Textbook of diagnostic ultrasonography

Textbook of diagnostic ultrasonography

Ultrasound in Med. & BioL, Vol. 5, lap. 299-303 Pergamon Press Ltd., 1979, Printed in Great Britain BOOK REVIEWS A U S E R ' S G U I D E TO D I A G N...

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Ultrasound in Med. & BioL, Vol. 5, lap. 299-303 Pergamon Press Ltd., 1979, Printed in Great Britain

BOOK REVIEWS A U S E R ' S G U I D E TO D I A G N O S T I C U L T R A S O U N D I. M. SHIRLEY, R. J. BLACKWELL, G. CUSICK, D. J. FARMAN, F. R. VICARY Pitman Medical Publishing Co., Ltd. 329 pp. £12:00

This is a useful book, written by three physicists, an obstetrician and a gastroenterologist. As expected, the real strength of this book lies in the physics and instrumentation. This is explained in simple terms which the novice should be well able to understand, yet complicated instrumentation is adequately covered. The book starts with a glossary of technical terms and this in itself is extremely valuable. The level of the book is very basic and could be read with profit by all who envisage entering the ultrasound field, either in a technical or medical capacity. The first nine chapters are devoted to the basic technical principles, while another five chapters are on practical technical and nonclinical subjects. This leaves only five chapters on clinical subjectsu three of these on obstetrical and gynecological scanning. The technical quality of the scans leaves much to be desired for a 1978 text, but the basic material on obstetrics at both the elementary and advanced levels is well written and adequate. The few pages on pelvic masses, however, are inadequate for a section on gynecology, and unfortunately these deficiencies in the clinical section become more marked in the two chapters on the rest of the abdomen. Again, the technical quality of the scans is suboptimal. Obviously in so short a space it is impossible to cover the liver and biliary tree adequately. However, if anything, the second chapter on the abdomen (kidneys, adrenals, aorta,

pancreas) is the worst chapter of all. The difficulties of scanning the upper poles of the kidneys, in particular the left kidney, are referred to several times but nowhere does the author suggest that the patient should be scanned in the decubitus position. Scans of the kidney show no suggestion of the fine intrarenal anatomy that has been described in recent years. The pancreas section is also poor, and contains some frank errors such as "The superior mesenteric vein and splenic vein coalesce in front of the head of the pancreas..." instead of posterior to the neck of the pancreas. The method of finding the pancreas on parasagittal scans may be the reason why the authors find it so difficult to find the pancreas at all. The authors do not use the splenic vein or left renal vein to find the pancreas, as most people now do. The final 1-1/2 pages on the spleen, again, do not advocate the use of the decubitus position for intercostal scanning. In summary, this is a very useful book which achieves its stated purpose of familiarizing a beginner with the essential physical principles and limitations of the technique. I strongly advise my students to read this book, excluding, of course, the chapters on the abdomen.

Yale New Haven Hospital New Haven Connecticut U.S.A.


TEXTBOOK OF DIAGNOSTIC ULTRASONOGRAPHY By SANDRA L. HAGEN-ANSERT, illustrations by E. P. Teichman, C. V. Mosby Co., St. Louis. 432 pp. 1200 illus. $44.50 (U.S.). The author of this book is the senior sonographer in charge of ultrasound education at one of the prime ultrasound teaching institutions in the U.S.A. She has been involved in routine ultrasound, ultrasound research and teaching for many years, and has drawn upon her great experience to compile this book. In her preface she suggests that the book is aimed at the sonographer and it is not clear whether she intended to include medically qualified practitioners of this art as well as

ultrasound technicians. The thoroughness with which she covers anatomy, pathology and physiology will be valuable to both technicians and physicians. The book is divided into five main sections, the first covering the principles of ultrasound, the second cardiac, the third abdomen, the fourth pelvis, and the thyroid and vascular studies being included in the fifth section. One of my first surprises in reading this book was to see the somewhat unusual balance between the various sec299


