Ultrasound

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Ultrasound Services

Ultrasound (sometimes called “sonogram”) uses high-frequency sound waves to look at organs and structures inside the body. Health care professionals use them to view the heart, blood vessels, kidneys, liver and other organs. During pregnancy, doctors use ultrasound tests to examine the fetus. Unlike x-rays, ultrasound does not involve exposure to radiation.
During an ultrasound test, a special technician or doctor moves a device called a transducer over part of your body. The transducer sends out sound waves, which bounce off the tissues inside your body. The transducer also captures the waves that bounce back. Images are created from these sound waves.

Ultrasound studies include

Abdomen
Aorta
Breast
Kidneys
Pelvis
Obstetric
Biophysical Profile
Testicular
Thyroid
Thyroid Biopsy
Carotid Artery
Upper Extremity Venous
Lower Extremity Venous
Echocariogram (Cardiac Ultrasound)
Ultrasound Guided Amniocentesis
Ultrasound Guided Paracentesis/Thoracentesis
Ultrasound Guided Breast Biopsy

Where is the Ultrasound Department Located?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

Abdomen Ultrasound

What is an abdomen ultrasound and what does it do?

An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. Sometimes a specialized ultrasound is ordered for a detailed evaluation of a specific organ, such as a kidney ultrasound.
An abdominal ultrasound can evaluate the:

Abdominal aorta , which is the large blood vessel (artery) that passes down the back of the chest and abdomen. The aorta supplies blood to the lower part of the body and the legs.
Liver, which is a large dome-shaped organ that lies under the rib cage on the right side of the abdomen. The liver produces bile (a substance that helps digest fat), stores sugars, and breaks down many of the body’s waste products.
Gallbladder, which is a small sac-shaped organ beneath the liver that stores bile. When food is eaten, the gallbladder contracts, sending bile into the intestines to help in digesting food and absorbing fat-soluble vitamins.
Spleen, which is the soft, round organ that helps fight infection and filters old red blood cells. The spleen is located to the left of the stomach, just behind the lower left ribs.
Pancreas, which is the gland located in the upper abdomen that produces enzymes that help digest food. The digestive enzymes are then released into the intestines. The pancreas also releases insulin into the bloodstream. Insulin helps the body use sugars for energy.
Kidneys, which are the pair of bean-shaped organs located behind the upper abdominal cavity. The kidneys remove wastes from the blood and produce urine.

Abdominal ultrasounds can be ordered as complete or limited.
The abdomen limited includes images of the pancreas, liver, gallbladder, and right kidney.

The abdomen complete includes imaging of the aorta, IVC, pancreas, liver, gallbladder, right and left kidneys, and spleen.

Why It Is Done

Abdominal ultrasound is done to:

Find the cause of abdominal pain.
Find, measure, or monitor an aneurysm in the aorta. An aneurysm may cause a large, pulsing lump in the abdomen.
Check the size, shape, and position of the liver. An ultrasound may be done to evaluate jaundice and other problems of the liver, including liver masses, cirrhosis, fat deposits in the liver (called fatty liver), or abnormal liver function tests.
Detect gallstones, inflammation of the gallbladder (cholecystitis), or blocked bile ducts.
Learn the size of an enlarged spleen and look for damage or disease.
Find problems with the pancreas, such as a pancreatic tumor.
Look for blocked urine flow in a kidney. A kidney ultrasound may also be done to find out the size of the kidneys, detect kidney masses, detect fluid surrounding the kidneys, investigate causes for recurring urinary tract infections, or check the condition of transplanted kidneys.
Find out whether a mass in any of the abdominal organs (such as the liver) is a solid tumor or a simple fluid-filled cyst.
Guide the placement of a needle or other instrument during a biopsy.
Look for fluid buildup in the abdominal cavity (ascites). An ultrasound also may be done to guide the needle during a procedure to remove fluid from the abdominal cavity (paracentesis).

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

You must be NPO (nothing to eat or drink) for at least 8 hours prior to an abdominal ultrasound. You may take your medications with only a few sips of water.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You will lie on your back (or on your side) on a padded exam table. Warmed gel will be spread on your abdomen to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your abdomen and moved back and forth over it. A picture of the organs and blood vessels can be seen on a video monitor.

You may be asked to change positions so more scans can be done. For a kidney ultrasound, you may be asked to lie on your stomach.

