Anatomy – The foundation of ultrasound imaging

Ultrasound is the most accessible, and the most utilised, of all medical imaging. Miniaturisation has reduced the cost and the portability such that anatomical imaging is now available in places we would never have ventured in the past. Today, it is possible to image a growing fetus in the middle of desert with no wired electricity; or to image the chest of a sailor on a yacht in the middle of the ocean to identify whether they have a ruptured aortic aneurysm; or to determine the extent of internal bleeding of an injured soldier in the middle of a warzone; or to identify a child in a remote location that is suffering from rheumatic heart disease and needs life-preserving penicillin treatment. Diagnostic ultrasound should be available to everyone, and everywhere, but the image quality may not be the same, and we may be restricted to simple black and white anatomy.

Since my career with ultrasound began, we have moved from being able to image the anatomy in two dimensions with limited functional assessment, to three-dimensional moving images with blood flow measurement and tissue motion detection, to name but a few innovations. We use ultrasound beyond diagnosis, to predict prognosis and to plan treatment strategies, but the new wave of handheld transducers has brought us back to the beginning and reminds me that anatomy is key. The so much clinical information can be obtained from simple grey scale anatomical pictures. Anatomy remains the foundation of ultrasound imaging.

In this issue of AJUM, we are reminded that underlying anatomical knowledge is key to important clinical decisions. Ward et al.¹ use ultrasound to document the migration of the placental cord insertion during pregnancy and suggest that this should be routinely reported on antenatal ultrasound examinations.

Fenech et al.² present a detailed review article about anatomy and ultrasound appearances of femoral and saphenous veins, and their branches, and advocate for users to become familiar with the normal appearances in order that we may accurately identify abnormalities. The imaging of nerves is increasingly being utilised as a tool for nerve blockade. Ultrasound anatomical imaging is frequently used to assist procedures. and Zanfini et al.³ present a series of over 500 intrathecal injections where ultrasound was used to help identity the injection site. Although intravenous access can be done without ultrasound imaging, would you want to ignore the benefits of improved precision with anatomical image guidance?

I, like many student sonographers, learned and refined my anatomical knowledge while looking at ultrasound images. I watch as newly qualified doctors remembering their anatomy as they look at an ultrasound screen. And increasingly, ultrasound is being applied in medical schools to supplement medical students' anatomy learning. Anatomy is the heart of what ASUM members and AJUM readers use ultrasound for each day.