Ultrasound uses sound waves to identify internal organs. Ultrasound technology is utilized in a wide range of examinations, including the abdomen, pelvic, breast, prostrate and thyroid. Because no radiation is involved, ultrasound is frequently used for obstetric work. The vascular lab performs a variety of procedures that detect problems in arteries and veins in all parts of the body.
The Vascular Lab at Covenant HealthCare has multiple modalities along with color capability to detect and visualize various problems in arteries and veins. Modalities include state-of-the science duplex, Doppler and impedance plethysmography.
PREPARATION:
Patients under 2 years of age are to have nothing by mouth (NPO) for 4 hours and those over 2 years of age, NPO for 6 hours before exam. If the patient has eaten, the gallbladder could be contracted and not visualized or may appear diseased. Food matter in the stomach or bowel may give the appearance of abdominal masses or may obscure visualization of other structures.
EXAM DESCRIPTION:
High frequency sound waves rather than x-rays are used to evaluate soft tissue organs in the upper abdomen. The gallbladder, kidneys and aorta are also imaged in addition to the above-mentioned areas. The abdominal organs can be evaluated for size, shape and the presence of masses. The stomach and bowel cannot be imaged and excessive gas in the bowel will obscure the visualization of other structures.
LENGTH OF TIME INVOLVED:
The examination usually takes between 30-45 minutes.
PREPARATION:
Patient should have nothing by mouth (NPO) 4-6 hours prior to examination if possible. Fasting limits intestinal gas interference that may obstruct view of the entire aorta. In some patients, it is possible to view the aorta without fasting. Prep if necessary and instruct according to doctor.
EXAM DESCRIPTION:
Using high frequency sound waves rather than x-rays, the abdominal aorta is scanned from diaphragm to the bifurcation. Images obtained will demonstrate presence and size of aneurysm, thrombus and calcification.
LENGTH OF TIME INVOLVED:
Scanning time is approximately 15-20 minutes.
PREPARATION:
No preparation is necessary.
EXAM DESCRIPTION:
Utilizing high frequency sound waves rather than x-rays, images are obtained of the intracranial structures. By scanning over the anterior fontanel, abnormalities such as hemorrhage and hydrocephalus are demonstrated.
LENGTH OF TIME INVOLVED:
Scanning time is approximately 10-20 minutes.
PREPARATION:
Drink 4-5 (8 oz) glasses of any fluid other than milk, finishing one hour before your examination. Do not empty your bladder. Your bladder must be very full when you arrive to prevent delays or rescheduling of your examination. You should have a regular breakfast and lunch prior to your exam. In a pregnancy the full bladder is used to indicate the lower uterine border, to elevate the fetal head in a cephalic presentation and to demonstrate the cervical opening for the diagnosis of placenta previa.
EXAM DESCRIPTION:
Ultrasound is a procedure utilizing high frequency sound waves rather than x-rays in evaluating the pregnancy. A gel is spread on the skin surface and a transducer moving across the abdomen performs scans. Measurements are taken routinely of the fetal skull, abdomen and femurs to determine fetal age. The placenta is scanned to determine location, rule out placenta previa and placental grade. The fetus is scanned to rule out anomalies, determine fetal lie and confirm viability.
LENGTH OF TIME INVOLVED:
The procedure takes between 30-45 minutes once the patient has a sufficiently full bladder.
PREPARATION:
Drink 4-5 (8 oz) glasses of any fluid other than milk, finishing one hour before your examination. Do not empty your bladder. Your bladder must be very full when you arrive to prevent delays or rescheduling of your examination. You should have a regular breakfast and lunch prior to your exam. The full bladder pushes the pelvic organs up above the symphysis, moves bowel aside and provides a "window" which allows visualization of the uterus and ovaries in a female and the prostate gland in a male. If there are abnormalities to be found in the pelvis, we cannot detect it if the bladder is not completely full.
EXAM DESCRIPTION:
Ultrasound is a procedure using high frequency sound waves rather than x-rays to determine abnormalities in the pelvis. A water-based gel is spread on the skin surface and a transducer moving across the skin performs scans. The procedure is painless other than discomfort experienced from the full bladder.
LENGTH OF TIME INVOLVED:
The procedure takes between 10-15 minutes once the patient has a sufficiently full bladder.
PREPARATION:
Drink 4-5 (8 oz) glasses of any fluid other than milk, finishing one hour before your examination. Do not empty your bladder. Your bladder must be very full when you arrive to prevent delays or rescheduling of your examination. You should have a regular breakfast and lunch prior to your exam. Filling the bladder for the pelvic ultrasound first allows pushing up of the pelvic organs and allows a "window" to visualize the uterus and ovaries. A distended urinary bladder could cause some pain during endovaginal scanning, therefore, the patient is asked to void prior to endovaginal scanning.
