{"id":1350,"date":"2021-09-08T18:48:23","date_gmt":"2021-09-08T18:48:23","guid":{"rendered":"https:\/\/probo2020.bssdev.com\/?p=1350"},"modified":"2021-10-30T16:47:08","modified_gmt":"2021-10-30T16:47:08","slug":"ultrasound-imaging-guide","status":"publish","type":"post","link":"https:\/\/stage.probomedical.com\/ca\/learn\/blog\/ultrasound-imaging-guide\/","title":{"rendered":"Ultrasound Imaging Guide"},"content":{"rendered":"
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With 20+ years of experience and technical support for our customers, we created this ultrasound image optimization guide to provide you with an easy to read manual to understand and to get the best images from your ultrasound machine. Oftentimes manufacturer presets are not \u201coptimal\u201d for your practices needs, so learning how to adjust your ultrasound machine\u2019s specifications will help you achieve better clinical results with the best images and become more efficient.<\/span><\/h5>\n

Navigation Menu:<\/strong><\/p>\n

Introduction<\/p>\n

A.\u00a0What is a \u201cgood\u201d ultrasound image?<\/p>\n

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  1. Brightness\/Contrast Settings<\/li>\n
  2. Presets<\/li>\n<\/ol>\n

    B.\u00a0Basic Image Optimization Techniques<\/p>\n

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    1. Gain Control<\/li>\n
    2. Time Gain Compensation controls<\/li>\n
    3. Focal Zones<\/li>\n
    4. Frequency Selection<\/li>\n
    5. Auto Optimization<\/li>\n<\/ol>\n

      C.\u00a0Tissue Harmonics, Speckle Reduction Imaging, Compound Imaging<\/p>\n

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      1. Tissue Harmonics Imaging<\/li>\n
      2. Compound Imaging<\/li>\n
      3. Speckle Reduction Imaging<\/li>\n<\/ol>\n

        D. Beyond the Basics: Advanced Image Optimization<\/p>\n

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        1. Dynamic Range (Compression)<\/li>\n
        2. Ultrasound Gray Maps<\/li>\n
        3. Line Density<\/li>\n
        4. Frame Average\/Persistence<\/li>\n
        5. Rejection<\/li>\n
        6. Edge Enhance<\/li>\n<\/ol>\n

          Taking Control<\/b><\/h3>\n

          It can be an intimidating experience when you first look at an ultrasound and physicians can quickly realize that using these machines isn\u2019t as easy as it seems. In my experience, it\u2019s been a tough learning curve, which is why I created this guide to help you avoid any complications. Physicians regularly express their confusions to me; they open the box, see a bunch of foreign knobs and buttons, and frustration sets in. Coupled with a poorly designed user manual, it only adds to their confusion, leaving them to stare at a screen and feel lost once they turn it on.<\/span><\/p>\n

          From my experience over the past 20 years, I\u2019ve found a simple solution; learning where to begin and understand what knobs and buttons truly matter.<\/span><\/p>\n

          This guide is for physicians and clinicians who often do not receive formal training for their ultrasound machinery. By simply testing a few controls, you can quickly gain a basic understanding of ultrasounds and become a master at image optimization.\u00a0<\/span><\/p>\n

          In this guide, I\u2019ll begin by clarifying the key controls and functions for optimizing your ultrasound images. Deeper in this guide, we\u2019ll help you fine-tune and fully understand your ultrasound through understanding the more advanced technologies.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Ultrasound\n\t<\/div>\n\n<\/div><\/div>
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          Don\u2019t let your ultrasound overwhelm you.<\/p>\n

          Grab your user manual for reference<\/span><\/i><\/p>\n

          Every user manual has a section in the front which outlines the location of different controls. Find that page and leave it open. If you can't find a hard copy of the manual, press the F1 key on your keyboard, this will typically open the electronic manual. As a reference, take a picture of this page with your phone or tablet to refer back later.\u00a0<\/span><\/i><\/p>\n