You need to lie very still while the ultrasound scan is being done. You may be asked to take a breath and hold it for several seconds during the scanning. This lets the sonographer see organs and structures, such as the bile ducts, more clearly because they are not moving. Holding your breath also temporarily pushes the liver and spleen lower into the belly so they are not hidden by the lower ribs, which makes it harder for the sonographer to see them clearly.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Aorta Ultrasound

What is an Aorta ultrasound and what does it do?

An ultrasound of the abdominal aorta is a non-invasive, painless test that uses high-frequency sound waves to image the “aorta,” the main blood vessel leading away from the heart.

Below are some common indications for abdominal aorta ultrasounds.

Screening for aneurysms for patients with medical conditions such diabetes, high cholesterol, and high blood pressure which increases the risk of developing an abdominal aorta aneurysm.
Evaluate for an aneurysm if a pulsatile mass is felt on a physical exam
Known abdominal aortic aneurysm and the scan is being done to check for any change in size of the aneurysm
Evaluate the aorta because of a bruit (rushing, whistling noise) of the abdominal aorta heard during a physical exam

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

You must be NPO (nothing to eat or drink) for at least 8 hours prior to an abdominal ultrasound. You may take your medications with only a few sips of water.

What happens during your exam?

You may be asked to change positions so more scans can be done.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Amniocentesis (Ultrasound Guided)

What is an Amniocentesis and what does it do?

Amniocentesis is a prenatal test in which a small amount of amniotic fluid is removed from the sac surrounding the fetus for testing. The sample of amniotic fluid (less than one ounce) is removed through a fine needle inserted into the uterus through the abdomen, under ultrasound guidance. The fluid is then sent to a laboratory for analysis. Different tests can be performed on a sample of amniotic fluid, depending on the genetic risk and indication for the test.

Why is an Amniocentesis Performed?

Amniocentesis is performed to look for certain types of birth defects, such as Down syndrome, a chromosomal abnormality.

Because amniocentesis presents a small risk for both the mother and her baby, the prenatal test is generally offered to women who have a significant risk for genetic diseases, including those who:

Have an abnormal ultrasound
Have a family history of certain birth defects
Have previously had a child or pregnancy with a birth defect
Will be 35 or older at the time of delivery

Amniocentesis does not detect all birth defects, but it can be used to detect the following conditions if the parents have a significant genetic risk:

Down syndrome
Sickle cell disease
Cystic fibrosis
Muscular dystrophy
Tay-Sachs and similar diseases

Amniocentesis can also detect certain neural tube defects (diseases where the brain and spinal column don’t develop properly), such as spina bifida and anencephaly.

Because ultrasound is performed at the time of amniocentesis, it may detect birth defects that are not detected by amniocentesis (such as cleft palate, cleft lip, club foot, or heart defects). There are some birth defects, however, that will not be detected by either amniocentesis or ultrasound.

If you are having an amniocentesis, you may ask to find out the baby’s sex; amniocentesis is the most accurate way to determine the baby’s gender before birth.

An amniocentesis can also be done during the third trimester of the pregnancy to determine if the baby’s lungs are mature enough for delivery, or to evaluate the amniotic fluid for infection.

Who performs the test?

The amniocentesis itself is performed by your OB doctor with the assistance of an ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

At Jackson Hospital in the Imaging Services Department.

How long does it take?

This exam generally takes about 45 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

A small area of the abdomen is cleansed with an antiseptic to prepare for the amniocentesis. You may receive a local anesthetic (pain-relieving medication) to reduce any discomfort. The doctor first locates the position of the fetus and placenta with an ultrasound. Under ultrasound guidance, the doctor inserts a thin, hollow needle through your abdomen and uterus, and into the amniotic sac, away from the baby. A small amount of fluid (less than an ounce) is removed through the needle and sent for laboratory analysis.

You may feel minor menstrual-like cramping or discomfort during the amniocentesis or for a few hours after the procedure.

What to do after your exam?

After an amniocentesis, it is best to go home and relax for the remainder of the day. You should not exercise or perform any strenuous activity, lift anything over 20 pounds (including children), and you should avoid sexual relations.

You may take two Tylenol (acetaminophen) every 4 hours to relieve discomfort. The day after the procedure, you may resume all of your normal activities unless otherwise directed by your doctor.

The results of the amniocentesis are generally available within 2-3 weeks. If you have not received the results within 3 weeks, call your health care provider.

Breast Biopsy (Ultrasound Guided)

What is an Ultrasound Guided Breast Biopsy and what does it do?

Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.

A breast biopsy is performed to remove some cells—either surgically or through a less invasive procedure involving a hollow needle—from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. Image-guided needle biopsy is not designed to remove the entire lesion, but most of a very small lesion may be removed in the process of biopsy.