EXAM DESCRIPTION:
A water-based gel is spread on the skin and a transducer moving across the skin performs scans. The patient is then instructed to empty their bladder. An ultrasound probe is then introduced into the vaginal canal the same way a tampon would be inserted. The uterus, ovaries and adnexal area are imaged. This exam is performed in addition to a pelvic ultrasound. Endovaginal Ultrasound only is rarely performed. It has been very effective in evaluating early pregnancies, as well as the ovaries and uterus. The transducer is covered with a condom and is sterilized after each use.
LENGTH OF TIME INVOLVED:
The procedure takes approximately 15-20 minutes.
PREPARATION:
The patients should use a Fleet's enema at home two (2) hours before the procedure. The patient should have a broad-spectrum antibiotic, prescribed by their physician, and taken according to the physician's instructions. The patient should be off Coumadin and have a PT value that is within 2 sec of control. Bladder should be somewhat full upon arrival. (Drink approximately 0.6 liters). The patient will be asked to prep himself with a Fleet's enema at home. This will remove any fecal material from the rectum. No other preparation is needed unless ordered with a biopsy.
EXAM DESCRIPTION:
An ultrasound transducer is inserted into the rectum to image the gland and guide the physician in placing the biopsy needle, where a series of specimens will be obtained from the prostate.
LENGTH OF TIME INVOLVED:
This exam takes approximately 30 minutes.
PREPARATION:
The patient should use a Fleet's enema at home 2 hours before the exam. This will remove any fecal material from the rectum. No other preparation is needed unless ordered with a biopsy.
Patient should arrive with a full bladder (should drink approximately 20 ounces of fluid).
EXAM DESCRIPTION:
An Ultrasound probe is inserted into the rectum and the prostate gland is imaged and measured.
LENGTH OF TIME INVOLVED:
This exam takes approximately 30 minutes.
PREPARATION:
Patient is to drink 20-30 oz of any fluid (except milk), finishing 1 hour prior to exam. Do not empty bladder 1 hour before exam. Must arrive with full bladder. Distention of the urinary bladder is necessary to image the bladder.
EXAM DESCRIPTION:
Using high frequency sound waves, the transplanted kidney is scanned to determine size and presence of fluid collections, evidence of obstruction or masses. Doppler is obtained to study the resistive indices of small, arcuate arteries.
LENGTH OF TIME INVOLVED:
The examination usually lasts 20 - 30 minutes.
PREPARATION:
Drink 30-40 oz. of fluid (except milk), finishing 1 hour before exam starts. Do not empty bladder 1 hour before exam. Patient must have full bladder upon arrival to Ultrasound Department. Distention of the bladder is necessary to image the bladder.
EXAM DESCRIPTION:
Using high frequency sound waves rather than x-rays, both kidneys are scanned to determine size and shape, and evaluate of obstruction or masses. The ureters cannot be visualized unless there is a hydroureter. The urinary bladder will be evaluated with ultrasound if the bladder is full.
LENGTH OF TIME INVOLVED:
The examination usually takes between 20-30 minutes.
RUQ Ultrasound (Includes Liver, Gallbladder, Bile Ducts, Right Kidney, and Pancreas)
PREPARATION:
Patients age 2 or under are to have nothing by mouth (NPO) for 4 hours and those over 2 years of age, NPO for 6 hours prior to exam. In order to properly evaluate the gallbladder, it must be distended. Eating will cause the gallbladder to contract. Also, food matter in the bowel will cause gas that will obscure visualization.
EXAM DESCRIPTION:
Using high frequency sound waves rather than x-rays, the gallbladder and bile ducts are evaluated for size, masses and the presence of stones. If the patient had a previous cholecystectomy, an abdominal ultrasound should be ordered.
LENGTH OF TIME INVOLVED:
The examination takes between 20-30 minutes.
PREPARATION: None
EXAM DESCRIPTION:
Using high frequency sound waves, the testicles and surrounding tissue are evaluated for size, excess fluid, masses and blood flow.
LENGTH OF TIME INVOLVED:
Approximately 30 minutes.
PREPARATION:
None. Thyroid Nuclear Medicine Scans are the method of choice for determining presence of masses or enlarged thyroid gland. If a defect in the thyroid is detected during Nuclear Medicine scanning, Ultrasound can be used to identify mass characteristics. This helps in determining whether the mass is cystic or solid and identifies other masses not seen on the isotope study.
EXAM DESCRIPTION:
Utilizing high frequency sound waves rather than x-rays, the neck is scanned to demonstrate the thyroid and parathyroid region. Abnormal tissue density such as solid or cystic lesions can be identified.
LENGTH OF TIME INVOLVED:
The exam takes approximately 15-20 minutes.
PREPARATION:
No preparation necessary
EXAM DESCRIPTION:
Patient placed in supine position. A scanning gel is placed over area of graft. Using Real-Time Ultrasound and color Doppler, the A-V graft is identified. Several flow measurements are recorded as well as any abnormalities, such as hematomas, pseudoaneurysms, etc.
