DK2985_C000 1..28 - AlSharqia Echo Club

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1Principles of UltrasoundALAIN GAUVIN, GUY CLOUTIERUniversity of Montreal, Montreal, CanadaI. Principles of Ultrasound 1A. Nature: Compression and Rarefaction 1B. Frequency, Wavelength, PropagationSpeed in Biological Tissues 31. Frequency 32. Wavelength 33. Propagation Speed 3C. Other Properties of Ultrasound Waves 41. Amplitude 42. Power 43. Pressure 44. Intensity 4D. Specular Reflection 61. Acoustic Impedance 62. Angle Dependence 63. Acoustic Impedance Mismatch 7E. Scattering, Refraction, and Attenuation 81. Scattering 82. Refraction 83. Attenuation 9II. Imaging 11A. Advantages and Limitations ofA-, B-, and M-ModeUltrasonography 111. A Mode 112. B Mode 133. M Mode 144. Other Modes 14B. Instrumentation 141. Transducers 142. Transmitting/ReceivingElectronics 153. Scan Converters 16C. Signal Processing, Image Resolution,and Display 161. Time Gain Control 162. Image Resolution 163. Display 17D. Related Factors 171. Pulsing Characteristics 172. Frame Rate and Time to GenerateOne Frame 183. Number of Lines per Frame 194. Depth 195. Temporal Resolution 206. Pixels 20III. Conclusion 21Bibliography 21I. PRINCIPLES OF ULTRASOUNDA. Nature: Compression and RarefactionUltrasound consists of mechanical sound waves whose frequenciesare above the audible range, that is, &20,000 Hz(Hz stands for the number of wave cycles per second).Ultrasound can also be defined as a mechanical wavethat propagates in a medium. The mode of propagationof ultrasound is related to successive molecular compressionsand rarefactions occurring in that medium1
2 Transesophageal <strong>Echo</strong>cardiographyFigure 1.1 Ultrasound wave. Representation in terms of alternatingmolecular compressions and rarefactions. Corresponding2D plot of density as a function of distance along the propagationdirection. The wavelength (l) is the distance corresponding toone cycle of the longitudinal wave.(Fig. 1.1). Isotropic solids can experience both transverse(or shear) and longitudinal waves. An example of a transversewave is the vertical motion of a boat on the surface ofthe ocean as the wave passes underneath. Ultrasound influids and gases only experiences longitudinal propagationbecause of the lack of strong coupling between themolecules. Consequently, transverse waves do not playan important role in medical ultrasound imaging.However, recent research suggests that shear waves maybecome clinically useful to characterize the visco-elasticproperties of biological tissues.In order to understand ultrasound production, one canimagine a small transducer driving an oscillating surfacein contact with gas molecules, as illustrated in Fig. 1.2.As the surface moves forward, it pushes gas moleculesin front of it, creating a zone of compression, as seen inFig. 1.2(A). The oscillating surface then retracts, duringwhich time the newly created zone of compressionmoves forward. However, this backward motion of thesurface causes a rarefaction of local gas molecules, asshown in Fig. 1.2(B). In the time elapsed betweenFig. 1.2(A) and Fig. 1.2(B), the zone of increased densityinitially created moves forward at propagation speeddenoted as c. If the oscillation of this surface, which canbe referred to as the source, is sustained, a continuous travelingwave made by alternating compressions and rarefactionsis established.At a given point in space, the rarefactions andcompressions are accompanied by local oscillation of moleculesin a direction parallel to the axis of propagation ofthe wave. During the transition from compression to rarefaction,molecules, initially located in a compressiveregion, move on average backwards (with respect to thedirection of propagation of ultrasound) so that the localdensity of molecules is reduced. The velocity of theFigure 1.2 Generation of ultrasound wave. Representation ofthe density of gas molecules subjected to the oscillation of acolumn of gas from a small transducer at one end. (A) Thesurface has moved forward with respect to its rest position,creating a zone of increased molecule density (compression).(B) The surface has retracted behind its rest position, and nowleaves a zone of decreased density (rarefaction). The initialzone of compression created in A has moved forward. (C) Thesurface is back to the same position as in A and it has created anew zone of compression. The compression from A has traveledeven further, and the rarefaction from B has also traveled.(D) The situation of B is repeated, again with all previouscompressions and rarefactions correspondingly displacedforward.molecules reaches a maximum when the local density ishalf that of the maximum density, for a sinusoidal wavewhich occurs midway between a maximum and aminimum density. Molecules eventually come to a stop,at which point their local density is at its minimum, rightin the middle of the rarefaction zone. Motion thenresumes, and the velocity reaches a maximum midwayin the transitory period, just as it did previously. Finally,molecules again come to rest when the density is at itshighest. Therefore, at any given point in space, moleculesexperience all density states at different times, as illustratedin Fig. 1.2.Such waves are said to be longitudinal. The processrepeats itself as long as the surface is in oscillatingmotion. It is, therefore, the momentum (or the mechanicalmotion of molecules initially at rest) that propagates, notthe molecules themselves which merely oscillate backand forth when insonified.In conclusion, these compressions and rarefactions aremade possible by the elastic nature of the material, arisingfrom intermolecular interactions. It is this elasticity,together with the density of the material, which mainlygoverns the properties of the medium with respect towave propagation.
