This book will be of interest to anyone who wants to use ultrasound to understand human physiology both in the clinical setting and the classroom. Tremendous advances in ultrasound technology have resulted in portable ultrasound systems that are easy to use, produce excellent images, and are affordable with quality hand-held and laptop-sized systems costing between $2K and $20K. These systems are now being used at the patient bedside or point of care by almost all medical and surgical specialities from primary care to orthopaedic surgery. These portable systems, especially the hand-held devices, are now being called the stethoscopes of the 21st century and will likely be used by many that are presently using stethoscopes including physicians, nurses, physician assistants, medics and other health professionals.
Ultrasound began to be used in medical student education in the 1990s and is steadily becoming a common teaching tool for courses like anatomy and physiology. It is a visual, highly interactive learning tool that bridges the basic and clinical sciences and allows the learner to observe physiology principles in a living model. Ultrasound is also being used to teach other health professions students as well as undergraduate college students and high school students. Despite this interest there are no books available that provide an introduction to ultrasound and how it can be used to enhance the teaching of physiology. This e-book will do just that as well as offer “How to Scan” videos with example laboratory exercises to further engage learners.
Author(s): L. Britt Wilson, Richard A. Hoppmann, Floyd E. Bell, Victor V. Rao
Series: Physiology in Health and Disease
Publisher: Springer
Year: 2023
Language: English
Pages: 323
City: Cham
Contents
Chapter 1: Using Ultrasound to Teach Physiology: An Introduction
1.1 Ultrasound Technology, Point-of-Care Ultrasound, and Ultrasound in Education
1.2 Advantages of Using Ultrasound to Teach Physiology
1.2.1 Safety and Ease of Learning Ultrasound to Visualize Anatomy and Assess Physiology/Function
1.2.2 Ultrasound Use in Multiple Teaching Formats
1.2.3 Competency-Based Medical Education (CBME)
1.2.4 Integration Across Life Sciences and Medical Curricula
1.2.5 A Learning Tool That Becomes a Clinical Practice Tool
Further Reading
Chapter 2: The Basics of Ultrasound Physics
2.1 What Is Ultrasound?
2.2 How Does Ultrasound Work?
2.3 Interactions of Sound Waves in the Body
2.3.1 Reflection
2.3.2 Scatter
2.3.3 Refraction
2.3.4 Absorption
2.3.5 Attenuation
2.3.6 Interactions Summary
2.4 Propagation Speed of Ultrasound Waves
2.5 What Determines Returning Echo Signal Strength?
2.6 What Characteristics of Echoes Contribute to Image Display?
2.6.1 Echo Signal Amplitude
2.6.2 Position of Returning Echo on Probe Footprint
2.6.3 Time for Echo Return
2.6.4 Frequency Shifts
2.7 Modes of Ultrasound
2.7.1 Brightness Mode (B-Mode)
2.7.2 Motion Mode (M-Mode)
2.7.3 Color Doppler
2.7.4 Spectral Doppler
2.7.5 Power Doppler
2.8 Ultrasound Machine Considerations
2.8.1 Probe Frequency
2.8.1.1 High Frequency
2.8.1.2 Low Frequency
2.8.2 Shape/Design of Probe
2.8.2.1 Sector
2.8.2.2 Curvilinear
2.8.2.3 Linear
2.8.3 Display Parameters for Optimizing Images
2.8.3.1 Depth
2.8.3.2 Gain
2.8.3.3 TGC
2.8.3.4 Focus
2.8.3.5 Frequency
2.8.3.6 Presets
2.8.4 Other Machine Features
2.8.4.1 Freeze
2.8.4.2 Measure
2.8.4.3 Save
2.9 Patient Considerations
2.9.1 Patient Preparation
2.9.2 Position
2.9.3 Maneuvers and Manipulations
2.10 Scanner Considerations
2.10.1 Probe Placement
2.10.2 Probe Manipulation
2.10.2.1 Rocking
2.10.2.2 Fanning
2.10.2.3 Rotation
2.10.2.4 Compression
2.10.2.5 Sliding or Sweeping
2.11 Scan Planes
2.11.1 Long Axis
