Ultrasound

First TV spot ob sono capture with Kristin and sonographer student
Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (X-ray). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Providence Imaging Center (PIC) offers the latest in ultrasound technology and a compassionate team of ARDMS certified sonographers. In 2013 PIC in Anchorage purchased state-of-the-art Siemens Acuson S2000 systems that provide improved detail resolution. Two of our ultrasound rooms are located in the Women’s Center, allowing for greater privacy when performing breast procedures.

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (X-ray). Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is usually a painless medical test that helps physicians diagnose and treat medical conditions.

Conventional ultrasound displays the images in thin, flat sections of the body.

A Doppler ultrasound study may be part of an ultrasound examination. Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel, including the body’s major arteries and veins in the abdomen, arms, legs and neck.

For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.

A clear gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) then presses the transducer firmly against the skin and sweeps it back and forth over the area of interest.

Doppler sonography is performed using the same transducer.

When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.

In some ultrasound studies, the transducer is attached to a probe and inserted into a natural opening in the body. These exams include:

  • Transvaginal ultrasound. The transducer is inserted into a woman’s vagina to view the uterus and ovaries.

Most ultrasound examinations are completed within 30 minutes to an hour.

PIC offers the following ultrasound procedures, both general and doppler:

General

  • Abdominal (includes gall bladder, liver, pancreas, spleen, kidney, and aorta)
  • Aorta
  • Biophysical profile
  • Breast cyst aspiration – Download Instructional PDF
  • Ultrasound-guided breast biopsy – Download Instructional PDF
  • Hysterosonogram
  • Infant hips/spine/neonatal
  • Obstetric
  • Pediatric
  • Pelvic with transvaginal
  • Renal/bladder
  • Testicular
  • Thyroid
  • Thyroid biopsy/fine needle aspiration – Download Instructional PDF

Doppler

  • Mesenteric, porta-hepatic, and renal arterial
  • Venous/arterial doppler of the arms and legs
  • Carotid
  • Liver transplant, renal transplant
  • Ankle Brachial Index (ABIs) – arterial legs
  • Vein mapping of the arms and legs

While many ultrasound procedures require no preparation for our patients, some do. You should wear comfortable, loose-fitting clothing for your ultrasound exam. You will need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Other preparation depends on the type of examination you will have. For some scans your doctor may instruct you not to eat or drink for as many as 12 hours before your appointment. For others you may be asked to drink up to six glasses of water two hours prior to your exam and avoid urinating so that your bladder is full when the scan begins.

Each preparation helps the technologist get the best possible images for review.

Please see below for specific instructions for each test.

No prep required

  • Breast
  • Carotid doppler
  • Cranial
  • Testicular
  • Venous doppler arms/legs
  • ABIs
  • Arterial doppler of the arms/legs
  • Groin
  • Vein mapping

No eating or drinking (including water) after midnight the evening before these tests; this includes no smoking or chewing gum.

  • Abdominal
  • Aorta
  • Liver transplant
  • Mesenteric doppler
  • Porta-hepatic doppler
  • Renal arterial doppler
  • Renal transplant

Water prep for three (3) exams

  • Pelvis or OB ultrasound: One and one-half hours before the exam, start drinking 32 ounces of water (about four cups). Complete drinking water about one hour prior to the scheduled exam. Do not urinate until after the test.
  • Renal ultrasound: Drink plenty of clear liquids the day before the exam. The day of the exam, drink 24 ounces (about three cups) of water. Complete drinking water about 30 minutes prior to the scheduled exam. Do not urinate until after the test.

Images from the ultrasound exam are reviewed and interpreted by a PIC radiologist, who will dictate a report, which is transcribed and sent to the healthcare provider who ordered the exam. This is usually accomplished within three days after the exam.

The sonographer is not able to render a diagnosis based on what they see in the exam room. Patients should contact their healthcare provider for the results of their ultrasound exam.

