Ultrasound, Industry, Medicine, Analysis, Market research

Good afternoon and welcome to webinar Wednesday we’re excited to have nearly 400 registered attendees for today’s. Webinar which is eligible for one credit from the ACI let’s get started by giving one of our lucky attendees a webinar Wednesday surprise package for answering this week’s.

Trivia question today’s sponsor and ibadis imaging is headquartered in Pennsylvania which. Iconic symbol of American independence is also located in Philadelphia answer. Now using the questions feature on your dash board while you’re answering I want to invite everyone to join us for the fifth annual ice conference also known as the imaging conference. And Expo which will be held February 16 through 18 2018 at the M Resort Spa casino in Las Vegas the ice conference will bring imaging service professionals from across the nation to. Las Vegas for two days of learning networking and the latest advances in imaging.

Ultrasound, Industry, Medicine, Analysis, Market researchFind out more about this conference by visiting attend ice calm alright unless you our lucky winner is this week Edie vikon congratulations you’re. The winner of our webinar Wednesday surprise package the correct answer was the Liberty Bell webinar Wednesday would like to thank our sponsor. And a bottom’s imaging and Nevada imaging is your trusted provider for MRI coil. Ultrasounds transducer see our reader and dry film printer repair with exceptional repair capabilities quality solutions ISO 13485 certification and dedicated customer care they provide excellent value in third-party service find out more. About today’s sponsor by visiting their website Nevada imaging comm our presenter today is Matt Moore a head of strategic advancement at a Nevada imaging formerly bear multi-vendor services matt. Has over 30 years of experience in the diagnostic ultrasound industry with both manufacturers and independent service organizations performing a wide variety.

Ultrasound, Industry, Medicine, Analysis, Market research Business NewsOf roles including build service service management service technical training technical support research and development. Clinical application sales and marketing Matt you may begin whenever you’re ready Thank. You Jamie and welcome to ultrasound applications essentials and image artifacts just a little a little additional. Intro to the classes this class was developed due to a lack of soft skills training for ultrasound service engineers in the industry in my previous life I have taught probably about 10 or. 15 different ultrasound platforms as far as technical training I’ve written many of those manuals but what. We haven’t seen in the industry is a class where people really understand how these systems operate how to operate the different functions the different terminologies.

Ultrasound, Industry, Medicine, Analysis, Market research NewsAnd then we go into image artifacts so this class was developed in actually conjunction with my wife who is. A registered stenographer she and I co-wrote this several years ago. And have continued continued to develop and polish it from there. So thank you for joining us and let’s get started so I’m in ibadis imaging just a quick intro to us we became in. Of us imaging on September 1st we previously were bear multi-vendor service but under. Bear multi-vendor service we had a strategic relationship with both West Co which.

Is our probe repair arm in Tulsa Oklahoma and MD med tech which is our FDA registered transducer and transducer or a. Facility in Denver Colorado we had we previously had a strategic. Alliance but as of September 1st we all came together under one.

Company and we are now known as in ibadis imaging so that’s who we are so why are. We here today why is this knowledge as and why is this knowledge important first and foremost it’s to instill customer confidence if you understand.

The terminology and you understand how to operate the systems you’d become a much more of an authority in the eyes of your. Customer it also gives me the ability to differentiate between an applications issue and a malfunction this.

Is a huge time in credit boat credibility saver in my previous life. I was a service engineer for about 20-some odd years. And what I found was the majority of reports of nebulus system malfunctions or image quality issues turned out to be not a malfunction of the system but it was a setting. Or the way the system was being utilized this also gives you the ability to test the system clinically and understand the language of the sonographer or technologists and. I want to reiterate the word technologist I made a mistake very early in my career that I hope I can help you all prevent in making.

And that is calling an ultrasound stenographer a technician call them a technologist a huge differentiator there but they haven’t language all. Their own and I’ve heard all kinds of interesting terms over the years where you’ll.

Hear somebody say my image is grainy my image is mushy my image is contrast my images bi-stable so there you’re going to hear. A lot of terms while you service these units and this this presentation will help you understand some. Of that terminal and this is really truly a differentiator between a good service engineer and a great service engineer so let’s. Start off with system display settings when you’re looking at an ultrasound system and you’re looking at the image settings the very. First thing you need to do before you go any further is ensured that the system. Display is set correctly um what you’ll see here on the screen is I have two images both these images are me and actually.

The vast majority of the images throughout this presentation if not all of them are my Anatomy so what you’re seeing here is liver which is this area on here and then this. White reflector down here this is my diaphragm and then this is my kidney over. Here and over in here we have a bowel and so what I did is I intentionally set this first image incorrectly and you can see that. The the image is very washed out very bright where this bottom image is actually set correctly so the first thing we want to do. Is we want to adjust our room lighting to typical scanning room intensity Sinagra purrs work in the dark their their light or their rooms are very poorly lit so they. Can see this display better so we want to make sure that if we are making any adjustments to the system main display we are setting the room lighting properly.

