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Sirpa Falk
MCR EMEA BL US
December 29, 2011
Routine exams
Abdomen, Small parts, Msk & Vascular
2
Introduction to Ultrasound
Abdominal Imaging - Anatomy
• The abdominal exam generally includes the examination of the following:
– Liver
– Gallbladder
– Right and Left Kidneys
– Spleen
– Pancreas
– Aorta
– IVC (inferior vena cava)
3
Philips C5-1
• C5-1 / C9-4
– Wide far-field of view
– Wider near field than
phased
– Supports multiple
modalities
• S5-1
– When greater
penetration is needed
Philips C9-4
Introduction to Ultrasound
Abdominal Imaging – Transducers
Philips S5-1
4
Introduction to Ultrasound
Abdominal Imaging - Anatomy
• Liver
– Located inferior to the
right 7th and 11th ribs
– Changes position with
inspiration
Right
Lobe
Left
Lobe
5
6
7
• Diffuse liver disease
–Cirrhosis (a condition in which the liver becomes
scarred and fibrous, thus reducing its ability to function
–Fatty Liver disease
–In the United States, chronic alcoholism and hepatitis
C are the most common causes.
Introduction to Ultrasound
Abdominal Imaging - Anatomy
8
Introduction to Ultrasound
Abdominal Imaging - Anatomy
• Liver transplant evaluations
9
• Liver Disease:
– Benign and malignant
neoplasms
– Metastatic disease
– Liver abscess
Introduction to Ultrasound
Abdominal Imaging - Anatomy
10
Liver: Normal and abnormal blood flow.
• Portal Veins
– Shows a monophasic flow pattern
– Flows continuously in to the liver
– Direction of flow is termed hepatopedal
– With traditional color flow orientation, it should be encoded red
• Hepatic vein
– Traditional color flow orientation is encoded blue
• Hepatic artery
– Might be mistaken for the CBD
11
• Liver Vasculature
– Hepatic veins
– Hepatic artery
– Portal Vein
Portal
Vein
Introduction to Ultrasound
Abdominal Imaging - Anatomy
13
• Gallbladder and Bile Ducts
– Most common reason for
gallbladder disease is
gallstones
– Gallstones are solid stones
formed in the gall bladder
from cholesterol and bile
salts
Introduction to Ultrasound
Abdominal Imaging - Anatomy
15
16
17
18
• Kidneys
Introduction to Ultrasound
Abdominal Imaging - Anatomy
Long axis or sagittal view
19
Transverse view
Introduction to Ultrasound
Abdominal Imaging - Anatomy
• Kidneys
20
21
22
Philips HD11 XE Ultrasound System
23
24
Introduction to Ultrasound
Abdominal Imaging - Anatomy
• Pancreas
– Pancreatitis
– Pancreatic
carcinoma
– Pseudocysts
25
27
Spleen: Physiology
• Large mass of lymphatic tissue
• Not essential for life
• Filters
– Blood
– From Antibodies
• Breakdown hemoglobin
• Reservoir for blood
• Blood formation for fetuses and severe anemia.
28
29
30
31
CHa
Spa
Ca
32
Introduction to Ultrasound
Small Parts Overview
• Imaging of:
– breasts, thyroid and testicles
• Performed to:
– Assess lumps or other abnormalities
– Guide interventional procedures
• Use linear transducer
– High frequency
– Increased resolution
Philips L12-5
33
Introduction to Ultrasound
Small Parts Overview - Thyroid Scanning
Demonstration
34
Introduction to Ultrasound
Small Parts Overview
• Which transducer?
• linear transducer
• Why?
– High frequency
– Increased resolution
35
Introduction to Ultrasound
Small Parts Overview – Thyroid Anatomy
36
An ultrasound of the thyroid is typically used to help diagnose:
・a lump in the thyroid (Goiter, benign or malignant mass/nodule )
・a thyroid that is not functioning properly
Introduction to Ultrasound
Small Parts Overview – Thyroid Imaging
37
38
39
40
41
42
43
44
Ilium
Osseous Acetabular
Ischium
Triradiate
Cartilage
Echogenic Labrum
45
First
Second
Third
46
Philips HD11 XE Ultrasound System
47
Introduction to Ultrasound
Vascular Overview
• Provides imaging of the body's veins and arteries.
• Useful in evaluating the body's circulatory system
• Vascular ultrasound is performed to:
– assess blood flow to organs and tissues
– identify blockages (stenosis) and other abnormalities like blood clots,
plaque or emboli
– determine whether a patient is a good candidate for a procedure
such as angioplasty
48
Introduction to Ultrasound
Vascular Overview -Anatomy
49
50
Introduction to Ultrasound
Vascular Overview – Carotid
• Carotid Artery
52
• Carotid Arteries:
– Assess patients with stroke, dizziness
– Flow patterns in the vessels (shape, speed & direction)
– Blood clot, dissection, narrowing of vessels, plaque
– Assess intima-media vessel layer thickness, an indicator of
cardiovascular disease
Introduction to Ultrasound
Vascular Overview - Carotid
53
Introduction to Ultrasound
Vascular Overview – Carotid
Philips L9-3 (work-horse
vascular transducer)
Which Transducer?
Linear transducer (L9-3, L11-3
or similar)
Why?
High Frequency
Better detail resolution
Linear beam ideal for imaging
tubes
54
55
56
57
58
59
• Which Transducer?
– Sector transducer (S5-1 or similar)
• Why?
– Good access to scanning windows available
– Good frequency range for penetration
Introduction to Ultrasound
Vascular Overview - TCD
60
Transtemporal
Window
Transoccipital/
Suboccipital
Window
Transorbital
Window
Introduction to Ultrasound
Vascular Overview – TCD windows
61
Introduction to Ultrasound
Vascular Overview - TCD
Global Training and Education Internal and Confidential30
Trans-cranial Artery Anatomy
MCA
ACA
VERTEBRAL
BASILAR
PCA
PCoA
ACoA
62
• What are we looking for?
– Flow patterns in the
vessels
– Shape, speed and
direction of flow
– Assessing patients with
strokes and cerebral
bleeding
Introduction to Ultrasound
Vascular Overview - TCD

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Abdo, smp, msk, vasc routine exams anatomy