Basics Of Doppler

By
Dr. Amit Kumar
PG JR1
Department Of Radiodiagnosis
 Doppler Shift
• Difference in frequency between the
transmitted and received frequencies.

• Large Doppler shift – High velocities

• Small Doppler Shift – Low Velocities

 Doppler effect

• It is defined as the change in frequency of sound wave due to

a reflector moving towards or away from the transducer.

• If the reflecting source is in motion either toward or away

from the emitting source the frequency of the sound waves
received will be higher (positive Doppler shift) or lower
(negative Doppler shift) than the frequency at which they
were emitted, respectively .
• Positive Doppler shift

– Source reflecting sound waves is moving toward the emitting source

– Depicted in colour flow Doppler as red

– Object (RBCs ) moving towards the transducer. Frequency of received sound waves

> frequency of emitted sound waves

– Results in a positive doppler shift.

– Flow above the baseline

Negative Doppler shift
– Object (RBCs) moving away from the transducer.

– Frequency of received sound waves < frequency of emitted sound

waves

– Results in a negative doppler shift.

– Flow below the baseline.

– Depicted in colour flow Doppler as blue

 Doppler Angle
• It is the angle between the axis of flow and the incident
ultrasound beam.

• Measurement of flow velocity with Doppler imaging is

dependent on the angle between the ultrasound beam and
the target (insonation angle), with the maximum and true
velocity achieved at 0 degrees (parallel to the target).

• Angle correction is considered accurate for diagnostic

purposes at insonation angles less than 60 degrees.
• At angles above 60 degrees, an error of up to 20-30% in
calculated velocities can occur.

• At an angle of 90 degrees,there is no relative movement of

the target toward or away from the transducer, and no
Doppler frequency shift is detected.
 Types Of Doppler

1. Power Doppler
• Detects the presence or absence of blood flow.

• Measure the strength of doppler signal returning to the

transducer,rather than the shift in frequency.

• High sensitivity(picks up small vessels ,low flow velocities).

• Cannnot detect velocity or direction of blood flow .

• Not dependent on angle or subject to aliasing.

2. Color Doppler
• Can detect presence or absence of blood flow,flow
velocity and direction of flow.
• Assigns a color to the different speeds and
directions of flow.
• Measure the frequency shift between the
transmitted and the received frequencies.
• The shift in doppler frequency is displayed as either
a positive or negative shift.
3. Spectral Doppler
2 types of spectral doppler
• Pulsed wave
• Continuous wave

Pulsed Wave Spectral Doppler

• Collects the doppler information from a small
area (the sample gate).
• Demonstrate the flow characterstics from that
region(flow direction,velocity,waveform pattern and
presence/absence of flow).
• Flow characterstics are diplayed as a spectral tracing
(waveform)
• There are characterstic waveform patterns for
arteries and veins and for each vessel in the body.
• Deviation from the expected pattern can indicate
presence of disease or incorrect machine settings.
• This type of ultrasound can produce a grayscale
ultrasound image ,power doppler ,color doppler and
spectral doppler information.
 Continuous Wave Doppler
• Continuous wave Doppler simultaneously transmits
and receives sound waves with
separate piezoelectric crystals, recording every velocity
received along a path defined by the operator.

• It is capable of recording the direction and velocity of

flow even at high velocities but is unable to localise
from where individual velocity elements originate .

• Can not form a grey scale ultrasound image.

• Common uses in sonography include the analysis of:
1. Aortic stenosis
2. Aortic regurgitation
3. Mitral stenosis
4. Tricuspid regurgitation
Normal Arterial Doppler Waveforms
Triphasic: having three phases, due to crossing the zero flow
baseline twice in each cardiac cycle
– systolic forward flow
– early diastolic flow reversal (below zero velocity baseline)
– late diastolic forward flow (slower than in systole)

Biphasic: having two phases or variations having forward and

reverse flow

Monophasic: having one phase systolic forward flow

continuing into diastole, lacking reverse diastolic flow.
 Doppler Indices
• PSV - Peak Systolic Velocity
• EDV - End Diastolic Velocity
• PI – Pulsatility Index
• RI – Resistive Index
• AT - Acceleration Time
• AI - Acceleration Index
 PSV
• Peak systolic velocity (PSV) is an index measured
in spectral Doppler ultrasound.

