Understanding Physiology with Ultrasound

Contents
Chapter 1: Using Ultrasound to Teach Physiology: An Introduction
	1.1 Ultrasound Technology, Point-of-Care Ultrasound, and Ultrasound in Education
	1.2 Advantages of Using Ultrasound to Teach Physiology
		1.2.1 Safety and Ease of Learning Ultrasound to Visualize Anatomy and Assess Physiology/Function
		1.2.2 Ultrasound Use in Multiple Teaching Formats
		1.2.3 Competency-Based Medical Education (CBME)
		1.2.4 Integration Across Life Sciences and Medical Curricula
		1.2.5 A Learning Tool That Becomes a Clinical Practice Tool
	Further Reading
Chapter 2: The Basics of Ultrasound Physics
	2.1 What Is Ultrasound?
	2.2 How Does Ultrasound Work?
	2.3 Interactions of Sound Waves in the Body
		2.3.1 Reflection
		2.3.2 Scatter
		2.3.3 Refraction
		2.3.4 Absorption
		2.3.5 Attenuation
		2.3.6 Interactions Summary
	2.4 Propagation Speed of Ultrasound Waves
	2.5 What Determines Returning Echo Signal Strength?
	2.6 What Characteristics of Echoes Contribute to Image Display?
		2.6.1 Echo Signal Amplitude
		2.6.2 Position of Returning Echo on Probe Footprint
		2.6.3 Time for Echo Return
		2.6.4 Frequency Shifts
	2.7 Modes of Ultrasound
		2.7.1 Brightness Mode (B-Mode)
		2.7.2 Motion Mode (M-Mode)
		2.7.3 Color Doppler
		2.7.4 Spectral Doppler
		2.7.5 Power Doppler
	2.8 Ultrasound Machine Considerations
		2.8.1 Probe Frequency
			2.8.1.1 High Frequency
			2.8.1.2 Low Frequency
		2.8.2 Shape/Design of Probe
			2.8.2.1 Sector
			2.8.2.2 Curvilinear
			2.8.2.3 Linear
		2.8.3 Display Parameters for Optimizing Images
			2.8.3.1 Depth
			2.8.3.2 Gain
			2.8.3.3 TGC
			2.8.3.4 Focus
			2.8.3.5 Frequency
			2.8.3.6 Presets
		2.8.4 Other Machine Features
			2.8.4.1 Freeze
			2.8.4.2 Measure
			2.8.4.3 Save
	2.9 Patient Considerations
		2.9.1 Patient Preparation
		2.9.2 Position
		2.9.3 Maneuvers and Manipulations
	2.10 Scanner Considerations
		2.10.1 Probe Placement
		2.10.2 Probe Manipulation
			2.10.2.1 Rocking
			2.10.2.2 Fanning
			2.10.2.3 Rotation
			2.10.2.4 Compression
			2.10.2.5 Sliding or Sweeping
	2.11 Scan Planes
		2.11.1 Long Axis
		2.11.2 Short Axis
		2.11.3 Scan Plane vs Body Plane
	2.12 Image Display Orientation
	2.13 Image Description Terminology
	2.14 Artifacts
		2.14.1 Shadowing
		2.14.2 Enhancement
		2.14.3 Mirror Image
		2.14.4 Reverberation
		2.14.5 Ring Down
		2.14.6 Comet Tail
		2.14.7 Anisotropy
		2.14.8 Loss of Contact
		2.14.9 Edge Artifact
		2.14.10 Aliasing
	2.15 Safety Considerations
		2.15.1 Output Power
		2.15.2 Mechanical Index
		2.15.3 Thermal Index
		2.15.4 ALARA
	Further Reading
Chapter 3: Ultrasound of the Vascular System
	3.1 Anatomy and Physiology of the Vascular System
	3.2 Hemodynamics
		3.2.1 Pressure/Flow/Resistance
		3.2.2 Velocity
		3.2.3 Turbulence
		3.2.4 Extravascular Pressure
	3.3 Vascular Ultrasound: Settings
		3.3.1 Preset
		3.3.2 Color Doppler
		3.3.3 Spectral Doppler
		3.3.4 Doppler Equation
	3.4 US Laboratory Exercises
		3.4.1 Exercise 1: Common Carotid Artery (CCA) and Internal Jugular Vein (IJV)
			3.4.1.1 Learning Objectives
			3.4.1.2 Transducer/Probe
			3.4.1.3 Additional Equipment and Supplies
			3.4.1.4 Patient Position and Image Orientation
			3.4.1.5 Performing the Scan
		3.4.2 Exercise 2: Quantitating Velocity in the Common Carotid Artery
			3.4.2.1 Learning Objectives
			3.4.2.2 Transducer/Probe
