Philosophical Thinking in Ultrasound Imaging

The diagnostic principle of imaging is that doctors receive images, then use their own knowledge and memory to make judgments and draw conclusions. Traditional imaging methods such as X-rays, CT, and MR have fixed image patterns, and doctors usually review images together for diagnosis. This combines the thinking and existing medical knowledge of multiple doctors for diagnosis, which to some extent improves the accuracy of the diagnosis. However, ultrasound imaging is often performed by an individual and mostly requires rapid diagnostic results. This requires ultrasound work not only to have comprehensive and solid medical knowledge but also scientific philosophical thinking methods. Mastering scientific philosophical thinking methods will significantly improve the efficiency of ultrasound work.

1 Objective Reflection
Imaging reflects objective human body structures through subjective images; ultrasound is no exception. Its reflection of the objective human body is reflected not only in the description of the ultrasound report but also in its diagnostic conclusions.

1.1 Description Aspects

By describing the lesion's location, morphology, size, margins, internal echo, surrounding conditions, and blood flow signals, the ultrasound doctor can obtain a specific impression of the lesion. However, various aspects of the lesion reflected by ultrasound should also be emphasized. For example, in the description of a huge abdominal mass, the key points should objectively reflect whether there is a capsule, the boundaries with surrounding tissues (including surrounding organs and blood vessels), whether there are enlarged lymph nodes in the abdominal cavity and retroperitoneum, and whether there is metastasis to other organs, because understanding the surrounding relationship of the huge mass and whether the mass can be surgically removed is the most important concern clinically. In the description of breast nodules, in addition to the accurate location description, the key is to reflect its benign or malignant characteristics, which are the most important concern. In this case, the morphology, margins, and the presence or absence of microcalcification within the nodule become the focus, as the benign or malignant characteristics of the nodule will indicate whether the next clinical treatment is to continue follow-up or undergo surgery soon.

1.2 Conclusion Aspects

Since ultrasound images only reflect the patient's pathological anatomy and cannot replace pathology, and there are phenomena of "one image, multiple diseases" and "one disease, multiple images," the reflection of the lesion's location, morphology, size, and physical properties (solid, liquid, mixed) is objective, while the nature of the lesion is an inferred result. Therefore, in ultrasound conclusions, inferential words such as "possible," "consider," and "consistent with" should be used more often, which can also provide more thinking space for clinical practice and avoid directly making a diagnosis of "XX Ca." because the accuracy of ultrasound diagnosis for all diseases cannot be 100%. Objectively reflecting the location, source, and physical properties of the lesion in the conclusion and inferring its pathological diagnosis can help clinicians obtain objective and accurate information and avoid misleading.

2 Contradictory Views

2.1 Recognizing the Primary and Secondary Aspects of Contradictions
The main steps of ultrasound diagnosis are first to differentiate whether the image is normal, whether the abnormal structure in the image is an artifact, and whether there are normal variations. The diagnostic method commonly uses the method of exclusion. In the diagnostic process, normal images, artifacts, and variations first become the various aspects of the contradiction. Among them, normal images usually constitute the main aspect of the contradiction. This requires ultrasound workers to not ignore the importance of normal images, which is especially important for beginners. After repeatedly accumulating a certain number of normal images and adding some basic ultrasound knowledge and human anatomy knowledge, the operator can quickly identify artifacts and normal variations, and their ultrasound diagnostic level can be rapidly improved. Second, after considering the image abnormal, the various aspects of the contradiction change, and the image characteristics of the lesion become the main aspect of the contradiction. This requires operators to strengthen the study of lesion characteristics, pathology, and clinical knowledge. After a period of practice, their ultrasound level will be sublimate.

2.2 Grasping the Main Aspect of the Contradiction
When examining postoperative patients, the main aspect of the contradiction is often transformed from the preoperative disease to postoperative complications, and the most common postoperative complications are infection and bleeding. Mastering their characteristics and carefully examining key areas (such as the surrounding surgical area and subdiaphragmatic area) can often lead to correct conclusions. In patients with acute trauma, the main aspect of the contradiction is post-traumatic diseases, which are often manifested as effusion in ultrasound. Examining the liver-kidney, spleen-kidney recesses, subxiphoid area, and pelvis can quickly draw conclusions.

3 Unified View

3.1 Unification with Other Imaging Methods

Based on the same human anatomy and pathology, ultrasound, CT, and MR reflect the same lesions using different imaging principles. The results they jointly obtain are unified. Therefore, in the process of ultrasound diagnosis, referring to CT and MR images and results can not only help improve the correct diagnosis rate but also guide ultrasound to further accurately locate the lesions and guide surgical resection. After failing to find calcification in the breast tissue for the first time using ultrasound, carefully reading the mammogram may help find and locate calcification, enabling surgical resection.

3.2 Unification with Clinical Medicine
Ultrasound medicine provides patient information for clinical medicine, and in turn, obtains patient information from clinical medicine, thereby making more accurate judgments. The two are a unified whole in serving patients. Combining ultrasound with clinical practice is a fixed principle in ultrasound work. The emergence of interventional ultrasound unifies diagnosis and treatment, making the relationship between ultrasound and clinical medicine closer and making ultrasound medicine a part of clinical medicine. This requires ultrasound doctors to better learn clinical knowledge and better unify ultrasound and clinical knowledge in the diagnosis and treatment of patients.

4 Developmental View

4.1 Development of Diseases and Their Understanding

All diseases have a developmental process, and understanding this process is very important in ultrasound work. For patients with hematuria, when a mass appears in the hydronephrotic renal pelvis, with unclear changes in position and blood flow signals, if a blood clot or tumor is suspected, the patient should be asked to return for a follow-up examination after one week, which can help with differentiation. For suspected malignant thyroid tumors, follow-up examinations can be performed after 3-4 months to observe their growth rate and changes, which can help with accurate diagnosis. Diseases are developmental, and human understanding of them is also a developmental process. In the development of the widespread application of ultrasound, people's understanding of characteristics such as left ventricular false tendons, strong light spots in the fetal ventricle, and testicular microlithiasis has gradually deepened.
The developmental nature of understanding requires ultrasound doctors to continuously learn new knowledge to meet the requirements.

4.2 Development of Ultrasound Equipment and New Technologies

The emergence of ultrasound equipment is the crystallization of modern technological development. With the rapid development of modern science and technology, its functions are becoming more and more powerful. The advantages of high definition and high sensitivity are continuously improving the diagnostic rate, but also require ultrasound doctors to master its correct operation and optimization methods. With the emergence of new equipment, new technologies are also continuously emerging, requiring ultrasound workers to constantly update their knowledge in order to keep pace with the times.

In short, philosophical thinking is indispensable in ultrasound work. Only by truly integrating ultrasound knowledge, clinical knowledge, and other knowledge related to ultrasound medicine can the subjective ultrasound diagnostic process more truly reflect the objective anatomical, physiological, and pathological processes of the human body, thus improving the accuracy of ultrasound diagnosis and better serving patients.

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