General Ultrasound

Scan f or m obi l e l i nk . G eneral U l t rasound U l t rasou nd i m ag i ng u ses sou nd w aves t o produ ce pi ct u res of t h e i nsi de of t h e body. I t i s u sed t o h el p di ag nose t h e cau ses of pai n, sw el l i ng and i nfect i on i n t h e body’s i nt ernal org ans and t o exam i ne a baby i n preg nant w om en and t h e brai n and h i ps i n i nfant s. I t ’s al so u sed t o h el p g u i de bi opsi es, di ag nose h eart condi t i ons, and assess dam ag e aft er a h eart at t ack . U l t rasou nd i s safe, noni nvasi ve, and does not u se i oni z i ng radi at i on. Th i s procedu re requ i res l i t t l e t o no speci al preparat i on. Y ou r doct or w i l l i nst ru ct you on h ow t o prepare, i ncl u di ng w h et h er you sh ou l d refrai n from eat i ng or dri nk i ng beforeh and. Leave jew el ry at h om e and w ear l oose, com fort abl e cl ot h i ng . Y ou m ay be ask ed t o w ear a g ow n. W h at i s G eneral U l t rasound I m ag i ng ? U l t rasou nd i s safe and pai nl ess, and produ ces pi ct u res of t h e i nsi de of t h e body u si ng sou nd w aves. U l t rasou nd i m ag i ng , al so cal l ed u l t rasou nd scanni ng or sonog raph y, i nvol ves t h e u se of a sm al l t ransdu cer (probe) and u l t rasou nd g el pl aced di rect l y on t h e sk i n. H i g h -frequ ency sou nd w aves are t ransm i t t ed from t h e probe t h rou g h t h e g el i nt o t h e body. Th e t ransdu cer col l ect s t h e sou nds t h at bou nce back and a com pu t er t h en u ses t h ose sou nd w aves t o creat e an i m ag e. U l t rasou nd exam i nat i ons do not u se i oni z i ng radi at i on (as u sed i n x-rays) , t h u s t h ere i s no radi at i on exposu re t o t h e pat i ent . Becau se u l t rasou nd i m ag es are capt u red i n real -t i m e, t h ey can sh ow t h e st ru ct u re and m ovem ent of t h e body's i nt ernal org ans, as w el l as bl ood fl ow i ng t h rou g h bl ood vessel s. U l t rasou nd i m ag i ng i s a noni nvasi ve m edi cal t est t h at h el ps ph ysi ci ans di ag nose and t reat m edi cal condi t i ons. Convent i onal u l t rasou nd di spl ays t h e i m ag es i n t h i n, fl at sect i ons of t h e body. Advancem ent s i n u l t rasou nd t ech nol og y i ncl u de t h ree-di m ensi onal (3-D) u l t rasou nd t h at form at s t h e sou nd w ave dat a i nt o 3-D i m ag es. A Doppl er u l t rasou nd st u dy m ay be part of an u l t rasou nd exam i nat i on. G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 1 of 7 Revi ew ed Mar-9 -2018

Doppl er u l t rasou nd, al so cal l ed col or Doppl er u l t rasonog raph y, i s a speci al u l t rasou nd t ech ni qu e t h at al l ow s t h e ph ysi ci an t o see and eval u at e bl ood fl ow t h rou g h art eri es and vei ns i n t h e abdom en, arm s, l eg s, neck and/ or brai n (i n i nfant s and ch i l dren) or w i t h i n vari ou s body org ans su ch as t h e l i ver or k i dneys. Th ere are t h ree t ypes of Doppl er u l t rasou nd: Col or Doppl er u ses a com pu t er t o convert Doppl er m easu rem ent s i nt o an array of col ors t o sh ow t h e speed and di rect i on of bl ood fl ow t h rou g h a bl ood vessel . Pow er Doppl er i s a new er t ech ni qu e t h at i s m ore sensi t i ve t h an col or Doppl er and capabl e of provi di ng g reat er det ai l of bl ood fl ow , especi al l y w h en bl ood fl ow i s l i t t l e or m i ni m al . Pow er Doppl er, h ow ever, does not h el p t h e radi ol og i st det erm i ne t h e di rect i on of bl ood fl ow , w h i ch m ay be i m port ant i n som e si t u at i ons. Spect ral Doppl er di spl ays bl ood fl ow m easu rem ent s g raph i cal l y, i n t erm s of t h e di st ance t ravel ed per u ni t of t i m e, rat h er t h an as a col or pi ct u re. I t can al so convert bl ood fl ow i nform at i on i nt o a di st i nct i ve sou nd t h at can be h eard w i t h every h eart beat . W h at are som e com m on uses of t h e p roced ure? U l t rasou nd exam i nat i ons can h el p t o di ag nose a vari et y of condi t i ons and t o assess org an dam ag e fol l ow i ng i l l ness. U l t rasou nd i s u sed t o h el p ph ysi ci ans eval u at e sym pt om s su ch as: pai n sw el l i ng i nfect i on U l t rasou nd i s a u sefu l w ay of exam i ni ng m any of t h e body's i nt ernal org ans, i ncl u di ng bu t not l i m i t ed t o t h e: h eart and bl ood vessel s, i ncl u di ng t h e abdom i nal aort a and i t s m ajor branch es l i ver g al l bl adder spl een pancreas k i dneys bl adder u t eru s, ovari es, and u nborn ch i l d (fet u s) i n preg nant pat i ent s eyes t h yroi d and parat h yroi d g l ands scrot u m (t est i cl es) brai n i n i nfant s h i ps i n i nfant s spi ne i n i nfant s U l t rasou nd i s al so u sed t o: G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 2 of 7 Revi ew ed Mar-9 -2018

g u i de procedu res su ch as needl e bi opsi es, i n w h i ch needl es are u sed t o sam pl e cel l s from an abnorm al area for l aborat ory t est i ng . i m ag e t h e breast s and g u i de bi opsy of breast cancer (see t h e U l t rasou nd-G u i ded Breast Bi opsy pag e. di ag nose a vari et y of h eart condi t i ons, i ncl u di ng val ve probl em s and cong est i ve h eart fai l u re, and t o assess dam ag e aft er a h eart at t ack . U l t rasou nd of t h e h eart i s com m onl y cal l ed an “ech ocardi og ram ” or “ech o” for sh ort . Doppl er u l t rasou nd i m ag es can h el p t h e ph ysi ci an t o see and eval u at e: bl ock ag es t o bl ood fl ow (su ch as cl ot s) narrow i ng of vessel s t u m ors and cong eni t al vascu l ar m al form at i ons redu ced or absent bl ood fl ow t o vari ou s org ans g reat er t h an norm al bl ood fl ow t o di fferent areas, w h i ch i s som et i m es seen i n i nfect i ons W i t h k now l edg e abou t t h e speed and vol u m e of bl ood fl ow g ai ned from a Doppl er u l t rasou nd i m ag e, t h e ph ysi ci an can oft en det erm i ne w h et h er a pat i ent i s a g ood candi dat e for a procedu re l i k e ang i opl ast y. How sh oul d I p rep are? Y ou sh ou l d w ear com fort abl e, l oose-fi t t i ng cl ot h i ng for you r u l t rasou nd exam . Y ou m ay need t o rem ove al l cl ot h i ng and jew el ry i n t h e area t o be exam i ned. Y ou m ay be ask ed t o w ear a g ow n du ri ng t h e procedu re. Preparat i on for t h e procedu re w i l l depend on t h e t ype of exam i nat i on you w i l l h ave. For som e scans you r doct or m ay i nst ru ct you not t o eat or dri nk for as m any as 12 h ou rs before you r appoi nt m ent . For ot h ers you m ay be ask ed t o dri nk u p t o si x g l asses of w at er t w o h ou rs pri or t o you r exam and avoi d u ri nat i ng so t h at you r bl adder i s fu l l w h en t h e scan beg i ns. W h at d oes t h e equi p m ent l ook l i k e? U l t rasou nd scanners consi st of a consol e cont ai ni ng a com pu t er and el ect roni cs, a vi deo di spl ay screen and a t ransdu cer t h at i s u sed t o do t h e scanni ng . Th e t ransdu cer i s a sm al l h and-h el d devi ce t h at resem bl es a m i croph one, at t ach ed t o t h e scanner by a cord. Som e exam s m ay u se di fferent t ransdu cers (w i t h di fferent capabi l i t i es) du ri ng a si ng l e exam . Th e t ransdu cer sends ou t h i g h -frequ ency sou nd w aves (t h at t h e h u m an ear cannot h ear) i nt o t h e body and t h en l i st ens for t h e ret u rni ng ech oes from t h e t i ssu es i n t h e body. Th e pri nci pl es are si m i l ar t o sonar u sed by boat s and su bm ari nes. Th e u l t rasou nd i m ag e i s i m m edi at el y vi si bl e on a vi deo di spl ay screen t h at l ook s l i k e a com pu t er or t el evi si on m oni t or. Th e i m ag e i s creat ed based on t h e am pl i t u de (l ou dness) , frequ ency (pi t ch ) and t i m e i t t ak es for t h e u l t rasou nd si g nal t o ret u rn from t h e area w i t h i n t h e pat i ent t h at i s bei ng exam i ned t o t h e t ransdu cer (t h e devi ce pl aced on t h e pat i ent 's sk i n t o send and recei ve t h e ret u rni ng sou nd w aves) , as w el l as t h e t ype of body st ru ct u re and com posi t i on of body t i ssu e t h rou g h w h i ch t h e sou nd t ravel s. A sm al l G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 3 of 7 Revi ew ed Mar-9 -2018

