Ultrasound and Doppler

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Ultrasound and Doppler

Dr. NAVEEN M. BALLAL , BALLAL SCAN CENTRE

Information regarding various types of Radiology, Ultrasound and Doppler studies are given here.Some more information will be added here soon.

Abdominal Ultrasound

Patient Preparation:
* 6 hours of fasting. However water can be taken.
* Full urinary bladder. Not passing urine during the period of 2 hours prior to the study and drinking up to about 400ml of water can do this

Duration of this procedure: about 15 minutes.

Technical Details:
Liver, gall bladder, kidneys, spleen, pancreas, Para-aortic area, urinary bladder, prostate, uterus, ovaries and other structures are studied to detect various diseases by Abdominal Ultrasound.
Evaluation of intestines, appendix can be done for some extent, as there are some limitations to image these structures.
Abdominal Ultrasound in economical, noninvasive and highly informative as compared with other investigations with similar purpose.

Pregnancy ultrasound:

Patient Preparation:

* For pregnancy less than 3 months:
Full urinary bladder. Not passing urine during the period of 2 hours prior to the study and drinking up to about 400ml of water can do this.
* For pregnancy more than 3 months:
Do not pass urine during 30 minutes before study
Partially filled urinary bladder is adequate

Duration of this procedure: about 15 minutes

Technical Details:

This test gives maximum information than any other tests carried out during pregnancy. Ultrasound in pregnancy has given great benefit to the pregnant mother and Obstetrician in giving good medical care.
In first trimester USG is used
* To confirm the pregnancy, to rule out ectopic pregnancy,
* To assess the viability of the developing baby,
* To look for any problems in uterus and adnexae.
In second trimester, USG will be used
* To assess the growth of the baby
* To look for anomalies in developing child
* To assess the placenta,
* To assess the amount of amniotic fluid
* To assess the maternal structures
in third trimester USG is used
* To assess the presentation
* To assess the growth of the baby,
* To assess the placenta, to rule out low lying placenta (previa)
* To assess the amount of amniotic fluid
* To assess the maternal structures
Please note that ultrasound has certain limitations. Some fetal anomalies can go unnoticed depending upon the nature of the anomaly and timing of ultrasound study.

Pregnancy Doppler

Patient Preparation: no preparation

Duration of this procedure: about 20 minutes

Technical Details:
This test evaluates the flow patterns in fetoplacental and uteroplacental circulations. Calculates the Doppler Indices (RI, PI, SD Ratio) are made by this study.
The vessels assessed are
* Umbilical artery
* Umbilical vein
* Fetal aorta
* Fetal Middle cerebral artery
* Uterine / arcuate artery
* Other fetal vascular structure depending upon the need.
Pregnancy Doppler provides information regarding the fetal well being and helps in predicting the appropriate timing of termination of pregnancy to have better outcome for the baby

Fetal Biophysical Profile Study by Ultrasound

Patient Preparation: No preparation

Duration of this procedure: about 30-40 minutes

Technical Details:
This study is carried out to assess the fetal well being. Based on the score obtained prediction of normalcy / fetal hypoxia / fetal asphyxia are made. Following specific observations are made for a specific period of time and appropriate score is given.
* Fetal movements
* Fetal breathing movements
* Fetal tone
* Fetal reactivity
* Qualitative amniotic fluid volume

Follicular study
There are 2 types, namely Trans abdominal and Trans vaginal
Patient Preparation:
* For Trans abdominal study: Full urinary bladder. Not passing urine during the period of 2 hours prior to the study and drinking up to about 400ml of water can do this.
* For Trans vaginal study: No preparation

Duration of this procedure:
Few visits are needed till the follicle ruptures, usually on alternate days.
In each visit, study will take about 5 minutes

Technical Details:
This test is used in infertile females. This test helps in giving proper treatment and advises to help conception.
In this study,
* Development and timing of rupture of follicle in ovaries are evaluated.
* Follicular sizes are given in millimeters (Mean of 4 values of diameters in deferent planes)
* Endometrial thickness is assessed

