Google Time 09-23-2010

In this lab we were supposed to enjoy some "Google" time.  This meant that we had the whole lab time to just play around with the machine and see what all the knobs and buttons do.  It also gave us a chance to practice scanning the GV and liver.  I found this lab pretty fun, because we got a chance to use some of the functions that we have not had a chance to learn about.  I got a chance to play with the doppler and PDI a little bit.  Unfortunately I forgot to save a picture of it so that I could show what it looked like. 

I got a chance to see that I do remember the images that are required for the liver, for the most part.  I did need some occasional assistance from my patient.  The picture that I attached is a picture of the liver rt kidney interface.  In this picture you get to view the lower portion of the rt lobe of the liver, the gall bladder, the renal vein and the IVC.  I chose this one because I felt that it was a good image of everything that is required. 

I can't wait until doing an interrogation of the liver and taking pictures is like second nature.  I want to get passed this time where I have to think forever about what landmarks, anatomy and probe position is needed for each sweep and picture.  I am sure it will happen eventually!

Lab 09-16-10

Gallbladder Long Decubitus

     This is an image of the gallbladder taken while the patient was in decubitus position, meaning they were lying on their side.  I found that I had some trouble originally locating the gallbladder.  Once I located it though, I found it every time I set the probe down.  It showed up very clear.  You can tell that my patient had not eating a fatty meal prior to her scan because the gallbladder is not contracted.  I do feel that it was a bit easier to obtain this picture with the patient lying on their side. It does help sometimes to move some of the gas out of the way that could possibly obstruct my image.

      

Transverse Portal Vein

In this lab we were asked to scan the liver using the ribs as the acoustic window.  I had a lot of trouble with this lab.  It was hard to figure out where everything was using a new area and new angles to obtain our images.  I do see how there were some advantages to using this window.  We were able to get some very good views once you got between the ribs. 

When your patient takes a deep breath everything moves down.  This makes some structures easier to see, or distinguish.  For example you can determine when you are looking at IVC as opposed to aorta because respirations do affect the IVC.  When you have the patient take a deep breath and hold it you are able to sometimes get a better image because the breathing is not causing movement on your pictures. 

This lab did make me very aware of how much I need to study my anatomy and landmarks so I am able to distinguish what I am looking for much faster.  Also I would have a better understanding of the relationships of organs and structures. 

I was supposed to obtain two images of the aorta, one using the harmonics feature and one without.  This first picture is the image that was obtained without using harmonics.  The aorta in this image has a lighter more grainy appearance.  In a way it blends with the surrounding structures more, making it harder to get a clear picture of the aorta by itself.  In the picture below where harmonics were used the aorta becomes darker and is more hypoechoic.  It makes the aorta stand out from its surrounding a bit better.  The harmonics also make everything posterior to the aorta much more hypoechoic as well.                 

       I am having a hard time choosing which picture I prefer.  The one with the harmonics does appear to make the aorta clearer and easier to focus on, but the one without seems to make the overall picture more pleasing to me. I suppose for diagnostic purposes the harmonics image would be better because you do get a clearer view of the aorta.