am ou nt of g el i s pu t on t h e sk i n t o al l ow t h e sou nd w aves t o t ravel from t h e t ransdu cer t o t h e exam i ned area w i t h i n t h e body and t h en back ag ai n. U l t rasou nd i s an excel l ent m odal i t y for som e areas of t h e body w h i l e ot h er areas, especi al l y ai r-fi l l ed l u ng s, are poorl y su i t ed for u l t rasou nd. How d oes t h e p roced ure w ork ? U l t rasou nd i m ag i ng i s based on t h e sam e pri nci pl es i nvol ved i n t h e sonar u sed by bat s, sh i ps and fi sh erm en. W h en a sou nd w ave st ri k es an object , i t bou nces back , or ech oes. By m easu ri ng t h ese ech o w aves, i t i s possi bl e t o det erm i ne h ow far aw ay t h e object i s as w el l as t h e object 's si z e, sh ape and consi st ency (w h et h er t h e object i s sol i d or fi l l ed w i t h fl u i d) . I n m edi ci ne, u l t rasou nd i s u sed t o det ect ch ang es i n appearance, si z e or cont ou r of org ans, t i ssu es, and vessel s or t o det ect abnorm al m asses, su ch as t u m ors. I n an u l t rasou nd exam i nat i on, a t ransdu cer bot h sends t h e sou nd w aves i nt o t h e body and recei ves t h e ech oi ng w aves. W h en t h e t ransdu cer i s pressed ag ai nst t h e sk i n, i t di rect s sm al l pu l ses of i nau di bl e, h i g h -frequ ency sou nd w aves i nt o t h e body. As t h e sou nd w aves bou nce off i nt ernal org ans, fl u i ds and t i ssu es, t h e sensi t i ve recei ver i n t h e t ransdu cer records t i ny ch ang es i n t h e sou nd's pi t ch and di rect i on. Th ese si g nat u re w aves are i nst ant l y m easu red and di spl ayed by a com pu t er, w h i ch i n t u rn creat es a real -t i m e pi ct u re on t h e m oni t or. One or m ore fram es of t h e m ovi ng pi ct u res are t ypi cal l y capt u red as st i l l i m ag es. Sh ort vi deo l oops of t h e i m ag es m ay al so be saved. Doppl er u l t rasou nd, a speci al appl i cat i on of u l t rasou nd, m easu res t h e di rect i on and speed of bl ood cel l s as t h ey m ove t h rou g h vessel s. Th e m ovem ent of bl ood cel l s cau ses a ch ang e i n pi t ch of t h e refl ect ed sou nd w aves (cal l ed t h e Doppl er effect ) . A com pu t er col l ect s and processes t h e sou nds and creat es g raph s or col or pi ct u res t h at represent t h e fl ow of bl ood t h rou g h t h e bl ood vessel s. How i s t h e p roced ure p erf orm ed ? For m ost u l t rasou nd exam s, you w i l l be posi t i oned l yi ng face-u p on an exam i nat i on t abl e t h at can be t i l t ed or m oved. Pat i ent s m ay be t u rned t o ei t h er si de t o i m prove t h e qu al i t y of t h e i m ag es. Aft er you are posi t i oned on t h e exam i nat i on t abl e, t h e radi ol og i st (a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons) or sonog raph er w i l l appl y a w arm w at er-based g el t o t h e area of t h e body bei ng st u di ed. Th e g el w i l l h el p t h e t ransdu cer m ak e secu re cont act w i t h t h e body and el i m i nat e ai r pock et s bet w een t h e t ransdu cer and t h e sk i n t h at can bl ock t h e sou nd w aves from passi ng i nt o you r body. Th e t ransdu cer i s pl aced on t h e body and m oved back and fort h over t h e area of i nt erest u nt i l t h e desi red i m ag es are capt u red. Th ere i s u su al l y no di scom fort from pressu re as t h e t ransdu cer i s pressed ag ai nst t h e area bei ng exam i ned. H ow ever, i f scanni ng i s perform ed over an area of t enderness, you m ay feel pressu re or m i nor pai n from t h e t ransdu cer. Doppl er sonog raph y i s perform ed u si ng t h e sam e t ransdu cer. G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 4 of 7 Revi ew ed Mar-9 -2018

Rarel y, you ng ch i l dren m ay need t o be sedat ed i n order t o h ol d st i l l for t h e procedu re. Parent s sh ou l d ask abou t t h i s beforeh and and be m ade aw are of food and dri nk rest ri ct i ons t h at m ay be needed pri or t o sedat i on. Once t h e i m ag i ng i s com pl et e, t h e cl ear u l t rasou nd g el w i l l be w i ped off you r sk i n. Any port i ons t h at are not w i ped off w i l l dry qu i ck l y. Th e u l t rasou nd g el does not u su al l y st ai n or di scol or cl ot h i ng . I n som e u l t rasou nd st u di es, t h e t ransdu cer i s at t ach ed t o a probe and i nsert ed i nt o a nat u ral openi ng i n t h e body. Th ese exam s i ncl u de: Transesoph ag eal ech ocard i og ram . Th e t ransdu cer i s i nsert ed i nt o t h e esoph ag u s t o obt ai n i m ag es of t h e h eart . Transrectal ul trasound . Th e t ransdu cer i s i nsert ed i nt o a m an's rect u m t o vi ew t h e prost at e. Transvag i nal ul trasound . Th e t ransdu cer i s i nsert ed i nt o a w om an's vag i na t o vi ew t h e u t eru s and ovari es. W h at w i l l I exp eri ence d uri ng and af t er t h e p roced ure? U l t rasou nd exam i nat i ons are pai nl ess and easi l y t ol erat ed by m ost pat i ent s. U l t rasou nd exam s i n w h i ch t h e t ransdu cer i s i nsert ed i nt o an openi ng of t h e body m ay produ ce m i ni m al di scom fort . I f a Doppl er u l t rasou nd st u dy i s perform ed, you m ay act u al l y h ear pu l se-l i k e sou nds t h at ch ang e i n pi t ch as t h e bl ood fl ow i s m oni t ored and m easu red. Most u l t rasou nd exam i nat i ons are com pl et ed w i t h i n 30 m i nu t es, al t h ou g h m ore ext ensi ve exam s m ay t ak e u p t o an h ou r. W h en t h e exam i nat i on i s com pl et e, you m ay be ask ed t o dress and w ai t w h i l e t h e u l t rasou nd i m ag es are revi ew ed. Aft er an u l t rasou nd exam i nat i on, you sh ou l d be abl e t o resu m e you r norm al act i vi t i es i m m edi at el y. W h o i nt erp ret s t h e resul t s and h ow d o I g et t h em ? A radi ol og i st , a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons, w i l l anal yz e t h e i m ag es and send a si g ned report t o you r pri m ary care ph ysi ci an, or t o t h e ph ysi ci an or ot h er h eal t h care provi der w h o requ est ed t h e exam . U su al l y, t h e referri ng ph ysi ci an or h eal t h care provi der w i l l sh are t h e resu l t s w i t h you . I n som e cases, t h e radi ol og i st m ay di scu ss resu l t s w i t h you at t h e concl u si on of you r exam i nat i on. Fol l ow -u p exam i nat i ons m ay be necessary. Y ou r doct or w i l l expl ai n t h e exact reason w h y anot h er exam i s requ est ed. Som et i m es a fol l ow -u p exam i s done becau se a pot ent i al abnorm al i t y needs fu rt h er eval u at i on w i t h addi t i onal vi ew s or a speci al i m ag i ng t ech ni qu e. A fol l ow -u p exam i nat i on m ay al so be necessary so t h at any ch ang e i n a k now n abnorm al i t y can be m oni t ored over t i m e. Fol l ow -u p G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 5 of 7 Revi ew ed Mar-9 -2018

exam i nat i ons are som et i m es t h e best w ay t o see i f t reat m ent i s w ork i ng or i f a fi ndi ng i s st abl e or ch ang ed over t i m e. W h at are t h e benef i t s vs. ri sk s? Benef i t s Most u l t rasou nd scanni ng i s noni nvasi ve (no needl es or i nject i ons) . Occasi onal l y, an u l t rasou nd exam m ay be t em porari l y u ncom fort abl e, bu t i t sh ou l d not be pai nfu l . U l t rasou nd i s w i del y avai l abl e, easy-t o-u se and l ess expensi ve t h an ot h er i m ag i ng m et h ods. U l t rasou nd i m ag i ng i s ext rem el y safe and does not u se any i oni z i ng radi at i on. U l t rasou nd scanni ng g i ves a cl ear pi ct u re of soft t i ssu es t h at do not sh ow u p w el l on x-ray i m ag es. U l t rasou nd i s t h e preferred i m ag i ng m odal i t y for t h e di ag nosi s and m oni t ori ng of preg nant w om en and t h ei r u nborn babi es. U l t rasou nd provi des real -t i m e i m ag i ng , m ak i ng i t a g ood t ool for g u i di ng m i ni m al l y i nvasi ve procedu res su ch as needl e bi opsi es and fl u i d aspi rat i on. Ri sk s For st andard di ag nost i c u l t rasou nd, t h ere are no k now n h arm fu l effect s on h u m ans. W h at are t h e l i m i t at i ons of G eneral U l t rasound I m ag i ng ? U l t rasou nd w aves are di sru pt ed by ai r or g as; t h erefore u l t rasou nd i s not an i deal i m ag i ng t ech ni qu e for ai r-fi l l ed bow el or org ans obscu red by t h e bow el . I n m ost cases, bari u m exam s, CT scanni ng , and MRI are t h e m et h ods of ch oi ce i n su ch a set t i ng . Larg e pat i ent s are m ore di ffi cu l t t o i m ag e by u l t rasou nd becau se g reat er am ou nt s of t i ssu e at t enu at e (w eak en) t h e sou nd w aves as t h ey pass deeper i nt o t h e body and need t o be ret u rned t o t h e t ransdu cer for anal ysi s. U l t rasou nd h as di ffi cu l t y penet rat i ng bone and, t h erefore, can onl y see t h e ou t er su rface of bony st ru ct u res and not w h at l i es w i t h i n (except i n i nfant s w h o h ave m ore cart i l ag e i n t h ei r sk el et ons t h an ol der ch i l dren or adu l t s) . For vi su al i z i ng i nt ernal st ru ct u re of bones or cert ai n joi nt s, ot h er i m ag i ng m odal i t i es su ch as MRI are t ypi cal l y u sed. Di scl ai m er Th i s i nf orm at i on i s cop i ed f rom t h e Rad i ol og yI nf o W eb si t e (h t t p : / / w w w . rad i ol og yi nf o. org ) w h i ch i s d ed i cat ed t o p rovi d i ng t h e h i g h est qual i t y i nf orm at i on. To ensure t h at , each sect i on i s revi ew ed by a p h ysi ci an w i t h exp ert i se i n t h e area p resent ed . Al l i nf orm at i on cont ai ned i n t h e W eb si t e i s f urt h er revi ew ed by an ACR (Am eri can Col l eg e of Rad i ol og y) - RSNA (Rad i ol og i cal Soci et y of Nort h Am eri ca) com m i t t ee, com p ri si ng p h ysi ci ans w i t h exp ert i se i n several rad i ol og i c areas. G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 6 of 7 Revi ew ed Mar-9 -2018