• On a Doppler waveform, the peak systolic velocity

corresponds to each tall “peak” in the spectrum window
• The normal peak systolic velocity (PSV) in peripheral
lower limb arteries varies from 45–180 cm/s.
• Severe arterial disease manifests as a PSV in excess of
200 cm/s, monophasic waveform and spectral
broadening of the Doppler waveform.
 EDV
• End-diastolic velocity (EDV) is an index measured in spectral Doppler
ultrasound.
• On a Doppler waveform, the EDV corresponds to the point marked at the end
of the cardiac cycle (just prior to the systolic peak)

• Low resistance vessels (e.g. internal carotid artery, renal artery) supply end
organs which require perfusion throughout the entire cardiac cycle. These
vessels exhibit high diastolic flow and EDV .

• High resistance vessels (e.g. external carotid artery, limb arteries) are
characterised by early reversal of diastolic flow, and low or absent EDV.

• In stenosis, a localised reduction in vascular radius increases resistance,

causing increased PSV and EDV distal to the stenosed site.
• An increased degree (%occlusion) of stenosis corresponds to
increased PSV and EDV.

• In near occlusion (>99%), flow velocity indices become

unreliable (may be high, low or absent) . In this setting, a
significant reduction in post-stenotic flow velocity is termed
“trickle flow” .

• In complete occlusion, PSV and EDV are absent.

 Pulsatility index

• The pulsatility index (PI) (also known as the Gosling index) is a

calculated flow parameter in ultrasound, derived from the
maximum, minimum, and mean Doppler frequency shifts during
a defined cardiac cycle.

• Along with the resistive index (RI), it is typically used to assess

the resistance in a pulsatile vascular system.

• PI = (peak systolic velocity - minimal diastolic velocity) / (mean

velocity)

• The range of normal values is between 3 and 5.

 Clinical scenarios in which a pulsatility index are calculated
include:
• malignant ovarian lesions
• transcranial Doppler
• carotid artery evaluation for stenosis
• umbilical vein Doppler
• fetal middle cerebral artery Doppler - fetal middle cerebral
artery pulsatility index
• umbilical arterial pulsatility index
Hypertension
• Indices will be uniformly slightly increased.

Abnormalities of heart rate and rhythm

• Both pulsatility and resistance indices will be decreased in
tachycardias and increased in bradycardias.
• Irregularities such as atrial fibrillation will invalidate the use
of any of the Doppler indices.
 Resistive index (RI)
• The resistive index (RI), also known as the Pourcelot index, is a calculated flow
parameter in ultrasound, derived from the maximum, minimum, and mean
Doppler frequency shifts during a defined cardiac cycle.

• RI = (PSV - EDV) / PSV

• The resistive index (RI) is one of the most common vascular ultrasound indices
used owing to its simplicity.

• The RI is proportional to not only vascular resistance but also vascular

compliance. As a vessel narrows and resistance to flow increases, the RI will
increase.
• When the stenotic segment is located distal or downstream to the ultrasound
probe, peak systolic velocity (PSV) is slightly decreased and end-diastolic velocity
(EDV) decreases more than the PSV, thus resulting in increased RI.

• When the stenotic site is located just beneath the ultrasound probe, both PSV and
EDV are raised.

• When the stenotic site is located proximal or upstream to the ultrasound probe,
PSV decreases more than the EDV, resulting in decreased RI, producing a tardus
parvus waveform.
• Different vessels and vascular beds have different flow requirements, so there are
different normal RI values depending on the target organ.

• Blood vessels supplying vital organs such as the internal carotid, hepatic, renal,
and testicular arteries generally have a low RI (0.55-0.7) .

• Blood vessels supplying extremities of the body such as the external carotid,
external iliac, axillary, superior mesenteric, and inferior mesenteric arteries (during
fasting) have a high RI (>0.7).
Acceleration Time
• Renal intraparenchymal acceleration time is a parameter
used in assessing renal arterial stenosis on Doppler
ultrasound. It is the time taken from the start of systole to
peak systole.

• Normal range: a value of usually <0.07 seconds (<70 ms) is

taken as being within normal limits.
• Acceleration index is used in the Doppler assessment of the renal
arteries when assessing for renal artery stenosis.
• Acceleration index is calculated by subtracting the initial systolic
velocity from the peak systolic velocity and then dividing it by the
time between those two points, known as the acceleration time.
• Acceleration index = (v1-v0) / t
• v1: peak systolic velocity (m/s)
• v0: initial systolic velocity (m/s)
• t: acceleration time (s)
• The normal value of the acceleration index is >3 m/s2. Decreased
values, together with other signs, may indicate renal artery
stenosis.
 Normal Venous Flow
• Spontaneity - Spontaneous flow without augmentation

• Phasicity – Flow changes with respiration

• Augmentation – Compression distal to the site of the
examination.Patency below site of examination.
• Valsalva – Deep Breath,strain while holding breath.Patency of
abdominal and pelvic veins.
THANK YOU