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Lesson 10 - Ultrasound

Ultrasound uses high frequency sound waves to produce images of the inside of the body. It is a safe imaging technique that does not use ionizing radiation. Ultrasound can be used to visualize soft tissues, blood flow, and fetal development during pregnancy. Doppler ultrasound detects the Doppler shift of reflected sound waves to measure blood flow velocity. Developments like 4D ultrasound and Doppler allow more detailed visualization of moving structures like the heart.

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196 views

Lesson 10 - Ultrasound

Ultrasound uses high frequency sound waves to produce images of the inside of the body. It is a safe imaging technique that does not use ionizing radiation. Ultrasound can be used to visualize soft tissues, blood flow, and fetal development during pregnancy. Doppler ultrasound detects the Doppler shift of reflected sound waves to measure blood flow velocity. Developments like 4D ultrasound and Doppler allow more detailed visualization of moving structures like the heart.

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Medical uses of

ultrasound

WHAT IS ULTRASOUND?
Ultrasound or ultrasonography is a medical
imaging technique that uses high frequency
sound waves and their echoes.
Known as a pulse echo technique
The technique is similar to the echolocation
used by bats, whales and dolphins, as well as
SONAR used by submarines etc.

Bats!

Bats navigate using ultrasound

Bats: Navigating with ultrasound


Bats make high-pitched chirps which are too high for
humans to hear. This is called ultrasound
Like normal sound, ultrasound echoes off objects
The bat hears the echoes and works out what caused
them
Dolphins also navigate with ultrasound
Submarines use a similar method called sonar
We can also use ultrasound to look inside the body

Bats: Navigating with ultrasound


If a bat hears an echo 0.01 second after it makes a chirp,
how far away is the object?
Clue 1: the speed of sound in air is 330 ms-1
Clue 2: The speed of sound equals the distance travelled
divided by the time taken
Answer: distance = speed x time
Put the numbers in:
distance = 330 x 0.01 = 3.3 m
But this is the distance from the bat to the object and
back again, so the distance to the object is 1.65 m.

Ultrasound imaging

Ultrasound imaging: What does it look like?

CATEGORIES OF
SOUND
Infrasound (subsonic) below 20Hz
Audible sound 20-20,000Hz
Ultrasound above 20,000Hz
Nondiagnostic medical applications
<1MHz
Medical diagnostic ultrasound >1MHz

Ultrasound imaging: How does it work?

An ultrasound element acts like a bat.


Emit ultrasound (1 to 12 megahertz) and detect echoes
Map out boundary of object

Ultrasound imaging: How does it work?

Now put many elements together to make a probe and


create an image

THE TRANSDUCER (Probe)


* PIEZOELECTRIC EFFECT is a property of some
crystalline materials, like quartz of PZT (lead zirconate
titanate) that allows them to convert electrical signals to
mechanical and vice versa. When compressed or
expanded these materials show a voltage between the
compressed or expanded surfaces (due to the
molecular alignment in the crystal lattice). Changing
polarity is a means of electromechanical conversion.
Transmits pulses of sound into tissue and listens for
echos
Most of the time is spent listening for echoes

Transducer Power
on
-6
10 sec

Power of
Transducer
receiving
echoes
10-3sec

Piezoelectric crystal
Emit sound after electric
charge applied
Sound reflected from
patient
Returning echo is
converted to electric
signal grayscale
image on monitor
Echo may be reflected,
transmitted or refracted
Transmit 1% and receive
99% of the time

Ultrasound imaging: development of a pregnancy


24 weeks

8 weeks gestation (out of a 40 week pregnancy)


18 weeks

Ultrasound imaging: foetus feet

This is a 2D ultrasound scan


through the foot of a foetus. You can
see some of the bones of the foot.

We can process the image in a


computer to find the outline of the foot.
This is called surface rendering. Here,
the foot has been surface rendered

Ultrasound imaging: more surface rendering

Ultrasound imaging: imaging the heart

atrium
heart valves

ventricle

Doppler ultrasound

Doppler effect: change in wavelength with speed


Ultrasound, like normal sound, is a wave.
If a source of sound moves towards the listener, the
waves begin to catch up with each other. The wavelength
gets shorter and so the frequency gets higher the sound
has a higher pitch.
We use this principle to work out how fast blood cells
move. Ultrasound reflects off the blood cells and causes a
Doppler shift

The ultrasound probe


emits an ultrasound wave
A stationary blood cell
reflects the incoming wave
with the same wavelength:
there is no Doppler shift

The ultrasound probe


emits an ultrasound wave
A blood cell moving away
from the probe reflects the
incoming wave with a
longer wavelength
In reality, there is actually
two Doppler shifts. The
first one occurs between
the probe and the moving
blood cell (not shown
here) and the second one
occurs as the red blood
cell reflects the
ultrasound.