2.11.2 Short Axis
2.11.3 Scan Plane vs Body Plane
2.12 Image Display Orientation
2.13 Image Description Terminology
2.14 Artifacts
2.14.1 Shadowing
2.14.2 Enhancement
2.14.3 Mirror Image
2.14.4 Reverberation
2.14.5 Ring Down
2.14.6 Comet Tail
2.14.7 Anisotropy
2.14.8 Loss of Contact
2.14.9 Edge Artifact
2.14.10 Aliasing
2.15 Safety Considerations
2.15.1 Output Power
2.15.2 Mechanical Index
2.15.3 Thermal Index
2.15.4 ALARA
Further Reading
Chapter 3: Ultrasound of the Vascular System
3.1 Anatomy and Physiology of the Vascular System
3.2 Hemodynamics
3.2.1 Pressure/Flow/Resistance
3.2.2 Velocity
3.2.3 Turbulence
3.2.4 Extravascular Pressure
3.3 Vascular Ultrasound: Settings
3.3.1 Preset
3.3.2 Color Doppler
3.3.3 Spectral Doppler
3.3.4 Doppler Equation
3.4 US Laboratory Exercises
3.4.1 Exercise 1: Common Carotid Artery (CCA) and Internal Jugular Vein (IJV)
3.4.1.1 Learning Objectives
3.4.1.2 Transducer/Probe
3.4.1.3 Additional Equipment and Supplies
3.4.1.4 Patient Position and Image Orientation
3.4.1.5 Performing the Scan
3.4.2 Exercise 2: Quantitating Velocity in the Common Carotid Artery
3.4.2.1 Learning Objectives
3.4.2.2 Transducer/Probe
3.4.2.3 Additional Equipment and Supplies
3.4.2.4 Patient Position and Image Orientation
3.4.2.5 Performing the Scan
Further Reading
Chapter 4: Ultrasound of the Heart
4.1 Anatomy and Physiology of the Heart
4.2 Cardiac Muscle Contraction
4.3 Ultrasound Anatomy
4.4 Common Applications of Cardiac Ultrasound
4.5 The Electrical Activity of the Heart
4.6 Heart Sounds
4.7 The Cardiac Cycle
4.7.1 Phase 1: Atrial Systole (Fig. 4.16)
4.7.2 Phase 2: Ventricular Isovolumetric Contraction (Fig. 4.17)
4.7.3 Phase 3: Ventricular Rapid Ejection of Blood (Fig. 4.18)
4.7.4 Phase 4:Ventricular Reduced Ejection (Fig. 4.19)
4.7.5 Phase 5: Ventricular Relaxation Isovolumetric (Fig. 4.20)
4.7.6 Phase 6: Ventricular Rapid Filling (Fig. 4.21)
4.7.7 Phase 7: Ventricular Reduced Filling (Diastasis) (Fig. 4.22)
4.8 The Ventricular Pressure-Volume Relationships and the Cardiac Loop
4.9 Cardiac Output
4.10 Determinants of Stroke Volume
4.10.1 Preload
4.10.2 Afterload
4.10.3 Contractility
4.11 Ejection Fraction
4.12 Hypertension, Cardiac Remodeling, and Heart Failure
4.13 Diastolic Dysfunction
4.14 Ultrasound Laboratory Exercises
4.14.1 Exercise 1: The Parasternal Long Axis (PLAX) View of the Heart
4.14.1.1 Learning Objectives
4.14.1.2 Transducer/Probe
4.14.1.3 Additional Equipment and Supplies
4.14.1.4 Patient Position and Image Orientation
4.14.1.5 Performing the Parasternal Long Axis View
4.14.2 Exercise 2: Combining Ultrasound with Auscultation of the Heart
4.14.2.1 Learning Objectives
4.14.2.2 Transducer/Probe
4.14.2.3 Additional Equipment and Supplies
4.14.2.4 Auscultation of the Heart
4.14.2.5 Ultrasound and Auscultation of the Heart
4.14.3 Exercise 3: The Apical Four and Five Chamber Views of the Heart
4.14.3.1 Learning Objectives
4.14.3.2 Transducer/Probe
4.14.3.3 Additional Equipment and Supplies
4.14.3.4 Patient Position and Image Orientation
4.14.3.5 Performing the Apical Four Chamber View
4.14.4 Exercise 4: Color Doppler Ultrasound to Assess Cardiac Blood Flow and Heart Valves
4.14.4.1 Learning Objectives
4.14.4.2 Transducer/Probe
4.14.4.3 Additional Equipment and Supplies
4.14.4.4 Applying Color Doppler to Apical Cardiac Views
Further Reading
Chapter 5: Ultrasound of the Respiratory System
5.1 Anatomy and Physiology of the Respiratory System
5.2 How We Breathe
5.2.1 Alterations in Intrapleural Pressure due to Pathologic States: Appearance on Ultrasound
5.2.2 Inspiration
5.2.3 Expiration
5.3 Diaphragmatic Excursion: Appearance on Ultrasound
5.4 Other Respiratory Muscles
5.5 Compliance and Elasticity
5.6 Gas Exchange and Hypoxemia