			3.4.2.3 Additional Equipment and Supplies
			3.4.2.4 Patient Position and Image Orientation
			3.4.2.5 Performing the Scan
	Further Reading
Chapter 4: Ultrasound of the Heart
	4.1 Anatomy and Physiology of the Heart
	4.2 Cardiac Muscle Contraction
	4.3 Ultrasound Anatomy
	4.4 Common Applications of Cardiac Ultrasound
	4.5 The Electrical Activity of the Heart
	4.6 Heart Sounds
	4.7 The Cardiac Cycle
		4.7.1 Phase 1: Atrial Systole (Fig. 4.16)
		4.7.2 Phase 2: Ventricular Isovolumetric Contraction (Fig. 4.17)
		4.7.3 Phase 3: Ventricular Rapid Ejection of Blood (Fig. 4.18)
		4.7.4 Phase 4:Ventricular Reduced Ejection (Fig. 4.19)
		4.7.5 Phase 5: Ventricular Relaxation Isovolumetric (Fig. 4.20)
		4.7.6 Phase 6: Ventricular Rapid Filling (Fig. 4.21)
		4.7.7 Phase 7: Ventricular Reduced Filling (Diastasis) (Fig. 4.22)
	4.8 The Ventricular Pressure-Volume Relationships and the Cardiac Loop
	4.9 Cardiac Output
	4.10 Determinants of Stroke Volume
		4.10.1 Preload
		4.10.2 Afterload
		4.10.3 Contractility
	4.11 Ejection Fraction
	4.12 Hypertension, Cardiac Remodeling, and Heart Failure
	4.13 Diastolic Dysfunction
	4.14 Ultrasound Laboratory Exercises
		4.14.1 Exercise 1: The Parasternal Long Axis (PLAX) View of the Heart
			4.14.1.1 Learning Objectives
			4.14.1.2 Transducer/Probe
			4.14.1.3 Additional Equipment and Supplies
			4.14.1.4 Patient Position and Image Orientation
			4.14.1.5 Performing the Parasternal Long Axis View
		4.14.2 Exercise 2: Combining Ultrasound with Auscultation of the Heart
			4.14.2.1 Learning Objectives
			4.14.2.2 Transducer/Probe
			4.14.2.3 Additional Equipment and Supplies
			4.14.2.4 Auscultation of the Heart
			4.14.2.5 Ultrasound and Auscultation of the Heart
		4.14.3 Exercise 3: The Apical Four and Five Chamber Views of the Heart
			4.14.3.1 Learning Objectives
			4.14.3.2 Transducer/Probe
			4.14.3.3 Additional Equipment and Supplies
			4.14.3.4 Patient Position and Image Orientation
			4.14.3.5 Performing the Apical Four Chamber View
		4.14.4 Exercise 4: Color Doppler Ultrasound to Assess Cardiac Blood Flow and Heart Valves
			4.14.4.1 Learning Objectives
			4.14.4.2 Transducer/Probe
			4.14.4.3 Additional Equipment and Supplies
			4.14.4.4 Applying Color Doppler to Apical Cardiac Views
	Further Reading
Chapter 5: Ultrasound of the Respiratory System
	5.1 Anatomy and Physiology of the Respiratory System
	5.2 How We Breathe
		5.2.1 Alterations in Intrapleural Pressure due to Pathologic States: Appearance on Ultrasound
		5.2.2 Inspiration
		5.2.3 Expiration
	5.3 Diaphragmatic Excursion: Appearance on Ultrasound
	5.4 Other Respiratory Muscles
	5.5 Compliance and Elasticity
	5.6 Gas Exchange and Hypoxemia
		5.6.1 Lab Excercise: Assessment of Lung Sliding and Pneumothorax Simulation
			5.6.1.1 Learning Objectives
			5.6.1.2 Transducer/Probe
			5.6.1.3 Patient Position and Image Orientation
			5.6.1.4 Evaluating the Pleural Surface and Lung Sliding
	References
		Further Reading
Chapter 6: Ultrasound of the Gastrointestinal Tract
	6.1 Anatomy and Physiology of the Gastrointestinal Tract
	6.2 Motility
	6.3 Absorption
	6.4 Excretion
	6.5 Immunity
	6.6 Regulation of the Gastrointestinal Tract
	6.7 Layers of the Gastrointestinal Wall
	6.8 Unique Ultrasound Features of the GI Tract
		6.8.1 Depth
		6.8.2 Intestinal Air
		6.8.3 Peristalsis
