Ultrasound

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewellery in the area to be examined. You may be asked to wear a gown during the procedure.

For most ultrasound exams, you will be positioned lying face-up on an examination table that can be tilted or moved. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer (ultrasound technologist) or radiologist then places the transducer on the skin in various locations, sweeping over the area of interest or angling the sound beam from a different location to better see an area of concern.

Doppler sonography is performed using the same transducer.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

This ultrasound examination is usually completed within 30 to 45 minutes. More complex exams may take a longer period of time.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry to a powder. The ultrasound gel does not stain or discolour clothing.

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam, and he/she will share the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.

• Determining the Nature of a Breast Abnormality

The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography or breast magnetic resonance imaging (MRI).

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.

Doppler ultrasound is used to assess blood supply in breast lesions.

• Supplemental Breast Cancer Screening

Mammography and 3D Breast Ultrasound are known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of ducts, glands, fibrous tissue and less fat, many cancers can be hard to see on mammography. In this case, 3D Breast Ultrasound is recommended as it is proven to provide highly accurate diagnostic information for patients with dense or small breast.

• For more information on 3D Breast Screening, please visit: canadianbreastscreening.com/new-safe-choice/

• Ultrasound-guided Breast Biopsy 

When an ultrasound examination reveals a suspicious breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures. An ultrasound exam will usually need to be performed before the biopsy in order to plan the procedure and to determine if this method of biopsy can be used.

You will be asked to undress from the waist up and to wear a gown during the procedure. No other special preparation is needed.

You will lie on your back on the examining table and may be asked to raise your arm above your head.

After you are positioned on the examination table, the radiologist or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry to a powder. The ultrasound gel does not stain or discolor clothing.

The conventional (2D) ultrasound usually takes about 35-30 minutes for both breasts. A 3D procedure takes about 20 minutes.

Ultrasound images are typically used to help diagnose:

• tendon tears, or tendinitis of the rotator cuff in the shoulder, Achilles tendon in the ankle and other tendons throughout the body.

• muscle tears, masses or fluid collections.

• ligament sprains or tears.

• inflammation or fluid (effusions) within the bursae and joints.

• early changes of rheumatoid arthritis.

• nerve entrapments such as carpal tunnel syndrome.

• benign and malignant soft tissue tumors.

• ganglion cysts.

• hernias

• foreign bodies in the soft tissues (such as splinters or glass).

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Ultrasound scanners consist of a computer and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out inaudible high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen. The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area of the patient being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to travel back and forth from the transducer.

For certain ultrasound examinations of the musculoskeletal system, the patient may be seated on an examination table or a swivel chair. For other ultrasound exams, the patient is positioned lying face-up or face-down on an examination table. The radiologist or sonographer may ask you to move the extremity being examined or may move it for you to evaluate the anatomy and function of the joint, muscle, ligament or tendon.

Ultrasound examinations are painless and easily tolerated by most patients.

Musculoskeletal ultrasound examination is usually completed within 15 to 30 minutes but may occasionally take longer.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

After an ultrasound examination, you should be able to resume your normal activities immediately.

Ultrasound has difficulty penetrating bone and, therefore, can only see the outer surface of bony structures and not what lies within (except in infants who have more cartilage in their skeletons than older children or adults). For visualizing internal structure of bones or certain joints, other imaging modalities such as MRI are typically used.

There are also limitations to the depth that sound waves can penetrate; therefore, deeper structures in larger patients may not be seen easily.

Ultrasound has not proven useful in detecting whiplash injuries or most other causes of back pain.

Obstetrical ultrasound is a useful clinical test to:

• establish the presence of a living embryo/fetus

• estimate the age of the pregnancy

• diagnose congenitalabnormalities of the fetus

• evaluate the position of the fetus

• evaluate the position of the placenta

• determine if there are multiple pregnancies

• determine the amount of amniotic fluid around the baby

• check for opening or shortening of the cervix

• assess fetal growth

• assess fetal well-being

Different information is gained at different times (trimesters) during the pregnancy.

• 1st-trimester fetal ultrasound is done to:

· Determine how pregnancy is progressing.

· Find out if there is more than 1 fetus.

· Estimate the age of the fetus (gestational age).

· Estimate the risk of a chromosomedefect, such as Down syndrome.

· Check for birth defects that affect the brain or spinal cord.

