MSK Ultrasound Basic Principles of MSK US Physics and Image Optimization

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1 MSK Ultrasound Basic Principles of MSK US Physics and Image Optimization

2 Objectives Provide a basic introduction to: Ultrasound Physics Equipment Considerations Knobology Image Optimization Scanning considerations

3 US Physics What is Ultrasound? Frequency > 20,000 Hz Similar to echolocation used by: Dolphins, Bats, Sonar Diagnostic US Between 2 and 18 MHz 3

4 Scanning Components Transducer Pulse Controls Central Processing Unit (CPU) Display Keyboard/Cursor Disk Storage Printers

5 Transducers Workhorse of unit Sound wave produced by a piezoelectric transducer encased in a housing Strong, short electrical pulses make the tranducer ring Frequencies between 2-18Mhz Sound focused by shape of transducer or Beamforming Wave travels into the body and comes into focus at a desired depth

6 Ultrasound Beam Beam slice approx. 1 mm thick Image produced is 2D tomographic slice 1 mm

7 Piezoelectric effect Definition: The principle of converting energy by applying pressure to a crystal Electric charge causes crystals to vibrate with a short duration pulse (60-120V) elements are pulsed simultaneously Reverse of piezo effect converts the energy back to its original form Based on Pulse-Echo principle Transducer acoustic stack Weigang et al

8 Pulse-Echo principle PULSE Pulse of sound sent to soft tissues Sound interaction with soft tissue = bioeffects Pulsing is determined by the transducer or probe crystal(s) and is not operator controlled ECHO Produced by soft tissues Tissue interaction with sound = acoustic propagation properties Echoes are received by the transducer crystals Echoes are interpreted and processed by the US machine

9 Electronic Transducers Linear Array Piezoelectric elements linearly arranged Transducer face is flat Produces rectangular image Sequentially activated to produce an image Superficial applications Sector Array Crystals are placed parallel or in concentric rings Transducer face is curved Produces sector or pie-shaped image Deeper applications

10 Phased Array Transducers Active area has been subdivided into small segments or elements When connected to a phased array instrument the angle and focus of sound beam can be changed on each pulse repetition Elements are activated with phase differences to allow steering of the ultrasound signal Smaller scanning surface (foot print) Good for echocardiography More expensive Linear curved Linear 2D matrix

11 Ultrasound Transmission Acoustic impedance Reflection Absorption Scattering Attenuation

12 Attenuation Definition: the reduction in power and intensity as sound travels through a medium Higher frequencies attenuate, or are absorbed, faster than lower frequencies Some energy is lost every time an echo is formed but most is lost from absorption Transducer frequency Depth of penetration

13 Resolution Ability to delineate between two different objects that are closely related, both in terms of space and echo amplitude Wavelength (frequency) dependent All current equipment has an overall spatial resolution of 1.0 mm or less 1. Gray Scale Resolution 2. Spatial Resolution Lateral Axial Slice thickness 3. Temporal Resolution

14 Gray Scale Resolution Adequate gray scale resolution allows for the differentiation of subtle changes in the tissues Dynamic Range determines how many shades of gray are demonstrated on an image

15 Resolution Axial Resolution Discriminate 2 objects at different depths along the beam path Improved by higher frequency at the expense of penetration Near field, Far field Lateral Resolution Generally poorer than axial Sound beam: width of the crystal Beam width increases with lower freq transducers Compressed down the pathway Focal zone: best lateral resolution Increased Gain will increase the beam width and reduce resolution

16 Temporal Resolution Dependent on frame rate = Frame per second Improved by Minimizing depth Narrowing the sector Minimize line density (at the expense of lateral resolution) Multiple focal zones Decreases frame rate Decrease temporal resolution

17 Frequency vs Resolution Higher frequency transducers provide: Better lateral and axial image resolution but lower penetration Better gray scale resolution Improved ability to distinguish fine detail Transducer frequency Resolution and Image detail

18 Acoustic Artifacts Shadowing Diminished sound posterior to a strongly reflecting or attenuating structure Strong reflectors Large calcifications, bone Stong attenuators Solid tissue, significandense masses Enhancement Increased through transmission of the sound wave posterior to a weakly attenuating structure Gain curve expected a certain loss of attenuation with depth Posterior to Simple cysts

19 Modes A mode Transducer scans a line through the body and plotted as a function of depth B mode Linear array of transducers simultaneously scans a plane viewed as a 2D image on screen M Mode (Motion) Rapid sequenceof B Mode scans whose images follow each other in sequence on the screen. Can see and measure ramge of motion as the organ boundaries move relative to probe Doppler mode - based on relative velocity moving towards or away from probe Color Doppler = displayed as a color coded overlay on top of a B-mode image Power Doppler = nondirectional, more sensitive Spectral = displayed as a graph

20 Doppler Ultrasound Continuous wave (CW) Seldom used, not a/v in most AED machines Pulsed wave (PW) Color Doppler Duplex Doppler Putting Color Doppler on top of Grey-scale B mode Power Doppler

21 Transducer Selection Where is the area of interest? --superficial or deep Size of scanning window? Patient size?

22 TRANSDUCER FREQUENCIES All purpose Shoulder/knee 13-6 MHZ Small contact Fingers, toes, ankle 13-6 MHZ Hip 5-2 MHZ Higher frequency > resolution < depth

