Training and Education
TRAINING AND EDUCATIONAL EXPERTISE
 Being
confident, comfortable and knowledgeable on your new Biosound
MyLab® ultrasound system is our #1 priority. Your
new system combined with our expert support will significantly
enhance your diagnostic abilities and level of confidence.
Every system is delivered with a complete in-service and
training from our professional applications support. Our
commitment to your satisfaction goes well beyond your
initial acquisition. You become part of ever growing family
of satisfied users.
Basics
DIAGNOSTIC ULTRASOUND AND HOW IT WORKS
A diagnostic
ultrasound system provides an
image of internal soft tissue by transmitting short bursts
of ultrasonic energy into the body, producing echoes as
the energy bursts encounter acoustic interfaces The scanner
measures the intensity, timing and direction of these
echoes. This information is processed and used to generate
the ultrasound display.
Principal of operation Ultrasound energy,
or ultrasound, refers to the high-frequency sound above
the level of human hearing (greater than 20.000 Hz [cycle/sec]).
For diagnostic imaging, frequencies ranging from 2 to
20 MHz are typically used. Ultrasound waves or mechanical
vibrations require a tissue medium for transmission. They
can be predictably aimed, focused and reflected as they
exhibit normal wave properties of reflection, refraction
and diffraction.
A transducer,
which consists of piezoelectric elements, is placed on
the skin after Acoustic coupling gel is first applied
as a contact medium. The transducer converts an electric
signal into ultrasonic energy, which can be transmitted
into tissues. Some of the ultrasonic energy transmitted
by the transducer is reflected (echo) back toward the
source when it reaches a boundary between tissues of different
densities. The transducer reconverts this echo into an
electric signal. Depending on the density of the tissue,
echoes are produced in varying degrees of intensity.
Several different
types of transducers can be used; the frequency
these transducers emit depends on the thickness of the
piezoelectric crystal. Transducers that generate higher
frequencies produce shorter wave lengths and narrower
beams thus improving image resolution. Higher frequency
sound energy is more readily absorbed by tissue and the
available depth of penetration is decreased. Higher frequencies
can be used to obtain improved image resolution where
deep structure evaluation is not necessary.
The ultrasound system contains an
operator adjustable compensation
system (TGC) to increase amplification
from more distant echoes. The scanner measures the intensity
of echoes, the time between them and their direction.
This information is then processed and used to generate
the ultrasound display.
VENOUS DISEASE and TREATMENTS
What are varicose veins?
The Arteries route blood from
the heart under pressure to the extremities. Under normal
conditions, the venous system returns the blood to the
heart under a low pressure system by utilizing gravity
from the upper extremities and a “Calf Pump”
mechanism from the lower extremities. To increase efficiency,
the vein contains a series of one-way valves to always
keep the blood moving in one direction. Occasionally these
valves become dysfunctional, allowing the blood to flow
in the reverse direction. As the pressure increases in
the venous system from the continued reversal of flow,
the veins can become enlarged and discolored. These enlarged
veins are commonly referred to as “spider veins”
or varicose veins. Spider veins are usually small and
can be red, blue or purple in color and most commonly
branch out across the surface of the skin. Varicose veins
are larger distended veins that are located somewhat deeper
than spider veins but still separate from the deep vein
system.
Frequent pain in the legs can be associated with abnormal
leg veins and varicose veins should be considered. Symptoms
such as pain, fatigue, aching, itching, burning, cramping,
and restlessness can often be made worse by prolonged
standing or sitting for long periods of time. Severe varicose
veins that are left untreated can lead to compromised
circulation to the skin and lend to eczema, inflammation
or even ulcerations of the lower leg.
Varicose Veins – Causes
and Risk Factors
Heredity is the number one contributing
factor causing varicose and spider veins and women are
more likely to suffer from abnormal leg veins than men.
