Interventional ultrasound, also known as ultrasonography, encompasses a range of invasive or surgical procedures guided by ultrasound imaging. While its widest application lies in intravascular ultrasound imaging for measuring atherosclerotic plaque, it has proven valuable in various medical fields.
In urology, ultrasound-guided interventions are employed for treatments like high intensity focused ultrasound (HIFU) in prostate conditions. The precise imaging provided by ultrasound aids in targeting the affected area and delivering therapeutic energy effectively.
In intraabdominal conditions, endoscopic ultrasound is frequently utilized. This technique combines ultrasound imaging with an endoscope to visualize and evaluate structures within the gastrointestinal tract, allowing for precise diagnoses and targeted interventions.
Ultrasound-guided procedures play a significant role in several medical specialties, including liver sonography, obstetric and gynecologic ultrasound, and thyroid ultrasound. These procedures involve interventions such as RF thermal ablation or biopsies, which are guided by real-time ultrasound imaging.
For instance, in liver sonography, ultrasound guidance is crucial for performing biopsies or RF thermal ablation, a technique used to treat liver tumors by delivering localized heat to destroy the abnormal tissue. The real-time imaging allows for precise needle placement and monitoring during the procedure.
In obstetric and gynecologic ultrasound, ultrasound-guided procedures, such as biopsies, can be performed to obtain tissue samples for diagnostic purposes. Additionally, ultrasound guidance is valuable during interventions like amniocentesis or fetal blood sampling, enabling accurate and safe procedures.
Thyroid ultrasound procedures often involve ultrasound-guided fine-needle aspiration biopsy (FNAB), which allows for the sampling of thyroid nodules for cytological examination. The ultrasound image helps guide the needle into the targeted area, ensuring accurate sampling and minimizing potential complications.
Overall, ultrasound-guided interventions provide minimally invasive and precise approaches to diagnosis and treatment. The real-time imaging capabilities of ultrasound contribute to enhanced accuracy, safety, and patient outcomes in procedures like biopsies, injections, and drainage.

See also Transurethral Sonography, Endocavitary Echography, and B-Mode Acquisition and Targeting.

(ESWL) Extracorporeal shock wave lithotripsy is a special use of kidney ultrasound, where high intensity focused ultrasound pulses are used to break up calcified stones in the kidney, bladder, or urethra. Pulses of sonic waves pulverize dense renal stones, which are then more easily passed through the ureter and out of the body in the urine. The ultrasound energy at high acoustic power levels is focused to a point exactly on the stone requiring an ultrasound scanning gel for maximum acoustic transmission.
Air bubbles in the ultrasound couplant, regardless of their size, degrade the performance of Lithotripsy and have the following effect:
Air bubbles smaller that 1/4 wavelength cause scattering of the sound waves as omni directional scatterers and less acoustic energy reaches the focal point. The result is less acoustic power at the focal point to disintegrate the kidney stone.
Air bubbles larger than 1/4 wavelength act as reflectors and deflects the acoustic energy off in a different direction. These results in less acoustic energy at the focal point.
Microbubbles dispersed throughout the ultrasound couplant layer change the average acoustic impedance of the gel layer (which reduces the total transmitted energy) and, due to refraction, change the focal point.

A liver sonography is a diagnostic tool to image the liver and adjoining upper abdominal organs such as the gallbladder, spleen, and pancreas. Deeper structures such as liver and pancreas are imaged at a lower frequency 1-6 MHz with lower axial and lateral resolution but greater penetration. The diagnostic capabilities in this area can be limited by gas in the bowel scattering the sound waves.
The application of microbubbles may be useful for detection of liver lesions and for lesion characterization. Some microbubbles have a liver-specific post vascular phase where they appear to be taken up by the reticuloendothelial system (RES). Dynamic contrast enhanced scans in a similar way as with CT or MRI can be used to studying the arterial, venous and tissue phase.
After a bolus injection, early vascular enhancement is seen at around 30sec in arterialized lesions (e.g., hepatocellular carcinomas (HCC), focal nodular hyperplasia (FNH)). Later enhancement is typical of hemangiomas with gradually filling towards the center. In the late phase at around 90sec, HCCs appear as defects against the liver background. Most metastases are relatively hypovascular and so do not show much enhancement and are seen as signal voids in the different phases.
Either with an intermittent imaging technique or by continuous scanning in a nondestructive, low power mode, characteristic time patterns can be used to differentiate lesions.

See also Medical Imaging, B-Mode, High Intensity Focused Ultrasound, Ultrasound Safety and Contrast Medium.

The prostate is a walnut-shaped gland surrounding the beginning of the urethra in front of the rectum and below the bladder. The prostate can become enlarged (particularly in men over age 50) and develop diseases like prostate cancer or inflammation (prostatitis). A large tumor can be felt by a rectal examination. The most effective way of detecting the early signs of prostate cancer is a combination of a prostate-specific antigen (PSA) blood test and a prostate ultrasound examination.
An abnormally high level of PSA can indicate prostate cancer or other prostate diseases such as benign prostatic hypertrophy or prostatitis. The transrectal sonography is an important diagnostic ultrasound procedure in determining whether there is any benign enlargement of the prostate or any abnormal nodules.
The imaging is performed with a rectal probe, yielding high resolution. High resolution 3D ultrasound provides reliable and accurate determination of the size and the location of cancer. Additionally, ultrasound elastography is a technique in development to improve the specificity and sensitivity of cancer detection. Ultrasound is also used to detect whether cancerous tissue is still only within the prostate or whether it has begun to spread out and to guide a diagnostic biopsy or ultrasound therapy.

See also Brachytherapy, and High Intensity Focused Ultrasound.

(TRUS) Transrectal sonography (also called transrectal ultrasonography, transrectal echography (TRE), endorectal ultrasound (ERUS or EUS)) is an ultrasound procedure used to examine the prostate gland, the rectum or bladder.
A small, lubricated transducer placed into the rectum releases sound waves, which create echoes as they enter the region of interest. A computer creates a picture called a sonogram.
TRUS is commonly used for guidance during a prostate needle biopsy and may be used to deliver brachytherapy and monitor cancer treatment. Transrectal ultrasonography detects enlargement, tumors and other abnormalities of the prostate, rectal polyps, rectal cancer, perianal infection, and sphincter muscle injuries. TRUS is also performed on male patients with infertility to view the prostate and surrounding structures and on patients with suspected bladder conditions or disease to view the bladder.

See also Transurethral Sonography, Endoscopic Ultrasound, Pelvic Ultrasound, Rectal Probe, Biplane Probe, Endocavitary Echography and High Intensity Focused Ultrasound.