And then we want to look at the system grayscale bar if you look on the left hand side of both these images there is a grayscale bar and it will either. Be 16 grayscale steps or it will be a continuous grayscale bar and what. We want to do is we want to set the background where this last step is barely visible it’s basically one shade away from the. Background of the image so you can see the bottom image. We can barely see this last step down here and then we it fades into our background whereas this one up here up top we see a large difference between. Those two gray scales so we want to make sure what we set.

That properly and then we adjust our whites or our contrast for proper. Whites but not blooming you can see these whites up here especially in the textarea are blooming where we’re losing resolution so you want to set the whites where they’re properly with with a. Proper intensity and this is a requirement by the way for a CR accreditation and at the bottom I make a note ensure. Custom approves of and understands any changes made um what I don’t suggest you do is arbitrarily adjust your customers. Monitors or main displays without sharing why you’re doing it and having their input um. Sometimes people like their monitors that’s what I would believe to be incorrectly but.

That’s the way they do it and especially like up here if you look at this. Particular image people in the Korea bassier Suites a lot of times.

Will make their background lighter than what we would normally see and so make sure that your customer is involved. In the decision and as you’re setting that there there you’re getting buy-in I have a quick pop quiz here at. The very end of this presentation I provide my meat my email address and so please email me your answer but this is a pop quiz will adjusting the system’s.

Main display settings have any effect on the image presentation on a pass display you can see over here this image on the left is is far. Too bright the background is way too bird way too bright this image on the right the image is way. Too dark so if I set my main display on my ultrasound system way too bright or way too dark will it or will it not effects the. Effect need pass this way so at the end I’ll give you my email address and I’d love to hear your answers and I like. An explanation as well I want to get into just really quick the different transducers and the types you see at. The top I call them transducer probe or scan head types these are different terminologies that the manufacturers use all the same thing and so we.

Have three main formats one is a linear overhear or trapezoidal manufacturers will actually use software to make this image a trapezoid shaped display this is typically used for vascular interoperative or small parts. Exams and a small part exam would consist of breasts testicles thyroids musculoskeletal those types of exams the. Next type of transition we have is a curved linear or convex array you can see that we have a nice wide. Field or wide near field here and we have a very wide far field these types of transducers are typically used for abdominal obstetrical and endo cavity exams in an endo.

Cavity exam would either be an endovascular endo rectal or trans esophageal and then we have a sector or vector array you can see we have a very narrow Near Field in. A wide far field um this is typically used for cardiac. Or abdominal exams where we need access on this small access point here is typically used for what’s called intercostal or in between the rib imaging um I. Want to touch briefly on transducer construction we get a lot of questions on transducers and I. Think the the transducer as a class to medical device is highly misunderstood so I just want to touch on transistor construction for just a couple of minutes I’m.

Just so we have an understanding of these devices and how they’re how they’re created I. Want to start with the lens of the length of the critical part of the transducer it is designed for the. Mechanical focus of the ultrasound beam there’s several different focuses which we don’t get into in this particular webinar but there’s several different focuses that ultrasone systems have. But the lens is responsible for a mechanical focus of the beam it’s. Made of either single or multiple layers and it must be iso 10 993 compliant and 10 993 refers to being biocompatible since we do have patient contact with the lens it has to be.

Made of biocompatible materials below our lens we have what are called matching layers and there are one or more some. Transducers have up to seven matching layers and they’re designed to maximize the transmission transmission. Of energy from the array to the tissue on by reducing reflection basically there’s a massive acoustic. Impedance mismatching between the transducer and the body and so what these matching layers do is they even. Out that acoustic impedance mismatch for efficient energy transmission and just to get you a little bit familiar.

With the science that goes into these matching layers on they’re generally in thickness a quarter of the wavelength the center frequency of. The transducer so if you want to do the math say you have a five megahertz transducer senator frequency figure out the wavelength of that particular probe divide that by. Four and that’s how thick these matching layers are now we have our array the array is a piezoelectric material and its purpose is to convert electrical energy to mechanical energy. Or pressure waves and then back and these arrays can have from one to thousands of individual elements.

Or crystals and if you look at this graphic off to. The right you can see what we did and this photograph was taken. In our manufacturing facility in Denver we actually overlaid a human hair onto a transducer array just so you can see the scale of these crystals and what they look like and then some.

Transducers not all will have some shielding which are typically around the. Array in the backing material and they’re designed to reduce EMI or. Electromagnetic interference and then our backing material which is up here this is designed as somewhat of a backboard if you will for the. Resonating crystals what they’re what the backing material does is it dampens down the vibration of. The crystals to reduce what’s called pulse duration which gives us better axial resolution moving on down the transducer we have a flex circuit.

And basically that’s just a bridge from the transducer elements or from the array elements down to our interconnect and we have an interconnect Wiz which is. A further bridge which may or may not have circuitry some transducers today have multiplexing built into that particular circuit board on some actually do some beam forming which used to. Be the province of the ultrasound machine but it has been moved up into the scan head then we have our miniature. Coaxials which are over here on these miniature coaxials there are anywhere from 64 to 128 of these miniature cables these are very similar to what you would. Have for your cable or satellite TV only miniaturize below that we have our strain relief which prevents acute stressing of the miniature cables within the transducer neck our cable.