H ow ever, i t i s not p ossi bl e t o assure t h at t h i s W eb si t e cont ai ns com p l et e, up -t o-d at e i nf orm at i on on any p art i cul ar subject . Th eref ore, ACR and RSNA m ak e no rep resent at i ons or w arrant i es about t h e sui t abi l i t y of t h i s i nf orm at i on f or use f or any p art i cul ar p urp ose. Al l i nf orm at i on i s p rovi d ed " as i s" w i t h out exp ress or i m p l i ed w arrant y. Pl ease vi si t t h e Rad i ol og yI nf o W eb si t e at h t t p : / / w w w . rad i ol og yi nf o. org t o vi ew or d ow nl oad t h e l at est i nf orm at i on. Not e: I m ag es m ay be sh ow n f or i l l ust rat i ve p urp oses. Do not at t em p t t o d raw concl usi ons or m ak e d i ag noses by com p ari ng t h ese i m ag es t o ot h er m ed i cal i m ag es, p art i cul arl y your ow n. Onl y qual i f i ed p h ysi ci ans sh oul d i nt erp ret i m ag es; t h e rad i ol og i st i s t h e p h ysi ci an exp ert t rai ned i n m ed i cal i m ag i ng . Cop yri g h t Th i s m at eri al i s cop yri g h t ed by ei t h er t h e Rad i ol og i cal Soci et y of Nort h Am eri ca (RSNA) , 8 20 Jori e Boul evard , Oak Brook , I L 60523-2251 or t h e Am eri can Col l eg e of Rad i ol og y (ACR) , 18 9 1 Prest on W h i t e Dri ve, Rest on, VA 2019 1-439 7. Com m erci al rep rod uct i on or m ul t i p l e d i st ri but i on by any t rad i t i onal or el ect roni cal l y based rep rod uct i on/ p ubl i cat i on m et h od i s p roh i bi t ed . Cop yri g h t ® 2018 Rad i ol og i cal Soci et y of Nort h Am eri ca, I nc. G eneral U l t rasound Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 7 of 7 Revi ew ed Mar-9 -2018

Scan f or m obi l e l i nk . U l t rasound - Abd om en U l t rasou nd i m ag i ng of t h e abdom en u ses sou nd w aves t o produ ce pi ct u res of t h e st ru ct u res w i t h i n t h e u pper abdom en. I t i s u sed t o h el p di ag nose pai n or di st ent i on (enl arg em ent ) and eval u at e t h e k i dneys, l i ver, g al l bl adder, bi l e du ct s, pancreas, spl een and abdom i nal aort a. U l t rasou nd i s safe, noni nvasi ve and does not u se i oni z i ng radi at i on. Th i s procedu re requ i res l i t t l e t o no speci al preparat i on. Y ou r doct or w i l l i nst ru ct you on h ow t o prepare, i ncl u di ng w h et h er you sh ou l d refrai n from eat i ng or dri nk i ng beforeh and. Leave jew el ry at h om e and w ear l oose, com fort abl e cl ot h i ng . Y ou m ay be ask ed t o w ear a g ow n. W h at i s U l t rasound I m ag i ng of t h e Abd om en? U l t rasou nd i s safe and pai nl ess, and produ ces pi ct u res of t h e i nsi de of t h e body u si ng sou nd w aves. U l t rasou nd i m ag i ng , al so cal l ed u l t rasou nd scanni ng or sonog raph y, i nvol ves t h e u se of a sm al l t ransdu cer (probe) and u l t rasou nd g el pl aced di rect l y on t h e sk i n. H i g h -frequ ency sou nd w aves are t ransm i t t ed from t h e probe t h rou g h t h e g el i nt o t h e body. Th e t ransdu cer col l ect s t h e sou nds t h at bou nce back and a com pu t er t h en u ses t h ose sou nd w aves t o creat e an i m ag e. U l t rasou nd exam i nat i ons do not u se i oni z i ng radi at i on (as u sed i n x-rays) , t h u s t h ere i s no radi at i on exposu re t o t h e pat i ent . Becau se u l t rasou nd i m ag es are capt u red i n real -t i m e, t h ey can sh ow t h e st ru ct u re and m ovem ent of t h e body's i nt ernal org ans, as w el l as bl ood fl ow i ng t h rou g h bl ood vessel s. U l t rasou nd i m ag i ng i s a noni nvasi ve m edi cal t est t h at h el ps ph ysi ci ans di ag nose and t reat m edi cal condi t i ons. An abdom i nal u l t rasou nd produ ces a pi ct u re of t h e org ans and ot h er st ru ct u res i n t h e u pper abdom en. A Doppl er u l t rasou nd st u dy m ay be part of an abdom i nal u l t rasou nd exam i nat i on. Doppl er u l t rasou nd, al so cal l ed col or Doppl er u l t rasonog raph y, i s a speci al u l t rasou nd t ech ni qu e t h at al l ow s t h e ph ysi ci an t o see and eval u at e bl ood fl ow t h rou g h art eri es and vei ns i n t h e abdom en, arm s, l eg s, neck and/ or brai n (i n i nfant s and ch i l dren) or w i t h i n vari ou s body org ans su ch as t h e l i ver or k i dneys. U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 1 of 6 Revi ew ed Ap r-10-2018

W h at are som e com m on uses of t h e p roced ure? Abdom i nal u l t rasou nd i m ag i ng i s perform ed t o eval u at e t h e: k i dneys l i ver g al l bl adder bi l e du ct s pancreas spl een abdom i nal aort a and ot h er bl ood vessel s of t h e abdom en U l t rasou nd i s u sed t o h el p di ag nose a vari et y of condi t i ons, su ch as: abdom i nal pai n or di st ent i on (enl arg em ent ) abnorm al l i ver fu nct i on enl arg ed abdom i nal org an k i dney st ones g al l st ones an abdom i nal aort i c aneu rysm (AAA) Addi t i onal l y, u l t rasou nd m ay be u sed t o provi de g u i dance for bi opsi es. Doppl er u l t rasou nd i m ag es can h el p t h e ph ysi ci an t o see and eval u at e: bl ock ag es t o bl ood fl ow (su ch as cl ot s) narrow i ng of vessel s t u m ors and cong eni t al vascu l ar m al form at i ons redu ced or absent bl ood fl ow t o vari ou s org ans g reat er t h an norm al bl ood fl ow t o di fferent areas, w h i ch i s som et i m es seen i n i nfect i ons How sh oul d I p rep are? Y ou sh ou l d w ear com fort abl e, l oose-fi t t i ng cl ot h i ng for you r u l t rasou nd exam . Y ou m ay need t o rem ove al l cl ot h i ng and jew el ry i n t h e area t o be exam i ned. Y ou m ay be ask ed t o w ear a g ow n du ri ng t h e procedu re. Preparat i ons depend on t h e t ype of u l t rasou nd you are h avi ng . For a st u dy of t h e l i ver, g al l bl adder, spl een, and pancreas, you m ay be ask ed t o eat a fat -free m eal on t h e eveni ng before t h e t est and t h en t o avoi d eat i ng for ei g h t t o 12 h ou rs before t h e t est . For u l t rasou nd of t h e k i dneys, you m ay be ask ed t o dri nk fou r t o si x g l asses of l i qu i d abou t an h ou r before t h e t est t o fi l l you r bl adder. Y ou m ay be ask ed t o avoi d eat i ng for ei g h t t o 12 h ou rs before t h e t est t o avoi d g as bu i l du p i n t h e i nt est i nes. U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 2 of 6 Revi ew ed Ap r-10-2018

For u l t rasou nd of t h e aort a, you m ay need t o avoi d eat i ng for ei g h t t o 12 h ou rs before t h e t est . W h at d oes t h e equi p m ent l ook l i k e? U l t rasou nd scanners consi st of a consol e cont ai ni ng a com pu t er and el ect roni cs, a vi deo di spl ay screen and a t ransdu cer t h at i s u sed t o do t h e scanni ng . Th e t ransdu cer i s a sm al l h and-h el d devi ce t h at resem bl es a m i croph one, at t ach ed t o t h e scanner by a cord. Som e exam s m ay u se di fferent t ransdu cers (w i t h di fferent capabi l i t i es) du ri ng a si ng l e exam . Th e t ransdu cer sends ou t h i g h -frequ ency sou nd w aves (t h at t h e h u m an ear cannot h ear) i nt o t h e body and t h en l i st ens for t h e ret u rni ng ech oes from t h e t i ssu es i n t h e body. Th e pri nci pl es are si m i l ar t o sonar u sed by boat s and su bm ari nes. Th e u l t rasou nd i m ag e i s i m m edi at el y vi si bl e on a vi deo di spl ay screen t h at l ook s l i k e a com pu t er or t el evi si on m oni t or. Th e i m ag e i s creat ed based on t h e am pl i t u de (l ou dness) , frequ ency (pi t ch ) and t i m e i t t ak es for t h e u l t rasou nd si g nal t o ret u rn from t h e area w i t h i n t h e pat i ent t h at i s bei ng exam i ned t o t h e t ransdu cer (t h e devi ce pl aced on t h e pat i ent 's sk i n t o send and recei ve t h e ret u rni ng sou nd w aves) , as w el l as t h e t ype of body st ru ct u re and com posi t i on of body t i ssu e t h rou g h w h i ch t h e sou nd t ravel s. A sm al l am ou nt of g el i s pu t on t h e sk i n t o al l ow t h e sou nd w aves t o t ravel from t h e t ransdu cer t o t h e exam i ned area w i t h i n t h e body and t h en back ag ai n. U l t rasou nd i s an excel l ent m odal i t y for som e areas of t h e body w h i l e ot h er areas, especi al l y ai r-fi l l ed l u ng s, are poorl y su i t ed for u l t rasou nd. How d oes t h e p roced ure w ork ? U l t rasou nd i m ag i ng i s based on t h e sam e pri nci pl es i nvol ved i n t h e sonar u sed by bat s, sh i ps and fi sh erm en. W h en a sou nd w ave st ri k es an object , i t bou nces back , or ech oes. By m easu ri ng t h ese ech o w aves, i t i s possi bl e t o det erm i ne h ow far aw ay t h e object i s as w el l as t h e object 's si z e, sh ape and consi st ency (w h et h er t h e object i s sol i d or fi l l ed w i t h fl u i d) . I n m edi ci ne, u l t rasou nd i s u sed t o det ect ch ang es i n appearance, si z e or cont ou r of org ans, t i ssu es, and vessel s or t o det ect abnorm al m asses, su ch as t u m ors. I n an u l t rasou nd exam i nat i on, a t ransdu cer bot h sends t h e sou nd w aves i nt o t h e body and recei ves t h e ech oi ng w aves. W h en t h e t ransdu cer i s pressed ag ai nst t h e sk i n, i t di rect s sm al l pu l ses of i nau di bl e, h i g h -frequ ency sou nd w aves i nt o t h e body. As t h e sou nd w aves bou nce off i nt ernal org ans, fl u i ds and t i ssu es, t h e sensi t i ve recei ver i n t h e t ransdu cer records t i ny ch ang es i n t h e sou nd's pi t ch and di rect i on. Th ese si g nat u re w aves are i nst ant l y m easu red and di spl ayed by a com pu t er, w h i ch i n t u rn creat es a real -t i m e pi ct u re on t h e m oni t or. One or m ore fram es of t h e m ovi ng pi ct u res are t ypi cal l y capt u red as st i l l i m ag es. Sh ort vi deo l oops of t h e i m ag es m ay al so be saved. Doppl er u l t rasou nd, a speci al appl i cat i on of u l t rasou nd, m easu res t h e di rect i on and speed of bl ood cel l s as t h ey m ove t h rou g h vessel s. Th e m ovem ent of bl ood cel l s cau ses a ch ang e i n pi t ch of t h e refl ect ed sou nd w aves (cal l ed t h e Doppl er effect ) . A com pu t er col l ect s and processes t h e sou nds and creat es g raph s or col or pi ct u res t h at represent t h e fl ow of bl ood t h rou g h t h e bl ood vessel s. U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 3 of 6 Revi ew ed Ap r-10-2018