A CD of the exam can be burned and kept at the front desk for pickup by the patient or ordering clinician. Please contact the File Room at 212-3144 for more information.

An ultrasound-guided breast biopsy is a non-surgical, minimally invasive procedure used to obtain tissue samples for microscopic examination. Ultrasound guidance is used to find the area, which usually cannot be felt. The radiologist removes samples of breast tissue using a special needle. These tissue samples are sent to the pathologist for review. The patient’s healthcare provider will receive a pathology report several days after the biopsy and will review the results with the patient.

Ultrasound-guided breast biopsy is an important tool utilized at Providence Imaging Center in Anchorage, and complements our comprehensive breast imaging services.

How to prepare for a ultrasound-guided breast biopsy

There are no diet restrictions; eat and drink as usual.  Take your usual medications on the day of your appointment.

If you take daily aspirin or any anticoagulant such as coumadin, heparin or plavix, please notify our staff. There may be special instructions for you.

Please advise us if you have any allergies prior to your appointment.  Lidocaine is the local anesthetic normally used for the procedure.  

A two piece outfit will be more comfortable.  Please wear or bring a supportive bra.

What to expect during the procedure

During an ultrasound-guided biopsy, you will lie on your back on a padded table with one arm raised above your head.  You will usually be able to watch the ultrasound screen as the radiologist performs the procedure if you wish.

Your skin will be cleaned before the radiologist administers lidocaine, a local anesthetic.  This will numb an area about the size of a quarter.  A very small incision will be made and several tissue samples will be obtained.

During the procedure you will be informed about what is occurring.  If you experience discomfort, the radiologist can administer more local anesthetic during the procedure.

After the procedure

  • The radiologist or technologist will apply pressure to the biopsy area for several minutes to stop any bleeding.  Your incision will be closed with a steri strip and a sterile dressing.  You will be given a small ice pack to put in your bra for a few hours to help prevent bruising.
  • Please avoid heavy lifting for the next two days to further prevent bleeding or extended bruising.
  • Take a non-aspirin pain reliever like Tylenol, Advil, Motrin, etc., if you experience any discomfort.  Avoid aspirin for about 48 hours.
  • Remove the gauze dressings and shower the morning after your biopsy.  Leave the steri strips in place; they should began to peel off on their own in four to five days.
  • Check the biopsy area daily.  If you notice excessive pain, bleeding, swelling, drainage, redness, or the area is warm to the touch please call the nurse at PIC.  The nurse is available M-F 8 a.m. – 4 p.m.
  •  You should be able to drive or return to work following your biopsy.

Note:  You may notice some bruising of the biopsy area which should go away in about a week.  You may also have a very small amount of bleeding.  If bleeding occurs after you leave the Imaging Center, apply continuous direct pressure over the incision site for five minutes and replace the bandages. It is common to feel a small lump after the biopsy. It will slowly reabsorb.

Results and follow-up

Your clinician’s office should contact you with the results of your biopsy about 3-5 working days after the procedure.  A diagnostic mammogram and/or a breast ultrasound may be recommended at six months post biopsy.  

If you have any questions about your procedure or results, call the nurse at Providence Imaging Center, 212-3607.

 

Ultrasound Breast ACR Accredited

An image-guided fine needle aspiration allows the radiologist to sample the cell tissues in your thyroid without surgery. Ultrasound is used to find the area. The radiologist removes samples of your thyroid cells using a special needle. The tissue samples are sent to the cytologist for diagnosis. A lab report is sent to your health care provider several days after your procedure. Your healthcare provider will go over the results with you.

What to do prior to your procedure

Please pre-register by telephone before your scheduled appointment by calling 212-3151. If you register the day of your appointment, please arrive 15 minutes early. If you have had a prior thyroid ultrasound performed at another facility, please have those films available at PIC at the time of your appointment.

There are no diet restrictions; eat and drink as usual. Take your usual medications on the day of your appointment.