Book Reviews

tions. Approximately one third of the book is devoted to abdominal ultrasound, obstetrics receives only 6.5% of the book whereas cardiology occupies over 40%. I would have assumed that when writing a book encompassing all aspects of ultrasound the author would have attempted to achieve a balance which more accurately reflects the normal workload of an ultrasound department. The quality of the different sections of this book varies considerably and I will briefly review each in chronological order. Part 1 covers the basic principles, physics and instrumentation of diagnostic ultrasound. These topics are included in most ultrasound text books, presumably in an attempt to achieve a complete text. It is doubtful whether it is now necessary for every book to include such a section. However, Part 1 of this book is fairly comprehensive yet moderately concise. The basic formulae and essential principles which it is advisable for ultrasound practitioners to understand are all presented and discussed in moderate detail with useful similes where necessary. Any ultrasonographer using this book as their first introduction to the subject will find this section very adequate. Section 2 incorporates echocardiography and, as mentioned above is the largest section of this book. The section is introduced by a concise review of the anatomy and physiology of the heart which is both readable and useful. The technique for echocardiography is then discussed with valuable advice about the positioning of the patient, and ultrasound transducer to optimize detection of the various intracardiac structures. The authors then present the standard format which they employ for the recording of data obtained at cardiac ultrasound examinations, and these forms will be useful to anybody setting up an ultrasound service. The author then discusses in sequence the use of ultrasound for the investigation of specific intracardiac structures, and concludes with a presentation of a number of interesting case histories. There are well over 200 illustrations of both normal and abnormal echocardiograms with a minimum of text. It is difficult to be certain of the real value of this section as it is rather too superficial for the cardiac physician yet is possibly too comprehensive for the majority of cardiac ultrasound technicians. However, since the author is known to set her sights very high those technicians wishing to emulate her will go a long way towards achieving this goal if they manage to assimilate the majority of the information referred to in this section. Part 3 presents the use of ultrasound in the abdomen and is prefaced by a review of the abdominal anatomy with special reference to the liver, pancreas, spleen, digestive tract, vessels and kidneys. There are well reproduced and annotated photographs of cadaver sections which I found extremely useful, and are certainly more valuable than many of the sections included in the now

popular atlases of transverse axial anatomy. Ten longitudinal cadaver sections are also included, but these are rather small, and lacking in detail and are therefore unfortunately of rather limited value. Having reviewed the scanning protocol for various anatomical regions and discussed the different forms of artifacts which may appear in the images the clinical use of ultrasound in the different abdominal organs is then systematically reviewed. The quality of the illustrations is generally high though some are presented as black on white whilst others consist of white echoes on a black backround. A moderately wide range of pathology is included and I found the whole of this section both interesting and easy to read. The pelvis and its contents are presented in Part 4 and probably constitute the weakest section of the book. Pelvic masses are disposed of with less than 350 words of text whilst inflammatory disease receives a mere 9 lines. Most practitioners performing gynaecological ultrasound examinations will find this text of little if any value. Obstetricians will also be rather disappointed in the rather cursory and sometimes inaccurate treatment of their subject. We are told that the fetal spine becomes visible at 20 weeks of gestational age, but this statement ignores the fact that many ultrasonologists are now routinely screening for spina bifida at 15 to 16 weeks. Perhaps one of the major uses of ultrasound in obstetrics is for the monitoring of fetal growth, and regrettably this subject is also given inadequate treatment. Only passing reference is made to fetal trunk measurements whereas biparietal diameter measurements are g i v e n more thorough discussion. I must however express considerable disquiet at the statement that "there is also a high degree of correlation between the biparietal diameter and fetal weight." This statement just is not true despite the fact that we are presented with a large table to permit conversion of B.P.D. measurements into fetal weights to the nearest 0.1 of a gram with no standard deviations. The author clearly has some serious misconceptions about the value and limitations of B.P.D. measurements. The final section covers the use of ultrasound in thyroid diagnosis and reviews Doppler techniques. The thyroid ultrasonograms are rather indifferent in quality, and again give rather cursory treatment to this important area of ultrasound diagnosis. The 8 pages devoted to Doppler techniques consists exclusively of text and line diagrams and again is too superficial to be of any real value. Surely it would not be unreasonable to expect the inclusion of at least some sonograms and ultrasound vessel images? There are two useful appendixes at the back of the book with some useful comments on the educational requirements for ultrasound and there is an extremely comprehensive and valuable bibliography. The best features of this book are the high


