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by International Certification and Educational Accreditation Foundation |
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by International Certification and Educational Accreditation Foundation |
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TEMARIO: Guía de estudio para el exámen de certificación en ultrasonido Gineco obstetrico (el exámen se ofrece simúltaneamente en inglés y español).
NOTA: El temario es demasiado extenso..., conviene inscribirse a la brevedad para recibir TIPs sobre los
tópicos mas frecuentes y participar del curso propedéutico.
The percentage ranges that are shown are an indication of approximately how many questions on the examination may be included from that section of the outline.
I. Elementary Principles (8%-12%)
A. Nature of Ultrasound
1. Definition of sound
a. propagation of vibration
(1) compression
(2) rarefaction
2. Differentiation between audible sound and ultrasound
B. Frequency, Wavelength, Propagation Speed
1. Definition of terms
2. Relationships
C. Properties of Ultrasound Waves
1. Amplitude
2. Pressure
3. Power
4. Intensity
D. Decibels
1. Definition
a. related to intensity
b. related to amplitude
2. Numerical examples
E. Physical Units
1. Scientific notation
2. Metric notation (e.g., micro, Mega)
3. Common units
F. Measurement Dimensions
1. Distance
a. Linear
b. Circumference
2. Area
3. Volume
II. Propagation of Ultrasound through Tissues (10%-14%)
A. Speed of Sound
1. Average speed of sound in tissues
2. Range of propagation speeds in the body
a. air
b. soft tissue (average)
c. soft tissue: specific tissues (e.g., muscle, fat, parenchyma)
d. bone
B. Reflection
1. Characteristic of acoustic impedance - definition
2. Reflection and transmission at specular interfaces
a. interface size and contour (smooth or irregular)
b. dependence on angle
c. dependence on acoustic impedance mismatch
3. Scattering
a. definition of scattering
b. frequency dependence (Rayleigh scattering)
c. Interface contour (smooth or irregular)
d. contrast media
e. harmonics
C. Refraction
1. Definition of refraction
2. Dependence of angle
3. Dependence of velocity mismatch
4. Numerical example
D. Attenuation
1. Definition and sources of attenuation
a. Scattering
b. Absorption
1. heat
2. Measurement
c. Reflection
2. Typical values in soft tissue
3. Variation with frequency - numerical example
4. Effects on images
E. Useful Diagnostic Frequency Range
1. Numerical values
2. Tradeoff: penetration vs. spatial resolution
F. Terminology Associated with Image Characteristics
1. Echogenic (e.g., hyperechoic, hypoechoic, anechoic, isoechoic, etc.)
2. Homogeneity, Heterogeneity, etc.
3. Other
III. Ultrasound Transducers (17%-25%)
A. The Piezoelectric Effect
1. Definition and concept
2. Curie point
3. Piezoelectric materials
B. Transducer Construction and Characteristics
1. Thickness resonance of crystal
2. Operating (resonance) frequency
a. Crystal thickness
b. Speed of sound in crystal material
3. Frequency characteristics (spectrum)
a. Bandwidth
1. Quality factor
2. Effect of damping
b. Multi-Hertz
1. Harmonics
4. Damping
5. Matching layer-numerical example
C. Sound Beam Formation - Near Field and Far Field (Fresnel and Fraunhofer Zones)
1. Interference phenomena
a. Huygen's principle
b. diffraction (divergence)
c. Bandwidth
2. Length of near field (focal distance)
3. Shape of near field and far field
a. Beam width
b. Natural focus
4. Dependence on frequency and crystal or aperture size
D. Axial Resolution
1. Dependence on spatial pulse length/ pulse duration
2. Numerical example
