ULTRASOUND

Ultrasound operates much the same as sonar, using high-frequency sound

waves as its imaging source.
Ultrasound is the reflection of a sound wave as it collides with the anatomy
being studied.
The resulting pattern of that reflection is converted into diagnostic
information via a hand-held transducer passed over the area being imaged.
Advances in ultrasound technology have resulted in applications that extend
far beyond fetal imaging to include cardiac, vascular and breast imaging, as
well as cyst identification and guidance of a variety of surgical and other
therapeutic procedures.
 Ultrasound
examination

Convex 3.5 MHz

Ultrasound For abdominal and
machine OB/GYN studies

Micro-convex: 6.5MHz
For transvaginal and
transrectal studies
Basic Ultrasound Physics
Amplitude

oscillations/sec = frequency - expressed in Hertz (Hz)

 Ultrasound Physics
 Sound is a mechanical, longitudinal wave
that travels in a straight line
 Sound requires a medium through which to
travel
 Ultrasound is a mechanical, longitudinal
wave with a frequency exceeding the upper
limit of human hearing, which is 20,000 Hz
or 20 kHz.

 Medical Ultrasound 2MHz to 16MHz

Ultrasound Pulse Production and Reception
A transducer is a device that can convert one form of energy into another. Ultrasound
transducers are used to convert an electrical signal into ultrasonic energy that can be
transmitted into tissue, and to convert ultrasonic energy reflected back from the tissue
into an electrical signal.

The general composition of an ultrasound transducer is shown below:

• the most important component is a thin
piezoelectric (crystal) element located near the
face of the transducer
• the front and back face of the element is coated
with a thin conducting film to ensure good
contact with the two electrodes
• the outside electrode is grounded to protect the
patient from electrical shock
• an insulated cover is used to make the device
watertight
• an acoustic insulator made of cork or rubber is
used to prevent the passing of sound into the
housing (i.e.: reduces transducer vibrations)
• the inside electrode is against a thick backing block that absorbs sound waves
transmitted back into the transducer
Transducer Characteristics

Transducer Thickness

A transducer can be made to emit sound of any frequency by driving it (in continuous
mode) with an alternating voltage of that frequency. However, a transducer vibrates
most violently and produces the largest output (pressure amplitude) of sound when

 = 2 • t

where the  is wavelength of sound and t is the thickness of the piezoelectric crystal.

The frequency of the emitted sound waves is then given by

frequency = v = v
 2 • t

where v is the speed of sound in the piezoelectric crystal.

operating frequency  crystal thickness 

Ultrasound Production
 Transducer produces ultrasound pulses (transmit 1%
of the time)
 These elements convert electrical energy into a
mechanical ultrasound wave

 Reflected echoes return to the scan head which

converts the ultrasound wave into an electrical signal
Frequency vs. Resolution
 The frequency also affects the QUALITY of the
ultrasound image
 The HIGHER the frequency, the BETTER the
resolution
 The LOWER the frequency, the LESS the resolution
 A 12 MHz transducer has very good resolution, but
cannot penetrate very deep into the body
 A 3 MHz transducer can penetrate deep into the body,
but the resolution is not as good as the 12 MHz

Low Frequency High Frequency

3 MHz 12 MHz
Two basic equations used in ultrasonic imaging:
1
d  tc
2
Where:
d = the one way distance of an object that cause the echo
t = time delay (for the round trip)
c - speed of sound in tissue (between 1450 and 1520 m/s)
The other equation:

S (t ) T (t )  B(t )  A(t )  (t )
Where:

S(t) - Received signal strength.

T(t) - Transmitted signal
B(t) - transducer properties
A(t) - The attenuation of signal path to and from the scatterer
(t) - The strength of the scatterer

In the frequency domain it turns to be:

S ( f ) T ( f ) B ( f ) A( f ) ( f )
Ultrasound Terminology
• Anechoic
• No returning echoes= black (acellular fluid)

• Echogenic
• Regarding fluid--some shade of grey d/t returning
echoes

• Relative terms
• Comparison to normal echogenicity of the same
organ or other structure
• Hypoechoic, isoechoic, hyperechoic
• Spleen should be hyperechoic to liver
Constructive Interference
(waves A & B add to form a
new wave of amplitude A + B)

Destructive Interference
(waves A & B add to form a new
wave of amplitude A + B = 0)