Jacket which is our outer cover for our main cable and then again our main. Cable which has the 64 128 classical cables which have a very specific impedance and capacitance and they go on down to our connector which connects to the ultrasound.

Machine itself now I want to touch on resolution a little bit. As well there are different types of resolution that you’ll hear a stenographer talk about so it’s important. That we’re familiar with these different types of resolution this is also important for accreditation the different accreditation organizations I’m asked about. Spatial resolution and it’s important that you understand the components of spatial resolution so let’s start off with lateral um lateral resolution is essentially on side to side so our lateral.

Resolution of an ultrasound machine and the transducer is the ability to distinguish between two objects which are perpendicular to. The ultrasound beam so basically left to right our axial. Resolution is the ability to distinguish between two objects parallels are the old song beam so basically up and down and typically axial.

Resolution does not vary with transducer deck and then we have something called elevational which is a really fancy term for slice thickness if you look at an ultrasound probe. Essentially what that probe is doing is it’s taking a slice in.

Your body must let the CT slice but the the thickness will vary depending on the design of the transducer and. The design of the array and the the actual lens itself and so our elevational resolution. Is the ability to distinguish between two objects perpendicular to the scan plane or our slice and that will vary with that and then our next type. Of resolution is our contrast resolution if you look over here at our phantom this is a graphic of a tissue mimicking phantom.

You can see our target groups here and essentially these targets are objects of similar densities and our contrast resolution is the ability of the ultrasound system and probe to differentiate between. Two objects of similar densities and then our last type of resolution is our temporal resolution which is the ability to distinguish change.

Over time this becomes very important with say a cardiac exam where we need very high frame rates to watch the heart move in real time on transducer designations this is the question. We get on a regular basis these are rules of thumb but these are not hard. And fast rules when you see an ultrasound transducer and I have some examples up. Here the GE EAC the e stands for endo cavity the C stands for convex or the scan format and. Then the 8 is somewhat of a center frequency if you go down to our Pope’s key 5-2. It’s a convex to C and then 5 to 2 mega Hertz.

Is the frequency range of that particular transducer same with being Siemens forcing one for example on that is also a convex transducer and the frequency range is four and a half to 1. Mega Hertz and then we have our GE and other examples of GE ml 6-15 that is a matrix array which. Means that it has a two-dimensional array where there are rows and columns of elements within the transducer um.

It is a linear probe the frequency range is 4 to 15 and the D stands for the type of connector so if somebody tells you. I have a again say a c5 – 2 you should be able to tell what type of transducer that is by the designation usually let’s get into the. Different types of imaging modes ultrasound systems today have a variety of different imaging modes back when I started it in and I’m dating. Myself 1986 the first system I started working on only had two imaging modes and now they have multiples but our basic 2d image is called B mode imaging or brightness mode essentially.

We are sound waves are emitted what’s called along the exit propagation so basically we’re firing the lines into the body the echoes are received back and convert it into voltages and. The voltages are amplified and displayed as various shades of grey so in this particular picture this is actually my son then this this is about 11 years old um but. You can see here in this area here this is the bones in his forehead you can see they’re a very bright they’re very bright reflectors and so the Machine has assigned very bright. Shades of grey to those echoes where as you look in his developing brain um that is very soft tissue. Very weak reflectors and so the machine has assigned very dark shades of gray and everything in between that’s how that’s how B mode imaging works and then we have something that’s really. Cool it’s been off for a while but I’m still fascinated by it is three and 40 volume imaging and it’s done in a variety of ways either with a mechanical probe or.

A solid-state probe but this allows us to interrogate the body through a variety of scan planes and then and then aggregate those planes together and create this 3-dimensional. Image what you see here is a mechanical probe up in the. Top right within that transducer is a standard transducer array that is attached to a motor and it is inside an oil bath behind the dome of the. Probe and that array sweeps back and forth mechanically and interrogate the body there are transducers that are solid state and we use electronic beam stirring to sweep through the body but then we reconstruct.

Those images and we create these really cool three and four dimensional images that we. See here I’m and mode imaging and mode imaging stands for motion mode we utilize this to. Look promotion and you can see up here it says it’s used to detect. Temporal motion of the cardiac structure what we’re doing if you look over in the.

Image here you see this white line we have told. The Machine that we want it to look for motion along this particular scan line and so down here this line is going through the valve and heart and down here we actually. See the motion of that valve and so this is mainly ears in. Adult cardiac pediatric cardiac and it’s also used in fetal exams what we’ll. Do when a scenographer or technologist does a fetal exam he or she. Will drop that line down to baby’s heart and look for the motion and they can interpret that motion to see basically look for her health but they can also.

Use that to measure fetal heart rate and we have Doppler mode Doppler mode has been around. For probably 30 35 years and it’s really cool there’s all different kinds of dopplers but basically doppler helps us determine motion for those of you. Who have ever had a speeding ticket it’s a very same principle essentially with with a police officer who is looking for speeders he or she will use a radar gun and. They send out a beam at a fixed frequency on a car coming towards or going away from them and that beam since it is a fixed frequency when it comes back if. It comes back at a higher frequency and the car is coming towards them they know that they can they can do through an algorithm they can determine how.