		6.8.4 Fed or Fasting
	6.9 Gastrointestinal Tract
		6.9.1 Oral Cavity
		6.9.2 Larynx/Pharynx
		6.9.3 Esophagus
		6.9.4 Stomach
		6.9.5 Small Intestine
		6.9.6 Large Intestine
		6.9.7 Liver
			6.9.7.1 Overview
			6.9.7.2 Hepatic Circulation
			6.9.7.3 Liver Structure
			6.9.7.4 Functions of the Liver
			6.9.7.5 Liver Fibrosis and Cirrhosis
			6.9.7.6 Albumin
		6.9.8 Gallbladder and Bile
			6.9.8.1 Gallbladder
			6.9.8.2 Common Bile Duct
			6.9.8.3 Gallbladder Contraction
			6.9.8.4 Bile
		6.9.9 Pancreas
	6.10 Table of US Applications
	6.11 Lab Exercises
		6.11.1 Exercise 1: Esophagus Swallow-Examining Peristalsis
			6.11.1.1 Learning Objectives
			6.11.1.2 Transducer/Probe
			6.11.1.3 Needed Supplies
			6.11.1.4 Patient Position and Image Orientation
			6.11.1.5 Performing the Scan
			6.11.1.6 A Step Further
		6.11.2 Exercise 2: Observing Changes in the Fasting and Post Prandial Gallbladder
			6.11.2.1 Learning Objectives
			6.11.2.2 Transducer/Probe
			6.11.2.3 Needed Supplies
			6.11.2.4 Patient Position and Image Orientation
			6.11.2.5 Performing the Scan on a Fasting Gallbladder
			6.11.2.6 Performing the Scan on a Post-Prandial Gallbladder
			6.11.2.7 One Step Further
	6.12 Conclusion
	Further Reading
		Reference Books
		Articles: General Ultrasound of the Gastrointestinal Ttract
Chapter 7: Ultrasound of the Urinary System
	7.1 Anatomy and Physiology of the Urinary System
		7.1.1 Renal Structures on Ultrasound
		7.1.2 Bladder on Ultrasound
		7.1.3 Renal Vasculature on Ultrasound
	7.2 Clinical Topic 1
		7.2.1 Urinary Obstruction
			7.2.1.1 Hydronephrosis
			7.2.1.2 Bladder Assessment
	7.3 Clinical Topic 2
		7.3.1 Renal Injury
			7.3.1.1 Acute Kidney Injury
			7.3.1.2 Chronic Kidney Disease
		7.3.2 Ultrasound Assessment in Renal Injury
			7.3.2.1 Cortical Echogenicity
			7.3.2.2 Kidney Size
			7.3.2.3 Volume Assessment
		7.3.3 Laboratory Exercises
			7.3.3.1 Exercise #1: Focused Kidney & Bladder Assessment
				Learning Objectives
				Transducer/Probe
				Additional Equipment and Supplies
				Patient Position and Image Orientation
				Performing the Scan
			7.3.3.2 Exercise #2: Inferior Vena Cava (IVC) Assessment
				Learning Objectives
				Transducer/Probe
				Additional Equipment and Supplies
				Patient Position and Image Orientation
				Performing the Scan
	References
Chapter 8: Ultrasound of the Musculoskeletal System
	8.1 Anatomy and Physiology of the Musculoskeletal System
		8.1.1 Skeleton
		8.1.2 Skeletal Muscle
	8.2 US Imaging of the MSK
		8.2.1 Echotexture of the Tissues in the MSK System
			8.2.1.1 Skeletal Muscle
			8.2.1.2 Tendons and Ligaments
			8.2.1.3 Bone and Cartilage
			8.2.1.4 Joints, Joint Capsules, and Bursae
		8.2.2 Dynamic Imaging
		8.2.3 Examples of Clinical Applications of MSK Ultrasound Imaging
		8.2.4 Laboratory Exercises That Demonstrate Concepts of Physiology of the MSK System
			8.2.4.1 Exercise 1: Ultrasound Imaging of Muscle Architecture During Contraction
				Protocol
			8.2.4.2 Exercise 2: Use Power Doppler to Observe Differences in Blood Perfusion of Muscle at Rest and After Exercise
				Protocol
			8.2.4.3 Exercise 3: Use Ultrasound Imaging to Explore Venous Return in the Popliteal Vein
				Protocol
			8.2.4.4 Exercise 4: Use Spectral Doppler to Demonstrate the Change from a High Resistance Waveform to a Low Resistance Wavefor...
