is where there is vaginal bleeding during pregnancy. It does not always mean that you will go on to have a miscarriage; there is an 83% chance of your pregnancy continuing. If the pregnancy continues the bleeding will not cause any harm to the baby, even if the bleeding is heavy.
  
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• What is a clinical miscarriage?
  
  
  
  
  
  The term clinical miscarriage is used when ultrasound examination or histological evidence has confirmed that an intrauterine pregnancy has existed. Clinical miscarriages may be subdivided into early clinical pregnancy losses (before gestational week 12) and late clinical pregnancy losses (gestational weeks 12 to 21).
  

• back pain.
  
• diarrhea.
  
• nausea.
  
• pelvic cramping (may feel like you're getting your period)
  
• severe abdominal pain.
  
• fluid coming from your vagina.
  
• tissue coming from your vagina.
  
• unexplained weakness
  
• ..................................................
  
• What is the best treatment for a threatened miscarriage?
  
  There's nothing your provider can do to stop a miscarriage from occurring. Some pregnancy care providers prescribe progesterone, a hormone that supports a pregnancy. Low levels of progesterone may be a sign of a threatened miscarriage. You can take progesterone through injections, suppositories or 
  
• tablets.Jun
  
• What is progesterone in threatened abortion?
  
  The symptoms of threatened miscarriage are vaginal bleeding, with or without abdominal pain, while the cervix of the womb is closed and the baby inside the womb is alive. Progesterone is a hormone that is known to prepare the uterus for implantation of the fertilized egg and suppress uterine contractions until term.
  
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• What is the difference between threatened and inevitable miscarriage?
  
  Inevitable miscarriage is where women have unexplained vaginal bleeding and abdominal pain early in their pregnancies. Compared with a threatened miscarriage, an inevitable miscarriage is where the cervix opens in addition to the bleeding and pain.
  
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Choose a probe
• 
  Linear array probe: High-frequency (eg, 5 to 10 MHz) high-resolution image, little depth of penetration, flat footprint, rectangular image; choose for imaging superficial structures in detail (eg, for vascular cannulation or arthrocentesis)
  
• 
  Curvilinear probe: Low-frequency (eg, 1 to 5 MHz), lower-resolution image, greater depth of penetration, convex footprint, fanned image; choose for general imaging of deeper structures (eg, for E-FAST or aortic aneurysm evaluation)
  
• 
  Phased array probe: Typically low resolution and high depth, very small footprint that can fit in tight spaces (eg, between the ribs); often chosen specifically for cardiac imaging
  
• 
  Intracavity probe: Tight curvilinear probe, high frequency; choose for imaging within body cavities (eg, intraoral [peritonsillar tissues], transvaginal [ovaries], transrectal [prostate])
  

Probes typically have labels, such as a letter and number. The letter “C” stands for curved and “L” stands for linear. The adjacent numbers correspond to the probe’s frequency.How To Do Ultrasonography: Selecting a ProbeHide Details Procedure demonstrated by Robert Strony, DO, MBA, RDCS, FACEP, Medical Director, Point of Care Ultrasound, Geisinger; Clinical Associate Professor of Medicine, Geisinger Commonwealth School of Medicine; Associate Professor (Adjunct) Lewis Katz School of Medicine, Temple University. Operate the ultrasound console
• 
  B (brightness) mode: This is the commonly used 2-dimensional imaging mode.
  
• 
  M (motion) mode: In M mode, the operator sees a one-dimensional image in the y-axis over time in the x-axis. The monitor shows 2 images: a single acoustic beam (solid line) imposed on the smaller B mode image on one portion of the monitor, and that single beam presented as a vertical line moving across the monitor in a separate M mode area. Motion, such as the beating of a heart, appears as repeating linear disturbances, and static structures create solid, undisturbed horizontal lines as the beam moves across the screen.
  
• 
  Color flow Doppler: This mode is diagnostic for the direction of blood flow. It also shows flow velocity. Red represents blood flow toward the transducer; blue represents blood flow away from it.
  
• 
  Probe: Select the probe you are using on the console.
  