In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the doctor’s instruments to the site of the abnormal growth.

An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:

a suspicious solid madd
a distortion in the structure of the breast tissue
an area of abnormal tissue change

One of four instruments will be used:

A fine needle attached to a syringe, smaller than needles typically used to draw blood.
A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or a shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
A vacuum-assisted device (VAD), a vacuum-powered instrument that uses pressure to pull tissue into the needle.
A thin guide wire, which is used for a surgical biopsy.

Who performs the test?

The biopsy itself is performed by a physician with the assistance of an ultrasonographic specifically trained or certified in Ultrasound imaging.

Where does it take place?

At Jackson Hospital in the Imaging Services Department.

How long does it take?

This exam generally takes about 45 minutes to complete.

What you can do to make it a success?

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician will advise you to stop taking aspirin or a blood thinner three days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions. You may want to have a relative or friend accompany you and drive you home afterward.

What to do before your exam?

No special preparation is needed for this study

What happens during your exam?

Breast biopsies are usually done on an outpatient basis.

You will be positioned lying face up on the examination table or turned slightly to the side.

A local anesthetic will be injected into the breast to numb it.

Pressing the transducer to the breast, the sonographer or doctor will locate the lesion.

A very small nick is made in the skin at the site where the biopsy needle is to be inserted.

The doctor, monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass.

Tissue samples are then removed using one of three methods:

In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells
In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with ‘cores’ of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After this sampling, the needle will be removed.

If a surgical biopsy is being performed, a wire is inserted into the suspicious area as a guide for the surgeon.

A small marker may be placed at the site so that it can be located in the future if necessary.

Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

A mammogram may be performed to confirm that the marker is in the proper position.

This procedure is usually completed within an hour.

What to do after your exam?

You will be given detailed discharge instructions to take home with you. These will have your after care instructions, what to watch for, and contact information.

Biophysical Profile

What is a Biophysical Profile and what does it do?

A biophysical profile (BPP) test measures the health of your baby (fetus) during pregnancy. A BPP test may include a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. The BPP measures your baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around your baby.

A BPP is commonly done in the last trimester of pregnancy. If there is a chance that your baby may have problems during your pregnancy (high-risk pregnancy), a BPP may be done by 32 to 34 weeks or earlier. Some women with high-risk pregnancies may have a BPP test every week or twice a week in the third trimester.

Why It Is Done

A biophysical profile (BPP) test is done to:

Learn about and keep track of your baby’s health. Special ultrasound methods are used to keep track of movement, increases in heart rate with movement (nonstress test), muscle tone, breathing rate, and the amount of amniotic fluid (amniotic fluid index) surrounding your baby. If these five areas are within a normal range, your baby is considered to be in good health.
Check on your baby’s health if you have:
- Hyperthyroidism.
- Bleeding problems.
- Lupus.
- Chronic kidney disease.
- Type 1 diabetes or gestational diabetes.
- High blood pressure (hypertension).
- Preeclampsia
- A small amount of amniotic fluid (oligohydramnio) or too much amniotic fluid (polyhydramnios)
- A multiple pregnancy (such as twins or triplets).
- A pregnancy that has gone past your due date, between 40 and 42 weeks.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 to an hour to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

For OB patients greater than 14 weeks: No preparation.
If you smoke, you will be asked to stop smoking for 2 hours before the external monitoring test because smoking decreases your baby’s activity.

What happens during your exam?

You may be asked to change positions so more scans can be done.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Breast Ultrasound

What is a Breast ultrasound and what does it do?

A breast ultrasound uses sound waves to make a picture of the tissues inside the breast. A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram. Breast ultrasound does not use X-rays or other potentially harmful types of radiation.

A breast ultrasound does not replace the need for a mammogram, but it is often used to check abnormal results from a mammogram.

For a breast ultrasound, a small handheld unit called a transducer is gently passed back and forth over the breast. A computer turns the sound waves into a picture on a TV screen. The picture is called a sonogram or ultrasound scan.

