OCULAR SONOGRAPHY

OVERVIEW

 Transmits high-frequency sound waves through the eye and measures their reflection from
ocular structure.
 A-scan converts echoes into waveforms whose crests represent the positions of different
structures, providing a one-dimensional picture.
 A-scan is more valuable in measuring eye’s axial length and characterizing tissue texture of
abnormal lesions.
 Helpful in evaluating a fundus clouded by an opaque medium such as cataract.

Purpose

 To aid evaluating the fundus in an eye with opacity such as cataract.

 To aid in the diagnosis of vitreous disorders and retinal detachment.
 To diagnose and differentiate between intraocular and orbital lesions and to follow their
progression through serial examinations.
 To locate intraocular foreign bodies.
 To measure the dimensions of other tumors detectable by opthalmoscopy.

PROCEDURE

Preparation

 Describe and explain the procedure to the patient.

 Inform the patient that he need not restrict food and fluids.
 Tell the patient that a small transducer will be placed on his closed eyelid and that the
transducer transmits high-frequency sound waves that are reflected by the structures in the
eye.
 Inform the patient that he may be asked to move his eyes or change his gauze during the
procedure and that his cooperation to ensure accurate test results.

Implementation

 The patient is placed in the supine position on an X-ray table.

 For the B-scan, the patient is asked to close his eyes and a water-soluble gel is applied to his
eyelid. The transducer is then placed on the eyelid.
 For the A-scan, anesthetizing drops are instilled in the patient’s eye and a clear plastic eye is
placed directly on the eyeball.
 A water-soluble gel is then applied to the eye cup and the transducer is positioned on the
medium.
 The transducer then transmits high-frequency sound waves into the patient’s eye and the
resulting echoes are transformed into the images or waveforms on the oscilloscope screen.
Patient Care

 After the test, remove the water-soluble gel from the patient’s eyelid.

INTERPTRETATION

Normal Results

 The optic nerve and the posterior lens capsule produce echoes that take on characteristic forms
on A and B-scan images.
 The posterior wall of the eye appears as a smooth, concave curve.
 The lens and vitreous humor are also visible.
 Normal orbital echo patterns depend on the position of the transducer and the position of the
patient’s gaze during the procedure.

Abnormal Results

 Eyes clouded by a vitreous hemorrhage

 Massive vitreous organization and vitreous bands.
 Retinal detachment
 Intraocular tumors
 Melanomas, metastatic tumors, hemaglomas and cystic lesions.


ULTRASONOGRAPHY, LIVER

OVERVIEW:

 Transmits high-frequency sound waves into the right upper quadrant of the abdomen; the
resultant echoes are converted to electrical energy, amplified by a transducer and displayed on
a monitor.
 Depicts various tissue densities by different shades of gray.
 Shows intrahepatic structures as well as organ size, shape and position.

PURPOSE:

 To distinguish between obstructive and nonobstructive jaundice.

 To screen for hepatocellular disease.
 To detect hepatic metastases and hematoma.
 To define cold spots as tumors, abscesses or cysts.

PROCEDURE:

Preparation:

 Make sure the patient has signed a consent form.

 Note and report all allergies.
 Tell the patient to fast for 8 to 12 hours before the test.
 Warn the patient that he may feel mild pressure as the transducer presses against the skin.
 Stress the need for the patient to remain as still as possible during the procedure and to hold his
breath when requested.

Implementation:

 Assist the patient into a supine position.

 A water-soluble lubricant is applied to the face of the transducer and transverse scans are taken
at ½ (1-cm) intervals, using a single-sweep technique between the costal margins.
 Sector scans are taken through the intercostals spaces to view the remainder of the right lobe.
 Scans are taken longitudinally, from the right border of the liver to the left.
 Oblique cephalad-angled scans may be taken beneath the right costal margin for better
demonstration of the right lateral dome.
 Scans are taken parallel to the hepatic portal, at a 45-degree angle toward the superior right
lateral dome, to examine the peripheral anatomy, portal venous system, common bile duct and
biliary tree.
 During each scan, the patient should hold his breath briefly in deep inspiration.
 Clear images are photographed for later study

Patient care:
  Remove lubricating jelly from the patient’s care.
 Have the patient resume his usual diet.

