Vascular Ultrasound and Ultrasound Physics
VUT 101
Prerequisites: None
Orientation and Introduction to Health Care System Students learn about the importance of health care delivery, medico legal problems and medical ethics
Topics of discussion and class lectures about interpersonal communications, discrimination, sexual harassment and prejudice. Patients reception and appointments and proper patient transportation, emergency care and sterile technique.
VUT 102
Prerequisites: VUT 101
Medical Terminology
Students learn medical terminology, medical abbreviations and glossary words pertaining to cardiac, vascular and other medical specialties.
VUT 103
Prerequisites: VUT 101 and 102
Anatomy and Physiology of the cardiovascular system
Detail Explanation of the Venous and Arterial system
Anatomy and physiology of the Heart and Blood vessels
Structure of the Artenes and Veins
Carotids. External carotid, Internal carotid and bifurcation
Aorta
Ascending Aorta
Descending Aorta
Brooches of the arch of the Aorta
Lowers extremity arteries
upper extremity
Abdominal vasculature
Cerebral extracranial arteries
Venous system
Abdominal venous system
Vena cava, portal, mesenteric and renal veins
Upper extremity veins
Deep, superficial perforators
Patient Assessment
Patients signs and symptoms in various cardiovascular diseases
Skin changes and vascular ulcers in the legs
Inspection and palpation for pulses and aneurysms and pressure
Auscultation for briuts
Lymmphedema
Obtaining patient history
Cold sensitivity, hypertension ,stroke, diabetes, hyperlipedemia
transient ischemic attacks, previous surgery related to cardiovascular
age, smoking, previous DVT, cardiac history and medication
UVT 104
Prerequisites: UVT 101.102 and 103
Pathology of the Vascular system
Venous system diseases
The following topics will be covered
Peripheral & central venous diseases, acute deep vein thrombosis,
chronic venous insufficiency and valvular disease, carcinoma, diabetes,
pregnancy, birth control pills, varicose veins. obesity & cardiac disease.
Interpretation by noninvasive testing
Thrombosis location & characteristics and AV fistula
Arterial system disease vascular disease
Pathology of peripheral vascular disease
Central arterial disease, acute and chronic
Interpretation of arterial disease with noninvasive testing
Diagnostic indication, values, diagnostic criteria and limitation of interpretation.
The following topics are discussed in detail
Atherosclerosis, Hematomas, Embolism, Aneurysm, Entrapment syndrome
AV fistuta.Throracicr outlet syndrome.Arteritis and Raynauds syndrome
Cerebrovascular Disease
Pathology of the cerebrovascular system
Interpretation of cerebrovascular disease with noninvasive testing
The following will be covered in detail
Haemorrhage, ulceration, aneurysm, tumours, stenosis, embolism and subclavian steal syndrome
UVT 105
Prerequisites UVT 101.102.103, and 104
Haematology
The blood chemistry and blood components
Red blood cells, White blood cells (leukocytes) WBC differential
count and platelets formation normal count and role in thrombosis
The Coagulation, thrombosis. clot formation and blood groups.
Normal and abnormal blood flow through the vessels
UVT 106
Prerequisites: UVT 101,102,103.104 and 105
Cardiovascular Pharmacology
Adrenergic and cholinergic drugs
Anticoagulants
Vasopressors and Vasodilators
Antihypertensive
Thrombolytic drugs
Nitrates
Cardiac glycosides
Beta blockers
Calcium channel blockers
Antiplatelet
Diuretics
Antiarrhythmic
UVT 107
Prerequisites UVT 101.102,103,104,105 and 106
Physics and Instrumentation
History of Ultrasound application in Medical field
sound beam formation
Near field, far field and focal zone and beam focusing
Physical properties of ultrasound
Definition and explanation of the following terms
Cycle, Wavelength, Velocity, Frequency and the harmonics
Velocity of sound in human tissue and propagation of speed in different media.
