2 Intro To Imaging And Ultrasound FA24 PDF

#2: Intro to Imaging, Intro to Ultrasound Learning Objectives Erin Simons, Ph.D. Office: Dr. AGD Science Hall 250-N 1. Describe methods of transmission imaging (radiograph, C...

#2: Intro to Imaging, Intro to Ultrasound Learning Objectives Erin Simons, Ph.D. Office: Dr. AGD Science Hall 250-N 1. Describe methods of transmission imaging (radiograph, CT), emission [email protected] imaging (MRI), and reflective imaging (ultrasound). 2. Describe proper orientation used in different imaging techniques. 3. Distinguish images taken using different techniques. Text abbreviations NI: Netter’s Introduction to Imaging 4. Describe echogenicity of objects observed in ultrasound imaging. EUA: Essential Ultrasound Anatomy 5. Describe primary uses of main ultrasound probes. © 2024 Erin Simons, © 2024 Midwestern University  Intro Imaging, 2 Why study imaging in Anatomical Sciences? Imaging is a diagnostic tool to see anatomy in a “non-invasive” manner This is how you will see most anatomy in most patients Requires skills in visualization, orientation, and interpretation Vs. Research has shown that practicing physicians identify skill with medical imaging as universally important Resources available to you: Lecture slides Imaging self-study Ultrasound workshop guides Textbooks (MDA and Netter’s Intro to Imaging – available as ebooks through MWU library) https://onlinelibrary.wiley.com/doi/full/10.1002/ase.1401  Intro Imaging, 3 Methods of Image Production Transmission type Emission type Reflective (X-ray, CT) (MRI) (Ultrasound)  Intro Imaging, 4 Methods of Image Production – Transmission types NI 1.1, 1.3 Transmission type Beams of high-energy Advantages Disadvantages photons are transmitted Quick Uses radiation through the body structure Good for bone Contrasts (X-ray, CT) Relatively potentially inexpensive problematic Contrasts often used to Good resolution renal improve imaging of hollow (particularly CT) function spaces (gut, vessels) Widely available allergies Computed tomography (CT) Produces serial x-rays that can be formatted in multiple views (axial, Radiograph (“X-ray”) coronal, sagittal). Computer interprets densities as shades of gray (high Density differences seen as density=white, low density=black). Density measured by Hounsfield shades of gray scale. Higher density (radio- opaque) =white, indicates denser tissue (i.e., bone) or tissue overlap Lower density (radio- translucent) =black Standard orientation for axial CT is patient supine viewed from inferior  Intro Imaging, 5 Methods of Image Production – Emission types NI 1.6, 1.9 Emission type Magnetic resonance imaging (MRI) Equipment detects radiofrequency (MRI) energy of hydrogen protons in a strong magnetic field MRI Modalities (bone is dark for both) T1-weighting Standard for MRI Fluid dark T2-weighting Fluid bright Better for pathology Advantages Disadvantages No ionizing Slow radiation Expensive Better soft Loud tissue detail Data manipulation Versatile limited Claustrophobia Can’t have metal in/on body  Intro Imaging, 6 Image orientation Weir & Abrahams' Imaging Atlas of Human Anatomy Modality: X-ray, CT, MRI? Modality: X-ray, CT, MRI? Modality: X-ray, CT, MRI? View: Axial, Coronal, Sagittal? View: Axial, Coronal, Sagittal? View: postero-anterior (PA) Label: anterior, posterior, right, left Label: superior, inferior, right, left Label: right, left  Intro Imaging, 7 Methods of Image Production - Angiography NI 1.13, 1.14 Angiography Imaging of vasculature – can be achieved with transmission and emission techniques Provides views on internal space of vessels Arteriogram = arteries Venogram = veins Modalities X-ray – standard angiogram CT angiogram – can be manipulated for 3D image MRA – MRI generated image  Intro Imaging, 8 Methods of Image Production - Reflective NI 1.11, EUA 2.2 Bedside ultrasound – a transducer emits pulses of soundwaves, then records the energy that echoes back Basic Ultrasound Physics When a soundwave encounters an interface between tissues, some sound is reflected (echo) and some continues on (though- transmission) Conduction through tissues depends on density and stiffness Transducers have piezoelectric crystals that convert electricity to sound (produce the pulse) and sound Reflected soundwaves have different return times, ultrasound (reflected echoes) to electrical signals (create machines analyze this data and create an image based on image) – very expensive hand-made devices. echogenicity of tissues  Intro Imaging, 9 Echogenicity Echogenicity = the amount of US reflection by a tissue (relative to surrounding tissues) Displayed as shades of grey ranging from white – black Hyperechoic—bright