Fast that car is going well we do the same thing with ultrasound essentially what we do is we send sound beams into a blood vessel typically and we bounce. That sound beam off of red blood cells and we get that beam back and we determine.

Depending on the frequency sent out we determine with the frequency that sent back if that blood is going towards us or. Away from us and we can tell how fast is going so.

It’s actually very simple the way it’s done there are different types of Doppler there’s this first image at the top we see we have pulse we adopt ler this spectrum that you. See down here shows us the blood flow in this common carotid artery and that’s what we’re looking at here this is my common. Carotid and so we can see direction the blood is going towards the transducer because our our signals above. What’s called a baseline we can see how fast it’s going we see it there’s a scale over here and so this scale. Tells us how fast in centimeters per second this blood is going.

And we can see the location this little gate up here tells us. Exactly where we’re measuring this velocity within the blood vessel um then we have something called continuous wave Doppler this is typically used within cardiac and it looks very similar to this we see we. See a spectrum where the velocities are displayed but the difference between pulse wave and continuous wave is continuous wave is constantly firing and that’s designed for. Very high velocities which are typical velocities that we do see with the heart in this image up here we also have color Doppler velocity and and this allows us to. Sign colors to various velocities within a vessel um you can see over here.

On the right-hand side of this image there is a scale and that scale will show us that blood going in one direction is. Dark blue to light blue and then the other direction is dark red going down to yellow and so what we’re doing is we’re assigning different colored pixels to different speeds of flow so.

We can get a graphical representation of what the blood is doing within a vessel where this comes in handy is say for example when I did this I had a. Big giant piece of plaque right in the middle of this vessel well what would happen is as the blood was flowing towards my head from right to left. As it hit that plaque it would swirl and change direction briefly before it went around well when it swirls it changes direction.

So it shifts from red to blue and so that’s how we can tell if there’s a problem using this color Doppler in the second image we have something. Called power or energy Doppler this is another type of Doppler but what this shows.

Is just the presence of flow it does not give us the loss of any direction or or angle. The only thing it tells us is hey there’s flow here it’s extremely sensitive. And where this really comes in handy is where you’re looking for very low flow such as to sip your exam would. Be a good example or if you had say an elderly patient patient and you were looking for flow and extremity down towards the ankle or in the foot if you. Didn’t really care whether whether or what direction the flow was going in you just want to know do I have. Flow power or energy Doppler is very useful for that and then this last one is relatively new it’s called dashi.

Or Doppler tissue imaging or velocity and it allows us to determine motion of structures and here. We have a heart you can see the four chambers of the heart down here and you can see the valves and so what we’re doing. Is we’re assigning different colors to different speeds of tissue a very highly trained physician who is reading this would be able to tell the health of the. Heart muscle by looking at these various velocities um this.

Is a this is not a malfunction but this is something that I. Have gotten if not dozens maybe hundreds of service calls over the year where somebody will. Say my doppler display is not working correctly my signal is wrapping around and what we’re seeing here and what I did is I intentionally missed just at this particular machine when I was. Doing my common carotid artery and you can see we have our spectrum but. The peak is getting cut off by this top bar and you can see how it’s wrapping around and coming in from underneath this is very common and it’s called aliasing and.

This is something that I did intentionally but sometimes it will be accidentally missed set on a machine on but over here you see my scale is set. 4.30 meters per second that is too low of a setting for my common carotid artery and so what I’m getting is I’m getting this wrap around so the the fix.

For that is what we have to do is we have to raise our scale. Up so the next setting on this particular machine ID would be believe would be like a. Point 4 2 which would be a proper setting for my common carotid we can also get color Doppler aliasing if you look at this top image this is my common carotid here. And above kind of peaking through here is my jugular vein and so this top image.

Is properly set so you see we have really good flow I don’t have much plaque. To speak of I have a teeny tiny bit right in here but a very healthy arteries so we wouldn’t expect any reversal of. Flow on what I did on the bottom image is I intentionally changed my scale instead of point 4 6 up here I changed at the. 0.23 which is far too low of a scale for what I’m looking at and so you see a lot of blue in here that does not mean my flow is reversed which. Would indicate a problem that if you have flow reversal you’re coming carted or artery that’s a serious problem. All I did was I changed this to 2 low scale and so I’m.

Wrapping around so my velocities are exceeding this point two three I’m wrapping around and I’m introducing that blew into my common carotid so this is not a malfunction. This is thankfully not an unhealthy patient this is just a system setting that is incorrect let’s talk about applications and presets um every. Ultrasound system design throughout history has multiple presets um and each one is designed for specific body part body type and transducer and here’s. Some examples small parks which is what I went into earlier adult echo pediatric echo abdomen.

This is something you’ll see on machine just the abdomen and abdomen plus plus abdomen. Plus plus would indicate a heavier or mid more difficult to image patient obviously the patients have. Visibility to the screen what you don’t want to put. Necessarily is large patient not good for their body image so what a lot of stenographers.