How i s t h e p roced ure p erf orm ed ? For m ost u l t rasou nd exam s, you w i l l be posi t i oned l yi ng face-u p on an exam i nat i on t abl e t h at can be t i l t ed or m oved. Pat i ent s m ay be t u rned t o ei t h er si de t o i m prove t h e qu al i t y of t h e i m ag es. Aft er you are posi t i oned on t h e exam i nat i on t abl e, t h e radi ol og i st (a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons) or sonog raph er w i l l appl y a w arm w at er-based g el t o t h e area of t h e body bei ng st u di ed. Th e g el w i l l h el p t h e t ransdu cer m ak e secu re cont act w i t h t h e body and el i m i nat e ai r pock et s bet w een t h e t ransdu cer and t h e sk i n t h at can bl ock t h e sou nd w aves from passi ng i nt o you r body. Th e t ransdu cer i s pl aced on t h e body and m oved back and fort h over t h e area of i nt erest u nt i l t h e desi red i m ag es are capt u red. Th ere i s u su al l y no di scom fort from pressu re as t h e t ransdu cer i s pressed ag ai nst t h e area bei ng exam i ned. H ow ever, i f scanni ng i s perform ed over an area of t enderness, you m ay feel pressu re or m i nor pai n from t h e t ransdu cer. Doppl er sonog raph y i s perform ed u si ng t h e sam e t ransdu cer. Once t h e i m ag i ng i s com pl et e, t h e cl ear u l t rasou nd g el w i l l be w i ped off you r sk i n. Any port i ons t h at are not w i ped off w i l l dry qu i ck l y. Th e u l t rasou nd g el does not u su al l y st ai n or di scol or cl ot h i ng . W h at w i l l I exp eri ence d uri ng and af t er t h e p roced ure? U l t rasou nd exam i nat i ons are pai nl ess and easi l y t ol erat ed by m ost pat i ent s. Abdom i nal u l t rasou nd i s u su al l y com pl et ed w i t h i n 30 m i nu t es. I f a Doppl er u l t rasou nd st u dy i s perform ed, you m ay act u al l y h ear pu l se-l i k e sou nds t h at ch ang e i n pi t ch as t h e bl ood fl ow i s m oni t ored and m easu red. W h en t h e exam i nat i on i s com pl et e, you m ay be ask ed t o dress and w ai t w h i l e t h e u l t rasou nd i m ag es are revi ew ed. Aft er an u l t rasou nd exam i nat i on, you sh ou l d be abl e t o resu m e you r norm al act i vi t i es i m m edi at el y. W h o i nt erp ret s t h e resul t s and h ow d o I g et t h em ? A radi ol og i st , a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons, w i l l anal yz e t h e i m ag es and send a si g ned report t o you r pri m ary care ph ysi ci an, or t o t h e ph ysi ci an or ot h er h eal t h care provi der w h o requ est ed t h e exam . U su al l y, t h e referri ng ph ysi ci an or h eal t h care provi der w i l l sh are t h e resu l t s w i t h you . I n som e cases, t h e radi ol og i st m ay di scu ss resu l t s w i t h you at t h e concl u si on of you r exam i nat i on. Fol l ow -u p exam i nat i ons m ay be necessary. Y ou r doct or w i l l expl ai n t h e exact reason w h y anot h er exam i s requ est ed. Som et i m es a fol l ow -u p exam i s done becau se a pot ent i al abnorm al i t y needs fu rt h er U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 4 of 6 Revi ew ed Ap r-10-2018

eval u at i on w i t h addi t i onal vi ew s or a speci al i m ag i ng t ech ni qu e. A fol l ow -u p exam i nat i on m ay al so be necessary so t h at any ch ang e i n a k now n abnorm al i t y can be m oni t ored over t i m e. Fol l ow -u p exam i nat i ons are som et i m es t h e best w ay t o see i f t reat m ent i s w ork i ng or i f a fi ndi ng i s st abl e or ch ang ed over t i m e. W h at are t h e benef i t s vs. ri sk s? Benef i t s Most u l t rasou nd scanni ng i s noni nvasi ve (no needl es or i nject i ons) . Occasi onal l y, an u l t rasou nd exam m ay be t em porari l y u ncom fort abl e, bu t i t sh ou l d not be pai nfu l . U l t rasou nd i s w i del y avai l abl e, easy-t o-u se and l ess expensi ve t h an ot h er i m ag i ng m et h ods. U l t rasou nd i m ag i ng i s ext rem el y safe and does not u se any i oni z i ng radi at i on. U l t rasou nd scanni ng g i ves a cl ear pi ct u re of soft t i ssu es t h at do not sh ow u p w el l on x-ray i m ag es. U l t rasou nd provi des real -t i m e i m ag i ng , m ak i ng i t a g ood t ool for g u i di ng m i ni m al l y i nvasi ve procedu res su ch as needl e bi opsi es and fl u i d aspi rat i on. Ri sk s For st andard di ag nost i c u l t rasou nd, t h ere are no k now n h arm fu l effect s on h u m ans. W h at are t h e l i m i t at i ons of Abd om i nal U l t rasound I m ag i ng ? U l t rasou nd w aves are di sru pt ed by ai r or g as; t h erefore u l t rasou nd i s not an i deal i m ag i ng t ech ni qu e for ai r-fi l l ed bow el or org ans obscu red by t h e bow el . I n m ost cases, bari u m exam s, CT scanni ng , and MRI are t h e m et h ods of ch oi ce i n su ch a set t i ng . Larg e pat i ent s are m ore di ffi cu l t t o i m ag e by u l t rasou nd becau se g reat er am ou nt s of t i ssu e at t enu at e (w eak en) t h e sou nd w aves as t h ey pass deeper i nt o t h e body and need t o be ret u rned t o t h e t ransdu cer for anal ysi s. Di scl ai m er Th i s i nf orm at i on i s cop i ed f rom t h e Rad i ol og yI nf o W eb si t e (h t t p : / / w w w . rad i ol og yi nf o. org ) w h i ch i s d ed i cat ed t o p rovi d i ng t h e h i g h est qual i t y i nf orm at i on. To ensure t h at , each sect i on i s revi ew ed by a p h ysi ci an w i t h exp ert i se i n t h e area p resent ed . Al l i nf orm at i on cont ai ned i n t h e W eb si t e i s f urt h er revi ew ed by an ACR (Am eri can Col l eg e of Rad i ol og y) - RSNA (Rad i ol og i cal Soci et y of Nort h Am eri ca) com m i t t ee, com p ri si ng p h ysi ci ans w i t h exp ert i se i n several rad i ol og i c areas. H ow ever, i t i s not p ossi bl e t o assure t h at t h i s W eb si t e cont ai ns com p l et e, up -t o-d at e i nf orm at i on on any p art i cul ar subject . Th eref ore, ACR and RSNA m ak e no rep resent at i ons or w arrant i es about t h e sui t abi l i t y of t h i s i nf orm at i on f or use f or any p art i cul ar p urp ose. Al l i nf orm at i on i s p rovi d ed " as i s" w i t h out exp ress or i m p l i ed w arrant y. Pl ease vi si t t h e Rad i ol og yI nf o W eb si t e at h t t p : / / w w w . rad i ol og yi nf o. org t o vi ew or d ow nl oad t h e l at est i nf orm at i on. U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 5 of 6 Revi ew ed Ap r-10-2018

Not e: I m ag es m ay be sh ow n f or i l l ust rat i ve p urp oses. Do not at t em p t t o d raw concl usi ons or m ak e d i ag noses by com p ari ng t h ese i m ag es t o ot h er m ed i cal i m ag es, p art i cul arl y your ow n. Onl y qual i f i ed p h ysi ci ans sh oul d i nt erp ret i m ag es; t h e rad i ol og i st i s t h e p h ysi ci an exp ert t rai ned i n m ed i cal i m ag i ng . Cop yri g h t Th i s m at eri al i s cop yri g h t ed by ei t h er t h e Rad i ol og i cal Soci et y of Nort h Am eri ca (RSNA) , 8 20 Jori e Boul evard , Oak Brook , I L 60523-2251 or t h e Am eri can Col l eg e of Rad i ol og y (ACR) , 18 9 1 Prest on W h i t e Dri ve, Rest on, VA 2019 1-439 7. Com m erci al rep rod uct i on or m ul t i p l e d i st ri but i on by any t rad i t i onal or el ect roni cal l y based rep rod uct i on/ p ubl i cat i on m et h od i s p roh i bi t ed . Cop yri g h t ® 2018 Rad i ol og i cal Soci et y of Nort h Am eri ca, I nc. U l t rasound - Abd om en Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 6 of 6 Revi ew ed Ap r-10-2018

Scan f or m obi l e l i nk . U l t rasound - Muscul osk el et al U l t rasou nd i m ag i ng u ses sou nd w aves t o produ ce pi ct u res of m u scl es, t endons, l i g am ent s and joi nt s t h rou g h ou t t h e body. I t i s u sed t o h el p di ag nose sprai ns, st rai ns, t ears, and ot h er soft t i ssu e condi t i ons. U l t rasou nd i s safe, noni nvasi ve, and does not u se i oni z i ng radi at i on. Th i s procedu re requ i res l i t t l e t o no speci al preparat i on. Leave jew el ry at h om e and w ear l oose, com fort abl e cl ot h i ng . Y ou m ay be ask ed t o w ear a g ow n. W h at i s U l t rasound I m ag i ng of t h e Muscul osk el et al Syst em ? U l t rasou nd i s safe and pai nl ess, and produ ces pi ct u res of t h e i nsi de of t h e body u si ng sou nd w aves. U l t rasou nd i m ag i ng , al so cal l ed u l t rasou nd scanni ng or sonog raph y, i nvol ves t h e u se of a sm al l t ransdu cer (probe) and u l t rasou nd g el pl aced di rect l y on t h e sk i n. H i g h -frequ ency sou nd w aves are t ransm i t t ed from t h e probe t h rou g h t h e g el i nt o t h e body. Th e t ransdu cer col l ect s t h e sou nds t h at bou nce back and a com pu t er t h en u ses t h ose sou nd w aves t o creat e an i m ag e. U l t rasou nd exam i nat i ons do not u se i oni z i ng radi at i on (as u sed i n x-rays) , t h u s t h ere i s no radi at i on exposu re t o t h e pat i ent . Becau se u l t rasou nd i m ag es are capt u red i n real -t i m e, t h ey can sh ow t h e st ru ct u re and m ovem ent of t h e body's i nt ernal org ans, as w el l as bl ood fl ow i ng t h rou g h bl ood vessel s. U l t rasou nd i m ag i ng i s a noni nvasi ve m edi cal t est t h at h el ps ph ysi ci ans di ag nose and t reat m edi cal condi t i ons. U l t rasou nd i m ag es of t h e m u scu l osk el et al syst em provi de pi ct u res of m u scl es, t endons, l i g am ent s, joi nt s, and soft t i ssu es t h rou g h ou t t h e body. W h at are som e com m on uses of t h e p roced ure? U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 1 of 6 Revi ew ed : Ap r-1-2017

