INTRO PT 1: Planes, Positions, Directional Terms, Transducers, Knobology & Quadrants

Anterior/ventral

towards the front surface of the body or body part

ex: The aorta is anterior to the vertebral column

Contralateral

on the opposite side of the body

deep

away from the surface of the body or structure

ex: your aorta and IVC are deep structures

distal

farther away from the attachment point or origin of an extremity to the trunk of the body

ex: the urethra is distal to the urinary bladder

inferior/caudal

towards the feet or away from the head

ex: The uterus is inferior to the gallbladder.

ipsilateral

on the same side of the body

lateral

away from the midline of the body or pertaining to the side; situated at or on the side

ex: the right kidney is lateral to the left lobe of the liver

medial

towards the midline of the body or organ

ex: the left lobe of the liver is medial to the right lobe of the liver

posterior/dorsal

towards the back surface of the body

ex: The right kidney is posterior to the gallbladder

proximal

towards the origin or attachment of a structure to the trunk

ex: the ureter is proximal to the urinary bladder

superficial

closer to the surface of the body or structure

ex: your skin is superficial to your muscles

superior/cephalic

towards the head or higher in the body

ex: The Liver is superior to the urinary bladder.

Midsagittal Plane

divides the body between equal left and right halves

Anatomic Position

Anatomic position assumes that the body is standing erect, the eyes are looking forward, and the arms are at the sides with the palms and toes directed forward.

Label these

1. supine

2. prone

3. right lateral decubitus

4. left lateral decubitus

5. right posterior oblique

6. left posterior oblique

7. sitting semi-erect

8. sitting erect

Supine

Lying on the back (1)

Prone

Lying face down (2)

Right lateral decubitus (RLD)

lying the right side (3)

left lateral decubitus (LLD)

lying on the left side (4)

Right posterior oblique (RPO)

Lying semi-supine, rolled up on the right side slightly, and elevating the left side (5)

Left posterior oblique (LPO)

Lying semi-supine, rolled up on the left side slightly, and elevating the right side (6)

Left anterior oblique (LAO)

Lying semi-prone, rolled up on the left side slightly, and elevating the right side (7)

right anterior oblique (RAO)

Lying semi-prone, rolled up on the right side slightly, and elevating the left side (8)

Fowler Position

Various inclined positions in which the head of the bed is raised (varies from low to high); the head of the bed is typically raised 18-20 in above the heart with the knees elevated

Trendelenburg

Person in the supine position with the feet raised higher than the level of the head at an angle of 15-30 degrees

The ____ side of the patients body is aligned with the observer’s ____

right, left

if the patient is supine, the orientation is as if the observer were looking at the patient from the ____

feet

Label This

1. Anterior / Ventral

2. Posterior / Dorsal

3. Distal

4. Proximal

5. cranial / cephalic / superior

6. caudal / inferior

7. medial

8. lateral

Transverse Plane

• divides superior and inferior

• screen displays right to left

• Abbreviations: TRV & TRANS

Label this

1. sonogram

2. anterior

3. medial

4. posterior

5. lateral

Sagittal / Longitudinal Plane

• divides into right and left

• screen displays superior to inferior

• abbreviations: SAG, LONG

Label this:

1. sonogram

2. anterior

3. cephalic/superior

4. posterior

5. caudal/inferior

Coronal Plane

• divides into anterior and posterior

• abbreviations: COR

Transducers

• used to obtain an image of the human body using ultrasound

• can convert energy from one form to another

• operates using the pulse-echo principle

• transducers come in different shapes and sizes for different examination types

Pulse-Echo Principle

• transducer uses the pulse-echo principle

  • the crystal inside of the transducer produces the ultrasound wave once pulsed with electricity

  • the wave is sent into the body and returns to the transducer

  • the strength of the echo is displayed on the systems monitor

what is this

linear array transducer

what is this

curvilinear array transducer

Transducer Manipulation

• requires the use of acoustic gel

  • so the ultrasound waves can pass through the body

  • acts as a lubricant for ease of transducer manipulation

• For large organs (i.e liver), drastic movement may be needed

• for smaller structures, fine-tuned movement is needed to enhance visualization

• transducer may need manipulation to obtain an optimal acoustic or sonographic window

• PRACTICE!

