Advanced Techniques of Ultrasonography PDF

Advanced techniques of Ultrasonography  INTRODUCTION A doppler ultrasound is a non-invasive imaging technique used to evaluate blood flow through vessels. It is especially useful in detecting abnormalities such as blockages, narrowing (stenosis), or clots in arteries and veins....

Advanced techniques of Ultrasonography  INTRODUCTION A doppler ultrasound is a non-invasive imaging technique used to evaluate blood flow through vessels. It is especially useful in detecting abnormalities such as blockages, narrowing (stenosis), or clots in arteries and veins. Doppler ultrasound uses high-frequency sound waves to measure the movement of blood cells, which helps determine the speed and direction of blood flow In vascular sonography, Doppler ultrasound is commonly used to: Detect blood clots (deep vein thrombosis, or DVT) Assess narrowing of arteries (such as carotid artery stenosis) Evaluate varicose veins and chronic venous insufficiency Check for aneurysms or vascular malformations Monitor blood flow after surgery or injury 3 Types of Doppler Ultrasound 1.Color Doppler: Uses different colors to visualize the speed and direction of blood flow. 2.Power Doppler: More sensitive in detecting blood flow, particularly in small vessels.\ 3.Spectral Doppler: Provides a graphical representation of blood flow over time. 4.Continuous Wave Doppler: Measures high-velocity blood flow in vessels. 4 Patient Preparation for Vascular Doppler Ultrasound: 1. Clothing: 1. The patient should wear loose-fitting clothing. 2. Depending on the area to be scanned, patients may need to change into a gown. 2. Dietary Instructions: 1. For abdominal Doppler studies, fasting may be required for 6 to 8 hours before the procedure to reduce interference from gas in the intestines. 2. No specific preparation is usually needed for peripheral (limb) or carotid artery Doppler studies. 3. Medications: 1. Patients can generally continue taking their regular medications unless instructed otherwise by the physician. 2. Blood thinners or anticoagulants typically do not need to be stopped before the procedure. 4. Hydration: 1. For certain exams (such as a Doppler of the pelvic vessels), patients might be instructed to drink water beforehand to ensure a full bladder. 5. Special Considerations: 1. Patients with wounds or bandages may need special arrangements for the scan. 2. For pregnant patients, Doppler ultrasound is considered safe and does not use ionizing radiation. 5  Transabdominal Sonography (TAS) Purpose: TAS is used to visualize pelvic organs such as the uterus, ovaries, bladder, and prostate. Technique: Probe: A curvilinear or sector probe is used, typically with a frequency of 3–5 MHz. Scanning: The transducer is moved over the lower abdomen, using a conductive gel to improve sound transmission. The sonographer sweeps the probe in multiple planes to capture images of pelvic organs. Preparation: Full bladder: The patient is required to have a full bladder to displace bowel loops and create an acoustic window for better visualization of pelvic organs. This usually involves drinking 1–1.5 liters of water 30–60 minutes before the exam and avoiding urination until after the procedure. 6 Instructions to Patient: 1.Drink water (1–1.5 liters) about 1 hour before the test and avoid urination. 2.Wear comfortable, loose-fitting clothes to make it easier to expose the abdomen. 3.You will lie on a table, and a gel will be applied to your lower abdomen. A transducer will then be moved across the skin to capture Position: images. Supine (lying flat on the back) with the abdomen exposed. A full bladder is typically required to provide a clear acoustic window, so the patient is asked to drink water prior to the examination. The probe is placed on the Transvaginal Sonography (TVS) Purpose: TVS provides detailed images of the female reproductive organs, including the uterus, ovaries, and fallopian tubes. Technique: Probe: A high-frequency transducer (5–8 MHz) is used, designed for insertion into the vagina. The probe provides detailed images of the female reproductive organs. Scanning: The probe is gently inserted into the vagina, and images are captured by rotating or angling the probe to visualize the uterus, ovaries, and surrounding structures. Preparation: Empty bladder: The patient is typically asked to empty their bladder before the examination to improve image quality and comfort. Consent: Informed consent is obtained because this is an internal examination. 8 Instructions to Patient: 1.You will be asked to empty your bladder before the procedure. 2.Wear comfortable clothing. You may be given a gown for the procedure. 3.The examination will take place with you in the lithotomy position (on your back with knees bent and feet supported). 4.A thin, covered, and lubricated probe will be inserted into the vagina. It should be painless, though some patients may experience mild discomfort. 