What Is An Ultrasound?

Wednesday 16 May 2012 - 12am PST

Written by Christian Nordqvist
Copyright: Medical News Today
An ultrasound scan, also referred to as asonogram, diagnostic
sonography, andultrasonography, is a device that uses high frequency
sound waves to create an image of some part of the inside of the body, such as
the stomach, liver, heart, tendons, muscles, joints and blood vessels. Experts
say that as sound waves, rather than radiation are used, ultrasound scans are
safe. Obstetric sonography is frequently used to check the baby in the womb.
Ultrasound scans are used to detect problems in the liver, heart, kidney or the
abdomen. They may also be useful in helping the surgeon when carrying out
some types of biopsies.
The word "ultrasound", in physics, refers to all sound with a frequency humans
cannot hear. In diagnostic sonography, the ultrasound is usually between 2 and
18 MHz. Higher frequencies provide better quality images, but are more readily
absorbed by the skin and other tissue, so they cannot penetrate as deeply as
lower frequencies. Lower frequencies can penetrate deeper, but the image
quality is inferior.
According to Medilexicon's medical dictionary:
Diagnostic ultrasound is: "the use of ultrasound to obtain images for medical
diagnostic purposes, employing frequencies ranging from 1.6 to about 10 MHz."
Therapeutic ultrasound is: "high intensity ultrasound causing coagulation
necrosis of tissue, used in treatment of some benign tumors, such as uterine
leiomyomata."

A Doctor carries out an ultrasound scan on a patient

What is the difference between an Ultrasound Scan and a Sonogram?

An ultrasound scan is the procedure, the event

A sonogram is the image produced when an ultrasound scan is
performed

How does Ultrasonography work?

Although ultrasound travels through soft tissue and fluids, it bounces back off
denser surfaces. Ultrasound will travel through blood, for example in the heart
chamber, but much of it will echo (bounce back) when hitting a heart valve.
If there are no solid gallstones in the gallbladder, ultrasound will travel
straight through, but when there are stones, ultrasound will bounce back from
them.
The denser the object the ultrasound hits, the more of it bounces back.
The bouncing back, or echo, is what gives the ultrasound image its features varying shades of gray reflect different densities.
What can ultrasound scans be used for?
Ultrasound is commonly used in medicine today. Health care
professionals can use sonography for either diagnosis or treatment (therapeutic
procedures), as well as for guidance during procedures that require
intervention, such as biopsies.
A medical professional who performs ultrasound scans is called
a Sonographer. Scans, or images are then interpreted by radiologists,
cardiologists, or other medical specialists. The sonographer usually holds a
transducer; a hand-held device which is placed on the skin of the patient.

Below are examples of medical sonography:

Anesthesiology - often used by anesthetists for guidance (accuracy)
when injecting needles with anesthetic solutions near nerves.

Cardiology - used in echocardiography, also known as cardiac

ultrasound. Two-dimensional slices of the heart are imaged. Modern devices
can produce 3-dimensional images.
As well as creating images of the cardiovascular system, echocardiograms
can accurately assess the speed of blood flow and cardiac tissue at specific
points using pulses or continuous wave Doppler ultrasound. The health care
professional can assess the function and state of cardiac valve areas,
abnormalities between the left and right side of the heart, valvular
regurgitation (blood leaking from valves), as well as working out how well the
heart pumps out blood.
Arterial sonography can also be used to assess the patency and possible
blockage of arteries, as well as diagnosing deep vein thrombosis (DVT).
Venosonography may help determine how severe a case of venous
insufficiency might be.

Emergency medicine - the use of ultrasound in emergency medicine

has grown considerably over the last two decades. In fact, for emergency
medicine ultrasound training has become increasingly popular.
Today, in emergency medicine, ultrasound is used in the FAST (Focused
Assessment with Sonography for Trauma) for assessing trauma, pericardial

tamponade (fluid builds up in the sac in which the heart is enclosed; the
pericardium) or hemoperitoneum (blood in the peritoneal cavity).
Sonography is also used to speed up care for patients with suspected
gallstones orinflammation of the gallbladder (cholecystitis). These
patients usually come in with abdominal pain in the right upper quadrant.

