9/9/23

What is Ultrasound?
BASIC CONCEPTS OF –
™ Ultrasound is the name given to high-frequency sound
ULTRASOUND waves over 20,000 cycles per second (20kHz). These waves,
inaudible to humans can be transmitted in beams and are
– used to scan tissues of the body.

By:Associate Prof. Myna Marie Nerona RRT, MSRT ™ Ultrasound’s frequency ranges from 2 to 10 MHz.
Dean ™ The UTZ’s duration of the pulse is about 1 microsecond
University of Makati and the pulses are repeated about 1000 times per second.

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CATEGORIES OF
SOUND
– ™ ULTRASOUND – –
1) ULTRASOUND – High frequency sound waves ™ AUDIBLE SOUND
2) AUDIBLE SOUND – Above 20,000 cycles per second (20 kHz) – Sound is a form of energy which causes a mechanical disturbance
in the form of vibration of molecules within a medium
3) INFRASOUND – Inaudible to humans – Sound is a mechanical wave that travels in a medium in a
– Used to scan tissues of the body LONGITUDINAL WAVE

– Ultrasound Pulse: 1-10 MHz – Sound requires a medium containing molecules, and
– Pulse Duration: 1 microsecond therefore cannot travel through a vacuum
– Pulse Repetition: 1000 times/second – sound requires a vibrating object
– 16 Hz to 20,000 Hz

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– – –
™ INFRASOUND When a sound travels through a medium: TYPES OF SOUND WAVES
– Below 16 Hz
The molecules of that medium are alternately 1. LONGITUDINAL OR COMPRESSION WAVES
compressed (squeezed) and rarefied (stretch).

2. TRANSVERSE WAVES OR SHEAR WAVES

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™ Ultrasound is a longitudinal, mechanical wave that

carries variations of quantities referred to as acoustic FREQUENCY APPLICATION RANGE
variables.
–
™ Longitudinal wave the particles of the medium are in a
direction parallel to the wave propagation
ABOVE 20,000 Hz
–
DIAGNOSTIC 1-10 MHz FREQUENCY – APPLICATION RANGE
ULTRASOUND OR
™ Mechanical wave a wave that requires a medium in ABOVE 20 kHz
ABOVE 20,000 Hz DIAGNOSTIC 1-10 MHz
which to travel and, therefore cannot propagate in a ULTRASOUN OR
THERAPEUTIC 0.7-1.0 MHz D ABOVE 20 kHz
vacuum.
™ Acoustic variable SURGERY 1-5 MHZ THERAPEUTIC 0.7-1.0 MHz
™ Acoustic Wave has a frequency higher than the upper
SURGERY 1-5 MHZ
limit of human hearing (above 20,000 cycles per second) INDUSTRIAL 25-400 kHz
or 20,000 Hz INDUSTRIAL 25-400 kHz
MILITARY 20-50 kHz
MILITARY 20-50 kHz

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FREQUENCY APPLICATION

FREQUENCY
– MEDIUM SPEED IN
– –
m/sec ACOUSTIC VARIABLES
1. Period
INFRA BELOW 16 Hz EARTHQUAKES
AUDIBLE BETWEEN AIR (at 32º F) 331
SOUND 2. Wavelength
SOUND 16 Hz TO 20,000 Hz
OR 3. Amplitude
16 Hz TO 20 kHz
4. Frequency
5. Velocity
WATER (SEA) (at 1531 6. Power
77º F)
7. Intensity
SOLID (STEEL) 5200

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ACOUSTIC
VARIABLES
– – –
™ Period (T): the time taken for one complete cycle to 1. PERIOD (us) PERIOD
PERIOD FREQUENCY
& FREQUENCY
occur (s or µs)
™ Wavelength (λ): length of space over which one
cycle occurs (m or mm)
™ Amplitude (Depth): the maximum displacement PERIOD FREQUENCY
that occurs in an acoustic variable
™ Frequency: cycle per second (Hz) Period (T)
™ Velocity: frequency times wavelength The TIME taken for one complete cycle to occur
)

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2. WAVELENGTH (λ), (mm)

– – –
PERIOD & FREQUENCY 3. AMPLITUDE (Pa)

•Length/ DISTANCE of space over which one

Period = 1
cycle occurs
Frequency The maximum displacement that occurs in
•Length of a wave or cycle an acoustic variable. (depth, height)

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CHAPTER 1
– – –
3. AMPLITUDE (Pa) 3. AMPLITUDE (Pa) 3. AMPLITUDE (Pa)

Unit of Amplitude expressed in Pressure Sound pressure àPascal

™ Amplitude is defined by the parameters à Pascals or MPa
difference between the peak Sound pressure level àDecibel
(maximum) or trough Amplitude diminishes as sound
(minimum) of the wave and the propagates through the body 1Pa = 94 dB SPL
average value (Attenuation) 1 dB SPL = 0.00002244 Pa

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– – –
4. FREQUENCY (Hz) 4. FREQUENCY (Hz) 4. FREQUENCY (Hz)

™ Is the number of cycles that occurs Sonography uses pulsed ultrasound:

in one second
™ C/sec
Ex:
™ It affects penetration of sound and
A few cycles (2-3 cycles) of ultrasound separated
image quality (resolution) 1 Hertz = 1Cycle per second in time with gaps of no signal.

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PRP PRF
– – –
Pulse repetition frequency (PRF)
Pulse Repetition Period (PRP) PRP decreases as PRF increases.
PRP PRF
Number of pulses occurring in 1 s. Time from the beginning of one pulse to
More pulses occur in a second, less
Usually expressed in kHz. the beginning of the next.
time from one to the next.
Pulse/ sec Usually expressed in microseconds (µs).

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– – –
Pulse duration (ms)
PRP = 1 PRP (µs) = 1
PRF PRF (kHz)
TIME it takes for one pulse to occur
Period = 1 Period (s) = 1
Frequency Frequency (Hz)
.
PD= Period x # of cycles in the pulse.
.

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PULSE DURATION FREQUENCY

– – –
(PD) vs (Frequency) 5. VELOCITY (m/sec)
PULSE DURATION FREQUENCY ™ Is velocity at which sound travels through
a particular medium
™ is dependant on the compressibility and
PD decreases if the frequency is density of the medium
increased. ™ Usually, the harder the tissue, the faster
the propagation velocity

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– – –
M5. VELOCITY (m/sec) 5. VELOCITY (m/sec) 6. POWER (Watts)
E The faster the Utz ™ Is the rate of energy transferred
D The velocity of a sound wave in a
I
propagation medium, is related to its wavelength and through the sound wave.
Density Speed
U frequency
M Hardness v ™ Power is proportional to the
Compressibility amplitude squared of a sound
Stiffness
f λ 5 MHz ultrasound beam has a wave
wavelength of 0.308 mm in ™ P = A²
soft tissue with a velocity of
1540 m/sec.

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THE HISTORY OF 1794: LAZZARO

– ULTRASOUND SPALLANZANI
7. INTESITY (Watt/ cm²) First to Study Ultrasound Physics by
™ Is the concentration of energy in deducing Bats (echolocation)
a sound wave. –
™ It is dependent on the Power
(Watt) and the cross sectional
area (cm²) of a sound beam
™ Intensity = Watt/ cm²

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1826: JEAN DANIEL 1842:CHRISTIAN ANDREAS 1880: PIERRE & JACQUES

COLLADON DOPPLER CURIE
Uses Church Bell (early ultrasound Discover the Piezo-Electric Effect
Suggests that the frequency of a sound wave
“transducer”) to calculate Speed of Sound through
Water. Prove Sound Travelled Faster through Water depends on the speed of the source.
than Air. “Doppler Effect”

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1915: PAUL LANGEVIN 1942: KARL DUSSIK 1948: GEORGE LUDWIG M.D.
After Titanic Sinking (1912) Invents first physician to use ultrasound for medical first described the use of ultrasound to
Hydrophone (1st Transducer) to detect diagnosis (brain tumors) diagnose gallstones
Icebergs and Submarines during WW1

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1953: INGE EDLER AND HELLMUTH 1958: IAN DONALD 1950s:DOUGLASS HOWRY & JOSEPH
HERTZ HOLMES
Pioneer of OB-GYN Ultrasound
Performed the first successful echocardiogram
pioneer 2D B-mode Ultrasound

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Early 1950s Late 1950sà the first contact compound 1966: DON BAKER, DENNIS
Because air does not transmitted B-scanner (using olive oil as a lubricant) WATKINS, AND JOHN REID
ultrasound waves efficiently, the air was developed. This equipment used an
interface between the transducer and the articulating arm to produce static Pulsed Doppler ultrasound technology
patient’s skin was initially a problem. images.