Transducer Orientation

• All transducers have a reference point to show the monographer the correct transducer orientation

  • may be called the index or the notch and may be represented by a groove, light, or manufacturer symbol on one part of the transducer

• essential to obtaining correct anatomic orientation

Name these transducer positions

1. perpendicular —- transducer is straight up and down

2. subcostal —- the transducer is angled superiorly just beneath the inferior costal margin

3. intercostal —- transducer is between the ribs. It can be perpendicular, subcostal, or angled

4. angled —- transducer is angled superiorly, inferiorly, or right and left laterally at varying degrees.

5. rotated —- transducer is rotated varying degrees to oblique the scanning plane

Sweep Scanning motion

requires the transducer to remain in one area while using a large wrist motion with the probe perpendicular to the skin surface to sweep through the abdomen

Slide Scanning Motion

Used when the transducer is physically moved along the abdomen, such as longitudinal movement to follow the course of the abdominal aorta into the bifurcation of the iliac arteries

Rock/Pivot Scanning motion

Once an area of interest is located, the monographer may pause over the structure and slowly “rock” or pivot the transducer back and forth or up and down to image the area completely or to follow the anatomical structure

Fan Scanning Motion

smaller version of sweep motion, which is used when the transducer is minutely swept, pivoting on a point of interest.

• may be useful in superficial structures such as the breast when differentiation is needed between the duct and the invasive lesion within the duct

rotate scanning motion

motion is useful to navigate between the ribs or to change from transverse to longitudinal planes, where the transducer is held in one area and rotated 90 degrees to the opposite plane

• also used for smaller increments as the transducer is slowly turned around the area of interest

Care and Cleaning of transducers

• dont drop transducers or roll machine over the cords

• report any cracks in transducer to supervisor

• never be autoclaved

• should be cleaned with manufacturer-recommended disinfectant before and after each examination

• transducers used for intracavity purposes may be disinfected with a glutaraldhyde-based solution

Brightness Mode (B-Mode imaging)

displays the returning echoes as dots of varying brightness related to the strength of the echo

Realtime Imaging

ability of the machine to gather information and display it on the screen almost instantaneously

What does echocardiography use?

A-Mode (amplitude mode)

Doppler Technology

the effect of differing frequencies with motion

• continuous-wave doppler

• pulsed-wave doppler

• color doppler imaging

• power doppler

Continuous-Wave Doppler

a doppler device that utilizes two elements— one element that continuously sends ultrasound waves into the body and another element to continuously listen for the returning signal

Pulsed-Wave Doppler

• intermittently sends sounds and pulses to listen to signals

• sonographers can select depth in which the vessel will be scanned with doppler

Color Doppler Imaging

Doppler shift information presented as a color or hue superimposed over a greyscale image

Power Doppler

Amplitude mode of Doppler where it is not the shift itself that provides the signal but rather the strength (amplitude) of the shift

Knobology

the study of knobs or the functionality of controls

Acoustic Power

control that relates to the amount of energy the transducer is emitting into the patient

Annotation Keys

letters of the keyboard that allow for the labeling of images, similar to the display on a computer keyboard

B-Color

colorizes the greyscale of images

Body Markers

tool used for labelling different anatomic structures or for identifying where the transducer is placed on a body part

Calipers

measures structures during a sonographic examination; can measure the depth of structures as well

Cine (Cine Loop)

a collection of image frames stored temporarily in the system’s memory before the image is frozen

Depth

varies the deepness of the echoes that are displayed on the monitor

Dual image

allows the display to be split into two separate images

Ellipse

allows for the measurement of round structures

Field of View (extended field of view)

ability for sonographers to make maximal use of the screen’s potential resolution while simultaneously displaying all of the relevant areas

Freeze

allows all data to be started or stopped

HD Zoom

allows for magnification of the image with an adjustment made for resolution, offering true magnification

Image Store/print

allows for images to be stored within the hard drive of the machine

Multihertz

allows the user to choose between different sending frequencies of the transducer.