Class lectures and drawings will help the students to understand the following
Impedance
Reflection
Refractions
Absorption
Impedance & interfaces
Specular Echoes & Scattered Echoes
Resolution and Attenuation
Transducers Design and types of transducers
Focussed single crystal and Annular Array
Phased Array transducers and Mechanical transducers
Piezoelectric effect
Beam Focussing
Near Field and far field
Lateral Resolution and Axial Resolution
Axial elements and beam steering
Definitions and detail explanation of the following
Frequency and Wave length
A -Mode
B-Mode
M-mode
Bandwidth
Hertz
Power Range and Velocity
Laws Ohm's law, Poiseuille's law and Bernoulli's
Doppler instrumentation Pulsed Wave Continuous Wave Signal processing,
the following will be covered in detail
Integral time analysis
Decibel gain
Digital signal
Dynamic range
Fast Fourier transformation
Post scan processing
Scan converters
Zero crossing detector
Time gain compensation, TGC graph
detail explanation Principles of Doppler
Doppler effect
Doppler equation
Doppler Instrumentation
Continuous Wave Advantage of continuous wave in high velocity
Disadvantages in range definition
Pulsed Doppler
Aliasing Nyquist effect (effect on high velocity ) and PRF Signal processing
Integral time analysis
Decibel gain
Digital signal
Dynamic Range
Fast Fourier Transportation
Post scan processing
Scan converters
Time gain compensation
Zero crossing detector
Biologic effects, safety mechanism
Electrical and mechanical hazards
Units of measurements
Length -distance
Mass-weight
Area - Volume
Time and Temperature
Statiscal Analysis
Descriptive statistic
Mean, Median, Range and Mode
Standard deviation Analysis of variance, sensibility and specificity
UVT 108
Prerequisites: UVT 101,102,103,104,105,106 and 107
Hemodynamics
Normal and abnormal blood flow through the veins and the arteries
Velocity acceleration,
Diameter reduction
Venous resistance
Arterial Pressure
Atherosclerosis,
diameter reduction of a vessel , abnormal blood flow
Blood flow pattern
laminar, parabolic and plug flow
Distributed and turbulent flow pattern
Measurement of volume flow with Doppler instruments
Sample volume, Flow direction by colour-Duplex spectrum
display Auditory spectrum display and Graphic Spectrum Display
UVT 109
Prerequisites: 101, 102, 103, 104, 105,106, 107 and 108
Cerebrovascular Examination Patient's Assessment for the following
Atherosclerosis Embolus from the Heart Vasospasm,
Aneurysm and subarachnoid hemorrhage
Thrombotic states due to Carotid disease Dissection: Carotid artery and Vertebral artery Vascular Anatomy,
Physiology and pathology Arteries arising from the arc of aorta
Two internal Carotid arteries
Two vertebral arteries
Intracranial cerebrovascular & circle of Willis Cerebral Hemodynamics
Collateralization Clinical Indications Stroke, TIA,
Transient monocular blindness (amaurosis fugas) To rule out carotid artery disease and
carotid endarectomy
Noninvasive Cerebrovascular testing
Transcranial Doppler Ultrasonic Windows
Four different approaches
Transtemporal
Transorbital
Suboccipital
Submandibular
The gray scale images
Doppler shift frequencies and color-duplex information will help to define the area of brain involvment.
UVT 110
Prerequisites: UVT 101, 102, 103, 104, 105, 106, 107, 108, 109
Evaluation of Carotid Arteries Anatomy and Physiology of Carotid arteries
Pathology of the carotid arteries Atherosclerosis and plaque
Abnormal development stenosis and Aneurysm
Non-invasive Testing Instrumentation
High -frequency transducers with short focal distances for near -field
Colour-duplex scan
Examination Patient Position Recording of the entire scanning to document normal and abnormal flow.
Longitudinal carotid image, external and internal carotids
Carotid bifurcation's imaged from two longitudinal transducer position
Transverse carotid examination at the clavicle toward cephalad along common carotid artery,
common carotid, bifurcation, internal & external carotids Aneurysm,
Atherosclerosis, fibromuscular hyperplasia following endarterectomy
If there is plaque deposits For accurate assessment of the Plaque features the image plane perpendicular to
the axis of the artery and evaluation of plaque deposit site severity of lumen narrowing and surface of the plaque
Low, moderate or strong echogenic Doppler evaluation Flow pattern normal, abnormal, stents and carotid
Endarectomy Doppler velocity in stenosis and Doppler spectral analysis pulsatility Interpretation,
Common carotid volume flow Spectral Analysis should begin with comparison of right & left common carotid pulsatility carotid volume flow measurement in each carotid severity of the stenosis,
Peak systolic and peak end -diastolic duplex parameters used to define the stenosis
Assessment of post stenotic flow disturbance
High grade obstruction, high -amplitude and low-velocity signals measurements
UVT 111
Prerequisites: 101,102,103,104,105.106,107,108, 109and 110
Arterial evaluation
Anatomy and Physiology of the abdominal, lower and upper extremities
Arterial blood flow, normal and abmormal Pathology of the arteries
Atherosclerosis, Aneurysm, Artentis, Arteriovenous fistulas Kawasaki.
Takayasu's disease and Raynaud's syndrome Entrapment syndrome,
Thoracic outlet syndrome
Arterial involvement in diabetic patients
Thromboangititis obliterans
Surgical complcations and thrombosis Aorta & abdominal branches
Thoracic and abdominal Aorta Iliac arteries.
hepatic renal and superior mesentric artery
Noninvasive testing Assessment of the Patient
Segmental Pressure duplex examination for Aneurysms, tumours, embolism and atherosclerosis
Scanning Views Aorta upto bifurcation - Longitudinal Aorta upto bifurcation
Transverse Aorta - Coronal view
Common iliac arteries - Transverse Iliac arteries - Longitudinal Kidneys - Longitudinal Diagnostic Accuracy Upper Extremity Arterial Anatomy, Anatomic variants and collaterals
Duplex scanning in conjunction with other noninvasive vascular tests to detect the upper arterial disease
Arterial occlusive disease Aneurysms, AV fistula and emboli Thoracic outlet Syndrome
The subclavian artery ( through tharacic outlet over 1st rib behind clavicle ) continues as axillary artery, brachial artery (brachial artery spirals around humerus) collaterals, deep brachial (anticubital fossa), bifurcation of brachial artery Radial and Ulnar arteries Deep and superficial palmar arches and the digital branches.