Complications:

 None known

INTERPRETATION:

Normal Results

 The liver demonstrates a homogenous, low-level echo pattern, interrupted only by the different
echo patterns of its vascular channels.
 Intrahepatic biliary radicles and hepatic arteries aren’t apparent, but portal and hepatic veins,
the aorta and the inferior vena cava appear.
 Hepatic veins appear completely sonolucent; portal veins have margins that are highly
echonegic.

Abnormal Results

 Dilated intrahepatic biliary radicles and extrahepatic ducts suggest obstructive jaundice.
 Variable liver size, dilated, tortuous portal branches associated with portal hypertension and an
irregular echo pattern with increased echo amplitude, suggest possible cirrhosis.
 Hepatomegaly and a regular echo pattern that although greater in echo amplitude than that of
normal parenchyma, don’t alter attention suggest possible fatty infiltration of the liver.

Interfering Factors

 Overlying ribs and gas or residual barium in the stomach or colon.

 Deficiency of body fluids in a dehydrated patient.
 ULTRASONOGRAPHY, PANCREAS

OVERVIEW

 Transmits high-frequency sound waves into the epigastric region; resultant echoes are
converted to electrical impulses, amplified by transducer and displayed on a monitor.
 The display pattern varies with the tissue density and represents the size, shape, and
position of the pancreas and surrounding viscera.
 Can’t provide sensitive measure of pancreatic function but is useful in detecting anatomic
abnormalities, such as pancreatic carcinoma and pseudocytes and in guiding the insertion of
biopsy needles.

Purpose

 To aid in the diagnosis of pancreatitis, pseudocytes and pancreatic carcinoma.

PROCEDURE

Preparation:

 Make sure the patient has signed a consent form.

 Note and report all allergies.
 Tell the patient to fast for 8 to 12 hours before the test to reduce bowel gas, which hinders
transmission of ultrasound.
 Instruct the patient to abstain from smoking before the test to eliminate the risk of swallowing
air while inhaling, which interferes with the test results.
 Provide reassurance that this study isn’t harmful or painful, although the patient may
experience mild pressure.
 Instruct the patient to inhale deeply during scanning, when requested.
 Stress the need for the patient to remain as still as possible during imaging.

Implementation:

 Assist the patient into supine position.

 Apply a water-soluble lubricant or mineral oil to the abdomen. With the patient at full
inspiration, transverse scans are taken at ½ (1-cm) intervals, starting from the xiphoid and
moving caudally.
 Other techniques include the longitudinal scan to view the hear, body and tail of the pancreas in
sequence; the right anterior oblique view for the head and the body of the pancreas; the
oblique sagittal view for the portal vein and the sagittal view for the vena cava.
 Good oscilloscopic views are photographed for later study.

Patient Care

 Remove the lubricating jelly from the patient’s skin.

  Have the patient resume his usual diet.

INTERPRETATION

Normal Results

 The pancreas demonstrates a coarse, uniform echo pattern (reflecting tissue density) and is
usually more echogenic than the adjacent liver.

Abnormal Results

 Alterations in the size, contour and parenchyma texture of the pancreas suggest possible
pancreatic disease.
 An enlarged pancreas with decreased echogenicity and distinct borders suggests pancreatitis.
 A well-defined mass with an essentially echo-free interior suggest pseudocyts.

INTERFERING FACTORS

 Failure of patient to fast before test

 Bowel gas
 Dehydration
 Barium from previous diagnostic tests
 Obesity
ULTRASONOGRAPHY, PELVIS

OVERVIEW

 Transmits high-frequency sound waves into the interior pelvic region; resultant echoes are
converted to electrical impulses, amplified by a transducer and displayed on a monitor.
 A-mode technique records only distances between interfaces.
 Used to evaluate symptoms that suggests pelvic disease, to confirm a tentative diagnosis and to
determine fetal growth during pregnancy.

