Basic Notions of Critical Ultrasound

Notions of the physical properties of ultrasound are not indispensable for the user (as we wrote in our 1992, 2002 and 2005 editions). If needed, they can be found in any ultrasound textbook. We will discuss here notions useful for understanding critical ultrasound. Every maneuver that favors simplicity will be exploited. We will explain why only one setting is used, why, at the lung or venous area, only one orientation probe is favored; and how to easily improve the image quality.

The freeze button is apparently insignicant. If one operator (sonographer) provides a static image, and another operator (radiologist) interprets this image (i.e., US used with US habits), the potential of critical ultrasound is not exploited. Our philosophy stems from deactivating the freeze function. Critical ultrasound is a real-time discipline.

Step 1: Learning to Interpret Spatial Dimensions

As opposed to radiography, CT or MRI, the operator creates the image. This weakness is a strength. Spatial learning is the rst step and, without doubt, the most delicate to acquire. The rest is easy. Yet, it is possible to make this step easy, using simple rules. Favoring the lung (the easiest since the window is always the same) or the venous network using only cross-sectional scans makes this task easier than traditional ultrasound. The operator must understand how to locate the elements displayed on the four parts of the screen: upper, lower, left and right (Fig. 1.1). Our probe has sectorial scanning, displaying a triangular image, the probe head being on top. The upper part of the screen shows the supercial areas. The lower part of the screen represents the deep areas. This is not a source of problems. Interpretation of the left and the right parts of the screen can be simplied by deactivating the left-right inversion button, once set in the optimal position. Immediately things become much easier. The user has just to follow the landmark, easily palpable on any well-designed probe for immediate control. For transversal scans, the universal convention in imaging (X-rays, CT, etc.) is to see the image as if it
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Preliminary Note on Knobology

The ideal material is described in Chap. 2. An ultrasound unit includes a number of buttons and cursors. The only functions we deem really useful for critical ultrasound at the beginning are: 1. The switch-on button (which is not always obvious to nd) 2. The gain setting 3. The image depth 4. The M-mode (for demonstrating dynamic acquisitions like lung sliding) The sole use of these four settings converts any complex unit into a simple stethoscope. We never utilize all of the multiple pre- and postprocessing possibilities: we always use the same, natural image. Annotations are useless when the examination is not made for another doctor: that is the spirit of critical ultrasound. We use once for all a single positive negative inversion position. We bypass most lters, which distort the reality (see the next chapter). Opinions about sophisticated modes, harmonics, etc., are available in Chap. 2 and debated in Chap. 30.

D. A. Lichtenstein, Whole Body Ultrasonography in the Critically Ill, DOI: 10.1007/978-3-642-05328-3_1, Springer-Verlag Berlin Heidelberg 2010