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Ultrasound Machine - knobology-Dr. Vaidyanathan R.pptx
POCUS or point of care ultrasound has become the buzzword for all clinicians be it in ER, OR ,ICU or elsewhere. This presentation aims to give a basic idea of how to use the ultrasound machine and the different probes for POCUS.
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Ultrasound Machine - knobology-Dr. Vaidyanathan R.pptx
- 1. Dr.VAIDYANATHAN R CONSULTANT INTENSIVIST HEAD,DEPT OF ANAESTHESIA, INTENSIVE CARE & PAIN CAUVERY HEART & MULTISPECIALITY HOSPITAL MYSORE ULTRASOUND MACHINE - KNOBOLOGY
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- 6. Spending little moretime is the key to master……
- 7. Spend time withmachine as usual !!!
- 8. ULTRASOUND KNOBOLOGY -SETTINGS Step-by-Step Approach
- 9. Yes themost important button of all is the power button ! Simple enough! • Universal On/Off Power Button Symbol • This power symbol applies to almost all ultrasound devices as well. • Just look for it when you want to turn on your machine. Knobology Step 1: Power Button
- 10. Knobology Step 2: Switch to the Correct Probe After turning on the ultrasound machine, the next most important step is to switch to the correct ultrasound probe you need. Every machine will have a way to for you to switch b/w transducers/probe.
- 11. THREE AVAILABLE PROBES PROBESELECTION WILL DEPEND ON PENETRATION,RESOLUTION AND FOOTPRINT
- 12. RESOLUTION : • ABILITYTO DISTINGUISH TWO STRUCTURES AS SEPARATE WHEN LYING CLOSE - determines the clarity of the image. • Dependent of axial and lateral resolution. • Axial resolution - Ability to see two structures as separate when parallel to the beam. • Lateral resolution - image generated when two structures are perpendicular to the beam • Higher frequency and short pulse length will provide a better axial image. THE ULTRASOUND PROBE “FOOTPRINT” : • Refers to the area of probe in contact with the patient’s skin to produce an ultrasound image. • It is located at the very tip of the probe & has a soft “rubbery” feel. Depending on the application you may want a smaller or larger footprint. • Footprint width from largest to smallest is as goes: Curvilinear > Linear > Phased Array. PENETRATION – DEPTHTOWHICH SOUNDWAVESTRAVEL • Generally curvilinear probes used to scan deeper visceral structures
- 13. Linear Ultrasound Probe The linear ultrasound probe is a high- frequency transducer (5-15 MHz) that will give you the best resolution out of all of the probes but is only able to see superficial structures. A general rule of thumb is that if you are going to ultrasound anything less than about 8cm, then use the linear probe.Anything above 8cm you won’t be able to see much. The linear probe will give you a rectangular field of view that corresponds with its linear footprint:
- 14. Curvilinear Ultrasound Probe The curvilinear ultrasound probe has a frequency range of 2-5MHz. It is considered a low-frequency probe and has a large/wide footprint, allowing for better lateral resolution (compared to the phased array probe). The curvilinear ultrasound probe is often used for abdominal and pelvic ultrasound exams. However, it can also be used for cardiac and thoracic ultrasound exams but is limited by the large footprint and difficulty with scanning between rib spaces.
- 15. Phased Array –Cardiac Probe • The phased array (or sector array) transducer is commonly branded as the “cardiac probe” and has a frequency range from 1-5MHz. • It has a similar frequency range as the curvilinear probe but has a smaller and flat footprint. • The advantage of this probe is that piezoelectric crystals are layered and packed in the center of the probe making it easier to get in-between small spaces such as the ribs
- 16. COMPARISON OF 3PROBES
- 17. Ultrasound Probe Movementsand Manipulation
- 18. SLIDING Sliding involves movingthe entire probe in a specific direction to find a better imaging window.This is usually used to find the best window, move to different areas of the body, or to follow a specific structure (such as a vessel).
- 19. TILTING (FANNING) • Tiltinginvolves moving the probe from side to side along the short axis of the probe. • It is commonly also called “Fanning” as well. • Tilting will allow visualization of multiple cross-sectional images of a structure of interest. • One can apply this technique to structures such as the heart, kidney, bladder, vessels, etc.