Page 2: TransesophagealEchocardiographyMult
Page 5 and 6: Published in 2005 byTaylor & Franci
Page 10: ForewordThe use of transesophageal
Page 13 and 14: xPrefaceThere are several other ind
Page 16 and 17: ContentsForeword Jean-Francois Hard
Page 18 and 19: ContributorsRobert Amyot, MD, FRCPC
Page 20: ContributorsxviiFrançois Marcotte,
Page 23 and 24: xxAbbreviationsCNS central nervous
Page 25 and 26: xxiiAbbreviationsPMLPpaPPHPPHTNPraP
Page 28 and 29: How to Use the Transesophageal Echo
Page 32 and 33: Principles of Ultrasound 3Table 1.1
Page 34 and 35: Principles of Ultrasound 5the ratio
Page 36 and 37: Principles of Ultrasound 7transduce
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Page 42 and 43: Principles of Ultrasound 13PULSERBE
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Page 48 and 49: Principles of Ultrasound 19(A)(B)(E
Page 50: Principles of Ultrasound 21to the i
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Page 70 and 71: 3TransducersFRANÇOIS HADDADUnivers
Page 72 and 73: Transducers 43(A)(C)(B)Figure 3.3 (
Page 74 and 75: Transducers 45more frequencies than
Page 76 and 77: Transducers 47Figure 3.10 Beam focu
Page 78 and 79: Transducers 49sound that propagate
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Transducers 51(A)(B)(C)Figure 3.15
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54 Transesophageal Echocardiography
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5Quantitative EchocardiographyJEAN
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Quantitative Echocardiography 91dim
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Quantitative Echocardiography 93Fig
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Quantitative Echocardiography 101Fi
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Quantitative Echocardiography 105in
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Quantitative Echocardiography 115On
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Quantitative Echocardiography 117Ha
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Quantitative Echocardiography 119fl
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6Imaging Artifacts and PitfallsROBE
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Imaging Artifacts and Pitfalls 123F
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Imaging Artifacts and Pitfalls 125F
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Imaging Artifacts and Pitfalls 127(
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Imaging Artifacts and Pitfalls 1391
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142 Transesophageal Echocardiograph
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9Global Ventricular Function and He
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Global Ventricular Function and Hem
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10CardiomyopathyVICKY SOULIÈRE, PH
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Cardiomyopathy 217Figure 10.1 (A, B
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Cardiomyopathy 219Figure 10.4 Systo
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Cardiomyopathy 221RVOT must also be
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Cardiomyopathy 223either by reduced
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Cardiomyopathy 225Figure 10.10 Flow
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Cardiomyopathy 227On the other hand
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Cardiomyopathy 229volumes are both
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Cardiomyopathy 231(A)TMFAE(B)PVFDMe
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Cardiomyopathy 233(A)(B)LUPVLAAoLAA
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Cardiomyopathy 235(A)(B)LALV(C)Figu
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Cardiomyopathy 237than moderate MR
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Cardiomyopathy 23920. Yu EH, Omran
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12AortaIVAN IGLESIAS, DANIEL BAINBR
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Aorta 263GRADE 1:NORMALAoGRADE 2:IN
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Aorta 265(A)(B)LALMCARAAoRVRCAFigur
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Aorta 267Figure 12.9Short- (A, B) a
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Aorta 269(A)(B)AORTAMOBILEATHEROMA(
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Aorta 271diameter (22). Aneurysms o
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Aorta 273(A)(B)NCCRALARCCMPALCCANEU
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Aorta 275(A)(B)LAARTEFACT(C)AoARTEF
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Aorta 277(A)(B)AoLATVRAFL TLPVRV(C)
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Aorta 279(A)(B)AORTICHEMATOMAAo(C)A
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Aorta 281(A)(B)FLTLAo(C)(D)INTRALUM
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Aorta 28331. Bansal RC, Chandraseka
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14Perioperative Role of TEE in Mech
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TEE in Mechanical Circulatory Assis
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15Native Aortic ValveFRANÇOIS A. B
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Native Aortic Valve 331Figure 15.2
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Native Aortic Valve 333(A)(B)ARANTI
