What is a thyroid ultrasound exam?

Let’s say you recently went to your primary care physician because of thyroid problems. Your doctor then requested you to undergo a thyroid ultrasound.

Thyroid ultrasound is a technique which employs the use of high frequency sound waves to create images of the thyroid gland. Also called ultrasound scanning or sonography, uses an ultrasound machine, which transmits sound waves to your thyroid gland using an ultrasound transducer. These sound waves travel to your thyroid gland and they hit a boundary between blood and soft tissue or between soft tissue and bone. There are sound waves which get reflected back to the probe and they are then sent back again and back and forth. The ultrasound machine then calculates the distance from the probe to the thyroid gland and its tissues using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of the each echo's return (usually on the order of millionths of a second). The ultrasound equipment then displays the distances and intensities of the echoes on the screen, forming a two-dimensional image. The sound waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.

What is interesting is that ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid or both). In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.

An ultrasound machine looks like this: it usually contains a computer, a video display screen and a probe or transducer which is being placed on the body. The probe is a hand-held device that looks like a microphone attached to a cord. The probe is the one responsible for sending sound waves into the body and picks up the returning echoes from the tissues being examined. The images are then formed on the display monitor and are dependent on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.

So, why do you think your doctor requested a thyroid ultrasound exam?

Doctors typically request tests which are useful to your diagnosis. A thyroid gland is often imaged under ultrasound to help diagnose a lump in the thyroid or a thyroid which is not functioning properly. Also, it is also used as a guide in procedures such as ultrasound guided needle biopsies. A needle biopsy is a procedure which uses needles to extract sample cells from an abnormal area for laboratory testing. Also, the ultrasound can help guide placement of a catheter or draining device in the thyroid gland.

If indeed, you have been requested to obtain a thyroid ultrasound you should prepare well for the examination. No other special preparation is needed. On the day of the examination, you should wear comfortable, loose fitting clothing for your ultrasound examination. You should also remove all clothing and jewelry in the area to be examined. This is to ensure that there would be no interferences to the test. The technician may also ask you to wear a gown for the procedure.

A pillow will be placed behind the neck to extend the area to be scanned for a thyroid study.  A clear water-soluble ultrasound gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or physician then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.  There is usually no discomfort from pressure as the transducer is pressed against the area being examined.

If scanning is performed over an area of tenderness, the patient may feel pressure or minor pain from the transducer. The patient will need to extend your neck to gain appropriate access, which may be mildly uncomfortable.

When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or physician is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately. This ultrasound examination is usually completed within 10-15 minutes.

Once the imaging is complete, the gel will be wiped off the skin. The patient is then able to resume normal activities immediately.

Regarding the results, a physician specifically trained to interpret ultrasound examinations, will analyze the images and send a signed report to the patient’s primary care physician or review the results with the patient.

Most ultrasound scanning is noninvasive (no needles or injections) and is usually painless. It is a procedure which is widely available, easy-to-use and less expensive than other imaging methods. It does not use any ionizing radiation. It gives a clear picture of soft tissues that do not show up well on x-ray images. It provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration.

What's the Difference Between New, Used and Refurbished Ultrasound Systems?

What’s the Difference? New, Used or Refurbished Ultrasound?

In the past 5 years, I’ve gotten these questions plenty of times.  I’ve heard the following repeated:

“I want to buy a new ultrasound system, but it’s outside my budget. What can I do?”

“I’ve got this great deal on this used ultrasound machine, why should I buy it new?”

 “Do you have any refurbished ultrasound equipment?”

In order to see what’s best for your practice, let’s define what each one means:

New Ultrasound System – This means you are purchasing an ultrasound system that’s never been used before and it normally comes straight from the manufacturer.  Although, there are some circumstances where distributors purchase large lots of ultrasound systems for re-sale.  It’s like buying an automobile at a new car dealership.

Used Ultrasound Machine – This means that you are purchasing an ultrasound system directly from another clinician or another 3^rd party source.  Most of the time, they usually don’t come with a warranty nor training.  It is similar to purchasing a car from a used car lot or from a classified ad.