5.The entire procedure typically lasts 10–20 minutes. Position: Lithotomy position (lying on the back with legs bent and feet in stirrups or supported). The patient is draped appropriately for privacy. An empty bladder is usually preferred for this procedure to enhance imaging clarity. The transvaginal probe (covered with a 9 protective sheath and gel) is gently Transrectal Ultrasound (TRUS) Purpose: TRUS is primarily used to visualize the prostate gland in men and assess other pelvic organs. Technique: Probe: A high-frequency transducer (7–10 MHz) is used, designed for rectal insertion. Scanning: The probe is inserted into the rectum, allowing the sonographer to visualize the prostate and surrounding tissues in men, or pelvic structures in both men and women. Preparation: Bowel preparation: In some cases, the patient may be asked to use a rectal enema a few hours before the procedure to clear the rectum of stool. Consent: Informed consent is obtained due to the internal nature of the procedure. 10 Instructions to Patient: 1.You may be asked to perform bowel preparation, such as using a rectal enema before the exam. 2.You will be placed in the left lateral decubitus position (lying on your left side with knees bent). 3.A covered, lubricated probe will be gently inserted into the rectum. This is usually well-tolerated, though some patients may feel mild discomfort. 4.The procedure typically takes 10–30 minutes, depending on the exam's complexity. Position: Left lateral decubitus position (lying on the left side with knees bent toward the chest). The patient may also be positioned prone, depending on the clinician's preference. The transrectal probe, covered with a protective sheath and lubricated, is 11 inserted into the rectum. Neck ultrasound (USG) Neck ultrasound (USG) is a non-invasive imaging technique used to evaluate structures in the neck, including the thyroid gland, lymph nodes, salivary glands, and blood vessels. It’s commonly used to assess thyroid nodules, enlarged lymph nodes, and other abnormalities. 12 Technique: Probe: A high-frequency linear transducer (7–12 MHz) is typically used for neck imaging to provide detailed visualization of superficial structures. Scanning: The patient lies in a supine position (on their back) with the neck slightly extended (chin up) to expose the area. A water-based gel is applied to the neck to improve contact and conduction of sound waves. The sonographer moves the transducer over different regions of the neck to capture images of the thyroid, lymph nodes, and other structures in real-time. Imaging is performed in transverse (horizontal) and longitudinal (vertical) planes to provide a comprehensive view. 13 Preparation: No specific preparation is usually required. The patient may be asked to remove any jewelry or clothing around the neck that could interfere with the procedure. Instructions to Patient: 1.Comfortable Clothing: Wear loose, comfortable clothing, and you may be asked to remove necklaces or scarves that could obstruct the neck area. 2.Positioning: You will lie on your back on the examination table, with a pillow placed under your shoulders to gently extend your neck. This helps the sonographer access and visualize the structures more easily. 3.Procedure: A gel will be applied to your neck, and a probe will be gently moved across the skin to capture images. You might be asked to turn your head slightly or swallow during the exam to help visualize certain areas. 4.Duration: The procedure usually takes about 15–30 minutes, depending on the complexity and number of areas being examined. 5.After the Procedure: There is no downtime. You can immediately resume your normal activities. 14  Ultrasound post care After an ultrasound, patient care and maintenance can vary depending on the type of ultrasound (e.g., Abdominal, pelvic, or cardiac), the patient's condition, and whether the procedure was diagnostic or therapeutic. Here are general guidelines for patient care post-ultrasound: o 1. Immediate post-ultrasound care: Abdominal ultrasound: patients may resume eating and drinking if they were fasting before the procedure unless otherwise instructed by their healthcare provider. Pelvic ultrasound: for patients who had a transvaginal ultrasound, mild cramping or spotting may occur. Advise them to rest if discomfort arises. Cardiac/other ultrasounds: there are usually no restrictions, but patients should be advised to follow any specific instructions provided by their healthcare team. o 2. Hydration: Encourage patients to stay hydrated after the scan, especially if they were required to fast or had to empty their bladder before the ultrasound. o 3. Monitor for discomfort: Pain or discomfort: ultrasound is generally non-invasive and painless, but if patients feel discomfort, especially after transvaginal or transrectal ultrasounds, they may use mild pain relievers (as per the doctor’s advice) and should report any severe or prolonged symptoms. 15 o 4. Wound care (for interventional ultrasounds): For patients who underwent ultrasound-guided procedures (like biopsies), it’s essential to monitor the puncture site. Instruct patients on keeping the area clean and watching for signs of infection (redness, swelling, discharge). o 5. Results and follow-up: Patients should be advised that ultrasound results will typically be reviewed by a radiologist, and their healthcare provider will follow up to discuss findings. Schedule follow-up appointments as needed to discuss the next steps, whether it’s further testing or treatment. o 6. Rest and recovery: In cases of therapeutic ultrasound or interventional procedures, advise patients to rest and avoid strenuous activities for a day or two, depending on the specific instructions from their healthcare provider. o 7. Emotional support: Some patients may feel anxious about their results, so providing reassurance and offering to answer any questions can be helpful for their mental well-being. 