Radio/1-29-10/

Irvin D. Dulos, MD
Radio-Sonologists

GENITOURINARY ULTRASOUND:
Basic Principles and Instrumentation

UTZ converts electrical to mechanical energy

Sound waves:
Frequency (f) = # of cps (cycles per second)
Inversely related to peroid T (f=1/T)

Hertz
- unit of frequency
- 1 Hz = 1 cps
- 1 MHz = 1,000,000 cycles/sec

Diagnostic range for GU UTZ is approximately 3.5 to 10 MHz

Sound waves:
Tissue Penetration
- Tissue penetration increases with decreasing frequency of the transducer
o A 5 MHz transducer penetrate spatial resolution increases with increase
frequency of the transducer
o A 10 MHz
o

Tissue Propagation
- Propagation velocities of body tissues
o Bone 4
o Average 1540 m/s
o
o
- Depth of an object is determined by the time for the sound wave to reach and return from
the object
- Propagation velocity is assumed to be 1540 m/s in the body
o .00018 sec x 1540

0.2 ms 0.18 ms

A B
Doppler UTZ
- Used to evaluate blood flow direction and velocity
- The Doppler shift or the change in frequency which occurs when a transmitted
- When the transmitted UTZ wave encounters a moving target, the frequency of the
reflected wave differs from the inconstant wave frquency
- The Doppler frequency _____ can be shown as a (+) or (-) waveform

Color Doppler UTZ

- Change in frequency can be displayed in color
 - Doppler shift is related to the velocity of the moving blood
- The greater the velocity of flow the greater the Doppler shift
- This velocity can be displayed in several ways

UTZ units vary considerably in features and costs but have certain basic components

Polar transducer receiver display image

Transducers
- The main functions of the transducers are to send out sound waves, receive
- Certain piezoelectric materials which can convert 1 form of energy into another
- Electric pulses cause expansion and contraction of the piezoelectric material in the
transducer which results in the

3.5 MHz Curvilinear Transducer

- sufficient penetration of tissue
- good renal detail
- trapezoid

5 MHz Curvilinear Transducer

- trapezoid shape
- wider view
- decreased tissue penetration
- improve spatial resolution

7.5 MHz Linear Transducer

- lens penetration
- higher resolution
- field limited to contrast area
- for small, superficial objects

10 MHz

UTZ artifacts

INTRODUCTION TO DIAGNOSTIC SONOGRAPHY

- The use of UTZ has greatly expanded in clinical medicine over the past decades.
- More and more physicians worldwide are using this valuable imaging tool

What is UTZ?
- Consists of sound waves with frequencies that excess the audible range (_______)

What is the primary difference between UTZ and other diagnostic imaging?
- Unlike Radiography, CT and MRI, UTZ does not use EM radiation to create and image
- UTZ does not cause ionization because of a

History
1921
- During WWI technology of using sound to locate underwater object was developed by the
British called SONAR (Sound Navigation Ranging)
- Its potential use was so great that it was kept a secret and use effectively in WWII

1940
- Attempts to use sonar in diagnostic medicine began
1950
- Accepted as medical tool
- Renamed UTZ because it was

1970
- Most of the advances have taken place

Scanner UTZ
- The electrical signals are sent to the scanner from the transducer to the image produce
- The UTZ transducer sends a series of US beams into patients tissue
- The US image produced

- The arrow (A), linear (B), sector (C) array transducers provide differing..

Transducer
- Device that translates one form of energy to another
- Medical UTZ is performed using very high sound frequencies in the range of 1-20 MHz
- The best image resolution
- An UTZ machine works by signaling vibrations
- The reflected sound wave is received by the transducer

Bioeffect
- Few studies of UTZ have been conducted on human fetus and no definite evidence to
suggest that the machine can cause harm

Clinical applications
- Emergency UTZ
- RUQ pain
o Gallstones
o Acute cholecystitis
o Biliary dilatation

Gallstones
- Clinical
- Gallstones affect 10-15% of the population and are a major cause of GB morbidity

Acute Cholecystitis
- Most commonly caused by impacted GB stone

RUQ pain:
- Diagnostic for Acute Cholecystitis
Major Criteria:
- Gallstones
- Sonographic Murphys sign
Minor Criteria:
- Wall thickening >3mm