Why It Is Done

Breast ultrasound can add important information to the results of other tests, such as a mammogram or magnetic resonance imaging (MRI). It also may provide information that is not found with a mammogram. A breast ultrasound may be done to:

Find the cause of breast symptoms, such as pain, swelling, and redness.
Check a breast lump found on breast self-examination or physical examination. It is used to see whether a breast lump is fluid-filled (a cyst) or if it is a solid lump. A lump that has no fluid or that has fluid with floating particles may need more tests.
Check abnormal results from a mammogram.
Look at the breasts in younger women because their breast tissue is often more dense, and a mammogram may not show as much detail.
Guide the placement of a needle or other tube to drain a collection of fluid (cyst) or pus (abscess), take a sample of breast tissue (biopsy), or guide breast surgery.
Watch for changes in the size of a cyst.
Check your breasts if you have silicone breast implants or dense breasts. In these situations, a mammogram may not be able to see breast lumps.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

There is no special preparation for this test. You may eat and take your medications as prescribed.

What happens during your exam?

You will be asked to undress above the waist. You will be given a gown to drape around your shoulders.

Gel will be put on your breast so the transducer can pick up the sound waves as it is moved back and forth over the breast. A picture of the breast tissue can be seen on a TV screen.

You may be asked to wait until a radiologist has reviewed the pictures. The radiologist may want to do more ultrasound views of some areas of your breast.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Carotid Artery Ultrasound

What is a Carotid Ultrasound and what does it do?

The carotid ultrasound is most frequently performed to detect narrowing, or stenosis, of the carotid artery, a condition that substantially increases the risk of stroke.

The major goal of carotid ultrasound is to screen patients for blockage or narrowing of their carotid arteries, which if present may increase their risk of having a stroke. If a significant narrowing is detected, a comprehensive treatment may be initiated.

It may also be performed if a patient has high blood pressure or a carotid bruit (pronounced brU-E)—an abnormal sound in the neck that is heard with the stethoscope.

Risk factors indicating the need for a carotid ultrasound are:

diabetes
elevated blood cholesterol
a family history of stroke or heart disease

A carotid ultrasound is also performed to:

locate a hematoma, a collection of clotted blood that may slow and eventually stop blood flow.
check the state of the carotid artery after surgery to restore normal blood flow.
verify the position of a metal stent placed to maintain carotid blood flow.

Doppler ultrasound images can help the physician to see and evaluate:

blockages to blood flow (such as clots).
narrowing of vessels.
tumors and congenital vascular malformation.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study. You will need to remove jewelry from your head or neck before the test.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You may be asked to undress above the waist and drape a towel or sheet around your shoulders. Remove all jewelry from your head or around your neck.

You will lie on your back (or on your side) on a padded exam table.

Warmed gel will be spread on your neck to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your next and moved back and forth over it. A picture of the blood vessels can be seen on a video monitor.

You need to lie very still while the ultrasound scan is being done.

Doppler sonography is performed using the same transducer.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Echocardiogram (Cardiac Ultrasound)

What is an Echocardiogram and what does it do?

An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

The different types of echocardiograms are:

Transthoracic echocardiogram (TTE) with Doppler. This is the most common type. Views of the heart are obtained by moving the transducer to different locations on your chest or abdominal wall. Doppler echocardiogram. This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.
Stress echocardiogram with Doppler. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine that makes your heart beat harder and faster. A stress echocardiogram is usually done to find out if you might have decreased blood flow to your heart (coronary artery disease, or CAD). Doppler echocardiogram. This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

At Jackson Hospital in the Imaging Services Department.

How long does it take?

This exam generally takes about 45 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You may be asked to undress above the waist and a drape or tower may be placed over you. You will lie on your back on a padded exam table. Warmed gel will be spread on your chest to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your skin and moved back and forth over it. A picture of the heart can be seen on a video monitor.

You will need to lie very still while the ultrasound scan is being done. You may be asked to take a breath and hold it for several seconds or change positions during the scanning. Doppler sonography is performed using the same transducer.

What to do after your exam?

An Internist/Cardiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Elastography

What is an Ultrasound Elastography exam and what does it do?

An elastography ultrasound is an ultrasound of the liver that involves taking measurements of liver tissue to determine the elasticity or the stiffness of the liver. These measurements aid in detecting the presence and severity of liver disease.

Who performs the test?

A technologist certified in ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital.

How long does it take?

The exam generally takes 30 minutes to complete.

What you can do to make it a success?

Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

You must be NPO (nothing to eat or drink) for at least 8 hours prior to an abdominal ultrasound. You may take your medications with only a few sips of water.

What happens during the exam?

You may be asked to change positions so more scans can be done. You need to lie very still while the ultrasound scan is being done. You may be asked to take a breath and hold it for several seconds during the scanning. This lets the sonographer see organs and structures more clearly because they are not moving. Holding your breath also temporarily pushes the liver and spleen lower into the belly so they are not hidden by the lower ribs, which makes it harder for the sonographer to see them clearly.