- 20. ROTATING • Rotating theultrasound probe involves turning the transducer in a clockwise or counterclockwise direction along its central axis. • Rotation is most commonly used to switch between the long and short axis of a specific structure such as a vessel, the heart, the kidney, etc.
- 21. ROCKING Rocking theultrasound probe involves “rocking” the ultrasound probe either towards or away from the probe indicator along the long-axis. Rocking allows you to help center the area of interest.This is also referred to as “in- plane” motion because the image is kept in-plane throughout the manipulation.
- 22. COMPRESSION Compression withthe ultrasound probe involves putting downward pressure on the probe to evaluate the compressibility of a structure or organ of interest. The most common use is to evaluate for deep vein thrombosis, differentiate between artery versus vein, and evaluation for appendicitis (non-compressible).
- 23. Indicator (Orientation Marker)Position PROBE Indicator (Orientation Marker) Position The “probe indicator” on the ultrasound probe can be identified as an orientation marker (ridge, indentation, groove, or nub) on one side of the probe.This corresponds to the indicator or orientation marker on the ultrasound image.
- 24. Ultrasound IMAGE Indicator (OrientationMarker) Position Indicator Orientation Marker – Cardiac Indicator Orientation Marker – Standard
- 25. KNOBOLOGY STEP 3:Application Preset After switching to the correct ultrasound probe, the next step is to select the correct application preset for that transducer. Each transducer will have a different list of application presets based on its frequency and footprint. The ultrasound device companies will create application presets that make sense for those specific probes. Selecting the correct application preset is similar in that it will automatically select the ideal frequency, depth, and gain for that application (i.e. cardiac vs abdominal).This gives you a great starting point to further fine-tune your image with the other knobs/buttons (depth, gain, focus,TGC, etc). In addition, the ultrasound will always start in B-mode or “greyscale” mode by default.
- 26. Knobology Step 4: Depth Application preset will usually give you a decent image right when you place the ultrasound probe on the patient. However, there are some ultrasound settings that may need to be adjusted to optimize your ultrasound settings further. The first of these ultrasound settings you should adjust is the depth. The ultrasound depth setting is simply how deep you want the ultrasound machine to be able to scan. The rule of thumb is to only use as much depth that is necessary to see your structure of interest. Often times for beginning users, their depth will be too high and there is a lot of wasted “Ultrasound Real Estate” on the bottom of the screen. The right side of the screen will have dots or lines that correspond to the depth in centimeters.This can give you an estimation of how deep your structures are as well.As you INCREASE the depth setting on your machine, you will see the numbers increase on the right side of the screen to correspond to the depth of penetration INCREASING DEPTH DECREASING DEPTH
- 27. Knobology Step 5: Gain After optimizing your depth, the next ultrasound setting you should adjust is your gain. Ultrasound gain simply means how bright or dark you want your image to appear. It increases or decreases the strength of the returning ultrasound signals that you visualize on the screen
- 28. Knobology Step 6: Near/FarField Gain & Time Gain Compensation (TGC) • The commonly used Sonosite machines allow you to adjust the “Near field” and “Far field” gain of your ultrasound images. • The near field refers to the top half of the ultrasound screen and the far field refers to the bottom half of the ultrasound screen. • The overall gain is just called “Gain” and is on the bottom left-hand corner of the Sonosite machine buttons. Near Field and Far Field Gain (Sonosite)
- 29. Time Gain Compensation(TGC) • Most other ultrasound machines will allow you to further adjust the gain in even more specific areas of your ultrasound screen.This ultrasound setting is called “Time Gain Compensation” orTGC. • Adjusting theTime Gain Compensation (TGC) allows you to adjust the gain at almost any depth of your ultrasound image, not just the near and far-fields. • The top rows of theTime Gain Compensation control the near field gain and the bottom rows control the far-field gain.
- 30. Knobology Step 7:Focus The last ultrasound setting you can use to optimize your image is by adjusting the focus. When you adjust your focus you are simply concentrating your ultrasound waves at a specific depth of the image to maximize the resolution at that depth. Some machines like the Sonosite don’t allow adjusting the focus since the machine has auto-focus built in.
- 31. Knobology Step 8: Freeze, Measure , Capture Freeze Just like the world implies, the “freeze” button freezes a frame for you so you have time to view it in more detail. The ultrasound machine will usually store a 10- 30 seconds of data and you can scroll back to see previous frames as well. Calipers (Measure) Calipers are an important feature of ultrasound machines that allows you to measure the distance of specific structures of interest. Image/Video Capture All ultrasound machines will allow you to save an image and/or video clip of your ultrasound scan.