Abdominal Sonography (gastroenterology) - the healthcare

professional is able to see images of the spleen, kidneys, bile ducts, gall
bladder, liver, aorta, inferior vena cava, pancreas and other solid organs
located in the abdomen. If the appendix is swollen, as may be the case
with appendicitis, it can sometimes show up in the imaging. Sonographers
say that certain quantities of fat and gas in the bowel can sometimes block
the ultrasound waves, making diagnosis more difficult.

Newborn infants (neonatology) - the Sonographer can perform an

ultrasound scan on an infant by placing the probe in the newborn's
fontanelle (soft spot in the skull) to check for abnormalities in the
brain, hydrocephalus and preiventricular leukomalacia (a form of whitematter brain injury). As the Fontanelle gets smaller in time, the quality of the
images becomes poorer.

Neurology - ultrasound may be used to measure blood flow in the

carotid arteries. Known as carotid Ultrasonography, the scan looks out for
blood clots and atherosclerotic plaque build-up. A carotid duplex is a form of
carotid ultrasonopgraphy using Duplex ultrasonography, which may include
a Doppler ultrasound - a test which can reveal how blood cells move through
the carotid arteries.

Obstetric Ultrasonography - ultrasound is used to create images of

the fetus or embryo in the uterus. Today, often referred to simply as an
ultrasound scan, it is part of standard prenatal care. Obstetric
Ultrasonography can reveal various aspects of the fetus' health, as well as
the mother's. It can also help the health care professional assess the
progress of the pregnancy.

Photo left: ultrasound of a fetus at 22 weeks. Photo right: little big feet in
the uterus at 18 Weeks.
The probe, or transducer is typically placed on the mother's abdomen, but
may also be placed in her vagina - transvaginal Sonography. A transvaginal
scan gives a clearer picture during early pregnancy, and may be a better
option for obese mothers. A Doppler Sonography shows the fetus' heartbeat,
and can help the doctor detect signs of abnormalities in the heart and blood
vessels.

Urology - ultrasound is used in urology for many purposes, such as

checking how much urine remains in the patient's bladder after going to the
toilet. Organs in the pelvic region can be checked, including the uterus,
testicles (to tell testicular torsion from epididymitis). In young adult male
patients, ultrasound is sometimes used to distinguish hydrocele or varicocele
from testicular cancer. Testicular cancer, even though highly curable, must
be treated in order to preserve the man's fertility and overall health.
Pelvic sonographies can be carried out internally or externally. In a male the
internal sonogram may be inserted transrectally, while in a female
transvaginally. Ultrasound scans of the pelvic floor can help the doctor
determine the extent of, for example, a pelvic prolapse, incontinence or
obstructed defecation. At higher frequencies, ultrasound can be used to
break up kidney stones or crystals (nephrolithiasis).

Musculoskeletal sonography - this can be used to examine ligaments,

bone surfaces, soft tissue masses, nerves, muscles and tendons
What is Doppler Ultrasound?
Doppler ultrasound is a type of ultrasound that depends on the Doppler
Effect, a change in the wave's frequency, which can occur from the motion of a
reflector, such a red blood cell.

We experience the Doppler Effect when, for example, an ambulance

approaches us, passes and then drives away. The received frequency is higher
than the emitted frequency during the ambulance's approach, is identical when
it is passing directly by us, and lower when it has passed and is moving away.
The Doppler Effect, or Doppler Shift was named after Christian Doppler (1803 1853), an Austrian mathematician and physicist.
Below are some examples of Doppler Ultrasound:

Color Doppler - the blood flow's average velocity is estimated via a

system of color coding the data. Blood flow direction is assigned the color
blue or red, one color indicates whether blood is moving towards and the
other away from the ultrasound transducer.
Pulsed Doppler - this method allows the health care professional to see a
full range of blood velocities within a sampling volume (gate). In this
method, shades of gray determine how many red blood cells there are.

Power Doppler - the power of Doppler signals is depicted, instead of

the frequency shift. Small vessels can be better visualized, at the expense of
blood velocity and directional data.