Now, the blood cell moves


towards the probe. It
reflects the incoming wave
with a shorter wavelength

Doppler effect: blood flow in artery

Doppler imaging: combine imaging and Doppler


Use BOTH normal ultrasound imaging and Doppler
imaging
Used to image blood flow

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.

INSTRUMENTATION AND
CONSIDERATIONS

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

Acoustic Impedance

The product of the tissues density and the sound


velocity within the tissue
Amplitude of returning echo is proportional to the
difference in acoustic impedance between the two
tissues
Velocities:
Soft tissues = 1400-1600m/sec
Bone = 4080
Air = 330
Thus, when an ultrasound beam encounters two
regions of very different acoustic impedances, the
beam is reflected or absorbed
Cannot penetrate
Example: soft tissue bone interface

Frequency and Resolution


As frequency increases,
resolution improves
As frequency increases,
depth of penetration
decreases
Use higher frequency
transducers to image
more superficial
structures
Ex: Equine Tendons

Frequency
Penetration

Instrumentation - Ultrasound
Probes
A B
C
A

Transducers/Probes
Sector scanner
Fan-shaped beam
Small surface required for contact
Cardiac imaging
Linear scanner
Rectanglular beam
Large contact area required
Curvilinear scanner
Smaller scan head
Wider field of view

Monitor and Computer


Converts signal to an image/ archive
Tools for image manipulation:
Gain amplification of returning echoes
Overall brightness
Time gain compensation (curve)
Adjust brightness at different depths
Freeze
Depth
Zoom in for superficial view
Zoom out for wide view
Depth limited by frequency
Focal zone
Optimal resolution wherever focal zone is

Image controls

Modes of Display
A mode
Spikes where precise length and depth
measurements are needed ophtho
B mode (brightness) used most often
2 D reconstruction of the image slice
M mode motion mode
Moving 1D image cardiac mainly

Artifacts
Artifacts lead to the improper display of the
structures to be imaged
Affect the quality of images
Improper machine settings gain
Image too bright or too dark
Can disguise underlying pathology

Artifacts
Reverberation
Time delays due to travel of echoes when there
are 2 or more reflectors in the sound path
Mirror image liver, diaphragm and GB
Return of echoes to transducer takes longer
because reflected from diaphragm
A second image of the structure is placed
deeper than it really is
Comet tail gas bubble
Ring down skin transducer surface

Mirror Image Artifact

Dr. Matthews

Dr. Matthews

Comet Tails

Reverberation

What Happened Here?

Artifacts
Acoustic shadowing
U/S beam does not pass through an object
because of reflection or absorption
Black area beyond the surface of the
reflector
Examples: cystic calculi, bones
Acoustic enhancement
Hyperintense (bright) regions below objects
of low U/S beam attenuation
AKA Through transmission
Examples: cyst or urinary bladder

Acoustic Shadowing

Acoustic Enhancement

Acoustic Enhancement

Artifacts
Refraction:
Occurs when the sound wave reaches two
tissues of differing acoustic impedances
U/S beam reaching the second tissue
changes direction
May cause an organ to be improperly
displayed

What type of artifact is this?

Ultrasound Terminology
Never use dense, opaque, lucent
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
Liver is hyperechoic to kidneys

Ultrasound safety

Ultrasound: safety
Ultrasound is energy and is absorbed by
tissue, causing heating
Question: 2D ultrasound has been used
to image the foetus for about 50 years. It
is thought to be completely safe and
does not cause significant heating
4D ultrasound is new, requires more
energy and therefore generates more
heating. We think it is safe.
Should we use it to diagnose foetal
illness?
Should we use it to make videos of
healthy babies for parents?

Summary:
We can get images of the body by recording
echoes of ultrasound
Ultrasound is good at imaging soft tissues
The Doppler effect can be used to detect blood
flow

Acknowledgements:
Thanks to GE Healthcare, Prof Jem Hebden and Prof Alf
Linney for providing images.
This lesson was developed by Adam Gibson, Jeff Jones,
David Sang, Angela Newing, Nicola Hannam and Emily
Cook
We have attempted to obtain permission and acknowledge
the contributor of every image. If we have inadvertently used
images in error, please contact us.

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