Exploring Specializations in Sonography: Beyond the Basics

Sonography is an important healthcare practice that is integral to diagnostics and treatment. This field is far more diverse than people may realize, and it takes targeted skills and knowledge to successfully complete a myriad of medical imaging exams. Aspiring healthcare professionals who take the time to develop these skills can be rewarded with a wonderful career path that includes several compelling job opportunities and, of course, the chance to help a variety of patients.

Interested in becoming a medical sonographer but not quite sure where to start? In this guide, we’ll answer all your questions surrounding medical sonography as a career path: What is sonography — and what, exactly, distinguishes its common branches? You’ll emerge with a clear understanding of what ultrasounds accomplish and why they are so essential.

What Is Medical Sonography, and What Are the Different Types?

Medical sonography is a common form of imaging that relies on sound waves to produce diagnostic ultrasounds. This differs considerably from other forms of imaging, which often involve some level of radiation exposure. According to the Society of Diagnostic Medical Sonography, this imaging strategy is used to “gain advanced insights into the inner workings of the body” and is, after X-rays, the most common form of diagnostic imaging relied on in the modern healthcare field.¹

While today’s sonography solutions incorporate advanced technology, the field remains reliant on the simple science of the sound wave. Sonographers are responsible for beaming high-frequency waves into the body. These waves bounce off tissues and are eventually used to form detailed, high-quality images that can be used to detect and diagnose a variety of illnesses and conditions.

How this occurs varies between specialties. Below, we have highlighted several forms of medical diagnostic sonography, along with the specific concerns they are used to identify.

Knowing How to Navigate the Abdominal Sonography

Abdominal sonography is one of the most commonly sought-after forms of medical imaging. According to Johns Hopkins, this ultrasound solution allows for the “quick visualization of the abdominal organs and structures from outside the body” and can “also be used to assess blood flow to abdominal organs.”²

What Is It?

Meant to assess the pancreas, liver, gallbladder and other internal structures of the abdomen, this type of medical imaging relies on sound waves to provide a thorough overview while also helping to diagnose or rule out a wide array of potential conditions.

This is a common screening solution for abdominal aortic aneurysms, which involve enlarged areas near the aorta. Abdominal ultrasounds are frequently used as aneurysm screenings for men over the age of 65 — particularly those who currently smoke or have smoked in the past.

How Do You Use It?

Abdominal sonography looks, in many respects, like the ultrasound procedures typically associated with pregnancy (which we’ll cover in detail below). Patients are placed on their backs, with specialized gels applied to their abdomens to facilitate higher-quality images.

A handheld wand (known as a transducer) is then applied to the relevant parts of the abdomen, where it glides over the skin while sending high-frequency sound waves. These bounce off organs, soft tissues and other key structures, with the sonographer assessing the size, texture and characteristics of organs such as the liver, spleen and gallbladder.

Obstetrics and Babies

When the average person outside the healthcare field pictures ultrasound procedures, they almost certainly think of the highly anticipated imaging appointments that women undergo during pregnancy.

These ultrasounds are important for checking the health of the mother and the baby, of course, but this can also be a time of great excitement for the mom-to-be. Obstetric sonography provides valuable peace of mind or, if concerns are detected, ensures that they are addressed promptly.

What Is It?

Sometimes referred to as prenatal imaging, obstetric ultrasounds involve sound waves that create adorable images of fetuses at various stages of pregnancy, as well as the mother’s ovaries and uterus. This is the preferred solution for monitoring mothers and babies throughout the course of a pregnancy, in part because there is no need for ionizing radiation.

How Do You Use It?

While urgent matters may call for more frequent ultrasounds, it is common practice for healthy women to take part in two main scans while pregnant: one during the first trimester (with the main goal of confirming the pregnancy and determining the due date) and another around twenty weeks (to provide insight into the anatomy, including the sex, of the baby).

In both cases, the procedure will, at the outset, resemble that of a typical abdominal scan: the patient will have gel applied to the abdomen and then the sonographer will glide a transducer over the area to provide a real-time view of the baby and the uterus.

What, exactly, is observed during the scan will depend on when and why it’s conducted. During early scans, sonographers use scans to assess fetal biometry — the growth of the baby thus far. Later, scans provide an ideal opportunity to screen for spina bifida or other potential defects. Scans can also provide insight into potential complications, such as ectopic pregnancies or placenta previa.