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Native Aortic Valve 335(A) (B) (C)
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Native Aortic Valve 337(A)(B)LAAoLV
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Native Aortic Valve 339(A)(B)MVAoVL
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Native Aortic Valve 341(A)(B)LAAoVL
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Native Aortic Valve 343(A)(B)SAMLAI
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Native Aortic Valve 345(A)(B)AoVLAT
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Native Aortic Valve 347Although the
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Native Aortic Valve 349substitution
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Native Aortic Valve 351(A)(B)AoVLVO
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Native Aortic Valve 353(A)(B)LARPAL
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Native Aortic Valve 355(A)(B)LAAoVR
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Native Aortic Valve 357In those pat
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Native Aortic Valve 359Table 15.4 E
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Native Aortic Valve 36111. Levine R
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17Mitral ValveANDRÉ SAINT-PIERRELa
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Mitral Valve 385(A)SCHEMATIC VIEW(B
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Mitral Valve 387Figure 17.5 Echocar
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Mitral Valve 389(A)(B)LVP3A2LAAA1Fi
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Mitral Valve 391(A)(B)(C)(D)A1LAP1L
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Mitral Valve 393(A)(B)LARALVRV(C)(D
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Mitral Valve 395(A)(B)AoVFLAIL P1LA
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Mitral Valve 397(A)(B)P3LALVLAAA1(C
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Mitral Valve 399(A)(B)LALAALV(C)(D)
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Mitral Valve 401Table 17.3Mitral Re
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Mitral Valve 403(A)(B)MITRAL VALVEV
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Mitral Valve 405(A)EKG(B)PVFPaSDRES
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Mitral Valve 407Table 17.4BVR Echoc
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Mitral Valve 409Left ventricular sy
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Mitral Valve 411(A)(B)LALVAoRV(C)TM
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Mitral Valve 413Table 17.8StenosisT
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Mitral Valve 415identification of a
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19Pulmonic and Tricuspid ValvesFRAN
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Pulmonic and Tricuspid Valves 449Ta
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Pulmonic and Tricuspid Valves 451(A
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Pulmonic and Tricuspid Valves 459ti
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Pulmonic and Tricuspid Valves 463AN
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Pulmonic and Tricuspid Valves 46939
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23Intracavitary ContentsMARIA DI LO
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Intracavitary Contents 499(A)(B)PFO
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Intracavitary Contents 501(A)(B)LAL
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Intracavitary Contents 503artery ca
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Intracavitary Contents 505(A)(B)MYX
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Intracavitary Contents 507(A)(B)LVL
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Intracavitary Contents 509(A)(B)THY
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Intracavitary Contents 511wall clos
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Intracavitary Contents 513(A)(B)LAR
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Intracavitary Contents 515(A)(B)PER
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Intracavitary Contents 517dysfuncti
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Intracavitary Contents 519endocardi
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Intracavitary Contents 521and angle
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Intracavitary Contents 52317. Lando
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25Indications for Perioperative Tra
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Indications for Perioperative TEE 5
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570 IndexAortic aneurysmclassificat
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572 IndexColor jet area, 402Commiss
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574 IndexHypotension, 491Hypothermi
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576 IndexMitral valve repair, 394,
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578 IndexRight atrial thrombus, 517
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580 IndexTricuspid leafletsanterior
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DK2985_C000 1..28 - AlSharqia Echo Club

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