Ultrasound is a diagnostic imaging method that uses high-frequency sound waves and does not involve exposure to radiation. The ultrasound technology is based on the use of the echo and is regulated by the principles of ultrasound emission: refraction and reflection. The examination does not involve any biological damage and it provides useful diagnostic information, also allowing the interventional radiology specialist to guide minimally invasive procedures, as in the case of pain management treatments.
Ultrasound is an operator-dependent method, effectiveness is therefore related to the skill (sensitivity and specificity) of the specialist. The ultrasound imaging professional must therefore have an excellent knowledge of the anatomy and a multidisciplinary approach. The exam uses frequencies that vary on average from 2 to 20 Mhz: raising the frequency intensifies the sensitivity of the studied element, however reducing the depth of investigation. Using the 20 Mhz probe it is possible to accurately analyze structures that are 2 cm from the skin surface, beyond 2 cm the instrument loses sensitivity. Through the 2 Mhz probe it is possible to analyze deep structures, such as the pancreas.
Who should schedule this appointment?
Ultrasound is a type of diagnostic procedure that replaces the physical examination and it represents the first step to rule out certain conditions, before referring the patient to more complex diagnostic paths (for example magnetic resonance imaging, computed tomography, angiography). There are different areas and conditions that can be analyzed with the ultrasound study, for example:
- Osteoarticular system: ankles, knees, shoulders
- Soft tissues for the detection of subcutaneous tissue swelling, lipomas. The examination can consider both benign and malignant conditions
- Complete analysis of the abdomen: considering both the upper quadrants (liver and upper organs) and the lower quadrants (bladder, uterus), always using a percutaneous approach
- Pancreas, kidney and bladder analysis to rule out neoplastia, also considering obstructive stones and nephropathies
- Tumor analysis
- Examination of inflammatory conditions and metabolic disorders
- Biliary stones, hepatic steatosis (fatty liver)
Why choose MediClinic?
MediClinic's ultrasound service makes use of the collaboration of multiple specialists, a particularly important element when taking into consideration the different diagnostic areas that may request or be involved in this type of instrumental exam (for example Surgery, Orthopedics, Nephrology, Neurology).
MediClinic uses top-notch devices, equipped with multifrequency transducers that can be attached to a probe for various applications. The medical facility represents a new concept of the Health Service and the environment itself, characterized by large spaces, is particularly relaxing and comfortable for the patient.
Why is it done?
At MediClinic, ultrasound is mainly diagnostic, however in some cases it can become an interventional-therapeutic procedure. The ultrasound can provide very precise information and it is also used as a support tool for several procedures that can be facilitated by a visual guide, towards certain anatomical targets, such as in the case of ultrasound-guided injections.
The MediClinic specialist, through the use of the ultrasound probe, is able to investigate the existence of neoplasm, identifying a large series of conditions that were once sought through palpation and which can now be analyzed with greater precision. Using the available clinical and laboratory information, the MediClinic specialist can then carry out the diagnostic hypotheses concerning the patient (pathologies, metabolic disorders), through a careful interpretation of the images offered by the instrument.
In the field of neoplasms, ultrasound plays an important role in terms of prevention, as it can provide useful information for the early diagnosis of a variety of diseases and conditions. Any newly identified lesion can be benign or malignant. Some of the benign formations can be diagnosed through the analysis of ultrasound images (i.e. angioma, cyst), others can be discovered during this same diagnostic exam however they might require following second level radiological analyses (for example CT scan with contrast medium) and third level analyses (Magnetic Resonance Imaging), up to the PET scan mainly used to monitor organs that are already under treatment
Available medical devices
Classic 2D ultrasound
MediClinic uses a high-performance two-dimensional ultrasound system for the diagnostic investigation: the second harmonic frequencies allow to carry out investigations with a high spatial resolution, enabling the identification of elements that are very close to each other and the reaching deep anatomical areas. These characteristics are possible by regulating a series of parameters, such as the intensity of the ultrasound beam and the wave frequency. In the ultrasound, the higher the frequency, the less the field is able to go in depth, however clearly identifying points that are close to each other. By lowering the frequency, it is possible to reach greater depths, obtaining in most cases a good compromise in terms of resolution.
MediClinic has made available to its specialists the Vivid E9 ultrasound system, a high performance digital ultrasound imaging system produced by General Electrics. It is among the most advanced devices for both basic (two-dimensional) and three-dimensional ultrasound examination. The three-dimensional ultrasound has introduced a significant innovation. In fact, compared to the standard two-dimensional ultrasound, the three-dimensional ultrasound examination is much more advanced because it allows the physician to visualize the spatial depth and to dynamically study anatomical structures during the examination (that is therefore no more limited to the post-processing phase). This method adds information that increases the specificity and sensitivity of the exam, making the diagnosis safer.
