How to interpret a USG (Ultrasound) image?

USG Image Ko Kaise Samjhe (How to Interpret a USG Image)

USG image ko sahi tarike se interpret karne ke liye, aapko systematically approach karna chahiye - pehle transducer ki positioning aur orientation samjho, phir normal anatomy ko identify karo, aur finally pathological findings ko recognize karo, jisme artifacts aur technical factors ka dhyan rakhna zaroori hai. 1

Basic Principles of Image Interpretation

Transducer Orientation aur Screen Convention

• Screen par left side typically proximal, cranial, ya upper structures ko represent karti hai 1
• Screen par right side distal, caudal, ya lower structures ko dikhati hai 1
• Longitudinal scans mein yeh orientation maintain karna zaroori hai proper interpretation ke liye 1

Image Quality aur Technical Factors

• High frequency transducers (7-15 MHz) superficial structures jaise tendons, ligaments aur small joints ke liye best hote hain 1
• Low frequency transducers (3.5-5 MHz) deeper structures jaise shoulder ya hip ke liye zyada suitable hain 1
• Resolution aur depth of penetration mein hamesha compromise hota hai - higher frequency better resolution deti hai lekin kam depth tak jaati hai 1

Systematic Scanning Approach

Real-Time Scanning Technique

• Systematically scan karo structure ko real-time mein, dono long axis aur short axis views mein 1
• Multiple directions se views lena helpful hota hai small stones identify karne mein aur artifacts resolve karne mein 1
• Patient positioning change karna (jaise decubitus position) better windows provide kar sakta hai 1

Anatomical Landmarks Identify Karna

• Pehle normal anatomical structures ko locate karo as reference points 1
• Example: Gallbladder exam mein, portal vein ko identify karo to locate common bile duct 1
• Structures ko unke characteristic appearance se recognize karo - tubular structures, fluid-filled spaces, solid organs 1

Normal vs Abnormal Findings

Echogenicity Patterns

• Hyperechoic (bright) - fat, calcifications, gas dikhate hain 1, 2
• Hypoechoic (dark) - fluid, edema, certain soft tissues 1
• Anechoic (black) - pure fluid collections 1
• Surrounding tissues se comparison karke echogenicity assess karo 2

Measurements aur Size Assessment

• Measurements hamesha transverse plane mein most accurate hote hain tubular structures ke liye 1
• Intraluminal diameter measure karo (inside wall to inside wall) 1
• Normal values ko age aur patient factors ke saath correlate karo 1

Common Pathological Findings

Stones aur Calcifications

• Echogenic with distal shadowing - typical appearance of stones 1
• Mobile hote hain patient positioning ke saath 1
• Gain, frequency aur focal zone settings optimize karna zaroori hai small stones identify karne ke liye 1

Wall Thickening aur Fluid Collections

• Wall thickness >3mm abnormal consider hota hai (jaise gallbladder mein) 1
• Pericholecystic fluid hypo- ya anechoic regions ke roop mein dikhta hai 1
• Anterior wall par measurements most reliable hote hain 1

Vascular Structures

• Color-flow Doppler use karke vessels ko non-vascular structures se differentiate karo 1
• Blood flow patterns assess karo pathology identify karne ke liye 1

Critical Artifacts to Recognize

Common Artifacts

• Shadowing - highly attenuating structures (stones, bone) ke peeche dark areas 1, 3
• Reverberation artifacts - multiple parallel echoes from strong reflectors 3
• Comet-tail artifact - pneumobilia suggest kar sakta hai 1
• Bowel gas se artifacts differentiate karna important hai true pathology se 1, 3

Artifact Mitigation

• Transducer position aur angle change karo artifacts reduce karne ke liye 3
• Multiple windows use karo confirmation ke liye 1
• Gain settings optimize karo to minimize artifacts 1, 3

Clinical Correlation - Sabse Important

Operator Dependence

• USG sabse zyada operator-dependent imaging modality hai 1
• Experience aur expertise directly diagnostic accuracy ko affect karte hain 1
• Clinical history aur physical examination ke saath images ko correlate karna mandatory hai 1

Documentation Standards

• Har examination ko carefully document karo 1
• Pathological findings ko do perpendicular planes mein document karo 1
• Standardized way mein images record karo reproducibility ke liye 1

Common Pitfalls to Avoid

• Pseudosac ko gestational sac mat samjho - intracavitary fluid pointed margins ke saath pseudosac hota hai 1
• Gas-filled bowel se shadows ko gallstones se confuse mat karo 1
• Low-hanging structures obscured ho sakte hain gas se - positioning change karo 1
• Artifacts ko real pathology samajhne ki galti mat karo 3
• Bina proper training ke interpretation risky hai - continuous education zaroori hai 1