Ultrasound Scanning Fundamentals - Week 1 Flashcards

Anatomical Position and Directional Terminology

• Anatomical Position (as the reference standard)

  • Patient is erect and facing the observer

  • Feet flat and directed forwards

  • Arms at sides

  • Palms facing forward

  • Thumbs pointing away from the body

  • Purpose: ensures consistency when describing anatomical landmarks and pathology

  • Always refer to this position when giving directions

• Directional Terminology (major concepts)

  • Superior and Inferior

  • Superior = Above; toward the head (cranial)

  • Inferior = Below; away from the head (caudal)

  • Mnemonic: "Superior = Cranial; Inferior = Caudal"

  • Medial and Lateral

  • Midline = imaginary vertical line down the middle of the body

  • Medial = toward the midline or middle of the body

  • Lateral = toward the side of the body

  • Anterior and Posterior

  • Anterior = Front; toward the front of the body

  • Posterior = Back; toward the back of the body

  • Anterior = Ventral; Posterior = Dorsal

  • Mnemonic: A before P (Anterior before Posterior)

  • Proximal and Distal

  • Proximal = Toward the trunk; near the origin

  • Distal = Away from the trunk; far from the origin

  • Ipsilateral and Contralateral

  • Ipsilateral = On the same side of the body

  • Contralateral = On opposite sides of the body

  • Superficial and Deep

  • Superficial = Closer to the surface of the body

  • Deep = Away from the surface of the body

• Quadrants of the Body

  • Right Upper Quadrant (RUQ)

  • Left Upper Quadrant (LUQ)

  • Right Lower Quadrant (RLQ)

  • Left Lower Quadrant (LLQ)

  • Note: familiarize with the quadrant codes when locating structures

• Regions of the Body

  • Regions used most often include: subcostal, iliac crest, etc. (as a scanning guide)

• Anatomical Planes

  • Transverse Plane (Axial Plane)

  • Axial or short axis of the body

  • Body divided into upper and lower sections

  • Horizontal plane

  • 90 degrees to the sagittal plane

  • Sagittal Plane (Longitudinal Plane)

  • Divides the body into right and left sections

  • Vertical plane

  • 90 degrees to the transverse plane

  • Coronal (Frontal) Plane

  • Divides the body into unequal anterior and posterior sections

  • Vertical plane

  • 90 degrees to the sagittal plane

Patient Positions (clinical scanning contexts)

• Supine

  • Flat on the back, looking up

• Prone

  • Flat on the abdomen, face down

• Left/Right Lateral Decubitus (LLD/RLD)

  • Patient lies on left or right side

  • Hips and shoulders at 90 degrees to the stretcher

  • The side touching the bed is the dependent side

• Left/Right Posterior Oblique (LPO/RPO)

  • One shoulder touching the stretcher; the other shoulder at a 45-degree angle from the stretcher

• Trendelenburg

  • Body flat on bed with feet higher than the head (often tilted; can be opposite)

• Fowler’s / Sitting (Semi-erect)

  • Upright/semi-upright position; facilitates breathing

• The “exams” jokey positions

  • The Burrito, The Sistine Chapel, The Bagel, The Luge, The Egg, The Grandad, The Drama Queen, Breakdance, etc. (illustrative mnemonics used in class for quick recall of positions)

• Practical notes

  • Position choices depend on patient comfort and the organ system being imaged

  • Always confirm which position will best expose the anatomy of interest

Breathing Techniques for Ultrasound Imaging

• Purpose

  • Sonographers guide patient breathing to optimize image quality

  • Different techniques reduce organ motion and improve visualization

• Techniques
  1) Breath In and Hold It

  • Fills lungs with air and pushes diaphragm and organs inferiorly

  • Movement stops during hold; improves optimization of structures
    2) Stop Breathing Without a Breath In

  • Minimizes organ motion without a full inhalation; structure pushed lower
    3) Small Breath In and Exhale Fully

