Echo Artifacts: The Cause and Solution

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1 Echo Artifacts: The Cause and Solution David Adams, RCS, RDCS, FASE Duke University Medical Center

2 Disclosures None

3 My Happy / Sad ratio 20% Sad 1 st talk on Sunday (post party) Talk about Artifacts

4 Artifacts - definition From 2 Latin words: arte = by skill factum = to make OLD!!!!

5 Happy / Sad ratio 20% Sad 1 st talk on Sunday (post party) Talk about Artifacts 80% Happy Being here Finished the talk Saturday No snow or tornadoes

6 Artifact Talks I ve Heard Knowledge Why I Drink Time

7 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!

8 It s Not the Heart Stupid! DUKE: Adams

9 Kissloisms Artifacts Not enough just to know that something is an artifact. What is the physics behind it

10 ARTIFACTS That s our goal today.

11 ARTIFACTS My Classification Easy Difficult Impossible

12 DATING My Classification Easy Difficult Impossible

13 ARTIFACTS Causes: violation of assumptions equipment malfunction or design physics of US operator error

14 ARTIFACTS Error in imaging: not real missing reflectors improper size, shape, brightness, position ALL ultrasound images contain artifacts!

15 BASIC ASSUMPTIONS ASSUME ASS U ME

16 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

17 BASIC ASSUMPTIONS sound travels in a straight line

18 BASIC ASSUMPTIONS reflections only arise from structures along the beam s main axis

19 sound travels exactly 1540 meters/sec BASIC ASSUMPTIONS

20 BASIC ASSUMPTIONS imaging plane is extremely thin

21 BASIC ASSUMPTIONS imaging plane is extremely thin

22 BASIC ASSUMPTIONS sound travels directly to a reflector & back

23 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

24 ARTIFACTS My Classification Easy common identify explain

25 Bovie Cautery Interference

26 SHADOWING a hypoechoic region appearing beneath a structure with abnormally high attenuation

27 SHADOWING - MS

28 SHADOWING - TVR

29 WHAT CAUSES THIS ARTIFACT?

30 REVERBERATION

31 REVERBERATION

32 Main Bang Artifact - Herbie

33 ARTIFACTS? Change depth

34 ARTIFACTS?

35 ARTIFACTS? Change depth Change transducer frequency See in more than one view

36 ARTIFACTS?

37 COMET TAIL

38 GSW Upper Chest DUKE: Adams

39 Comet Tail Artifact

40 Bioptome Comet Tail

41 St. Jude Valve

42 Shadowing & Comet Tail

43 Shadowing & Comet Tail

44 ARTIFACTS My Classification Difficult easy identify but explaining?? I m sorry Can be applied to dating

45 Edge Shadow Artifact a hypoechoic region appearing beneath the edge of a curved structure

46 Edge Shadow Artifact

47 Side Lobes Grating Lobes sound directed off-axis 2 nd copy of reflector along side of true anatomy real artifact

48 Side Lobes Grating Lobes

49

50 Grating Lobe

51 Grating Lobe

52 Cor Triatriatum

53 Cor Triatriatum???

54 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

55 Rib or Lung Interference

56 Starr-Edwards MVR

57 Starr-Edwards Valve

58 Starr-Edwards MVR

59 MIRROR IMAGE

60 MIRROR IMAGE

61 MIRROR IMAGE

62 REFRACTION

63 Double Ao - Refraction

64 Double Ao - Refraction

65 Double LV - Refraction

66 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

67 Ghosting Artifact

68 Ghosting Artifact

69 ARTIFACTS My Classification Easy Difficult Impossible Weird things not explained by physics (Don t mention dating / women)

70 Breast Implant

71 PDA Doppler Artifact

72 ? Artifact in the Ao

73 ? Artifact disproved by contrast

74 Multiple Artifacts (4)

75 ARTIFACTS In all Images Most can be explained If you think its real change depth or xducer & document in more than one view.

76 Duke ER The End DUKE: Adams

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