Will use an application specialist to use abdomen plus plus or difficult abdomen um these presets are created for individual. Preferences what looks good to one scenographer may not look. Good to another in fact as my wife and I were creating this presentation if you could have been a fly on the wall with the bickering that went back and forth between what.

Constituted a good image between her and I it would have. Been hysterical because I have a certain image presentation that I like she has a certain image presentation that she likes on. Neither one is wrong both give you all the diagnostic information that you need it’s just a different presentation it’s like it’s like liking different shades of blue so to speak and. So they are created for individual preferences um factory settings.

Are rarely if ever used and so every system sold is customized on each individual preset has twenty to thirty unique system parameter settings an application specialist. From the manufacturers spend hours or days creating these presets the moral. Of the story is this you are not going to get out of this webinar this one hour webinar how to create presets that takes years and a. Lot of specialized training what I’m trying to impress upon you now is back up often and back up your back up if you have an ultrasonic goes down and you go in. And you reload the soft an hour later you’re done and.

That system is up and running but you have not restored those presets that system is not up and running yet because the. Sonographer will not be happy with factory defaults so when I was a service engineer every time I got in front of the machine. I did a back up takes about two or three minutes you do them on the cd/dvd thumb drive it’s extraordinarily easy and it will save you. A tremendous amount of time and customer satisfaction underneath these precepts this is one of them we’ll talk about power and acoustic output power or acoustic output is the amount. Of energy acoustic or mechanical energy transmitted into the body and it’s measured as mechanical index the system is calibrated to OEM.

Specifications an OEM spec transducer for accuracy if you have a transducer that is improperly repaired the system is no longer tell abraded and will. Show an incorrect power output because the system is expecting an OEM spec transducer if you do not have an OEM spec transducer this power reading will be wrong we’re dentists we spend a. Tremendous amount of time and resources ensuring that our transducers match what the OEM intended that probe to do so our repairs will ensure correct acoustic output measurement one of the things that. We want to ensure that we’re doing when we when we talk about acoustic output is. We want to use that the philosophy of olara or as low as reasonably achievable we want to use the lowest power possible to get a diagnostic image and.

These powers are measured in decibels or percentage of maximum output down here you can see every three decibel change equals a 50% power change and I’ve actually done experiments in the past I’ve I’ve. Examined my my liver and kidney I’ve gone about 16 centimeters. Into my body and I’ve slowly turned down the power to see how much power I really needed to.

Penetrate my abdomen I’m about 185 pounds so not an easy scan not a hard scan and I’ve gotten down to 12 and a half percent. Maximum power output and still got in the diagnostic image. So it’s amazing how these machines will compensate for low. Power you can see down here the receiver amplifiers will compensate for changes in transmitted power to a certain degree and so as we decrease the amount of power we’re. Putting into the body the system will automatically try and amplify the received echoes to compensate for that and this is the received side so we have. An ultrasound transducer a transducer by definition is a device that converts one type of energy to another we’re converting.

Electrical energy to mechanical and a mechanical back to a level so we have a transmit and receive our acoustic output is our transmit. Our gain is our received and all our gain is is how much are we amplifying those return echoes if you look at these two images off to the right this. Is my thyroid and this is my common carotid artery a cross-section of it my esophagus here but this is thyroid on here. This soft tissue and all I’ve done is I’ve changed the gain I’ve changed nothing else in this particular image.

There’s different types of game we have our overall game and then we have something called TG C or D G C or LG C our LG. C is this top area and that allows just the gain of the image for uniformity from left to right and then our TG C or D G C it stands for. Time gain control or depth gain control but allows us to adjust our receiver gain.

Throughout the image from top to bottom and create a uniform image and so you’ll see a scenographer as the stenographer is performing an exam he or she. Will be running their hands up and down those pods and all they’re doing is making sure that they are making the the image uniform on. Transducer frequency um when I started in ultrasound transducers had one frequency and that was. It nowadays they’re pretty fancy they have six eight ten 12 different frequencies due to some technology within the machine and within the arrays themselves the transmitted frequencies vary depending on.

Probe and what you’re looking at our lower frequencies are. For deep abdomen deep cardiac things like that are very – frequencies are for superficial structures like breasts like thyroids think like that lower frequencies will give us higher prior penetration. On however the trade off due to physics is that.

We get lower resolution conversely our high frequencies are lower penetration. So we’re not going very deep into the body but much higher.

Resolution you can see here that for an example for a thyroid I would use anywhere from 12 to 18 megahertz on this particular image. Over here we’re using 14 megahertz and this is a breast setting for a deep abdomen. I’d use anywhere from 1 to 2 megahertz and that’s selectable by a but it’s as easy as a stenographer pushing a button on the system I mean you. Can either change the numerical frequency or on the Philips or GE machines you have an option to use what’s called resolution which is the high frequency normal would be your.