What to expect during the procedure

Your skin will be prepared with an antiseptic cleaning solution before the radiologist administers lidocaine, a local anesthetic that will numb an area about the size of a quarter. Several samples will be obtained. As the samples are taken, you will feel the radiologist moving the needle. During the procedure you will be informed about what is occurring. Some people experience pain to the jaw or the ear – this is normal. If you experience discomfort during the procedure, the radiologist can administer more local anesthetic.

What happens after the procedure

  • Take a non-aspirin pain reliever like Tylenol, Advil, Motrin, etc., if you experience any discomfort.
  • Check the sampled area daily. If you notice excessive pain, bleeding, swelling, drainage, redness or the area is warm to the touch, please call PIC or your clinician’s office.
  • You should be able to drive or return to work following your biopsy.

Note: You may notice some bruising of the biopsy area which should go away in about a week. You may also have a very small amount of bleeding. If bleeding occurs after you leave Providence Imaging Center, apply continuous direct pressure over the incision site for 15 minutes and replace the bandages.

Results and follow-up

Your healthcare provider should contact you with the results of your thyroid fine needle aspiration several days after the procedure.

Questions

Contact your clinician’s office if you have any questions. You may also contact the Providence Imaging Center nurse at 212-3607.

Download Thyroid Biopsy Instructions (PDF)

A cyst aspiration with imaging guidance allows the radiologist to remove the fluid from one or more breast cysts.

What to do prior to your cyst aspiration

Please pre-register by telephone before your scheduled appointment by calling 212-3151. If you register the day of your appointment, please arrive 15 minutes early.

There are no diet restrictions; eat and drink as usual. Take your usual medications on the day of your appointment. A two-piece outfit will be more comfortable. Please wear a supportive bra, or bring one with you.

What to expect during the procedure

Your skin will be cleaned before the radiologist administers lidocaine, a local anesthetic that will make a small area numb. No incision is necessary for a cyst aspiration. A small needle will be introduced into the cyst and the fluid will be aspirated into a syringe. Most women experience minimal discomfort with the injection of the local anesthetic, with no additional pain. If you experience continued pain, you should inform the radiologist, who will administer additional anesthetic. If additional cysts are to be aspirated, the procedure will be repeated for each aspiration.

What happens after the procedure

Take a non-aspirin pain reliever like Tylenol, Advil, Motrin, etc., if you experience any discomfort.
Note: You may notice some bruising of the aspiration site, which should go away in about a week.

Results and Follow-up

Your healthcare provider should contact you with the results of your breast cyst aspiration.

Questions

Contact your clinician’s office if you have any questions. You may also contact the Providence Imaging Center nurse at 212-3607.
If you are having a cyst aspiration with possible breast biopsy, please
follow the additional instructions below.

 

For Patients Whose Procedure May Become An Imaging Guided Breast Biopsy

Aspirin and anticoagulants increase your risk of bleeding and bruising. If you take aspirin, we ask that you stop taking it three to seven days prior to your breast cyst aspiration if possible. If you take an anticoagulant such as coumadin, heparin or plavix, you should ask your doctor if you can stop the medication for a few days before your appointment. Herbal substances that affect bleeding, such as Gingko biloba, should be stopped two weeks prior to your breast cyst aspiration.

What to expect during the biopsy procedure

The radiologist may take tissue samples, which will be sent to pathology for review. A pathology report will be sent to your healthcare provider several days after the biopsy. Your healthcare provider will review the results with you.

What happens after the procedure

  • Take a non-aspirin pain reliever like Tylenol, Advil, Motrin, etc., if you experience any discomfort. Avoid taking aspirin for about 48 hours.
  • The radiologist or technologist will apply pressure to the biopsy area for several minutes to stop any bleeding. Your incision will be closed with a steri strip and a sterile dressing. You will be given a small ice pack to put in your bra for a few hours to help prevent bruising.
  • Please avoid heavy lifting for the next two days to further prevent bleeding or extended bruising.

