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Next, I'm going to talk about mechanisms

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for obtaining and optimizing breast ultrasound images.

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So, what are some general ultrasound settings for breast ultrasound?

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Essentially, we want to have the gain settings, focal zone selections, and field

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of view optimized to obtain high-quality images.

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Patients should be positioned to minimize

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the thickness of the portion of the breast being evaluated.

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So for example, if you are scanning the lateral part of the breast,

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it's good to have the patient in decubitus position with the lateral

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part of the breast up, so that the thicker parts of the breast

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fall medial and you are only scanning the thin parts of the lateral breast.

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We want high-resolution, real-time, linear-array, broad-bandwidth transducer.

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The central frequency is recommended to be

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at least 12 megahertz or higher, and the highest frequency capability for adequate

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penetration to the depth of interest should be used.

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So also think about where you're scanning.

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For evaluation of superficial lesions,

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again, you want to make sure you think about where you're scanning and you want

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to use a standoff pad or a thick layer of gel, which may be helpful.

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And we know for a lot of patients,

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we look at sebaceous cyst in the skin, we look at skin thickening,

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so when you're worried about these things,

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you want to make sure you use a standoff device of some form.

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So when we look to optimize ultrasound images,

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we want to look at adjusting the image

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depth and zoom, signal gain, which is signal amplification,

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the frequency of ultrasound waves used, image focus and frame rate.

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So for adjusting image depth and zoom, reducing the depth results in an increased

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frame rate, leading to enhanced resolution.

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So, if you decrease the depth, you're going to get a nicer picture.

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However, sometimes you can't decrease the depth because of where the image is

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located in wanting to look at the image closer.

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So, the important thing to know is once you locate what you're looking for,

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your lesion of interest or region of interest, you want to zoom in on it.

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The problem is, when you zoom in, you're going to get decreased resolution.

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And that's fine because you've already done a survey of the big area

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with high resolution to make sure there's nothing abnormal.

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You only zoom in once you find something

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abnormal and you'd zoom in for each abnormal area.

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So if you're doing a survey of the right upper or outer quadrant, let's say,

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you're scanning in at a zoomed out range so that you have really good

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resolution of that image so you can see abnormalities.

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Once you find an abnormality,

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then you can zoom in on it and do your measurements and make a nicer picture

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to look at, because you know you don't worry about missing stuff

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on the outside because you've already looked at that when you were zoomed out.

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So that's really important.

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So zoom in, decreased resolution.

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Zoom out, increased resolution.

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And here's an example of that.

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So, this is just a little area of tissue with some maybe ductal ectasia in it.

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And this is the zoomed out image on my left.

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And you can see lots of resolution,

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everything's very crisp, everything is lovely.

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We've got the skin up here.

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We're getting closer to the chest wall in the lung down here.

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Now we zoomed in on this central area, and when we zoomed in on this central

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area, this area of ductal ectasia, you can see how the borders get fuzzy.

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Things aren't as crisp.

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So we're losing resolution by zooming in.