Medical Ultrasound Imaging
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Ultrasound System Performance
Ultrasound machines, with their various components and types, have revolutionized the field of medical imaging. These devices enable healthcare professionals to visualize internal structures, assess conditions, and guide interventions with real-time imaging capabilities. Today, medical ultrasound systems are complex signal processing machines. Assessing the performance of an ultrasound system requires understanding the relationships between the characteristics of the system, such as the point spread function, temporal resolution, and the quality of images. Image quality aspects include the detail resolution, contrast resolution and penetration. Systems with microbubble scanner modification are particularly suitable for contrast enhanced ultrasound.

Low-performance systems constitute approximately 20% of the world ultrasound market. These ultrasound machines are characterized by basic black and white imaging and are primarily used for basic OB/GYN applications and fetal development monitoring. They are often purchased by private office practitioners and small hospitals, with a unit cost below $50,000. These scanners commonly come equipped with a transvaginal probe.
Mid-performance sonography systems also hold around 20% market share. These machines are basic gray scale imaging, color and spectral Doppler and are used for routine examinations and reporting. They typically utilize a minimum number of scanheads and find applications in radiology, cardiology, and OB/GYN. The cost of these systems ranges between $50,000 and $100,000. Refurbished advanced and high-performance ultrasound machines with fewer optional features can also be found in this price range.
High-performance ultrasound systems generally provide high-resolution gray scale imaging, advanced color power and spectral Doppler capabilities. They usually include advanced measurement and analysis software, image review capabilities, and a variety of probes. These high-performance sonography devices have a market share of approximately 40% and cost between $100,000 and $150,000.
The remaining 20% of the market consists of premium or advanced performance ultrasound systems, typically sold for over $150,000. Premium performance systems offer high-resolution gray scale imaging, advanced color flow, power Doppler, and spectral Doppler, as well as features like tissue harmonic imaging, image acquisition storage, display and review capabilities, advanced automation, and more. Premium systems are equipped with a wide assortment of transducer scanheads.

In summary, ultrasound machines have diverse performance levels and corresponding price ranges, catering to various medical imaging needs. From low-performance systems with basic imaging capabilities to high-performance and premium systems with advanced features, ultrasound technology continues to advance healthcare imaging capabilities.
See also Ultrasound Physics, Handheld Ultrasound, Environmental Protection, Equipment Preparation.
Environmental Protection
Environmental protection in ultrasound imaging involves adopting practices and technologies that minimize the environmental impact associated with the use of ultrasound equipment and disposables.

Here are some key considerations:
Energy Efficiency:
Opt for energy-efficient ultrasound machines and equipment that are designed to minimize energy consumption. This helps reduce the overall environmental impact associated with power usage.
Digitalization and Paper Reduction:
Embrace digital imaging and archiving systems to reduce reliance on paper. Storing images and reports electronically minimizes paper consumption, printing supplies, and physical storage space.
Waste Management:
Implement proper waste management practices for ultrasound-related disposables, such as ultrasound gel bottles, probe covers, and cleaning materials. Follow local regulations for the disposal of medical waste and prioritize recycling and responsible disposal methods.
Equipment Lifespan and Disposal:
Choose ultrasound equipment known for its durability and longevity. Maximizing the lifespan of equipment reduces the frequency of replacements, minimizing electronic waste generation. When disposing of old equipment, ensure proper recycling and disposal in accordance with local regulations.
Education and Awareness:
Promote education and awareness among ultrasound professionals about environmentally conscious practices. Encourage staff to adopt energy-saving habits, such as turning off equipment when not in use, and emphasize the importance of responsible waste management. Develop standardized and optimized examination protocols to minimize the duration and number of ultrasound scans required per patient. This helps reduce the energy consumption associated with prolonged imaging sessions and decreases the overall environmental impact.

By focusing on energy efficiency, digitalization, waste management, equipment lifespan, and education, healthcare facilities can make significant strides towards reducing their carbon footprint and the environmental impact of ultrasound imaging practices.

See also Ultrasound System Performance, Equipment Preparation, Ultrasound Accessories and Supplies and Sonographer.
Equipment Preparation
Equipment Preparation is an essential step in ensuring optimal ultrasound imaging quality and maintaining a safe and hygienic scanning environment. The following considerations should be taken into account:
Ultrasound Machine Warm-Up:
The ultrasound scanner should be turned on and allowed to warm up for at least 5 minutes before initiating the examination. This allows the system to stabilize and ensures consistent performance.
Transducer Selection:
The appropriate pobe should be selected based on the type of examination required, as well as the patient's body size, weight, and habitus. Different transducer offer varying frequencies, field of view, and imaging capabilities, allowing for tailored imaging based on the specific clinical needs.
Power Settings and Techniques:
Prior to beginning the examination, it is crucial to verify and adjust the power settings and imaging techniques according to the examination protocol. This ensures that the ultrasound machine is optimized for the specific diagnostic requirements
Acoustic Couplant Application:
An adequate amount of acoustic couplant, such as warmed ultrasound gel, should be applied to the patient's skin or the transducer surface. This gel serves as a medium that promotes maximum transmission of the sound beam by eliminating air interfaces, leading to improved image quality.
Transducer Cleaning and Probe Covers:
All transducers should be cleaned and readily available for use with each patient. While endocavitary ultrasound probes are often protected by single-use disposable probe covers, it is important to maintain proper hygiene by performing a high-level disinfection of the probe between each use. Additionally, using a probe cover as an additional measure can help keep the probe clean and minimize the risk of cross-contamination.

