echo artifacts: the cause and solution - ase foundation · echo artifacts: the cause and solution...
TRANSCRIPT
![Page 1: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/1.jpg)
Echo Artifacts: The Cause and
SolutionDavid Adams, RCS, RDCS, FASE
Duke University Medical Center
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None
Disclosures
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My Happy / Sad ratio• 20% Sad
– 1st talk on Sunday (post party)– Talk about Artifacts
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Artifacts - definition• From 2 Latin words:
• arte = “by skill”• factum = “to make”
• OLD!!!!
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Happy / Sad ratio• 20% Sad
– 1st talk on Sunday (post party)– Talk about Artifacts
• 80% Happy– Being here– Finished the talk Saturday– No snow or tornadoes
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Artifact Talks I’ve Heard
Why I Drink
Kno
wle
dge
Time
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The Kisslo Rules
1. If you don’t point at it you can’t see it.
2. If you don’t see it you can’t diagnosis it.
3. It’s not the heart stupid!
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It’s Not the Heart Stupid!
DUKE: Adams
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Kissloisms•Artifacts
– Not enough just to know that something is an artifact.
– What is the physics behind it
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That’s our goal today.
ARTIFACTS
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• Easy
• Difficult
• Impossible
ARTIFACTS – My Classification
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• Easy
• Difficult
• Impossible
DATING – My Classification
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• Causes:– violation of assumptions
– equipment malfunction or design
– physics of US
– operator error
ARTIFACTS
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• Error in imaging:– not real
– missing reflectors
– improper size, shape, brightness, position
• ALL ultrasound images contain artifacts!
ARTIFACTS
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BASIC ASSUMPTIONS
•ASSUME•ASS U ME
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BASIC ASSUMPTIONS• sound travels in a straight line• reflections only arise from structures along
the beam’s main axis• sound travels exactly 1540 meters/second • imaging plane is extremely thin• sound travels directly to a reflector and back
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BASIC ASSUMPTIONS
• sound travels in a straight line
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BASIC ASSUMPTIONS
• reflections only arise from structures along the beam’s main axis
![Page 19: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/19.jpg)
BASIC ASSUMPTIONS
• sound travels exactly 1540 meters/sec
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BASIC ASSUMPTIONS
• imaging plane is extremely thin
![Page 21: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/21.jpg)
BASIC ASSUMPTIONS
• imaging plane is extremely thin
![Page 22: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/22.jpg)
BASIC ASSUMPTIONS•sound travels directly to a reflector & back
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ARTIFACTS• appear & disappear depending on the view • disappear when corrective measures are
taken• actual anatomy remains visible• if obvious artifact remains, call a service
person
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• Easy common
identify
explain
ARTIFACTS – My Classification
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Bovie Cautery Interference
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SHADOWING• a hypoechoic region appearing beneath a
structure with abnormally high attenuation
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SHADOWING - MS
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SHADOWING - TVR
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WHAT CAUSES THIS ARTIFACT?
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REVERBERATION
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REVERBERATION
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Main Bang Artifact - Herbie
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• Change depth
ARTIFACTS?
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ARTIFACTS?
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• Change depth
• Change transducer frequency
• See in more than one view
ARTIFACTS?
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ARTIFACTS?
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COMET TAIL
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DUKE: Adams
GSW Upper Chest
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Comet Tail Artifact
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Bioptome – Comet Tail
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St. Jude Valve
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Shadowing & Comet Tail
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Shadowing & Comet Tail
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• Difficult easy identify
but explaining??
I’m sorry
Can be applied to dating
ARTIFACTS – My Classification
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Edge Shadow Artifact• a hypoechoic region appearing beneath the
edge of a curved structure
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Edge Shadow Artifact
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Side Lobes – Grating Lobes
real artifact
sound directed off-axis 2nd copy of reflector
along side of true anatomy
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Side Lobes – Grating Lobes
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Grating Lobe
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Grating Lobe
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Cor Triatriatum
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Cor Triatriatum???
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SPEED ERRORS• when sound travels at speeds other
than 1,540 m/s, reflectors are placed at incorrect depths
• when speed is greater than 1,540 reflectors appear too shallow on the image
• when speed is less than 1,540 reflectors appear too deep on the image
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Rib or Lung Interference
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Starr-Edwards MVR
![Page 57: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/57.jpg)
Starr-Edwards Valve
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Starr-Edwards MVR
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MIRROR IMAGE
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MIRROR IMAGE
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MIRROR IMAGE
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REFRACTION
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Double Ao - Refraction
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Double Ao - Refraction
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Double LV - Refraction
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DOPPLER ARTIFACTS• pulsating vessel walls and
moving structures (heart) can create small Doppler shifts – clutter
• color flash or ghosting appears in early systole due to heart motion
• wall filters eliminate color from small Doppler shifts that arise from structure motion
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Ghosting Artifact
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Ghosting Artifact
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• Easy
• Difficult
• Impossible• Weird things not explained by
physics
• (Don’t mention dating / women)
ARTIFACTS – My Classification
![Page 70: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/70.jpg)
Breast Implant
![Page 71: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/71.jpg)
PDA Doppler Artifact
![Page 72: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/72.jpg)
? Artifact in the Ao
![Page 73: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/73.jpg)
? Artifact disproved by contrast
![Page 74: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/74.jpg)
Multiple Artifacts (4)
![Page 75: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/75.jpg)
• In all Images
• Most can be explained
• If you think its real – change depth or xducer & document in more than one view.
ARTIFACTS
![Page 76: Echo Artifacts: The Cause and Solution - ASE Foundation · Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center. None. Disclosures. My](https://reader033.vdocuments.us/reader033/viewer/2022042213/5eb8b471bd191f33af06d8f9/html5/thumbnails/76.jpg)
Duke ER
The End
DUKE: Adams