• 
  Preset: If available on your machine, select the preset setting for the study you are doing (eg, obstetric, nerve, abdominal, cardiac).
  
• 
  Depth or frequency: Most machines allow adjustment for frequency. Adjust these to image the object of interest in the middle of the monitor. Unless it is determined by the preset, select the frequency on the machine console. This control may be labeled something other than “frequency,” such as “depth” (or “penetration”), or “resolution.” Examine deep structures first, then go superficial.
  
• 
  Focus: Most machines allow focus adjustment. Move the “x” mark on the side of the monitor to set the desired depth of focus.
  
• 
  Gain: Adjust the gain (brightness) so that fluids look black (anechoic), enhancing contrast with other solid, brighter (hyperechoic) structures. Automatic gain, or “autogain,” if available, sometimes helps clarify images, but sometimes results are better with manual adjustment. Some machines allow adjustment of gain separately at the top and bottom of the screen.
  
  Dense objects, such as bone and stones, decrease the echogenicity of objects behind them (so there is usually a dark area behind them).
  
  Conversely, hypoechoic objects act as “acoustic windows,” making objects behind them more echogenic and clear. For example, tissues behind a filled, hypoechoic bladder enhance brightly, and enhanced images of the heart are obtained by aiming the probe through the hypoechoic liver. Gain may need to be decreased to clearly image brightly enhanced objects.
  
  Gas (eg, bowel gas) tends to give random, uninterpretable images, typically with mixed echogenicity due to mixed fluid and air. This is so-called dirty shadowing, with brighter images behind, caused by air.
  
  Reverberation artifacts are common with curved or phased array transducers; they appear as parallel, equidistant lines (eg, within cysts or behind the pleura). One example of how to use them clinically is the comet tail, a type of vertical reverberation artifact created when the pleura rubs against the lung. Its absence suggests pneumothorax.
  
• 
  Freeze bar: Most machines have a freeze bar that captures the screen image and also have a roll-back feature that retrieves images from seconds earlier (eg, 3 seconds), in case an image of interest is inadvertently passed over.
  
• 
  Measurements: Machines typically have measurement capabilities (eg, labeled “measure” or sometimes “caliper”). For example, in some machines, freeze an image by pressing “freeze.” Move the monitor indicator to mark the beginning and the end points of the measurement and press “select.” The length between the marks is displayed on the upper left hand side of the monitor. Many machines can make calculations from measured values (eg, calculating bladder volume or estimated gestational age).
  

How To Do Ultrasonography: Console and ControlsHide Details Procedure demonstrated by Robert Strony, DO, MBA, RDCS, FACEP, Medical Director, Point of Care Ultrasound, Geisinger; Clinical Associate Professor of Medicine, Geisinger Commonwealth School of Medicine; Associate Professor (Adjunct) Lewis Katz School of Medicine, Temple University. Maneuver the probe do ultrasound imaging
• 
  Standard probe orientation: With correct placement, the right side of the patient should appear on the left side of the monitor. The probe orientation mark on one side of the probe should face the patient's right side (or cephalad if the probe is oriented longitudinally), and the marker dot on the ultrasound monitor is at the upper left corner of the ultrasound monitor.
  
• 
  Cardiac examination orientation: By selecting the cardiac preset, the marker dot will be on the right side of the monitor.
  
• 
  Coat the probe tip with ultrasound gel.
  
• 
  When using a covered probe, apply gel to the probe and then pull a glove or probe cover tightly over the probe tip to eliminate all air bubbles in the gel, and wrap rubber bands around the probe. Apply more gel in large amounts to the covered probe to ensure an adequate film as you move the probe.
  
• 
  Hold the probe and move it like a pen. Use your other fingers to stabilize the probe against the patient as you view the ultrasound monitor.
  
• 
  Optimize imaging. Try to avoid bone and gas, which are hyperechoic and can hide structures of interest. Gas can sometimes be pushed away. Optimize the imaging path to the target by using an acoustic window, generally through hypoechoic structures (eg, the liver when imaging the heart).
  
• 
  Begin by scanning large areas (sometimes called survey views) and then focus in to smaller areas of interest.
  