Purpose:

 To detect foreign bodies and distinguish between cyst and solid masses.
 To measure organ size
 To evaluate fetal viability, position, gestational age and growth rate.
 To detect multiple pregnancy.
 To confirm fetal and maternal abnormalities

PROCEDURE

Preparation:

 Make sure the patient has signed a consent form.

 Note and report all allergies.
 Instruct the patient to drink fluids and avoid urination before the test because pelvic
ultrasonography requires a full bladder as a landmark to define pelvic organs.
 Explain that the test won’t harm the fetus.

Implementation

 With the patient in supine position, coat the lower abdomen with mineral oil or water-soluble
jelly to increase sound wave conduction.
 The transducer crystal is guided over the area, images are observed on the oscilloscope screen
and good images are photographed.

Patient Care

 Allow the patient to empty her bladder immediately after the test.
 Remove ultrasound gel from the patient’s skin.

INTERPRETATION

Normal Results

 The uterus is normal size and shape.

 The ovaries are normal in size, shape and sonographic density.
  The body of the uterus lies on the superior surface of the bladder; the uterine tube is attached
laterally.
 No other masses are visible.

Abnormal Results

 Homogenous densities suggests both cysts and solid masses; however, solid masses appear
more dense on ultrasonography.
 Inappropriate fetal size suggest possible miscalculation of conception or delivery date.
 Fetal abnormalities suggest possible malpresentation and cehalopelvic disproportion.
ULTRASONOGRAPHY, SPLEEN

OVERVIEW

 Transmits high frequency sound waves into the left upper quadrant of the abdomen, creating
echoes that vary with changes in tissue density.
 Echoes converted to electrical energy, amplified by transducer and displayed on a monitor.
 Indicated for patients with a left upper quadrant mass of unknown origin, with known
splenomegaly.
 Can show splenomegaly, but usually doesn’t identify the cause.

Purpose:

 To demonstrate splenomegaly.
 To monitor progression of primary and secondary splenic disease.
 To evaluate the effectiveness of therapy.
 To evaluate the spleen after abdominal trauma.
 To detect splenic cysts and subphrenic abscess.

PROCEDURE

Preparation

 Make sure the patient has signed a consent form.

 Note and report all allergies.
 Tell the patient to fast for 8 to 12 hours before the test.
 Inform the patient that he will feel only mild pressure during the procedure.
 Instruct the patient to remain as still as possible during the procedure and to hold his breath
when requested.

Implementation

 Because the procedure for ultrasonography varies depending on the size of the spleen or the
patient’s body habitus, it’s usually necessary to reposition the patient several times.
 A water-soluble lubricant is applied to the face of the transducer and the transverse scans of the
spleen are taken ½” to 1”(1-2.5 cm) intervals, beginning at the level of the diaphragm and
moving posteriorly while the transducer is angled anteromedially.
 After the patient is placed in right lateral decubitus position, additional transverse scans are
taken through the intercostals spaces using a sectoring motion.
 For longitudinal scans, the patient remains in the right lateral decubitus position and scans are
taken from the axilla toward the iliac crest.
 To prevent the artifacts, oblique scans are taken by passing the transducer face along the
intercostals spaces, this scan provides the best view of the splenic parenchyma.
  During each scan, the patient may be asked to hold his breath briefly at varying stages of
inspiration.

Patient Care

 Remove the lubricating jelly from the patient’s skin.

 Have the patient resume his usual diet.

INTERPRETATION

Normal Results

 The splenic parenchyma demonstrates a homogenous, low-level echo pattern.

 The superior and lateral splenic borders are clearly defined, each having a convex margin.
 The undersurface and medical borders in contrast, show indentations from surrounding organs.
 The hilar region, where the vascular pedicle enters the spleen, commonly produces an area of
highly reflected echoes.

