1. Introduction to Head & Neck Ultrasound

2. Learning Objectives
To recognize the indications for and clinical utility of H&N ultrasound.
To identify normal H&N anatomy
To know basic ultrasound machine capabilities and control functions
ALSO –
How to explain to a patient
Proper handling of transducer
Anatomy: thyroid, salivary glands, carotid, jugular, trachea

3. What is Ultrasound? Sound waves: 2-10 MHz Waves are propagated through
different tissues at different velocities
Boundary of two tissues causes impedance mismatch
Sound waves are reflected back at different frequencies
Differentiation of tissues
MegaHz.
Audible sound waves are 2-20 kHz (which is MHz)
1MHz = 1000kHz
Tissue impedance = measure of resistance of propagation of the sound waves
The BOUNDRY of two tissues causes the reflection back

4. Impedance = density x acoustic velocity
Attenuation
Resolution
2nd and 3rd princples we cannot go into with time allotted

5. There are other things to consider like artifact and resolution, but don’t have time.

6. Piezoelectric Crystals
Converts the reflected waves (acoustic echoes) into a grayscale image
Converts electrical current into sound waves
Conversion done in the transducer
Mechanical energy is the sound waves

7. What can we see? Thyroid gland: nodules, goiter Parotid glands
Over 200 nodes in neck, normally do not see
Can tell “normal” characteristics
What can we see?
Thyroid gland: nodules, goiter
Parotid glands
Submandibular glands
Enlarged or pathologic lymph nodes

8. What can we see? Skin / platysma  Epidermal inclusion cysts
Subcutaneous  Lipoma
Muscle
Soft tissue  Lymph nodes

9.  Skin Sub-Q  Strap Strap L thyroid R thyroid Trachea CCA CCA Esoph
Air is black (total reflection) (has much much less velocity than soft tissue)
Fluid is black (near total propagation)
Sub Q = adipose layer is dark with bright striations
Parenchyma is isoechoic gray

10. Echogenicity
anechoic  hypoechoic  isoechoic  hyperechoic Homogeneous vs Heterogeneous
Anechoic = tissue that transmits ultrasound waves
Hyperechoic = tissue that transmits and reflects waves

11. Orientation Sagittal view Transverse view Transverse – think axial cut
Sagittal – think sagittal cut

12. Indications for H&N ultrasound
Palpable lymph node or neck mass
Lymphadenopathy: malignant versus reactive
Salivary gland neoplasm
Branchial cleft cyst
Thyroid nodules
Palpable
Incidentally found
Essentially no contraindications

13. Reminder: complete your workshop cards and turn them in at the end of this session.
Score cards will be used for admission to workshops and attendance.
Credit will only be awarded for completed score cards.
Rotate and complete each station.
Completion of workshop is NOT contingent on pass/fail

14. Ultrasound Session Evaluation
Score cards will be used for admission to sessions and attendance.
Credit will only be awarded for completed score cards.
Last Name
Session
Scale: 1=NO or LOW, to 5=YES or most likely/most positive
Scale 1 to 5
1. Were learning objectives met?
2. Was instruction free of commercial bias?
3. Was there adequate instruction before hands-on practice?
4. Was there adequate supervision during practice?
5. Were training aids useful/realistic in learning desired skill?
6. How likely are you to perform these skills in the future?
7. Did this training improve your skills?
ATTENDEE NAME (print) ___________________________________
ATTENDEE SIGNATURE:

15. Ultrasound Score Card Rotate and complete each station.
“Go/No Go” for internal use only.
Completion of workshop is NOT contingent on pass/fail.
Task Go
No Go
1. Identify one indication for US exam.
2. Explain the procedure as you would to a patient.
3. Demonstrate proper handling of the US transducer.
4. Identify one anatomical landmark.
Comments
Proctor Name
Proctor Signature

16. Ultrasound Las Palmas C 20x31 10 learners per session
16 chairs, 2 6ft tables, 2 smaller tables, AV setup
Screen
Door
Door
Station 4
Station 2 US unit
Station 1
US unit
Projector
Speaker
Equipment Table
Equipment Table
Proctors