- 32. Basic Ultrasound Modes(B-Mode and M-Mode) B-Mode (Brightness Mode) B-mode is the single most important mode you need to master in order to be proficient at point of care ultrasound (POCUS).All of the other modes rely on you getting a good B- mode (2D) image. The buttons to get you back to B- mode/2D can be: B (just the letter) – GE machines 2D (Sonosite and Philips)
- 33. M-Mode (Motion Mode) Ultrasound M-mode is defined as a motion versus time display of the B-mode ultrasound image along a chosen line. The motion is represented by theY-axis and time is represented by the X-axis. We use M-mode in lung ultrasound to evaluate for lung sliding and rule out pneumothorax. Other applications include looking at E point septal separation in cardiac scanning or calculating fetal heart rate in obstetrics. Notice on theY-axis how the structures (subcutaneous tissue, muscle, and pleural line) correlate between the M-mode and B-mode images. You can also see the relative motion of these structures over time (X-axis).
- 34. Here are thesteps to acquiring an M-mode Image: Step 1:Acquire 2D image and Center Structure of Image Step 2: Push the M-mode button to make the M-mode cursor line appear Step 3: Place the M-mode cursor line along the structure of interest Step 4: Push the M-mode button again to activate M-mode Step 5: Push the Freeze Button Step 6: Scroll to the desired image Step 7: Push the Measure Button Step 8: Measure Area of Interest Remember how me measure IVC DIAMETER !!
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- 36. Color Doppler Mode Whatdo the colors on ultrasound mean? RED means there is flowTOWARDS the ultrasound probe and BLUE means that there’s flow AWAY from the ultrasound probe. It is a misconception that red is arterial and blue is venous. It actually just depends on the direction blood is flowing relative to the angle of your ultrasound beam. An easy way to remember this is to use the BART mnemonic: Blue AWAY, RedTOWARDS.
- 37. Color Doppler Steps: Step 1:Activate Color Doppler Step 2:Adjust Color Doppler Area Step 3:Adjust Color Doppler Scale Step 4:Adjust Color Doppler Gain
- 38. Pulse wave, Continuouswave &Tissue Doppler These are very advanced settings. However, the same principles of color Doppler apply to these other Doppler modes as well. The ultrasound probe is just detecting flow or motion either TOWARDS or AWAY from it. If flow/motion is towards the probe there will be a positive deflection and if it is away from the probe there will be a negative deflection.
- 39. Ultrasound Imaging Planes/Orientation Sagittal Plane Parallel to the long axis of the body and separates the body from left to right. Transverse Plane Perpendicular to the long axis of the body and separates body from top (superior) to bottom (inferior). Coronal Plane Parallel to the long axis of the body and separates the body from front (anterior) to back (posterior). Oblique Plane Oblique imaging planes refer any plane that uses a combination of those planes.
- 40. Short Axis andLong Axis Orientation: Cylindrical and non-circular structures can additionally be described using the terms Short vs Long axis. Long Axis: plane parallel to the maximal length of a structure. Short Axis: plane perpendicular to the long-axis of a structure. These views can be obtained by rotating 90 degrees relative to each other.These terms are helpful in structures such as vascular and cardiac applications. Also, this is useful when deciding to perform a procedure in a short versus long-axis approach. Going from Short to Long Axis of Artery
- 41. Long Axis AndShort Axis Of The Heart. Parasternal LONG axis of heart Parasternal SHORT axis of heart
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- 43. AND FINALLY………. SPENDAS MUCH TIME WITH MACHINE AS YOU CAN JUST BECAUSE THERE ARE TOO MANY KNOBS/BUTTONS ,YOU DON’T NEED THEM ALL!!! THE MORE YOU USE IT ,THE BETTRER IT GETS… AND REMEMBER ,YOU HAVE TO JUST DO A FOCUSSED POINT OF CARE ULTRASOUND TO HELP TAKE DECISIONS TO MANAGE CASES. DON’T ATTEMPT TO TAKE OVER RADIOLOGISTS/CARDIOLOGISTSWORK. HAVE OPEN MIND, USE MULTIPLE MODES / HYBRID APPROACH
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