white; dense/stiff objects HYPERECHOIC e.g., bone, dense connective tissue, fat Isoechoic—medium grey; average density/stiffness e.g., liver, spleen ISOECHOIC Hypoechoic—dark grey; low density/stiffness e.g., nerves, skeletal muscle, kidney cortex HYPOECHOIC Anechoic—black; fluid filled structures, “shadows” e.g., vessels, cysts, bladder ANECHOIC  Intro Imaging, 10 Probes (Transducers) Basic probe types for bedside ultrasound – use different frequencies of soundwaves Linear array probe Curved (curvilinear) array probe Phased array probe High frequency Low frequency Low frequency good image detail modest image detail modest image detail poor penetration good penetration good penetration Typically used for shallow Used for abdominal exams Typically used for intercostal exams exams AAA assessment Heart MSK FAST Lung Ocular Liver, gallbladder, kidney Carotid Carpal tunnel Carpal tunnel exam Cardiac exam in apical view Gallbladder exam in sagittal/longitudinal view  Intro Imaging, 11 Probes (Transducers) Handheld ultrasound devices – replace piezoelectric crystals with a silicon chip, offer a more affordable portable option Butterfly iQ Large dynamic range – low to high frequency depending on selected ‘preset’ Whole body scans with one device  Intro Imaging, 12 Ultrasound best practices – orientation is key Probe orientation: Axial (transverse) view→ marker to patient’s right Longitudinal (sagittal) view→ marker to patient’s head Explore area of interest: make small adjustments to probe orientation to get best image. Keep probe hand anchored on patient. Toe-Heel rocking Side-side tilting Rotating Translating *There are exam-specific & practitioner-specific exceptions  Intro Imaging, 13 Ultrasound image orientation Footprint: where probe is on body surface Marker: marker on the probe matches orientation marker on the screen Depth scale: penetration in cm Nydam library  Intro Imaging, 14 Ultrasound image orientation Ultrasound images are wedges of 2D anatomy Nydam library  Intro Imaging, 15 Ultrasound image artifacts Artifacts are alterations in an image that don’t reflect actual anatomy. Understanding is essential to prevent misdiagnoses. Acoustic shadow → anechoic Deep acoustic enhancement → Dirty shadow → Obstruction Anisotropy→ scattering of area deep to a mineralized tissues deep to a fluid filled of deeper structure due to soundwaves from non- structure space appear brighter bowel gas perpendicular tendon Lumbar vertebra in transverse view Gallbladder in cross-section Carpal tunnel Bowel posterior to liver Dark tendons due to anisotropic effect Carpal tunnel Gallstones in gallbladder Urinary bladder in sagittal section Bowel posterior to liver Tendons bright – probe perpendicular  Intro Imaging, 16 Imaging Study Tips 1. Know your anatomy! a) Necessary to orient and identify potential pathology b) Identify landmarks c) Use Relationships d) Look for known Patterns (symmetry, distribution, etc.) e) Unusual or out-of-place structures may be pathology 2. Follow “lines” to find pathology a) Anatomy is typically “smooth”, particularly bone vs. b) Sudden changes in a contour is likely a pathology 3. One view is “no view” a) 2D radiographs are still a very common imaging technique b) Lack of 3D perspective could lead to misinterpretation/misdiagnosis c) Additional views helpful For each block with an ultrasound 4. Subtlety is common workshop, make sure you read a) Many pathologies are subtle through the posted ultrasound b) Require practice to recognize guide and watch the recommended c) We will mostly deal with recognizing “normal” anatomy videos BEFORE coming to workshop! © 2024 Erin Simons, © 2024 Midwestern University  Midwestern Wellness Support Professional school can be difficult, we have resources Student Counselors Other Mental Health Resources Brandy Strom, Psy.D., MS, LPC If you or someone you know are feeling suicidal: Krista Sheldon, MSW, LCSW Melody McGee-Hillard, MA, Ed.S, LPC, NCC  EMPACT Mobile Crisis Intervention/Suicide Aaron “Baab” Aster, MA, LPC, NCC Prevention Center – 24/7 Emergency Mental Health Crises, including Suicidal ideation/Suicide Please email to request an appointment: 480-736-4952 [email protected]  Call or text 988 – 24/7 Confidential Lifeline In the Moment Mental Health Counseling network crisis center 24/7 live telephonic counseling when you need to speak to someone immediately 855-850-4301 or text “hello” Teletherapy (ALL MWU students can access the to 61295 following free services) Resiliency Forum Academic Live Care: https://midwestern.myahpcare.com/telehealth to A place for ALL MWU student to meet and connect on register. 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