What to do after the exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24–48 hours.

Lower Extremity Venous Insufficiency Ultrasound

Your arteries carry blood from your heart out to the rest of your body. Your veins carry blood back to the heart, and valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs to the heart, it’s known as venous insufficiency. In this condition, blood doesn’t flow back properly to the heart, causing blood to pool in the veins in your legs.

A venous ultrasound provides us with pictures of the veins throughout the body that carry blood back to the heart. This painless noninvasive exam measures the function of the vein valves that are critical to venous function and can also identify vein blockages.
Doppler vein mapping gives a more detailed ultrasound evaluation of the abnormal veins of the legs which illustrates the path of the blood flowing through the abnormal veins and where the trouble begins.

Careful mapping of the lower extremity venous system aids us in determining the optimal treatment plan to meet each patient’s specific needs.

Who performs the test?

An ultrasonographer specifically trained and certified in Ultrasound imaging.

Where does it take place?

At Jackson Hospital in the Imaging Services Department.

How long does it take?

This exam generally takes about an hour to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You may be asked to undress below the waist and a drape or towel may be placed over you. You will lie on a specialized table that will tilt at an angle. Gel will be spread on your leg(s) to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your skin and moved back and forth over it. A picture of the blood vessels can be seen on a video monitor. The sonographer will apply compressions at different levels down each of your legs. You will need to lie very still while the ultrasound scan is being done and you may be asked to manipulate or bend your leg at different stages of the test. You may also be asked to stand during the exam if you are able. Doppler sonography is performed throughout the exam and you may hear noises from the machine during this time.

What to do after your exam?

The radiologist (or other qualified physician) will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Lower Extremity Venous Ultrasound

What is a Lower Extremity Venous Ultrasound and what does it do?

A Lower Extremity Ultrasound is used to evaluate blood flow through major veins in the legs. The most common reason for a venous ultrasound exam is to search for blood clots. This condition is often referred to as deep vein thrombosis or DVT.

Doppler ultrasound is used to measure your blood flow and blood pressure by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can’t show blood flow. A Doppler ultrasound can estimate how fast blood flows by measuring the rate of change in its pitch (frequency).

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You may be asked to undress below the waist and a drape or towel may be placed over you. You will lie on your back on a padded exam table. Compression will be applied at different levels along the length of your leg(s). Warmed gel will be spread on your leg(s) to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your skin and moved back and forth over it. A picture of the blood vessels can be seen on a video monitor. You will need to lie very still while the ultrasound scan is being done.
Doppler sonography is performed using the same transducer.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

OB (Obstetric) Ultrasound

What is an OB ultrasound and what does it do?

Obstetrical ultrasound provides pictures of an embryo or fetus within a woman’s uterus, as well as the mother’s uterus and ovaries.

A Doppler ultrasound study may be part of an obstetrical ultrasound examination.

Doppler ultrasound is a special ultrasound technique that evaluates blood flow through a blood vessel, including the body’s major arteries and veins in the abdomen, arms, legs, and neck. During an obstetrical ultrasound, the examiner may evaluate blood flow in the umbilical cord or may, in some cases, assess blood flow in the fetus or placenta.

Obstetrical ultrasound is a useful clinical test to:

establish the presence of a living embryo/fetus.
estimate the age of the pregnancy.
diagnose congenital abnormalities of the fetus.
evaluate the position of the fetus.
evaluate the position of the placenta.
determine if there are multiple pregnancies.
determine the amount of amniotic fluid around the baby.
check for opening or shortening of the cervix.
assess fetal growth.
assess fetal well-being.

The radiologist or sonographer may elect to examine an early pregnancy by means of transvaginal ultrasound in order to see the pregnancy more closely.

For a Transvaginal ultrasound, a thin, lubricated transducer probe will be gently inserted into your vagina. Only the tip of the transducer is put in the vagina.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

For OB patients less than 14 weeks: You will need to have a full bladder prior to having your ultrasound exam. Please drink 32 ounces one hour prior to your appointment time.

For OB patients greater than 14 weeks: No preparation.

What happens during your exam?

If a transvaginal ultrasound is warranted, you will be asked to empty your bladder. You will lie on your back with your feet placed in stirrups.
A thin, lubricated transducer probe will be gently inserted into your vagina. Only the tip of the transducer is put in the vagina. You need to lie very still while the ultrasound scan is being done.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Paracentesis/Thoracentesis (Ultrasound Guided)

What is a Paracentesis/Thoracentesis and what does it do?