  • Diaphragm and organs move superiorly; improves optimization of structures
    4) Breath In and Hold It With Pushing the Stomach Out (Valsalva)

  • Stops organ movement; pushes gas out of the way to optimize structures; may raise organs

Ultrasound Machine, Knobology, and Transducers

• Ultrasound Machine Components (overview)

  • Monitor/screen, console, keyboard, knobology, accessory equipment

• Transducers/Probes (Selection and Presets)

  • Abdominal/Pelvic imaging: Curvilinear probe (C6-2) — deeper penetration

  • Superficial structures: Linear probes (L18-4 or L12-5) — higher resolution for superficial structures

  • Vascular imaging: Linear probe (L12-4)

  • Echocardiography: Sector probe (S4-2)

• Probe Handling (Hold and Manipulation)

  • Hold: light, comfortable grip; hand in a “C” shape

  • Pinkie-side of the right hand against patient’s skin for stability and control; wrist comfort

  • Expect some wrist/arm fatigue at the start

  • For echocardiography: hold like a pencil

• Transducer Manipulation Techniques

  • Sliding: move probe across skin while maintaining contact

  • Compression: press toward deeper structures to make them appear superficial; differentiate structures by compressibility (e.g., veins vs arteries)

  • Rotating/Pivoting: rotate probe to change plane (e.g., Sagittal ↔ Transverse)

  • Angling/Rocking (Transverse Plane): tilt the probe medial/lateral/right/left to extend the imaging window

  • Angling/Heel-Toe/Rocking (Sagittal Plane): shift cranial (toe) or caudal (heel) to extend the imaging window

  • Angling/Tilting (Transverse Plane): tilt superior/inferior

  • Angling/Tilting (Sagittal Plane): tilt medial/lateral

• Imaging Planes and Orientation

  • Transverse (Axial) plane: orientation marker toward patient’s right side; probe horizontal

  • Sagittal (Longitudinal) plane: orientation marker toward superior; probe vertical

  • Coronal (Frontal) plane: probe vertical; beam enters from left or right lateral position

• Depth and Focus (Knobology basics)

  • Depth: adjust depth to include region of interest; critical for resolution and field of view

  • Focus: zone where ultrasound beam is narrowest; highest intensity in the focal zone; typically 100x brighter within focal zone compared to outside

  • Depth and Focus relation to image quality: deeper structures require greater depth and possibly different focal zone placement

• Gain and TGC

  • Overall Gain (ABC): overall image brightness

  • Time Gain Compensation (TGC): depth-dependent gain controls; individual buttons correspond to different depths (top to bottom)

• Freeze and Image Capture

  • Freeze: suspend real-time imaging

  • Measurements/Calculations can be performed while frozen

  • Print/Store/Acquire: save still images or cine clips to storage

• Frequency Settings

  • Higher frequency: better imaging of superficial structures

  • Lower frequency: better imaging of deeper structures

  • Note on equipment: frequency settings labeled (e.g., Philips nomenclature HGen/HPen/HRes)

• Trackball

  • Used to guide cursor on the screen

• Quick reference: typical knobology tasks

  • Depth, Focus, Gain, TGC, Freeze, Print/Store/Acquire (Still and Cine), Trackball

Ultrasound Scanning Planes and Orientation

• Transverse (Axial) Plane

  • Beam enters from anterior/posterior with patient supine

  • Orientation marker on transducer should point to patient’s right

  • Probe held horizontally

• Sagittal (Longitudinal) Plane

  • Beam enters from anterior/posterior with patient supine

  • Orientation marker on transducer should point superiorly

  • Probe held vertically

• Coronal (Frontal) Plane

  • Beam enters from left or right lateral position

  • Cuts body into anterior and posterior sections

  • Probe held vertically

• Practical guidance

  • Always consider patient position on the stretcher; skin-facing side is anterior