Early scanning technique required the

patient to be immersed in a bath of water
in order to provide good transmission of
sound wave into the body.

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1970s: 1980s: KAZUNORI BABA 1990s:

Continuous wave Doppler, spectral 3D ultrasound technology and captured three- 4D (real time) capabilities and
wave Doppler and color Doppler dimensional images of a fetus in 1986.
Ultrasound guided biopsies
ultrasound instruments.

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2000s - Present
The iPhone now has a – –
telesonography app. BIOLOGIC EFFECTS OF a. Thermal Index (TI)
ULTRASOUND???? ™ Is a predictor of max. temperature increases under
clinically relevant conditions.
™ Heat Index
In general UTZ is considered to be safe image ™ Absorption of sound waves may cause heating in
modality.. tissue
™ TI = Below 1.0 (1 degree celsius)
Ø TIB (bone)
a. Thermal Index (TI) Ø TIC (cranial)
b. Mechanical Index (MI) Ø TIS (soft tissue)

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– – THE PIEZOELECTRIC
b. Mechanical Index (MI) EFFECT
The ISUOG and WFUMB, 2009..
• Gives an estimation of cavitation
–
effect of UTZ Disapproved the use of UTZ for the sole
purpose of providing souvenir images of
™MI = Below 1.0 (1 degree celsius) the fetus and also for entertainment
purposes..

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B. PIEZOELECTRIC
MATERIALS
– – –
A. PIEZOELECTRIC EFFECT B. PIEZOELECTRIC MATERIALS/
ELECTROCERAMIC NATURAL SYNTHETIC
™PIEZOà is a Greek word “PIEZIN” 1. Quartz 1. Lead Zirconate Titanate (PZT)

™means to “press or pressure, squeeze”; ™ Quartz- naturally occurring crystals

2. Tourmaline 2. Barium Titanate
™ Lead zirconate titanate (PZT)- man made
™This is the ability of a material to generate ceramics 3. Rochelle Salt 3. Lead Metaniobate
an electrical charge in response to applied
pressure ™ Plumbium zirconante titanate (PZT)
4. Ammonium dihydrogen phosphate

5. Lithium Sulphate

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™Normally these dipolar molecules ™If the materials are heated above
– –
have a random arrangement –
the Curie temperature in
•Piezoelectric materials are
crystalline materials composed of presence of an electric field, the
™they are unable to align themselves
dipolar molecules without an applied electric field.
molecules align themselves with
that field.
•Positive at one end and negative
at the other.

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THE PIEZOELECTRIC CRYSTAL

AS TRANSMITTER OF SOUND THE PIEZOELECTRIC CRYSTAL AS
RECEIVER OF SOUND
– – NOTE: –
™Piezoelectric materials are used in the Piezoelectric materials are used in ™As the crystal diameter decreases,
production of ultrasound by the detection of echo by
converting: the beam divergence increases.
converting:
™Electrical energy into Mechanical
energy (sound) ™Mechanical energy (sound) into ™As the crystal diameter increases,
Electrical energy. the beam divergence decreases
™E à M ™M à E

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ACOUSTIC – –
IMPEDANCE A. ACOUSTIC IMPEDANCE (Z) ™A substance which has densely
packed molecules will have a high
– Acoustic impedance. Ex. Bone
™The resistance offered by tissues to
the movement of particles caused by
the ultrasound waves. ™A substance which has loosely packed
particles will have a low acoustic
™ Ex: Bone tissue Vs. Soft Tissue
impedance. Ex. Air

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CHAPTER III CHAPTER III

– – –
Z= Product of density and speed
Z= ρc The average velocity of
ultrasonic waves in soft tissue
™Density (ρ) kg/m 3
is:
™Speed of sound (c) m/s
™Acoustic impedance (Z) rayls = kg/m 2/s 1540 meters per second

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CHAPTER III
– – –
B. ACOUSTIC IMPEDANCE C. ACOUSTIC IMPEDANCE C. ACOUSTIC IMPEDANCE MISMATCH
MISMATCH AND REFLECTION AND REFLECTION
MISMATCH
™Substances with the same acoustic
impedanceà
™The greater the impedance mismatch,
™The difference in acoustic the greater the percentage of energy ™Have a total transmission of energy and
impedance between two that will be reflected at the interface or therefore no reflection.
substances is known as the boundary between one medium and ™ZR= 0% ; ZT=100%
acoustic impedance mismatch. another.

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– – –
™Substances with a small difference in ™Substances with a large difference ™ If there is a large acoustic mismatch
acoustic impedanceà in acoustic impedanceà ™ Ex: between (bone and muscle) ; (air and soft
tissue)
™Large amount of reflected energy
™Small amount of energy is reflected and a small amount of transmitted
but the majority is transmitted. energy.
large propor-
produces a do not have
bright image very little
tion of energy is enough energy
energy is
on the to produce
™ZR= 99% ; ZT=1%
reflected.
display. transmit-ted im age.

™ZR= 5% ; ZT =95%

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– –
MISMATCH REFLECTION TRANSMISSION ™Therefore, it is not practical to use
ultrasound to produce images of soft
Ultrasound Beam
tissue subjects containing GAS OR
BONE.
–
MISMATCH REFLECTION TRANSMISSION
™Ultrasound imaging is very good at
discriminating between substances with
small differences in acoustic impedance
such as soft tissues.

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BEAM SHAPE ™Increasing the frequencyà will

result CHAPTER
in
FREQUENCYa longer
NEARnear IV FAR
FIELDfield andFIED
–
™The area through which the sound energy emitted – less far field
INCREASE –
divergence.
LONG (vice
LESS
from the ultrasound transducer travels is known ™It can be divided in two regions: versa)
DECREASE SHORT MORE
as the ultrasound beam.
™The beam is three dimensional and is symmetrical 1. Near Field (Fresnel zone)
around its central axis. narrow crystal
™ACRYSTAL diameterà
NEAR FIELD will
FAR FIELD
2. Far Field (Fraunhofer zone) DIAMETER
result in a narrower beam in the
NARROW DECREASE INCREASE
near field, and there is more
divergence
WIDE inINCREASE
the far fieldDECREASE

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CHAPTER IV
– – –
II. SIDE LOBES
™These echoes will therefore be ™In addition, they cause a
incorrectly placed on the image.
degradation of lateral resolution
The extraneous beams of the
due to the effective widening of
ultrasound generated from the ™15% à side lobes
the beam in the scan plane.
edges of individual transducer.
™Grating lobes

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– –
III. BEAM WIDTH Ultrasound Artifacts
™The beam width affects the
LATERAL RESOLUTION
–
™Beam width refers to the
dimension of the beam in the scan
plane. ™the narrower the beam width, the
better the Lateral resolution.

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1.
™ Different types of UTZ artifacts
Reverberation
REVERBERATION
2. Acoustic shadowing
– 3.
4.
Acoustic enhancement
Edge shadowing
– –
™This is the production of spurious (false) echoes
5. Beam width artifact due to repeated reflections between two interfaces
6. Slice thickness artifact with a high acoustic impedance mismatch.
™An ultrasound artifact is a 7. Side lobe artifacts
™Comet tail
structure in an image which 8. Mirror image
does not directly correlate with 9. Double image
10. Equipment-generated artifacts
actual tissue being scanned.

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– – –
™This artifact can be differentiated from the real echoes
™Artifacts appearing as parallel, equally ™This artifact will often be seen: due to the lack of breathing movement occurring.
spaced lines is called reverberation
™To help to eliminate this artifact it may be useful to:
™Reverberation artifacts are a result of the 1. At the skin-transducer interface 1. Increase the amount of gel used
presence of two or more strong reflecting 2. Gas surface and the transducer 2. Used a stand-off pad (gel pad or a bag of saline)
3. Reduce the gain
surfaces 4. Move the position of the transducer.