Mid frequencies or pen or penetration would be your lower frequencies over here these are two pictures of my liver and kidney that’s the same image that we started the presentation out with on these. Are identical images I haven’t changed a thing other than this top image is scanned. At two megahertz you can see two megahertz up here and. This bottom image same probe I change that to four megahertz and what you can see this coarse texture especially if. You look at the liver there’s very coarse texture within the liver down here it’s very fine we get a much finer image much higher spatial resolution if we’re using a higher frequency probe the. Rule of thumb is always use the highest frequency possible for the anatomy that.

You’re looking at harmonics harmonics are really cool I expect we probably have some some musicians in the room today but who would understand harmonics but harmonics are it is a secondary. Or a it’s a second or third or even fourth or fifth component of a transmitter to receive some way for example if we send two megahertz.

Into the body what we can do is we can receive that two megahertz filter that out and listen for four megahertz so the four the harmonics of two megahertz would be. Either one or four it would be either 500 kilohertz or eight so it’s always half or. Double your primary frequency and so in this particular image I’m using a little over four megahertz on. This top image and then what I did is I turned harmonics on and this is my.

Gallbladder that you’re seeing here this object that I’m circling with my arrow here this. Is you can see a little bit of noise down in here this noise could be interpreted as slugs within a gallbladder thankfully I do not have sludge I have a. Clean gallbladder and we were able to determine that by turning on harmonics and what the harmonics did was filter out some of the noise and it cleaned out my. Gallbladder here so these two images identical probe identical preset identical patient it’s just a I’m just using harmonic dynamic range another. Setting within a machine this tells the Machine what range of echoes I want displayed do I want more Gray’s or less Gray’s and. It depends on the type of anatomy that you’re looking.

At these two particular images is my thyroid you can see my thyroid in here I want a lot of shades of grey for soft tissues. So this bottom image is much more preferable to a sonographer into a radiologist. Than the top image now if you look at these two images um this is my common carotid artery I use a very low dynamic range on. This top image of 50 and I went to ninety vegetables on the bottom one you can see how beautiful and clean this carotid is here and how it’s very. Noisy and well are not well-defined in this bottom one and that in fact up here you. Can see this very thin line here this is actually plaque within.

My artery that plaque disappears down this bottom image so this this is a clinical reason why we want to use a low dynamic. Range for different types of exams especially the capacitors folklore transmitted zones as I mentioned earlier we’re talking about transducer construction the lens of a transducer is responsible for the fixed mechanical focus of. A transition we can also focus the system using something called an electronic focus and. You can see on these two images here we have multiple focal zones what I’ve done here is I’ve turned on multiple Foucault’s own basically what I’m doing.

Is I’m telling the machine to focus in multiple areas the good news is is it will do that and I get a very very sharp image the bad. News is since I’m focusing multiple times is my framerate goes down and so my temporal resolution we talked about resolution earlier on. My temporal resolution will decrease and when we do use multiple pocos owns we can create what’s. Called the stitching artifact if you service folks ever see a horizontal artifact in an ultrasound image do not troubleshoot it you will chase your tail for days and weeks and months and you will. Throw parts and parts and parts and probes at it and you will not fix it this is part of the physics of stitching images.

Together if you ever see that artifact have your customer turn off multiple focal zones that. Should disappear if it does you know it’s not a malfunction I’m frame rate we talked about this a little bit earlier. This is our temporal resolution frame rates depend on system settings we can choose higher frame rates and that is that is great for a patient.

Who you can’t get to sit still or if you’re doing a cardiac exam or if you’re doing. A fetal exam and baby’s moving around you’re looking at baby’s heart you need you have to have high frame rates if. You’re looking at soft tissue so you’re looking at somebody’s thyroid and you want to get the maximum resolution out of that image and that patient can and. Will hold still will hold their breath you can use these multiple focal zones that we see here and get a higher resolution image and so frame rates are always displayed on the image and.

Again lower frame rate typically a better image but there are compromises to that space time and resolution this is another. Setting on the machine essentially what you’re doing is you’re telling the system I want you to focus more on spatial resolution versus temporal. Resolution and spatial resolution is our axial lateral and elevational resolution our temporal is our.

Frame rate so if you’re looking at a heart you want maximum temporal resolution if you’re looking at a thyroid you want maximum spatial resolution so that’s what that term. Means is space time or resolution settings we they call edge edge or pre-processing is a setting on all ultrasound machines and what it does is it allows you to. Define the sharpness of borders of structures within the body it’s very similar to the sharpness setting on your television you can. See my top image I have a very high edge setting and this border of.

My thyroid and the muscle is very very sharp I took. That all the way down to men on down here and you can see the image got the Musa sonographer term here.

It got mushy and so you can see that this bottom image is not very clear I’m usually you want that somewhere in between maximum on most machines is. Plus three minimum is minus three I’m somewhere in the middle is usually good and we have something called persistence or frame averaging and that allows. Us to take multiple ultrasound images and average them together so the image is not noisy you can see this image of my thyroid again and it’s very sharp. Somewhat noisy on this bottom image is a little bit smoother I’m usually you want that averaging somewhere in.

The middle post-processing or gray maps as I mentioned earlier when we’re talking about B mode imaging you can. Be most sense for brightness mode we’re assigning shades of gray to the different intensities that the machine is receiving back. We can make it anything we want I can make a black and white I can make it white on black and if. You look off to the right I can make it all these beautiful colors it’s really whatever the sonographer wants it to.