LENGTH OF TIME INVOLVED:
The exam takes 1 - 1 1/2 hours.
PREPARATION:
Patient must have nothing by mouth (NPO) 6 hours before the exam. Patient must be NPO to eliminate bowel gas that will obstruct the visualization of abdominal structures mentioned above.
EXAM DESCRIPTION:
Patient is placed in supine position. An ultrasound scanning gel is placed over patient's abdomen. Using Real-Time ultrasound and color Doppler, flow measurements are taken in area of interest; portal vein, IVC, etc. This study will determine portal vein thrombus, etc.
LENGTH OF TIME INVOLVED:
The exam takes 1 hour.
Arterial Doppler, Lower Extremities Doppler, Arterial Peripheral Vascular
Resting Doppler, Non-Stress Doppler
PREPARATION:
No preparation necessary.
EXAM DESCRIPTION:
With the patient lying supine, pressure cuffs are placed around both calves and thighs. Arterial pulses are identified at the dorsalis pedis, posterior tibial, popliteal and femoral areas. Cuffs are then inflated and systolic pressure distal to the cuff is measured. The waveforms obtained together with the pressures determine the arterial blood supply at different sites on both lower extremities. Stress may bring out ischemia.
LENGTH OF TIME INVOLVED:
The procedure takes approximately 45 minutes to an hour depending on the ease of locating pulses.
PREPARATION:
No preparation necessary.
EXAM DESCRIPTION:
The patient is placed in supine position. An ultrasound scanning gel is placed over area of bypass graft. Using Real-Time ultrasound and color Doppler, the bypass graft is identified and several flow measurements are taken along graft. Also, any abnormality is imaged such as hematomas. The procedure is performed post-op following bypass surgery of legs.
LENGTH OF TIME INVOLVED:
The exam takes 1 hour.
PREPARATION:
No preparation necessary.
EXAM DESCRIPTION:
With the patient in semi-erect position, a pressure cuff is placed on forearm and upper arm. Arterial pressures are taken on radial, ulnar and brachial arteries and on first digits. Together, arterial Doppler waveforms and pressure readings will determine arterial blood supply to arms and fingers.
LENGTH OF TIME INVOLVED:
The procedure takes 45 minutes with limited difficulty.
PREPARATION:
Patient must be shaven prior to the exam.
EXAM DESCRIPTION:
The patient is placed on their back with the head flat. A scanning gel is placed on both sides of the neck and sound waves are used to obtain images of the carotid arteries. Doppler signals are used simultaneously to measure the flow of blood through the common carotid and internal and external branches. Recorded images and waveforms demonstrate stenosis, plaque formation (calcified and ulcerated plaque) and velocity of blood flow.
LENGTH OF TIME INVOLVED:
The exam takes approximately 30 to 40 minutes.
PREPARATION:
Patient must have nothing by mouth (NPO) 6 hours prior to exam. Patient must be NPO to eliminate bowel gas that will obstruct the visualization of abdominal structures mentioned above.
EXAM DESCRIPTION:
Patient is placed on their back. An ultrasound scanning gel is placed over patient's abdomen. Using Real-Time Ultrasound and Color Doppler, flow measurements are taken in area of interest, renal arteries. This study will determine renal artery stenosis.
LENGTH OF TIME INVOLVED:
The exam takes 2 1/2 hours.
PREPARATION:
This exam requires that the patient walk on a treadmill at the speed of 2 miles per hour for a maximum of 5 minutes or until discomfort in the legs is experienced. The patient should wear well-fitting walking shoes and non-restricting clothing. This exam follows a resting (non-stress) Doppler.
EXAM DESCRIPTION:
After walking on a treadmill at 2 miles per hour for 5 minutes or until claudicating in legs is too severe to continue, the patient will lie down on a stretcher. Arterial pressures will be recorded at the dorsalis pedis and posterior tibial pulses at specified intervals. The patient will be on an EKG monitor during exercise and a target heart rate as well as other criteria for termination of the exam will be utilized.
LENGTH OF TIME INVOLVED:
The test takes approximately 45 minutes beyond resting study.
PREPARATION:
No preparation is necessary.
EXAM DESCRIPTION:
Patient is placed on their back with the affected leg in frog position. Deep and superficial veins are then examined using a compression and color Doppler technique and imaged. Patient will also be turned onto their stomach to examine popliteal veins.
LENGTH OF TIME INVOLVED:
This exam takes approximately 45 to 60 minutes.
PREPARATION:
No preparation necessary.
EXAM DESCRIPTION:
The patient is placed on their back. Table position is placed so patients feet are lower than head. A scanning gel is placed on the leg or legs and using an ultrasound transducer, the saphenous vein is identified. A mark is made on patient's skin with ink marker. The entire length of vein is drawn on the patient's leg. This exam provides information to patient's physician before bypass surgery.
LENGTH OF TIME INVOLVED:
The exam takes 1 to 1 1/2 hours.