Trans vaginal ultrasound

Patient Preparation: no preparation

Duration of this procedure: about 10 minutes

Technical Details:
This test is carried out by placing a specially designed probe in the vagina. This technique gives the better quality of image of Uterus, Ovaries and Other pelvis structures. Trans vaginal ultrasound helps to clarify certain doubts which remain unanswered by usual ultrasound of abdomen

Echocardiography (Ultrasound and Doppler study of heart ) - Trans thoracic

Patient Preparation: No preparation is needed.

Duration of this procedure: about 20 minutes

Technical Details:

Echocardiography is nothing but ultrasound and Doppler study of heart. 2-D Echocardiography is ultrasound imaging of heart. Doppler Echocardiography is the evaluation of haemodynamics of heart.

2-D Evaluation includes the assessments of followings:
* chamber dimensions and Wall thickness
* LV function (Ejection fraction)
* Regional wall motion abnormalities if any
* valvular morphology
* septal integrity
* intracardiac clot and vegetation if any
* pericardium
* aorta and pulmonary artery ( only the segment adjacent to heart)
* SVC and IVC ( only the segment adjacent to heart)
Doppler Evaluation includes the assessments of followings:
* Flow velocity and flow pattern across the valves to identify valve stenosis, pressure gradients, diastolic LV dysfunction etc
* Detection and gradification abnormal flows like in septal defects, PDA, valvular regurgitations

Echocardiography evaluates structures and hemodynamics of heart. It can not detect coronary artery blocks, nature of rhythm abnormalities of heart. Some abnormalities like small septal defects, small clots small vegetations may go unnoticed sometimes. Trans esophageal echocardiography will be very much useful in such situations.

Neurosonogram

Patient Preparation: No preparation

Duration of this procedure: about 15 minutes

Technical Details:
This is ultrasound imaging of brain. This in possible only in infants. As in infants, there are soft areas in head (fontanels) and skull bones are thinner, ultrasound beam can pass through. In adults skull bones prevent passage of ultrasound beam and Ultrasound of brain is not possible in older children and adults.
Following structures are studied:
* Ventricular System
* Brain parenchyma ( cerebrum, cerebellum, brainstem structures)
* Extra axial structures ( Epidural, subdural, subarachnoid spaces)

Breast Ultrasound:

Patient Preparation: No preparation

Duration of this procedure: about 15 minutes

Technical Details:
This includes 2D and Doppler Ultrasound imaging of breasts.
This study is useful in:
* Detection of focal breast disease
* Characterization of the lesions
* Assessment of vascularity pattern of the lesions