It is estimated that up to 50% of American women may be
affected. A familial history combined with hormonal factors
including puberty, pregnancy, menopause, the use of birth
control pills, estrogen, and progesterone can adversely
affect the disease. It is very common for pregnant women
to develop varicose veins during the first trimester.
Pregnancy causes increased hormone levels and blood volume
which in turn can cause veins to enlarge. In addition,
the enlarged uterus pressing on the pelvic veins can cause
increased pressure in the lower extremity venous system.
Varicose veins due to pregnancy often improve within 3
months after delivery. However, with successive pregnancies,
abnormal veins are more likely to persist and worsen.
Other predisposing factors include aging, standing or
sitting occupations, obesity and leg injury.
Vein disorders are not always visible
so thorough diagnostic techniques are important in determining
the cause and severity of the problem. In addition to
a physical examination, non-invasive ultrasound is used
quite often to determine or confirm blood flow and direction.
Statistical Occurrence of Venous
Insufficiency:
- In MEN, ages 20-29, 1
% have venous insufficiency.
- In MEN, ages 30-39, 15%
have venous insufficiency.
- In MEN, ages 40-49, 25%
have venous insufficiency.
- In MEN, ages 50-59, 40%
have venous insufficiency.
- In MEN, ages 60-69, 45%
have venous insufficiency.
- In WOMEN, ages 20-29,
10 % have venous insufficiency.
- In WOMEN, ages 30-39,
25% have venous insufficiency.
- In WOMEN, ages 40-49,
40% have venous insufficiency.
- In WOMEN, ages 50-59,
45% have venous insufficiency.
- In WOMEN, ages 60-69,
75% have venous insufficiency.
TREATMENT OPTIONS
Ultrasound Guided Sclerotherapy
Sclerotherapy is a common method of
treatment and can be used for both varicose and spider
veins. With minimal reported discomfort, a tiny needle
is inserted into the vein to inject small amounts of sclerosing
solution. The solution causes the injected vein to sclerose
or close up. Typically these closed veins will be reabsorbed
by the body in time and disappear. Sclerotherapy relieves
symptoms due to varicose and spider veins in most patients.
The procedure is performed in the office, in sessions
that last approximately 15-20 minutes. The number of sessions
required will depend on the amount and severity of venous
disease present.
Endovenous Laser
Treatment
Endovenous Laser Treatment is a treatment
alternative to surgical stripping of the greater saphenous
vein. A small laser fiber is inserted, usually through
a needle stick in the skin, into the damaged vein and
guided to the treatment location under ultrasound. Pulses
of laser light are delivered inside the vein, which causes
the vein to collapse and seal shut. The procedure can
be done in-office under local anesthesia in about 1-2
hours. Following the procedure a bandage or compression
hose is placed on the treated leg and the patient is encouraged
to walk as well as to return to normal activities. Endovenous
Laser Treatment is FDA-approved for the treatment of the
greater saphenous vein.
Ambulatory Phlebectomy
Ambulatory Phlebectomy is a method
of surgical removal of surface varicose veins. This is
usually done in the office using local anesthesia. Tiny
segmental incisions are made in the skin along the diseased
vein path (stitches are generally not necessary) Following
the treatment, a compression bandage and/or compression
stockings are worn. Walking or biking is commonly recommended
after treatment. This reduces pressure and increases the
flow in the veins to reduce the risk of forming a blood
clot...
Radiofrequency Occlusion
Radiofrequency Occlusion is a treatment
alternative to surgical stripping of the greater saphenous
vein. A small catheter is inserted, usually through a
needle stick in the skin, into the damaged vein and guided
under ultrasound to the treatment site. The catheter delivers
radiofrequency energy to the vein wall, causing it to
heat. As the vein warms, it collapses and seals shut.
The procedure is generally done in an outpatient or in-office
setting. It may be done under local anesthesia. Following
the procedure, the catheter is removed and a bandage or
compression stocking is placed on the treated leg. Radiofrequency
Occlusion is FDA approved for the treatment of the greater
saphenous vein. 
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