If wave B is wave front (C) and

wave F is wave front (D) then we
see that when transducer
thickness is one half the
wavelength, both wave fronts are
in phase and constructive
interference (ie: their individual
amplitudes add) occurs.
Ultrasound Beam Characteristics
In order to understand the beam characteristics of ultrasound we have to revisit our
view of wave front (compression region) generation. A piezoelectric crystal surface
actually behaves more like a series of vibrating points and not as the piston-like
surface that we have implied previously.

simplified
model

more accurate
model

• the compression waves are not uniform (at least not close to the crystal surface)
• each vibrating point produces multiple concentric rings or waves that eventually form
a continuous front as they reinforce each other along a line parallel to the surface of
the crystal
• the distance at which the waves become synchronous depends on their wavelength,
the shorter the wavelength the close the front forms to the surface of the transducer
Fresnel Zone (Near Field)

The length of the Fresnel zone is given by:

d2
4•
where d is the diameter of the transducer and  is the wavelength.

• the Fresnel zone increases with transducer size and frequency (lower wavelength)
• ultrasound imaging normally uses the Fresnel zone but not the Fraunhofer zone in
which resolution is poor
• beam intensity falls off because of attenuation
Fraunhofer Zone (Far Field)

The angle of divergence of the Fraunhofer zone is given by:

sin(q) = 1.22 
d
where d is the diameter of the transducer and  is the wavelength.

• beam intensity falls of due to attenuation and beam divergence

• angle of divergence increases with decreasing transducer diameter and frequency
• no useful imaging can be made in this region
Resonant Frequency

The frequency at which the transducer is the most efficient as a transmitter of sound
is also the frequency at which it is most sensitive as a receiver of sound. This
frequency is called the natural or resonant frequency of the transducer.

• the thickness and the material (i.e.: speed of sound in the crystal) of the piezoelectric
crystal determines the resonant frequency of the transducer
• transducers crystals are normally manufactured so that their thickness (t) is equal to
one-half of the wavelength () of the ultrasound produced by the transducer

Bandwidth Resonant Frequency

The range of frequencies in the

emitted ultrasound wave is called the
bandwidth and is defined to be the full
width of the frequency distribution at
half maximum (FWHM).

bandwidth  SPL 
 Continuous voltage waveform Pulsed voltage waveform

Frequency distribution of emitted ultrasound wave

Continuous waveform Pulsed waveform

can be represented by can be represented by
a single sine wave (one the sum of many sine
frequency), thus frequency waves each of different
distribution is very frequency, thus frequency
narrow distribution is wide
Q-factor
The Q-factor of a transducer system describes the shape of the frequency distribution
(response curve) and is defined as

Q-factor = f0 Bandwidth = (f2 - f1)

(f2 - f1)

where f0 is the resonance frequency, f1 is the frequency below resonance at which

intensity is reduced by half and f2 is the frequency above resonance at which
intensity is reduced by half

• high Q transducers produce relatively

pure frequency spectrums and low Q
transducers produce a wider range of
frequencies
• short pulses correspond to reduce Q
values and vice versa

bandwidth  Q-factor 
 Transducers Q factor

The Q factor is related to the

frequency response of the crystal
The Q factor determines the
purity of the sound and length
of time the sound persists, or
ring down time
Q = operating frequency
(MHz) / bandwidth (width of the
frequency distribution)
Q = f0/BW
High-Q transducers produce a
relatively pure frequency
spectrum
Low-Q transducers produce a
wider range of frequencies
Pulse Ultrasound Mode
Because a transducer can be a transmitter and a receiver of ultrasonic energy, it
clearly stands to reason that a continuous voltage waveform can not be used. If such
a waveform was used, the transducer would always function as a transmitter. Since
the internally generated sound waves are stronger than the returning echoes, the
returning signal is lost in the noise of the system. To over come this problem, most
transducers are used in a pulse mode where the voltage waveform consists of many
pulses each separated by a fixed distance and time. The transducer functions as a
transmitter during pulse excitation and as a receiver during the time interval between
pulses.

