devices IMAGING

Matthew D.Winter, DVM, Diplomate ACVR, University of Florida

Ultrasonography in Practice:
Practical Considerations

The use of ultrasonography in veterinary medicine has had a great

impact in diagnostic accuracy and quality of care.
ver the past 10 years, technical advance- nary medicine. Perhaps the most common is the application. Ocular ultrasonography can help

O ments have increased the utility of ultra-

sonography and decreased its cost to
general practitioners.1–3 Before purchasing an
abdominal examination, closely followed by
echocardiography. The utility of ultrasonography
in the diagnosis and management of muscu-
evaluate the fundus in patients with mature
cataracts. Noncardiac thoracic ultrasonography
is also useful for assessing pleural disease,
ultrasonography unit, however, you should ask loskeletal disease has also been well docu- mediastinal masses, and peripheral pulmonary
several important questions about anticipated mented. Cervical ultrasonography, especially for lesions (Figure 1).
application and expense: evaluating the thyroid lobes, is another common c o n t i n u e s
• What types of ultrasonographic examinations
will you be performing most frequently?
• Will you mainly be doing abdominal
ultrasonography?
• Is a member of your practice experienced
in echocardiography?
• Will you be investigating lamenesses with
musculoskeletal ultrasonography?
The answers to these initial questions will dic-
tate how much you spend on your unit and
which transducers you select for purchase.

It is important to note that the utility of ultra-

sonography is almost entirely operator depend-
ent; the purchase of a technologically superior
unit is no substitute for time, patience, experi-
ence, and expertise. Therefore, acquisition of
any ultrasonography equipment should be
accompanied by a regimented training program;
review of related texts and articles;2,4 an under-
standing of cross-sectional anatomy; and fre-
quent, practical application (practice, practice,
practice) in your hospital.
1
Indications A radiologist performs a noncardiac thoracic ultrasonographic examination. Note that ambient lighting was
Ultrasonography has many applications in veteri- increased for photography purposes; imaging should be performed in a darkened environment.

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devices CONTINUED

One of the most helpful applications of ultra- cases of large fluid accumulations, ultrasonogra- tary role of diagnostic-quality abdominal radiog-
sonography in veterinary medicine is ultrasonog- phy may also produce a therapeutic effect. raphy in the complete evaluation of suspected
raphy-guided fine-needle aspiration and biopsy. abdominal disease cannot be overstated. Diag-
Often, the results of ultrasonography are nonspe- Considerations nostic-quality radiographs supply information
cific. The identification of parenchymal nodules Complementary Role about the musculoskeletal system and help focus
or masses may indicate a benign or malignant Ultrasonography is often incorrectly considered the ultrasonographic examination.
process, and cellular evaluation is needed for a superior imaging modality due to its ability to
definitive diagnosis. Ultrasonography is an excel- reveal the internal structure of an organ. Ultra- Operator Skill
lent tool for safely and accurately guiding a nee- sonography does allow for identifying distinct The accuracy and utility of ultrasonography are
dle into a nodule or mass to ensure proper internal features of soft tissue structures and totally operator dependent. It is the role of most
sampling and an accurate diagnosis. organs that are not possible to distinguish on veterinary ultrasonographers to produce diag-
radiography. For example, a radiographically nostic-quality images while simultaneously inter-
In addition, the use of ultrasonography to guide enlarged kidney may indicate the presence of a preting findings. Recognition of lesions that
abdominocentesis, thoracocentesis, pericardio- renal mass, diffuse parenchymal enlargement, require further interrogation and the proper
centesis, cystocentesis, or biliary centesis or hydronephrosis. Distinction between these application of additional tools, such as color
increases the safety of each procedure when soft tissue radiographic lesions may be possible Doppler, are important in the thorough evalua-
small volumes of fluid are sampled. In some with ultrasonography. However, the complemen- tion of the veterinary patient.

The Inner Workings

of Ultrasound
The essential components of the ultrason-
ography unit are the transducer (Figure 2)
and computer (Figure 3).