• In general, increasing the frequency improves resolution while using less penetration

Overall Gain

adjusts the brightness or the degree of echo amplification of the entire image

Time Gain Compensation

controlled by adjusting the slide pots which alter the brightness of an image at a specific depth

Tissue Equalization

allows for system-controlled image optimization for B-Mode and spectral Doppler

Trace

allows for a structure to be traced and the distance measured

Trackball

allows for the control of the cursor for text, cine looping, etc.

Transductor Select

permits the activation of different transducers

M-Mode

motion mode

• demonstrates the motion of structures along a single scan line

• used in obstetrics to demonstrate the movement of the fetal heart

Pulsed-Wave Doppler

activates and often controls the gain of the PW Doppler.

It can adjust the sample gate or sample volume (area where info is being collected with a PW doppler), baseline, scale, and angle of insonation

Transmit Zone / Focus

enhances the resolution of an area in the image by electronic focusing.

• adjusted by moving the indicator (caret)

Primary Imaging Controls

1. Depth

2. Gain

3. Time Gain Compensation

4. Annotation

5. Focal Zone

6. Section Width

7. Zoom

8. Color

9. Doppler

10. Measurements (calipers)

Attenuation

the weakening of sound as it travels through a medium

Basic Operation

• enter patient name and ID

• select appropriate transducer

• place transducer in patient with a generous amount of coupling gel

• adjust imaging depth to cover the area of interest

• adjust TGC and overall gain to achieve the desired image

Picture Archiving and Communication System

• images viewed and stored on a computer and/or network server

• digital format

  • allows for improved image resolution

  • software controlled

Hospital Information System (HIS)

allows the sonographer communication with the patient’s medical records

Radiology Information System (RIS)

provides images and reports from other imaging examinations

Subcostal Plane

the upper horizontal line joins the lowest point of the costal margin on each side of the body

Intertubercular Plane

the lowest horizontal line joins the tubercles on the iliac crests

Transpyloric Plane

the horizontal plane passes through the pylorus, duodenal junction, neck of the pancreas, and hilum of the kidneys

Abdominal Quadrents

1. Right Upper Quadrant (RUQ)

2. Left Upper Quadrant (LUQ)

3. Right Lower Quadrant (RLQ)

4. Left Lower Quadrant (LLQ)

the quadrant of determined by the midsagittal and transverse planes that pass through the umbilicus

What is in the RUQ?

• right lobe of liver

• gallbladder

• pylorus

• first 3 parts of duodenum

• head of pancreas

• right adrenal gland

• right kidney

• right hepatic flexure

• superior part of ascending colon

• right half of transverse colon

What is in RLQ?

• cecum

• appendix

• most of ileum

• inferior part of ascending colon

• right ovary

• right uterine tube

• ureter

• right spermatic cord

What is in LUQ?

• left lobe of liver

• spleen

• most of stomach

• jejunum and proximal ileum

• body and tail of pancreas

• left adrenal gland

• left kidney

• left scenic flexure

• superior part of descending colon

• left half of transverse colon

what is in LLQ?

• sigmoid colon

• inferior part of descending colon

• left ovary

• left uterine tube

• left ureter

• left spermatic cord

Name these regions

1. right hypochondrium

2. epigastrium

3. left hypochondrium

4. right lumbar region

5. umbilical region

6. left lumber region

7. right iliac fossa

8. hypogastrium

9. left iliac fossa