• 2nd-trimester fetal ultrasound is done to:

· Estimate the age of the fetus (gestational age).

· Look at the size and position of the fetus, placenta, and amniotic fluid.

· Determine the position of the fetus, umbilical cord, and the placenta during a procedure, such as an amniocentesisor umbilical cord blood sampling.

· Detect major birth defects, such as a neural tube defect or heart problems.

• 3rd-trimester fetal ultrasound is done to:

· Make sure that a fetus is alive and moving.

· Look at the size and position of the fetus, placenta, and amniotic fluid.

You should wear a loose-fitting, two-piece outfit for the examination. Only the lower abdominal area needs to be exposed during this procedure.

Sometimes the radiologist determines that a transvaginal scan needs to be performed in order to see the pregnancy more closely or to assess the cervix. This technique often provides improved, more detailed images of the uterus and ovaries. It is especially useful in early pregnancy.

For more information on transvaginal ultrasound, please see the Pelvic Ultrasound section.

You will be positioned lying face-up on an examination table that can be tilted or moved.

After you are positioned on the examination table, the sonographer will apply a warm water-based gel to the lower abdomen area. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined.

Ultrasound examinations are painless and easily tolerated by most patients.

However, at times during an obstetrical ultrasound, the sonographer may have to press more firmly to get closer to the embryo or fetus to visualize the structure better. Any discomfort is usually minimal and temporary.

With transvaginal scanning, there may be minimal discomfort as the transducer is inserted into the vagina.

Obstetric ultrasound examination is usually completed within 30 minutes.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

After an ultrasound examination, you should be able to resume your normal activities immediately.

Obstetric ultrasound cannot identify all fetal abnormalities. Consequently, when there are clinical or laboratory suspicions for a possible abnormality, a pregnant woman may have to undergo non-radiologic testing such as amniocentesis (the evaluation of fluid taken from the sac surrounding the fetus) or chorionic villus sampling (evaluation of placental tissue) to determine the health of the fetus, or she may be referred by her primary care provider to a perinatologist (an obstetrician specializing in high-risk pregnancies).

A nuchal translucency test is done to find out the chance that your developing baby (fetus) may be at risk for having Down syndrome or other problems.

You may need a full bladder for the nuchal translucency test. If so, you’ll be asked to drink water or other liquids just before the test and to avoid urinating before the test.

Talk with your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

Most often, a nuchal translucency test is done by a specially trained ultrasound technologist. But it may be done by a radiologist or an obstetrician who has received special training to do this test.

Often you don’t need to remove your clothes for the test. You can lift your shirt and push down the waistband of your skirt or pants. If you’re wearing a dress, you’ll be given a cloth or paper covering to put over your legs during the test.

During the test:

• You’ll lie down on your back or on your side on an exam table.

• A gel will be spread on your belly.

• A small, handheld device called a transducer will be pressed against the gel on your skin and moved over your belly. Images of the baby are displayed on a monitor. The technologist or doctor will look for and measure the thickness of the fluid buildup at the back of the baby’s neck.

When the test is done, the gel is wiped off your skin. You can urinate as soon as the test is done.

The test usually takes about 15 to 20 minutes.

During a nuchal translucency test, you may have a feeling of pressure in your bladder. The gel may feel cool when it is first put on your belly. You’ll feel a light pressure from the transducer as it passes over your belly.

There are no known risks linked with a nuchal translucency test, either to you or the baby. But you may feel anxious if the test shows there is an increased chance that your baby may have a problem.

Your doctor will look at the results of the nuchal translucency test to see if the area at the back of the baby’s neck is thicker than normal.

Normal: 2.5 millimeters (mm) or less

Abnormal: More than 2.5 mm

You may not receive information about the test right away. Full results are usually available in 1 or 2 days.

The nuchal translucency test can find out if your developing baby (fetus) is at higher-than-normal risk for problems. But it can’t tell for sure that the baby has a problem. You would need to undergo another test for confirmation.

The accuracy of this test is based on how often the test correctly finds a problem. For example:

• The nuchal translucency test correctly finds Down syndrome in 64 to 70 out of 100 fetuses who have it. It misses Down syndrome in 30 to 36 out of 100 fetuses.

• First-trimester screening (nuchal translucency combined with bloodtests) correctly finds Down syndrome in 82 to 87 out of 100 fetuses who have it. But these tests miss it in 13 to 18 out of 100 fetuses.

