Sonography in the Diagnosis of Adult Brain Injury

Abstract
Sonography, in the medical field, helps in detecting the amount of damage in a human being body through the creation of visual images. The damage may be in an organ such as the brain or a problem with the flow of blood. The literature review on the research shows optic nerve sonography as an important method to diagnose brain injury as well as the foundation for future investigations. With the ability to detect various injuries, sonography gives the patients with brain injuries the chance to have the problem identified and rectified.

Literature Review: The Importance of Sonograpy in the Diagnosis of Adult Brain Injury
According to Karakitsos et al. (2006), diagnostic sonography is one of the ultrasound diagnostic imaging methods used in observing internal body organs or structures like the brain and vessels in order to come up with the proper diagnosis of the health complications. One of the health problems that it has been applied successfully is the diagnosis of adult brain injury. Some of the causes of brain injury include skull fractures, epidural hematoma, acute subdural hematoma and chronic subdural hematoma. These brain injuries result in elevated intracranial pressure (ICP) and optic nerve shealth diameter (ONSD) (Gerraerts et al., 2007, p. 1704). Elevated intracranial pressure (ICP) is commonly manifested in brains that are severely injured and require interventions through therapeutics. Optic nerve sheath diameter (ONSD) increases sometimes in patients who have injured brains. The measurements of ONSD correlation with simultaneous invasive and noninvasive measurements of the adults who are brain-injured with intracranial pressure (ICP) are important (Gerraerts et al., 2007, p. 1704).
For quite a long time, doctors have been using an intracranial catheter in diagnosing brain injuries like intracranial hypertension, however this diagnosis method is no longer popular among the physicians due to coagulopathy which is a clotting disorder and the limited number of neurosurgical experts. These challenges led to the increased use of sonography in the diagnosis of adult brain injury (Soldatos et al., 2008, p. 4). It is important to note that ONSD measurements do relate with invasive and noninvasive ICP estimate measurements, and also with scan findings of computed tomography of the head in adults whose brains are injured. Therefore, optic nerve sonography serves as an additional tool for diagnostics that can pass some information to clinicians to elevated ICP presence when invasive ICP is not available (Gerraerts et al., 2007, p. 1704).
The discovery of sonography can be traced back to the 1880s with the discovery of piezoelectricity by one of the great physicist, Pierre Curie. Generally, the first people to use ultrasonography were psychiatrists from the University of Vienna for the diagnosis of brain tumor. Diagnostic sonography, is therefore one of the modern complex field of medicine. The invention of sonography, therefore, solved the curiosity of many physicians who were eager to see the internal organs and tissues of human beings in order to diagnose various diseases.
There has been increased conflict on the best method that can be used in diagnosing adult brain injury. Some of the methods that have been used in diagnosing brain injury and other internal body injuries are radiography and intracranial catheter. However, all diagnostic methods have side effects and the one that is assumed to be risk free is sonography (Splavski et al., 2006). This literature review, therefore, focuses on the suitability of sonograpy in diagnosing the adult brain injury and whether it is the safest diagnostic method.
Methodology
The method of the study applied to a certain topic influences the outcomes and conclusion arrived at. The study on the topic is rather complex in nature, and therefore two methods of data and information collection are applied to assist in the minimization of potential mistakes and setbacks. In this case, the literature review and evaluation of already conducted research in peer review journals, and the collection and evaluation of primary data are applied.
In order to carry out a comprehensive review of the above topic, I carried out journal, articles and book reviews relating to the topic. These books helped me in doing meta analysis of the already existing literature which are related to the subject matter of this review. The majority of my articles and books were retrieved from google scholar while some were retrieved from online books and articles or e-book. Therefore, the internet was the primary source of literatures used in this literature review.
Results
Sonography is a modern technology that is used in health sectors to diagnose various diseases like brain injury. In a study by Širanović et al. (2011, pp. 33-35), twenty brain injury patients (18 male patients and two female patients) were involved and these patients boasted of a median Glasgow Coma Scale (GCS) score of 5. This study undertook a comparison of ultrasonographic measurement of ONSD as opposed to usage of direct measurement of intracranial pressure (ICP) in the brain injury patients. The study utilized MedCalc to analyze the data obtained to highlight the relationsip between ONSD and ICP. The mean ONSD for 8 patients with ICP > 20 cmH2O was 7.6 +/- 0.8 mm, and for 18 patients with ICP 20 cm H2O was 6.1, with sensitivity of 100 % and specificity of 83 %. (the area under the curve was 0.98, 95 % CI = 0.825-0.990) (Širanović et al., 2011, pp. 33-35).
It is important to note that medical practitioners need to conduct correct and quick diagnosis of elevated intracranial pressure while dealing with traumatic brain injury patients. The quick diagnosis serves as a preventive measure to secondary brain injury. Furthermore, fast diagnosis allows for early treatment of brain injury before the condition becomes out of hand. Other methods such as the usage of computed tomography have underlying demerits as they fail to give room for direct measurement of ICP. On the other hand, ultrasonographic measurement of ONSD works in a quick and safe manner as it is noninvasive. Futrthermore, this method is more readily available than other procedures to various healthcare facilities delaing with brain injury patients (Kimberly, Shah, Marill & Noble, 2008). Many medical practitioners prefer this method over other methods like intracranial catheter due to the many medical advantages that the method come with. (Bellner et al. 2004). The method takes care of both the patients and doctors since it is safe. Besides, it is more convenient to use and some of the factors that make it the most preferred method in diagnosing adult brain injury are discussed bellow.
Limited Risks to both Patient and Physicians
Physicians prefer this method of diagnosing adult brain injury because of the few risks it comes with. The traditional methods like radiography have been known to pose a lot of risk to both the patient and the physicians due to the emission of radiation. Exposure to radiation has a negative effect on the patient since it comes with side effects like skin rashes and sensitivity that damage the skin. Radiation effect can also lead to problems like tissue or organ damage, which can bring further complications in the body. Moreover, it can lead to infertility on both the patient and the doctor if they are exposed to radiation (Blaivas, M. 2007). On the other hand, research has shown that sonography does not emit any radiation and therefore safer that any other method that can be used in diagnosing adult brain injury.
According to Torloni et al. 2009, there is no reliable evidence pointing out the harms of using sonography (603). Unless a patient is exposed to a prolonged ultrasound from sonography, the process will not have any significant effects on both the patient and the physician attending to the patient (“American Institute of Ultrasound in Medicine”, 2003, p. 1116). One can therefore conclude that sonography has no adverse effect on the patient and the patient is not at risk when it is used in diagnosing adult brain injury.
Sonography is comfortable and inexpensive
Many people have failed to get a proper brain injury diagnosis due to due to the high cost. However, with increased technology and the invention of sonography, the trend has changed since more people can now afford to pay for the method. Sonography, compared to other methods of diagnosing brain injury, is cheaper and therefore affordable. Also it makes work easier for the physician and sonographers since it is portable and easy to use.
Apart from the above advantages of sonography, there are many others advantages of using sonograpy to diagnos an injury in the adult brain. First, the method has the ability to show the structures and functions of almost all major organs in the body including the brain, which is very complex. Secondly, the method is completely non invasive and painless, making the patient to be comfortable. At the same time, the machine is portable and can function almost everywhere and therefore the patient does not need to be moved from one place to another for diagnosis. (Benavita, 2009, p. 210).
Potential Risks of using Sonography
Even though sonography is not associated with any risk, there are some potential risks that are likely to occur if the process is not carried out effectively. The first potential risk is thermal effect. Sonography produces sound that releases some heat, which will definitely increase the temperature (Daffertshofer et al., 2005, p. 1443). Increased heat is most likely to have some negative effects on the patient, including the injury of the tissue like necrosis and apoptosis tissues. Increased temperatures will also lead to abnormal cell migration and it will also affect the function of the membrane.
However, these potential risks are associated with negligence on the part of the physicians and sonographers since there are well stipulated international standards which should be followed. International standards demand that sonographic machines Output Display Standards (ODS) for the safety of the patients. But it has been found that the majority of the physicians and sonographers does not observe these standards and are therefore exposing patients to danger. Studies have also shown that some physicians and sonographers are not knowledgeable enough and are therefore not competent to operate the machines. For instance, a study of 133 physicians and sonographers done in the US found that only 20.8% of sonographers were able to use the sonographic machine effectively and only 32.2% of participants confirmed that they were familiar with common terms like TI and MI. This study shows that lack of enough knowledge and skills on the use of sonographic machines is a threat to the life of patients and can lead to more damages, especially when one is dealing with the brain ( Bhatia, A., & Gupta, A. K. 2007).
Therefore, proper education and experience is needed for properly diagnose an of adult brain injury. For instance, if the sonographer is not well trained, he may not be able to observe the images which are required for appropriate diagnosis of brain injury. A study from England has also shown that a sonographer with a wide scope of practice may not correctly interpret the images which may lead to wrong diagnosis. These findings have made some patients and physicians to prefer radiology to sonography since some studies have found that radiologists provide a clearer diagnosis than sonograhers. One can therefore conclude that the accuracy of diagnosing adult brain injury through the use of sonography depends on the experience and skills of the sonographers.