™Shotgun wound

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ACOUSTIC
SHADOWING
–
This appears as an area of low amplitude echoes (hypoechoic or
– –
™If the shadowing contains reverberation
anechoic) behind an area of strongly attenuating tissue. ™Acoustic shadowing will occur at the (ringdown echoes), it is likely to be gas.
™ It is cause by severe attenuation of the beam at interference, resulting
in very little sound being transmitted beyond. interface with a large acoustic
™ The attenuation can be due to either absorption or reflection of the
sound waves or a combination of two.
mismatch such as:
™If the shadowing is clear shadowing,
1. Soft tissue and gas absent of any ringdown, it is likely to be
2. Soft tissue and bone or calculus
a calculus

™Calcified mass

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ACOUSTIC
ENHANCEMENT
– – –
™This artifact appears as a localized area of ™Can commonly be seen distal to fluid filled
increased echo amplitude behind an area of structures such as the urinary bladder, the ™Acoustic enhancement is
low attenuation.
gallbladder or a cyst. caused by weakly attenuating
structures.
™This artifact can often be a useful diagnostic
aid, particularly when scanning a soft-tissue
mass or cyst containing low-level echoes. ™Fluid filled mass

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BEAM WIDTH
EDGE SHADOWING
ARTIFACT
– – –
™A combination of refraction and reflection
occurring at the edges of rounded structures (and ™All echoes returning to the transducer will
when the speed of sound is different from that in
surrounding tissue) will result in an edge
have arisen from across the full width of the
beam, which can vary by several millimetres.
™Correct positioning of the focal
shadowing artifact.
zone will help to reduce this
artifact.

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SLICE THICKNESS
ARTIFACT
– of the beam, and are
These occur due to the thickness – –
similar to beam width artifacts.
™However, they occur at 90 degree to the scan plane ™These artifacts will typically be seen
with echoes from interfaces in front of and behind in transverse views of the urinary
the assumed plane of origin appearing in the
bladder ™This artifact is a result of inherent
display. characteristics of the transducer, and
apart from trying a different
™Beam thickness artifact is primarily transducer, cannot be eliminated.
dependent upon beam angulation

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SIDE LOBE MIRROR IMAGE

ARTIFACT ARTIFACT
– beam exists as
™The energy within the ultrasound
several side lobes radiating at a number of angles
– –
from a central lobe. ™These artifacts result in a mirror image of a
™Echoes are generated by these side lobes in ™They may also arise within a cyst, where structure occurring in an ultrasound display.
addition to the main lobe, but all the returning adjacent structures are portrayed as if arising They arise due to specular reflection of the
echoes are assumed by the transducer to have from within the cyst. These appearances can
arisen from the central axis of the main lobe. beam at a large smooth interface.
give rise to a false diagnosis of septations
within a cyst.

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DOUBLE IMAGE
ARTIFACT
– – –
™An area close to a specular reflector will ™This artifact is caused by refraction of
be imaged twice, once by the original the beam and may occur in areas such
ultrasound beam and once by the beam as the rectus abdominis muscle on the ™In the transverse plane the edges of the
after it has reflected off the specular anterior abdominal wall. muscle act as a lens and cause the
reflector. ultrasound beam to be refracted and
this causes a single structure to be
™fluid-air interface. interrogated by the two separate
™Diaphragm refracted beams.

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– – –
™If too mach gain is applied then the
10. EQUIPMENT-GENERATED electronic noise, inherent in all systems,
™In order to establish whether these will also be amplified.
echoes are genuine, it is necessary to ARTIFACTS
move the transducer slightly to one
side to avoid the junction of the rectus
™If too little gain is applied, this can lead to
abdominis muscles. ™Incorrect use of the equipment controls loss of relevant information, and incorrect
can lead to artifacts appearing. diagnosis may occur.

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ACOUSTIC
Velocity of sound
VARIABLES
– – –
™ Period (T): the time taken for one complete cycle to ™ The velocity of sound in a medium is determined by ™ Cycle is composed of one compression and one
occur (s or µs) the density and elastic properties of the medium. rarefaction, or a complete positive and negative
™ Wavelength (λ): length of space over which one ™ It differs greatly among air, bone and soft tissue change in an acoustic variable
cycle occurs (m or mm) ™ But varies only slight form one tissue to another
™ Amplitude (Depth): the maximum displacement
that occurs in an acoustic variable
™ Frequency: cycle per second (Hz)
™ Velocity: frequency times wavelength

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– – –
™ Frequency is the number of cycles per second. ™ Period is the time it takes for 1 cycle to occur; the ™ Wavelength (λ) is the distance the wave must travel
– It also describes how many times the acoustic variable inverse of frequency in 1 cycle.
changes in one second. ™ Units of period: seconds (s)and microseconds (µs) – It determined by both the source of the wave and the
– Cycles of compressions and rarefactions in a sound medium in which it is propagating
waves – Units of wavelength: meters (m) and millimeters (mm)
™ Period= 1/frequency
– Units of frequency: hertz (Hz) or megahertz (MHz)
– It is inversely proportional to the frequency.
– Frequency =
– Wavelength= propagation speed /frequency

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–
™Propagation Speed is the maximum speed with
which an acoustic wave can move through a
– –
™ Propagation speed is greater than in solids>liquid>gases. ™ Example:
medium, determined by the density and – If the frequency of an UTZ wave traveling through
stiffness of the medium. ™ Propagation speed (c) is equal to frequency (f) times
soft tissue is increased from 5 to 10 MHz, what
wavelength (λ) happens to the wavelength?
™It increases proportionally with the stiffness ™ Because the propagation speed is constant for a given
™Density is the concentration of mass per unit medium, if the frequency increases, the wavelength will
volume, the propagation speed is inversely decrease. Conversely, if the frequency decreases, the
proportional to density wavelength will increase.
™Units: meters/seconds (m/s),
millimeters/microseconds (mm/µs)

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Parameters used to Pulse Repetition Pulse Repetition Period

Describe Pulse Waves Frequency
– – –
™ Pulse Repetition Frequency ™ Is the number of pulses per second. ™ Is the time from the beginning of one pulse to the
™ Pulse Repetition Period ™ Units: hertz (Hz), kilohertz (kHz) beginning of the next.
™ Pulse Duration ™ It is used depends on imaging depth. ™ Units: seconds (s) , milliseconds (ms)
™ Duty Factor ™ As the imaging depth increases, the PRF must ™ PRP= 1/PRF
decrease ™ The PRP increases as the imaging depth decreases.
When PRP decreases, the imaging depth increases.

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Pulse Duration
Duty Factor Spatial Pulse Length
– –
™ Is the fraction of time that the transducer is generating a
–
™ Is the time it takes for a pulse to occur; the period of pulse. ™ Is the distance over which a pulse occurs.
the ultrasound in the pulse multiplied by the ™ Units: millimeters (mm)
number of cycles in the pulse.
™ Maximum value : 1.0 in continuous waves, the transducer ™ SPL= wavelength x number of cycles in a pulse (n)
™ Units: seconds (s) milliseconds (ms) is always generating a pulse. A second transducer acts as
™ Pulse Duration= number of cycles (n) x period (p) the listening device
™ Minimum value 0.0. the transducer is not being excited. In
clinical imaging, using pulse echo system is the duty factor
from 0.001 to 0.01
™ Units: Unitless

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DIFFERENT MODES
Amplitude OF ULTRASOUND
– – OPERATIONAL MODES –
™ Is the maximum variation that occurs in an acoustic ™ A-MODE 1. Static imaging modeà A-mode (useful for
variable. ™ B-MODE measuring midline shifts of the brain) , B-mode
™ it indicates the strength of the sound waves ™ REAL-TIME (used primarily for abdominal imaging)
™ To arrive at this variation, the undistributed value is ™ M-MODE 2. Dynamic Imaging modesà M-mode (application in
subtracted from the maximum value, and the unit ™ DOPPLER ULTRASOUND dynamic imaging of internal structures), Real-time
for the acoustic variable is applied. (allows for observation of structures in motion)
3. Ranging modeà Doppler mode (used for depth and
flow measurements and investigations of moving
surfaces.)

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A mode scan
1.) A-MODE display (Amplitude Mode) – –
Modes of Display ™ Echoes are shows as peaks
™ One-dimensional graphic display with vertical deflections of the baseline.
– ™ Y-axis (height of the deflection) represents the amplitude/ strength of the
echo
™ X-axis represents the distance in time is a function of where on the
horizontal baseline the deflection occurs.
™ Distance between various structures can be measured
™ Used to build two-dimensional B-mode image

In this mode, utz is emitted in pulses by the transducer, which

then also receives echoes or reflections from tissue interfaces. This
type of emission is called pulse-echo technique.