• The integrated screening test(first-trimester tests plus the triple or quad screening blood tests in the second trimester) correctly finds Down syndrome in about 95 out of 100 fetuses who have it. This means that the test misses Down syndrome in 5 out of 100 fetuses.

Ultrasound imaging of the scrotum is the primary imaging method used to evaluate disorders of the testicles, epididymis (a tube immediately next to a testis that collects sperm made by the testicle) and scrotum.

This study is typically used to:

• determine whether a mass in the scrotum felt by the patient or doctor is cystic or solid and its location.

• diagnose results of trauma to the scrotal area.

• diagnose causes of testicular pain or swelling such as inflammation or torsion.

• evaluate the cause of infertility such as varicocele.

• look for the location of undescended testis.

• ultrasound is also a valuable tool for evaluating the epididymis and the prostate.

A sudden onset of pain in the scrotum should be taken very seriously. The most common cause of scrotal pain is epididymitis, an inflammation of the epididymis. It is treatable with antibiotics. If left untreated, this condition can lead to an abscess or loss of blood flow to the testicles.

Ultrasound can often detect an absent or undescended testicle as well. It is estimated that approximately three percent of full-term baby boys have undescended testicles. The testicle normally migrates from the abdomen, down the inguinal canal and then into the usual position in the scrotal sac. If it is not present in the scrotal sac, it may have stopped on its way and lie in the inguinal region, in which case the ultrasound examination will often see it. If it has not left the abdominal cavity, it may not be seen by an ultrasound. If a testicle is not detected, urologist may be consulted in order to decide whether additional imaging such as an MRI is needed to determine its location. If the testicle is found to be in the inguinal region, it can be moved into the scrotum. If left in the abdomen too long, it may become cancerous and may need to be removed.

Ultrasound can identify testicular torsion, the twisting of the spermatic cord that contains the vessels that supply blood to the scrotum. Caused by abnormally loose attachments of tissues that are formed during the fetal development, torsion commonly appears during adolescence, and less often in the neonatal period, and is very painful. Torsion requires immediate surgery to avoid permanent damage to the testes.

Ultrasound also can be used to locate and evaluate masses (lumps or tumours) in the testicle or scrotum. Collections of fluid and abnormalities of the blood vessels may appear as masses and can be assessed by ultrasound. Masses, both outside and within the testicles may be benign or malignant and should be evaluated as soon as they are detected.

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewellery in the area to be examined. You may be asked to wear a gown during the procedure. No other preparation is required.

For most ultrasound exams, you will be positioned lying face-up on an examination table that can be tilted or moved.

After you are positioned on the examination table, the radiologist or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Ultrasound examinations are painless and easily tolerated by most patients.

Ultrasound imaging of the scrotum is usually completed within 15 to 30 minutes, though sometimes more time is necessary.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

After an ultrasound examination, you should be able to resume your normal activities immediately.

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam, and he/she will share the results with you. Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.

Benefits

• Most ultrasound scanning is non-invasive (no needles or injections).

• Occasionally, an ultrasound exam may be temporarily uncomfortable, but it is almost never painful.

• Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.

• Ultrasound imaging is extremely safe and does not use any ionizing radiation.

• Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.

• Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration.

Risks

For standard diagnostic ultrasound, there are no known harmful effects on humans.

Ultrasound of the scrotum is helpful for finding abnormalities such as masses in the scrotum or testicles. However, it does not always permit an exact diagnosis (i.e., the exact type of tissue a mass is composed of, especially when the mass is solid). Blood flow images of the testicles are not always reliable in determining if the blood supply to a testicle has twisted. When searching for an absent testicle, ultrasound may not be able to find it if it is located in the abdomen because gas filled bowel loops may block the view.

• determine if the prostate is enlarged

• diagnose prostate cancer

• Transrectal ultrasound is done if the doctor suspects cancer because of an increased prostate-specific antigen (PSA) level, abnormalities felt during digital rectal examination (DRE) or certain symptoms are present, such as problems with urination.

• help guide the doctor when taking biopsy samples of the prostate

• help diagnose the cause of infertility in a man

• help guide the doctor during treatments for prostate cancer

• Transrectal ultrasound is used to guide the placement of implants during brachytherapy.

• It may help the doctor perform cryosurgery.

