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A radiologist’s experience

A radiologist will talk about his experience with ultrasound imaging and introduce some problems that may arise.
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JURGEN FÜTTERER: My name is Jurgen Fütterer. I’m an interventional radiologist in the Radboud University Nijmegen Medical Centre in the Netherlands. In our department, ultrasound is one of the main imaging modalities, next to x-ray imaging, CT, and MRI. Not only is ultrasound used as an imaging modality, but also as a therapy modality. For example, we can apply high intensity focused ultrasound to treat patients with prostate cancer. Although all body parts of the patients, from head to toe, are scanned for diagnostic purposes, most of the diagnostic examinations are in the abdominal region.
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Ultrasound imaging is the first imaging method of choice for abdominal pathology. It’s easy, accessible, has lower costs, and quickly provides the operator with information, compared to other imaging techniques. You have to know how ultrasound works before you are able to choose the right equipment, transducer, and settings. Only then you are able to make an educated assessment of the images you have acquired.
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The abdominal region contains multiple organs that can be examined using ultrasound. The liver, gallbladder, pancreas, kidneys, spleen, and abdominal aorta are frequently assessed.
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It is also easy to quickly check up on the other organs, when the organ of interest is, for example, the liver. Only the stomach, small, and large intestines are difficult to assess, since they are air containing organs.
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Here, we see a typical abdominal ultrasound examination. The operator uses the curvilinear or convex probe, allowing visualisation of deep structures. The operator is assessing the liver and gallbladder. Typical liver assessments focus on the presence of inflammation, cysts, or cirrhotic disease, which can be an indication for liver cancer. In this case, the gallbladder is hard to visualise, since our volunteer has eaten just before the examination. The pancreas can also be assessed upon inflammation, or for benign or malign tumours. Kidneys can, for example, be assessed for the presence of kidney stones, cysts or kidney swelling due to obstructive outlet, as well as cancerous lesions. The spleen can be assessed for enlargement, mostly indicating an underlying hematologic problem.
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And finally, we can appreciate if there is something wrong with the aorta, like when it has widened in case of an aneurysm. Of all these assessable organs, you may have seen that it is important to have the suitable transducer, to let ultrasound reach all the important deep structures. Imaging parameters should be adapted to optimise imaging for each individual organ or even a part of an organ. Furthermore, the abdominal organs are, of course, three-dimensional, whereas our ultrasound is only transmitted in two dimensions, making a 2D image. A proper visual-spatial perception of 2D and 3D surfaces is therefore essential for interpretation of the ultrasound images.
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JURGEN FÜTTERER: In the next video, you will see a patient who had a bike accident. In the ultrasound examination at the radiology department, our focus will be at the abdominal region of this patient.
A radiologist tells what ultrasound imaging means for his clinical practice. You will see live action of the ultrasound device most frequently used at the radiology department at the University Medical Center Nijmegen St. Radboud by a specialised sonographer.
Our patient in this video is a healthy volunteer with no known physical abnormalities. This ultrasound examination was conducted solely to give you an impression of the experiences and possibilities for a radiologist.
The educator in the video is:

Jurgen Fütterer, MD PhD

Interventional radiologist at Radboud University Medical Centre in Nijmegen. He has a research focus on ultrasound treatment possibilities with HIFU. Presenter of the third case (Weeks 1 and 6), with the cooperation of Denise Janssen-Bell, Kevin May, and Stefan Hummelink.
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Ultrasound Imaging: What Is Inside?

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