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B-Mode Scan
– –
2.) B-MODE display (Brightness mode)
™ This type of image shows all the tissue traversed by
–
the ultrasound scan.
™ Displays the echoes as variations in the brightness of
üThe main purpose for employing the line spots on the image.
™ The position of the spot on the baseline is related to
A-mode is to measure the depth of the depth of the reflecting structure: the brightness is
proportional to the strength of the echo.
interferences and to detect their
separation accurately. ™ Two-dimensional images in which the echo amplitude
is depicted as dots of different brightness.

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3. ) REAL-TIME
From the M-mode display the x-axis is a depth axis;
–This mode display motion by showing the the y-axis is a time axis that can be used to
–
images of the part of the body under the
transducer as it is being scanned, the images
– –
measure the time between successive heartbeat..
4.) M-MODE display (Motion-mode)
changes with each movement of the – Shows movement as a function of time
transducer or id any part of the body is – Used in cardiac scanning
moving. – Another way of displaying motion
–Examples: moving fetus or pulsating artery. – Result is a wavy line.
–The movement id shown on the monitor in ü If the A-mode image contains moving interfaces
real time as it occurs. In most real time units, it and is converted to a B-mode display so that the
is impossible to freeze the displayed image, vertical axis is time driven, M-mode display
results.
holding it stationary so that it can be studies
and measured if necessary.

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M-Mode Scan
– – –
Sometimes called… 4.) Doppler Ultrasound
1. TM mode (time-motion mode); Demonstrates and measures blood flow
2. PM- mode (position-motion
mode) and
3. UCH (ultrasonic cardiography) Christian Johann Doppler noted in
1842 that the wavelength of light varied
since its principal application is to according to the relative motion of the source
monitor the heart.
of the light and the observer.

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– – –
Stars moving away from the The Doppler shift frequency
earth produce light that appears is in the audible range, and
shifted to the red (longer therefore an audio amplifier and
wavelength). Stars moving speaker are all that is necessary
toward the earth appear more to listen to the fetal heart, called
blue. utz stethoscope.

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DOPPLER EFFECT BASIC TYPES OF

™ The change in apparent frequency of a wave as a result of
DOPPLER
–
relative motion between the observer and the source – –
ULTRASOUND UNIT
™ Stationary Reflector: reflected echoes are the same as the
™ 1.) Continuous Wave Doppler Unit
transmitted waves
– Ultrasound is continuous
™ Reflector that Moves Closer: reflected echoes are higher than
– Measures high velocities accurately
the transmitted echoes
– No depth resolution
™ Reflector that Moves Away: reflected echoes are lower than
the transmitted echoes

157 158 159

– – –
™ 2.) Pulsed Wave Doppler Unit ™ 3.) Colour Doppler Unit ™ 4.)Duplex Doppler System
– Ultrasound is transmitted in pulses ™ The distribution and direction of the flowing blood ™ Combination of a B-mode and Doppler system
– With good depth resolution are shown as a two dimensional image in which the – A blood vessel is located by B-Mode ultrasound
– Measures the speed of the blood in a particular vessel velocities are distinguished by different colours. imaging and then the blood flow is measured by the
– Cannot measure high blood velocities in deep vessels Doppler Ultrasound.

– High velocities may be wrongly displayed as low ™ Allows the Doppler beam to be directed accurately at
velocities any particular blood vessels

160 161 162

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WAVE
PROPAGATION WAVELENGTH
– – –
™ The transmission and spread of ultrasound waves to ™ WAVELENGTH
different tissues – The length of a single cycle of the ultrasound wave
™ Average Propagation for Soft Tissues: 1540 m/s – Inversely proportional to the frequency
™ Average Propagation for Soft Tissues: 4620 m/s – Determines the resolution of the scanner
– Higher the frequency, the shorter the wavelength
– The shorter the wavelength, the better resolution,
giving clearer image and more details on the screen

163 164 165

FOCUSING Attenuation AMPLIFICATION

™ Tissues in the body absorb and scatter

™ To improve resolution
–
™ Adjustment of the ultrasound beam
–
ultrasound in different ways.
™ Higher frequencies are more readily
–
™ Done by the time-gain-compensation (TGC) amplifier
™ May be electronic or by a lens attached to the absorbed and scattered that lower ™ To compensate for ultrasound attenuation in any part of
transducer frequencies the body
™ To reach deeper tissues, it is necessary ™ To improve the quality of the final image
to use lower frequencies because the
waves are less likely to be diverted as
they traverse intervening structures.

166 167 168

BOUNDARIES
–
™ The line at the periphery of two tissues which propagate
– –
™ The greater the difference between the characteristic
ultrasound differently
acoustic impedances, the greater the fraction which
™ The zone of echoes at the interface is reflected.
™ The greater the ratio of the propagation speeds, the
greater the fraction which is refraction.
A fraction of the incident wave is reflected at an angle equal
to the angle of incidence.
Another fraction passes across the interface and is refracted,
continuing at an angle that is different from the angle of
incidence.

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–
™ If reflecting boundaries is much wider than the wavelength, it
Part II Relevant –
acts like a mirror and is called specular reflector.
– Examples: Fetal skull, the diaphragm, walls of the vessels and
Terminologies ™ PIEZOELECTRIC EFFECT
connective tissues
™ Ultrasound waves scatter when the width of the reflectors is
– ™ Piezein – “press or pressure”
™ Ability of a material to generate an electrical charge unresponse
smaller than the wavelength. Organs are called scattering to applied pressure
media
– Examples: Liver and Kidney parenchyma

172 173 174

PIEZOELECTRIC
MATERIALS
™
–
Crystalline materials composed of dipolar molecules
™ PIEZOELECTRIC CRYSTALS
– Generate ultrasound waves
– –
™ Quartz – naturally occurring crystals – Capable of changing electrical signals into mechanical ™ Ceramic crystals that deform and vibrate when they
™ Lead zirconate titanate – man made ceramic (ultrasound) waves are electronically simulated generates the sound
™ Natural Materials: pulse used for diagnostic sonography.
™ PIEZOELECTRIC CRYSTAL AS TRANSMITTER OF SOUND
– Quartz – Converting electrical energy into mechanical energy (sound) ™ Each pulse consists of a band of frequencies referred
– Tourmaline
to as bandwidth.
– Rochelle Salt ™ PIEZOELECTRIC CRYSTAL AS TRANSMITTER OF SOUND
™ Synthetic Materials: – Converting mechanical energy (sound) into electrical energy
– Lead zirconate titanate (PZT)
– Barium titanate ™ NOTE:
– Lead metaniobate ™ Small crystal diameter
– Ammonium dihydrogen phosphate – Increased beam divergence
– Lithium sulphate ™ Larger crystal diameter
– Decreased beam divergence

175 176 177

ACOUSTIC
IMPEDANCE Acoustic Impedance
– – –
™ PIEZOELECTRIC ELEMENTS ™ ACOUSTIC IMPEDANCE ™ Ultrasound wave is similar to a light beam in that it
™ Crystalline minerals that generate voltages when – Property of a substance may be :
subjected to a mechanical force – Describes how the particles of that substance behave – Focused
when subjected to pressure wave
™ Piezein – “to press or squeeze” – Refracted
– High density substance – high acoustic impedance
™ Piezoelectric Effect – discovered by Jacques and – Reflected
– Low density substance – low acoustic impedance
Pierre Curie – Formula: Z=pc – Scattered
™ Thinner Piezoelectric Materials ™ p = density of material (kg/m3) At interfaces between different media
™ c = speed of sound (m/s)
– Higher resonant frequencies ™ Z = acoustic impedance (rayls)

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– – –
™ REFLECTION ™ SCATTERING ™ REFRACTION
™ Occurs when two large structure of significantly ™ Occurs when an ultrasound wave strikes a boundary ™ Occurs when the beam encounters an interface
different acoustic impedance form an interface or interface between two small structures between two different tissues at an oblique angle
™ Occurs when a sound wave strikes an object that is ™ Occurs when a sound wave strikes an object that is ™ The beam will be deviated as it travels through the
larger than the wavelength equal to or smaller than the wavelength tissue
™ ™ Occurs due to difference in wave velocity across an
interface between two materials
™

181 182 183

– – –
™ DIVERGENCE ™A substance which has densely
™ Occurs when the beam travels through tissue and it
will diverge due to diffraction effects
packed will have a high Acoustic
impedance. Ex. Bone