3. Effect of damping
4. Transducer frequency spectrum-relation to pulse duration
5. Bandwidth
E. Lateral Resolution
1. Dependence on beam width
2. Frequency
3. Transducer size and focal characteristics
4. Range
F. Slice Thickness Resolution (Elevational Resolution)
1. Dependence on beam width
2. Transducer array and focal characteristics
3. Frequency
4. Lateral and axial resolution relationship
G. Focusing
1. Methods of focusing
a. Mechanical (internal and external)
b. Electronic (transmit and receive)
2. Focal zone characteristics
a. Focal distance (length)
b. Focal zone region
1. Maximum intensity
H. Transducer Arrays and Image Appearance
1. Mechanical and/or electronic construction
2. Multiple element construction
a. Linear array
b. Curved array
c. Annular array
d. Multi-dimensional array
3. Multiple element operation
a. Sequenced
b. Phased
c. Annular
d. Vector
e. Multi-dimensional
4. Beam Steering
a. Transmission time delays
b. Reception time delays
5. Beam focusing
a. Time delays
b. Dynamic reception focus
c. Multiple transmission foci
d. Apodization
e. Subdicing
f. Dynamic aperture
I. Transducer Care and Maintenance
IV. Pulse Echo Instruments (6%-10%)
A. Range Equation - General Concepts
B. Pulsing Characteristics
1. Pulse repetition frequency
2. Pulse repetition period
3. Pulse duration
4. Spatial pulse length
5. Duty factor
C. Transmitter (Output)
1. Effect of transmitter voltage on penetration
2. Effect of transmitter voltage on intensity and on patient exposure
D. Receiver
1. Amplification (overall gain)
2. Compensation (swept gain-TGC or DGC)
a. Attenuation with range
b. Effects on return signal and display
c. Dynamic frequency tuning
d. Harmonic processing
3. Compression
a. Dynamic range
1. Definition
2. Dynamic range (receiver)
a. Compare to other system components
b. Numerical values (dB)
4. Demodulation
a. Rectification
b. Smoothing (enveloping)
5. Rejection
V. Principles of Pulse Echo Imaging (6%-10%)
A. Principal Display Modes (A-mode, B-mode, 3-D, M-mode)
1. Definition of each mode
2. Information displayed on each mode
3. Advantages and disadvantages of each mode
B. Principles of Real-time, B-Mode Image Formation
1. Relationship between echo amplitude and B-mode display
2. Positioning of echoes
3. Harmonics
C. Scanning Speed Limitations
1. Applications of range equation and relationship to pulsing characteristics
2. Real-time systems-relationships between
a. Pulsing characteristics
b. Frame rate and time required to generate one frame
c. Number of lines per frame
d. Number of focal regions
e. Field of view (e.g., sector angle)
f. Image depth (penetration)
3. Temporal resolution, ability to evaluate rapid motion
VI. Images, Storage, and Display (10%-14%)
A. Role of scan converter
1. Image storage
2. Scan Conversion
B. Digital Devices
1. Binary system
a. Terminology (bits, bytes, pixels)
b. Discrete nature of binary numbers
2. Steps in processing echo information
a. Analog-to-digital converter
b. Digital memory
1. Spatial resolution
a. pixels
b. matrix
c. Field of view
2. Contrast resolution
a. Size of memory
c. Digital-to-analog converter
d. Display devices
C. Preprocessing versus Postprocessing
1. Definition
2. Preprocessing functions
a. Time (depth) gain compensation
b. Logarithmic compression
c. write magnification
3. Postprocessing function
a. Freeze frame
b. Black/white inversion
c. Read magnification
d. Contrast variation
4. Preprocessing or postprocessing functions (equipment manufacturers' discretion)
a. Persistence
b. Frame averaging
c. Edge enhancement
d. Smoothing
e. Fill-in interpolation
D. Display devices