Biliary Dilatation
- Clinical
 - US in ~90% accurate in differentiating obstructive from non-obstructive jaundice by
depicting the presence of biliary dilatation
- Causes for biliary dilatation are impacted v gallstones
- CBD (common bile duct) is considered dilated in adults if its diameter is > 7mm

Epigastric pain
- Abdominal Aortic Aneurysm
o Clinical
o approximately 90-95% of abdominal aortic aneurysm are confined to the intrarenal
area
o sonographic findings
at abdominal aorta >3cm

Pancreatitis
- clinical
- acute pancreatitis is more commonly caused by alcohol abuse or gallstone
- sonographic
o (+) diffuse enlargement of pancreas with ill defined
o peripancreatic

RLQ PAIN
1. Appendicitis
- Clinical
- Differential diagnosis is often gynecological &
- Sonographic diagnosis
o Visualization of an aperistatlic

# an obstructing appendicolith

2. Appendicolith

FLANK PAIN
- Nephrolithiasis
o UTZ reliably demonstrates stones >5mm size, but smaller stones, up to 40% are
commonly not detected. CT is commonly used for detection and is excellent
o Sonographic findings
Both radioopaque & radiolucent calculi produce highly echogenic foci with
acoustic shadowing

- Hydronephrosis
o clinical
o Sonographic findings
1. Dilatation of calyces pelvis and ureter

PELVIC PAIN
- Adnexal mass
o Sonographic
1. Functional cyst or smooth, round,
2. Hemorrhagic cyst homogenous internal echoes, fishnet
3. Cystic teratoma only tip of the iceberg sign
4. Endometrioma diffuse low-level internal echoes
 5. Ovarian torsion diagnosis rests on ovarian enlargement with normal ovarian
volume being up to appoximately
6. Ovarian malignancy solid component

TESTICULAR PAIN
- Epididymitis
- Clinical
o Epididymitis is usually caused by Chlamydia species but gonorrhea is also a
common pathogen. It is not for..

TESTICULAR TORSION
- Clinical: No color flow = no blood supply!
- Lack of attachment of the testis and epididymis to the posterior scrotal wall
- Testicular torsion must be identified within a few hours

Other Clinical Applications

- Upper abdominal UTZ
- Lower abdominal UTZ
o Kidney
o UB (urinary bladder)
o Uterus, ovaries

OB-GYNE UTZ
- Transabdominal (TAS)
- Transvaginal (TVS)
o Fetal evaluation, fetal age determination
o Pelvic mass
Ovarian cysts, myoma
- All stages of pregnancy

Obstetrics
- UTZ is a useful diagnostic tool..

Common cause of abdominal pain & vaginal bleeding during pregnancy:

1st trimester
- Ectopic pregnancy
- Complete/incomplete abortion
- Molar pregnancy

2nd trimester
- Placenta previa
- Abruptio placenta

Prostate UTZ
- BPH (benign prostatic with hypertrophy)
- Prostatic cancer

Scrotal UTZ
- Part of fertility work up in male
- Varicocoele, Hydrocoele, Hernia

Thyroid
- Mass
- Nodular goiter
Breast UTZ
- Solid mass vs. Cystic mass

Cardiac
- 2D-echo cardiography
- Doppler study of carotid artery and extremities

Transcranial

Musculoskeletal

Trauma
- Splenic rupture
- Laceration of the liver
- hemoperitoneum

Invasive application of UTZ

- UTZ guided by thoracentesis..

# cholelithiasis
# GB stone
# acalculus
# right hepatic mass

Liver cirrhosis
- Intrahepatic duct dilatation
- ?

Nephrolithiasis
- Mild hydronephrosis
- Ureteropelvic junction acalculi
- Staghorn calculi
- Nephrocalcinosis presence of calculi
- Hydroureteronephrosis
- Ureterosacral junction calculi
- Urinary bladder calculus
- Prostate enlargement

Scrotal UTZ
- ..
- Epididymoorchitis
- varicocoele

UTERUS normal
- introverted uterus

IN CONCLUSION:
- Basic education in diagnostic sonography from medical students provides a foundation
that individualized subspecialty group using .. can build in to advance training.