™A substance which has loosely

packed particles will have a low
acoustic impedance. Ex. Air

184 185 186

– – –
ACOUSTIC IMPEDANCE AND
REFLECTION
Z= ρc The average velocity of
ultrasonic waves in soft tissue ™In substances with the same acoustic
impedanceà there is a total transmission
™ Density (ρ) kg/m3 is 1540 meters per second of energy and therefore no reflection.
™ Speed of sound (c) m/s
™ Acoustic impedance (Z) rayls =
kg/m2/s ™Z1= 0% ; Z2=100%

187 188 189

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– – –
™In substances with a large difference THE INTENSITY REFLECTION EQUATION
in acoustic impedanceà there is a
™In substances with a small ™ This equation allows you to calculate the intensity
large amount of reflected energy reflection coefficient (R) for an interface between two
difference in acoustic substances providing you know their acoustic impedance.
and a small amount of transmitted R= Ir or R = (Z 1 –Z 2)2
impedanceà a small amount of energy. Ii (Z 1 + Z 2)2
energy is reflected but the
majority is transmitted. Ir = reflected intensity
™Z1 = 99% ; Z2 =1% Ii= transmitted intensity
™Z1= 5% ; Z2=95%

190 191 192

– – –
™Example: what is the intensity reflection ACOUSTIC IMPEDANCE AND
coefficient R for an interface between liver ULTRASOUND IMAGING ™ If there is a large acoustic mismatchà Ex:
(Z1= 1.65Mrayls) and fat (Z2= 1.35 Mrayls) between bone and muscle or air and soft tissue,
then a large proportion of energy is reflected.
™ This results in a strong echo, which produces a
™The difference in acoustic bright image on the display.
R = (Z1 –Z2)2 = (1.65-1.35)2 = (0.3)2
impedance between two ™ However, very little energy is transmitted across
(Z1 + Z2)2 (1.65+1.35)2 = (3.0)2 the interface and any echoes produced beyond
substances is known as the the interface do not have enough energy to
= (0.1)2 = 0.01 = 1.0 % acoustic impedance mismatch. produce image.

193 194 195

ACOUSTIC
IMPEDANCE AND
– – REFLECTION
–
™ Substances with same acoustic impedance:
– 100% energy transmission
™If the acoustic impedance mismatch is ™Therefore, it is not practical to use – No reflection
smallà Ex: between two soft tissues, then ultrasound to produce images of soft ™ Substances with a small difference in acoustic
impedance:
a small proportion of energy (1% or less) tissue subjects containing gas or bone.
– 95% energy transmission
is reflected. – 5% reflection
™The rest of the energy is transmitted ™Ultrasound imaging is very good at ™ Substances with a large difference in acoustic
across the interface to produce further discriminating between substances with impedance:
echoes from other interfaces deeper – 1% energy transmission
small differences in acoustic impedance – 99% reflection
within the subject. such as soft tissues

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– ™ TRANSDUCERS/SCANNING PROBES –
™ The most expensive part of any ultrasound unit
Part III Transducer TRANSDUCER/PROBE
™ A device which converts one form of energy to
™ 1.) Linear Array/ Linear sequenced Array Transducer
– another
™ Converts electrical energy into ultrasound waves ™ 2.) Sector/Curvilinear Array Transducer
and vice versa ™ 3.) Convex Transducer
™ Contains piezoelectric crystals ™ 4.) Phased Array Transducer
– Transmit ultrasound beam
– Receive reflected echoes

199 200 201

™ 1.) Linear Array Transducer

– Parallel scan lines
– Rectangular field of view
–
– Vascular, small parts and musculoskeletal applications
– They are most useful in obstetrics and for scanning the breast and
– –
the thyroid ™ 2.) Sector/Curvilinear Array Transducer ™ 3.) Convex Transducer
– High resolution in the near field and a large superficial field of – Provides wide field of view
– Wide fan-shaped
view – a fan shaped , almost triangular and originate through
– Useful for all parts of the body
– Above 4 MHz a very small acoustic window
– Except for specialized echocardiography
– Disadvantages: – Most useful in in the upper abdomen and
gynecological and cardiological examination
™ Large size
™ Limited use in areas where access is limited – Best suited to image deep lying structures
™ Limited deep field of view – 3.5 MHz

202 203 204

CHOOSING THE
APPOPRIATE TRANSDUCER
– – ™ 3.) Pediatric Ultrasound –
™ 4.) Phased Array Transducer ™ 1.) Obstetric Ultrasound ™ 5.0 MHz transducer: for children
– Flat faced transducer ™ Focused at 5-7 cm
™ Linear or convex transducer
– Wide field of view
™ 3.5 MHz: better in later pregnancy ™ Sector transducer of 7 MHz:
– useful in cardiac and cranial ultrasound
™ 5.0 MHz: best during early pregnancy – Neonatal brain scans
™ Focused at 7-9 cm – For adult testis and neck
™ Focused at 4-5 cm
™ 2.) General Purpose Ultrasound
™ Sector or convex transducer
™ 3.5 MHz
™ Focused at 7-9 cm

205 206 207

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BEAM SHAPE

™The area through which the sound energy

–
emitted from the ultrasound transducer travels –
Ultrasound Beam is known as the ultrasound beam. ™It can be divided in two regions:
™The beam is three dimensional and is 1. Near Field (Fresnel zone)
– symmetrical around its central axis.
2. Far Field (Fraunhofer zone)

208 209 210

– – –
™Increasing the frequencyà will result II. INTENSITY OF THE BEAM III. SIDE LOBES
in a longer near field and less far
field divergence
CRYSTAL NEAR FIELD FAR FIELD
™A narrow crystal diameterà will
™The intensity of the beam is the ™Some of the energy from the
THIN
result DECREASE
in a narrower beam inINCREASE
the near power (measured in watts) flowing transducer radiates at various
field,
FREQUENCY and thereFIELD
is more divergence
THICK NEARINCREASE FARDECREASE
FIED in through a unit area. angles to the transducer face, and
the far field
INCREASE LONG LESS these are known as side lobes.
DECREASE SHORT MORE

211 212 213

CHAPTER IV CHAPTER IV CHAPTER IV

– – –
The extraneous beams of the ™Any interfaces encountered by any of ™These echoes will therefore be
ultrasound generated from the these side lobes will return echoes to incorrectly placed on the image.
the transducer, which the equipment
edges of individual transducer erroneously assumes to have been
elements and not in the direction of received by the main beam. ™Approximately 15% of the energy
the main ultrasonic beam in the beam will be within the side
lobes

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CHAPTER IV CHAPTER IV CHAPTER IV

– – –
™Both side lobes and grating lobes can IV. BEAM WIDTH
lead to considerable artifacts due to
™Grating lobesà are lobes at the three dimensional misregistration
various angles to the main beam. which inevitably occurs. ™Beam width refers to the
™In addition, They cause a degradation dimension of the beam in the scan
of lateral resolution due to the plane, or the plane through which
effective widening of the beam in the
scan plane. the beam is sweeping

217 218 219

CHAPTER IV CHAPTER IV CHAPTER IV

– – –
V. SLICE THICKNESS
™The beam width affects the spatial
resolution of the image (the ability ™Inherent characteristics of the
™The ultrasound image viewed on
of the operator to distinguish small beam can lead to a number of
structures), and generally, the the monitor is three dimensional
artifacts such as side lobes artifacts,
narrower the beam width, the volume displayed as a two beam width artifacts and slice
better the spatial resolution. dimensional image. thickness artifacts.

220 221 222

™ Different types of UTZ artifacts

1. Reverberation
2. Acoustic shadowing
– 3.
4.
Acoustic enhancement
Edge shadowing
–
Ultrasound Artifacts 5.
6.
Beam width artifact
Slice thickness artifact
– ™An ultrasound artifact is a 7. Side lobe artifacts
structure in an image which 8. Mirror image
does not directly correlate with 9. Double image
10. Equipment-generated artifacts
actual tissue being scanned.

