FINAL

What does HIPAA stand for?

Health Information Portability and Accountability Act

What must be used when handling someone with a wound?

1. Probe covers

2. Sterile gel

Airborne Precautions

1. Used when patients have or are suspected to have diseases that are transmitted via the air

2. Examples

   1. Measles

   2. Tuberculosis (TB)

   3. Varicella

Droplet Precautions

1. Used when patients have diseases that are borne on droplets

2. Heavier; don’t travel more than 3 ft.

3. Examples

   1. Diphtheria

   2. Influenza

   3. Mumps

   4. Pertussis

   5. Adenovirus

   6. Meningitis

Contact Precautions

1. Used when patients have diseases that are spread by direct contact with the germ

2. Examples

   1. MRSA

   2. VRE

   3. E. coli

   4. Draining wounds

   5. Impetigo

   6. Pinkeye

Blood-Borne Transmission

1. Falls under standard precautions because we treat all body fluids and blood as if they were infected

2. Examples

   1. Hepatitis B & C

   2. HIV

Subjective Health Assessment

1. Information patient gives about how they FEEL

2. Qualitative information

Objective Health Assessment

1. Information obtained through observation

2. Quantitative information

3. Examples

   1. Blood pressure

   2. Weight

Bradycardia

Below 60 bpm

Tachycardia

Above 120 bpm

Normal Respirations

16-20 per min

Systolic Pressure

1. Top number (100-130)

2. Left ventricle max contraction

Diastolic Pressure

1. Bottom number (60-80)

2. Left ventricle relaxation

Acidosis

Blood pH of 6.8 or less

Alkalosis

Blood pH of 7.8 or more

Sagittal

1. AKA Longitudinal

2. Divides body into left and right

Transverse

Divides body into superior and inferior

Coronal

Divides the body into anterior and posterior

Oblique

Any scan plane between longitudinal and transverse planes

Supine

Laying flat on back

Prone

Laying flat on stomach

Left Lateral Decubitus

1. Laying directly on left side

2. 90 degrees

Right Lateral Decubitus

1. Laying directly on right side

2. 90 degrees

Left Posterior Oblique

Laying on left side but more tilted on their back

Right Posterior Oblique

Laying on right side but more tilted on their back

What does right or left in the name of a patient position indicate?

Indicated what side they are LAYING on, not what side you are scanning

Sitting Semi-Erect

Sitting Erect

How do you label a coronal image?

1. Superior/inferior

2. Lateral/medial

How do you label a sagittal image?

1. Superior/inferior

2. Anterior/posterior

How do you label a transverse image?

1. Anterior/posterior

2. Laterals (right/left)

What is the most common site of pain for a sonographer?

1. Shoulder of scanning arm

2. AKA “sonographer’s shoulder”

What are the most common causes of WRMSDs?

1. Holding arm away from body for long periods of time

2. Maintaining constant pressure

3. Standing with back twisted

4. Holding neck in an awkward position

Rotator Cuff Syndrome

Multiple micro tears that result in weakness/tears of rotator cuff

Carpal Tunnel Syndrome

Repetitive motion injury involving thickening of fascia at neuromuscular outlet of wrist resulting in hand and wrist pain and numbness

de Quervain Syndrome

Tenosynovitis of wrist/thumb caused by repetitive motion

How do we prevent WRMSDs?

1. Transducer grip

2. Wrist position

3. Neck position

4. Shoulder abduction

5. Spine alignment

6. Don’t hang yourself on a cross

   1. Crucifixion

7. Exercise

What degree should sonographers shoulders be abducted to?

30 degrees or less

Anechoic

1. Black structures

2. No internal echoes

Echogenic

Reflects sound with brighter intensity (white)

Posterior Enhancement

Brighter area behind a fluid structure due to low attenuation

Fluid Level

Difference in echogenicity of two fluids in same structure

Loculated Mass

1. Compartments within a mass or fluid collection

2. Septations

Shadowing

Failure of echoes to pass through a dense structure

Heterogenous

Not uniform in texture/composition

Homogenous

Smooth uniform texture/composition

Hypoechoic

Darker than adjoining tissues/reference tissue

Infiltrating

1. No discrete borders

2. Diffuse disease process

Irregular Borders

Borders absent or not well-defined

Isoechoic

Same echogenicity as adjoining tissues

Sound

A mechanical longitudinal wave

Phased Array

1. Small footprint probe

2. Used for abdominal organs from between ribs

Curved Array

1. Larger footprint probe

2. Larger field of view than linear or phased arrays

3. Better resolution than phased array

4. Used for abdominal imaging and OB/GYN

Linear Array

1. Rectangular footprint probe

2. Used for superficial and peripheral vascular structures

What is ALARA?