Voltage waveform Ultrasound pulses produced by transducer

NOTE
• most transducers are designed to have short pulses (improved resolution) with low
Q values (broad bandwidth - desirable in order to receive echoes of many different
frequencies)
Array transducers use the same principal as acoustic lenses to focus an
acoustic beam. In both cases variable delays are applied across the
transducer aperture. Focusing and steering is done by delayed excitation
signals as follows:

Excitation
signals Transmit
focus

The acoustic signal from all elements reach the focal point at the same time.
According to Huygens principle the net acoustic signal is the sum of all
signals. For receiving an ultrasound echo, the phase array works in reverse.
The echo from a receive focus is incident on each array element at a
different time interval. The received signals are electronically delayed so that
the delayed add in phase for an echo originating at the focal point.
In the receive mode, the focal point can be dynamically adjusted so that it
coincides with the range of returning echoes.
After transmission of acoustic pulse, the initial echoes return from targets
near the transducer. Therefore, the scanner focuses the phase array on
these targets, located at the first focus.
As echoes return from more distance targets, the scanner focuses at a
greater depth. Focal zones are established with adequate depth of field so
targets are always in focus to receive. This process is called dynamic
receive focusing.

f1

f2
time time
Arrays can be configured as :
Linear sequential array (~512 elements)
Curvilinear (convex) arrays.
Linear phased arrays.
1.5D arrays
2D arrays.
Linear
phased

Linear

Backi
ng
2D array

PZT Matching Face plate

layer
 Interactions of Ultrasound with
Tissue
• Acoustic impedance (AI) is dependent on the density of
the material in which sound is propagated
- the greater the impedance the denser the material.
• Reflections comes from the interface of different AI’s
• greater  of the AI = more signal reflected
• works both ways (send and receive directions)
Transducer

Medium 1 Medium 2 Medium 3

 Interactions of ultrasound with tissue
similar to wave behavior observed in light :--
(i) Reflection (ii) Refraction (iii) Scattering
(iv) Diffraction (v) Divergence (vi) Interference
(vii) Absorption

(i) Reflection

Acoustic Impedance/Characteristic impedance (Z)

 Quantity analogous to “momentum” in classical
mechanics; measure of the resistance to ultrasound
passing through the medium
Z= ρc

ρ: density of the medium

c: velocity of sound in same medium
 Unit: kg/m2/s (Rayl) 62
 c, ρ and Z in biological tissues
Material ρ(kg/m3) c(m/s) Z(kg/m2/s x106)
Air (200C): 1.3 330 m/s 0.0004
Lung: 400 650 0.26
Water (370C)1000 1480 m/s 1.48
Soft tissue: 1060 1540 m/s 1.63
Blood: 1057 1575 m/s 1.62
Bone: 1912 4080 m/s 7.80
PZT: 7650 3791 29
 Knowledge of velocity in a particular medium:
important in calculating depth to which ultrasound
wave has penetrated before being reflected
 Depth of penetration= (c x t)/2 63
 Impedance Mismatch

 Difference in Z  amount of u/s waves

reflected at the interface; regardless of the
thickness of the material from which it is
reflected

 If difference in Z is small  magnitude of

reflected wave is small

(i) air-bone interface  mostly reflected

(echoencephalography)
(ii) liver visualization  intercostal spaces b/w
ribs
64
 Reflection and Transmission coefficient
Acoustic energy reflected at tissue interfaces b/w
tissues with differing Z:

% of incident wave energy reflected:

%R = (Z2-Z1/Z2+Z1)2 x 100%

Z1 : acoustic impedance of medium 1

Z2 : acoustic impedance of medium 2

(u/s beam strikes the interface at a rt angle)

T coefficient: 1- (Z2-Z1/Z2+Z1)2 = 4Z1Z2/(Z2+Z1)2

65
%T=4Z Z /(Z +Z ) x 100%
2
 Reflection at tissue interfaces

fat/kidney

muscle/air

At 900 incidence  no change in direction 66

 Reflection at tissue interfaces
liver (Z=1.66x106 Rayl)/kidney (Z=1.63x106
Rayl) 
reflection coefficient is 0.000008 
less than hundred thousandth part of the
transmitted
energy is reflected at the boundary

fat (Z=1.42 x 106 Rayl)/air (Z=0.0004 x 106 Rayl)


reflection coefficient is 0.9987 
99% of the sound wave is reflected

67
 Factors affecting reflection
(i) angle at which incident beam hits the interface b/w
the different media
(as θi ~900  a higher % of u/s beam reflected)

(ii) difference b/w Z of the two media

(greater the diff in Z  greater the amount of energy
reflected)

Need for coupling medium/jelly

Z (air)=0.0004 x 106 Rayl; Z (tissue)=1.6 x 106 Rayl
∆Z very LARGE  most of the energy REFLECTED at
the interface. Jelly: air-free path b/w transducer and
skin  minimizes E reflection
68
 Specular Reflection
 If a sound beam is directed towards a
A
smooth & large surface and is >> B
width of the beam
 Rare in medical ultrasound; a flat surface >> λ
of the signal required. e.g.: strikes a large bone
at a high angle
 Follows the law of reflection