Put simply, Doppler ultrasound is used to determine how well blood is flowing in
a vessel - this includes determining blood velocity and whether there are any
obstructions, and how badly they affect blood flow.

Doppler ultrasound - Images of fetal heart (heart beat)

Types of ultrasound transducers
In the majority of cases, a transducer is used that is placed on the surface of
the patient's body. However, there are transducers that are placed internally -

these tend to give better and more informative images.

The following transducers can be used for internal use:

An endovaginal transducer - it goes in through the vagina

An endorectal transducer - it goes in through the rectum

A transesophageal transducer - it goes through the esophagus (down the
patient's throat)

Some tiny transducers can be placed onto the end of catheters and inserted
into blood vessels so that images of vessel walls can be examined.
Using ultrasound for treatment
Ultrasound can be used for therapy by bringing agitation or heat to the
targeted area in the body. In such cases, higher energy levels are required than
are needed for ultrasound scans. Frequency varies considerably, depending on
what kind of treatment is needed.
Ultrasound can also be used by dentists to clean teeth.
Ultrasound has been used in cancer treatment, physical therapy and
occupational therapy. As far as musculoskeletal therapies are concerned,
ultrasound therapy has had mixed results.
Focused Ultrasound Surgery (FUS) or High Intensity Focused Ultrasound (HIFU)
can generate localized heat to treat tumors and cysts. Such ultrasound
therapies use much lower frequencies than those used for imaging scans,
although energy levels are much higher.
Lithotripsy can be used to break up kidney stones.
Cataracts can be treated via phacoemulsification.
Low-intensity ultrasound may help stimulate bone-growth, as well as helping
drugs pass the blood-brain barrier.
Preparing for an ultrasound scan
In most cases, no special preparation is needed before going for a routine
ultrasound scan. Experts advise patients to wear loose-fitting and comfortable
clothing.
If the doctor wants to check your liver or gallbladder, you will be usually asked
to eat nothing (fast) for several hours before the procedure.
If you are going for a scan during pregnancy, especially early pregnancy, the

doctor or nurse will ask you to drink several glasses of water and not go to the
toilet (no pass urine) for several hours before the test. When the bladder is full
the nearby loops of the intestine are displaced, and the scan produces a better
image of the uterus.
What happens during an ultrasound scan?
The majority of scans take between 15 to 45 minutes and will usually occur in
the X-ray department in a hospital. Many doctors' own practices today have
ultrasound devices. The test is performed either by a doctor or a sonographer.
In most countries, the sonographer has specialized training in viewing,
analyzing and modifying the scan to optimize the data in the image.
Sonographers need to understand the physics involved in ultrasound, as well as
having good knowledge cross sectional anatomy, pathology, and physiology.

External ultrasound - an example is when the doctor wants to

examine the patient's heart, or the fetus in the uterus. The sonographer
places lubricating gel onto the patient's skin and then places a transducer
over the lubricated skin. The transducer is moved over the part of the body
that needs to be examined.
The patient should feel no discomfort, and only the transducer over the skin.
Pregnant women may feel slight discomfort because they have to come in
with a full bladder.

Internal ultrasound - internal ultrasounds may be used when the

doctor wants to have a better look at the prostate gland, ovaries or uterus.
The probe is placed into the vagina (in females) or the rectum (in males).

Endoscopic ultrasound image of a mass (lung cancer)

Endoscopic ultrasound - an endoscope is inserted into the patient's body,

usually through his/her mouth. This type of scan is used when the doctor
wants to have a better look at the esophagus, chest lymph nodes or the
stomach.
There is a light as well as an ultrasound device fitted to the end of the
endoscope. Patients are given painkilling medications, and/or sedatives
before the procedure begins.
There is more discomfort with internal ultrasound scans compared to external
ones, as well as a slight risk of internal bleeding.

Referencias:
Nordqvist Christian (2012) What is an Ultrasound? en revista
Medical News Today, version online. Disponible en:
http://www.medicalnewstoday.com/articles/245491.php