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle and a plastic catheter inserted through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

Why It Is Done

Paracentesis may be done to:

Find the cause of fluid buildup in the belly.
Diagnose an infection in the peritoneal fluid.
Check for certain types of cancer, such as liver cancer.
Remove a large amount of fluid that is causing pain or difficulty breathing or that is affecting how the kidneys or the intestines (bowel) are working.
Check for damage after a belly injury.

Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with a needle and a plastic catheter inserted through the chest wall. Ultrasound pictures are often used to guide the placement of the needle. This pleural fluid may be sent to a lab to determine what may be causing the fluid to build up in the pleural space.

Normally only a small amount of pleural fluid is present in the pleural space. A buildup of excess pleural fluid (pleural effusion ) may be caused by many conditions, such as infection, inflammation, heart failure, or cancer. If a large amount of fluid is present, it may be hard to breathe. Fluid inside the pleural space may be found during a physical examination and is usually confirmed by a chest X-ray.

Why It Is Done

Thoracentesis may be done to:

Find the cause of excess pleural fluid (pleural effusion).
Relieve shortness of breath and pain caused by a pleural effusion.

Who performs the test?

The Paracentesis/Thoracentesis itself is performed by a physician with the assistance of an ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital in the Ultrasound Suite in the Imaging Services Department

How long does it take?

This exam generally takes about 45 minutes to complete.

What you can do to make it a success?

Paracentesis

Tell your doctor if you:

Are taking any medicine.
Are allergic to any medicines, including numbing medicines (anesthetics).
Have had bleeding problems or are taking blood thinners, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin (Coumadin).
Are or might be pregnant.

Thoracentesis

Tell your doctor if you:

Are taking any medicines.
Have allergies to any medicines, including anesthetics.
Have any bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).
Are or might be pregnant.

Also, certain conditions may increase the difficulty of thoracentesis. Let your doctor know if you have:

Had lung surgery. The scarring from the first procedure may make it difficult to do this procedure.
A long-term (chronic), irreversible lung disease, such as emphysema.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

Paracentesis:

The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. An ultrasound may be used to show where the fluid is in your belly. If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle for the fluid to drain into it.

Thoracentesis:

During the procedure, you will be seated but leaning forward on a padded bedside table. An ultrasound may be used to confirm the location of fluid in your chest. The needle site between your ribs will be cleaned with an antiseptic solution. Your doctor will give you a local anesthetic in your chest wall so you won’t feel any pain when the longer needle that withdraws the fluid is inserted. Once the area is numb, your doctor will insert the needle to where the fluid has collected (pleural space). You may feel some mild pain or pressure as the needle enters the pleural space.

A syringe or a small tube attached to a vacuum bottle is used to remove the pleural fluid. Your doctor will collect fluid to send to the lab. Once the fluid is removed, the needle or small tube is removed and a bandage is put on the site.

An X-ray may be taken right after the procedure to make sure that no complications have occurred.

What to do after your exam?

You will be given detailed discharge instructions to take home with you. These will have your after care instructions, what to watch for, and contact information.

Pelvic Ultrasound

What is a Pelvic ultrasound and what does it do?

A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower belly (pelvis). A pelvic ultrasound looks at:

The bladder, ovaries, uterus, cervix, and fallopian tubes of a woman. See a picture of female organs seen on pelvic ultrasound .
The bladder, prostate gland, and seminal vesicles of a man. See a picture of male organs seen on pelvic ultrasound .

Pelvic ultrasound can be done three ways: transabdominal, transrectal, and transvaginal.

Transabdominal ultrasound. A small handheld device called a transducer is passed back and forth over the lower belly. A transabdominal ultrasound is commonly done in women to look for large uterine fibroids or other problems.
Transrectal ultrasound. The transducer is shaped to fit into the rectum. A transrectal ultrasound is the most common test to look at the male pelvic organs, such as the prostate and seminal vesicles. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the rectum during a transrectal ultrasound.
Transvaginal ultrasound. The transducer is shaped to fit into a woman’s vagina. A woman may have both transabdominal and transvaginal ultrasounds to look at the whole pelvic area. A transvaginal ultrasound is done to look for problems with fertility.

