In ultrasonography, a signal generator is combined with a transducer. Piezoelectric crystals in the signal generator convert electricity into high-frequency sound waves, which are sent into tissues. The tissues scatter, reflect, and absorb the sound waves to various degrees. The sound waves that are reflected back (echoes) are converted into electric signals. A computer analyzes the signals and displays an anatomic image on a screen.
Ultrasonography is portable, widely available, relatively inexpensive, and safe. No radiation is used.
Uses of Ultrasonography
Ultrasonography can identify superficial growths and foreign bodies (eg, in the thyroid gland, breasts, testes, limbs, and some lymph nodes). With deeper structures, other tissues and densities (eg, bone, gas) can interfere with images.
Ultrasonography is commonly used to evaluate the following:
Heart (echocardiography): For example, to detect valvular and chamber size abnormalities and to estimate ejection fraction and myocardial strain (see Echocardiography Echocardiography This photo shows a patient having echocardiography. This image shows all 4 cardiac chambers and the tricuspid and mitral valves. Echocardiography uses ultrasound waves to produce an image of... read more )
Gallbladder and biliary tract: For example, to detect gallstones and biliary tract obstruction (see Imaging Test of the Liver and Gallbladder: Ultrasonography Ultrasonography Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more )
Urinary tract: For example, to distinguish cysts (usually benign) from solid masses (often malignant) in the kidneys or to detect obstruction such as calculi or other structural abnormalities in the kidneys, ureters, or bladder (see Genitourinary Imaging Tests: Ultrasonography Ultrasonography Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents... read more )
Pregnancy: For example, to evaluate the growth and development of the fetus and to detect abnormalities of the placenta (eg, placenta previa—see Evaluation of the Obstetric Patient: Ultrasonography Ultrasonography Ideally, women who are planning to become pregnant should see a physician before conception; then they can learn about pregnancy risks and ways to reduce risks. As part of preconception care... read more ).
Musculoskeletal: To evaluate muscles, tendons, and nerves.
Bedside ultrasonography How To Do Ultrasonography Bedside ultrasonography is increasingly used in acute care settings to assist both diagnosis (eg, fluid accumulations or foreign bodies) and treatment (eg, intravenous catheterization or arthrocentesis)... read more (also called, point-of-care ultrasound) is increasingly used in acute care settings to assist both diagnosis (eg, volume status, cause for hypotension, foreign bodies) and treatment (eg, intravenous catheterization, arthrocentesis).
Ultrasonography can also be used to guide biopsy sampling and place intravenous catheters.
Ultrasonography is sometimes done internally, using a small transducer on the tip of an endoscope or vascular catheter.
Variations of Ultrasonography
Ultrasound information can be displayed in several ways.
A-mode is the simplest; signals are recorded as spikes on a graph. The vertical (Y) axis of the display shows the echo amplitude, and the horizontal (X) axis shows depth or distance into the patient.
This type of ultrasonography is used for ophthalmologic scanning.
B-mode is most often used in diagnostic imaging; signals are displayed as a 2-dimensional anatomic image.
B-mode is commonly used to evaluate the developing fetus and to evaluate organs, including the liver, spleen, kidneys, thyroid gland, testes, breasts, uterus, ovaries, and prostate gland.
B-mode ultrasonography is fast enough to show real-time motion, such as the motion of the beating heart or pulsating blood vessels. Real-time imaging provides anatomic and functional information.
M-mode is used to image moving structures; signals reflected by the moving structures are converted into waves that are displayed continuously across a vertical axis.
M-mode is used primarily for assessment of fetal heartbeat and, in cardiac imaging, most notably to evaluate valvular disorders.
Doppler ultrasonography is used to assess blood flow. It uses the Doppler effect (alteration of sound frequency by reflection off a moving object). The moving objects are red blood cells in blood.
Direction and velocity of blood flow can be determined by analyzing changes in the frequency of sound waves:
If a reflected sound wave is lower in frequency than the transmitted sound wave, blood flow is away from the transducer.
If a reflected sound wave is higher in frequency than the transmitted sound wave, blood flow is toward the transducer.
The magnitude of the change in frequency is proportional to blood flow velocity.
Changes in frequency of the reflected sound waves are converted into images showing blood flow direction and velocity.
Doppler ultrasonography is also used
To evaluate vascularity of tumors and organs
To detect occlusion and stenosis of blood vessels
To detect blood clots in blood vessels (eg, in deep venous thrombosis Deep Venous Thrombosis (DVT) Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. DVT is the primary cause of pulmonary embolism. DVT results from conditions... read more )
To detect synovitis in joints
Spectral Doppler ultrasonography displays blood flow information as a graph with velocity on the vertical axis and time on the horizontal axis. Specific velocities can be measured if the Doppler angle (the angle between the direction of the ultrasound beam and the direction of blood flow) can be determined. Velocity measurements and the appearance of the spectral Doppler tracing can indicate the severity of vascular stenoses.
Duplex Doppler ultrasonography combines the graphic display of spectral ultrasonography with the images of B-mode.
Color Doppler ultrasonography converts the Doppler blood flow information into a color image with blood flow in color; it is displayed on a gray-scale anatomic ultrasound image. Direction of blood flow is indicated by the shade of color (eg, red for blood flow toward the transducer, blue for blood flow away from the transducer). Average blood flow velocity is indicated by the brightness of the color (eg, bright red indicates high-velocity flow toward the transducer; dark blue indicates low-velocity flow away from the transducer).
Disadvantages of Ultrasonography
Quality of images depends on the skills of the operator.
Obtaining clear images of the target structures can be technically difficult in overweight patients.
Ultrasonography cannot be used to image through bone or gas, so certain images may be difficult to obtain.