5.6.1 Lab Excercise: Assessment of Lung Sliding and Pneumothorax Simulation
5.6.1.1 Learning Objectives
5.6.1.2 Transducer/Probe
5.6.1.3 Patient Position and Image Orientation
5.6.1.4 Evaluating the Pleural Surface and Lung Sliding
References
Further Reading
Chapter 6: Ultrasound of the Gastrointestinal Tract
6.1 Anatomy and Physiology of the Gastrointestinal Tract
6.2 Motility
6.3 Absorption
6.4 Excretion
6.5 Immunity
6.6 Regulation of the Gastrointestinal Tract
6.7 Layers of the Gastrointestinal Wall
6.8 Unique Ultrasound Features of the GI Tract
6.8.1 Depth
6.8.2 Intestinal Air
6.8.3 Peristalsis
6.8.4 Fed or Fasting
6.9 Gastrointestinal Tract
6.9.1 Oral Cavity
6.9.2 Larynx/Pharynx
6.9.3 Esophagus
6.9.4 Stomach
6.9.5 Small Intestine
6.9.6 Large Intestine
6.9.7 Liver
6.9.7.1 Overview
6.9.7.2 Hepatic Circulation
6.9.7.3 Liver Structure
6.9.7.4 Functions of the Liver
6.9.7.5 Liver Fibrosis and Cirrhosis
6.9.7.6 Albumin
6.9.8 Gallbladder and Bile
6.9.8.1 Gallbladder
6.9.8.2 Common Bile Duct
6.9.8.3 Gallbladder Contraction
6.9.8.4 Bile
6.9.9 Pancreas
6.10 Table of US Applications
6.11 Lab Exercises
6.11.1 Exercise 1: Esophagus Swallow-Examining Peristalsis
6.11.1.1 Learning Objectives
6.11.1.2 Transducer/Probe
6.11.1.3 Needed Supplies
6.11.1.4 Patient Position and Image Orientation
6.11.1.5 Performing the Scan
6.11.1.6 A Step Further
6.11.2 Exercise 2: Observing Changes in the Fasting and Post Prandial Gallbladder
6.11.2.1 Learning Objectives
6.11.2.2 Transducer/Probe
6.11.2.3 Needed Supplies
6.11.2.4 Patient Position and Image Orientation
6.11.2.5 Performing the Scan on a Fasting Gallbladder
6.11.2.6 Performing the Scan on a Post-Prandial Gallbladder
6.11.2.7 One Step Further
6.12 Conclusion
Further Reading
Reference Books
Articles: General Ultrasound of the Gastrointestinal Ttract
Chapter 7: Ultrasound of the Urinary System
7.1 Anatomy and Physiology of the Urinary System
7.1.1 Renal Structures on Ultrasound
7.1.2 Bladder on Ultrasound
7.1.3 Renal Vasculature on Ultrasound
7.2 Clinical Topic 1
7.2.1 Urinary Obstruction
7.2.1.1 Hydronephrosis
7.2.1.2 Bladder Assessment
7.3 Clinical Topic 2
7.3.1 Renal Injury
7.3.1.1 Acute Kidney Injury
7.3.1.2 Chronic Kidney Disease
7.3.2 Ultrasound Assessment in Renal Injury
7.3.2.1 Cortical Echogenicity
7.3.2.2 Kidney Size
7.3.2.3 Volume Assessment
7.3.3 Laboratory Exercises
7.3.3.1 Exercise #1: Focused Kidney & Bladder Assessment
Learning Objectives
Transducer/Probe
Additional Equipment and Supplies
Patient Position and Image Orientation
Performing the Scan
7.3.3.2 Exercise #2: Inferior Vena Cava (IVC) Assessment
Learning Objectives
Transducer/Probe
Additional Equipment and Supplies
Patient Position and Image Orientation
Performing the Scan
References
Chapter 8: Ultrasound of the Musculoskeletal System
8.1 Anatomy and Physiology of the Musculoskeletal System
8.1.1 Skeleton
8.1.2 Skeletal Muscle
8.2 US Imaging of the MSK
8.2.1 Echotexture of the Tissues in the MSK System
8.2.1.1 Skeletal Muscle
8.2.1.2 Tendons and Ligaments
8.2.1.3 Bone and Cartilage
8.2.1.4 Joints, Joint Capsules, and Bursae
8.2.2 Dynamic Imaging
8.2.3 Examples of Clinical Applications of MSK Ultrasound Imaging
8.2.4 Laboratory Exercises That Demonstrate Concepts of Physiology of the MSK System
8.2.4.1 Exercise 1: Ultrasound Imaging of Muscle Architecture During Contraction
Protocol
8.2.4.2 Exercise 2: Use Power Doppler to Observe Differences in Blood Perfusion of Muscle at Rest and After Exercise
Protocol
8.2.4.3 Exercise 3: Use Ultrasound Imaging to Explore Venous Return in the Popliteal Vein
Protocol
8.2.4.4 Exercise 4: Use Spectral Doppler to Demonstrate the Change from a High Resistance Waveform to a Low Resistance Wavefor...