223 224 225

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REVERBERATION
– – –
™This is the production of spurious (false) echoes
due to repeated reflections between two interfaces ™Artifacts appearing as parallel, equally ™This artifact will often be seen:
with a high acoustic impedance mismatch. spaced lines is called reverberation
™Comet tail
™Reverberation artifacts are a result of the 1. At the skin-transducer interface
presence of two or more strong reflecting 2. Gas surface and the transducer
surfaces
™Shotgun wound

226 227 228

ACOUSTIC
SHADOWING
–
™This artifact can be differentiated from the real echoes
–
This appears as an area of low amplitude echoes (hypoechoic or
–
due to the lack of breathing movement occurring. anechoic) behind an area of strongly attenuating tissue. ™Acoustic shadowing will occur at the
™ It is cause by severe attenuation of the beam at interference, resulting
in very little sound being transmitted beyond. interface with a large acoustic
™ The attenuation can be due to either absorption or reflection of the
™To help to eliminate this artifact it may be useful to: sound waves or a combination of two. mismatch such as:
1. Increase the amount of gel used
2. Used a stand-off pad (gel pad or a bag of saline) 1. Soft tissue and gas
3. Reduce the gain
2. Soft tissue and bone or calculus
4. Move the position of the transducer.

229 230 231

ACOUSTIC
ENHANCEMENT
–
™If the shadowing contains reverberation
– –
(ringdown echoes), it is likely to be gas. ™This artifact appears as a localized area of ™Can commonly be seen distal to fluid filled
increased echo amplitude behind an area of
structures such as the urinary bladder, the
low attenuation.
gallbladder or a cyst.
™If the shadowing is clear shadowing,
absent of any ringdown, it is likely to be
a calculus ™This artifact can often be a useful diagnostic
aid, particularly when scanning a soft-tissue
mass or cyst containing low-level echoes.
™Calcified mass

232 233 234

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BEAM WIDTH
EDGE SHADOWING
ARTIFACT
– – –
™A combination of refraction and reflection
occurring at the edges of rounded structures (and
when the speed of sound is different from that in ™All echoes returning to the transducer will
™Acoustic enhancement is surrounding tissue) will result in an edge have arisen from across the full width of the
caused by weakly attenuating shadowing artifact. beam, which can vary by several millimetres.

structures.

™Fluid filled mass

235 236 237

SLICE THICKNESS
ARTIFACT
– – of the beam, and are
These occur due to the thickness –
similar to beam width artifacts.
™However, they occur at 90 degree to the scan plane ™These artifacts will typically be seen
™Correct positioning of the focal with echoes from interfaces in front of and behind in transverse views of the urinary
the assumed plane of origin appearing in the
zone will help to reduce this display. bladder
artifact.
™Beam thickness artifact is primarily
dependent upon beam angulation

238 239 240

SIDE LOBE
ARTIFACT
– – beam exists as
™The energy within the ultrasound
several side lobes radiating at a number of angles
–
from a central lobe.
™Echoes are generated by these side lobes in ™They may also arise within a cyst, where
addition to the main lobe, but all the returning adjacent structures are portrayed as if arising
™This artifact is a result of inherent echoes are assumed by the transducer to have from within the cyst. These appearances can
arisen from the central axis of the main lobe.
characteristics of the transducer, and give rise to a false diagnosis of septations
apart from trying a different within a cyst.
transducer, cannot be eliminated.

241 242 243

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MIRROR IMAGE DOUBLE IMAGE

ARTIFACT ARTIFACT
– – –
™These artifacts result in a mirror image of a ™An area close to a specular reflector will ™This artifact is caused by refraction of
structure occurring in an ultrasound display. be imaged twice, once by the original the beam and may occur in areas such
They arise due to specular reflection of the ultrasound beam and once by the beam as the rectus abdominis muscle on the
after it has reflected off the specular anterior abdominal wall.
beam at a large smooth interface. reflector.

™fluid-air interface.
™Diaphragm

244 245 246

– – –
™In the transverse plane the edges of the ™In order to establish whether these 10. EQUIPMENT-GENERATED
muscle act as a lens and cause the echoes are genuine, it is necessary to ARTIFACTS
ultrasound beam to be refracted and move the transducer slightly to one
this causes a single structure to be side to avoid the junction of the rectus
interrogated by the two separate abdominis muscles. ™Incorrect use of the equipment controls
refracted beams. can lead to artifacts appearing.

247 248 249

COMPONENTS AND
CONSTRUCTION OF A TYPICAL
TRANSDUCER
– ™ FREQUENCY – –
™If too mach gain is applied then the ™ Affects the quality the ultrasound image ™ 1.) PHYSICAL HOUSING
electronic noise, inherent in all systems, ™ Higher Frequency – Contains all individual components
will also be amplified. – Shorter wavelength – Provides the necessary structural support
– Better Resolution – Acts as an electrical and acoustic insulator
– Lower Penetration
– Higher Absorption
™ 2.) ELECTRICAL CONNECTIONS
™If too little gain is applied, this can lead to ™ Lower Frequency
– Formed in front and back of the crystal
loss of relevant information, and incorrect – Longer wavelength
– Made of thin film of gold or silver
diagnosis may occur. – Poor Resolution
– Higher Penetration
– Lower Absorption

250 251 252

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BANDWIDTH
™ BACKING/DAMPING MATERIALS
– – –
™ 5.) ACOUSTIC LENS
™ Shortens the ultrasound pulse length ™ Reduce the beam width of the transducer ™ The range of frequencies contained within an
™ Improve image resolution
Width of the Beam: determines lateral resolution
ultrasound pulse
™ Eliminates the vibrations from the back face ™
™ Lateral Resolution: the ability to resolve structure across or perpendicular to the
beam axis
™ Wide Bandwidth:
™ Controls the length of vibrations from the front face ™ Materials:
– Aluminum
– Shorter spatial pulse length
™ Improves axial resolution – Perspex – Wider range of frequency
™ Materials: – Polystyrene
™ ™ Narrow Bandwidth:
– Plastic or epoxy resin ™ 6.) IMPEDANCE MATCHING LAYER
™ Sandwich between the piezoelectric crystal and the patient – Longer spatial pulse length
– Cork ™ Chosen to improved transmission into the body
™ BANDWIDTH
– Narrower range of frequency
– Rubber
– Araldite loaded with tungsten powder
™

253 254 255

– – –
™ CHOOSING THE APPOPRIATE TRANSDUCER ™ 3.) Pediatric Ultrasound ™
™ 5.0 MHz transducer: for children ™ TWO REGIONS OF ULTRASOUND BEAM
™ ™ 1.) Near Field/Fresnel zone
™ 1.) Obstetric Ultrasound ™ Focused at 5-7 cm ™ 2.) Far Field/Fraunhofer zone
™ Linear or convex transducer ™ Sector transducer of 7 MHz: ™ Increasing Frequency
™ 3.5 MHz: better in later pregnancy – Neonatal brain scans – Longer near field
™ 5.0 MHz: best during early pregnancy – For adult testis and neck – Less far field divergence
™ Narrow Crystal Diameter
™ Focused at 7-9 cm ™ Focused at 4-5 cm – Narrower near field
™ ™ – More far field divergence
™ ™ ULTRASOUND BEAM ™ Thin Crystal
– Decreased near field
™ 2.) General Purpose Ultrasound ™ Area through which the sound energy emitted from the ultrasound
transducer – Increased far field
™ Sector or convex transducer ™ Thick Crystal
™ 3.5 MHz ™ Three dimensional and symmetrical around its central axis – Increased near field
™ Focused at 7-9 cm ™ – Decreased far field

256 257 258

– – –
™ BEAM INTENSITY ™ SLICE THICKNESS ™ SPATIAL RESOLUTION
™ The power (measured in watts) flowing through a unit area ™ Three dimensional volume displayed as a two ™ Detail Resolution
™ ™ The ability to display two structures situated close together as
™ SIDE LOBES/GRATING LOBES dimensional image separate images
™ Lobes at various angles to the main beam ™ ™ Higher Frequency:
™ Approximately 15% of the energy in the beam ™ RESOLUTION – Better resolution
™ Cause a degradation of lateral resolution ™ The ability of an imaging system to differentiate between – Lower penetrability
™ structures – Higher absorption
™ BEAM WIDTH ™ Lower Frequency:
™ The dimension of the beam in the scan plane ™ Spatial Resolution: resolution in space
– Poor resolution
™ Affects the spatial resolution ™ Contrast Resolution: resolution of gray shades
– Higher penetrability
™ Narrow Beam Width ™ Temporal Resolution: resolution in time
– Lower absorption
– Better spatial resolution

