What is an Ultrasound?

Medical sonography (ultrasonography) is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images. Ultrasound has been used by sonographers to image the human body for at least 50 years and has become one of the most widely used diagnostic tools in modern medicine. The technology is relatively inexpensive and portable, especially when compared with other modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT). Ultrasound is also used to visualize fetuses during routine and emergency prenatal care. Such diagnostic applications used during pregnancy are referred to as obstetric sonography.

As currently applied in the medical field, properly performed ultrasound poses no known risks to the patient.

Sonography is generally described as a "safe test" because it does not use mutagenic ionizing radiation, which can pose hazards such as chromosome breakage and cancer development. However, ultrasonic energy has two potential physiological effects: it enhances inflammatory response; and it can heat soft tissue. Ultrasound energy produces a mechanical pressure wave through soft tissue. This pressure wave may cause microscopic bubbles in living tissues and distortion of the cell membrane, influencing ion fluxes and intracellular activity. When ultrasound enters the body, it causes molecular friction and heats the tissues slightly. This effect is typically very minor as normal tissue perfusion dissipates most of the heat, but with high intensity, it can also cause small pockets of gas in body fluids or tissues to expand and contract/collapse in a phenomenon called cavitation; however this is not known to occur at diagnostic power levels used by modern diagnostic ultrasound units.

In 2008, the AIUM published a 130-page report titled "American Institute of Ultrasound in Medicine Consensus Report on Potential Bioeffects of Diagnostic Ultrasound" stating that there are indeed some potential risks to administering ultrasound tests, which include "postnatal thermal effects, fetal thermal effects, postnatal mechanical effects, fetal mechanical effects, and bioeffects considerations for ultrasound contrast agents." The long-term effects of tissue heating and cavitation have shown decreases in the size of red blood cells in cattle when exposed to intensities higher than diagnostic levels. However, long term effects due to ultrasound exposure at diagnostic intensity is still unknown.

There are several studies that indicate the harmful side effects on animal fetuses associated with the use of sonography on pregnant mammals. A Yale study in 2006 suggested exposure to ultrasound affects fetal brain development in mice. A typical fetal scan, including evaluation for fetal malformations, typically takes 10–30 minutes. The study showed that rodent brain cells failed to migrate to their proper positions and remained scattered in incorrect parts of the brain. This misplacement of brain cells during their development is linked to disorders ranging from "mental retardation and childhood epilepsy to developmental dyslexia, autism spectrum disorders and schizophrenia." However, this effect was only detectable after 30 minutes of continuous scanning. No link has yet been made between the test results on animals such as mice and the possible effects on humans. Although the possibility exists that biological effects on humans may be identified in the future, currently most doctors feel that based on available information the benefits to patients outweigh the risks.

Obstetric ultrasound can be used to identify many conditions that would be harmful to the mother and the baby. Many health care professionals consider the risk of leaving these conditions undiagnosed to be much greater than the very small risk, if any, associated with undergoing an ultrasound scan. According to Cochrane Review, routine ultrasound in early pregnancy (less than 24 weeks) appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible.

Sonography is used routinely in obstetric appointments during pregnancy, but the FDA discourages its use for non-medical purposes such as fetal keepsake videos and photos, even though it is the same technology used in hospitals.

Obstetric ultrasound is primarily used to:

  • Date the pregnancy (gestational age)
  • Confirm fetal viability
  • Determine location of fetus, intrauterine vs ectopic
  • Check the location of the placenta in relation to the cervix
  • Check for the number of fetuses (multiple pregnancy)
  • Check for major physical abnormalities.
  • Assess fetal growth (for evidence of intrauterine growth restriction (IUGR))
  • Check for fetal movement and heartbeat.
  • Determine the sex of the baby

Unfortunately, results are occasionally wrong, producing a false positive (the Cochrane Collaboration is a relevant effort to improve the reliability of health care trials). False detection may result in patients being warned of birth defects when no such defect exists. Sex determination is only accurate after 12 weeks gestation. When balancing risk and reward, there are recommendations to avoid the use of routine ultrasound for low risk pregnancies. In many countries ultrasound is used routinely in the management of all pregnancies.