Protocol
8.3 Summary
References
Chapter 9: Ultrasound of the Endocrine System
9.1 Anatomy and Physiology of Endocrine System
9.2 Hormone Synthesis
9.3 Mechanisms of Hormone Action
9.4 The Hypothalamus: The single Most Important Orchestrator of Hormones in the Body
9.5 Hormone Receptor Regulation
9.6 The Thyroid: A Model for Using of Ultrasound to Probe Hormonal Physiology
9.7 Scanning the Thyroid Gland
9.8 Diseases of the Thyroid Gland
9.9 Hyperthyroidism
9.10 Hypothyroidism
9.11 Goiter
9.11.1 Exercise 1: Midline Transverse View of the Thyroid Gland and the Surrounding Structures
9.11.1.1 Learning Objectives
9.11.1.2 Type of Transducer/Probe
9.11.1.3 Patient Position and Image Orientation
9.11.1.4 Performing the Transverse View of the Thyroid Gland
9.11.2 Exercise 2: Using Ultrasound to Observe and Obtain Thyroid Volume
9.11.2.1 Learning Objectives
9.11.2.2 Type of Transducer/Probe
9.11.2.3 Patient Position and Image Orientation
9.11.2.4 Calculating Thyroid Volume
Further Reading
Chapter 10: Ultrasound of the Reproductive System
10.1 Anatomy and Physiology of Reproductive System
10.1.1 Male Reproduction
10.1.2 Some Common Clinical Ultrasound Applications for Male Reproductive Physiology
10.2 Female Reproduction
10.2.1 Some Common Clinical Ultrasound Applications for Female Reproductive Physiology
10.3 Laboratory Exercises in Reproductive Physiology
10.3.1 Exercise 1: Observing the Male Pelvis with the Abdominal Approach
10.3.1.1 Learning Objectives
10.3.1.2 Transducer/Probe
10.3.1.3 Additional Equipment and Supplies
10.3.1.4 Patient Position and Image Orientation
10.3.1.5 Performing the Male Abdominal Pelvic Ultrasound
10.3.2 Exercise 2: Observing the Female Pelvis with the Abdominal Approach
10.3.2.1 Learning Objectives
10.3.2.2 Transducer/Probe
10.3.2.3 Additional Equipment and Supplies
10.3.2.4 Patient Position and Image Orientation
10.3.2.5 Performing the Female Abdominal Pelvic Ultrasound
Further Reading
Chapter 11: Ultrasound of the Nervous System
11.1 Anatomy and Physiology of the Nervous System
11.2 Pupillary Light Reflex
11.3 Myotatic Stretch Reflex
11.3.1 Exercise 1: Ultrasonography of the Consensual Reflex
11.3.1.1 Learning Objectives
11.3.1.2 Transducer/Probe
11.3.1.3 Additional Equipment and Supplies for Exercise and Optional Assessment
11.3.1.4 Patient Position and Image Orientation
11.3.1.5 Performing the Pupillary Eye Examination
11.3.1.6 Optional Assessment of the Pupillary Response
11.3.2 Exercise 2: Ultrasonography of Stretch Reflex
11.3.2.1 Learning Objectives
11.3.2.2 Transducer/Probe
11.3.2.3 Additional Equipment and Supplies
11.3.2.4 Patient Position and Image Orientation
11.3.2.5 Performing the Stretch Reflex with B-mode: Transverse View
11.3.2.6 Optional Assessment of the Stretch Reflex Response
Stretch Reflex with B- and M-Modes: Transverse View
Stretch Reflex with B- and Doppler (Spectral) Modes: Transverse View
Further Reading
Chapter 12: Introducing Ultrasound into a Physiology Course from A to Z
12.1 Purchase of Ultrasound Systems
12.1.1 Number of Ultrasound Systems
12.1.2 Type of Systems
12.1.3 Demonstration, Testing, and Purchase Options
12.2 Models and Standardized Patients
12.3 Trained Instructors
12.4 Student Contact Hours for Ultrasound
12.5 Ultrasound Educational Materials and Student Assessment
12.5.1 Student Assessment
12.5.2 Estimated Student Time for Ultrasound When Initiating a Program
12.6 Student Feedback
12.7 Space and Equipment for Ultrasound Laboratory Sessions
12.8 Residency Ultrasound Training
12.9 Ultrasound Fellowship
12.10 Potential Sources of Funding for Ultrasound
12.10.1 Institutional Support
12.10.2 Industry Partnerships and Grants
12.10.3 Donations
12.10.4 Grants
12.10.5 Training Revenue Streams
12.10.6 Patents and Licenses
12.10.7 Student Fees
12.11 A Scaled-Back Model to Introduce Ultrasound into Physiology Courses with Limited Resources
12.12 Ultrasound Initiation Checklist
Further Reading and Resources
Journal Articles
Online Resources
