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ABDOMINAL AND PELVIC ULTRASOUND IMAGING

What is abdominal or pelvic ultrasound Imaging?


Abdominal ultrasound (US) is a method of obtaining images from inside the
human body through the use of high frequency sound waves. The
soundwaves' echoes are recorded and displayed as a real-time, visual image.
No radiation is involved in ultrasound Imaging. An abdominal US image is a
useful way of examining internal organs, including the liver, gallbladder,
spleen, pancreas, kidneys, and bladder. US images are captured in real-time,
so they can show movement of internal tissues and organs, such as the
pumping of the heart and the flow of blood in arteries and veins. This can help
to diagnose a variety of conditions and to assess damage caused by illness.
For women, pelvic ultrasound is most often used to examine the uterus and
ovaries and, during pregnancy, to monitor the health and development of the
embryo or fetus. In males, a pelvic ultrasound usually focuses on the bladder
and the prostate gland.
What are some common uses of abdominal or pelvic ultrasound?
Ultrasound Imaging is used extensively for examining the kidneys, liver,
gallbladder, pancreas, spleen, and blood vessels of the abdomen. Because it
provides real time images, it can also be used to guide procedures such as
needle biopsies, in which a needle is used to sample cells from an organ for
laboratory testing, help a clinician determine the source of many abdominal
pains, such as stones in the gall bladder or kidney, or help identify the cause
for enlargement of an abdominal organ.
For females, ultrasound examinations can help determine the causes of pelvic
pain, abnormal bleeding, or other menstrual problems. US images can also
help to identify and assess cysts and fibroid growths, as well as ovarian or
uterine cancers. For males, pelvic ultrasound is a valuable tool for evaluating
the prostate, as well as for evaluating the tubes that carry semen.
In both sexes, a pelvic ultrasound examination can help to identify tumours
and other disorders in the urinary bladder. Because ultrasound provides real
time images, it can also be used to guide procedures, such as needle
biopsies, in which a needle is used to sample cells from an organ for
laboratory testing. The pelvis shelters some of the largest blood vessels in the
body, and ultrasound can be used to evaluate blood flow in those vessels.
Is there anything I have to do to prepare for the procedure?
You should wear comfortable, loose fitting clothing for your US examination.
Other preparation depends on the type of examination you will have. Patients
requiring an ultrasound of the upper abdomen (liver, gallbladder and
pancreas) need to fast for 6 hours before the procedure so that gallstones can
be excluded. Patients requiring an ultrasound of the pelvis or kidneys and

bladder need to drink one pint of water one hour before the examination and
not go to the toilet until the examination is completed. This is important as a
full bladder helps to show the pelvic organs clearly.
What does the procedure involve?
The ultrasound equipment consists of a console containing a computer and
electronics, a video display screen and a transducer that is used to scan the
body. The transducer is a small, hand-held device about the size of a bar of
soap, attached to the scanner by a cable. The radiologist or sonographer
spreads a lubricating gel on the patient's abdomen in the area being
examined, and then presses the transducer firmly against the skin to obtain
images.
The US image is immediately visible on a nearby screen that looks much like
a computer or television monitor. The radiologist or sonographer watches this
screen during an examination; often, the patient is able to see it as well.
How does the procedure work?
Ultrasound Imaging is based on the same principles involved in the sonar
used by bats, ships at sea, and anglers with fish detectors. As a controlled
sound wave bounces against objects, its echoing waves can be used to
identify how far away the object is, how large it is, and how uniform it is.
The ultrasound transducer functions as both a loudspeaker (to create the
sounds) and a microphone (to record them). When the transducer is pressed
against the skin, it directs a beam of inaudible, high frequency sound waves
into the body. As the sound waves are echoed from the body's fluids and
tissues, the sensitive microphone in the transducer records tiny changes in
the sound's pitch and direction. These waves are instantly measured and
displayed by a computer, which in turn creates a real-time picture on the
monitor. The live images of the examination can be recorded on videotape. In
addition, still frames of the moving picture are usually "frozen" to capture a
series of images, which are stored on the Queen Elizabeth Hospitals Trust
Picture Archiving and Communication System (PACS).
How is the procedure performed?
There are three methods of performing pelvic ultrasound: abdominal
(transabdominal), vaginal (transvaginal, endovaginal), and rectal (transrectal).
The same principles of high-frequency sound apply in each technique.
In the transabdominal approach, the patient is positioned on an examination
table, and a clear gel is applied to the lower abdomen to help the transducer
make secure contact with the skin. (The sound waves produced by the
transducer cannot penetrate air, so the gel helps to eliminate air pockets
between the transducer and the skin.) The sonographer then presses the
transducer firmly against the skin and sweeps it back and forth to image the
area of interest.

