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Allan, Grant M. Baxter and Michael J. Weston to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act No part of this publication may be reproduced or transmitted familial cancer service royal derby hospital any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher.

Notices Knowledge and best practice in this field are constantly changing.

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As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein.

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In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided i on procedures featured or ii by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications.

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It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. The flexibility, ease of use, range of applications and relatively low cost of the equipment make ultrasound an important investigative imaging tool.

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The first and second editions of this book, edited by David Cosgrove, Keith Dewbury, Hylton Meire and Pat Farrant, were a great success, providing information and advice across the full range of diagnostic ultrasound. They were essential reading for those training in ultrasound and a source of information for many sonographers and sonologists across the world.

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Techniques, hardware and data processing have all evolved and progressed at a rapid rate since the second edition of this book was published in As a result of these developments, ultrasound equipment is now available in more sizes, specifications and complexity than ever before and this has enabled many different types of clinician to use ultrasound in particular niche areas, in addition to the more general imaging function that it has always provided.

The chapters in the two volumes of this book cover all aspects of general ultrasound, as well as more specialised areas such as peripheral vascular and ophthalmic ultrasound.

Some areas, such as musculoskeletal ultrasound, have developed into major applications of ultrasound and this is now essential to the management of patients with a wide variety of muscle and joint disorders. There has familial cancer service royal derby hospital been a significant enhancement of the coverage of these areas in this new edition.

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Conversely, detailed fetal and maternal obstetric scanning in the mid and final trimesters has followed cardiac echography into a separate sphere of expertise. There are many excellent text books dealing with these aspects, therefore, the editors felt that a comprehensive review of obstetric scanning was best left to these volumes. However, first trimester problems will still be seen by sonographers undertaking general scanning so an account of these is included in this book.

The potential applications of echo enhancing agents, or microbubbles, have developed and changed significantly since the publication of the second edition of this book.

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Originally developed to rescue inadequate Doppler examinations, interesting properties of these agents have led to potential uses delivering drugs and genes. The editors of the third edition of Clinical Ultrasound are extremely grateful to the many experts in their particular fields of ultrasound who have contributed the authoritative, comprehensive and informative chapters that make up this book.

In particular, our thanks go to Ian Beggs, David Pilling and Norman McDicken, who were responsible for coordinating the musculo­ skeletal, paediatric and physics sections of the book. We are also very grateful to Michael Houston, Ben Davie and all the other staff at Elsevier who have worked on the many aspects of publication between the first outline discussions and the final published product.

McDicken and T. Several texts exist which readers can consult to deepen their understanding. Values of these parameters for commonly encountered tissues and t virus vs las plagas are quoted for more values see Duck6 and Hill et al.

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The clinical user is not required to have a detailed knowledge of these values but some knowledge helps in the production and interpretation of ultrasound images and Doppler blood flow measurements. Basic physics is also of central importance in considerations of safety.

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Virtually all types of vibration are referred to as acoustic, whereas those of too high a pitch for the human ear to detect are also called ultrasonic. We therefore use frequencies in the range 20 kilohertz 20 kHz to 50 megahertz 50 MHz. We most commonly encounter audible acoustic waves produced by the action of a vibrating source on air vocal cords, loudspeaker, musical instruments, machinery.

Familial cancer service royal derby hospital medical ultrasound the source is a piezoelectric crystal, or several, mounted in a hand-held case and driven to vibrate by an applied fluctuating voltage. Conversely, when ultrasound waves strike a piezoelectric crystal causing it to vibrate, electrical voltages are generated across the crystal, hence the ultrasound is said to be detected.

The hand-held devices containing piezoelectric crystals and probably some electronics are called transducers since they convert electrical to mechanical energy and vice versa.

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They are fragile and expensive, about the same price as a motor car. Transducers are discussed more fully in Chapter 2. The great majority of medical ultrasound machines generate short bursts or pulses of vibration, e. Figure 1.

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