23 Transducer Selection

24 Transducers 5-2 MHz Curved array with 128 elements Steerable pulsed Doppler, Color Doppler, High PRF Doppler, Harmonic imaging Reusable Plastic Biopsy guide 17-5 MHz Ultra-fine pitch, 288 element, high resolution linear array Steerable pulsed Doppler, Color Doppler, Harmonic Imaging Reusable Plastic Biopsy guide

25

26 Image Optimization Broadband frequency selection-where is the beam focused the best? Penetration General Resolution

27 Image Optimization Adjust in the following order: Depth Focus TGC Zoom Gain Dynamic Range (contrast)

28 System Optimization Adjust so that the object being imaged is at the bottom of the screen Depth

29 Depth Start with higher Depth Decrease Depth to put area of interest at ¾ depth of screen Leave a small area behind to observe useful artifacts eg. Shadowing, enhancement

30 Ultrasound Beam Depth Determined by transducer frequency Adjusts displayed data Start deep to see all anatomy Adjust to fill display with area of interest

31 Image Optimization - depth Increasing the depth allows you to visualize deeper structures Adjust the depth so that the target vessel is centered in the image N E A R Tissue = Grey F A R Blood = Black Too shallow Too deep Just right

32 System Optimization Should be at the level of the object being imaged Only use as many focal ones as you need Focus

33 Focus Focal zone = best lateral resolution Adjust focus to the level of the point of interest Most modern machines can have multiple focal zones Increase number of focal zone decrease frame rate

34 Gain Optimize gain to obtain most details Most beginners use too high gain High gain can obscure many details

35 Ultrasound Gain Think: stereo volume, not power to the stereo from the wall outlet Adjust image so same level of brightness displayed regardless of depth Increase gain = brighter image Decrease gain = darker image

36 Ultrasound Gain Compensates for sound attenuation Based on depth Adjust so the overall brightness of the screen is appropriate

37 AutoGain One button optimization Too Much Gain Auto Gain Under Gain Auto Gain

38 Gain Settings not enough gain too much gain balanced

39 Gain Settings poor near field poor far field balanced

40 Dynamic Range How white is white and how black is black? Determines how many shades of gray are demonstrated on an image Adjust Dynamic Range for the contrast High Dynamic Range = Low Contrast

41 Time Gain Compensation Adjust if needed to focus gain on object being imaged

42 Time Gain Operator controlled adjustment to compensate for the attenuation of sound as it travels into the tissue Adjust TGC to obtain a smooth grey-scale picture Transit of TGC knobs should be gradual TGC = DGC = STC TGC: time gain compensation DGC: distance gain compensation STC: spatial time compensation Compensation

43 Scanning Skills Try different windows A lot of gel Transducer movements: Rotate Angle (Tip-toe) Pivot (fan-shaped movement) Transducer placement basics: Longitudinal view Transverse view

44 Why Use Gel? Coupling Agent Sound waves propagate as longitudinal waves Requires a medium, cannot propagate in a vacuum Speed of sound propagation depends upon the material properties

45 Ultrasound Beam Longitudinal Transverse

46 Orientation Marker orientation marker

47

48 US Scan Performance Transverse plane Longitudinal plane Always view pathologic findings in 2 orthogonal planes to confirm that the observation is real & not an artifact

49 Biceps Transverse

50 Biceps Longitudinal

51 Anatomic Planes Frontal or coronal plane (longitudinal or long axis) Sagittal plane (longitudinal) Transverse or horizontal plane (axial or short axis)

52 GUIDELINES FOR MSKUS PERFORMANCE Longitudinal scan Transverse scan Left side of screen Right side of screen Proximal, Cranial, Upper Distal, Caudal, Lower Medial, Ulnar, Tibial Lateral, Radial, Fibular

53 Image Descriptions Anechoic Echogenic Hyperechoic vs Isoechoic vs Hypoechoic Interface Noise Mirror image Shadow Cystic vs Sonolucent

54 Ultrasound Basics Hypoechoic Less echogenic than surrounding tissue Echogenicity Hyperechoic More echogenic than surrounding tissue

55 Ultrasound Basics Echogenicity Anechoic Absence of Echoes Isoechoic Same echogenicity as surrounding tissue

56 Color and Power Doppler Color, then CPD Select viewing box size, adjust position Adjust settings flow sensitivity (low for low flow states), PRF (pulse repetition frequency), WF (wall filter), Hz approx Large amount of gel with minimal pressure Don t move transducer (flash artifact) Adjust gain above bone flash, then turn down so bone artifact just gone

57 Musculoskeletal Ultrasound Color Power Doppler: Float the Transducer Heap up Gel No pressure

58 Musculoskeletal Ultrasound Color Power Doppler Synovitis M Investigator Meeting 07 August 2010 Ultrasound Training 58

59 Biological Effects AIUM statement on clinical safety 1983 No confirmed biological effects on patients or instrument operators caused by exposure at intensities typical of present diagnositic ultrasound instruments have ever been reported. Although the possibility exists that such biological effects may be identified in the future, current data indicate that the benefits to patients of the prudent use of diagnostic ultrasound outweigh the risks, if any, that may be present

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