16 Ultrasound-guided biopsy An ultrasound-guided biopsy is a minimally invasive procedure that uses ultrasound imaging to help locate and remove tissue or fluid from a suspicious area for examination. This procedure is commonly performed when a lesion or abnormality is detected through an imaging test (like an ultrasound, CT scan, or mammogram) and a tissue sample is needed for diagnosis. 17 Preparation: Consent: The patient will be informed about the procedure, its risks, and benefits, and they will provide written consent. Fasting: Depending on the biopsy site (e.g., abdominal area), the patient may be asked to fast for several hours before the procedure. Medications: Patients may be instructed to stop taking blood-thinning medications (e.g., aspirin or warfarin) to reduce the risk of bleeding. Positioning: The patient will be positioned to provide the best access to the biopsy site. The area of interest will be exposed and cleaned with an antiseptic solution. Local Anesthesia: A local anesthetic is injected into the skin around the biopsy site to numb the area. This ensures the patient feels little to no pain during the procedure, although they may feel some pressure when the needle is inserted. 18 Ultrasound Imaging: The doctor or technician uses an ultrasound probe (transducer) to visualize the area where the biopsy will be performed. Ultrasound provides real-time imaging, allowing the doctor to precisely guide the biopsy needle to the correct location. The images are displayed on a monitor, ensuring accuracy in targeting the suspicious tissue. Needle Insertion: Once the area is numb, the doctor inserts a fine needle or a core needle through the skin and into the target area, using ultrasound guidance to ensure the needle is placed accurately. Depending on the type of biopsy: Fine Needle Aspiration (FNA): A very thin needle is used to collect a small sample of cells or fluid. Core Needle Biopsy: A slightly larger needle is used to remove a core sample of tissue. The ultrasound imaging helps the doctor guide the needle to avoid critical structures like blood vessels, organs, or nerves. 19  Tissue Removal: Multiple samples may be taken, depending on the size of the lesion and the purpose of the biopsy. After each sample is collected, the needle is withdrawn, and the tissue is preserved for laboratory analysis. Post-Procedure: After the tissue samples are collected, pressure may be applied to the biopsy site to stop any bleeding. A small bandage or dressing is applied. No stitches are usually needed unless a larger incision was made. Patients are often monitored for a short period to ensure no immediate complications, such as excessive bleeding or reactions to the local anesthesia. 20 Aftercare and recovery: 1. Rest and observation: 1. Patients are typically advised to rest for a few hours after the procedure. Strenuous activity should be avoided for 24 hours. 2. If the biopsy was performed in a sensitive area, such as the breast, liver, or kidney, additional instructions may be provided about resting and avoiding heavy lifting. 2. Managing discomfort: 1. Some mild soreness or bruising around the biopsy site is common. Over-the-counter pain relievers like acetaminophen can help manage discomfort, but avoid blood-thinning medications like aspirin unless directed by a doctor. 3. Caring for the biopsy site: 1. Keep the biopsy site clean and dry. The dressing may be removed after 24 hours unless otherwise instructed. 2. Watch for signs of infection, such as increased redness, swelling, fever, or discharge from the biopsy site. Report these symptoms to a healthcare provider immediately. 4. Results and follow-up: 1. The biopsy sample is sent to a pathology lab for examination under a microscope. Results may take a few days to a week or more, depending on the complexity of the analysis. 2. A follow-up appointment will be scheduled to discuss the results and next steps. These may include further diagnostic tests, treatment plans, or surgery. 21 Risks and complications: While ultrasound-guided biopsies are generally safe and minimally invasive, there are some potential risks: Bleeding: mild bleeding at the biopsy site is common, but serious bleeding is rare. The risk increases with deeper biopsies (like liver or lung). Infection: any invasive procedure carries a small risk of infection. Keeping the area clean and following aftercare instructions reduces this risk. Pain or discomfort: mild pain or soreness at the biopsy site is common. Severe pain should be reported to the healthcare provider. Damage to nearby structures: ultrasound guidance minimizes this risk, but there is a small chance of injury to nearby organs, blood vessels, or nerves. 22 Thank you