• Transrectal ultrasound may be used to help deliver high-intensity focused ultrasound (HIFU).

A transrectal ultrasound is usually done as on outpatient procedure in a doctor’s office, clinic or hospital. The test usually takes 15–30 minutes.

Some special preparation is needed before a transrectal ultrasound:

• Avoid taking Aspirin and other medications that may thin the blood for 7–10 days before the test.

• An enema is used 1–4 hours before the procedure to help clean out the colon.

• The man may be told to urinate to empty his bladder just before the procedure.

You will be asked to wear a gown during the procedure. Patient usually lies on the left side with the knees bent toward the chest. A protective cover and lubricant are put on the ultrasound transducer (probe), then it is placed into the rectum. You may feel pressure or have a sensation of fullness in the rectum when the transducer is in place.

The transducer directs high-frequency sound waves at the prostate. A computer analyzes the echoes created by the sound waves and displays an image of the prostate gland on a monitor. The image shows how big the prostate is and whether there are any abnormalities.

Abnormal findings may include:

• enlarged prostate (benign prostatic hyperplasia)

• inflamed or infected prostate (prostatitis)

• prostate cancer

What happens if a change or abnormality is found:

The doctor will decide whether further tests, procedures, follow-up care or additional treatment is needed.

The most common reason for a venous ultrasound exam is to search for blood clots, especially in the veins of the leg. This condition is often referred to as deep vein thrombosis or DVT. These clots may break off and pass into the lungs, where they can cause a dangerous condition called pulmonary embolism. If the blood clot in the leg is found early enough, treatment can be started to prevent it from passing to the lung.

A venous ultrasound study is also performed to:

• determine the cause of long-standing leg swelling. In people with a common condition called “varicose veins”, the valves that keep blood flowing back to the heart in the right direction may be damaged, and venous ultrasound can help the radiologist decide how best to deal with this condition.

• aid in the placement of a needle or catheter into a vein. Sonography can help locate the exact site of the vein and avoid complications, such as bleeding or damage to a nearby nerve or artery.

• map out the veins in the leg or arm so that pieces of vein may be removed and used to bypass a narrowed or blocked blood vessel. An example is using pieces of vein from the leg to surgically bypass narrowed heart (coronary) arteries.

• examine a blood vessel graft used for dialysis if it is not working as expected; for example, the graft may be narrowed or blocked.

If a line is placed in a vein of the legs or arms, there is a much higher chance of developing a clot around it due to the smaller vessel size (especially in infants and young children). In some instances, a clot can suddenly form in the arm due to compression of the vein at the inlet of the chest or in the left leg due to compression of the vein on the left side by an artery in the abdomen.

Doppler ultrasound images can help the physician to see and evaluate:

• blockages to blood flow (such as clots).

• narrowing of vessels.

• tumours and congenital vascular malformations.

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

A period of fasting is necessary only if you are to have an examination of veins in your abdomen (Abdominal aorta scan). In this case, you will probably be asked not to ingest any food or fluids except water for six to eight hours ahead of time. Otherwise, there is no other special preparation for a venous ultrasound.

For most ultrasound exams, you will be positioned lying face-up on an examination table that can be tilted or moved.

A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The sonographer (ultrasound technologist) or radiologist then places the transducer on the skin in various locations, sweeping over the area of interest or angling the sound beam from a different location to better see an area of concern.

Doppler sonography is performed using the same transducer.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

Single extremity ultrasound examination is usually completed within 20 minutes. More complex exams (bilateral extremities) may take a longer period of time.

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam, and he/she will share the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.

Benefits

• Most ultrasound scanning is non-invasive (no needles or injections).

• Occasionally, an ultrasound exam may be temporarily uncomfortable, but it is almost never painful.

• Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.

• Ultrasound imaging is extremely safe and does not use any ionizing radiation.

• Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.

• Venous ultrasound helps to detect blood clots in the veins of the legs before they become dislodged and pass to the lungs. It can also show the movement of blood within blood vessels.

• Compared to venography, which requires injecting contrast material into a vein, venous ultrasound is accurate for detecting blood clots in the veins of the thigh down to the knee. In the calf, because the veins become very small, ultrasound is less accurate. However, potentially dangerous venous clots are typically lodged in the larger veins.

Risks

For standard diagnostic ultrasound, there are no known harmful effects on humans.