According to the European Committee of Medical Ultrasound Safety (ECMUS)

"Ultrasonic examinations should only be performed by competent personnel who are trained and updated in safety matters. Ultrasound produces heating, pressure changes and mechanical disturbances in tissue. Diagnostic levels of ultrasound can produce temperature rises that are hazardous to sensitive organs and the embryo/fetus. Biological effects of non-thermal origin have been reported in animals but, to date, no such effects have been demonstrated in humans, except when a microbubble contrast agent is present." Nonetheless, care should be taken to use low power settings and avoid pulsed wave scanning of the fetal brain unless specifically indicated in high risk pregnancies.

It should be noted that obstetrics is not the only use of ultrasound. Soft tissue imaging of many other parts of the body is conducted with ultrasound. Other scans routinely conducted are cardiac, renal, liver and gallbladder (hepatic). Other common applications include musculo-skeletal imaging of muscles, ligaments and tendons, ophthalmic ultrasound (eye) scans and superficial structures such as testicle, thyroid, salivary glands and lymph nodes. Because of the real time nature of ultrasound, it is often used to guide interventional procedures such as fine needle aspiration FNA or biopsy of masses for cytology or histology testing in the breast, thyroid, liver, kidney, lymph nodes, muscles and joints.

Ultrasound scanners have different Doppler-techniques to visualize arteries and veins. The most common is colour doppler or power doppler, but also other techniques like b-flow are used to show bloodflow in an organ. By using pulsed wave doppler or continuous wave doppler bloodflow velocities can be calculated.

Figures released for the period 2005-2006 by UK Government (Department of Health) show that non-obstetric ultrasound examinations contributed to more than 65% of the total number of ultrasound scans conducted.

Ultrasound is also increasingly being used in trauma and first aid cases, with emergency ultrasound becoming a staple of most EMT response teams.

Occupational exposure to ultrasound in excess of 120 dB may lead to hearing loss. Exposure in excess of 155 dB may produce heating effects that are harmful to the human body, and it has been calculated that exposures above 180 dB may lead to death.

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What is Ultrasound?

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Although this limit varies from person to person, it is approximately 20 kilohertz (20,000 hertz) in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound.

The production of ultrasound is used in many different fields, typically to penetrate a medium and measure the reflection signature or supply focused energy. The reflection signature can reveal details about the inner structure of the medium, a property also used by animals such as bats for hunting.

The most well known application of ultrasound is its use in sonography to produce pictures of fetuses in the human womb. There are a vast number of other applications as well.

The upper frequency limit in humans (approximately 20 kHz) is caused by the middle ear, which acts as a low-pass filter. Ultrasonic hearing can occur if ultrasound is fed directly into the skull bone and reaches the cochlea without passing through the middle ear. Carefully-designed scientific studies have been performed supporting what the authors call the hypersonic effect — that even without consciously hearing it, high-frequency sound can have a measurable effect on the mind.

It is a fact in psychoacoustics that children can hear some high-pitched sounds that older adults cannot hear, because in humans the upper limit pitch of hearing tends to become lower with age. A cell phone company has used this to create ring signals supposedly only able to be heard by younger humans; but many older people claim to be able to hear it, which is likely given the considerable variation of age-related deterioration in the upper hearing threshold.

Some animals — such as dogs, cats, dolphins, bats, and mice — have an upper frequency limit that is greater than that of the human ear and thus can hear ultrasound.

