Certificate in Clinician Performed Ultrasound (CCPU) Syllabus. Physics Tutorial

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1 Certificate in Clinician Perfrmed Ultrasund (CCPU) Syllabus Physics Tutrial Page 1 f 10 12/18

2 Physics Tutrial Syllabus Purpse: This unit is designed t cver the theretical and practical curriculum fr Physics. Training: Recgnised either thrugh the ASUM nline tutrial r attendance at an ASUM accredited Physics curse r equivalent. Assessments: There is ne multiple chice questin thrughut each tpic, and each tpic cncludes with a 5 multiple chice questin quiz. Intrductin: Ultrasnic imaging prvides impressively detailed images f grss anatmy and pathlgy. The high quality f these images can lead t vercnfidence in interpretatin f the images in a clinical setting. In practice, all ultrasund images are distrted t sme extent and are subject t artifact. While nt always materially detracting frm the image, it is essential t recgnise the presence f artifacts and minimise their effects in rder t draw apprpriate clinical cnclusins frm ultrasund images. This is f particular significance in studies invlving accurate measurement (fr example, estimating tumur grwth) and where accurate lcalisatin f a structure is required. As mst artifacts must be dealt with by the user at the time f the ultrasund examinatin, the imprtance f understanding the imaging prcess and its limitatins has led t the inclusin f a cmpulsry physics cmpnent in all qualificatins issued by ASUM. Althugh cmmnly referred t as physics, this syllabus deals mre generally with the technlgy relied upn in ultrasnic imaging and defining its limitatins in clinical applicatins. Curse Objectives On cmpleting this curse learners shuld be able t: Knw the parameters that define the safe use f diagnstic ultrasund Understand hw an ultrasund image is btained and hw the use f the cntrls n ultrasund equipment can be used t alter the image in rder t btain an ptimal image. Recgnise the limitatins f machine default settings Demnstrate understanding f the physical principles underpinning the practice f diagnstic ultrasund. Curse Cntent Intrductin: Page 2 f 10 12/18

3 The Ultrasund Examinatin Optimal Plane f Scan Optimising the Image Imaging Artifacts Origins f Artifacts Dealing with Artifacts Interactins Principles f Imaging: Frming a Greyscale Image Greyscale Imaging Tissue Harmnics Imaging Cntrls Gain TGC Preset Cntrls Strengths and Limitatins Flw Measurement and Imaging Spectral Dppler Clur Dppler Pwer Dppler Strengths and Limitatins Dppler Cntrls Gain TGC Dppler Gain Clur Gain Velcity Range Aliasing Baseline Shift Clur Quality Preset Cntrls High Pass Filters (HPF) Page 3 f 10 12/18

4 Dppler Artifacts Frequency Aliasing Intrinsic Spectral Bradening Inapprpriate HPF Inadequate Frame Rate Flw Reversal vs. Aliasing Transducer Arrays Single element transducer Multi-element arrays Scanning Steering Fcussing Multiple Fcal Znes Frame rate limitatins Guidelines fr Safe Practice Sectin 1 Prpagatin Ultrasund Wavelength Prpagatin Speed Relatinship between parameters The Pulse-Ech principle Range Errrs Attenuatin Attenuatin Cefficient Scattering Reflectin Attenuatin Specular reflectin Characteristic Impedance Reflectin Cefficient Scattering Refractin Page 4 f 10 12/18

5 Effect f Differences in Prpagatin Speed Critical Angle Effect f Refractin Relevance f Prpagatin Imaging Technlgy Single Element Transducers Multi-Element Transducer Arrays Transducers in Practice Sectin 2 Tissue Harmnic Imaging Frequency Cmpnents Distrtin f the Ultrasund Wave Harmnic Generatin in Tissue Tissue Harmnic Imaging Strength f Harmnics Reverberatin Artifacts Other Artifacts Transmit Pulse Bandwidth Pulse inversin harmnics Limitatins Cntrast harmnics Imaging Artifacts Reslutin artifacts Axial reslutin Lateral reslutin Slice thickness Tempral reslutin Depth f rigin artifacts Reverberatin artifact Prpagatin speed artifact Range ambiguity Beam path artifacts Page 5 f 10 12/18

6 Refractin artefact Mirrr artefact Mirrr artefact and Dppler Attenuatin artifacts Shadwing Enhancement Equipment settings artifacts TGC settings Mvement artifact Bieffects and Safety Types f Bieffect Thermal bieffect Mechanical bieffect Determining the acustic utput Acustic pressure Intensity Time variatin Spatial variatin Pwer Thermal and mechanical indices Thermal index Mechanical index Plicies and advice ALARA Equipment Perfrmance Spatial reslutin Axial reslutin Lateral reslutin Cntrast reslutin Tempral reslutin Image prcessing Testing equipment perfrmance Test bject Page 6 f 10 12/18

7 Phantm Measurement accuracy Spatial reslutin Slice thickness Cntrast reslutin Penetratin Equipment settings Dppler phantms Flw phantms Mving string phantm Sectin 3 Advances in Ultrasund Spacial cmpund imaging Advantages and limitatins Ultrasund cntrast agents Cntrast agents and harmnics Three dimensinal ultrasund Spatial reslutin 3D display methds Re-slicing Orthgnal plane view Surface rendering Maximum prjectin rendering 4D ultrasund Extended field f view Autmatic image ptimisatin Image prcessing Depth f penetratin Cded signals Matrix transducers Spectral Dppler The Dppler effect Page 7 f 10 12/18

8 Dppler ultrasund The Dppler equatin The Dppler angle Hw is the Dppler angle determined? Limits n the Dppler angle Cntinuus wave Dppler Cntinuus wave Dppler prcessing Cntrls Advantages Pulsed Dppler Pulsed Dppler prcessing Spectral analysis The spectral display Measurements frm the spectral display The Sampling Therem Pulsed Dppler sample vlume Patient expsure Clur Dppler Acquiring the clur Dppler infrmatin Clur Dppler signal prcessing Wall filter and tissue/bld discriminatin Clur Dppler signal prcessing The clur Dppler display Spatial filtering, persistence Variance Clur Dppler cntrls Clur bx, line density Gain, pwer Wall filter Grey-scale pririty Clur velcity scale, baseline shift Clur map Persistence Page 8 f 10 12/18

9 Uses and limitatins f clur Dppler Clur Dppler and pulsed Dppler Angle effects Pwer mde clur Dppler Tissue Dppler Dppler Artifacts Frequency aliasing Baseline shift Other remedies High PRF mde, range ambiguity Frequency aliasing in clur Dppler Intrinsic spectral bradening Spectral mirrr artifact Thump and flash artefact Clur Dppler tempral artefact Twinkle artifact Miscellaneus Glssary Mathematics Multiplicatin and divisin Units Pwers f 10 Scientific ntatin Lgarithms Decibels Reality checking answers Exercises Answers Teaching Methdlgies The ASUM Physics Tutrial is cnducted nline thrugh MyASUM. It is a self-paced tutrial. Page 9 f 10 12/18

10 Accredited curses can be fund n the ASUM website, G t Educatin Prgrams, CCPU, Curse Accreditatin infrmatin, List f Accredited Curses. Assessment There is ne multiple chice questin thrughut each tpic, and each tpic cncludes with a 5 multiple chice questin quiz. Page 10 f 10 12/18

Certificate in Clinician Performed Ultrasound (CCPU)

Certificate in Clinician Performed Ultrasound (CCPU) Syllabus Physics Tutorial Physics Tutorial Purpose: Training: Assessments: This unit is designed to cover the theoretical and practical curriculum for