By following these equipment preparation guidelines, healthcare professionals can ensure accurate and safe ultrasound examinations while promoting infection control measures and maintaining a hygienic environment for both patients and staff.
See also Environmental Protection, Portable Ultrasound Machine, Ultrasound Accessories and Supplies, and Ultrasound System Performance.
History of Ultrasound
The earliest introduction of vascular ultrasound contrast agents (USCA) was by Gramiak and Shah in 1968, when they injected agitated saline into the ascending aorta and cardiac chambers during echocardiographic to opacify the left heart chamber. Strong echoes were produced within the heart, due to the acoustic mismatch between free air microbubbles in the saline and the surrounding blood.
In 1880 the Curie brothers discovered the piezoelectric effect in quartz. Converse piezoelectricity was mathematically deduced from fundamental thermodynamic principles by Lippmann in 1881.
In 1917, Paul Langevin (France) and his coworkers developed an underwater sonar system (called hydrophone) that uses the piezoelectric effect to detect submarines through echo location.
In 1935, the first RADAR system was produced by the British physicist Robert Watson-Wat. Also about 1935, developments began with the objective to use ultrasonic power therapeutically, utilizing its heating and disruptive effects on living tissues. In 1936, Siemens markets the first ultrasonic therapeutic machine, the Sonostat.
Shortly after the World War II, researchers began to explore medical diagnostic capabilities of ultrasound. Karl Theo Dussik (Austria) attempted to locate the cerebral ventricles by measuring the transmission of ultrasound beam through the skull. Other researchers try to use ultrasound to detect gallstones, breast masses, and tumors. These first investigations were performed with A-mode.
Shortly after the World War II, researchers in Europe, the United States and Japan began to explore medical diagnostic capabilities of ultrasound. Karl Theo Dussik (Austria) attempted to locate the cerebral ventricles by measuring the transmission of ultrasound beam through the skull. Other researchers, e.g. George Ludwig (United States) tried to use ultrasound to detect gallstones, breast masses, and tumors. This first experimentally investigations were performed with A-mode. Ultrasound pioneers contributed innovations and important discoveries, for example the velocity of sound transmission in animal soft tissues with a mean value of 1540 m/sec (still in use today), and determined values of the optimal scanning frequency of the ultrasound transducer.
In the early 50`s the first B-mode images were obtained. Images were static, without gray-scale information in simple black and white and compound technique. Carl Hellmuth Hertz and Inge Edler (Sweden) made in 1953 the first scan of heart activity. Ian Donald and Colleagues (Scotland) were specialized on obstetric and gynecologic ultrasound research. By continuous development it was possible to study pregnancy and diagnose possible complications.
After about 1960 two-dimensional compound procedures were developed. The applications in obstetric and gynecologic ultrasound boomed worldwide from the mid 60's with both, A-scan and B-scan equipment. In the late 60's B-mode ultrasonography replaced A-mode in wide parts.
In the 70's gray scale imaging became available and with progress of computer technique ultrasonic imaging gets better and faster.
After continuous work, in the 80's fast realtime B-mode gray-scale imaging was developed. Electronic focusing and duplex flow measurements became popular. A wider range of applications were possible.
In the 90's, high resolution scanners with digital beamforming, high transducer frequencies, multi-channel focus and broad-band transducer technology became state of the art. Optimized tissue contrast and improved diagnostic accuracy lead to an important role in breast imaging and cancer detection. Color Doppler and Duplex became available and sensitivity for low flow was continuously improved.
Actually, machines with advanced ultrasound system performance are equipped with realtime compound imaging, tissue harmonic imaging, contrast harmonic imaging, vascular assessment, matrix array transducers, pulse inversion imaging, 3D and 4D ultrasound with panoramic view.

Probe
In the field of medical ultrasound imaging, the term 'probe' specifically refers to the ultrasound transducer and represent the handheld device that emits and receives ultrasound waves during an examination.
The probe encompasses various components such as the elements, backing material, electrodes, matching layer, and protective face that are responsible for both emitting and receiving the sound waves. Aperture, known also as the footprint, is the part of the probe that is in contact with the body. When the emitted sound waves encounter body tissues, they generate reflections that are received by the probe, which then generates a corresponding signal. In most cases, the probe emits ultrasound waves for only about 10% of the time and receives them for the remaining 90%.
Probes are available in different shapes and sizes to accommodate various scanning situations. The footprint is linked to the arrangement of the piezoelectric crystals and comes in different shapes and sizes e.g. linear array transducer//convex transducer. The transducer plays a huge role in image quality and is one of the most expensive parts of the ultrasound machine. Mechanical probes steer the ultrasound beam driven by a motor and are capable of producing high-quality images, but they are prone to wear and tear. Mechanical probes have been mostly replaced by electronic multi-element transducers, but mechanical 3D probes still remain for abdominal and Ob-Gyn applications.
In summary, the terms 'ultrasound transducer,' 'probe,' and 'scanhead' are often used interchangeably to refer to the same component of the ultrasound machine. Probes consist of multiple components and are available in different shapes and sizes depending on the sonographer's needs.

See also Handheld Ultrasound, Ultrasound System Performance, Omnidirectional, Probe Cleaning, and Multi-frequency Probe,
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