 Generally, perpendicular, specular reflection

gives the strongest echoes
 Responsible for major organ outlines in
diagnostic u/s: e.g. diaphragm and pericardium 69
 Specular Reflection (cont…)

It occurs when the sound wave meets a distinct

surface (significantly larger than the wavelength of
ultrasound)

Specular reflection is responsible for the bright

appearance of fibrous structures such as tendons and of
boundaries between different tissues
70
 Scattering (Diffuse reflection)

responsible for
providing the
internal texture
of organs in the
image
 small structures with sizes in the order of the
u/s λ
 common in med u/s structure of boundaries
b/w
tissues with diff Z usually not smooth but
IRREGULAR  u/s beams not reflected as 71
 Scattering (cont…)

This occurs at the small subtle boundaries that exist within tissue
(relative to the wavelength of ultrasound)
Small amounts of energy are absorbed and retransmitted in all
directions as if from a point source

Scattering gives rise to the characteristic texture (echo texture) of

the image seen within soft tissue
72
Specular and Non-specular Reflection

reflected beam directed at an

strongest echoes angle to the u/s beam

point
scatterers
<< u/s 

reradiates
u/s as
spherical
wavelets

redirected in several directions;

detectable echoes relatively weak
73
 Refraction
Requires:
• non-perpendicular incidence of the beam and
• different propagation speeds in the two media

Snell’s Law:

sin i/sin t = c1/c2

The change in direction is

caused by a change in  to
accommodate the change in
speed
74
 Refraction

c1>c2
bone

Here the wavelength of the

refracted ultrasound beam
is shorter than that of the
incident beam due to 
a decrease in propagation
speed

tissue

75
 Special cases of Snell’s Law
4 cases: (i) c1>c2 (ii) c1<c2 (iii) c1<c2 and θi is
beyond the critical angle and (iv) c1=c2
(i) [bone-tissue interface]: angle of
transmittance
bends towards
normal
(ii) [tissue-bone interface]: angle of
transmittance
bends away from
normal
(iii) refracted beam travels along the tissue-
bone interface & no energy enters the 2nd
medium; total reflection  Φc=22.2º for 76
 Interference and diffraction
Interference
• superposition of 2 or more waves

-- constructive interference (↑ amp)

-- destructive interference

• Every combination – from completely

constructive to completely destructive
interference can occur  resulting in a complex
wave summation

• Focusing of u/s beam in real time imaging 

based on the principle of wave interference

Diffraction
• Causes beam to diverge or spread out as the 77
waves move farther from the sound source
 Absorption
• Reflection/refraction/scattering/diffraction: ↓
the u/s
beam intensity: redirecting the beam energy

• Absorption: only process whereby u/s energy

is
dissipated in a medium; transformed into
thermal energy occurs due to heat production

• Three factors determine amount of

absorption:

(i) viscosity of the medium

(ii) relaxation time of the medium
(iii) beam frequency
78
 Viscosity

 determined by ability of molecules to move

past one another

 with ↑ viscosity  particle freedom ↓ &

internal friction ↑  absorbs the u/s beam  ↓
u/s intensity (by converting sound to heat)

 liquids  low viscosity  very little absorption

 soft tissue  viscosity higher  medium

amount of absorption

 bone  high absorption of ultrasound

79
 Relaxation time

• Time that it takes for a molecule to return to its

original position after it has been displaced

• Constant for any particular material

(a): molecule with short Rt and (b): with long Rt

(a): pushed by a longitudinal compression wave  molecules has

time to return to its resting state
before the next wave compression arrives

(b): molecules maybe moving back to and fro their original

position as the compression strikes them

more E required to stop (b)  additional energy

converted to heat

80
 Frequency
 most important parameter influencing
absorption

 affects absorption in relation to both (i) & (ii)

 if beam freq↑
(i) molecules move more often  ↑ heat
generated from the drag (caused by friction)

(ii) less time available to molecules to recover

during
relaxation process  molecules remain in
motion  more energy required to stop and
redirect them  more absorption 81
 Absorption: Mathematical Expression
 Rate of absorption  directly related to frequency
 If  doubles  rate of absorption also doubles

decreased frequency will travel more

A=A0e-z absorption of u/s beam
follows an exponential
function

A: where
peak amplitude of the beam at distance z
A0: original amplitude of the beam
a: absorption coefficient at a particular frequency
(dB/cm at a freq of 1 MHz)
z: distance travelled by the beam