259 260 261

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TWO COMPONENTS
OF SPATIAL
RESOLUTION
– – –
™ ™ LATERAL RESOLUTION ™ CONTRAST RESOLUTION
™ TWO COMPONENTS OF SPATIAL RESOLUTION ™ Azimuthal, Transverse, Angular or Horizontal ™ The ability of the imaging system to differentiate
™ between body tissue and display them as different
™ The ability to distinguish two objects perpendicular
™ 1.) AXIAL RESOLUTION to the ultrasound beam shades of gray
™ Longitudinal, Linear, Depth or Range
™ Depends upon the beam diameter ™ Optimized by using the correct overall gain
™ The ability to distinguish two objects parallel to the
ultrasound beam ™ Smaller Beam Width: better lateral resolution
™ Depends upon the spatial pulse length and wavelength ™ Larger Beam Width: poor lateral resolution
™ Short Spatial Pulse Length: good axial resolution ™
™ Longer Spatial Pulse Length: poor axial resolution

262 263 264

– – –
™ ™ FIVE MAIN PROCESSES THAT CAUSE ATTENUATIONS
™ TEMPORAL RESOLUTION ™
™ Frame Rate ™ ULTRASOUND INTERACTIONS AND ™ 1.) ABSORPTION
™ Occurs when ultrasound energy is lost to tissues by its conversion to heat
™ The ability of the imaging system to display events ATTENUATIONS ™ Main factor causing attenuation
which occurs at different times as separated images ™ ™ Higher Frequency:
– Greater amount of absorption
™ Higher Frame Rate: better temporal resolution ™ ATTENUATION ™ Bone: higher absorption coefficient
™ Increasing protein content gives increasing absorption
™ Decrease in the intensity and amplitude of the – Blood –> Fat –> Nerve –> Muscle –> Skin –> Tendon
ultrasound waves as they pass through tissues ™ –> Cartilage –> Bone
™ Best Absorption: tendon, ligament, fascia, joint capsule & scar tissue
™ Unit: decibels per centimeter

265 266 267

– – –
™ REFLECTION ™ SCATTERING ™ REFRACTION
™ Occurs when two large structure of significantly ™ Occurs when an ultrasound wave strikes a boundary ™ Occurs when the beam encounters an interface
different acoustic impedance form an interface or interface between two small structures between two different tissues at an oblique angle
™ Occurs when a sound wave strikes an object that is ™ Occurs when a sound wave strikes an object that is ™ The beam will be deviated as it travels through the
larger than the wavelength equal to or smaller than the wavelength tissue
™ ™ Occurs due to difference in wave velocity across an
interface between two materials
™

268 269 270

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– – –
™ ULTRASOUND ARTIFACTS ™ 1.) REVERBERATION
™ DIVERGENCE ™ Comet tail
™ Occurs when the beam travels through tissue and it ™ A structure in an image which does not directly ™ The production of spurious or false echoes due to repeated reflections
between two interfaces with a high acoustic impedance mismatch
will diverge due to diffraction effects correlate with actual tissue being scanned ™ The presence of two or more strong reflecting surfaces
™ Often occur at:
– Skin-transducer interface
– Gas surface and transducer
™ Prevention/Elimination:
– Increase the amount of gel used
– Used a stand-off gel pad
– Reduce the gain
– Move the position of the transducer
™

271 272 273

– – –
™ ACOUSTIC SHADOWING ™ ACOUSTIC ENHANCEMENT ™ EDGE SHADOWING
™ Caused by highly attenuating structure ™ Caused by weakly attenuating structures ™ Combination of refraction and reflection occurring at
™ Often occur at: ™ the edges of rounded structures
– Soft tissue and gas ™ Often occur at: ™
– Soft tissue and bone or calculus – Distal to fluid-filled urinary bladder, gallbladder
– Calcified mass or cyst
– Fluid-filled mass

274 275 276

– – –
™ BEAM WIDTH ARTIFACT ™ SLICE THICKNESS ARTIFACT ™ SIDE LOBE ARTIFACT
™ Variations of all echoes returning to the transducer ™ Occurs due to the thickness of the beam ™ Echoes generated by side lobes assumed by the
™ Prevention/Elimination: ™ Dependent upon beam angulation transducer to have arisen form the central axis of the
™ Often seen in: main lobe
– Correct positioning of the focal zone
– Transverse view of the urinary bladder ™ Appearance can give rise to a false diagnosis
™ Inherent characteristic of the transducer ™ Inherent characteristic of the transducer

277 278 279

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– – –
™ MIRROR IMAGE ARTIFACT ™ DOUBLE IMAGE ARTIFACT ™ EQUIPMENT-GENERATED ARTIFACT
™ Caused by specular reflection of the beam at a large ™ Caused by refraction of the beam ™ Caused by incorrect use of the equipment control
smooth interface ™ Often occur at:
™ Often seen in: – Rectus abdominis muscle
– Fluid-air interface ™ Prevention/Elimination:
– Diaphragm ™ Move the transducer slightly to one side to avoid the
™ junction of rectus abdominis muscle

280 281 282

A-mode
CHAPTER IX
– –
™ A-mode (A-scan, amplitude modulation) is a one-
Ultrasound techniques 1.) A-MODE display (Amplitude Mode) dimensional examination technique in which a transducer
with a single crystal is used.
ü Echoes are shown as peak and the distance ™ The echoes are displayed on the screen along a time
(distance) axis as peaks proportional to the intensity
between the various structures can be (amplitude) of each signal. The method is rarely used today,
measured. as it conveys limited information, e.g. measurement of
distances.
ü Strength , depth , height of echo.

283 284 285

B-mode
CHAPTER IX CHAPTER IX
– – mode)
2.) B-MODE display (Brightness –
1.) A-MODE display (Amplitude Mode) ™B-mode (brightness modulation) is a similar
™2D mode; Static Mode technique, but the echoes are displayed as
™The echoes are seen as bright dots which the points of different grey-scale brightness
ü A-Mode, or Amplitude Modulation, is the corresponding to the intensity (amplitude) of
display of amplitude spikes of different position of the reflecting structures on a two-
dimensional image each signal .a
heights.

286 287 288

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™ The arrangement of many one- M-mode or TM-mode

dimensional lines in one plane CHAPTER IX
makes it possible to build up a two-
–
dimensional (2D) ultrasound image
(2D B-scan). The single lines are
– –
generated one after the other by 3.) M-MODE display (Motion-mode) ™ M-mode or TM-mode (time motion) is used to
B-scan, two- analyse moving structures, such as heart valves. The
moving (rotating or swinging)
dimensional echoes generated by a stationary transducer (one-
transducers or by electronic ü This can be used to determine the velocity of dimensional B-mode) are recorded continuously
multielement transducers. specific organ structures. over time.
™ Rotating transducers with two to
four crystals mounted on a wheel
ü This is analogous to recording a video in
and swinging transducers ultrasound.
(‘wobblers’) produce a sector image
with diverging lines (mechanical
sector scanner)

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™ B-flow is a special B-scan technique

CHAPTER IX ™ The main prerequisite for construction of three-
dimensional (3D) ultrasound images is very fast
that can be used to show movement
without relying upon the Doppler
– –
data acquisition. The transducer is moved by
hand or mechanically perpendicular to the
scanning plane over the region of interest.
–
effect. The echoes from moving
scatterers (particularly blood cells in
Sometimes called… blood vessels) are separated from
B-flow
™ The collected data are processed at high speed, so
Three- and four- that real-time presentation on the screen is stationary scatterers by electronic
dimensional possible. This is called the four-dimensional (4D)
comparison of echoes from successive
1. TM mode (time-motion mode); techniques technique (4D = 3D + real time). The 3D image
can be displayed in various ways, such as pulses (autocorrelation). These very
2. PM- mode (position-motion mode) transparent views of the entire volume of interest weak echoes are amplified and
or images of surfaces, as used in obstetrics and
3. UCH (ultrasonic cardiography) not only for medical purposes. It is also possible depicted as moving dots on the
to select two-dimensional images in any plane, screen. This technique is effective in
especially those that cannot be obtained by a 2D
B-scan. showing the inner surface of blood
vessels, but, unlike Doppler methods ,
it provides no information about flow
velocity .