U l t rasou nd i m ag es are t ypi cal l y u sed t o h el p di ag nose: t endon t ears, or t endi ni t i s of t h e rot at or cu ff i n t h e sh ou l der, Ach i l l es t endon i n t h e ank l e and ot h er t endons t h rou g h ou t t h e body. m u scl e t ears, m asses or fl u i d col l ect i ons. l i g am ent sprai ns or t ears. i nfl am m at i on or fl u i d (effu si ons) w i t h i n t h e bu rsae and joi nt s. earl y ch ang es of rh eu m at oi d art h ri t i s. nerve ent rapm ent s su ch as carpal t u nnel syndrom e. beni g n and m al i g nant soft t i ssu e t u m ors. g ang l i on cyst s. h erni as. forei g n bodi es i n t h e soft t i ssu es (su ch as spl i nt ers or g l ass) . di sl ocat i ons of t h e h i p i n i nfant s. fl u i d i n a pai nfu l h i p joi nt i n ch i l dren. neck m u scl e abnorm al i t i es i n i nfant s w i t h t ort i col l i s (neck t w i st i ng ) . soft t i ssu e m asses (l u m ps/ bu m ps) i n ch i l dren. How sh oul d I p rep are? Y ou sh ou l d w ear com fort abl e, l oose-fi t t i ng cl ot h i ng for you r u l t rasou nd exam . Y ou m ay need t o rem ove al l cl ot h i ng and jew el ry i n t h e area t o be exam i ned. Y ou m ay be ask ed t o w ear a g ow n du ri ng t h e procedu re. U l t rasou nd exam i nat i ons are very sensi t i ve t o m ot i on, and an act i ve or cryi ng ch i l d can prol ong t h e exam i nat i on process. To ensu re a sm oot h experi ence, i t oft en h el ps t o expl ai n t h e procedu re t o t h e ch i l d pri or t o t h e exam . Bri ng i ng book s, sm al l t oys, m u si c or g am es can h el p t o di st ract t h e ch i l d and m ak e t h e t i m e pass qu i ck l y. Th e u l t rasou nd exam room m ay h ave a t el evi si on. Feel free t o ask for you r ch i l d's favori t e ch annel . No ot h er preparat i on i s requ i red. W h at d oes t h e equi p m ent l ook l i k e? U l t rasou nd scanners consi st of a consol e cont ai ni ng a com pu t er and el ect roni cs, a vi deo di spl ay screen and a t ransdu cer t h at i s u sed t o do t h e scanni ng . Th e t ransdu cer i s a sm al l h and-h el d devi ce t h at resem bl es a m i croph one, at t ach ed t o t h e scanner by a cord. Som e exam s m ay u se di fferent t ransdu cers (w i t h di fferent capabi l i t i es) du ri ng a si ng l e exam . Th e t ransdu cer sends ou t h i g h -frequ ency sou nd w aves (t h at t h e h u m an ear cannot h ear) i nt o t h e body and t h en l i st ens for t h e ret u rni ng ech oes from t h e t i ssu es i n t h e body. Th e pri nci pl es are si m i l ar t o sonar u sed by boat s and su bm ari nes. Th e u l t rasou nd i m ag e i s i m m edi at el y vi si bl e on a vi deo di spl ay screen t h at l ook s l i k e a com pu t er or U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 2 of 6 Revi ew ed : Ap r-1-2017

t el evi si on m oni t or. Th e i m ag e i s creat ed based on t h e am pl i t u de (l ou dness) , frequ ency (pi t ch ) and t i m e i t t ak es for t h e u l t rasou nd si g nal t o ret u rn from t h e area w i t h i n t h e pat i ent t h at i s bei ng exam i ned t o t h e t ransdu cer (t h e devi ce pl aced on t h e pat i ent 's sk i n t o send and recei ve t h e ret u rni ng sou nd w aves) , as w el l as t h e t ype of body st ru ct u re and com posi t i on of body t i ssu e t h rou g h w h i ch t h e sou nd t ravel s. A sm al l am ou nt of g el i s pu t on t h e sk i n t o al l ow t h e sou nd w aves t o t ravel from t h e t ransdu cer t o t h e exam i ned area w i t h i n t h e body and t h en back ag ai n. U l t rasou nd i s an excel l ent m odal i t y for som e areas of t h e body w h i l e ot h er areas, especi al l y ai r-fi l l ed l u ng s, are poorl y su i t ed for u l t rasou nd. How d oes t h e p roced ure w ork ? U l t rasou nd i m ag i ng i s based on t h e sam e pri nci pl es i nvol ved i n t h e sonar u sed by bat s, sh i ps and fi sh erm en. W h en a sou nd w ave st ri k es an object , i t bou nces back , or ech oes. By m easu ri ng t h ese ech o w aves, i t i s possi bl e t o det erm i ne h ow far aw ay t h e object i s as w el l as t h e object 's si z e, sh ape and consi st ency (w h et h er t h e object i s sol i d or fi l l ed w i t h fl u i d) . I n m edi ci ne, u l t rasou nd i s u sed t o det ect ch ang es i n appearance, si z e or cont ou r of org ans, t i ssu es, and vessel s or t o det ect abnorm al m asses, su ch as t u m ors. I n an u l t rasou nd exam i nat i on, a t ransdu cer bot h sends t h e sou nd w aves i nt o t h e body and recei ves t h e ech oi ng w aves. W h en t h e t ransdu cer i s pressed ag ai nst t h e sk i n, i t di rect s sm al l pu l ses of i nau di bl e, h i g h -frequ ency sou nd w aves i nt o t h e body. As t h e sou nd w aves bou nce off i nt ernal org ans, fl u i ds and t i ssu es, t h e sensi t i ve recei ver i n t h e t ransdu cer records t i ny ch ang es i n t h e sou nd's pi t ch and di rect i on. Th ese si g nat u re w aves are i nst ant l y m easu red and di spl ayed by a com pu t er, w h i ch i n t u rn creat es a real -t i m e pi ct u re on t h e m oni t or. One or m ore fram es of t h e m ovi ng pi ct u res are t ypi cal l y capt u red as st i l l i m ag es. Sh ort vi deo l oops of t h e i m ag es m ay al so be saved. How i s t h e p roced ure p erf orm ed ? For cert ai n u l t rasou nd exam i nat i ons of t h e m u scu l osk el et al syst em , t h e pat i ent m ay be seat ed on an exam i nat i on t abl e or a sw i vel ch ai r. For ot h er u l t rasou nd exam s, t h e pat i ent i s posi t i oned l yi ng face-u p or face-dow n on an exam i nat i on t abl e. Th e radi ol og i st or sonog raph er m ay ask you t o m ove t h e ext rem i t y bei ng exam i ned or m ay m ove i t for you t o eval u at e t h e anat om y and fu nct i on of t h e joi nt , m u scl e, l i g am ent or t endon. Most u l t rasou nd st u di es of i nfant s and ch i l dren are perform ed w i t h t h e ch i l d l yi ng on h i s or h er back on t h e exam i nat i on t abl e, bu t ot h er posi t i ons m ay be requ i red. Aft er you are posi t i oned on t h e exam i nat i on t abl e, t h e radi ol og i st (a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons) or sonog raph er w i l l appl y a w arm w at er-based g el t o t h e area of t h e body bei ng st u di ed. Th e g el w i l l h el p t h e t ransdu cer m ak e secu re cont act w i t h t h e body and el i m i nat e ai r pock et s bet w een t h e t ransdu cer and t h e sk i n t h at can bl ock t h e sou nd w aves from passi ng i nt o you r body. Th e t ransdu cer i s pl aced on t h e body and m oved back and fort h over t h e area of i nt erest u nt i l t h e desi red i m ag es are capt u red. Th ere i s u su al l y no di scom fort from pressu re as t h e t ransdu cer i s pressed ag ai nst t h e area bei ng U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 3 of 6 Revi ew ed : Ap r-1-2017

Th ere i s u su al l y no di scom fort from pressu re as t h e t ransdu cer i s pressed ag ai nst t h e area bei ng exam i ned. H ow ever, i f scanni ng i s perform ed over an area of t enderness, you m ay feel pressu re or m i nor pai n from t h e t ransdu cer. Once t h e i m ag i ng i s com pl et e, t h e cl ear u l t rasou nd g el w i l l be w i ped off you r sk i n. Any port i ons t h at are not w i ped off w i l l dry qu i ck l y. Th e u l t rasou nd g el does not u su al l y st ai n or di scol or cl ot h i ng . W h at w i l l I exp eri ence d uri ng and af t er t h e p roced ure? U l t rasou nd exam i nat i ons are pai nl ess and easi l y t ol erat ed by m ost pat i ent s. Mu scu l osk el et al u l t rasou nd exam i nat i on i s u su al l y com pl et ed w i t h i n 15 t o 30 m i nu t es bu t m ay occasi onal l y t ak e l ong er. W h en t h e exam i nat i on i s com pl et e, you m ay be ask ed t o dress and w ai t w h i l e t h e u l t rasou nd i m ag es are revi ew ed. Aft er an u l t rasou nd exam i nat i on, you sh ou l d be abl e t o resu m e you r norm al act i vi t i es i m m edi at el y. W h o i nt erp ret s t h e resul t s and h ow d o I g et t h em ? A radi ol og i st , a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons, w i l l anal yz e t h e i m ag es and send a si g ned report t o you r pri m ary care ph ysi ci an, or t o t h e ph ysi ci an or ot h er h eal t h care provi der w h o requ est ed t h e exam . U su al l y, t h e referri ng ph ysi ci an or h eal t h care provi der w i l l sh are t h e resu l t s w i t h you . I n som e cases, t h e radi ol og i st m ay di scu ss resu l t s w i t h you at t h e concl u si on of you r exam i nat i on. Fol l ow -u p exam i nat i ons m ay be necessary. Y ou r doct or w i l l expl ai n t h e exact reason w h y anot h er exam i s requ est ed. Som et i m es a fol l ow -u p exam i s done becau se a pot ent i al abnorm al i t y needs fu rt h er eval u at i on w i t h addi t i onal vi ew s or a speci al i m ag i ng t ech ni qu e. A fol l ow -u p exam i nat i on m ay al so be necessary so t h at any ch ang e i n a k now n abnorm al i t y can be m oni t ored over t i m e. Fol l ow -u p exam i nat i ons are som et i m es t h e best w ay t o see i f t reat m ent i s w ork i ng or i f a fi ndi ng i s st abl e or ch ang ed over t i m e. W h at are t h e benef i t s vs. ri sk s? Benef i t s Most u l t rasou nd scanni ng i s noni nvasi ve (no needl es or i nject i ons) . Occasi onal l y, an u l t rasou nd exam m ay be t em porari l y u ncom fort abl e, bu t i t sh ou l d not be pai nfu l . U l t rasou nd i s w i del y avai l abl e, easy-t o-u se and l ess expensi ve t h an ot h er i m ag i ng m et h ods. U l t rasou nd i m ag i ng i s ext rem el y safe and does not u se any i oni z i ng radi at i on. U l t rasou nd scanni ng g i ves a cl ear pi ct u re of soft t i ssu es t h at do not sh ow u p w el l on x-ray i m ag es. U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 4 of 6 Revi ew ed : Ap r-1-2017