82
 Absorption
Material  At 1 MHz
1 cm thick slice
Lung 41 dB/cm
kidney with an  of
Skull (bone) 20 dB/cm 1dB/cm reduces
Air 12 dB/cm sound I by 1 dB 
21% absorbed, 79%
Muscle 3.3 dB/cm remains
Lens of eye 2 dB/cm
Kidney 1 dB/cm 1 cm thick slice lung
Liver 0.94 dB/cm with an  of 41dB 
reduces I by a factor
Brain 0.85 dB/cm of > 10,000  less
Fat 0.63 dB/cm than 0.01% of the
beam remains
Blood 0.18 dB/cm
Water 0.0022 dB/cm 83
 Attenuation
Attenuation: sum of all possible mechanisms
leading to
loss of energy in the transmitted u/s signal
A=A0e-az
where a= attenuation coefficient
a = as +  where as= scattering
coefficient
Losses due to:
(i) beam spreading
(ii) scattering
(iii) absorption by the biological tissue 84
 Soft-tissue attenuation losses with frequency

Resolution dependent on  : higher the  , greater the

resolution  ideal design  trade-off b/w operating
frequency for best possible resolution and desirable
depth penetration (minimum attenuation) 85
Interactions of Ultrasound with
Tissue

 Reflection
 Refraction
 Transmission
 Attenuation
Interactions of Ultrasound with
Tissue
 Reflection
The ultrasound reflects off tissue and returns to
the transducer, the amount of reflection depends on
differences in acoustic impedance
The ultrasound image is formed from reflected
echoes

transducer
Refraction

reflective

refraction

Scattered
echoes

Incident

Angle of incidence = angle of reflection

Interactions of Ultrasound with
Tissue
Transmission
• Some of the ultrasound waves continue deeper
into
the body
• These waves will reflect from deeper tissue
structures

transducer
Interactions of Ultrasound with
Tissue
Attenuation
• Defined - the deeper the wave travels in the
body, the weaker it becomes -3 processes:
reflection, absorption, refraction
• Air (lung)> bone > muscle > soft tissue
>blood > water
 Reflected Echo’s

No Reflections = Black dots

Weaker Reflections =
Fluid within a cyst, urine, blood
Grey dots ‘Hypoechoic’ or echofree
• Most solid organs,
• thick fluid – ‘isoechoic’
What determines how far ultrasound
waves can travel?

• The FREQUENCY of the transducer

• The HIGHER the frequency, the LESS it can
penetrate
• The LOWER the frequency, the DEEPER it can
penetrate
• Attenuation is directly related to frequency
 Ultrasound Beam
Profile
 Beam comes out as a slice
 Beam Profile
Approx. 1 mm thick
Depth displayed – user controlled
 Image produced is “2D”
tomographic slice
assumes no thickness
 You control the aim

1mm
Accomplishing this goal
depends upon...

• Resolving capability of the system

• axial/lateral resolution
• spatial resolution
• contrast resolution
• temporal resolution
• Processing Power
• ability to capture, preserve and display the
information
 More on Imaging Modes

• A-mode: A-mode (amplitude mode) is the simplest type of ultrasound. A single

transducer scans a line through the body with the echoes plotted on screen as
a function of depth.
• B-mode or 2D mode: In B-mode (brightness mode) ultrasound, a linear array of
transducers simultaneously scans a plane through the body that can be viewed
as a two-dimensional image on screen. More commonly known as 2D mode
now.
• M-mode: In M-mode (motion mode) ultrasound, pulses are emitted in quick
succession – each time, either an A-mode or B-mode image is taken. Over time,
this is analogous to recording a video in ultrasound. As the organ boundaries
that produce reflections move relative to the probe, this can be used to
determine the velocity of specific organ structures.
Ultrasound Imaging Modes
• A-Mode Scan
• Amplitude-mode signal
• Transducer is fired rapidly and a succession of signals
can be displayed on an oscilloscope
• The time between successive firings is called
repetition time
• Interval should be long enough so that returning echoes
have died out, but fast enough to capture motion
• Useful when looking at heart valve motion
Ultrasound Imaging Modes
 B-mode scanners
Linear scanner – collection of transducers arranged in a line, does not
require motion. Requires large flat area with which to maintain contact with
the body.
○ Abdominal imaging
○ Obstetrics
Mechanical sector scanner – pivots a transducer about an axis orthogonal to
the transducer’s axis.
Phased array sector-scanner – collection of very small transducer elements
arranged in a line. Smaller than linear scanner. Advantage is that focus can
be varied over time providing a dynamic focus. Disadvantage is that
sidelobes of acoustic energy are generated and can lead to artifacts.
B-Mode
• B-mode ultrasound (Brightness-mode) is the
display of a 2D-map of B-mode data,
currently the most common form of
ultrasound imaging.
• This form of display (solid areas appear
white and fluid areas appear black) is also
called gray scale.
• The B-mode scan is the basis of 2D
scanning. The transducer is moved about to
view the body from a variety of angles. The
probe can be moved in a line (linear scan),
or rotated from a particular position (sector
scan).
Real Time B-mode
• Used phased array transducer called a real-
time scanner.
• Used most often to scan abdomen and to
check the fetus in pregnant women.
• System scans 15-60 frames/s.
• Hand-held transducer moved to different
positions or held at different angles to get
complete picture.
• Transducer can be moved and angles so that
get
3-D information.
M-mode
• The M-mode (Motion-mode) ultrasound is
used for analyzing moving body parts (also
called time-motion or TM-mode) commonly
in cardiac and fetal cardiac imaging.