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Ultrasound Therapeutic Applications

Ultrasound also has therapeutic applications, which can be highly beneficial when used with dosage precautions:

  • According to RadiologyInfo, ultrasounds are useful in the detection of pelvic abnormalities and can involve techniques known as abdominal (transabdominal) ultrasound, vaginal (transvaginal or endovaginal) ultrasound in women, and also rectal (transrectal) ultrasound in men.
  • Focused high-energy ultrasound pulses can be used to break calculi such as kidney stones and gallstones into fragments small enough to be passed from the body without undue difficulty, a process known as lithotripsy.
  • Treating benign and malignant tumors and other disorders via a process known as high intensity focused ultrasound (HIFU), also called ''focused ultrasound surgery'' (FUS). In this procedure, a generally lower frequencies than medical diagnostic ultrasound is used (250–2000 kHz), but significantly higher time-averaged intensities. The treatment is often guided by magnetic resonance imaging (MRI)—this is called ''Magnetic resonance-guided focused ultrasound'' (MRgFUS). Delivering chemotherapy to brain cancer cells and various drugs to other tissues is called acoustic targeted drug delivery (ATDD). These procedures generally use high frequency ultrasound (1-10 MHz) and a range of intensities (0-20 watts/cm2). The acoustic energy is focused on the tissue of interest to agitate its matrix and make it more permeable for therapeutic drugs. (ATDD).]]
  • Therapeutic ultrasound, a technique that uses more powerful ultrasound sources to generate cellular effects in soft tissue has fallen out of favor as research has shown a lack of efficacy and a lack of scientific basis for proposed biophysical effects. Ultrasound has been used in cancer treatment.
  • Cleaning teeth in dental hygiene.
  • Focused ultrasound sources may be used for cataract treatment by phacoemulsification.
  • Additional physiological effects of low-intensity ultrasound have recently been discovered, e.g. the ability to stimulate bone-growth and its potential to disrupt the blood-brain barrier for drug delivery.
  • Ultrasound is essential to the procedures of ultrasound-guided sclerotherapy and endovenous laser treatment for the non-surgical treatment of varicose veins.
  • Ultrasound-assisted lipectomy is lipectomy assisted by ultrasound. Liposuction can also be assisted by ultrasound.
  • Doppler ultrasound is being tested for use in aiding tissue plasminogen activator treatment in stroke sufferers in the procedure called ultrasound-enhanced systemic thrombolysis.
  • Low intensity pulsed ultrasound is used for therapeutic tooth and bone regeneration.
  • Ultrasound can also be used for elastography. This can be useful in medical diagnoses, as elasticity can discern healthy from unhealthy tissue for specific organs/growths. In some cases unhealthy tissue may have a lower system Q, meaning that the system acts more like a large heavy spring as compared to higher values of system Q (healthy tissue) that respond to higher forcing frequencies. Ultrasonic elastography is different from conventional ultrasound, as a transceiver (pair) and a transmitter are used instead of only a transceiver. One transducer acts as both the transmitter and receiver to image the region of interest over time. The extra transmitter is a very low frequency transmitter, and perturbs the system so the unhealthy tissue oscillates at a low frequency and the healthy tissue does not. The transceiver, which operates at a high frequency (typically MHz) then measures the displacement of the unhealthy tissue (oscillating at a much lower frequency). The movement of the slowly oscillating tissue is used to determine the elasticity of the material, which can then be used to distinguish healthy tissue from the unhealthy tissue.
  • Ultrasound has been shown to act synergistically with antibiotics in bacterial cell killing.
  • Ultrasound has been postulated to allow thicker eukaryotic cell tissue cultures by promoting nutrient penetration.
  • Ultrasound in the low MHz range in the form of standing waves is an emerging tool for contactless separation, concentration and manipulation of microparticles and biological cells, a method referred to as acoustophoresis. The basis is the acoustic radiation force, a non-linear effect which causes particles to be attracted to either the nodes or anti-nodes of the standing wave depending on the acoustic contrast factor, which is a function of the sound velocities and densities of the particle and of the medium in which the particle is immersed.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Ultrasound" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.