1. TV monitors
2. High resolution monitors
a. Lines and spatial resolution
b. Brightness
c. Contrast
d. Frame rate
E. Recording and Archiving Techniques
1. Video Format
a. Display (monitors)
b. Single or multi-image cameras and laser imagers
1. Photographic film
2. Emulsion film
c. Recorders
1. Fiber-optic
2. Videotape cassette
d. Printer
1. Thermal
2. Laser
2. Digital format
a. Magneto-optical disc (digital still recorder)
b. PACS (Picture Achiving and communication systems)
3. Contrast and brightness control adjustments
4. Advantages and limitations of each type
VII. Hemodynamic, Doppler, Color Flow, and Color Power Imaging (10%-14%)
A. Hemodynamics
1. Energy gradient
2. Effects of viscosity, friction, inertia
3. Pressure/flow relationships
4. Velocity
5. Steady flow vs pulsatile flow
6. Laminar versus turbulent flow
7. Effects of stenosis on flow characteristics
8. Venous resistance
9. Hydrostatic pressure
10. Pressure/volume relationship
11. Effects of respiration (phasicity)
B. Doppler Physical Principles
1. Doppler Effect
a. Principle as related to sampling red blood cell movement
b. Doppler equation
2. Factors influencing the magnitude of the Doppler shift frequency
a. Range of the Doppler shift frequency
b. Effects of beam angle, transmitted frequency, flow velocity, and flow direction
C. Doppler Instruments
1. Continuous wave and pulsed wave Doppler
a. Differences
b. Advantages and disadvantages of each
1. Aliasing (Nyquist criteria)
2. Range ambiguity
c. Instrumentation
1. Receiver
2. Demodulater
3. Wall filter for clutter rejection
4. Directional devices
2. Duplex instruments-definition and basic principles
3. Spectral analysis
a. Purpose
1. Direction
2. Velocity
3. Duration
4. Character
5. Magnitude
b. Fast Fourier transform (FFT)
c. Diagnostic measurements (indices-i.e., pulsatility, resistive)
D. Color Flow Imaging
1. Basic Principles
a. Sampling methods
b. Display of Doppler information
1. Reflector direction
2. Average velocity
3. Velocity variance
c. Advantages and limitations
2. Instrumentation
a. Autocorrelation
b. Time domain processing
c. Color field size and frame rate
1. Ensemble length (packet size, pulse packet)
2. Line density
3. Maximum depth
d. Color maps, assignment, or coding
1. Hue
2. Saturation
3. Luminance (significance, brightness, intensity)
e. Artifacts (see section VIII)
E. Color Power (Energy) Mode
1. Displayed information
2. Advantages and limitations
VIII. Artifacts (6%-10%)
A. Definition of Artifacts
B. Artifact Recognition in Performing and Interpreting Examinations
1. Echoes not representing actual interfaces
2. Missing echoes
3. Misrepresented interface location
4. Misrepresented interface amplitude
C. Artifacts Associated with Resolution and Propagation (Axial Resolution, Lateral Resolution, Section Thickness, Acoustic Speckle)
1. Definitions
2. Mechanisms of Production
3. Appearance
D. Artifacts Associated with Propagation (Reverberation, Comet-tail, Ring-down, Mirror Image, Multipath, Side Lobes, Grating Lobes, Refraction, Speed Error; and Range Ambiguity)
1. Definitions
2. Mechanisms of Production
3. Appearance
E. Artifacts Associated with Attenuation (Shadowing, Enhancement, and Focal Enhancement or Focal Banding)
1. Definitions
2. Mechanisms of Production
3. Appearance
F. Artifacts Associated with Doppler and Color Flow Instrumentation (Aliasing, Slice Thickness, Reverberation, Mirror Imaging, Ghosting or Flash, Registration, Incident Beam Angle, and Clutter)
1. Definitions
2. Mechanisms of Production
3. Appearance
G. Other (Electronic Noise, Equipment Malfunction)
1. Definitions
2. Mechanisms of Production