• Used for studying the motion of interface.

• The high sampling frequency (up to 1000

pulses per second) is useful in assessing
rates and motion, particularly in cardiac
structures such as the various valves and
the chamber walls.
 Transducer Ribs
Chest wall

Heart in cross section

(diastole-relaxation)

M-line

Heart in cross section

(systole-contraction)

Ultrasound line of sight

Major Uses Of Ultrasound In Medical

• Diagnostic Applications:
Ultrasound has been used in a variety
of clinical settings, including Obstetrics and
Gynecology, Endocrinology, Cardiology,
Urology, Ophthalmology, Neurology and
Musculoskeletal.

• Endocrinology
– In abdominal Sonography, the solid organs of the
abdomen are imaged such as the pancreas, aorta,
inferior vena cava, liver, gall bladder, bile ducts and
spleen..
Cont…
• Obstetrics & Gynecology
– Measuring the size of fetus.
– Determining the position of the fetus to see if it is in the
normal head down position.
– Checking the position of placenta to see if it is
improperly developing.
– Seeing the number of fetuses in uterus.
– Checking the fetus growth rate by making many
measurements.
– Seeing tumors of breast.
• Cardiology
– To diagnose the dilation of parts of the heart and the
function of heart ventricles and valves.
– Measuring blood flow through the heart and major blood
vessels.
• Urology
– Measuring the blood flow through the kidney.
– Seeing the kidney stones.
– Detecting the prostate cancer.

• Neurology
– For assessing blood flow and stenoses in the carotid
arteries (Carotid ultrasonography) and the big
intracerebral arteries.

• Musculoskeletal
– Seeing tendons, muscles, nerves, and bone surfaces.
Therapeutic Applications
Therapeutic applications use ultrasound to bring heat or agitation
into the body.
• Ultrasound may be used to clean teeth in dental hygiene.
• Ultrasound sources may be used to generate regional heating
and mechanical changes in biological tissue, e.g. in physical
therapy and cancer treatment.
• However the use of ultrasound in the treatment of
musculoskeletal conditions has fallen out of favor.
Cont….
• Focused ultrasound may be used to
generate highly localized heating to treat
cysts and tumors (benign or malignant).
• Focused ultrasound may be used to break
up kidney stones by lithotripsy.
• Ultrasound may be used for cataract
treatment by phacoemulsification.
Advantages Of Ultrasound
• Ultrasound scanning is noninvasive (no needles or
injections) and is usually painless.
• Ultrasound is widely available, easy-to-use and less
expensive than other imaging methods.
• Ultrasound imaging uses non ionizing radiation.
• Ultrasound scanning gives a clear picture of soft
tissues that do not show up well on x-ray images.
• Ultrasound causes no health problems and may be
repeated as often as is necessary if medically
indicated.
• There are no hazards for the patient and operator.
Disadvantages Of Ultrasound
• The major disadvantage is that the resolution of images is often limited.

• Still in many situations where X-rays produce a much higher resolution.

• Bone absorbs ultrasound so that brain images are hard to get.

• Attenuation can reduce the resolution of the image.