1. Radiation safety principle for minimizing radiation doses

2. A regulatory requirement for all radiation safety programs

Universal Precautions

Treat blood and any bodily fluid as if they were infected with HIV, Hep B/C

Standard Precautions

Treat everyone the same regardless of symptoms

What three characteristics does a simple cyst have?

1. Anechoic

2. Smooth borders

3. Posterior enhancement

Complex

Both fluid and solid areas within same mass

Solid

1. Mass with internal echoes

2. No posterior enhancement

Lobulated

1. Bumpy border

2. Bunch of grapes

Sustained awkward positioning can cause what?

1. Muscle spams

2. Misalignment of joints

Most sonograms are performed under which condition?

Indirect supervision by physician

What four things is it important for sonographers to know when looking at artifacts?

1. Recognize artifacts

2. Causes of artifacts

3. How to compensate artifacts

4. How to use artifacts to aid in making a diagnosis

What are the artifacts that correspond with improper equipment settings/technique caused by?

The sonographer

What are the artifacts that correspond with the interaction of sound with the tissues caused by?

The sound beam traveling through and interacting with other tissue in its path

What key things does the ultrasound machine always assume?

1. Sound travels in a straight line down beam axis

2. Echoes originate from structures along beam axis

3. Amplitudes of returning echoes directly correspond to \n echogenic nature of structure producing echo

4. Distance to reflectors corresponds to round-trip travel time

What distance does the ultrasound machine automatically assume tissues are at?

13 us/cm

Propagation Artifact

The result of the way sound passes through tissue

What two things does speckle come from?

1. Constructive interference

2. Destructive interference

What does speckle artifact result in?

The light and dark spots seen in tissue

When does reverberation occur?

1. Echoes “bounce” between transducer and strong reflector

2. Sound bouncing between two strong reflectors within tissues

What is mirror-image caused by?

Caused by sound interaction with large, curved reflector like the diaphragm

What does a mirror-image artifact result in?

An additional depiction of object deep to the strong reflector

What does a comet tail artifact result in?

1. Short-path reverberations

2. Series of small bands distal to reflector

Where does a comet tail artifact occur?

1. Behind a very strong interface

   1. Air bubble

   2. Metallic object (suture or bullet)

When does resonance (ring-down) occur?

Sound striking a gas bubble and causing it to vibrate

What is the chief characteristic that distinguishes ring-down from comet tail?

1. Comet tail = banding

2. Ring down = NO banding

What is refraction?

Bending of sound beam

What does refraction result in?

1. Reflectors to be displaced laterally on image

2. Leads to distortion of

   1. Size

   2. Shape

When does ghost-image occur?

When scanning through rectus abdominus muscles due to fat and rectus sheath

What does ghost-image result in?

Duplication of structures posterior to rectus muscles

What structures are typically seen as ghost-images?

1. Vessels

   1. Aorta

   2. IVC

2. Gestational sacs

When does a dirty shadow occur?

1. When sound beams hits air or bowel

2. Creates snowy gray

When does sharp shadow occur?

1. When sound strikes a calcified object

   1. Bone

   2. Mineral salts

   3. Metal

2. Creates black area posterior to object

When does posterior enhancement occur?

When sound passes through poorly attenuating structure

When can posterior enhancement be useful?

Proving that structures are cystic

Slice Thickness Artifact

1. AKA

   1. Section Thickness

   2. Partial Volume Artifact

2. Loss of lateral or axial resolution

What does a slice thickness artifact result in?

1. Blurring of the image

   1. Two structures blended to display as one

What does an elevation resolution/slice thickness artifact result in?

Appearance of echoes within an otherwise anechoic structure, like a blood vessel or cyst

When does an absence of focusing artifact occur?

When narrow part of beam is not at area of interest

What transducers are side lobes present in?

ALL

When do side lobe artifacts occur?

Off-axis lobes of energy are created outside the main ultrasound beam, resulting in artificial display of echoes along the main beam path

What does a side lobe artifact result in?

1. Linear echoes that can mimic dissection in

   1. Aorta

   2. Amniotic sheets in OB scans

2. Streaky, linear echogenic artifact

When does a grating lobe artifact occur?

Created by the way that elements are spaced in an array transducer

What is the difference between a side lobe and grating lobe artifact?

1. Side lobes

   1. Arise from individual elements

   2. Less bright

2. Grating lobes

   1. Arise from multiple elements

   2. Bright

When does propagation speed error occur?

When sound travels through tissue at a speed different from 1540 m/s assumed by machine

What happens if sound travels faster than assumed by the machine?

Object will be displayed more superficially than true location

What happens if sound travels slower than assumed by the machine?

Object will be displayed deeper than true location

Why does the range ambiguity artifact occur?

1. Ultrasound machine assumes that echoes received are generated by most recent transmitted pulse

2. Echoes are not received by transducer until after next pulse is transmitted