3. Appearance
H. Artifact Effects on Measurements (velocity or speed error and range ambiguity)
IX. Quality Assurance of Ultrasound Instruments (4%-8%)
A. General Concepts Regarding the Need for and Nature of a Quality Assurance Program
B. Methods for Evaluating Instrument Performance
1. Test objects
2. Phantoms (tissue, Doppler, flow)
C. Parameters to Be Evaluated
1. Test object
a. Dead zone
b. Axial resolution and lateral resolution (beam width)
c. Depth calibration accuracy
d. TGC characteristics
e. Uniformity
f. System sensitivity
2. Tissue equivalent (mimicking) phantom
a. Dead zone
b. Depth calibration accuracy
c. Lateral (horizontal) distance measurement accuracy
d. Axial, lateral, and section thickness (elevational) resolution
e. TGC characteristics
f. System sensitivity
g. Dynamic range
h. Contrast resolution
i. Lesion detection
3. Doppler flow, string, or belt phantoms
a. Maximum depth
b. Pulsed Doppler sample volume alignment (gate position accuracy)
c. Velocity accuracy
d. Color flow penetration
e. Image congruency test
D. Preventive Maintenance
1. Standard precautions
a. Equipment
1. Cleaning
2. Disinfecting
3. Sterilization
E. Record Keeping
F. Statistical Indices
1. Sensitivity/specificity
2. Negative/positive predictive value
3. Accuracy
X. Bioeffects and Safety (6%-10%)
A. Acoustic Output Quantities
1. Pressure
a. Units (MPa, mmHg)
b. Peak pressures (compression, rarefaction)
c. Methods of determining pressure (miniature hydrophone)
2. Power
a. Units (mW)
b. Methods of determining power (radiation force, hydrophone)
3. Intensity
a. Units (mW/cm2, W/cm2)
b. Spatial and temporal considerations
c. Average and peak intensities
d. Methods of determining intensity (hydrophones)
e. Common intensities
(1) SATA
(2) SPTA
(3) SPPA
(4) SPTP
4. Intensity and power values for different operating modes
B. Acoustic Output Labeling Standard
1. Thermal index
a. TIS
b. TIB
c. TIC
2. Mechanical index
C. Acoustic Exposure
1. Definition and concepts of prudent use (ALARA)
2. Methods of reducing acoustic exposure
D. Primary Mechanisms of Biologic Effect Production
1. Cavitation mechanisms: relevant acoustic parameters
2. Thermal mechanisms: relevant acoustic parameters
E. Experimental Biological Effect Studies
1. Animal studies
2. In vitro studies
3. Epidemiologic studies
a. Limitations
F. Guidelines and Regulations
1. American Institute of Ultrasound in Medicine (AIUM) Statements (e.g., mammalian, epidemiology, in vitro)
2. National Electrical Manufacturers Association (NEMA)
3. Food and Drug Administration (FDA)
G. Electrical and Mechanical Hazards
1. Patient susceptibility to electrical hazard
2. Equipment components which could present a hazard
I. Obstetrics (Total 50%-60%)
A. First Trimester (6%-8%)
1. Gestational sac
2. Yolk Sac
3. Embryo (normal physiologic development/sonographic appearance
4. Ovaries (corpus luteum)
5. Cul-de-sac
6. Pregnancy failure
7. Ectopic pregnancy
B. Second/Third Trimester (Normal Anatomy) (8%-12%)
1. Cranial
2. Spine
3. Heart
4. Thorax
5. Abdomen
a. gastrointestinal
b. genitourinary
c. general
6. Extremities
7. Fetal Position
8. Other
C. Placenta (1%-5%)
1. Development
2. Position
3. Anatomy
4. Membranes
5. Umbilical cord
6. Abruption
7. Previa
8. Masses & lesions
9. Maturity/grading
10. Doppler
11. Physiology
12. Accreta
D. Assessment of Gestational Age (2%-6%)
1. Gestational sac
2. Embryonic size/crown-rump length
3. Biparietal diameter
4. Femur length
5. Abdominal circumference
6. Head circumference
7. Transcerebellar measurements
8. Binocular measurements
9. Cephalic indices
10.Fetal lung maturity