At the heart of the transducer is the piezo-

electric crystal, a substance that reacts to the
periodic application of an electrical charge
to produce the ultrasound waves used for
imaging. The frequency of ultrasound waves
produced by the crystals, as well as the con-
figuration of these crystals, dictates the appli-
cation of each transducer. Frequency is
2
directly proportional to spatial resolution Ultrasound transducers—convex broadband transducer that can transmit at a frequency range of 9–4 MHz (A);
and is inversely proportional to penetration: microconvex transducer with a small footprint that can transmit at a frequency range of 8–5 MHz (B); linear
• High-frequency transducers are typi- transducer that can transmit at a frequency range of 17–5 MHz (C)

cally used in smaller patients or to visual-

ize superficial structures (tendons, • Linear transducers consist of a straight, flat footprint; a pie-shaped field of view; and
thyroid lobes, feline abdomens) array of crystals that produce a rectangular some loss of spatial resolution. These trans-
• Low-frequency transducers are used if field of view, with a wide, flat footprint. They ducers are most commonly used in echocar-
spatial resolution can be sacrificed for are typically high-frequency transducers, diography but can be used in other areas as
penetration and increased imaging depth providing high spatial resolution but more well.
(abdominal examinations in large dogs, limited penetration. • Convex and microconvex transducers offer
thoracic examinations in horses). • Sector (phased-array) transducers consist a compromise between the spatial resolution
Common crystal configurations, or crystal of an array of crystals that rapidly produce of a linear configuration and the small foot-
arrays, include linear-, sector- (phased-), ultrasound waves and thus yield images with print and wide, pie-shaped field of view pro-
convex-, and microconvex-array transducers: high temporal resolution; a small, square vided by a sector transducer. Convex

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To accurately interpret ultrasonographic images, and directly comparing the images created by Economic Impact
a working knowledge of ultrasonography physics, using the same imaging parameters (eg, depth, Although the cost of ultrasonography technology
including ultrasound wave production, interac- frequency). Image quality is primarily dictated has decreased over time, the investment
tion of ultrasound waves with tissues, and ultra- by transducer quality and can be measured in required for a high-quality ultrasonography unit
sonographic artifacts is necessary.1 Although terms of spatial resolution. Spatial resolution is is still significant. The practitioner must realisti-
many weekend short courses in ultrasonography the ability of the unit to distinguish 2 objects cally assess the frequency with which the ultra-
instruction are available, these are brief intro- that are in close proximity as separate struc- sonography unit will be used and justify the
ductions to ultrasonographic examinations and tures. This can be measured in the lateral (left- expense. Experience will increase diagnostic
interpretation. Using a high-quality atlas4 and an
to-right on the image plane), axial (top-to- accuracy and confidence, but it is the unfortu-
anatomy text will help the successful ultrasonog-
bottom on the image plane), and elevational nate habit of most veterinarians to neglect to
rapher build skill in the examination. A focus on
(resolution in the plane of slice thickness) charge for tests in which their confidence is
the production of diagnostic-quality images is
essential. The wide availability of teleradiology directions. The construction of a phantom may lacking. ■
consultation can aid in image interpretation. aid in comparing multiple ultrasonography
units; inexpensive methods for building one See Aids & Resources, back page, for
Evaluating Equipment have been described.5 Alternatively, examining references, contacts, and appendices.
Ultrasonographic equipment is best evaluated by the same patient with each ultrasonography unit Article archived on cliniciansbrief.com
performing an ultrasonographic examination may provide a standard for comparison.

Transducer Frequencies & Suggested Utility in Veterinary

Ultrasonographic Examinations
Frequency (MHz) Resolution Penetration Uses
10–17 Very high Very low Superficial structures:
Thyroid lobes, parathyroid
glands, eyes, tendons
6–10 High Low Superficial structures
Small patients
Small dogs
Cats
5 Medium Medium Medium-sized dogs
3 Low High Large-breed dogs
Equine thorax and
abdomen

transducers are slightly larger than micro- tion, and the sonographer must select the
convex transducers, and may be more diffi- proper transducer for each application. For 3
cult to maneuver when scanning a patient. ultrasonographic evaluation of the abdomen,
Microconvex transducers offer a smaller a microconvex high-frequency probe, a con- Ultrasound unit with a flat-screen display, 4 trans-
ducers (2 linear array, 1 convex, and 1 microcon-
footprint, and often allow for easier and vex lower-frequency probe, and a linear high-
vex), a touch screen, and a relatively simple
more complete evaluation of the cranial frequency probe would be an ideal place to ergonomic design. A keyboard is located beneath
abdomen. start. This would allow the practitioner the the interface to allow for additional image label-
ing.
greatest flexibility for the various abdominal
The type or types of transducers purchased will applications based on patient size and shape.
be directly influenced by the applications most For practices limited to cats or small dogs, the
frequently performed. In all cases, a compromise lower-frequency convex transducer would not
is made between spatial resolution and penetra- be necessary.

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