Transvaginal ultrasound involves the insertion of the transducer into the


vagina and is performed very much like a gynaecologic examination. A
protective cover is placed over the transducer, lubricated with a small amount
of gel, and then inserted into the vagina. The images are obtained from
different orientations to get the best views of the uterus and ovaries.
The prostate gland is located directly in front of the rectum, so the ultrasound
examination can be performed transrectally. A protective cover is placed over
the transducer, lubricated, and then placed into the rectum so the sound need
only travel a short distance. The images are obtained from different
orientations to get the best view of the prostate gland. If a suspicious lesion is
identified with ultrasound or with a rectal examination, an ultrasound-guided
biopsy can be performed. This procedure involves advancing a needle into
the prostate gland while the radiologist watches the needle movement with
ultrasound. A small amount of tissue is taken for microscopic examination.
Each method has its advantages. The transabdominal approach offers an
expanded view of the entire abdomen and/or pelvis, showing where one
internal structure is in relation to another. Since the transducer is brought
closer to the area being examined in the transvaginal and transrectal
approaches, improved visualisation may be achieved. Thus, it can be helpful
in locating the fetal heartbeat in an early pregnancy, evaluating the uterus, or
measuring a cyst in an ovary. The sonographer or radiologist will decide
whether one or a combination of approaches is best for your particular case.
The sonographer or radiologist is able to review the ultrasound images in real
time as they are acquired, and the patient can be released immediately after
the examination is completed. The examination usually takes less than 20
minutes.
What will I experience during the procedure?
Ultrasound Imaging of the abdomen or pelvis should be painless. With
transabdominal ultrasound, you will lie on your back on an examining table.
There may be varying degrees of discomfort from pressure as the transducer
is moved over your abdomen, especially if you are required to have a full
bladder.
With transvaginal ultrasound, although the examination is often performed to
look for a cause of pelvic pain, the ultrasound examination itself should not be
painful or significantly increase your discomfort. A vaginal sonogram is usually
more comfortable than a manual gynaecological examination, and is similar to
using a tampon.
If no biopsy is required, transrectal ultrasound examination of the prostate is
similar in discomfort to a rectal examination performed by your doctor. If a
biopsy is performed, additional discomfort, due to the needle insertion, is
usually minimal because the rectal wall is relatively insensitive in the region of
the prostate.

Almost all abdominal and pelvic examinations take less than 20 minutes.
Who interprets the results and how do I get them?
The radiologist or sonographer who performs the examination and is
experienced in US and other Imaging techniques, will analyse the images and
send a report, usually the same day. As soon as the examination is reported,
the report will be instantly available on the hospital information computer
system. Results for general practitioner (GP) patients are posted to the GP
and are usually available within 7 to 10 days after the procedure. Additionally,
once the images have been reported, all GP reports are electronically sent
direct to the GP surgery. The Queen Elizabeth Hospital has a picture
archiving and communications system (PACS), which allows the distribution
of diagnostic images and reports, within the hospital, by computer and the
images are usually available to hospital clinics and wards within 10 minutes of
being archived.
Are there any risks?
Ultrasound Imaging is a painless, non-invasive, low cost examination, which is
widely available and easy to use. Ultrasound Imaging uses no radiation, and
is the preferred Imaging modality for diagnosis and monitoring of pregnant
women and their unborn infants.
For standard diagnostic ultrasound there are no known harmful effects to
humans.
What are the limitations of abdominal or pelvic ultrasound Imaging?
Ultrasound has difficulty penetrating bone and therefore can only see the
outer surface of bony structures and not what lies within. For visualising bone
or internal structure of certain joints, ultrasound waves do not reflect clearly
from bone or air. For visualisation of bone, other Imaging modalities, such as
computed tomography (CT) or magnetic resonance Imaging (MRI) are
preferred. Excess body tissue may also reduce the quality of the images.
Any further questions?
We hope that this information has helped to answer some of your questions
and reinforced the information you have already been given.
If you have any questions that have not yet been answered, you may want to
write them down. This will help you to cover any concerns you still have when
you speak to the radiologist, sonographer or nurse.