11. Other
E. Complications (6%-10%)
1. Intrauterine growth retardation
a. symmetrical
b. asymmetrical
c. nonstress test
d. biophysical profile
e. Doppler flow studies
2. Multiple gestations
a. diamniotic
b. monoamniotic
c. complications
3. Maternal illness
a. gestational diabetes
b. diabetes mellitus
c. hypertension
d. other
4. Antepartum
a. preterm labor
b. premature rupture of membranes
c. RH isoimmunization
d. cervix related
e. other
5. Fetal therapy
a. fetal blood sampling/transfusion
b. other
6. Postpartum
a. hemorrhage
b. infection
c. caesarean section
d. other
F. Amniotic Fluid (1%-5%)
1. Assessment
2. Polyhydramnios
3. Oligohydramnios
4. Fetal pulmonic maturity studies
G. Genetic Studies (1%-3%)
1. Maternal serum testing
2. Amniotic fluid testing
3. Chorionic villus sampling
4. Dominate/recessive risk occurrence
H. Fetal Demise (0%-3%)
I. Fetal Abnormalities (10%-15%)
1. Cranial
2. Facial
3. Neck
4. Neural tube
5. Abdominal wall
6. Thoracic
7. Genitourinary
8. Gastrointestinal
9. Skeletal
10. Cardiac
11. Syndromes
12. Other
J. Coexisting Disorders (0%-3%)
1. Leiomyoma
2. Cystic
3. Trophoblastic disease
4. Solid/mixed
5. Myometrial contraction
6. Other
II. Gynecology (Total 40%-50%)
A. Normal Pelvic Anatomy (10%-15%)
1. Uterus
a. corpus
b. endometrium
c. cervix
d. vagina
2. Ovaries
3. Fallopian tubes
4. Supporting structures
5. Cul-de-sac
6. Vasculature
7. Doppler flow
8. Gynecology related studies
a. gastrointestinal
b. genitourinary
B. Physiology (6%-15%)
1. Menstrual cycle
2. Pregnancy tests
3. Human chorionic gonadotropin (hCg)
4. Fertilization
C. Pediatric (1%-5%)
1. Precocious puberty
2. Hematometra/hematocolpos
3. Sexual ambiguity
4. Other
D. Infertility/Endocrinology (2%-6%)
1. Contraception
2. Causes
3. Medications and treatment
4. Ovulation induction (follicular monitoring)
5. ART (Assisted Reproductive Technology), GIFT, IVF, ZIFT
E. Postmenopausal (6%-10%)
1. Anatomy
2. Physiology
3. Therapy
a. hormonal replacement
4. Pathology
a. hyperplasia
b. polyps
c. endometrial cancer
d. ovarian cancer
e. other
F. Pelvic Pathology (6%-10%)
1. Congenital uterine malformation
2. Uterine masses
3. Ovarian masses
4. Endometriosis
5. Polycystic ovarian disease
6. Inflammatory disease
7. Doppler flow studies
8. Gynecology related studies
a. gastrointestinal
b. genitourinary
9. Other
G. Extra-pelvic Pathology Associated with Gynecology (1%-3%)
1. Ascites
2. Liver metastasis
3. Hydronephrosis
4. Other
III. Patient Care Preparation/Technique (Total 1%-5%)
A. Review Charts
B. Explain Examinations
C. Supine Hypotensive Syndrome
D. Bioeffects
E. Infectious Disease Control
F. Scanning Techniques
G. Artifacts
H. Physical Principles
I. Instrumentation and Ultrasound Physics (12-18%)
A. Doppler equation
B. Continuous-wave/Pulsed wave Doppler
C. Spectral waveform analysis
D. Color/Power Doppler
E. B-mode imaging
F. Artifacts
II. Extracranial Cerebrovascular (22-28%)
A. Carotid/vertebral
B. Brachiocephalic vessels
III. Intracranial Cerebrovascular (1-4%)
A. Transcranial Doppler
IV. Peripheral Venous – Upper and Lower Extremity (17-23%)
A. Physiologic Testing (plethysmography)
B. Duplex Imaging
V. Peripheral Arterial – Upper and Lower Extremity (12-18%)
A. Physiologic Testing (segmental pressures/plethysmography)
B. Duplex Imaging
VI. Visceral Vascular (7-13%)
A. Aorta
B. Mesenteric/Renal
C. Hepatic/portal
D. Liver/Kidney transplants
VII. Special Testing (5-11%)
A. Aortic endografts
B. Intraoperative assessment
C. Graft surveillance
D. Dialysis grafts
VIII. Quality Assurance and Ultrasound Safety (2-8%)
A. Test validation
B. Bioeffects of ultrasound