• Sonography performs very poorly when there is a gas between the transducer
and the organ of interest

• Images of tissues on the far side of lungs are impossible to

get.
 Doppler Effect
• The motion of an object can be measured through a change in the
frequency of the waves emitted by the object
• The increase in pitch of an approaching police car is caused by the
compression of the sound wave
• The pitch decreases as the police car moves away
Doppler Effect

• Shift in perceived frequency when either source or

listener are moving relative to one another
• Familiar occurrence in audible sounds
• Also occurs in medical ultrasound
Doppler shift
• Doppler shift is the
difference between the
transmitted and received
frequencies.
• Transmitted and
received frequencies are
in the MHz range
• Doppler shift
frequencies often in
audible range
 Doppler Shift
 In astronomy, the same
effect happens to light waves

 A source that is moving away

will appear redder (redshift)

 A source that is moving

toward us will appear bluer
(blueshift)

 Note: Only objects moving

toward or away from us
(radial motion) will show this
effect
Doppler equation

• Relationship between Doppler shift (or just Doppler)

frequency, FD and reflector velocity, v:

2f o v cosθ
FD 
c
• fo is the ultrasound frequency, or the transmitted beam
frequency.
• v is the reflector velocity (m/s; cm/s)
• q is the Doppler angle
• c is the speed of sound
Types of Resolution
• Contrast Resolution
• the ability to resolve two adjacent objects of
similar intensity/reflective properties as
separate objects - dependant on the
dynamic range
Liver metastases
Acoustic Impedance
• The velocity of sound in a tissue and tissue density = determine
acoustic impedance
• Most soft tissues = 1400-1600m/sec
• Bone = 4080, Air = 330
• Sound will not penetrate – gets reflected or absorbed
• Travel time – dot depth

[Link]/~vetrad
Attenuation
• Absorption = energy is captured by the tissue then converted to heat
• Reflection = occurs at interfaces between tissues of different acoustic
properties
• Scattering = beam hits irregular interface – beam gets scattered

[Link]/~vetrad
Fetus Ultrasound
Ultrasound imaging: carotid artery
• Doppler imaging looks
at artery
• Get image and trace of
blood flow
• This is a healthy artery.
The flow is smooth and
all in the same
direction, like water in
a large, slow river
Ultrasound imaging: carotid artery
• This is also a carotid
artery.
• The flow is not all in the
same direction. It is
turbulent, like rapids in
a river.
• This is usually due to a
build-up of fatty
deposits in the artery
 Ultrasound imaging: 4D Doppler ultrasound

Ventricles
Atria

This is a complicated image

of the heart of a foetus. It
shows the blood moving
between the ventricles and
the arteries.
 Ultrasound contrast agents

Properties, Indications Substances Form

Gas bubbles, short half life, Shaken saline Solutions
difficult reproducabilty, Indocyanine green
cavitation and shaking effects
High density, low acoustic Perfluorooctylbromide, Colloidal emulsions
velocity, lower solubilty in lipid emulsions (foam)
blood, prolongs Doppler
enhancement.
Aqueous microparticle Iodipamide, ethyl ester, Colloidal suspensions
suspension with very fine gas microparticles
bubbles.
Right heart disease Galactose Suspensions with gas
diagnostics microparticles microbubbles
suspension forming
microbubbles
 Shadowing
• Clinical Manifestation
• reduction in imaged reflector amplitude
• Cause
• object between this reflector & transducer
attenuates ultrasound more than assumed Attenuates
• assumed compensation not enough to more than .5
provide proper signal amplitude dB/cm/MHz
• intensity under-compensated
• Opposite of Enhancement

Shadowed
Reflector
Shadowing

Attenuates
more than .5
dB/cm/MHz

Shadowed
Reflector
[Link]
 Enhancement
• Clinical Manifestation
• increase in imaged reflector amplitude
• Cause
• object between reflector & transducer Attenuates
attenuates ultrasound less than assumed less .5
dB/cm/MHz
• assumed compensation more than needed
to provide proper signal amplitude
• intensity over-compensated
• Opposite of Shadowing

Enhanced
reflector
Enhancement

Attenuates
less .5
dB/cm/MHz

Enhanced
reflector
[Link]
 Section Thickness Artifact

• anatomy may not be uniform over its

thickness
• universal problem of imaging 3D
anatomy
• in CT & MRI this is known as partial
volume effect

Thickness
Mirror Image & Doppler
• Analogous to mirror image artifact discussed
previously
• mirrored structures can include mirrored vessel
• duplicate image visible on opposite side of strong reflector
• example: bone
• Doppler data also duplicated
• flow & spectrum copied from original vessel
 Spectral Duplication
• mirror image of Doppler spectrum appears
on opposite side of baseline
• causes
• electronic duplication caused by receiver gain
set too high
• overloads receiver
• True sensing caused by too large Doppler
angle
• beam covers flow in both directions