Pelvic ultrasound may be done to:

Find out what is causing pelvic pain.
Look for the cause of vaginal bleeding.
Look for pelvic inflammatory disease (PID).
Find an intrauterine device (IUD).
Look at the size and shape of the uterus and the thickness of the uterine lining (endometrium).
Look at the size and shape of the ovaries.
Check the condition and size of the ovaries during treatment for infertility.
Confirm a pregnancy and whether it is in the uterus. Pelvic ultrasound may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic pregnancy) or multiple pregnancies.
Check the cervical length in a pregnant woman at risk for preterm labor.
Check a lump found during a pelvic examination.
Check uterine fibroids found during a pelvic examination. A pelvic ultrasound may also be done to check the growth of uterine fibroids.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy-to-remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

You will need to have a full bladder prior to having your ultrasound exam. Please drink 32 ounces one hour prior to your appointment time.

What happens during your exam?

You need to lie very still while the ultrasound is being done. You may be asked to take a breath and hold it for several seconds during the test.

You may be asked to wait until the doctor has looked at the pictures. The doctor may want to do more pictures.

Transabdominal ultrasound
You will lie on your back (or on your side) on a padded table. Gel will be put on your belly to improve the quality of the sound waves. A small, handheld instrument called a transducer is gently moved over your belly. A picture of the organs and blood vessels can be seen on a video screen.

Transrectal ultrasound
You will be asked to lie on your left side with your knees bent. Then a lubricated transducer probe will be gently inserted into your rectum. It will slowly be moved to take pictures from different angles. You may feel some pressure.

Transvaginal ultrasound
For transvaginal ultrasound, you will empty your bladder. You will be asked to lie on your back with your feet placed in stirrups.

A thin, lubricated transducer probe will be gently inserted into your vagina. Only the tip of the transducer is put in the vagina. You need to lie very still while the ultrasound scan is being done.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Renal (Kidney) Ultrasound

What is a Renal ultrasound and what does it do?

This test uses sound waves to study the renal system, which includes the kidneys, bladder, and ureters (the tubes that connect the kidneys to the bladder).

Reasons for Test

The test is done to look for:

Changes in the bladder wall
Changes in kidney size or structure
Kidney stone , cyst, mass, or other obstruction in the kidney
Stones in the urinary tract
Changes in the ureters

The test is also done to look at:

Kidneys before doing a renal biopsy (removal of tissue from the kidney for exam)
Blood flow to the kidneys (a Doppler ultrasound is used)

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

You must be NPO (nothing to eat or drink) for at least 8 hours prior to an abdominal ultrasound. You may take your medications with only a few sips of water.

What happens during your exam?

You may be asked to change positions so more scans can be done. You may be asked to lie on your stomach.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Testicular (Scrotal) Ultrasound

What is a Testicular Ultrasound and what does it do?

A testicular ultrasound (sonogram) is a test that uses reflected sound waves to produce a picture of the testicles and scrotum. An ultrasound can show the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis) and the tube (vas deferens) that connects the testicles to the prostate gland.

Why It Is Done

Testicular ultrasound is done to:

Evaluate a mass or pain in the testicles.
Identify and monitor infection or inflammation of the testicles or epididymis.
Identify twisting of the spermatic cord cutting off blood supply to the testicles (testicular torsion)
Monitor for recurrence of testicular cancer.
Locate an undescended testicle.
Identify fluid in the scrotum (hydrocele), fluid in the epididymis (spermatocele), blood in the scrotum hematocele, or pus in the scrotum (pyocele).
Evaluate an injury to the genital area.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

First, the technologist will explain the exam and may ask you historical questions that aid in obtaining a more diagnostic exam. You will need to remove all your clothes from the waist down and put on a gown before the test. You will be asked to lie on your back on a padded examination table. Folded towels will be used to cover the penis and lift the scrotum. A gel will be spread on your scrotum for the transducer. The transducer is pressed lightly against your skin and moved across your scrotum many times.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Thyroid Ultrasound

What is a Thyroid Ultrasound and what does it do?

A thyroid and parathyroid ultrasound is an imaging test to check the thyroid gland and parathyroid glands. A thyroid ultrasound can help measure the size and shape of the thyroid gland, but it cannot tell how well the thyroid gland is working. Ultrasound also may be used to check the four parathyroid glands that lie behind or next to the thyroid.

Why It Is Done

A thyroid and parathyroid ultrasound is done to:

Check lumps (nodules) in the thyroid gland. A thyroid ultrasound can usually show the difference between a solid thyroid gland nodule and a simple fluid-filled sac (cyst)
Find out whether the thyroid gland is enlarged. A thyroid ultrasound may also be used to keep track of the size of the thyroid gland during treatment for a thyroid problem.
Look for enlarged parathyroid glands caused by disease. Normal parathyroid glands are often difficult to see on ultrasound and cannot be felt during physical examination. But abnormal parathyroid glands may be enlarged and easily seen by ultrasound.
Guide the placement of the needle during a thyroid biopsy.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study. You will need to remove jewelry from your head or neck before the test.

