musculoskeletal ultrasound topics what is ultrasound ? how does it work ? equipment artefacts safety...
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Musculoskeletal Ultrasound Topics
• What is ultrasound ?• How does it work ?• Equipment• Artefacts• Safety • What does it offer to those interested in
musculo-skeletal problems ?
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What Is Ultrasound?
• Sound waves with frequency above 20,000hz.
• Frequency for musculoskeletal use 5 to 25 mega hz
• Use of ultrasound depends on detecting echoes.
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Components of an Ultrasound System
• Source of ultrasound waves
• Echo detection system
• Computer processing
• Image Display
• Image storage
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Ultrasound Production and Detection Systems
• Piezo-electric crystals• Vibrate when exposed to electrical current• Produce electrical output when excited by
vibration.• Parallel arrays• Acoustic focussing• 1% of time emitting ultrasound• 99% of time listening
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Piezo electric crystals
Ultrasound waves
Ultrasound Production and Detection Systems
Focussing by acoustic lens
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Piezo electric crystals
Ultrasound waves
Processing
Ultrasound Production and Detection Systems
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Piezo electric crystals
Ultrasound waves
Cyst
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Ultrasound Processing and Display
• Huge progress with advances in computers.
• Display modes
• B Mode - brightness mode, grey scale
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Ultrasound Equipment
• Radiology department based systems £120-150K
• Philips, Siemens, GE, Accuson, etc
• Late 1990’s new companies involved.
• Dedicated musculo-skeletal machines.
• Portable machines
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Diasus Musculoskeletal Ultrasound
• Dedicated musculoskeletal machine
• £30-35 K• Variety of probes • The machine I trained on
and still use regularly.• No colour Doppler
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Portable/Hand Held Ultrasound Machines
• Sonosite
• Portable can be run off battery.
• 5-10mHz probe for musculoskeletal work
• £15 – 25 K
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Sonosite Portable Machines
Handheld Version Makes Imaging Technology Battle-Ready
Ultimate Ultrasound
March 28 — A technology widely used for a glimpse at the soon-to-be-born has now been turned into a battlefield unit that may help keep soldiers from dying in Iraq.
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What Do You Need To Perform Ultrasound
Successfully ?• Equipment
• Training
• Anatomy knowledge
• Time
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What Does Ultrasound Offer
• Diagnosis
• Assessment of disease activity and treatment monitoring
• Guiding procedures– Aspiration 3x normal likely to obtain fluid– Injection accuracy increased from 59% to 96%
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Diagnosis
• Extends clinical examination• More sensitive for detecting effusions and
synovitis than clinical exam• Better than MRI for tendon and tendon sheath
problems• 7-10 x more sensitive than plain x-ray at detecting
erosions.• Equals MRI for detecting synovitis and erosions. • Equals MRI for soft tissue shoulder problems.
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Safety Issues• BMUS Guidelines• British Medical
Ultrasound Society• 15 points
1. Medical endorsement2. Operator training3. Awareness of machine
factors4. Initial power setting5. Exposure time6. Stationary probe7. Probe self heating
8. Pre-existing temperature elevation
9. Sensitive tissues10. Pulsed doppler11. Thermal and
mechanical indices12. Doppler for fetal heart
monitoring13. Peripheral pulse
monitoring14. Transcranial
ultrasound 15. Non-diagnostic uses of
ultrasound equipment
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Future Developments
• 2D, 3D, 4D
• High resolution power Doppler
• Microbubble contrast
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Future Developments
• High resolution power Doppler
• Microbubble contrast
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Future DevelopmentsPanorama Views
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Advantages of Musculoskeletal Ultrasound
• Increasingly available
• No major safety issues
• Extends clinical examination
• More sensitive than plain radiology
• As sensitive as MRI for erosions and synovitis.
• Allows more accurate injection and more successful aspiration.
• Dynamic, allows movement.
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Ultrasound of Normal Musculoskeletal Tissues
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Ultrasound of Normal Musculoskeletal Tissues
• Tendon and ligament• Muscle• Nerve• Bone• Joints• Cysts, bursi and effusions• Blood vessels• Fat
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Tendons
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Muscle Longitudinal Cross section
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Nerves
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Bone
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MCP Joint
MCP head
Phalangeal head
Cartilage
Extensor tendon
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Bursi, Cysts and Effusions
Pre-Tibial Bursitis
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Knee Effusion
Cyst
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Artery
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Artery
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Veins
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Fat
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Common Artefacts
• Anisotropy
• Reverberation
• Acoustic shadowing
• Increased transmission through cyst
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Piezo electric crystals
Ultrasound waves
Anisotropy
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Anisotropy Achilles Tendon
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Reverberation
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Piezo electric crystals
Ultrasound waves
Bone
Acoustic shadowing
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Acoustic shadowing
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Increased Transmission Thru Cyst
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Ultrasound PathologyHand and Wrist
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Tenosynovitis
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Flexor Tenosynovitis
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Joints
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Erosions
1-2mm erosion
2-4mm erosion
>4mm erosion
Thanks to David Kane
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Effusions and Synovitis
Thanks to David Kane
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Assessment of Synovitis using Power Doppler
MCP joint
Erosion
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Normal US 1st MTP
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.
Patella tendonitis or jumpers knee. Patella tendon insertion hypo-echoic and swollen.
Patella
Patella tendon
Hypo-echoic area
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Osgood Schlatters
• Patella tendon
• Tibial tuberosity
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.
Baker’s Cyst
Cyst
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.
Medial head of gastrocnemius
Bakers Cyst
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Muscle Tears
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Achilles Tendinopathy
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Achilles Tendinopathy
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Calcification in Achilles Tendon
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Achilles Tendon
Insertion Problems
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Achilles Tendon Rupture
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Tibialis Posterior Tenosynovitis
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Stress Fractures
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