State The Function TGC and Overall Gain in Ultrasound

1.
STATE THE FUNCTION TGC AND OVERALL GAIN IN ULTRASOUND
The function of TGC is to amplify the ultrasound signals based on the depth of the tissue being
imaged. As sound waves travel through the body, they encounter different types of tissues with
varying degrees of attenuation. High-frequency sound waves are more attenuated than low-
frequency sound waves. Therefore, if the received echoes are not compensated for attenuation, the
image will appear brighter near the surface and darker in deeper regions.
TGC compensates for this attenuation by applying different levels of gain (amplification) to the
received echoes based on their depth. The gain is typically adjusted using a series of sliders or
controls on the ultrasound machine. The operator can modify the gain at different depths to optimize
the image quality and ensure that structures at different depths are displayed with appropriate
brightness.
Overall gain in ultrasound refers to the total amplification applied to the ultrasound signals from the
time they are emitted by the transducer to the time they are displayed on the ultrasound image. It
includes both the transmit gain (initial amplification applied to the emitted sound waves) and the
receive gain (amplification applied to the received echoes). TGC is a component of the receive gain
and contributes to the overall gain in ultrasound imaging. By adjusting the TGC settings, the operator
can control the overall gain and optimize the image quality for different depths and tissue types.
2. 5 TRANSDUCER MOVEMENT
Transducer manipulation can be broken down into five basic movements: sliding (A, tilting (B),
rocking (C and D), rotating (E and F), and compressing (G). Combining these movements allows for
smooth scanning motion and anatomy visualization.
3. CLINCAL STANDARD FOR SONOGRAPHERS
The question is clinical standards for sonographers before performing an ultrasound examination.
Thus, it should be directed related to the patient before the examination starts.
 Patient identification verification

 Medical history
 Patient preparation
 Patient education
 Determination of protocol
4. US APPEARANCE OF HEPATITIS, FATTY LIVER, AAA, ADENOMYOMATOSIS, HCC
a. hepatitis - The ultrasound features are the liver is diffusely hypoechoic, portal tracts are
accentuated in contrast and the liver surface looks like the starry sky.
b. fatty liver – Fatty liver appears brighter (hyperechoic) than normal liver tissue on ultrasound due
to the accumulation of fat within the liver cells. Fatty liver exhibits increased attenuation of the
ultrasound beam, resulting in reduced penetration and decreased visualization of deeper structures.
In cases of severe fatty liver, the excessive fat can obscure the visualization of intrahepatic vessels,
making them difficult to identify on ultrasound
c. AAA – Focal dilatation, AP diameter > 3.0cm, Yin yang sign
d. Adenomyomatosis – Comet-tail artifacts (also known as reverberation artifacts): These are linear,
echogenic (bright) comet-tail-like structures that originate from the gallbladder wall and extend into
the gallbladder lumen. These artifacts are caused by sound waves bouncing between the
hyperplastic gallbladder wall layers and are a classic finding in adenomyomatosis. Increased
echogenicity within the gallbladder wall: Adenomyomatosis can result in increased echogenicity
(brightness) within the affected gallbladder wall. This increased echogenicity is due to the
hyperplastic changes and the presence of intramural diverticula (Rokitansky-Aschoff sinuses
e. HCC - The appearance of metastases on ultrasound is diverse, but most appear rounded with
sharp or smooth margins. They show variable echogenicity (hypo-, iso, or hyperechoic relative to the
surrounding parenchyma), with the hypoechoic halo pattern being the most common.
5. HBP
a. PATIENT PREP FOR HEPATOBILIARY SYSTEM
- fasting NBM 6 hours
- only clear fluid is allow
- Wear comfortable and loose-fitting clothing that allows easy access to the upper abdomen
- Remove any jewelry, belts, or accessories that may interfere with the ultrasound examination or
obstruct the area being imaged.
b. WHY PATIENT PREP IMPORTANT
Fasting: In most cases, it is recommended to fast for at least 6-8 hours before the ultrasound
examination. This fasting period helps ensure that the gallbladder is adequately distended and allows
for better visualization of the biliary system. As the gallbladder remains inactive during fasting, the
bile inside it can become more concentrated. Over time, this concentrated bile can cause the
gallbladder to become distended, meaning it fills up with bile and increases in size. The distension of
the gallbladder can be observed during an ultrasound examination and is one reason why fasting is
often recommended before a hepatobiliary ultrasound
c. BILIARY OBSTRUCTION, CHOLEDOCOLITHIASIS SONOGRAPHIC FEATURES
biliary obs – The “double barrel sign” essentially describes 2 tubes running side by side, due to
dilated bile ducts travelling along with the portal veins through the liver.
Choledocolithiasis - Twinkling artifact is seen with color flow Doppler ultrasound 1. It occurs as a
focus of alternating colors on Doppler signal behind a reflective object (such as a calculus), which
gives the appearance of turbulent blood flow
d. WHAT TYPE OF ARTIFACT CHOLDEDOCHO
acoustic shadowing
e.MACAM MANA ARTIFACT TU BOLEH TERJADI
The artefact shown in the image is acoustic shadow. Shadowing is the result of reflection and
refraction due to an object with high attenuation causing void signal behind the object.

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STATE THE FUNCTION TGC AND OVERALL GAIN IN ULTRASOUND

 Patient identification verification

4. US APPEARANCE OF HEPATITIS, FATTY LIVER, AAA, ADENOMYOMATOSIS, HCC

c. AAA – Focal dilatation, AP diameter > 3.0cm, Yin yang sign

a. PATIENT PREP FOR HEPATOBILIARY SYSTEM

- fasting NBM 6 hours

- only clear fluid is allow

b. WHY PATIENT PREP IMPORTANT

c. BILIARY OBSTRUCTION, CHOLEDOCOLITHIASIS SONOGRAPHIC FEATURES

d. WHAT TYPE OF ARTIFACT CHOLDEDOCHO

e.MACAM MANA ARTIFACT TU BOLEH TERJADI

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