Sonography Introduction to Normal Structure and Function

Front Cover
Half title page
Evolve page
Sonography
Copyright Page
Dedication
Contributors
Reviewers
Preface
	New to this Edition
	Workbook and Lab Manual for Sonography: Introduction to Normal Structure and Function
For the Instructor
Table Of Contents
I Clinical Applications
	1 Before and After the Ultrasound Examination
		Objectives
		Key Words
		Before the Ultrasound Examination
			Understanding Standard Precautions
			Reviewing the Ultrasound Request Form and Patient Chart
		After the Ultrasound Examination
			The Sonographer’s Technical Observation
			Interpretive Report
	2 Ultrasound Instrumentation:
		Objectives
		Key Words
		Alphanumeric Keyboard
		Primary Imaging Controls
		Basic Operations of an Ultrasound System
		Image Processing and Storage
	3 General Patient Care
		Objectives
		Key Words
		Interpersonal Skills
		Ultrasound Examination Room
		Patient Care During the Ultrasound Examination
		Aseptic Technique
	4 Introduction to Ergonomics and Sonographer Safety
		Objectives
		Key Terms
		Ergonomics Defined
		Ergonomics in Sonography
			Types of Injuries
			The Occupational Health and Safety Act (OSHA)
			Work-Related Musculoskeletal Disorders (WRMSDs)
			Contributing Causes and Risk Factors of Workplace Injury
		Creating a Safe Environment
II Sonographic Approach to Understanding Anatomy
	5 Interdependent Body Systems
		Objectives
		Key Words
		Nervous System
			Central Nervous System
			Peripheral Nervous System
		Endocrine System
			“Neuro” Endocrine System
			Pituitary Anatomy
			System Functions
		Cardiovascular system
			Arteries and Veins
			Pulmonary Circulation
			Systemic Circulation
			Atypical Blood Flow
			The Heart
		Lymphatic System
			Collection and Transportation of Fluid
			Fat Absorption
			Immune Function
		Musculoskeletal System
		Reproductive System
			Male Gamete Production and Maturation
			Female Gamete Production and Maturation
				Fertilization
		The Excretory Systems
			Digestive System–Urinary System–Respiratory System
			Digestive System
			Urinary System
				Anatomy
				Filtration
			Respiratory System
				Anatomy
	6 Anatomy Layering and Sectional Anatomy
		Objectives
		Key Words
		1. Directional Terminology
		2. Body Divisions
			Dorsal Cavity
			Ventral Cavity
		3. Tissue Layers
			Somatic Layers
			Extravisceral Layers (Visceral Layers)
			Intravisceral Luminal Layers
			Intravisceral Nonluminal Layers
		4. Structure Classification
			Musculoskeletal Unit
			Vascular Unit
			Visceral Unit
			Enclosing Unit
		5. Structure Orientation
			Vertical Orientation
			Vertical Oblique Orientation
			Horizontal Orientation
			Horizontal Oblique Orientation
			Variable Orientation
		6. Sectional Planes
			Transverse Plane
			Sagittal Plane
			Coronal Plane
		7. Body Structure Relationships
		8. Comparison of Cadaver Sections and Ultrasound Image Sections
		Abdominal Layers
			Muscle Layer
				Quadratus Lumborum Muscle
				Psoas Major Muscle
			Kidneys and Adrenal Glands
				Kidneys
				Adrenal Glands
			Inferior Vena Cava (IVC)
				Inferior Vena Cava (IVC)
				IVC Tributaries
			Abdominal Aorta
				Abdominal Aorta
				Aorta Branches
			Portal Venous System
				Portal Venous System
			Gallbladder and Biliary Tract
				Biliary Tract
				Gallbladder
			Pancreas
				Pancreas
			Gastrointestinal Tract
				Stomach
				Duodenum
			Liver
				Liver
			Muscle Layer
				Anterior Muscles
		Pelvic Layers
			True Pelvis Muscle Layer
				True Pelvis Muscles
			False Pelvis Muscles
				False Pelvis Muscles
			Rectum/Colon
				Rectum/Colon
			Uterus/Bladder
				Uterus/Urinary Bladder
			Prostate Gland/Bladder
				Prostate Gland/Urinary Bladder
			Muscle Layer
				Rectus Abdominus Muscle
	7 First Scanning Experience
		Objectives
		Body Planes
		Ultrasound Scanning Planes
		Clinical Criteria