Non invasive Testing Duplex scanning of the upper extremity is performed similarly to carotids and lower
extremity
Upper extremity scanning from the subclavian to the palmar and digital arteries
Probes used for subclavin lower frequency, visualized through supraclavicular infraclavicular or sternal notch.
Higher frequency probe for superficial arteries
Doppler Waveforms arteries, stenosis and AV shunt
Lower Extremity Normal Anatomy and Physiology
Anatomic variations
Duplication of the superficial femoral artery High bifurcation,
Normal bifurcation Absent posterior or anterior tibial artery Abnormality of dorsalis Pedis artery
Collateral circulation Lower abdominal Aorta, bifurcation into common iliac Internal and external iliac arteries
Common femoral (about 4cm long) divides Deep femoral also known as profunda femoris
Superficial femoral enters in adductor canal becomes Popliteal artery (this junction is known as supreme geniciar artery)
Popliteal artery behind the knee divides into anterior tibial artery tibioperoneal trunk, genicular and sural
arteries(collateral routes) posterior tibial artery continues posteromedial course behind the medial
malleolus bifurcates forming medial planter branches
Anterior tibial artery courses onto dorsum of the foot becomes Dorsalis pedis
The Planter Arch formation by union of lateral planter with the planter metatarsal branch of the dorsalis pedis artery
Metatarsal and Digital branches
Non invasive testing
Two - dimensional B-Mode imaging Pulse doppler flow and color duplex
Spectrum analysis Transducer used 3 or 5 MHz, for superficial arteries 7.5 or 10-MHz
Assessment of the patient for testing
UVT 112
Prerequisites: 101,102,103,104,105,106,107.108.109,110.111
Evaluation of Abdominal and Extremity Veins
Inferior Vena Cava and iliac veins
Renal vein thrombosis Renal Vein tumor extension
Noninvasive testing IVC testing
Multiple longitudinal and Transverse views of IVC including the suprahepatic, intrahepatic and infrahepatic
portion Upper portion of IVC assessed by doppler to examine the pulsatile flow pattern in reponse to cardiac and respiratory activity in increased venous pressure (to calculate PA pressure ) Thrombosis and to follow up post surgical filters and plication Portal Vein, splenic vein,superior mesenteric vein and hepatic vein and renal vein testing for flow, thrombosis and AV fistula Upper and Lower Extremity veins Assessment of Patient TIA,
Stroke, Previous DVT Varicose veins, primary and secondary varicose veins
Surgery, birth control pills and cardiac problems
Evaluation Upper extremity Veins The Jugular vein, Cephalic vein, Axiillary and Brachial veins and the Forearm veins
Examination protocol Image plane parallel to the vein axis
Doppler image to detect disease vein Doppler sample volume,
Flow pattern and Doppler spectrum display
Deep veins of the upper extremity accompanied by corresponding arteries
Lower extremity veins Examination protocol ( duplex scan mentioned above)
Patient position, supine and upright position for examination
Lower extremity dependent for distention of veins Iliac segment
Femoral segment Long saphenous vein
Popliteal segment and calf veins Locating the superficial veins ( mapping the veins)
Transducer position for the following scanning
Deep and superficial veins
Saphenofemoral Incompetence
Saphenous vein and Branch vein incompetence
Perforator Incompetence
Venous Thrombosis,superficial & deep vein thrombosis
Calf Vein Thrombosis
Femoropopliteal vein thrombosis
Iliac venous thrombosis and sequelae of DVT To ensure that the results are accurate
The sonographer should have an excellent knowledge of Anatomy & Physiology of the venous system and scanning protocal
UVT 113
Prerequisites: 101,102,103,104,105,106,107,108,109,110,111,112
Ultrasound Facility,Medical Ethics and Confidentiality of patient's reports
Ultrasound Department, technical support, scanning room and medical records
Patient care, legal and medical ethics
Professional responsibility patient identification
Verification of requested examination
Assessment of patient's condition
Patient transfer body mechanics
Patient Privacy
Basic patient Care
Emergency Care
JCAHO standards and OSHA regulations
Prevention of infection Isolation techniques
UVT 114
Prerequisites: 101,102,103,104,105,106,107,108,109,110,111,112,113
Vascular Scanning Class Lectures cover the scanning protocols,
Detail explanation with drawings
Basic and advance techniques,
Imaging Planes and segmental pressures
Normal Values, quantitative measuements and calculations