Book Reviews standards of its production, and the good quality and well reproduced ultrasonograms. My major reservations concern the extraordinary imbalance between the different sections of the book, and the fact that it appears often too comprehensive for the sonographer yet too superficial for the physician. Technicians will find a great wealth of useful tips and information in these pages, and in general the book can be strongly recommended to them.

The deficiencies in content belie the use of the term "textbook" and will severely limit its value to ultrasound physicians.

Clinical Research Centre Watford Road Harrow Middlesex HA 1 3 W England.


ATLAS OF GRAY SCALE ULTRASONOGRAPHY By KENNETH J. W. TAYLOR. Churchill Livingstone, New York, 1978. 411 pp. £19:50. After a concise introduction to the principles and techniques of clinical diagnostic ultrasound Bscanning, the author immediately starts with case studies of liver disease for which he is well known. Text of the normal anatomy is brief. The accompanying gray scale B-scans are outstanding and illustrate the point being discussed. Good illustrations (done by the author's wife) accompany the B-scan images, often with more shading than the ultrasound images. Marker location diagrams of the torso are good and indicate the anatomic area of the B-scan tomogram. The pancreatic chapter includes a section of normal anatomy and illustrates the vessels in the upper abdomen. The case material is good. In the renal chapter, several bistable B-scan images appear which illustrate the improved gray scale imaging now possible. Several algorhythms for the evaluation of renal mass lesions and nonfunctioning kidneys are presented at the end of this chapter. Near the end of the atlas, in the pelvic section, the coverage of obstetrics and gynecology is sparse. There are a number of near empty pages with minimal text opposite the ultrasound images. An exception to this is the section on the biparietal fetal head diameter scanning technique which is

excellent. The practical points and the information regarding the transducer angulation are most useful for individuals scanning obstetric patients. The thyroid chapter is brief and appears to be added a s an extra in a predominantly abdominal text. Deficiencies include areas not covered such as trauma or post-operative complications in the abdomen and the sparse bibliography at the end of the introduction to each section. There are no reference notations. This is a reference atlas, best for the upper abdomen, the liver, spleen, and pancreas. Excellent gray scale B-scan images of the liver, biliary system, spleen and kidney make this a useful atlas for the physician or student entering the field of abdominal diagnostic ultrasound or the experienced clinician comparing their individual gray scale B-scans to the author's excellent examples.


Department of Radiology Division of Diagnostic Ultrasound Thomas Jefferson University Hospital PA 19107, U.S.A.

ATLAS OF ABDOMINAL ULTRASONOGRAPHY IN C H I L D R E N GARY F. GATES. Churchill Livingstone, Edinburg. 282 pp. 109 Fig. £16.50. With the profusion of books on ultrasound, of varying quality, it was a pleasure to review this book which is devoted to one subspeciaity area of ultrasound, that is, pediatrics. The author did not attempt to wander out of his area of expertise, but in fact limited this book to ultrasound of the abdomen including the retroperitoneum and pelvis in the pediatric patient from birth up through adolescence. While this is called an ATLAS, I was very pleased with the extent of the text that accompanied the images. The book is very well

organized. Each of the descriptions in the sections follows a uniform format and is easy to read. The concepts of going into the various modalities that could be used, i.e. nuclear medicine, X-ray, and ultrasound will be most helpful to the clinicians in helping to decide which imaging procedure might be first used, as well as to the actual users of ultrasound in pediatrics in developing a fuller understanding of the approaches to a proper examination. Going into the anatomical and pathological abnormalities that go to form the