Refurbished Ultrasound Equipment – This means that you are purchasing it direct from the manufacturer or a 3^rd Party Distributor who has taken the system in and performed various quality checks to make sure it’s in working order.  They usually come with a limited warranty and some ultrasound training.  It is similar to purchasing a certified used car.

Which one should I purchase?

This will depend on what your current and future goals, specialty and your budget.

For example, in thyroid ultrasound, I would never recommend purchasing used or refurbished equipment.  The standards of care of changed the past 5-10 years, that some of these older systems are obsolete. For example, 10 years ago DOPPLER imaging wasn’t a requirement, but it is now.  The older systems will have difficulty connecting to EMR’s, since they were analog systems.

Furthermore, the new ultrasound machines in the market really streamline your workflow.   Your measurements are automatically inputted into a report page and you can create mini macros of your impressions.  For this specialty, it’s always best to go with a new ultrasound system.

Proposed 2012 fee schedule targets imaging payments, optimizes EHR and PQRS

Just came across this article from Part B News.

It'll be interesting to see if the Medicare cuts are postponed again.  I think Washington really needs to sit down and find a way to fix this major problem.  A reduction in cuts to physician's will definitely pay a part on not only to what medical services are offered to their patients, but what tools (especially ultrasound equipment)they will have to adequately provide those services.

Ultrasound Gel - Why is it Used?

Before a sonographer (medical professional who operates an imaging device or ultrasound) proceeds to perform an ultrasound scan, you’ll notice that a layer of thick gel is applied on the belly of a pregnant woman. That gel is water-based and serves as lubricant throughout the procedure to produce a great image of the growing baby inside the mother’s womb. To give you a broader understanding about this gel, let me discussed first where is this gel made from.

The typical gel for ultrasound contains Polyacrylamide or the byproduct of the gel that undergone process of electrophoresis (also known as cataphoresis which defines the relative motion of dispersing particles in a solution under the state of dimensionally uniform electric field) which is a common method in biochemistry that aims to separate macromolecules. This ultrasound gel is safe and non-toxic for both sonographer and patient, it contains some chemicals responsible for its texture, thickness and color.

Chemicals are differentiated as Propylene Glycol, Glycerin, Phenoxyethanol or Colorant. Propylene Glycol is commonly used in pharmaceutical and cosmetic purposes, its chemical molecule in nature is stable and neutral which is not reactive if combined with other substances. It also serves as emulsifier, helps in holding and binding water molecules and other substances. Glycerin is a compound commonly used in soap production. It’s characterized as colorless and sweet in taste, Polyol is its main component which is a molecule containing alcohol with multiple hydroxyl groups attached to it which helps absorbs water from air thus making it a good solvent. Phenoxyethanol  is a colorless oil-based and water soluble solution that is consider as glycolether, commonly used in derma products but somehow over usage can cause damage or toxicity of the central nervous system. Colorant is synthetic dyes of FD&C Blue No. 1 that is made out of petroleum are usually used in ultrasound gel. These types of dyes are mostly found in foods and cosmetics products.

Upon performing the ultrasound imaging procedure the medical professional applies the gel on the surface of the skin, it is clear, thick and adheres easily. It is normally cold, however there are ultrasound gel warmers to warm it before use.  The gel serves as the medium in the transmission of soundwaves. After the application, the transducer is then place and manipulated on the target area where the gel absorbs all air displaying clear and high quality images. It serves as the bridge of the soundwaves where it passes by and bounces back to the transducer, then transducers pick-up the waves and processed it to visualize the internal structure of the body organ. Ultrasound is helpful not only for pregnant women who wants to see the baby inside their tummy but also for the diagnosis of tumors whether benign or malignant, early detection of metastasis of cancer cells, abnormal masses and visualization of hollow internal organs. After the ultrasound procedure is done, the ultrasound gel is wiped off, the image produce is printed out or saved for patient’s benefits and hospital record purposes.

Smartsound Ultrasound (DrSmart.com) is a leading provider of ultrasound equipment and related supplies such as ultrasound gel used in ultrasound procedures.