Emerging Trends in Sonography
There have been an increased use and interpretation of sonographic results done bedside. This bedside interpretation of the results has been made possible because the sonographic machines are portable ane relatively cheaper than other imaging modalities. (Polat et al., 2011, p. 339). This trend is advantageous since it gives room for the interpretation of the results which can easily be associated with the patients’ observable signs and symptoms. Some scholars have predicted that the use of sonography will resemble that of stethoscope since it will be routinely used to monitor the patient’s conditions. This will also be made possible since sonographers are also increasing their scope of operation and more experts are being trained.
Discussion
The main question therefore is whether sonography is an important method for diagnosing adult brain injury. Base on the literature, sonography is an important method that can be used to diagnose any patient having had brain injuries. The method has a lot of advantages and one of the main advantage is that it guarantees the safety of the patient since it does not emit any radiation. At the same time the method is less expensive compared to other traditional methods like radiography which emitted a lot of radiation which can be harmful to the patient. Despite the many advantages, the method also comes with some risks to the patient. One of the main challenges facing the method is that some of the professionals are not competent enough in the field and this may be dangerous to the patient.
As much as it is a safe method, it also poses some challenges in terms of expertise and which is a major threat because a method can be effective, but without well trained experts one is likely to come up with the wrong diagnosis. The research should therefore focus on the suitability of sonography in diagnosing the adult brain injury basing the arguments about the positive and negative effects of sonography.

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