Diagnostic Ultrasound and Echocardiography

DIAGNOSTIC ULTRASOUND AND ECHOCARDIOGRAPHY

FOREWORD This course is oriented for five-year system students in the department of clinical medicine. This is a short training covering the very basis of ultrasonic theory and inspection. The course will take 12hrs. In this course, the main method of teaching is lectures and on-the-spot practice teaching. Part I OVERVIEW AND PRINCIPLES OF DIAGNOSTIC ULTRASOUND 1. Overview of diagnostic ultrasound, including its history, present status, and prospect. 2. Practical physics, instrumentation, terminology, and technical principles 3. Diagnostic modalities: (1) gray-scale two-dimensional ultrasound (2) Doppler Sonography ① Color Doppler flow imaging, CDFI

② Pulsed Doppler, PD

③ Power Doppler (3) Three-dimensional ultrasound (4) Contrast-enhanced ultrasound 4. Sonographic phenomenons and artefacts, examination techniques Part II – ECHOCARDIOGRAPHY (PART 1) 1. Principles of echocardiographic image acquisition and Doppler analysis (1) Tansducers for echocardiography (2) Ultrasound instruments and echocardiographic modalities 1 M-mode echocardiography 2 Two-dimensional echocardiography 3 Doppler echocardiography: color Doppler flow imaging, pulsed Doppler, continuous wave Doppler 4 Contrast echocardiography 5 Transesophageal echocardiography 2. Echocardiographic views, normal anatomy and color Doppler flow patterns (1) Basic imaging principles (2) Normal echocardiographic views (3) Normal M-mode curves (4) Normal intracardiac color Doppler flow patterns

1 3. Brief introduction of clinical application of echocardiography (1) An integral part of clinical cardiology (2) Initial diagnosis of cardiovascular disease (3) Application in clinical management and decision making for patients with cardiovascular diseases Part III – Applications of diagnostic ultrasound in liver, gallbladder and uterus General discussion about the abdominal ultrasonography, including techniques and applications. 1. Clinical application of diagnostic ultrasound in liver (1) Liver anatomy (2) Benign hepatic lesions 1 Hemangioma 2 Hepatic cyst 3 Liver cirrhosis 4 Hepatic abscess (3) Malignant hepatic tumors 1 Hepatocellular carcinoma 2 Liver metastasis 3. Clinical application of diagnostic ultrasound in gallbladder stone (1) Gallbladder anatomy (2) Characteristics of normal gallbladder (3) Gallstone and sluge (4) Gallstone and acute cholecystitis (5) Gallstone and gallbladder carcinoma 4. Clinical application of diagnostic ultrasound in uterine fibroid (leiomyomas) (1) Brief anatomy of pelvis and uterus (2) Normal fertile years findings (3) Transabdominal and transvaginal ultrasound evaluation (4) Sonographic appearance of uterine fibroid(leiomyomas) Part IV – ECHOCARDIOGRAPHY (PART 2) 1. Application of echocardiography in rheumatic valvular heart disease—mitral stenosis (1) Basic principles ① Pathophysiology of mitral stenosis

② Fluid dynamics of mitral stenosis

③ Relation between pressure gradients and velocity (2) Transthoracic echocardiographic diagnostic imaging of mitral stenosis

2 ① Two-dimensional echo

② M-mode 3 Color Doppler Flow Imaging 4 PD and CW (3) Transesophageal echocardiographic diagnostic imaging of mitral stenosis ① SEC

② LAA thrombus (4) Quantitation of mitral stenosis severity ① Pressure gradient

② Mitral valve area a. Two-dimensional echo valve area b. Pressure half-time(PHT) mitral area c. Continuity equation mitral valve area d. Proximal isovelocity surface area(PISA) (5) Clinical applications of echocardiography in management of patients with mitral stenosis a. Diagnosis, hemodynamic progression and timing of intervention b. Pre-and post percutaneous balloon mitral commissurotomy (valvuloplasty) c. Echocardiographic evaluation of patients with mitral stenosis underwent valvuloplasty and prosthetic valve replacement 2. Application of echocardiography in congenital heart disease— atrial septal defect (1) Anatomy (2) Echocardiographic diagnostic imaging ① Two-dimensional echo

② M-mode

③ Color Doppler Flow Imaging

④ PD and CW

⑤ Contrast echo

3 ⑥ Transesophageal echocardiography (3) Clinical applications of echocardiography in management of patients with atrial septal defect ① Echocardiographic guidance transcatheter device closure of atrial septal defect ② After operation repair of atrial septal defect 3. Application of echocardiography in cardiomyopathy— hypertrophic cardiomyopathy (1) Classification of cardiomyopathy (2) Typical features of hypertrophic cardiomyopathy (3) Echocardiographic diagnostic imaging ① Left ventricular asymmetric hypertrophy

② Left ventricular diastolic function

③ Dynamic outflow tract obstruction a. Two-dimensional echo and M-mode recordings of systolic anterior motion (SAM) of the mitral valve b. Doppler evaluation (4) Clinical utility ① Diagnosis and screening

② Evaluation of medical therapy

③ Monitoring of percutaneous septal ablation Part VI – DIAGNOSTIC ULTRASOUND IN SMALL-PARTS AND VESSELS 1. Application of diagnostic ultrasound in thyroid (1) Normal anatomy (2) Characteristics of normal thyroid (3) Sonographic features of thyroid nodules (4) Differentiation of thyroid nodules 2. Application of diagnostic ultrasound in lymph nodes (1) Normal lymph nodes (2) Characteristics of enlarged lymph nodes (3) Sonographic features of neoplastic neck nodes (4) Value of color Doppler flow imaging, power Doppler and contrast- enhanced ultrasound 3. Application of diagnostic ultrasound in extremity vessels

4 (1) Practical anatomy (2) Normal hemodynamics (3) Venous thrombosis (DVT) (4) Characteristics of pseudoaneurysm (5) Doppler sonographic features of arteriovenous fistula