The only impact that the 3D ultrasound examination has on the patient involves its duration: since this methodology offers many different diagnostic possibilities, it lasts approximately half an hour, compared to 20 minutes of the classic two-dimensional ultrasound.
Thanks to the innovative equipment available at MediClinic, specialists can perform ultrasound-guided treatments, that is, administered under the guidance of the ultrasound. This methodology allows the physician to easily reach the organ that needs to be treated, providing both the specialist and the patient the certainty that the treatment is as accurate and precise as possible. In particular, Pain management and ozone therapy treatments are available.
Infiltration therapy, guided through diagnostic imaging. Most of the procedures are guided by an ultrasound study that allows the physician to follow the needle entry site in real time and to intervene in the exact point where the problem is located. Some treatments are curative, others only symptomatic, with the aim of delaying surgery, such as in the case of rhizoarthritis, knee and hip osteoarthritis. All musculoskeletal diseases can be treated with infiltration treatments: from osteoarthritis due to anatomic alterations on patients of all ages, previous traumas or chondropathy (use of hyaluronic acid), up to wrist-hand conditions such as De Quervain's syndrome, trigger finger, carpal tunnel syndrome. Infiltration treatments often manage to avoid surgical DRG, achieving the same results.
The ultrasound-guided infiltrations are flanked by blind ones, where the orthopedic specialist is able to perform the infiltration inside the joint only in 50% of cases. The possibility of guiding the needle from the entry point to the injection point with the use of the ultrasound ensures the correct execution of the procedure. These conditions, that often impair sleep, can be treated without surgery. The procedure involves inserting one or two needles into the calcification, depending on the size. A lavage inside the calcification is then created, with recirculation, then the calcium salt is collected inside a bag and removed. These operations prevent the future formation of calcifications in the same area. The origin of the calcification depends on different factors, for example poor oxygenation within the joint favors the transformation of some cells (chondrocytes) into calcific tendinitis. This condition is an attempt performed by the body to adapt to a low oxygen content. It is also important to remember that calcifications follow a mutation over time: that is, they are characterized by a formation, stabilization and reabsorption phase. Pain is perceived when the calcification breaks and the migration of the calcium crystals takes place, in particular around the points where the nerve endings are located, causing pain stimuli (at the level of the shoulder, knee and other joints).
Ozone therapy is the treatment of soft or bone tissues with ozone, a gas that causes rapid oxidation of the tissue. Ozone is obtained by ionization starting from oxygen and has a very high oxidizing power. The tissue oxidation has multiple effects. At MediClinic this technique is applied to the musculoskeletal system, for example to treat conditions affecting the spine. In cases of disc conditions (herniated disc) the following steps are performed:
- The infiltrative treatment is performed only after identifying the areas on the spine that need to be treated. The patient suffering from disc conditions undergoes a CT / MRI scan, in order to identify the point where the herniated disc is located.
- Once the hernia distribution has been mapped, the patient lies on the bed in a prone position. With the use of the ultrasound, the access points are located based on the position of the spinous process. The skin surface is then marked to identify the exact insertion point.
- In normal conditions, the needle is inserted in the subcutaneous plane without reaching the paravertebral muscles, stopping on the myofascial plane that separates the long muscles of the back. The ozone mixture is then inoculated (25 micrograms per 100 micrograms of oxygen) in a concentration ranging from 10 to 25 micrograms/ml, which tends to be distributed along the cleavage planes in the fat tissues that separate the muscle groups, reaching the root zone within 3 minutes.
- The hernia is not touched, however it is possible to block the chain action linked to the inflammation (through the interleukins, the pain mediators).
With this procedure, the patient no longer feels pain and the hernia will follow its normal development through expulsion and dehydration. Once the hernia is expelled, as it is no longer supplied by blood, it dries up. Nowadays, surgery on herniated discs is avoided, unless these are paralyzing, preferring the administration of drugs that are often maintained for many years. With MediClinic’s ozone therapy sessions, it is possible to tackle these conditions with a different method that allows the patient to restore limb mobility with a limited number of sessions. The WHO does not recognize ozone as a drug, however the only areas in which ozone therapy is not recommended are those used systemically (large and small autotransfusion treatments) and in case of patients suffering from an enzyme deficiency. The ozone infiltration inside a joint cavity or tissue has no contraindications because it involves a local distribution of gas, persisting in the form of ozone for a limited time before turning into oxygen (about 5 minutes).