PATIENT PREPARATIONS FOR ULTRASOUND AND DOPPLER STUDIES Abdominal Ultrasound : * 6 hours of fasting. However water can be taken. * Full urinary bladder. Not passing urine during the period of 2 hours prior to the study and drinking up to about 400ml of water can do this. Chest Ultrasound : * No Preparation Doppler Studies - For Carotid, Limb arterial, limb venous, Scrotal, Doppler Studies : * No Preparation Doppler Studies - For Renal Doppler, Intra-abdominal vascular Doppler: * 6 hours of fasting. However water can be taken. Echocardiography * No Preparation Pregnancy Ultrasound - more than 3 months Pregnancy : * Do not pass urine during 30 minutes before study * Partially filled urinary bladder is adequate Pregnancy Ultrasound - Up to 3 months Pregnancy : * Full urinary bladder. Not passing urine during the period of 2 hours prior to the study and drinking up to about 400ml of water can do this. Trans Rectal Ultrasound : * Laxative HS on prior night * Enema (Self-administered ready to use enema or regular tap water enema) 1 hour before the Study. Trans Vaginal Ultrasound : * No Preparation Ultrasound of Small parts (Infant brain, Eye, Breast, Thyroid, Scrotum, Swellings, Musculoskeletal) : * No Preparation Doppler Study of Arterial System Patient Preparation: * For Doppler of limb arteries, Neck arteries: No preparation * For Doppler of Intra-abdominal arterial Systems: 4 hours of fasting. However water can be taken. Duration of this procedure: about 30-45 minutes Technical Details: This study involves 2-D imaging to study the morphology of various arteries and Color Doppler Imaging to know the flow velocity and flow patterns in various arteries Arterial Doppler detects followings: * Stenosis (narrowing) * Aneurysm ( dilatation) * Obstruction (clot, plaques etc) * Other abnormalities like AV fistula Doppler Study of Venous System Patient Preparation: * For Doppler of limb veins, Neck veins: No preparation * For Doppler of Intra-abdominal Venous Systems: 4 hours of fasting. However water can be taken. Duration of this procedure: about 30 minutes Technical Details: This study involves 2-D imaging to study the morphology of various viens and Color Doppler Imaging to know the flow velocity and flow patterns in various veins. Venous Doppler detects followings: * Deep vein thrombosis (Clot within veins) * Venous insufficiency * Incompetence at junctions between superficial and deep veins Eye and Orbit Ultrasound ( B Scan) Patient Preparation: No preparation Duration of this procedure: about 15 minutes Technical Details: Structures which can be studied for anatomical abnormalities, are: Anterior segment (with certain limitations) Posterior segment (vitreous, choroid, Retina, sclera) Optic Nerve Retrobulbar structures Measurement of eye ball Thyroid Ultrasound Patient Preparation: No preparation Duration of this procedure: about 15 minutes Technical Details: This includes 2D and Doppler Ultrasound imaging of thyroid glands. This study is useful in: * Detection of focal and diffuse thyroid disease * Characterization of the lesions * Assessment of vascularity pattern Chest (Thorax) ultrasound Patient Preparation: No preparation Duration of this procedure: about 15 minutes Technical Details: This test is done usually as secondary investigation to clarify the doubts in chest radiography. Chest ultrasound can image the structures which are not air filled and when there in no air filled structure between it and the ultrasound probe. Chest ultrasound is useful in: * Detecting pleural and pericardial effusion, even when they are minimal * Differentiation between consolidation of lung and pleural effusion * Assessment of pleural mass, pulmonary mass that is abutting the chest wall or heart. Point to be noted here that, if the mass is located deep inside the lung, there won't be any window for ultrasound beam, so assessment won't be possible. Scrotum Ultrasound and Doppler Patient Preparation: No preparation Duration of this procedure: about 20 minutes Technical Details: Identification and characterization of various types of diseases involving the structures of scrotum can be done this test. This study involves 2D and Doppler imaging of * Testes * Epididymis * Pampiniform plexus of veins * Other extratesticular structures Trans Rectal Ultrasound Patient Preparation: * Laxative HS on prior night * Enema (Self-administered ready to use enema or regular tap water enema) 1 hour before the Study Duration of this procedure: about 15 minutes Technical Details: This test is carried out by placing specially designed probe in rectum. This technique gives the better quality of image of prostate and Other pelvis structures. Trans Rectal ultrasound helps to clarify certain doubts which remain unanswered by usual ultrasound of abdomen Penile Doppler Patient Preparation: No preparation Duration of this procedure: about 40 minutes Technical Details: Blood vessels of the penis are evaluated by Doppler Ultrasound, before and after the injection of vasodilator agent like papaverine. At the same time 2D Ultrasound image of the penis is studied to look for other structural abnormalities. Ultrasound Guided Procedures Patient Preparation: depends upon the nature of procedure Duration of this procedure: depends upon the nature of procedure Technical Details: There many types of ultrasound guided procedures Few Examples are as follows: * Aspiration of deeply located abscesses and fluid collections * Cyst aspirations * FNAC/FNAB of various solid organs like liver, kidneys * Pericardial drainage * Pleural tapping * Sonosalpingography