MCCCD Program Description

Sonographic Principles and Instrumentation II

Course: DMS151

First Term: 2015 Fall

Lecture 2.0 Credit(s) 2.0 Period(s) 2.0 Load
Subject Type: Occupational
Load Formula: S- Standard

Description: Sonographic principles and instrumentation necessary for the performance of diagnostic sonographic examinations using Hemodynamics and Doppler imaging. Identifying and reducing image artifacts. Quality control materials and procedures. Biological effects of ultrasound energy.

MCCCD Official Course Competencies
1. Explain how pulsed Doppler, color flow imaging, and amplitude imaging is achieved. (I, II) 2. Recognize and describe image artifacts and techniques to minimize or eliminate them. (III) 3. Describe the importance of performance, safety, and output measurements and standards. (IV)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.

MCCCD Official Course Outline
I. Hemodynamic and Doppler Imaging A. Hemodynamics 1. Factors that influence blood flow a. Cardiac function b. Compliance c. Muscle tone d. Vessel branching patterns and dimensions e. Luminal vessel diameter 2. Pressure gradient a. Relationship between heart stroke volume, heart rate, blood volume b. Dependence on flow and resistance c. Effect of peripheral resistance d. Sources of resistance 3. Hemodynamic resistance a. Blood viscosity b. Friction c. Inertia 4. Poiseuille`s Law a. Relationship between pressure, flow volume, and resistance b. Effect of vessel radius to velocity and flow volume c. Effects of temperature, exercise, and pharmacologics (1). Specific to various systems 5. Bernoulli`s equation a. Relationship between velocity and pressure 6. Flow patterns a. Steady flow b. Pulsatile flow c. High resistance d. Low resistance e. Laminar f. Turbulent flow (1). Reynolds number (2). Bruit g. Effects of stenosis on flow characteristics h. Effects of peripheral resistance 7. Venous resistance a. Hydrostatic pressure b. Effects of respiration c. Muscle pump d. Gravitational pressure e. Incompetency f. Fistula formation g. Pressure versus volume effects B. Doppler Physical Principles 1. Doppler effect a. Principle as related to sampling red blood cell movement b. Doppler equation 2. Factors influencing the magnitude of the Doppler shift frequency a. Range of the Doppler shift frequency b. Effects of beam angle, transmitted frequency c. Relationship between frequency shift and flow velocity, flow direction d. Relationship between blood pressure and blood volume C. Doppler Instruments 1. Definition of continuous wave a. Range ambiguity b. Spectral appearance c. Advantages and disadvantages 2. Definition of pulsed-wave Doppler a. Range resolution b. Nyquist limit c. Advantages and disadvantages 3. Duplex instruments a. Definition b. Basic principles c. Instrumentation (1). Receiver (2). Demodulator (a). Quadrature phase detector (3). Wall filter (4). Directional knobs 4. Spectral analysis a. Appearance on the spectral display (1). Flow direction (2). Flow velocity (3). Velocity profiles (a). Plug (b). Turbulent (c). Laminar b. Waveform magnitude or brightness (1). Fast Fourier transform (FFT) c. Qualitative versus Quantitative evaluation D. Color Flow Imaging 1. Sampling methods a. PW Doppler b. RBC sampling c. Tissue sampling 2. Display of Doppler information a. Flow direction b. Average velocity c. Velocity maps d. Angle dependence 3. Advantages and disadvantages 4. Instrumentation a. Autocorrelation (1). Time domain processing (2). Dwell time (3). Color sensitivity b. Relationship between color box size and frame rate (1). Ensemble length/packet size/pulse packet 2) Line density 3) Depth of penetration c. Color maps 1) Hue 2) Saturation 3) Brightness/luminance/intensity E. Color Power/Energy Mode 1. Displayed information - formats a. Flow direction b. Displayed velocity c. Velocity maps d. Angle independence 2. Advantages and disadvantages II. Artifacts A. Definition 1. Assumptions