Be these two images here using post-processing exact same image I changed nothing between these two images of my thyroid other than changing my post-processing map the bottom is a map of a seven. On this particular machine the top one is a map of the one we can use colors. Colors are kind of cool it looks cool but it also doing the way our the human eye is constructed is it allows us to differentiate between more subtle changes by. Using colors so some people do use colors on their post-processing we also have something called speckle reduction imaging now you look at these two images this bottom. Image is very smooth this top image is very grainy all the different manufacturers have it ultrasound images are going more. Towards a smoother presentation these days I’m somewhat old-school I like the contrasting gray images and again it’s preference both these images have identical information I.

Can read both and I can see exactly what I’m looking for but a lot of it has to do with presentation then. We have compound imaging compound imaging has been around for a while very cool through electronic beam steering we can take a traditional ultrasound beam scan if you look down here instead of.

Just going straight perpendicular from our transducer lens we can actually fire our ultrasound beams at angles using compound. Imaging this allows us to hit a structure from various.

Angles and get a much better representation of the shape of that structure if you. Look at these two images the structure doesn’t really stand out all that well in. This top image down here is very well defined compound imaging it’s called cross beam GE called.

The cross beam Philips cause its own Oct all the manufacturers have it but it’s just another way to process images. Now we’re going to get into artifacts this particular transducer has an artifact I purposely chose it because it has. A drop out here artifacts are typically what’s called hypoechoic which means darker versus hyper cook which would be a lighter artifact if we see this type of artifact the first thing we want to. Do is we want to look at the transducer this particular artifact it’s probably only one. Maybe two elements out to the way to determine that is do we have another transducer at the same type can we plug it in and see if that. Artifact goes away that that tells us conclusively whether it’s the probe or not um the other thing we want.

To do is if we determined that it’s not the array we. Want to check the table the way the ultrasonic transducers are designed is the the transducer has a flex point there’s a strain relief coming out of the scan. Head the manufacturers created a strain relief to reduce the acute stresses that happen. But inevitably especially the cardiac probes transducers will start breaking tables within that neck and so to determine if you see an artifact like that if it’s caused by the cable what you. Can do is as you’re staring at the image the near-field.

You see that drop out is hold the transducer by the strain relief and flex it. Back and forth and see if that appears and disappears if it does it’s the pro cable then you want to go down to the probes or the probe pins in the. Connector you want to inspect those regularly and if you have a pinless connector um you want to clean that if you do have best pins remedy that immediately. Because what will happen is if there’s that pins on either the probe or the connector. Board you’ll plug that probe into another connector board and then you’ll damage that board and then other probes get plugged into that slot and then. You damage additional probes and essentially a virus it’ll grow and grow so.

If you have a damaged connector board or a damaged probe on the pins repair or replace. That absolutely positively immediately to prevent further damage if it’s nothing to do with the transducer then you then you need to go into the ultrasound system itself and looking at the front-end. Boards of the system on which I’m not going to cover today that’s a different module but that’s that’s how to UM field troubleshoot and. Ultrasonic transducer if you see an artifact like that image noise this is all. Kinds of fun when I was in service I used to love troubleshooting image problems or noise oblems because you were you were essentially a Ghostbuster you were looking for. You were looking for ghosts these these noise sources could be anything the first thing you did you want.

To do if you do see noise on an image and you can see these two images over here this was actually in the image problem that one of my service engineers was troubleshooting. Some years ago and I snapped these pictures up here you see noise in a.

Two dimensional image or a b-mode image down here that this is noise in a color Doppler image so where you want to start is the probe cable again start. Flexing the probe cable at the skinhead net see if you can make the noise come and go see if. You can make it better or worse if you can then you have a bad problem with or you have a you have a problem with your propane um if it’s not. The transducer at that point you want to start isolating the system what’s plugged into it do you have printers plugged into it do you have a DICOM cable plugged into. It is there if you’re old-school is there a VCR another type of printer plugged into it on board if so isolate that. Unplug everything if that doesn’t get rid of the noise now you want to look at a different power source can you try a.

Different outlet in the room on that maybe on a different circuit um can you move the system to a different environment within. The facility you may have noise within the department so you want to try a different room. Or an entirely different department within your facility um if the facility grown compromised and you know the question that. Is I had no idea I actually had a system one time. Where I used battery cables from the ground lug of the machine. To the cold water pipe in the room to check the system ground and I was able to determine that.

I had a bad ground within the room by going to the ground the cold water pipe I’ve had problems where I had a treadmill two. Rooms away from my ultrasound system that was inducing noise I’ve had fluorescent light ballasts I actually had. One problem where there was an elevator that was adjacent to the ultrasound room and every time the elevator passed by the. Floor it would induce noise and so there’s all kinds of ways to. Troubleshoot noise it’s it’s a difficult problem but in my opinion it’s a very.

