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Genitourinary Utz
Genitourinary Utz
Genitourinary Utz
Irvin D. Dulos, MD
Radio-Sonologists
GENITOURINARY ULTRASOUND:
Basic Principles and Instrumentation
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
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
UTZ units vary considerably in features and costs but have certain basic components
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
10 MHz
UTZ artifacts
- 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
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..
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
# 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.