of sonographic beams and instruments B. Performance and Interpretation Recognition 1. Appearance on display a. Display of non-structural echo signals b. Missing real structural echo signals c. Displacement of echo signals on display d. Distortion of echo signal 2. Definition of each artifact 3. Mechanisms of production C. Resolution and Propagation Association 1. Axial resolution 2. Lateral resolution 3. Slice thickness/beam width artifact 4. Acoustic speckle 5. Temporal resolution D. Propagation 1. Reverberation a. Comet-tail b. Ring-down 2. Mirror image 3. Duplication 4. Side lobes or grating lobes 5. Velocity error 6. Refraction 7. Edge shadowing 8. Range ambiguity 9. Multipath E. Attenuation 1. Shadowing 2. Enhancement 3. Focal enhancement or focal banding F. Miscellaneous 1. Dead zone/near field artifact/main bang 2. Excessive gain or TGC 3. Excessive reject 4. Electrical noise G. Doppler and Color Flow 1. Aliasing 2. Mirror imaging or ghosting 3. Color registration a. Ghosting or flash b. Bleed c. Noise 4. Incident beam angle 5. Clutter 6. Slice thickness 7. Reverberation H. Volumetric Imaging III. Quality Assurance/Quality Control of Sonographic Instruments A. Program 1. Purpose 2. Frequency 3. Documentation B. Evaluation of Instrument Performance 1. Test objects 2. Various tissue equivalent phantoms C. Parameters 1. Test object a. Dead zone b. Axial resolution c. Lateral resolution d. Range accuracy 1) Vertical depth calibration 2) Horizontal calibration e. TGC characteristics f. Uniformity g. System sensitivity 2. Tissue equivalent phantom a. Dead zone b. Range accuracy 1) Vertical depth calibration 2) Horizontal calibration c. Detail resolution 1) Axial resolution 2) Lateral resolution 3) Slice thickness/elevational resolution d. TGC characteristics e. System sensitivity f. Contrast resolution 1) Dynamic range a) Image congruency test 3. Doppler phantoms a. Maximum depth b. Pulsed Doppler sample volume accuracy c. Velocity accuracy d. Color flow sensitivity e. Image congruency test D. Statistical Indices 1. Chi square 2. Sensitivity/specificity 3. Negative/positive predictive value; prevalence of disease 4. Accuracy IV. Bioeffects and Safety A. General Terms 1. Hydrophone 2. Calorimeter 3. Thermocouple 4. Dosimetry 5. In vivo 6. In vitro B. Acoustic Output Quantities 1. Pressure a. Units 1) MPa 2) mmHg b. Peak pressures 2. Power a. Units 1) mW b. Methods of determining power (radiation force, hydrophone) 3. Intensity a. Units 1) mW/cm2 2) W/cm2 b. Spatial and temporal considerations c. Average and peak intensities d. Methods of determining intensity e. Intensities 1) Spatial average-temporal average (SATA) 2) Spatial peak-temporal average (SPTA) 3) Spatial peak-pulse average (SPPA) 4) Spatial peak-temporal peak (SPTP) 5) Spatial average-temporal peak (SATP) 4. Intensity and power values for operating modes C. Acoustic Output Labeling Standard 1. Definition of thermal index a. Thermal Index for Soft Tissue (TIS) b. Thermal Index for Bone (TIB) c. Thermal Index for Cranial Bone (TIC) 2. Definition of mechanical index (MI) a. Stable cavitation b. Transient cavitation D. Acoustic Exposure 1. Prudent use 2. Methods to reduce acoustic exposure a. As Low As Reasonably Achievable (ALARA) E. Primary Mechanisms of Biologic Effect Production 1. Cavitation mechanisms 2. Thermal mechanisms F. Experimental Biologic Effect Studies 1. Animal studies 2. In vitro studies 3. Epidemiologic studies 4. Limitations G. Guidelines and Regulations 1. Organizational statements a. Clinical safety b. Prudent use c. Bioeffects d. Epidemiology e. In vitro f. Safety in training and research g. Other 2. National Electrical Manufacturers Association (NEMA) 3. Food and Drug Administration (FDA) H. Electrical and Mechanical Hazard 1. Patient susceptibility 2. Operator susceptibility

MCCCD Governing Board Approval Date: June 16, 2015

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.