		Imaging Criteria
		Scanning
			A. Patient Preparation
			B. Patient Position
			C. How to Choose and Use a Transducer
				Choosing a Transducer
				Using a Transducer
			D. Breathing Technique
			E. The Survey
				Abdominal Aorta • Longitudinal Survey
					Sagittal Plane • Transabdominal Anterior Approach
				Abdominal Aorta • Axial Survey
					Transverse Plane • Transabdominal Anterior Approach
			F. Image Documentation Criteria
			G. Required Images
				Abdominal Aorta • Longitudinal Images
					Sagittal Plane • Transabdominal Anterior Approach
				Abdominal Aorta • Axial Images
					Transverse Plane • Transabdominal Anterior Approach
			H. Abnormal Findings
			I. Case Presentation
		How to Describe Ultrasound Findings
			Describing Diffuse Disease
			Describing Localized Disease
				Origin
				Size
				Composition
					Solid Masses
					Cystic Masses
					Complex Masses
			Other Considerations
	8 Embryology*
		Objectives
		Key Words
		Embryologic Development
			Heart and Abdominal Aorta Development
				Inferior Vena Cava Development
			Portal Venous Development
			Biliary System Development
			Liver Development
			Pancreas Development
			Urinary System Development
			Spleen Development
			Gastrointestinal Tract Development
			Male Pelvis Development
			Female Pelvis Development
			Breast Development
			Thyroid and Parathyroid Development
				Neonatal Brain Development
		Reference Charts
	9 Introduction to Laboratory Values
		Objectives
		Key Words
		Agency Oversight of Laboratory Testing
		Quality Control of Laboratory Values
		Laboratory Values
			Laboratory Value: Bilirubin
				Primary Organs: Liver, Gallbladder
			Laboratory Value: Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST)
				Primary Organs: Liver, Pancreas
			Laboratory Value: Cholesterol and Triglycerides
				Primary Organs: Liver, Heart
			Laboratory Value: Blood Urea Nitrogen (BUN)
				Primary Organs: Liver, Kidney
			Laboratory Value: Creatinine
				Primary Organ: Kidney
			Laboratory Value: Amylase, Lipase
				Primary Organ: Pancreas
			Laboratory Value: Glucose
				Primary Organs: Pancreas, Liver, Thyroid
			Laboratory Value: Lactate Dehydrogenase (LD)
				Primary Organ: Heart
			Laboratory Value: Creatine Phosphokinase (CPK)
				Primary Organs: Heart, Brain, Skeletal
			Laboratory Value: Prostate Specific Antigen (PSA)
				Primary Organ: Prostate
			Laboratory Value: Estrogen
				Primary Organ: Female and Male
			Laboratory Value: Human Chorionic Gonadotropin (hCG)
				Primary Focus: Pregnancy
			Laboratory Value: Alpha Fetoprotein (AFP)
				Primary Focus: Pregnancy
			Laboratory Value: Thyroid Stimulating Hormone, T3, T4
				Primary Organs: Thyroid and Parathyroid Glands
			Laboratory Values: Hematocrit and Prothrombin
				Primary Focus: Blood and Vital Organs
			Laboratory Value: Blood Cell Count and Sediment Rate
				Primary Focus: Blood
		Summary
	10 The Abdominal Aorta
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
		Physiology
		Sonographic Appearance
		Sonographic Applications
		Reference Charts
	11 The Inferior Vena Cava
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
		Physiology
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Reference Charts
	12 The Portal Venous System
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
		Physiology
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Reference Charts
III Abdominal Sonography
	13 Abdominal Vasculature
		Objectives
		Key Words
		The Abdominal Arterial System
			Location
			Size
			Sonographic Appearance
			Hemodynamic Patterns
			Doppler Velocity Spectral Analysis
		The Abdominal Venous System
			Location
			Size
			Sonographic Appearance
			Hemodynamic Patterns and Doppler Spectral Display
		Reference Charts
	14 The Liver
		Objectives
		Key Words
		Location
			Right Posterosuperior Surface
			Inferior (Visceral) Surface