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CHAPTER IX CHAPTER IX
– –
Doppler Ultrasound Doppler Ultrasound
Doppler flow
– üChristian Johann Doppler noted in 1842 ü This mode makes use of the Doppler effect
in measuring and visualizing blood flow

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™ In this technique, ultrasound is emitted in

CHAPTER IX
very short pulses. All echoes arriving at the
transducer between the pulses in a certain
time Pulsed wave the
interval (termed Doppler
gate) are registered

– – Continuous wave Doppler

–
and analysed .
™ A general problem with all pulsed Doppler
techniques is the analysis of high velocities:
™ The transducer consists of two the range for the measurement of Doppler

ü The Doppler shift frequency is in the crystals, one permanently frequencies is limited by the pulse repetition
emitting ultrasound and the frequency (PRF).
audible range, and therefore an audio other receiving all the echoes. ™ When the Doppler frequency is higher than
amplifier and speaker are all that is No information is provided the pulse repetition frequency, high
about the distance of the velocities are displayed as low velocities in
necessary to listen to the fetal heart, called reflector(s), but high flow the opposite direction (spectral Doppler) or
utz stethoscope. velocities can be measured. in the wrong colour (colour Doppler).

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REAL-TIME IMAGING,
DOPPLER EFFECT, AND
– DOPPLER
COLOR flOW –
™ The Doppler effect refer to a change in frequency when the
™ Real-time imaging is the presentation of multiple
motion of laminar or turbulent flow is detected within a
image frames per second over selected areas of the vascular structure.
Clinical applications
body.
™ The transducer may be composed of several elements ™ Color flow Doppler is a technique that assigns a color scale
–
that can be electronically focused and fired in rapid to the change in frequency or Doppler shift.
sequence to produce a real-time image. ™ Generally red signifies a shift toward the transducer,
™ Thus structures are visible as they change position in whereas blue signifies a shift away from the transducer
time. With this dynamic imaging it is possible to see,
for example, pulsatile vascular and cardiac structures,
diaphragm motion, and peristalsis in the bowel and
stomach.

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ABDOMEN
™ Once a mass is suspected, the sonographer
must evaluate its acoustic properties to
determine if it is heterogeneous,
AND
–
homogeneous, hypoechoic, hyperechoic,
isoechoic, or anechoic. RETROPERITONEUM
– –
™ A hypoechoic lesion is characterized by ™ The upper abdominal ultrasound examination generally
very low-level echoes with a good
posterior border. includes a survey of the abdominal cavity from the
Characteristics of the
sonographic image ™ A hyperechoic mass may represent a diaphragm to the level of the umbilicus.
tumor, thrombus, or calcification; the lesion ™ Specific protocols are followed to image the texture,
present with bright echo reflectors and
borders, anatomic relationships, and blood flow patterns
possibly shadowing beyond it.
™ An isoechoic mass shows nearly the same within the liver, biIiary system, pancreas, spleen, vascular
texture pattern as the surrounding structures, retroperitoneum, and kidneys.
parenchyma with no significant change in ™ Patients may be examined in the supine, decubitus,
the through transmission
upright, or prone positions.
™ An anechoic mass shows no internal
echoes, has smooth walls, and displays
increased through transmission.

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Liver and spleen

™The left upper quadrant
–
™ Air and gas in the abdominal cavity may obstruct the may be obscured – –
™ The liver and spleen are evaluated to assess the size and
ultrasound beam.
secondary to air in the homogeneity of the parenchymal tissues.
™ Consequently, the upper abdominal ultrasound examination ™ Abnormalities in this texture pattern enable the sonographer
is best performed after a patient has been fasting for at least 6 stomach or gas in the to determine if the organ has any of the following: fat
infiltration, abscess, hematoma, cystic displacement, diffuse
hours. overlying bowel, disease, or tumor invasion.
™ Fasting also allows the gallbladder and bile duct to be
distended for adequate visualization. making it difficult to ™ The presence or absence of vascular structures within the
hepatosplenic organs helps the sonographer determine if
™ Specific images of the abdominal cavity are obtained from the image the spleen, left portal hypertension, thrombosis, or diffuse disease is
present.
dome of the liver to the inferior border of the kidneys, with kidney, tail of the ™ The combined use of color flow and Doppler helps to
the vascular structures serving as the primary landmarks for
the abdominal organs. pancreas, and determine the direction of vascular flow or the presence of
thrombus within the portal system or hepatic veins.
™ Scanning is performed in the transverse, oblique, sagittal, suprarenal area.
coronal, and subcostal planes.

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Pancreas
– –
™The pancreas is a retroperitoneal gland. –
™Its head lies in the curve of the duodenum, and its
body and tail lie posterior to the antrum of the
stomach.
™The texture of the pancreas varies, depending on
the amount of fat that is interspersed throughout
its islets of Langerhans.

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Biliary system
–
™ On ultrasound examination the gallbladder and
bile ducts are seen just inferior to the right lobe of
– –
the liver and anterior to the right kidney.
™ The intrahepatic bile duct runs slightly anterior to
the portal vein as it drains bile from the liver into
the storage cistern (gallbladder) via the cystic
duct.
™ Bile is released into the common bile duct, where
it joins the pancreatic duct secretions to drain into
the duodenum at a small raised area called the
duodenal papilla.
™ The biliary system is evaluated with ultrasound
to assess size and wall thickness and to detect
sludge, stones, polyps, or other masses.

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Kidneys
– – –
™The kidneys rest on the posterior surface of the
abdominal cavity in an oblique plane lateral to
the psoas muscles
™The large right lobe of the liver causes the right
kidney to be slightly lower than the left kidney.
The renal vascularity may be imaged with color
Doppler as the patient is rolled into a slight
decubitus position.

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– – –

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GYNECOLOGIC
APPLICATIONS
SUPERFICIAL STRUCTURES
– – –
™ Anatomic features of the pelvis
™ Superficial structures such as the thyroid, ™ The pelvis is divided into the greater and lesser
breast, scrotum, and penis are imaged very
pelvic cavity, with the pelvic brim being the
well with ultrasound using high frequency
circumference of a plane divide ng the two
cavities.
transducer .
™ The greater pelvic cavity, or "false" pelvis, is
™ Routine ultrasound examination superior to the pelvic brim and is bounded on
demonstrate minute structures such a the each side by the ileum.
lactiferous ducts within the breast and the ™ The lesser pelvic cavity, or "true" pelvis, is
spermatic cord within the testes. In caudal to the pelvic brim.
conjunction with mammography, ™ The walls of the pelvic cavity are formed by
ultrasound is able to characterize the several muscles collectively called the pelvic
texture of a breast mass to determine if the diaphragm. These muscles include the levator
mass is fluid-filled, complex, or solid. ani, piriformis, and coccygeus muscles.

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Sonography of the
female pelvis
– – –
™ A complete transabdominal examination of the female ™ A high-frequency transducer is inserted into the vagina to
pelvis includes visualization of the distended urinary image the uterus, cervix, fallopian tubes, ovaries, and
bladder, uterus, cervix, endometrial canal, vagina, adnexal area in coronal and sagittal planes.
ovaries, and supporting pelvic musculature. ™ Sonography of the pelvis is clinically useful for imaging
™ The full bladder helps to push the small bowel normal anatomy, identifying the size of ovarian follicles
superiorly out of the pelvic cavity, flattens the body of as part of an infertility workup, measuring endometrial
the uterus, and serves as a sonic window to image the thickness, evaluating the texture of the myometrium,
pelvic. determining if a pregnancy is intrauterine or extrauterine,
detecting tumors or abscess formations, and localizing an
™ The rectum and other bowel structures may also be seen intrauterine contraceptive device
and must be distinguished from the normal pelvic
structures.

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OBSTETRIC
APPLICATIONS
– – –
™ The pregnant woman is the ideal candidate for an
ultrasound examination.
™ The amniotic fluid enhances the sound penetration to
differentiate fetal anatomy, umbilical cord, placenta, and
amniotic membranes within the uterine cavity.
™ Endovaginal ultrasound is the procedure of choice
during the first trimester of pregnancy to delineate the
gestational sac with the embryo, yolk sac, chorion, and
amniotic cavities . The gestational sac may be visualized
as early as 4 weeks from the date of conception with
endovaginal ultrasound
™ The embryo, heartbeat, and site of the placenta may be
seen at 5 weeks of gestation.

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–
• The beginning of the second trimester
( 1 3 to 28 weeks of gestation) allows
to image the detailed anatomy of the
fetus.
Thank you!
• Structures such as the brain, face, –
limbs,
neck, abdominal wall, liver, gallbladder,
kidneys, stomach, pancreas, bowel ,
heart,
lungs, and bladder may be seen with
high resolution transducers.
• Heart motion, fetal size and position,
and number
of fetuses may be easily assessed with
sonography.

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