Walk the Walk, Talk the Talk

small dog running in a grassy field

Now a good share of you have already been scanning a lot and some of you just dabble. You have probably done some ultrasound labs and attended a few lectures, and even read some journal articles. Have you ever checked out YouTube? The one thing that you may have noticed whichever you have been exposed to is the lingo that gets thrown around with ultrasound.

Okay, so most of you know what the words mean but let’s go over them just in case there is one that you missed!

Since ultrasound uses sound waves (I know what you’re thinking duh, I know that) but, bear with me I have to start with some physics. You can’t escape it!!! But, lucky for you, “Danielle physics” are a little less technical. When you pick up that transducer or probe (a radiologist once said to me “don’t call it a probe…aliens probe. Call it a transducer” ) and place it on the patient the sound waves go out into that area and at the same time it “listens” for the echoes that are bouncing back.

Some mathematical magic happens in that computer that is attached and this is what appears on the screen as the black, white, and grays. There, that wasn’t so painful was it? That means we talk about echoes and echogenicity and use words to describe what that echo looks like on the screen.

Hyperechoic, isoechoic, and hypoechoic are the words that are used with echogenicity. Each organ has its own echogenicity in its normal state. How do you know what that echogenicity is supposed to look like? This is where you have to do some homework.

The only way you are able to recognize what “normal” parenchyma of an organ looks like is you have to scan normal patients over and over and over again! Luckily, there are ultrasound books and plenty of pictures on the internet to help out as well. Taking part in ultrasound labs where there are experienced sonographers to point out normal helps as well. Did I mention YouTube?

Hyperechoic means that the area or tissue being scanned is more echogenic or brighter than normal. Isoechoic means that the tissue is equal to those around it. Hypoechoic means that the tissue is less echogenic or darker than normal. Now that we have established that, let’s consider now that the organs due to their parenchyma will have different densities. So their echogenicities in a normal state will not all be equal.

In the presence of disease the echogenicity of an organ can be altered, either more echogenic (hyperechoic) or less echogenic (hypoechoic) than usual. So knowing who is brighter or darker to one another can help categorize the type of disease process involved.

There is a mnemonic that was taught to me to help with remembering the order “my cat loves sunny places”, a mnemonic to help the scanner remember the order of echogenicity of normal organs. Using the first letter from each word the tissues go from hypoechoic (darker) to hyperechoic (brighter) relative to each other:

  1. M – medulla of the kidney
  2. C – cortex of the kidney
  3. L – liver
  4. S – spleen
  5. P – prostate

But, wait there’s more!! Not only do we have to think about echogenicity we also have to consider echotexture. How does the organ look? Is it heterogeneous meaning that the organ has dissimilar components or elements, appearing irregular or variegated? Or is homogenous and has similar characteristics or components?

And just when you thought it was safe to go back into the water… you also have to decide the shape and size of the organ you are imaging too! Is the organ too large, small, or non-existent? Is the shape rounded, lobulated, altered?

Whew! Are we done yet? Not quite! There are a few other terms that are used but they pertain to the way you move the transducer/probe. They are as follows:

  • Fan – meaning leaving the transducer in place and pivoting the transducer cranial, caudal, medial, or lateral.
  • Sweep – sliding the transducer SLOWLY cranial, caudal, medial, or lateral.
  • Rotate – usually leaving the transducer in place and rotating it clockwise or counter clockwise in very small increments. I like to say this movement is like your stereo knob. Turn the transducer/probe clockwise “turn the music up” or counterclockwise to “turn the music down.”
  • Longitudinal/Sagittal – this is an orientation term and refers to the indicator on the transducer/probe (a) that corresponds to the icon on the top left of your scan image (b) in that when the transducer is on the patient the indicator is pointed towards the head.
  • Transverse – this is an orientation term and refers to the indicator on the transducer/probe (a) that corresponds to the icon on the top left of your scan image (b) in that when the transducer is n the patient the indicator is pointed towards the right side of the patient.
transducer and ultrasound

The orientation of the image when the transducer is in longitudinal/sagittal and transverse are demonstrated in this image.

transducer longitudinal and transverse ultrasound image orientation

OK! Now we are done! Now you have the terminology to scan and converse with the cool kids!! I know this was a review for most but, hopefully you found some info that you can use.

Remember when you scan to have a good history and think about echogenicity, echotexture, size, and shape of the organs you are scanning! practice, practice, practice!!!