			Right-Sided Inferior Indentations
			Left Side of Inferior Surface
			Posterior Midportion of Inferior Surface
			Right Lobe
			Left Lobe
			Caudate Lobe
		Size
		Gross Anatomy
		Physiology
			Metabolic Functions of the Liver
			Detoxification of Poisonous and Harmful Substances
			Synthesizing Blood Proteins
			Additional Liver Functions
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Reference Charts
	15 The Biliary System
		Objectives
		Key Words
		Location
			Gallbladder
			Hepatic Ducts
			Common Hepatic Duct (CHD)
			Cystic Duct
			Common Bile Duct (CBD)
		Size
			Gallbladder
			Common Hepatic Duct (CHD)
			Cystic Duct
			Common Bile Duct (CBD)
		Gross Anatomy
			Gallbladder
			Hepatic Ducts
			Biliary Ducts
			Cystic Duct
		Physiology
		Sonographic Appearance
			Gallbladder
			Ductal System
		Sonographic Applications
			Indications for Examinations
		Normal Variants
			Gallbladder
			Biliary Ducts
		Reference Charts
	16 The Pancreas
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
			Head
			Neck
			Body
			Tail
		Vascular Anatomy
		Physiology
		Sonographic Appearance
			Transverse Scanning Plane Images Showing Longitudinal Pancreas
				Head (Inferior Vena Cava, Gastroduodenal Artery, Common Bile Duct)
				Neck (Superior Mesenteric Vein, Portal Splenic Confluence, Inferior Vena Cava)
				Body and Tail (Splenic Vein, Superior Mesenteric Artery, Aorta)
			Sagittal Scanning Plane Images Showing Axial Pancreas
				Head (Inferior Vena Cava, Gastroduodenal Artery, Common Bile Duct)
				Neck (Superior Mesenteric Vein, Portal Vein, Inferior Vena Cava)
				Body and Tail (Splenic Vein, Superior Mesenteric Artery, Aorta)
		Sonographic Applications
		Normal Variants
		Reference Charts
	17 The Urinary and Adrenal Systems
		Objectives
		Key Words
		Location
			Upper Urinary Tract: Kidneys, Ureters
				Kidneys
				Ureters
			Lower Urinary Tract: Urinary Bladder, Urethra
				Urinary Bladder
				Urethra
		Size
		Gross Anatomy
			Upper Urinary Tract: Kidneys, Ureters
				Kidneys
				Ureters
			Lower Urinary Tract: Urinary Bladder, Urethra
				Urinary Bladder
				Urethra
		Physiology
			How the Nephron Works
			Protective Mechanisms That Preserve Nephron Function
		Sonographic Appearance
			Upper Urinary Tract: Kidneys, Ureters
				Kidneys
				Ureters
			Lower Urinary Tract: Urinary Bladder, Urethra
				Urinary Bladder
				Urethra
			The Adrenal Glands
		Sonographic Applications
		Normal Variants
		Reference Charts
	18 The Spleen
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
		Physiology
			Defense
			Hematopoiesis
			RBC Removal
			Storage
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
			Accessory Spleen
			Asplenia
			Splenomegaly
		Reference Charts
	19 The Gastrointestinal System
		Objectives
		Key Words
		Location
			Mouth
			Pharynx
			Esophagus
			Peritoneum
			Stomach
			Small Bowel
				Duodenum
				Jejunum and Ileum
			Large Bowel
				Cecum
				Ascending Colon
				Transverse Colon
				Descending Colon
				Sigmoid Colon, Rectum, and Anus
		Size
			Pharynx
			Esophagus
			Stomach
			Pyloric Canal
			Small Bowel
				Duodenum
				Jejunum
				Ileum
			Large Bowel
		Gross Anatomy
			Esophagus
			Stomach
			Small Bowel
				Duodenum
				Jejunum and Ileum
			Large Bowel
		Physiology
		Sonographic Appearance
			Esophagus
			Stomach
			Small Bowel
			Large Bowel
		Sonographic Applications
		Normal Variants
		Reference Charts
IV Pelvic Sonography
	20 The Male Pelvis
		Objectives
		Key Words
		Location
			Prostate Gland
			Seminal Vesicles
		Size
			Prostate Gland
			Seminal Vesicles
		Gross Anatomy
			Prostate Gland
			Seminal Vesicles
		Physiology
		Sonographic Appearance
			Prostate Gland and Seminal Vesicles
		Sonographic Applications
			Prostate Gland
			Seminal Vesicles
		Reference Charts
	21 The Female Pelvis
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