Abnormal Results

 Increased echogenicity and enlarged vascular channels, especially in the hilar region, suggest
splenomegaly.
 Splenomegaly and an irregular, sonolucent area suggest splenic rupture.
 A sonolucent area beneath the diaphragm suggests possible subphrenic abscess.
ULTRANOSONGRAPHY, THYROID

OVERVIEW

 Emits pulses from a piezoelectric crystal in a transducer, directed at the thyroid gland and
reflected back to the transducer.
 Can also be performed on parathyroid glands.
 Useful in evaluating thyroid nodules during pregnancy because it doesn’t expose the fetus to
radioactive iodine used in other diagnostic procedures.

Purpose:

 To evaluate the thyroid structure.

 To differentiate between a cyst and a solid tumor
 To monitor the size of the thyroid gland during suppressive therapy.
 To allow accurate measurement of a nodule.
 To aid in the performance of thyroid needle biopsy.

PROCEDURE

Preparation

 Make sure the patient has signed a consent form.

 Note and report all allergies.
 Tell the patient that he need not restrict food and fluids before the test.
 Explain that the study is painless and safe.

Implementation

 Assist the patient into a supine position with a pillow under his shoulder blades to hyperextend
his neck.
 Coat the patient’s neck with water-soluble gel.
 The transducer scans the thyroid, projecting its echo graphic image on the oscilloscope screen.
 The image on the screen is photographed for subsequent examination.

Patient Care

 Thoroughly clean the patient’s neck to remove the contact solution.

INTERPRETATION

Normal Results

 A uniform echo pattern throughout the gland.

Abnormal Results
 Smooth-bordered, echo-free areas with enhanced sound transmission suggest cyst.
 Solid and well-demarcated areas with identical echo patterns suggest adenomas and
carcinomas.
 TRANSVAGINAL ULTRASONOGRAPHY

OVERVIEW

 Imaging technique using high-frequency sound waves to produce images of the pelvic
structures.
 Allows evaluation of pelvic anatomy and diagnosis of pregnancy at an earlier gestational
age.
 Eliminates the need for a full bladder and circumvents difficulties encountered with obese
patients
 Also known as endovaginal ultrasound.

Purpose

 To establish early pregnancy with fetal heart motion as early as the 5 th-6th week of gestation
 To identify ectopic pregnancy.
 To monitor follicular growth during infertility treatment.
 To evaluate abnormal pregnancy
 To visualize retained products of conception.
 To diagnose fetal abnormalities, placental location and cervical length
 To evaluate uterine lining.

PROCEDURE

Preparation

 Make sure the patient has signed an appropriate consent form.

 Note and report allergies.
 Explain to the patient that the test requires insertion of a vaginal probe and that self-insertion
may be possible.
 If the sonographer is a man, assure the patient that a female assistant will be present during
the examination.

Implementation

 Assist the patient into the lithotomy position.

 Water-soluble gel is placed on the transducer tip to allow better sound transmission, and a
protective sheath is placed over the transducer.
 Additional lubricant is placed on the sheathed transducer tip, which is gently inserted into the
vagina by the patient
 The pelvic structures are observed by rotating the probe 90 degrees to one side and then the
other.

Patient Care
  Help the patient remove any residual gel.

INTERPRETATION

Normal results

 The uterus and ovaries are normal in size and shape.

 The body of the uterus lies on the superior surface of the bladder, the uterine tubes are
attached laterally.
 The ovaries are located on the lateral pelvic walls with the external iliac vessels above and the
ureters posteroinferior and are covered by the fimbria of the uterine tubes medially.
 In pregnancy, the gestational sac and fetus are of normal size for the gestational period.

Abnormal Results

 Free peritoneal fluid in the pelvic cavity suggests possible peritonitis.

 A tubal mass suggests possible ectopic pregnancy.
 Structural abnormalities in a pregnant woman may suggests threatened abortion, multiple
pregnancy, fetal death; placental abnormalities.