				Protocol
	8.3 Summary
	References
Chapter 9: Ultrasound of the Endocrine System
	9.1 Anatomy and Physiology of Endocrine System
	9.2 Hormone Synthesis
	9.3 Mechanisms of Hormone Action
	9.4 The Hypothalamus: The single Most Important Orchestrator of Hormones in the Body
	9.5 Hormone Receptor Regulation
	9.6 The Thyroid: A Model for Using of Ultrasound to Probe Hormonal Physiology
	9.7 Scanning the Thyroid Gland
	9.8 Diseases of the Thyroid Gland
	9.9 Hyperthyroidism
	9.10 Hypothyroidism
	9.11 Goiter
		9.11.1 Exercise 1: Midline Transverse View of the Thyroid Gland and the Surrounding Structures
			9.11.1.1 Learning Objectives
			9.11.1.2 Type of Transducer/Probe
			9.11.1.3 Patient Position and Image Orientation
			9.11.1.4 Performing the Transverse View of the Thyroid Gland
		9.11.2 Exercise 2: Using Ultrasound to Observe and Obtain Thyroid Volume
			9.11.2.1 Learning Objectives
			9.11.2.2 Type of Transducer/Probe
			9.11.2.3 Patient Position and Image Orientation
			9.11.2.4 Calculating Thyroid Volume
	Further Reading
Chapter 10: Ultrasound of the Reproductive System
	10.1 Anatomy and Physiology of Reproductive System
		10.1.1 Male Reproduction
		10.1.2 Some Common Clinical Ultrasound Applications for Male Reproductive Physiology
	10.2 Female Reproduction
		10.2.1 Some Common Clinical Ultrasound Applications for Female Reproductive Physiology
	10.3 Laboratory Exercises in Reproductive Physiology
		10.3.1 Exercise 1: Observing the Male Pelvis with the Abdominal Approach
			10.3.1.1 Learning Objectives
			10.3.1.2 Transducer/Probe
			10.3.1.3 Additional Equipment and Supplies
			10.3.1.4 Patient Position and Image Orientation
			10.3.1.5 Performing the Male Abdominal Pelvic Ultrasound
		10.3.2 Exercise 2: Observing the Female Pelvis with the Abdominal Approach
			10.3.2.1 Learning Objectives
			10.3.2.2 Transducer/Probe
			10.3.2.3 Additional Equipment and Supplies
			10.3.2.4 Patient Position and Image Orientation
			10.3.2.5 Performing the Female Abdominal Pelvic Ultrasound
	Further Reading
Chapter 11: Ultrasound of the Nervous System
	11.1 Anatomy and Physiology of the Nervous System
	11.2 Pupillary Light Reflex
	11.3 Myotatic Stretch Reflex
		11.3.1 Exercise 1: Ultrasonography of the Consensual Reflex
			11.3.1.1 Learning Objectives
			11.3.1.2 Transducer/Probe
			11.3.1.3 Additional Equipment and Supplies for Exercise and Optional Assessment
			11.3.1.4 Patient Position and Image Orientation
			11.3.1.5 Performing the Pupillary Eye Examination
			11.3.1.6 Optional Assessment of the Pupillary Response
		11.3.2 Exercise 2: Ultrasonography of Stretch Reflex
			11.3.2.1 Learning Objectives
			11.3.2.2 Transducer/Probe
			11.3.2.3 Additional Equipment and Supplies
			11.3.2.4 Patient Position and Image Orientation
			11.3.2.5 Performing the Stretch Reflex with B-mode: Transverse View
			11.3.2.6 Optional Assessment of the Stretch Reflex Response
				Stretch Reflex with B- and M-Modes: Transverse View
				Stretch Reflex with B- and Doppler (Spectral) Modes: Transverse View
	Further Reading
Chapter 12: Introducing Ultrasound into a Physiology Course from A to Z
	12.1 Purchase of Ultrasound Systems
		12.1.1 Number of Ultrasound Systems
		12.1.2 Type of Systems
		12.1.3 Demonstration, Testing, and Purchase Options
	12.2 Models and Standardized Patients
	12.3 Trained Instructors
	12.4 Student Contact Hours for Ultrasound
	12.5 Ultrasound Educational Materials and Student Assessment
		12.5.1 Student Assessment
		12.5.2 Estimated Student Time for Ultrasound When Initiating a Program
	12.6 Student Feedback
	12.7 Space and Equipment for Ultrasound Laboratory Sessions
	12.8 Residency Ultrasound Training
	12.9 Ultrasound Fellowship
	12.10 Potential Sources of Funding for Ultrasound
		12.10.1 Institutional Support
		12.10.2 Industry Partnerships and Grants
		12.10.3 Donations
		12.10.4 Grants
		12.10.5 Training Revenue Streams
		12.10.6 Patents and Licenses
		12.10.7 Student Fees
	12.11 A Scaled-Back Model to Introduce Ultrasound into Physiology Courses with Limited Resources
	12.12 Ultrasound Initiation Checklist
	Further Reading and Resources
		Journal Articles
		Online Resources