          What is a \"good\" ultrasound image?<\/b><\/h3>\n

          Good image quality is relative to the capabilities of the machine and is fairly subjective and. Two people looking at the same image will frequently have a different perspective on their interpretation on what is \u201cgood.\u201d Experienced users are used to the image quality they see and often want these imaging capabilities to be similar to their old machines. New ultrasound users want images that fit their brain\u2019s perspective of what they perceive the anatomy <\/span>i<\/span><\/i>s supposed to look like. Yours and others' opinions may change over the course of you mastering the ultrasound, but in the end it's up to you to decide.<\/span><\/p>\n

          Note: I\u2019ll refer to musculoskeletal imaging (which includes needle guidance) because it\u2019s the most common type of user I speak with and these steps apply to all modalities.<\/span><\/i><\/p>\n

          Before you start, adjust the brightness and\/or contrast on your monitor<\/b><\/h3>\n

          On<\/span>e of the most important steps, particularly with CRT (non flat-panel LCD) monitors is balancing the brightness and\/or contrast to get the clearest images. On machines with CRT monitors, user manuals will list these recommended steps in enabling these imaging specifications. Most manufacturers recommend starting with 90-100% contrast, then adjusting the brightness if necessary.\u00a0<\/span><\/p>\n

          The greyscale bar (shown below) shows the ultrasound\u2019s current imaging greyscale from white to black. Begin by setting the lighting in the room to match the lighting you\u2019ll use when scanning to ensure best visibility. Next, turn your brightness to the highest point, then concentrate the grayscale bar to the very bottom which will be at its darkest point. Slowly turn the brightness down until the darkest level is black and no longer visible, leaving the top to be white, but not over-saturated. If you have a contrast adjustment (which many portable machines do not), you can set the specifications to meet your preferences. Note that your brightness setting will be impacted after adjusting the contrast.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Imaging\"\n\t<\/div>\n\n<\/div><\/div>
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          Grayscale Bar<\/p>\n

          The brightness setting is the only consistent adjustment that remains with every new exam. Unless you go through specific steps to save a custom preset, the remaining settings following will not be saved to the ultrasound. So feel free to experiment because you can start over by reselecting the preset.<\/span><\/i><\/p>\n

          Tip: Be ambidextrous or seek help<\/b><\/h4>\n

          In these following steps, you\u2019ll be interacting with a live image. If you don\u2019t have an assistant, put some gel on a probe, and with your right hand and place the probe on your left wrist or arm. As you make adjustments with your left hand (or the opposite for left-handed individuals), you\u2019ll see what happens on a live image. Don\u2019t worry about making the image perfect, you're just practicing.<\/span><\/p>\n

          Tip: Try different ultrasound presets, for some, MSK may not be the best starting point<\/b><\/h4>\n

          Many factory presets are poorly set up for the user interface. On older machines, it is best to try out different settings because MSK and needle guidance\/nerve settings are not commonly studied.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Ultrasound\n\t<\/div>\n\n<\/div><\/div>
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          For needle guidance and <\/span>MSK<\/span>, you can generally skip abdominal, <\/span>cardiac<\/span>, OB\/GYN, and u<\/span>rology<\/span>\u00a0settings when using a linear probe. Alternatively, look for any preset associated with superficial imaging such as small parts, default, venous, peripheral vascular, breast, nerve, thyroid, and different user settings (user 1, user 2, user 3, etc). Repeat these steps until you have a solid grasp of these reference points. Take a note of your favorites. For the upcoming steps, choose one and stick to it, you can go back over the other controls once you\u2019ve gained a firm understanding.<\/span><\/p>\n

          Note: Calculations are affected by the presets you choose. MSK is generally not an issue, but in other modalities, M&A (measurement and analysis) packages are associated with the preset. You can set the M&A package to a custom preset, but because it\u2019s unique to each machine, it\u2019s beyond the scope of this series.<\/span><\/i><\/p>\n

          Basic Optimization Techniques<\/b><\/h3>\n

          In the beginning, everyone must understand these basic controls. You\u2019ll frequently be using them no matter how advanced you get. In this segment, you\u2019ll learn what controls that you will most often use during all of your exams.<\/span><\/p>\n