  • When imaging specific structures, align transducer orientation with the plane that best visualizes the anatomy

• Self-Quiz prompt

  • Question: What would happen if the patient changes into a prone position? (Review in D2L self-quiz)

Sonographic Terminology and Image Interpretation

• Purpose of terminology

  • Guide to describe how a structure looks on ultrasound

  • Identify anatomy and location precisely

  • Serves as a common language among sonographers, cardiologists, and radiologists

• Echogenicity (brightness on ultrasound)

  • Hyperechoic / Echogenic: brighter than surrounding tissue

  • Hypoechoic / Echopenic: darker than surrounding tissue

  • Isoechoic: same brightness as surrounding tissue

  • Anechoic: no internal echoes (dark); fluid-filled structures

• Organ Texture

  • Homogeneous: uniform echo pattern; smooth texture (e.g., normal liver)

  • Heterogeneous: uneven echo pattern; varied echodensities (e.g., patchy liver)

• Attenuation

  • Structure absorbs some or all of the sound waves

  • Posterior shadowing: deep area behind a highly attenuating structure (e.g., bone appears bright/opaque and blocks the beam)

  • Through transmission (Acoustic/Posterior Enhancement): posterior brightening behind a fluid-filled structure (e.g., urine in bladder, bile in gallbladder) due to low attenuation

• Interface

  • Two adjacent structures with different absorptions of the ultrasound beam; used to compare echogenicities across borders (e.g., normal liver vs. kidney interface

• Practical notes

  • The terminology is intended to standardize reporting and communication across teams

  • Visual cues (hyperechoic vs hypo echoic, poster shadowing, posterior enhancement) guide diagnostic interpretation

Ultrasound Gel and Cleaning Protocols

• Ultrasound Gel

  • Purpose: acts as a medium between patient skin and transducer; eliminates air gap to enable sound transmission

  • It also helps with probe movement but is not the physics behind image formation (sound cannot travel efficiently through air)

• Cleaning and Hygiene

  • Screen/Touchscreen: clean with alcohol wipes

  • Console/Probes/Equipment: use appropriate germicidal wipes (e.g., Cavi/Accel) and wear gloves

  • Adherence to infection control policies is essential

Safety, Ethics, and Intellectual Property

• Institutional policies

  • The publication materials are protected by copyright; unauthorized reproduction and distribution are prohibited

  • For more information, contact the Director, Centre for Instructional Technology and Development at SAIT

• Clinical safety and etiquette

  • Wash hands; use gloves when appropriate; sanitize probes between patients

  • Ensure proper gel usage and disposal

Quick Reference: Key Equations and Numbers (LaTeX)

• Focal zone intensity relation

  • The focal zone has significantly increased intensity compared to outside the focal zone:
    ext{Intensity}{ ext{focal}} \,=\, 100 \times \, ext{Intensity}{ ext{outside}}

• Planes are perpendicular in standard anatomy

  • Sagittal and Transverse planes are typically at a right angle:
    \angle(\text{Sagittal}, \text{Transverse}) = 90^{\circ}

Connections to Practice and Real-World Relevance

• Consistency in terminology and patient positioning improves diagnostic accuracy and reduces miscommunication in multi-disciplinary teams

• Knowledge of planes and orientation markers is crucial for reproducible imaging and comparison across scans

• Proper transducer selection and knobology enable optimal visualization of target structures while minimizing patient discomfort

• Breathing techniques are integral to acquiring high-quality images, particularly in abdominal and pelvic imaging

Practical Implications and Ethics

• Patient safety and comfort: choosing appropriate positions and breathing techniques to minimize discomfort while maximizing image quality

• Infection control: strict screen/probe cleaning and glove use to prevent cross-contamination

• Professional standards: adherence to institutional policies about publication, distribution, and usage of teaching materials

• Continuous learning: use of self-quizzes and D2L resources to reinforce understanding and readiness for practical exams