U l t rasou nd provi des real -t i m e i m ag i ng , m ak i ng i t a g ood t ool for g u i di ng m i ni m al l y i nvasi ve procedu res su ch as needl e bi opsi es and fl u i d aspi rat i on. Pat i ent s w i t h cardi ac pacem ak ers and cert ai n t ypes of m et al l i c i m pl ant s or frag m ent s i n t h e body cannot be safel y exposed t o t h e st rong m ag net i c fi el d requ i red for m ag net i c resonance i m ag i ng (MRI ) ; h ow ever, pat i ent s can safel y recei ve u l t rasou nd i m ag i ng . U l t rasou nd i s al so an excel l ent al t ernat i ve t o MRI for cl au st roph obi c pat i ent s. Com pared t o MRI , u l t rasou nd m ay provi de g reat er i nt ernal det ai l w h en assessi ng soft t i ssu e st ru ct u res su ch as t endons and nerves. Becau se u l t rasou nd i m ag es are capt u red i n real t i m e, t h ey can sh ow t h e m ovem ent of a soft t i ssu e st ru ct u re su ch as a t endon, joi nt or an ext rem i t y. U l t rasou nd i m ag i ng i s fast er t h an MRI and does not requ i re t h e pat i ent t o rem ai n com pl et el y st i l l , al l ow i ng i nfant s t o be i m ag ed w i t h ou t sedat i on. Th e h i p joi nt s of i nfant s, u nl i k e t h ose of adu l t s, are l arg el y m ade of cart i l ag e. U l t rasou nd i s abl e t o cl earl y see cart i l ag e. Ri sk s For st andard di ag nost i c u l t rasou nd, t h ere are no k now n h arm fu l effect s on h u m ans. W h at are t h e l i m i t at i ons of U l t rasound I m ag i ng of t h e Muscul osk el et al Syst em ? U l t rasou nd h as di ffi cu l t y penet rat i ng bone and, t h erefore, can onl y see t h e ou t er su rface of bony st ru ct u res and not w h at l i es w i t h i n (except i n i nfant s w h o h ave m ore cart i l ag e i n t h ei r sk el et ons t h an ol der ch i l dren or adu l t s) . For vi su al i z i ng i nt ernal st ru ct u re of bones or cert ai n joi nt s, ot h er i m ag i ng m odal i t i es su ch as MRI are t ypi cal l y u sed. Th ere are al so l i m i t at i ons t o t h e dept h t h at sou nd w aves can penet rat e; t h erefore, deeper st ru ct u res i n l arg er pat i ent s m ay not be seen easi l y. U l t rasou nd h as not proven u sefu l i n det ect i ng w h i pl ash i nju ri es or m ost ot h er cau ses of back pai n. Di scl ai m er Th i s i nf orm at i on i s cop i ed f rom t h e Rad i ol og yI nf o W eb si t e (h t t p : / / w w w . rad i ol og yi nf o. org ) w h i ch i s d ed i cat ed t o p rovi d i ng t h e h i g h est qual i t y i nf orm at i on. To ensure t h at , each sect i on i s revi ew ed by a p h ysi ci an w i t h exp ert i se i n t h e area p resent ed . Al l i nf orm at i on cont ai ned i n t h e W eb si t e i s f urt h er revi ew ed by an ACR (Am eri can Col l eg e of Rad i ol og y) - RSNA (Rad i ol og i cal Soci et y of Nort h Am eri ca) com m i t t ee, com p ri si ng p h ysi ci ans w i t h exp ert i se i n several rad i ol og i c areas. H ow ever, i t i s not p ossi bl e t o assure t h at t h i s W eb si t e cont ai ns com p l et e, up -t o-d at e i nf orm at i on on any p art i cul ar subject . Th eref ore, ACR and RSNA m ak e no rep resent at i ons or w arrant i es about t h e sui t abi l i t y of t h i s i nf orm at i on f or use f or any p art i cul ar p urp ose. Al l i nf orm at i on i s p rovi d ed " as i s" w i t h out exp ress or i m p l i ed w arrant y. U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 5 of 6 Revi ew ed : Ap r-1-2017

Pl ease vi si t t h e Rad i ol og yI nf o W eb si t e at h t t p : / / w w w . rad i ol og yi nf o. org t o vi ew or d ow nl oad t h e l at est i nf orm at i on. Not e: I m ag es m ay be sh ow n f or i l l ust rat i ve p urp oses. Do not at t em p t t o d raw concl usi ons or m ak e d i ag noses by com p ari ng t h ese i m ag es t o ot h er m ed i cal i m ag es, p art i cul arl y your ow n. Onl y qual i f i ed p h ysi ci ans sh oul d i nt erp ret i m ag es; t h e rad i ol og i st i s t h e p h ysi ci an exp ert t rai ned i n m ed i cal i m ag i ng . Cop yri g h t Th i s m at eri al i s cop yri g h t ed by ei t h er t h e Rad i ol og i cal Soci et y of Nort h Am eri ca (RSNA) , 8 20 Jori e Boul evard , Oak Brook , I L 60523-2251 or t h e Am eri can Col l eg e of Rad i ol og y (ACR) , 18 9 1 Prest on W h i t e Dri ve, Rest on, VA 2019 1-439 7. Com m erci al rep rod uct i on or m ul t i p l e d i st ri but i on by any t rad i t i onal or el ect roni cal l y based rep rod uct i on/ p ubl i cat i on m et h od i s p roh i bi t ed . Cop yri g h t ® 2018 Rad i ol og i cal Soci et y of Nort h Am eri ca, I nc. U l t rasound - Muscul osk el et al Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 6 of 6 Revi ew ed : Ap r-1-2017

Scan f or m obi l e l i nk . U l t rasound - Pel vi s U l t rasou nd i m ag i ng of t h e pel vi s u ses sou nd w aves t o produ ce pi ct u res of t h e st ru ct u res and org ans i n t h e l ow er abdom en and pel vi s. Th ere are t h ree t ypes of pel vi c u l t rasou nd: abdom i nal , vag i nal (for w om en) , and rect al (for m en) . Th ese exam s are frequ ent l y u sed t o eval u at e t h e reprodu ct i ve and u ri nary syst em s. U l t rasou nd i s safe, noni nvasi ve and does not u se i oni z i ng radi at i on. Th i s procedu re requ i res l i t t l e t o no speci al preparat i on. Y ou m ay be ask ed t o dri nk w at er pri or t o t h e exam i nat i on t o fi l l you r bl adder. Leave jew el ry at h om e and w ear l oose, com fort abl e cl ot h i ng . Y ou m ay be ask ed t o w ear a g ow n. W h at i s Pel vi c U l t rasound I m ag i ng ? U l t rasou nd i s safe and pai nl ess, and produ ces pi ct u res of t h e i nsi de of t h e body u si ng sou nd w aves. U l t rasou nd i m ag i ng , al so cal l ed u l t rasou nd scanni ng or sonog raph y, i nvol ves t h e u se of a sm al l t ransdu cer (probe) and u l t rasou nd g el pl aced di rect l y on t h e sk i n. H i g h -frequ ency sou nd w aves are t ransm i t t ed from t h e probe t h rou g h t h e g el i nt o t h e body. Th e t ransdu cer col l ect s t h e sou nds t h at bou nce back and a com pu t er t h en u ses t h ose sou nd w aves t o creat e an i m ag e. U l t rasou nd exam i nat i ons do not u se i oni z i ng radi at i on (as u sed i n x-rays) , t h u s t h ere i s no radi at i on exposu re t o t h e pat i ent . Becau se u l t rasou nd i m ag es are capt u red i n real -t i m e, t h ey can sh ow t h e st ru ct u re and m ovem ent of t h e body's i nt ernal org ans, as w el l as bl ood fl ow i ng t h rou g h bl ood vessel s. U l t rasou nd i m ag i ng i s a noni nvasi ve m edi cal t est t h at h el ps ph ysi ci ans di ag nose and t reat m edi cal condi t i ons. Th ere are t h ree t ypes of pel vi c u l t rasou nd: abdom i nal (t ransabdom i nal) vag i nal (t ransvag i nal / endovag i nal ) for w om en rect al (t ransrect al) for m en A Doppl er u l t rasou nd exam m ay be part of a pel vi c u l t rasou nd exam i nat i on. U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 1 of 8 Revi ew ed : Ap r-1-2017

