ISUOG Basic Training

Transducers, Image Production,

Knobology and Scanning Planes

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Basic Training
 Learning objectives
At the end of the lecture you will be able to explain:

• How to set up the ultrasound machine

• Which knobs are important to ensure optimal imaging

• The correct orientation of ultrasound images

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 Key questions
1. Which controls should be used to maximise the quality of
the image?

2. What is the correct image orientation when scanning with

a transabdominal (TA) probe?

3. What is the correct image orientation when scanning with

a transvaginal (TV) probe?

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 Transducer types

TA TV

Linear Curvilinear Annular / Intracavitary

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 Hygiene for TV imaging

A sheath or cover must always be used when performing TV examinations. Prior to every
examination ask the patient if they have a latex allergy and ensure latex free covers are available.

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 Clean the transducer post scan
Efficient disinfection will significantly
reduce the risk of cross-contamination for
the ultrasound patient.
Transducers do not need to be visibly
soiled to be contaminated with bacterial
spores or viral capsids

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 Comparison of TA & TV imaging
Probe Transabdominal (TA) Transvaginal (TV)
Frequency 3.5 – 5 MHz 5 - 9.5 MHz
Resolution Inferior Superior
Field of view Larger Smaller
Structures > 4cm from Within field of view Beyond field of view
the probe face
• Imaging challenges • Full bladder in some cases • Field of view
• High body mass index • High BMI (to lesser extent)
(BMI) - distance from probe • Bowel gas (to lesser
face to area of interest extent)
• Bowel gas

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 Transducer selection

BMI

>-------- 5 MHz ------------------< >---------- 3.5 MHz ---------<

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 Comparison of TA & TV imaging

TA TV

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 Transducer selection
Examination Route Frequency
1st trimester 5-8 w TV 5 - 9.5 MHz

1st trimester 8-13 w TA 5 MHz (equivalent multi-frequency)

2nd trimester TA 5 MHz (equivalent multi-frequency)

If available, also consider 3D probe (heavier than 2D)

3rd trimester TA 3.5 MHz (equivalent multi-frequency)

If available, also consider 3D probe (heavier than 2D)

Accurate assessment of: TV 5 - 9.5 MHz

• Low placenta
• Cervical length

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 Image optimisation / knobology
• Adapt image according to scan plane & object of interest
• Multiple options
− Probe selection
− Frequency
− Preset On/off TGC

− Power
− Depth Power

− Gain Probe selection, frequency

Gain
Focus
− Time Gain Compensation (TGC) Pre-set Depth
− Focus Zoom

− Zoom (read/write)
Freeze
− Freeze Cineloop

− Cineloop

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 Power
• = Energy transmitted into
patient

• Default should NOT be set

at 100% (maximum output)

• Recommend 75% as
default, then use gain
control to optimise image

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 Power

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 Depth & zoom

X X

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 Depth & zoom
Read zoom Write zoom

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 Focus
• Compare to a lens
• Extremely important in US guided
needling
• Often forgotten!

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 Focus

X
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 2D gain

X
• Gain amplifies returning frequencies
• Fluid is black when correct gain settings are applied
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 Sector width
• Sector width related to
field of view required

• A narrow sector (right)

improves resolution, but
reduces field of view

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 Time gain compensation (TGC)

Insufficient near gain Uniform gain Excessive far gain

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 Cineloop

• Useful for retrieving optimal image of rapidly moving structure(s)

• Should not be used to ‘hunt’ for acceptable image

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 Room set up – TV & TA
Typically the scan is performed with:
• The woman lying to the right of and facing the operator
• The operator holding the probe in the right hand &
operating the machine controls with the left hand

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 Ultrasound planes

Coronal Sagittal Transverse

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 Probe orientation
• Every probe has one or more May also be
marks which you can feel and
called an
see
orientation
notch
• The mark on the probe always
relates to one side on the
monitor

• Check the position of the probe

and of the image on the monitor

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 Correct probe orientation - transverse
Rule:
When you look at the woman and at your
monitor:
• The Right side of the woman is
displayed on the Left on the monitor
• Use pressure of your finger to check the
correct position
• Fetus with its back to the right of the
woman
• NEVER rotate the probe > 1000 but go
back to where you started

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 Incorrect probe orientation - transverse

• The probe has been rotated,

incorrectly, through 1800 (the
mark is now towards the
woman’s left)
Pressure
• The fetus therefore seems to from finger
be lying with its back to the left
side of the woman

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 Correct probe orientation - longitudinal
Rule:
When you look at the woman and at
your monitor:
• The CEPHALAD /fundus of the
woman is displayed on the Left on Pressure
the monitor from
finger
• NEVER rotate the probe >1000, but
go back to where you started

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 Incorrect image orientation - longitudinal

• The probe has been rotated,

incorrectly, through 1800 (the
mark is towards the maternal
bladder) ‘Breech’ Pressure
position from
• The fetus is now diagnosed, finger
incorrectly, as in a breech
position

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 Transvaginal probe orientation

Sagittal Transverse/ Coronal

(rotate probe anticlockwise)

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 TV probe orientation sagittal

ANTERIOR

* CEPHALAD CAUDAD

POSTERIOR

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 TV probe orientation transverse / coronal

ANTERIOR

RIGHT LEFT

POSTERIOR

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 Transducer movements
• Rotating: Changes the transduce plane from
sagittal to transverse

• Sliding: Along wide and narrow axis of transducer

• Dipping (Heel/Toe): Along narrow axis of transducer

• Angling (Fanning): Along wide axis of transducer

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 Rotating : Changes transducer planes

• Transverse to Sagittal The notch should always be

……rotate Clockwise towards the patients right side
(transverse) or towards the head
(sagittal)
• Sagittal to Transverse
……rotate Counter Clockwise Rotation is also used to elongate a
structure such as to image the full
length of the femur

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 Slide in sagittal plane – along narrow axis

SLIDE in the sagittal plane

 Towards notch Away from notch 
• Centers anatomy on screen

• Towards or away from notch

• Slide along the narrow axis

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 Sagittal view: Sliding AWAY from notch - inferiorly

Sliding in the sagittal plane helps center the anatomy of interest on the screen

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 Slide in transverse plane – along wide axis
• Used for survey scan of the pregnancy / fetus

• Helps determine fetal lie and locate anatomy

- e.g. sliding from fetal heart to fetal stomach

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 Transducer movements:
Dipping (heel / toe)
• Dipping (heel / toe) towards or away from notch along narrow axis of
transducer

• Helps center anatomy on screen

• Toe is at the notch end,

• heel is the non-notch end

Toe Heel

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 Transducer movement: Angle / Fan

• Keeping probe in one spot :

Can angle from side to side
along wide axis of transducer

• This is used to center anatomy

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 Key points
1. Select correct probe

2. Adapt the machine settings throughout the examination to obtain &

maintain optimal views

3. Probe orientation and image orientation should be consistent

4. Rotate probe anti-clockwise when changing from longitudinal plane to

transverse/coronal plane for - TA and TV

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