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Medical Ultrasonography
Medical ultrasonography, or diagnostic sonography (ultrasonography) is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions. Obstetric sonography is commonly used during pregnancy and is widely recognized by the public. In physics, the term "ultrasound" applies to all acoustic energy (longitudinal, mechanical wave) with a frequency absove the audible range of human hearing. The audible range of sound is 20 hertz-20 kilohertz. Ultrasound is frequency greater than 20 kilohertz. It has wide application in the medical field.
1. Diagnostic applications
Typical diagnostic sonographic scanners operate in the frequency range of 2 to 18 megahertz, though frequencies up to 50-100 megahertz has been used experimentally in a technique known as biomicroscopy in special regions, such as the anterior chamber of eye. The above frequencies are hundreds of times greater than the limit of human hearing, which is typically accepted as 20 kilohertz. The choice of frequency is a trade-off between spatial resolution of the image and imaging depth: lower frequencies produce less resolution but image deeper into the body.
Sonography (ultrasonography) is widely used in medicine. It is possible to perform both diagnosis and therapeutic procedures, using ultrasound to guide interventional procedures (for instance biopsies or drainage of fluid collections). Sonographers are medical professionals who perform scans for diagnostic purposes. Sonographers typically use a hand-held probe (called a transducer) that is placed directly on and moved over the patient.
Sonography is effective for imaging soft tissues of the body. Superficial structures such as muscles, tendons, testes, breast and the neonatal brain are imaged at a higher frequency (7-18 MHz), which provides better axial and lateral resolution. Deeper structures such as liver and kidney are imaged at a lower frequency 1-6 MHz with lower axial and lateral resolution but greater penetration.
2. Risks and side-effects
Ultrasonography is generally considered a "safe" imaging modality. However slight detrimental effects have been occasionally observed (see below). Diagnostic ultrasound studies of the foetus are generally considered to be safe during pregnancy. This diagnostic procedure should be performed only when there is a valid medical indication, and the lowest possible ultrasonic exposure setting should be used to gain the necessary diagnostic information under the "as low as reasonably achievable" or ALARA principle.
World Health Organizations technical report series 875(1998) supports that ultrasound is harmless: "Diagnostic ultrasound is recognized as a safe, effective, and highly flexible imaging modality capable of providing clinically relevant information about most parts of the body in a rapid and cost-effective fashion". Although there is no evidence ultrasound could be harmful for the foetus, US Food and Drug Administration views promotion, selling, or leasing of ultrasound equipment for making "keepsake foetal videos" to be an unapproved use of a medical device.
3. Strengths
(1) It images muscle, soft tissue, and bone surfaces very well and is particularly useful for delineating the interfaces between solid and fluid-filled spaces.
(2) It renders "live" images, where the operator can dynamically select the most useful section for diagnosing and documenting changes, often enabling rapid diagnoses. Live images also allow for ultrasound-guided biopsies or injections, which can be cumbersome with other imaging modalities.
(3) It shows the structure of organs.
(4) It has no known long-term side effects and rarely causes any discomfort to the patient.
(5) Equipment is widely available and comparatively flexible.
(6) Small, easily carried scanners are available; examinations can be performed at the bedside.
(7) Relatively inexpensive compared to other modes of investigation, such as computed X-ray tomography, DEXA or magnetic resonance imaging.
(8) Spatial resolution is better in high frequency ultrasound transducers than it is in most other imaging modalities.
(9) Through the use of an Ultrasound research interface, an ultrasound device can offer a relatively inexpensive, real-time, and flexible method for capturing data required for special research purposes for tissue characterization and development of new image processing techniques.
4. Weaknesses
(1) Sonographic devices have trouble penetrating bone. For example, sonography of the adult brain is very limited though improvements are being made in transcranial ultrasonography.
(2) Sonography performs very poorly when there is a gas between the transducer and the organ of interest, due to the extreme differences in acoustic impedance. For example, overlying gas in the gastrointestinal tract often makes ultrasound scanning of the pancreas difficult, and lung imaging is not possible (apart from demarcating pleural effusions).
(3) Even in the absence of bone or air, the depth penetration of ultrasound may be limited depending on the frequency of imaging. Consequently, there might be difficulties imaging structures deep in the body, especially in obese patients.
(4) Body habitus has a large influence on image quality, image quality and accuracy of diagnosis is limited with obese patients, overlying subcutaneous fat attuates the sound beam and a lower frequency tranducer is required (with lower resolution)
The method is operator-dependent. A high level of skill and experience is needed to acquire good-quality images and make accurate diagnoses.
(5) There is no scout image as there is with CT and MRI. Once an image has been acquired there is no exact way to tell which part of the body was imaged.
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