Doppl er u l t rasou nd, al so cal l ed col or Doppl er u l t rasonog raph y, i s a speci al u l t rasou nd t ech ni qu e t h at al l ow s t h e ph ysi ci an t o see and eval u at e bl ood fl ow t h rou g h art eri es and vei ns i n t h e abdom en, arm s, l eg s, neck and/ or brai n (i n i nfant s and ch i l dren) or w i t h i n vari ou s body org ans su ch as t h e l i ver or k i dneys. W h at are som e com m on uses of t h e p roced ure? I n w om en, a pel vi c u l t rasou nd i s m ost oft en perform ed t o eval u at e t h e: u t eru s cervi x ovari es fal l opi an t u bes bl adder Pel vi c u l t rasou nd exam s are al so u sed t o m oni t or t h e h eal t h and devel opm ent of an em bryo or fet u s du ri ng preg nancy. See t h e Obst et ri cal U l t rasou nd pag e for m ore i nform at i on. U l t rasou nd exam i nat i ons can h el p di ag nose sym pt om s experi enced by w om en su ch as: pel vi c pai n abnorm al vag i nal bl eedi ng ot h er m enst ru al probl em s U l t rasou nd exam s al so h el p i dent i fy: pal pabl e m asses su ch as ovari an cyst s and u t eri ne fi broi ds ovari an or u t eri ne cancers A t ransvag i nal u l t rasou nd i s u su al l y perform ed t o vi ew t h e endom et ri u m (t h e l i ni ng of t h e u t eru s) and t h e ovari es. Transvag i nal u l t rasou nd al so eval u at es t h e m yom et ri u m (m u scu l ar w al l s of t h e u t eru s) . Sonoh yst erog raph y al l ow s for a m ore i n-dept h i nvest i g at i on of t h e u t eri ne cavi t y. Th ree-di m ensi onal (3-D) u l t rasou nd perm i t s eval u at i on of t h e u t eru s and ovari es i n pl anes t h at cannot be i m ag ed di rect l y. Th ese exam s are t ypi cal l y perform ed t o det ect : u t eri ne anom al i es u t eri ne scars endom et ri al pol yps fi broi ds cancer, especi al l y i n pat i ent s w i t h abnorm al u t eri ne bl eedi ng Som e ph ysi ci ans al so u se 3-D u l t rasou nd or sonoh yst erog raph y for pat i ent s w i t h i nfert i l i t y. I n t h i s set t i ng , t h ree-di m ensi onal u l t rasou nd provi des i nform at i on abou t t h e ou t er cont ou r of t h e u t eru s and abou t u t eri ne i rreg u l ari t i es. See t h e Sonoh yst erog raph y pag e for m ore i nform at i on. I n m en, a pel vi c u l t rasou nd i s u sed t o eval u at e t h e: bl adder sem i nal vesi cl es U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 2 of 8 Revi ew ed : Ap r-1-2017

sem i nal vesi cl es prost at e Transrect al u l t rasou nd, a speci al st u dy u su al l y done t o provi de det ai l ed eval u at i on of t h e prost at e g l and, i nvol ves i nsert i ng a speci al i z ed u l t rasou nd t ransdu cer i nt o a m an's rect u m . See t h e Prost at e U l t rasou nd pag e for m ore i nform at i on. I n m en and w om en, a pel vi c u l t rasou nd exam can h el p i dent i fy: k i dney st ones bl adder t u m ors ot h er di sorders of t h e u ri nary bl adder I n ch i l dren, pel vi c u l t rasou nd can h el p eval u at e: pel vi c m asses pel vi c pai n am bi g u ou s g eni t al i a and anom al i es of pel vi c org ans earl y or del ayed pu bert y i n g i rl s Pel vi c u l t rasou nd i s al so u sed t o g u i de procedu res su ch as needl e bi opsi es, i n w h i ch needl es are u sed t o ext ract a sam pl e of cel l s from org ans for l aborat ory t est i ng . Doppl er u l t rasou nd i m ag es can h el p t h e ph ysi ci an t o see and eval u at e: bl ock ag es t o bl ood fl ow (su ch as cl ot s) narrow i ng of vessel s t u m ors and cong eni t al vascu l ar m al form at i ons redu ced or absent bl ood fl ow t o vari ou s org ans g reat er t h an norm al bl ood fl ow t o di fferent areas, w h i ch i s som et i m es seen i n i nfect i ons How sh oul d I p rep are? Y ou sh ou l d w ear com fort abl e, l oose-fi t t i ng cl ot h i ng for you r u l t rasou nd exam . Y ou m ay need t o rem ove al l cl ot h i ng and jew el ry i n t h e area t o be exam i ned. Y ou m ay be ask ed t o w ear a g ow n du ri ng t h e procedu re. U l t rasou nd exam i nat i ons are very sensi t i ve t o m ot i on, and an act i ve or cryi ng ch i l d can prol ong t h e exam i nat i on process. To ensu re a sm oot h experi ence, i t oft en h el ps t o expl ai n t h e procedu re t o t h e ch i l d pri or t o t h e exam . Bri ng i ng book s, sm al l t oys, m u si c or g am es can h el p t o di st ract t h e ch i l d and m ak e t h e t i m e pass qu i ck l y. Th e u l t rasou nd exam room m ay h ave a t el evi si on. Feel free t o ask for you r ch i l d's favori t e ch annel . W h at d oes t h e equi p m ent l ook l i k e? U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 3 of 8 Revi ew ed : Ap r-1-2017

U l t rasou nd scanners consi st of a consol e cont ai ni ng a com pu t er and el ect roni cs, a vi deo di spl ay screen and a t ransdu cer t h at i s u sed t o do t h e scanni ng . Th e t ransdu cer i s a sm al l h and-h el d devi ce t h at resem bl es a m i croph one, at t ach ed t o t h e scanner by a cord. Som e exam s m ay u se di fferent t ransdu cers (w i t h di fferent capabi l i t i es) du ri ng a si ng l e exam . Th e t ransdu cer sends ou t h i g h -frequ ency sou nd w aves (t h at t h e h u m an ear cannot h ear) i nt o t h e body and t h en l i st ens for t h e ret u rni ng ech oes from t h e t i ssu es i n t h e body. Th e pri nci pl es are si m i l ar t o sonar u sed by boat s and su bm ari nes. Th e u l t rasou nd i m ag e i s i m m edi at el y vi si bl e on a vi deo di spl ay screen t h at l ook s l i k e a com pu t er or t el evi si on m oni t or. Th e i m ag e i s creat ed based on t h e am pl i t u de (l ou dness) , frequ ency (pi t ch ) and t i m e i t t ak es for t h e u l t rasou nd si g nal t o ret u rn from t h e area w i t h i n t h e pat i ent t h at i s bei ng exam i ned t o t h e t ransdu cer (t h e devi ce pl aced on t h e pat i ent 's sk i n t o send and recei ve t h e ret u rni ng sou nd w aves) , as w el l as t h e t ype of body st ru ct u re and com posi t i on of body t i ssu e t h rou g h w h i ch t h e sou nd t ravel s. A sm al l am ou nt of g el i s pu t on t h e sk i n t o al l ow t h e sou nd w aves t o t ravel from t h e t ransdu cer t o t h e exam i ned area w i t h i n t h e body and t h en back ag ai n. U l t rasou nd i s an excel l ent m odal i t y for som e areas of t h e body w h i l e ot h er areas, especi al l y ai r-fi l l ed l u ng s, are poorl y su i t ed for u l t rasou nd. For u l t rasou nd procedu res requ i ri ng i nsert i on of t h e t ransdu cer, su ch as t ransvag i nal or t ransrect al exam s, t h e devi ce i s covered w i t h a sh eat h and l u bri cat ed before i nsert i on. How d oes t h e p roced ure w ork ? U l t rasou nd i m ag i ng i s based on t h e sam e pri nci pl es i nvol ved i n t h e sonar u sed by bat s, sh i ps and fi sh erm en. W h en a sou nd w ave st ri k es an object , i t bou nces back , or ech oes. By m easu ri ng t h ese ech o w aves, i t i s possi bl e t o det erm i ne h ow far aw ay t h e object i s as w el l as t h e object 's si z e, sh ape and consi st ency (w h et h er t h e object i s sol i d or fi l l ed w i t h fl u i d) . I n m edi ci ne, u l t rasou nd i s u sed t o det ect ch ang es i n appearance, si z e or cont ou r of org ans, t i ssu es, and vessel s or t o det ect abnorm al m asses, su ch as t u m ors. I n an u l t rasou nd exam i nat i on, a t ransdu cer bot h sends t h e sou nd w aves i nt o t h e body and recei ves t h e ech oi ng w aves. W h en t h e t ransdu cer i s pressed ag ai nst t h e sk i n, i t di rect s sm al l pu l ses of i nau di bl e, h i g h -frequ ency sou nd w aves i nt o t h e body. As t h e sou nd w aves bou nce off i nt ernal org ans, fl u i ds and t i ssu es, t h e sensi t i ve recei ver i n t h e t ransdu cer records t i ny ch ang es i n t h e sou nd's pi t ch and di rect i on. Th ese si g nat u re w aves are i nst ant l y m easu red and di spl ayed by a com pu t er, w h i ch i n t u rn creat es a real -t i m e pi ct u re on t h e m oni t or. One or m ore fram es of t h e m ovi ng pi ct u res are t ypi cal l y capt u red as st i l l i m ag es. Sh ort vi deo l oops of t h e i m ag es m ay al so be saved. Th e sam e pri nci pl es appl y t o u l t rasou nd procedu res su ch as t ransrect al and t ransvag i nal w h i ch requ i re i nsert i on of a speci al t ransdu cer i nt o t h e body. Doppl er u l t rasou nd, a speci al appl i cat i on of u l t rasou nd, m easu res t h e di rect i on and speed of bl ood cel l s as t h ey m ove t h rou g h vessel s. Th e m ovem ent of bl ood cel l s cau ses a ch ang e i n pi t ch of t h e refl ect ed sou nd w aves (cal l ed t h e Doppl er effect ) . A com pu t er col l ect s and processes t h e sou nds and creat es g raph s or col or pi ct u res t h at represent t h e fl ow of bl ood t h rou g h t h e bl ood vessel s. U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 4 of 8 Revi ew ed : Ap r-1-2017