In select cases, a transvaginal scan may be required. This involves a thinner transducer, which is inserted into the vagina. These scans can provide more detailed images and accurate takeaways than their abdominal counterparts.

Gynecology and Women

Many women seek ultrasounds while pregnant, but this is far from the only time most women will require imaging throughout their reproductive years (and beyond).

Gynecology or pelvic ultrasounds may also be required at other stages of life, including, for many women, after giving birth. These ultrasounds help female patients and their providers gain valuable insight into their reproductive health and may also pave the way for early diagnosis of concerns such as ovarian cancer.

What Is It?

Gynecology sonography involving non-invasive imaging to learn more about the functioning of the female reproductive system. The trusted resource Comprehensive Gynecology explains that “gynecologic ultrasound is a cost-effective, noninvasive, and accessible imaging technique that can help elucidate the nature and extent of pelvic disease,” adding that this is “easily integrated into the process of gynecologic investigation and preoperative planning.”³

How Do You Use It?

As with obstetric ultrasounds, the main methods for pelvic or gynecology scans include transabdominal and transvaginal placement. The aforementioned Comprehensive Gynecology mentions that this is often used as a point-of-care strategy, allowing the patient to “become an integral part of the ongoing discussion of findings, and this enhances the process of shared decision-making.”

Pelvic ultrasounds cannot provide definitive cancer diagnoses, but they often offer detailed and valuable information about potentially problematic pelvic masses. However, these scans are frequently used in the diagnosis and assessment of endometrial conditions and a variety of other pelvic or reproductive concerns.

Vascular and Blood Flow

While many people are familiar with the basics of obstetric sonography, many may wonder: What is vascular sonography?

Vascular sonography is unique from other categories in that it can touch on health concerns in many areas of the body. Primarily meant to pinpoint blockages in the veins or arteries, vascular sonography can be used to gain insight into blood flow of the arms, legs, neck and abdomen.

What Is It?

Vascular ultrasounds are often used to verify decreased blood flow in various parts of the body, as this is commonly a sign of many health problems, such as aneurysms, varicose veins or hardening of the arteries (also known as atherosclerosis).

Research published in the journal Ultrasound indicates that this strategy plays a fundamental role in everything from diagnostic evaluation to treatment monitoring, partly because it can “anatomically describe tissues” and even “assess physiology by evaluating blood flow characteristics in real time.”⁴

How Do You Use It?

During a vascular ultrasound, a transducer is used to transmit sound waves, as in other types of sonography. Doppler ultrasounds are more common in this specialty, however, as these evaluate how the blood flows through the body’s veins and arteries.

Specifically, this technique sheds light on the role of the Doppler shift (or effect), in which the wavelength or frequency changes in response to movement of the observer.

With ultrasounds, this plays out with the “rate at which red blood cells are moving through the vasculature system.”

The resource Sonography Vascular and Lymphatic Assessment, Protocols, and Interpretation explains, “A positive doppler shift indicates that blood is moving towards the transducer, while a negative Doppler shift indicates movement away from the transducer.”⁵

The previously mentioned Ultrasound study indicates that, moving forward, multiparametric strategies (integrating several examination modalities) will become prominent, especially as ultrasound technologies see rapid improvements. The study claims that the “application[s] of contrast-enhanced ultrasound, tissue elastography, and 3D ultrasound feasible options [are] ready to contribute to the diagnostic performance of the ultrasonographic technique.”

Echocardiographers and Heart Sonography

Echocardiography involves two or three-dimensional scans of the heart and its chambers, with sonographers and physicians working together to determine valve function, chamber size and blood flow. The echocardiographer (often referred to as the cardiac sonographer) works closely with doctors to gain insight into heart conditions via targeted imaging technology.

What Is It?

Often simply referred to as an “echo,” an echocardiogram is a common yet critical scan used to provide a detailed look at the heart and the blood vessels. While this holds some similarities to the previously described specialty of vascular sonography, there are several distinctions worth noting. Vascular is mostly focused on blood flow throughout the body, while Nature Journal simply refers to echocardiography as the “ultrasonography of the heart.”⁶

How Do You Use It?