Fun one so I know this was very fast-paced normally this class takes about an hour and a half and there’s been a lot of times where I’ve done this. Class in person where we actually get a machine out and we scan we actually scan ourselves and we play with the buttons as we’re doing this but for purposes of the webinar we. Were able to shorten it down to an hour and kind of get through this pretty quickly so now we’re on to questions and I see that one question came over what. Happens if you set the frequency too high if the frequency is set too high what will happen as you’re loose you’ll lose penetration as I mentioned earlier you want. To set the frequency as high as possible for what you’re looking at so if I’m looking at my thyroid for example I use about 14 to.

15 maybe even 18 megahertz but that 14 to 18. Megahertz I would not be able to use on my abdomen I. Wouldn’t have the penetration so you always want to set the frequency as high as possible and still get the diagnostic image that you’re looking for um there’s. Another question that came over to I am is how can you tell if you have a bad transducer a great question the problem with an ultrasound transducer versus. An ultrasound part if you have a power supply and the power supply is bad it doesn’t.

Turn on if you have a monitor that’s that it doesn’t turn. On um the problem with a transducer is bad transducer transitions that are out of compliance will usually still work they’ll still create an image they’ll still create somewhat of a diagnostic image but you. Know the question is are they doing what they’re supposed to do and the answer that is out. In the field you really can’t tell that’s what when we remanufacture and recondition transducers we go we.

Develop specs that are long lines and what the manufacturers have and we get the transducers back to that so. We ensure that back in our laboratory but I’m out in the field to tell if you have a bad transducer just. With a nebulous image quality issue it’s very difficult if not impossible to to tell any other questions Jeremy hey.

Matt sure do I’ve got a couple of questions that came in and a few more of course attendees you have the ability to submit your. Question any time now we’re going to get through as many as we can but I do want you to rest assured. That if we don’t get to your question I’ll email it.

To Matt when we’re done and I know he’ll follow up with you offline but Madness next question is what. Training is required from an ultrasound smoger first oh yeah as I mentioned earlier my wife is a stenographer and on a regular basis she. Comes home a little livid and fortunately is not because of something. I did it’s because of questions she did it’s at work she’ll get patients who will come in and say hey can you teach me how to.

Do this or you know did you have to go to a seminar to learn. How to do altar sound to really become a stenographer to do this properly it takes years of education both in the classroom and in the clinical setting I’ve been doing this.

For 32 years I am NOT a registered stenographer I’ve learned to do this through literally daily just picking up a probe scanning myself playing with buttons and asking a lot of questions and of. Course I’ve been married for 13 years to a scenographer so I’ve learned a tremendous amount through.

Her but there’s a lot of education that goes into it the intent of today’s webinar was not to teach you to be stenographers that’s impossible given the amount of time we have. Together but it was just to familiarize you with the.

Terminology great is there a model phantom that you can recommend by checking image quality on ultrasound machines um you know we don’t officially as an organization endorse a phantom but I’ve. Always used and like the ACS line of phantoms Linda Hammond is the owner of ATS is a dear friend of mine and I just love their phantoms they’re solid. They don’t have to be recalibrated they’re extraordinarily durable and she has an entire. Line of phantoms to do anything you may need to do on the general.

One that I like it the HTS model 5:39 great a few more. Questions coming in let’s see if we can get through at least one more Matt how can I get more training and become more proficient at. It um you know you can reach out to me we we can do this class on-site we are available to do this on-site if you wish you reach out. To me directly you see my email address up on the screen and we can talk about doing it but I love doing this on site because that’s we we really have fun we get. In front of a machine we lift up our shirts we get some gel on.

Us and we start doing all these things that we talked about today live and so you can really see you know what you know what happens. When I change my acoustic output what changes when I have you know what happens when I change my dynamic range things. Like that great and I see one mark go ahead. Jimmy yeah one more did I chatted it over to.

You if you want to take it the cable sheath yeah if. A cable sheath separates from a stream is it repairable on the answer is yes and it depends on the level of damage if it’s if the sheep just comes out please don’t do a. Field repair on the manufacturers use certain adhesives to ensure that that probe is repairable if it. Comes out of the field I’ve seen a lot of people use superglue which. Will work for a short period of time but then now you’ve made the that particular joint unrepairable because it’s a permanent adhesive it also. Makes it very stiff and accelerates the damage to the internal cables.

That’s a fairly easy repair if the cables haven’t been damaged if cables have been damaged we can wreak able a probe and. Then redevelop that strain relief and basically get you back a brand new transducer great well Matt I appreciate your. Time and the knowledge that you share today is always very insightful when your webinar. Wednesday presenter and of course I want to thank our sponsor today and bought us imaging but I want to remind everyone that one lucky attendee will win an Amazon. Gift card for completing the post webinar survey yes you do need to.

Complete the survey to obtain your cee certificates if you do not see the survey that should appear on your screen shortly please email. Us at webinar at MD publishing comm we’ll be happy to send the survey over to. You of course we are continuing with webinars every Wednesday going through December 13th so to see our complete list of upcoming. Webinars please visit technicians website the URL is one technician com Ford slash webinars all right guys we’ll. See you back next Wednesday enjoy the rest of your afternoon Thank You Jaime.