• 
  Slide the probe side-to-side or up or down, moving the probe footprint. With the footprint steady, you can tilt the probe, also called rocking, fanning, or sweeping, to give a more 3-dimensional view. You can compress the probe, pushing downward.
  
• 
  Rotate the probe, to change between longitudinal and transverse axes while keeping the target in the frame.
  
• 
  The patient may assist, for example, by changing position or inhaling deeply.
  
• 
  For the best view of an organ, image both dimensions, and tilt the probe to focus on each end.
  
  “Mirror artifact” is expected when imaging reflective tissues such as the diaphragm. For example, in Morison pouch, mirror artifact can help rule out hemothorax or pneumothorax. When sound waves encounter the diaphragm, they do not penetrate it and thus take a longer time to reflect themselves back to the probe. The machine misinterprets this longer time as the presence of something behind the diaphragm that is actually in front of the diaphragm (you typically see a liver density behind the diaphragm on the patient’s right, or the spleen when imaging the left side). It is called mirror artifact because it mirrors what is in front of the diaphragm.
  

How To Do Ultrasonography: Obtaining ImagesHide Details Procedure demonstrated by Robert Strony, DO, MBA, RDCS, FACEP, Medical Director, Point of Care Ultrasound, Geisinger; Clinical Associate Professor of Medicine, Geisinger Commonwealth School of Medicine; Associate Professor (Adjunct) Lewis Katz School of Medicine, Temple University. Warnings and Common Errors
• 
  Inadequate use of gel or inadequate pressure on the probe to contact the patient's skin can limit views and distort images.
  

Tips and Tricks
• 
  Position the patient before the examination in a way to optimize probe positioning and to maximize sonographer and patient comfort.
  

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Position the patient before the examination in a way to optimize probe positioning and to maximize sonographer and patient comfort.

Maneuver the probe do ultrasound imaging

• 
  Standard probe orientation: With correct placement, the right side of the patient should appear on the left side of the monitor. The probe orientation mark on one side of the probe should face the patient's right side (or cephalad if the probe is oriented longitudinally), and the marker dot on the ultrasound monitor is at the upper left corner of the ultrasound monitor.
  
• 
  Cardiac examination orientation: By selecting the cardiac preset, the marker dot will be on the right side of the monitor.
  
• 
  Coat the probe tip with ultrasound gel.
  
• 
  When using a covered probe, apply gel to the probe and then pull a glove or probe cover tightly over the probe tip to eliminate all air bubbles in the gel, and wrap rubber bands around the probe. Apply more gel in large amounts to the covered probe to ensure an adequate film as you move the probe.
  
• 
  Hold the probe and move it like a pen. Use your other fingers to stabilize the probe against the patient as you view the ultrasound monitor.
  
• 
  Optimize imaging. Try to avoid bone and gas, which are hyperechoic and can hide structures of interest. Gas can sometimes be pushed away. Optimize the imaging path to the target by using an acoustic window, generally through hypoechoic structures (eg, the liver when imaging the heart).
  
• 
  Begin by scanning large areas (sometimes called survey views) and then focus in to smaller areas of interest.
  
• 
  Slide the probe side-to-side or up or down, moving the probe footprint. With the footprint steady, you can tilt the probe, also called rocking, fanning, or sweeping, to give a more 3-dimensional view. You can compress the probe, pushing downward.
  
• 
  Rotate the probe, to change between longitudinal and transverse axes while keeping the target in the frame.
  
• 
  The patient may assist, for example, by changing position or inhaling deeply.
  
• 
  For the best view of an organ, image both dimensions, and tilt the probe to focus on each end.
  
  “Mirror artifact” is expected when imaging reflective tissues such as the diaphragm. For example, in Morison pouch, mirror artifact can help rule out hemothorax or pneumothorax. When sound waves encounter the diaphragm, they do not penetrate it and thus take a longer time to reflect themselves back to the probe. The machine misinterprets this longer time as the presence of something behind the diaphragm that is actually in front of the diaphragm (you typically see a liver density behind the diaphragm on the patient’s right, or the spleen when imaging the left side). It is called mirror artifact because it mirrors what is in front of the diaphragm.