			Pelvic Organs
		Blood Supply
		Physiology
			The Ovarian Cycle
			The Endometrial Cycle
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Reference Charts
V Obstetrics
	22 First Trimester Obstetrics (0 to 12 Weeks)
		Objectives
		Key Words
		Maternal Physiology and Embryo Development
			Weeks 1 to 5: Ovarian Phase
				Weeks 4 to 5
			Weeks 6 to 10: Embryonic Phase
				Week 6
				Weeks 7 to 8
				Week 8
				Week 10
			Weeks 11 to 12: Fetal Phase
		Development of the Placenta
		Development of Fetal Membranes
		Development of Amniotic Fluid
		Sonographic Appearance of First Trimester Anatomy
			Gestational Sac Appearance
			Double Sac Sign
			Yolk Sac Appearance
			Embryo Appearance
			Umbilical Cord Appearance
			Placenta Appearance
			Membrane Appearance
			Amniotic Fluid Appearance
		Sonographic Determination of Gestational Age
		Sonographic Applications
		Normal Variations
		Reference Charts
	23 Second and Third Trimester Obstetrics (13 to 42 Weeks)
		Objectives
		Key Words
		The Placenta
		Amniotic Fluid
		Fetal Organ Systems
			Musculoskeletal System
			Axial Skeleton
				Spine
				Rib Cage
				Skull
			Appendicular Skeleton
				Extremities
			Muscles
			Cardiovascular System
			Heart Chambers and Septa
			Cava, Aorta, and Pulmonary Artery
			Respiratory System
			Upper Respiratory Tract
			Lungs, Ribs, and Diaphragm
			Gastrointestinal System
			Oral Cavity and Esophagus
			Stomach and Gallbladder
			Liver
			Pancreas
			Spleen
			Small and Large Bowel
			Genitourinary System
			Kidneys
				Cortex, Medulla, and Sinus
		Ureters
		Urinary Bladder
		Urethra
		Genitalia
		Adrenal Glands
		Central Nervous System
		The Brain
			Brain Stem
			Cerebrum
			Cerebellum
			Meninges
			Ventricles
			Vasculature
		The Spinal Cord
			Sonographic Appearance
		Determination of Gestational Age During the Second and Third Trimesters
			Biparietal Diameter (BPD)
			Cephalic Index (CI)
			Head Circumference (HC)
			Abdominal Circumference (AC)
			Femur Length (FL)
		Sonographic Applications
		Normal Variants
		Reference Charts
	24 High-Risk Obstetric Sonography
		Objectives
		Key Words
		High-Risk Pregnancies
		Fetal Sonographic Biophysical Profile
		Doppler Ultrasound Evaluation
		Ultrasound-Guided Procedures
			Amniocentesis
			Chorionic Villus Sampling
			Fetal Blood Sampling and Fetal Intravascular Transfusion
		Multifetal Gestations
			Embryology of Multifetal Gestations
			Sonographic Assessment of Multifetal Gestations
		The Expanding Role of Ultrasound in High-Risk Obstetrics
		Reference Charts
	25 Fetal Echocardiography
		Objectives
		Key Words
		Prenatal Development
			Fetal Circulation
		Location
		Size
		Gross Anatomy
		Physiology
		Sonographic Appearance
		Summary
		Sonographic Applications
		Normal Variants
		Reference Charts
VI Introduction to Specialty Sonography
	26 The Neonatal Brain
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
			The Brain
			The Ventricles
			The Cerebrum
			The Cerebellum
			The Brain Stem (“Hindbrain”)
		Physiology
			The Cerebrum
			The Diencephalon
			The Brain Stem
			The Cerebellum
		Sonographic Appearance
			Modified Coronal Plane Cross-Sections
			Modified Sagittal Plane Cross Sections
		Sonographic Applications
		Normal Variants
		Reference Charts
VII Small Parts Sonography
	27 The Thyroid and Parathyroid Glands
		Objectives
		Key Words
		Thyroid Gland
			Location
			Size
			Thyroid Volume
			Gross Anatomy
			Physiology
			Blood Supply
			Sonographic Appearance
			Sonographic Applications
			Normal Variants
		Parathyroid Glands
			Location
			Size
			Gross Anatomy
			Physiology
			Blood Supply
			Sonographic Appearance
			Sonographic Applications
			Normal Variants
			Reference Charts
	28 Breast Sonography
		Objectives
		Key Words
		Location
		Size
		Gross Anatomy
		Physiology
