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Ultrasound

Ultrasound imaging, also known as sonography, uses high-frequency sound waves (too high for a human to hear) to produce images of the inside of the body.

Ultrasound images are seen as they are actually happening. They can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging does not involve ionizing radiation but occasionally uses sedation.

Ultrasound showing adrenal mass in pediatric neuroblastoma patient

Ultrasound showing adrenal mass in pediatric neuroblastoma patient

Uses of ultrasound

Diagnosis

Ultrasound can be used to aid in the diagnosis of pediatric cancers:

Ultrasound can also be used to guide needle biopsies used to diagnose tumors. Ultrasound is helpful because it can help doctors see the tumor’s involvement with surrounding blood vessels.

Very young patient undergoes ultrasound.

The technologist presses the transducer firmly against the patient's skin on the area that is to be examined.

Ultrasound imaging is performed to evaluate the

  • Appendix
  • Stomach/pylorus 
  • Liver
  • Gallbladder
  • Spleen
  • Pancreas
  • Intestines/colon
  • Kidneys
  • Bladder
  • Testicles
  • Ovaries
  • Uterus
  • Thyroid
  • Arteries and veins

Screening 

Some pediatric facilities use ultrasound to screen patients who have a genetic condition that predisposes them to developing tumors. For example, patients with Beckwith-Wiedemann, Denys-Drash, Frasier, and WAGR syndromes have a predisposition to developing Wilms tumor.

Close up of the ultrasound transducer with gel

A transducer sends sound waves traveling into the body. The waves are reflected back from organs and tissues, allowing a picture to be made of the internal organs.

How it works

An ultrasound technologist uses a probe called a transducer to see an image of the inside of the body. A transducer sends sound waves traveling into the body. The waves are reflected back from organs and tissues, allowing a picture to be made of the internal organs. 

  • For the ultrasound exam, the patient will lie down on an exam table with the area to be scanned exposed.  
  • A clear water-based gel is put on the area of the body being studied. This gel is not a contrast agent and is harmless. This gel helps the transducer make better contact with the skin. The gel might feel cold at first, and when the ultrasound is over, it will be wiped off. 
  • Next, the technologist presses the transducer firmly against the patient’s skin on the area that is to be examined. To get the best image, the technologist sweeps the transducer across that area.

Contrast studies

Some ultrasound exams use a contrast agent to aid in seeing the blood flow in the organs in the body.  

If the patient does not already have an IV or port, then the nurse will need to start an IV. If an IV is needed, the staff will talk to the parent and child before it is done.

The contrast agent that is used is a type of microbubbles, which are small particles that are about the same size as a red blood cell and are very visible on ultrasound imaging. This is a safe, effective way to enhance an ultrasound image.  The contrast agent is contained in a small 3 ml vial and has a milky appearance. Side effects are rare, and when they occur, they are mild and short lived (like a funny taste in your mouth). If parents have any questions about the use of microbubbles, they should ask the technologist or physician.

Doppler ultrasound

A Doppler ultrasound study may be a part of an ultrasound exam. Doppler ultrasound is a technique that shows blood flow through blood vessels, including the body’s major arteries and veins in the body. It is helpful in showing features such as

  • Objects blocking blood flow, such as clots
  • Blood vessels becoming more narrow
  • Tumors and defects in the blood vessels and vascular system
 Pediatric cancer patient walks to ultrasound room with dad, ultrasound technologist and Child Life Specialist

Ultrasound images are seen as they are actually happening.

What do patients do to prepare for an ultrasound?

  • Patients should wear comfortable, loose-fitting clothing. They may need to remove certain clothing or jewelry in the area of the body that will be examined, or patients may need to wear a hospital gown during the exam.
  • For an ultrasound of the liver, gallbladder, spleen, and pancreas, patients are instructed to not eat or drink for 6 to 8 hours prior to the test.
  • For ultrasound of the kidneys, bladder and pelvis, patients may be asked to drink up to 64 ounces of liquid 2 to 3 hours (without urinating) before the test to fill the bladder. The best liquid to drink is water. It might be hard to get a small child to drink 64 ounces, but the goal is to drink as much as possible without emptying the bladder.
 Pediatric cancer patient undergoes ultrasound with dad nearby

Childhood cancer patients will lie down on an exam table with the area to be scanned exposed.

Who reads the results and when will I get them?

A radiologist, a doctor trained to supervise and read radiology exams, will look carefully at the images. Then that doctor will send a signed report to the primary care doctor or other staff member who sent the patient for the exam. The primary doctor will share the results with the patient and parents. In rare cases, the radiologist may talk about the results at the end of the patient’s exam.

A follow-up exam may be needed so that any abnormality can be observed over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable over time.


Reviewed: June 2018