Note: You may notice some bruising of the biopsy site, which should go away in about a week.

Questions

If you have questions about the procedure or results, call the Providence Imaging Center nurse at 212-3607.

Download Cyst-Aspiration-Instructions (PDF)

A “package” of three screening tests is available for patients at Providence Imaging Center in Anchorage that includes:

  • Abdominal Aorta Vascular Ultrasound screens for Aortic Aneurysm. Aortic aneurysm is a weakening in the wall of the aorta, which is the main artery in the chest and abdomen. This weakening can cause the artery to rupture causing possible death. Often there are no signs or symptoms of an aortic aneurysm until it ruptures. Risk factors for aortic aneurysms are: over age 60; family history of Aortic Aneurysms; smoking; high blood pressure; and more common in men than women.
  • Carotid Vascular Ultrasound looks at the arteries in the neck for Carotid Artery Disease. Carotid Artery Disease occurs when the carotid arteries, the main blood vessels that take blood to the brain, develop a buildup of plaque caused by hardening of the arteries. When this build up becomes severe it can cause a stroke. Risk factors for strokes are: high blood pressure; diabetes; smoking; high cholesterol, family history of stroke; and irregular heartbeat, particularly atrial fibrillation.
  • Leg Vascular Ultrasound looks for Peripheral Arterial Disease (PAD). PAD is a condition in which plaque builds up along the walls of the arteries that carry blood to the arms and legs affecting blood circulation. People with PAD are three times more likely to die of a heart attack or stroke than those without PAD. Risk factors for PAD are: high blood pressure; diabetes, smoking, high cholesterol, family history of serious vascular problems; and more common in men than women.

Providence Imaging Center in Anchorage offers ultrasound-based liver elastography (acoustic radiation force impulse imaging/shear wave elasticity imaging) to referring offices.

This non-invasive imaging test for fibrosis may help patients avoid liver biopsy.

If indicated on the referring provider’s order “with liver elastography”, elastography will be performed on patients referred for abdominal ultrasound with a diagnosis or history of Hepatitis B or C, and/or fibrosis or cirrhosis of the liver.

FAQ

How does an office schedule this test?
There are currently two ways to ask for elastography to be done on patients:

  • For a patient who is getting an abdomen complete ultrasound with special attention to the liver, to evaluate Hep B or C. Prep: Patient should be NPO for 8 hours prior. Appointments available: 8 a.m. – noon, M-F. What to order: Abdomen complete with liver elastography.
  • For a patient who needs to be seen only to evaluate the liver, to evaluate Hep B or C. A limited abdominal ultrasound will be scheduled. Prep: Patient should be NPO for 8 hours prior. Appointments available: 8 a.m. – noon, M-F. What to order: abdomen limited with liver elastography.

Is there an extra charge for the elastography portion of the abdominal exam? Yes. As this is a new test, we are still in the process of finalizing codes and charges. Elastography does not require pre-authorization; however, patients are encouraged to confirm specific benefits coverage with their insurance provider.

How is the test performed? The patient lies supine or left lateral decubitus, and a transducer is placed over the region of the liver. The sonographer, assisted by a time-motion image, locates a liver portion that is free of vascular structures, normally segment 8 or 9. The device calculates a numerical measurement (shear wave velocity), in meters per second for the selected ROI tissue, using a standardized ROI box.

What will the report say? The VTTQ worksheet, included in the images generated during the ultrasound, indicates the median velocity of the shear waves in m/s.

What does VTTQ mean? Virtual Touch™ Tissue Quantification – the proprietary name given by Siemens Medical Solutions.

Where is this test performed? Currently, Providence Imaging Center in Anchorage offers liver elastography at 3340 Providence Drive, in the A Tower, first floor.

How can I find out more about this test? Please contact Providence Imaging Center, at (907) 212-3151.             

Ultrasound ACR Accredited