Tutorial on

Ultrasound
Imaging
Artefacts
Uni of SA
Ultrasound Physics 1
Prepared by Sean McPeake
 Artefact 1
The artefact seen deep to the measured structure on the image below is one of
the important criteria in the diagnosis of this lesion.
[1] Name the artefact and the lesion.
[2] Discuss the formation of the artefact.
The artefact in question has aided in the diagnosis
of this lesion ( ) too!
 Artefact 2
[1] Name the artefact seen deep to the renal calculus in Image A and discuss its
formation.
When a calculus is small, like the one seen at the left ureteric orifice in Image B,
little or no shadowing will be seen.
[2] Approximately how big must a calculus be to cast a shadow?
[3] Why is the depth of the calculus important?
[4] What imaging parameter changes could be made to improve the visualisation of
the shadow behind such a small calculus? Explain your answers.

Image A Image B
Artefact 2 may be seen deep to calculi as in Image A but it may also be seen
deep to bowel gas as in Image B. Differentiate between the two shadows seen

Image B
Image A
 Artefact 3
This image is of a surgical staple in the dorsal aspect of a foot. The staple itself is
the linear echogenic structure a little under 1 cm long.
[1] Name the artefact seen deep to the staple.
[2] Explain in detail the formation of this artefact
In image A & B the same small cortical cyst in the left kidney is being imaged. For
Image A the transducer was placed directly over the cyst in both the beamwidth and
slice thickness planes. For Image B an angled approach was used.
Explain the relative ‘masking’ of the cyst in Image A.

Image A Image B
 Artefact 4
In the posterior aspect of this urinary bladder false echoes (blue arrow) are shown
within the lumen of the bladder. Name and discuss the formation of this artefact
More anteriorly in the bladder further false echoes are shown (red arrow) Name and
discuss the cause of these echoes.
 Artefact 5
This image was taken at right angles to the one on the previous slide. What do you
think is the cause of the false echoes seen in the posterior aspect of the bladder?
Name the artefact involved and contrast it to the artefact seen in the posterior part of
the bladder on the previous slide.
Complete this statement. Artefacts 4 & 5 are both P _ _ _ _ _ _ V _ _ _ _ _ artefacts
 Artefact 6
Name and with the aid of a sketch describe the formation of the artefact
causing the curvilinear band of false echoes through the urinary bladder
in the image below.
 Artefact 7
Images A & B are transverse images of the abdominal aorta. For Image A the
transducer was placed slightly away from the midline, whereas in Image B the
transducer was on the abdominal midline.
Explain with the aid of a diagram why the aorta has a ‘double barrel’ appearance
in Image B.

Image A Image B
From most angles there seems to be
only one calculus in the left VUJ, but
when scanning in the midline there at
times appears to be two. Explain.

MIDLINE SCAN
Abnormal thickening of the nuchal fold
>6mm at 18-20 weeks gestation has a
strong association with chromosomal
abnormality. When this fetus’ nuchal fold
was scanned through a midline approach
the fold looked thick. However with an
oblique scan away from the midline it
looked normal. Explain
 Artefact 8 & 9
Though the appearance on the image is similar the cause of the artefacts shown
in Image A & B are different. In Image A the artefact is caused by the presence
of gas in the biliary tree. In Image B the artefact is caused by the presence of
crystals in abnormal sinuses in the gall bladder wall.
Name the two different artefacts and briefly discuss the formation of each.

Image A Image B
 Artefact 10
In this coronal image the upper pole of the left kidney is being imaged through the
spleen but the lower pole is not. Although only mild in this case, explain what has
caused the apparent ‘fractured’ appearance to the kidney.
Ultrasound imaging identified a contour abnormality and probable solid mass at
the upper pole of this left kidney (blue arrow). However subsequent contrast
enhanced CT scanning of the abdomen revealed no abnormality here. What is
the cause of this ‘pseudo-mass’ then?
Another example of the same artefact.
 Artefact 11
A subtle but appreciable bend appears to have occurred in the needle as it passes
from subcutaneous fat to breast tissue during this FNAB. When the procedure was
complete the needle was examined carefully and appeared completely straight.
What is the explanation of this appearance?
Another example of Artefact 11
 Artefact 12
In abdominal ultrasound imaging the soft tissue-air interface adjacent the diaphragm
almost invariably gives rise to apparent liver-like tissue superior to the diaphragm on
the image. On occasions a there will be an apparent double image of a specific
structure, such as the small haemangioma in Image A or the Hepatic vein and IVC in
Image B.
With the aid of a diagram explain the formation of these double images.

Image A Image B
During this Paediatric Renal Ultrasound Scan a cystic lesion (blue star) was
transiently seen deep to the urinary bladder. The lesion strangely seemed to come
and go as gas in the bowel deep to the bladder peristalsed around. When the
patient emptied their bladder, careful scanning showed no cyst in the pelvis.

Give a explanation of this imaging artefact.

 Artefact 13
Image A & B are of the same section of the same Achilles tendon. The only
technical difference between the two Images is a subtle change of scan angle
between images. The anechoic area (blue arrow) in Image B is not real. Discuss
the cause of this artefact.

Image A Image B
The anechoic area (blue star) at the insertion of this supraspinatus tendon is
another example of the artefact seen on the previous slide. This artefact is
very common in the supraspinatus tendon because the tendon fibres curve
over the humeral head. Briefly explain how a sonographer overcomes this in
the practical setting.
 Equipment Artefacts
Note appearance of active transducer
wiped clean with an isowipe
During this Early Pregnancy scan the
transducer was accidentally dropped.
When scanning resumed a vertically
aligned anechoic band was seen in a
constant location down the left hand side
of the image.
Explain these appearances.
 Operator Artefacts
Both of the images below are not of diagnostic quality. Explain why and what
likely operator errors have caused the artefact in each case.

Image A Image B