What happens during your exam?

You will lie on your back on a padded table with your neck stretched out and a pillow under your shoulders. Gel will be spread on your neck to improve the passage of the sound waves (they do not pass easily through air).

The transducer will be pressed lightly against your neck, then moved back and forth over your neck. A picture of your thyroid gland and the tissue around it can be seen on a video monitor. You may be asked to turn your head away from the side being scanned so the jawbone is out of the way.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Thyroid Biopsy (Ultrasound Guided)

What is a Thyroid Biopsy and what does it do?

A thyroid biopsy is a procedure in which a small sample of tissue is removed from the thyroid gland and looked at under a microscope for cancer, infection, or other thyroid problems. The thyroid gland is found in front of the windpipe (trachea), just below the voice box (larynx).

Why It Is Done

A thyroid biopsy is done to:

Find the cause of a lump (nodule) found in the thyroid gland. Lumps in the thyroid gland may be found during a physical examination or seen on a thyroid ultrasound test or radioactive thyroid scan.
Find the cause of a goiter. Symptoms of a goiter include breathing and swallowing problems, paralyzed vocal cords, a feeling of fullness in the neck, and weight loss.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Tell your doctor if you:

Take any medicines regularly. Be sure your doctor knows the names and doses of all your medicines.
Are allergic to any medicines, including anesthetics.
Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin, for example).

Before having a thyroid biopsy, you may need to have blood tests to see whether you have any bleeding problems or blood-clotting disorders.

What to do before your exam?

No special preparation is needed for this study. You will need to remove jewelry from your head or neck before the test.

What happens during your exam?

During the test, you will lie on your back with a pillow under your shoulders, your head tipped backward, and your neck extended. This position pushes the thyroid gland forward, making it easier to do the biopsy. It is important to lie very still during the biopsy. Do not cough, talk, or swallow when the needle is in place.

Ultrasound will be used to guide the placement of the needle. Your doctor will put a thin needle into your thyroid gland and take out a small amount of thyroid tissue and fluid. The tissue will be sent to the lab to be reviewed under a microscope.

A small bandage is placed over the area where the needle was inserted.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Upper Extremity Venous Ultrasound

What is an Upper Extremity Venous Ultrasound and what does it do?

An Upper Extremity Ultrasound is used to evaluate blood flow through major veins in the arms. The most common reason for a venous ultrasound exam is to search for blood clots. This condition is often referred to as deep vein thrombosis or DVT.

Who performs the test?

An ultrasonographer specifically trained or certified in Ultrasound imaging.

Where does it take place?

Jackson Hospital Outpatient Center Hudnall Building, Room 110, located adjacent to the Hospital

How long does it take?

This exam generally takes about 30 minutes to complete.

What you can do to make it a success?

Bring your doctor’s orders with you when you come for your scheduled exam.
Wear comfortable, easy to remove clothing.
Follow all preparation instructions given to you by your physician’s office. If you have any questions, please call us for clarification. We want your exam to be as successful as possible.

What to do before your exam?

No special preparation is needed for this study.

What happens during your exam?

You will lie on your back on a padded exam table. Compression will be applied at different levels along the length of your leg(s). Warmed gel will be spread on your arm(s) to improve the quality of the sound waves. A small handheld unit called a transducer is pressed against your skin and moved back and forth over it. A picture of the blood vessels can be seen on a video monitor. You will need to lie very still while the ultrasound scan is being done.

Doppler sonography is performed using the same transducer.

What to do after your exam?

The radiologist will review your image(s) and a final report will go to your ordering physician in 24-48 hours.

Tissue Biopsy (Ultrasound Guided)

What is an Ultrasound-Guided Tissue Biopsy and What Does It Do?

An ultrasound-guided tissue biopsy is a medical procedure that uses high-frequency sound waves to help a physician precisely locate and collect a small sample of tissue for further examination. The ultrasound device emits sound waves through a transducer, which creates real-time images of the internal structures. This guidance allows for accurate needle placement when obtaining the tissue sample.

Types of Ultrasound-Guided Tissue Biopsies

Fine-Needle Aspiration (FNA): A thin, hollow needle is used to extract small amounts of fluid or cells from a suspicious area.
Core Needle Biopsy (CNB): A larger needle is used to remove a small cylinder (core) of tissue for a more detailed analysis.
Vacuum-Assisted Biopsy: Uses suction to obtain multiple tissue samples through a single insertion.