Blood
flows
toward
transducer
Blood
flows away
from
transducer
 Refraction Artifact
• refraction alters beam direction
• scanner places dot in wrong location along line of
assumed beam direction
• can alter reflector shape
Refraction Artifact

• refraction alters beam direction

• direction of sound travel
assumed to be direction sound
transmitted

Actual Object Position

X Position of Object on Image X
Refraction
 Distance from Transducer

Echo positioning on image

distance from transducer calculated
from assumed speed of sound
can place reflector too close to or
too far from transducer
can alter size or shape of reflector

V = 1380 m/s X
Actual Object Position
X Position of Object on Image
V = 1540 m/s
Attenuation
• For all scanning your scanner assumes
• soft tissue attenuation
• .5 dB/cm per MHz
• Your scanner’s action
• compensate for assumed
attenuation
• allow operator fine tuning
• TGC
Lobe Artifacts
• Side Lobes
• beams propagating from a single
element transducer in directions
different from primary beam
• reflections from objects here will be
placed on main sound transmission
line
• Grating Lobes
• same as above except for transducer X
arrays
Range Ambiguity
• Reflection from 1st pulse
reaches transducer after 2nd
pulse emitted
• scanner assumes this is reflection
from 2nd pulse
• places echo too close & in wrong 1
2
direction
Scanner Assumptions
Multipath
Artifact

Actual Object Position

X Position of Object on Image
X
 Multiple Reflection Scenario

• reflection from reflector “B”

splits at “A”
• some intensity re-reflected 1 2 3
toward “B”
• Result A
• later false echoes heard
B
• scanner places dots behind
reflector “B”

1 real
2
false
3
Resolution Artifacts
• Axial and Lateral Resolution Limitations
• results in failure to resolve 2 adjacent structures as
separate
• minimum image size equal to resolution in each
direction
 Constructive Interference
• 2 echoes received
at same time
• in phase
• Result

+
• higher intensity

=
 Destructive Interference
• 2 echoes received at
same time
• Exactly 180o out of
phase

-
• Result
• flat (zero) wave

=
Acoustic Speckle
texture seen on image may
not correspond to tissue
texture
Results from interference
effects between multiple
reflectors received
simultaneously which can
add together
 constructive interference
subtract from one another
 destructive interference
Dosages
• Measuring radiation dosage
• Because radiation can pass through the body, radiation dose is measured according to the amount of radiation received by
the whole body. The scientific unit of measurement for whole body radiation dose, called "effective dose," is the
millisievert (mSv). Other radiation dose measurement units include rad, rem, roentgen, sievert, and gray.
• Doctors use "effective dose" when they talk about the risk of radiation to the entire body. Risk refers to possible side
effects, such as the chance of developing a cancer later in life. Effective dose takes into account how sensitive different
tissues are to radiation. If you have an x-ray exam of tissues or organs that are more sensitive to radiation, your effective
dose will be higher. Effective dose allows your doctor to assess your risk and compare it to more familiar sources of
exposure, such as natural background radiation.
• Naturally-occurring "background" radiation
• We are exposed to natural sources of radiation all the time. According to recent estimates, the average
person in the U.S. receives an effective dose of about 3 mSv per year from natural radiation and cosmic
radiation from outer space. These natural "background doses" vary according to where you live.
• People living at high altitudes such as Colorado or New Mexico receive about 1.5 mSv more per year than
those living near sea level. A coast-to-coast round trip airline flight is about 0.03 mSv due to exposure to
cosmic rays. The largest source of background radiation comes from radon gas in our homes (about 2 mSv
per year). Like other sources of background radiation, the amount of radon exposure varies widely
depending on where you live.
• To put it simply, the amount of radiation from one adult chest x-ray (0.1 mSv) is equal to 10 days of natural
background radiation.
Effective radiation dose in adults
Benefit versus risk
The risk associated with medical imaging procedures refers to possible long-term
or short-term side effects. Most imaging procedures have a relatively low risk. Plus,
hospitals and imaging centers practice ALARA (As Low As Reasonably
Achievable). This means they make every effort to decrease radiation risk. It is
important to remember that a person is at risk if the doctor cannot accurately
diagnose an illness or injury. Therefore, it could be said that the benefit from
medical imaging (an accurate diagnosis) is greater than the small risk that comes
with using it. Talk to your doctor or radiologist about any concerns you may have
about the risks of a procedure.