          Don\u2019t fear the gain control<\/b><\/h4>\n

          The gain knob adjusts the overall brightness of the ultrasound image and will most likely be your go-to for imaging control. It will soon become second nature adjusting it, you\u2019ll be surprised at how a simple twist can have a great impact on your image quality.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Ultrasound\n\t<\/div>\n\n<\/div><\/div>
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          Gain Adjustment<\/p>\n

          TGC: Time Gain Compensation controls<\/b><\/h4>\n

          Each machine has 5-10 slide controls grouped together (TGC or Time Gain Compensation controls), with the exception of several tablets and the SonoSite. These controls adjust gain in particular areas of an image (far-field, mid-, and near-). The easiest way to see what a control does is to experiment by looking at a live image and seeing what happens when you slide any one of the controls all the way to the right, then all the way to the left. You\u2019ll notice that a certain section of the image turns very bright at first and then very dark as you slide to the left.<\/span><\/p>\n

          When starting up your new ultrasound techs typically adjust these to left-of-center for nearfield (top) imaging, and gradually move to right-of-center as quality decreases deeper in the image. The goal to getting a crisper image is to have a lower gain in the nearfield while having a higher gain deeper in the image, where image quality is fainter.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Refurbished\n\t<\/div>\n\n<\/div><\/div>
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          TGC Sidepots<\/p>\n

          SonoSite users: The general equivalent of TGC are two separate gain knobs that control farfield and nearfield gain.<\/span><\/i><\/p>\n

          Ultrasound Focus position, focal zones<\/b><\/h4>\n

          When determining the depth at which you\u2019d like the highest resolution, you will need to use the focal position. These image optimization features are important, but are often-overlooked. When you shift the focal position up and down, you\u2019ll see a dot or triangle move up or down on the right or left side of the image. This will improve the image resolution in the selected focal position area.<\/span><\/p>\n

          Focal zones allow the user to have multiple focus points. Increasing the number of focal zones will make your frame rate decrease and images refresh slower.<\/span><\/p>\n

          Frequency Selection<\/b><\/h4>\n

          Adjusting the frequency allows you to <\/span>increase penetration at the expense of resolution<\/span>, <\/span>or visa versa. Most transducers are broadband, meaning that adjusting the frequency will usually display a range of frequencies, not just a single frequency. Some machines show the actual frequency range (represented by MHz), while others will not show frequency and alternatively offer the choice of either \u201cPen\u201d, \u201cGen\u201d, or \u201cRes\u201d (\u201cHARM\u201d or \u201cHarmonics\u201d will be addressed later in this guide).<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Imaging\n\t<\/div>\n\n<\/div><\/div>
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          On these transducer\u2019s, \u201cPen\u201d describes the lowest range of frequencies meant for deeper tissue and difficult-to-image patients. \u201cGen\u201d describes mid-range frequencies that are typically the default setting. \u201cRes\u201d describes the highest frequency band for superficial imaging. Try a different setting for each image you take, based on what anatomy you\u2019re viewing, you\u2019ll need the highest possible frequency setting.<\/span><\/p>\n

          Some machines show a specific frequency or range of frequencies. In this case, use lower frequencies when you need penetration when imaging. Lower frequencies provide the best penetration, but at the expense of image resolution. Higher frequencies provide the best resolution when looking at superficial imaging, although you will lose penetration.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"Ultrasound\n\t<\/div>\n\n<\/div><\/div>
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          Frequency Adjustment<\/p>\n

          Auto Optimization<\/b><\/h4>\n

          Many ultrasounds have a feature that automatically optimizes the overall contrast and gain of the image, typically called a variation of one of the following names: Auto Optimize, Auto Tuning, or Tissue Equalization. This feature examines the tissue in the image and seeks to provide the most optimized image. Most users neglect this button, but it\u2019s a great starting point once your presets, depth, frequency and focus are dialed-in.<\/span><\/p>\n<\/div>\n<\/div><\/div>

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          \n\t\t\"AIO\"\n\t<\/div>\n\n<\/div><\/div>
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          Words to the wise:<\/b><\/h4>\n