How i s t h e p roced ure p erf orm ed ? Transabd om i nal : For m ost u l t rasou nd exam s, you w i l l be posi t i oned l yi ng face-u p on an exam i nat i on t abl e t h at can be t i l t ed or m oved. Pat i ent s m ay be t u rned t o ei t h er si de t o i m prove t h e qu al i t y of t h e i m ag es. Aft er you are posi t i oned on t h e exam i nat i on t abl e, t h e radi ol og i st (a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons) or sonog raph er w i l l appl y a w arm w at er-based g el t o t h e area of t h e body bei ng st u di ed. Th e g el w i l l h el p t h e t ransdu cer m ak e secu re cont act w i t h t h e body and el i m i nat e ai r pock et s bet w een t h e t ransdu cer and t h e sk i n t h at can bl ock t h e sou nd w aves from passi ng i nt o you r body. Th e t ransdu cer i s pl aced on t h e body and m oved back and fort h over t h e area of i nt erest u nt i l t h e desi red i m ag es are capt u red. Th ere i s u su al l y no di scom fort from pressu re as t h e t ransdu cer i s pressed ag ai nst t h e area bei ng exam i ned. H ow ever, i f scanni ng i s perform ed over an area of t enderness, you m ay feel pressu re or m i nor pai n from t h e t ransdu cer. Once t h e i m ag i ng i s com pl et e, t h e cl ear u l t rasou nd g el w i l l be w i ped off you r sk i n. Any port i ons t h at are not w i ped off w i l l dry qu i ck l y. Th e u l t rasou nd g el does not u su al l y st ai n or di scol or cl ot h i ng . Transvag i nal : Transvag i nal u l t rasou nd i s perform ed very m u ch l i k e a g ynecol og i c exam and i nvol ves t h e i nsert i on of t h e t ransdu cer i nt o t h e vag i na aft er you em pt y you r bl adder. Th e t i p of t h e t ransdu cer i s sm al l er t h an t h e st andard specu l u m u sed w h en perform i ng a Pap t est . A prot ect i ve cover i s pl aced over t h e t ransdu cer, l u bri cat ed w i t h a sm al l am ou nt of g el , and t h en i nsert ed i nt o t h e vag i na. Onl y t w o t o t h ree i nch es of t h e t ransdu cer end are i nsert ed i nt o t h e vag i na. Th e i m ag es are obt ai ned from di fferent ori ent at i ons t o g et t h e best vi ew s of t h e u t eru s and ovari es. Transvag i nal u l t rasou nd i s u su al l y perform ed w i t h you l yi ng on you r back , possi bl y w i t h you r feet i n st i rru ps si m i l ar t o a g ynecol og i c exam . Transrectal : For a t ransrect al u l t rasou nd, a prot ect i ve cover i s pl aced over t h e t ransdu cer. I t i s l u bri cat ed and t h en pl aced i nt o t h e rect u m . U su al l y, you l i e on you r si de, faci ng aw ay from t h e exam i ner, w i t h you r k nees and h i ps sl i g h t l y fl exed. Doppl er sonog raph y i s perform ed u si ng t h e sam e t ransdu cer. W h en t h e exam i nat i on i s com pl et e, you m ay be ask ed t o dress and w ai t w h i l e t h e u l t rasou nd i m ag es are revi ew ed. W h at w i l l I exp eri ence d uri ng and af t er t h e p roced ure? U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 5 of 8 Revi ew ed : Ap r-1-2017

For a transabd om i nal exam : A cl ear w at er-based g el i s appl i ed t o t h e abdom en. A t ransdu cer i s m oved back and fort h over t h i s area u nt i l t h e desi red i m ag es are capt u red. U l t rasou nd exam i nat i ons are pai nl ess and easi l y t ol erat ed by m ost pat i ent s. For a transvag i nal exam : W i t h t ransvag i nal u l t rasou nd, al t h ou g h t h e exam i nat i on i s oft en perform ed t o l ook for a cau se of pel vi c pai n, t h e sonog ram i t sel f sh ou l d not be pai nfu l or si g ni fi cant l y i ncrease you r di scom fort . A vag i nal sonog ram i s u su al l y m ore com fort abl e t h an a m anu al g ynecol og i c exam i nat i on. For a transrectal exam : I f no bi opsy i s requ i red, t ransrect al u l t rasou nd of t h e prost at e i s si m i l ar t o or m ay h ave l ess di scom fort t h an a rect al exam perform ed by you r doct or. I f a bi opsy i s perform ed, addi t i onal di scom fort (du e t o t h e needl e i nsert i on) i s u su al l y m i ni m al becau se t h e rect al w al l i s rel at i vel y i nsensi t i ve t o t h e pai n i n t h e reg i on of t h e prost at e. A bi opsy w i l l add t i m e t o t h e procedu re. I f a Doppl er u l t rasou nd st u dy i s perform ed, you m ay act u al l y h ear pu l se-l i k e sou nds t h at ch ang e i n pi t ch as t h e bl ood fl ow i s m oni t ored and m easu red. Th ese u l t rasou nd exam i nat i ons are u su al l y com pl et ed w i t h i n 30 m i nu t es. Aft er an u l t rasou nd exam i nat i on, you sh ou l d be abl e t o resu m e you r norm al act i vi t i es i m m edi at el y. W h o i nt erp ret s t h e resul t s and h ow d o I g et t h em ? A radi ol og i st , a ph ysi ci an speci fi cal l y t rai ned t o su pervi se and i nt erpret radi ol og y exam i nat i ons, w i l l anal yz e t h e i m ag es and send a si g ned report t o you r pri m ary care ph ysi ci an, or t o t h e ph ysi ci an or ot h er h eal t h care provi der w h o requ est ed t h e exam . U su al l y, t h e referri ng ph ysi ci an or h eal t h care provi der w i l l sh are t h e resu l t s w i t h you . I n som e cases, t h e radi ol og i st m ay di scu ss resu l t s w i t h you at t h e concl u si on of you r exam i nat i on. Fol l ow -u p exam i nat i ons m ay be necessary. Y ou r doct or w i l l expl ai n t h e exact reason w h y anot h er exam i s requ est ed. Som et i m es a fol l ow -u p exam i s done becau se a pot ent i al abnorm al i t y needs fu rt h er eval u at i on w i t h addi t i onal vi ew s or a speci al i m ag i ng t ech ni qu e. A fol l ow -u p exam i nat i on m ay al so be necessary so t h at any ch ang e i n a k now n abnorm al i t y can be m oni t ored over t i m e. Fol l ow -u p exam i nat i ons are som et i m es t h e best w ay t o see i f t reat m ent i s w ork i ng or i f a fi ndi ng i s st abl e or ch ang ed over t i m e. Benef i t s Most u l t rasou nd scanni ng i s noni nvasi ve (no needl es or i nject i ons) . U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 6 of 8 Revi ew ed : Ap r-1-2017

Most u l t rasou nd scanni ng i s noni nvasi ve (no needl es or i nject i ons) . Occasi onal l y, an u l t rasou nd exam m ay be t em porari l y u ncom fort abl e, bu t i t sh ou l d not be pai nfu l . U l t rasou nd i s w i del y avai l abl e, easy-t o-u se and l ess expensi ve t h an ot h er i m ag i ng m et h ods. U l t rasou nd i m ag i ng i s ext rem el y safe and does not u se any i oni z i ng radi at i on. U l t rasou nd scanni ng g i ves a cl ear pi ct u re of soft t i ssu es t h at do not sh ow u p w el l on x-ray i m ag es. U l t rasou nd i s t h e preferred i m ag i ng m odal i t y for t h e di ag nosi s and m oni t ori ng of preg nant w om en and t h ei r u nborn babi es. U l t rasou nd provi des real -t i m e i m ag i ng , m ak i ng i t a g ood t ool for g u i di ng m i ni m al l y i nvasi ve procedu res su ch as needl e bi opsi es and fl u i d aspi rat i on. Pel vi c u l t rasou nd can h el p t o i dent i fy and eval u at e a vari et y of u ri nary and reprodu ct i ve syst em di sorders i n bot h sexes w i t h ou t x-ray exposu re. Ri sk s For st andard di ag nost i c u l t rasou nd, t h ere are no k now n h arm fu l effect s on h u m ans. W h at are t h e l i m i t at i ons of Pel vi c U l t rasound I m ag i ng ? U l t rasou nd w aves are di sru pt ed by ai r or g as; t h erefore u l t rasou nd i s not an i deal i m ag i ng t ech ni qu e for ai r-fi l l ed bow el or org ans obscu red by t h e bow el . I n m ost cases, bari u m exam s, CT scanni ng , and MRI are t h e m et h ods of ch oi ce i n su ch a set t i ng . Larg e pat i ent s are m ore di ffi cu l t t o i m ag e by u l t rasou nd becau se g reat er am ou nt s of t i ssu e at t enu at e (w eak en) t h e sou nd w aves as t h ey pass deeper i nt o t h e body and need t o be ret u rned t o t h e t ransdu cer for anal ysi s. Ad d i t i onal I nf orm at i on and Resources RTAnsw ers. org Radi at i on Th erapy for G ynecol og i c Cancers Radi at i on Th erapy for Prost at e Cancer Di scl ai m er Th i s i nf orm at i on i s cop i ed f rom t h e Rad i ol og yI nf o W eb si t e (h t t p : / / w w w . rad i ol og yi nf o. org ) w h i ch i s d ed i cat ed t o p rovi d i ng t h e h i g h est qual i t y i nf orm at i on. To ensure t h at , each sect i on i s revi ew ed by a p h ysi ci an w i t h exp ert i se i n t h e area p resent ed . Al l i nf orm at i on cont ai ned i n t h e W eb si t e i s f urt h er revi ew ed by an ACR (Am eri can Col l eg e of Rad i ol og y) - RSNA (Rad i ol og i cal Soci et y of Nort h Am eri ca) com m i t t ee, com p ri si ng p h ysi ci ans w i t h exp ert i se i n several rad i ol og i c areas. H ow ever, i t i s not p ossi bl e t o assure t h at t h i s W eb si t e cont ai ns com p l et e, up -t o-d at e i nf orm at i on on any p art i cul ar subject . Th eref ore, ACR and RSNA m ak e no rep resent at i ons or w arrant i es about t h e sui t abi l i t y of t h i s i nf orm at i on f or use f or any p art i cul ar p urp ose. Al l i nf orm at i on i s p rovi d ed " as i s" w i t h out exp ress or i m p l i ed w arrant y. U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 7 of 8 Revi ew ed : Ap r-1-2017

f or use f or any p art i cul ar p urp ose. Al l i nf orm at i on i s p rovi d ed " as i s" w i t h out exp ress or i m p l i ed w arrant y. Pl ease vi si t t h e Rad i ol og yI nf o W eb si t e at h t t p : / / w w w . rad i ol og yi nf o. org t o vi ew or d ow nl oad t h e l at est i nf orm at i on. Not e: I m ag es m ay be sh ow n f or i l l ust rat i ve p urp oses. Do not at t em p t t o d raw concl usi ons or m ak e d i ag noses by com p ari ng t h ese i m ag es t o ot h er m ed i cal i m ag es, p art i cul arl y your ow n. Onl y qual i f i ed p h ysi ci ans sh oul d i nt erp ret i m ag es; t h e rad i ol og i st i s t h e p h ysi ci an exp ert t rai ned i n m ed i cal i m ag i ng . Cop yri g h t Th i s m at eri al i s cop yri g h t ed by ei t h er t h e Rad i ol og i cal Soci et y of Nort h Am eri ca (RSNA) , 8 20 Jori e Boul evard , Oak Brook , I L 60523-2251 or t h e Am eri can Col l eg e of Rad i ol og y (ACR) , 18 9 1 Prest on W h i t e Dri ve, Rest on, VA 2019 1-439 7. Com m erci al rep rod uct i on or m ul t i p l e d i st ri but i on by any t rad i t i onal or el ect roni cal l y based rep rod uct i on/ p ubl i cat i on m et h od i s p roh i bi t ed . Cop yri g h t ® 2018 Rad i ol og i cal Soci et y of Nort h Am eri ca, I nc. U l t rasound - Pel vi s Cop yri g h t © 2018 , Rad i ol og yI nf o. org Pag e 8 of 8 Revi ew ed : Ap r-1-2017