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Advanced Techniques in Breast Imaging
		Breast Self-Examination
		Reference Charts
	29 Scrotal and Penile Sonography
		Objectives
		Key Words
		Location
		Size
			Testis
			Epididymis
		Gross Anatomy
			Scrotum
			Testis
			Epididymis
			Ductus (Vas) Deferens
			Spermatic Cord
			Penis
		Physiology
		Sonographic Appearance
			Scrotal Contents
			Penis
		Sonographic Applications
			Scrotum
			Penis
		Normal Variants
		Reference Charts
VIII Superficial Sonography
	30 Pediatric Echocardiography
		Objectives
		Key Words
		Prenatal Development
			Fetal Circulation
			Fetal to Adult Circulation
		Location
		Size
		Gross Anatomy
			Cardiac Perfusion and Drainage
			Cardiac Conduction System
		Physiology
		Sonographic Appearance
		Sonographic Applications
		Normal Variants
		Reference Charts
	31 Adult Echocardiography
		Objectives
		Key Words
		Prenatal Development
		Location
		Size
		Gross Anatomy
		Physiology
			Circulatory System
			Conduction System
			The Electrocardiogram
			Systole/Diastole
		Sonographic Appearance
			Two-Dimensional Echocardiography
			M-Mode Echocardiography
			Doppler Echocardiography
				Normal Doppler Waveforms
					Mitral Valve.
					Aortic Valve.
					Aortic Arch.
					Tricuspid Valve.
					Pulmonic Valve.
			Transesophageal Echocardiography
			Three-Dimensional Echocardiography
		Sonographic Applications
		Normal Variants
		Reference Charts
	32 Vascular Technology
		Objectives
		Key Words
		Extracranial Cerebrovascular System
			Size of the Extracranial Cerebrovascular Vessels
			Sonographic Appearance of the Extracranial Carotid and Vertebral Arteries
			Hemodynamic Patterns of the Extracranial Carotid and Vertebral Arteries
			Doppler Velocity Spectral Waveforms
				Common Carotid Artery
				Internal Carotid Artery
				External Carotid Artery
				Carotid Bulb
				Vertebral Arteries
		The Intracranial Cerebrovascular System
			Size of the Intracranial Cerebrovascular Arteries
			Sonographic Appearance of the Intracranial Arteries
			Hemodynamic Patterns of the Intracranial Arteries
			Doppler Velocity Spectral Data and Flow Direction
				Middle Cerebral and Anterior Cerebral Arteries
				Posterior Cerebral Artery
				Ophthalmic Artery
				Carotid Siphon
				Vertebral and Basilar Arteries
		The Lower Extremity Arterial System
			Sonographic Appearance of the Lower Extremity Peripheral Arterial Vessels
			Size of the Lower Extremity Arteries
			Hemodynamic Patterns in the Lower Extremity Arterial System
			Doppler Velocity Spectral Waveforms
				Indirect Physiologic Tests
		The Lower Extremity Venous System
			The Deep Venous System
			The Superficial Venous System
			The Perforating Veins
			Size of the Deep and Superficial Veins
			Sonographic Appearance of the Deep and Superficial Venous Systems
			Hemodynamic Patterns of the Lower Extremity Deep Venous System
				Doppler Spectral Analysis
		Quality Assurance in Vascular Technology
			Measurements Used for Test Validation
			Statistical Correlation
			Understanding the Assigned Values
			Understanding the Columns and Rows
			Understanding the Calculations
		Summary
		Reference Charts
IX Advances in Sonography
	33 3-D/4-D Sonography
		Objectives
		Key Words
		Methods
			Step 1: Volume Acquisition
			Step 2: Volume Manipulations
				Aligning Data Sets Using the Z-Axis
			Step 3: Enhanced Display Features
		Sonographic Applications
			Obstetrics
			Gynecology
			Abdominal
			Small Parts
			Urology
			Pediatrics
		Advanced Features
		Summary
	34 Interventional and Intraoperative Ultrasound
		Objectives
		Key Words
		Ultrasound-Guided Intervention
			Percutaneous Biopsies
			Percutaneous Aspirations
			Percutaneous Drainage Procedures
		Intraoperative Ultrasound
			Equipment and Transducers
			Sterile Field Procedure
			Applications
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z