The American Heart Association identifies several subsets of echocardiography, including:

• Transthoracic echocardiography (TTE).As the most common type of echocardiogram, TTE relies on sound waves to create images of the heart and can be used for screening and diagnostic purposes. This is a minimally invasive option, and is therefore suitable (and even preferred) for a wide range of patients and health concerns.⁷
• Transesophageal echocardiography (TEE). Similar to TTE but more invasive by necessity, a transesophageal scan involves (as the name implies) the use of an endoscope, which must be applied via the esophagus. This is sometimes required following a TTE scan, particularly if more detailed images are needed to secure an accurate diagnosis.
• Stress echocardiography.Typically obtained prior to (and following) physical exercise, a stress echocardiogram can reveal how the heart functions when it beats fast. This common procedure is often referred to as an echo stress test or simply a stress test. In select situations, radioactive substances may be injected, with special imaging then used to detect this radiation while gaining more detailed insight into blood flow.
• Three-dimensional (3D) echocardiography. Offering greater depth and detail than standard 2D cardiograms, 3D tests are often used to determine which treatment strategies will be most effective for patients with heart disease. These may be used for further evaluation after patients have already undergone TTE or stress echocardiograms.

Musculoskeletal and Injuries

Many patients are unfamiliar with the distinct subset of sonography that centers around the muscles, joints, tendons and soft tissues. Typically referred to as musculoskeletal sonography, this specialty can provide powerful insight into how the muscles, joints and other structures function while in motion. This is a common application for point-of-care ultrasounds, which may occur bedside or wherever else there is a need for injuries to promptly be confirmed.

What Is It?

Musculoskeletal (MSK) ultrasounds focus on the muscles, ligaments, joints, tendons and even nerves. Like other types of ultrasounds, these tests produce real-time images that can provide extensive insight for diagnoses and treatment plans.

Yale Medicine’s Dr. Risa H. Kent explains that these ultrasounds differ from other types of sonography in that they purposefully incorporate movement. “We can focus on the exact location of the patient’s pain and use dynamic imaging to determine how motion affects the area of concern.” What’s more, through the ultrasound’s Doppler effect, it’s possible to “focus on arteries and veins — and determine how blood is flowing.”⁸

How Do You Use It?

While MSK ultrasounds can be used to diagnose a variety of concerns, they are especially common for sports injuries, such as rotator cuff tears. MSK ultrasounds also provide in-depth insight into chronic conditions such as rheumatoid arthritis.

In select cases, MSK ultrasounds may even be used to determine whether cancerous masses are present. Performed in real time, these exams involve extensive feedback from patients, who can help sonographers pinpoint problem areas and produce more targeted and accurate images.

Support Patients and Medical Teams Through the Art and Science of Sonography

Do you envision a future in sonography? Chances are good that your work will involve one or more of the specialties outlined above. You will want well-rounded training to prepare you for the full range of opportunities that this diverse career path provides.

Get started on your path to a career you love: learn more about the Diagnostic Medical Sonography program at SJVC today!

Many, but not all, of the topics and specialties covered in this guide are incorporated into the coursework for SJVC’s Diagnostic Medical Sonography program.

Sources

1. “Understanding Sonography.” Society of Diagnostic Medical Sonography. https://www.sdms.org/resources/what-is-sonography/understanding-sonography

2. “Abdominal Ultrasound.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/abdominal-ultrasound

3. Raymond, Licia, and Gretchen M. Lentz. “Endoscopy in Minimally Invasive Gynecologic Surgery.” Comprehensive Gynecology. https://doi.org/10.1016/b978-0-323-65399-2.00019-x.

4. Rafailidis, V., & Sidhu, P. S. “Vascular ultrasound, the potential of integration of multiparametric ultrasound into routine clinical practice.” Ultrasound. https://doi.org/10.1177/1742271×18762250

5. Covello, Brian, and Junaid Mukhdomi. “Sonography Vascular and Lymphatic Assessment, Protocols, and Interpretation.” https://www.ncbi.nlm.nih.gov/books/NBK567746/.

6. “Echocardiography – Latest Research and News.” Springer Nature. https://www.nature.com/subjects/echocardiography

7. “Echocardiogram (Echo).” American Heart Association. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo

8. “Musculoskeletal Ultrasound.” Yale Medicine. https://www.yalemedicine.org/conditions/musculoskeletal-ultrasound