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Journal of X-Ray Science and Technology 11 (2003) 133–139 133IOS Press
Cardiovascular ultrasound imaging –A survey of technical development
Zheng F. Lu
 Radiology Department, College of Physicians & Surgeons of Columbia University,177 Fort Washington Avenue, MHB 3-265B, New York, NY 10032, USATel.: +1 212 305 9020; Fax: +1 212 342 0927; E-mail: zfl1@columbia.edu
Abstract.
This article reviews the physics fundamentals in cardiovascular imaging using ultrasound and discusses the currenttechnology and advances in clinical practices. Challenges in future development are included at the end of the article.
1. Pros and cons of ultrasound in cardiovascular imaging
The proportion of ultrasound studies is estimated to be more than one out of every four medicalimaging studies in the world [1]. The reasons for its popularity are numerous. Perhaps the mainreason is derived from the safe nature associated with ultrasound and the fact that the equipment islow cost, mobile, and convenient to use. Compared to other imaging modalities, such as MRI and CT,ultrasound imaging offers a superior temporal resolution that is crucial in cardiovascular studies. Theultrasoundtechnologyhasbeenwidelyappliedincardiovascularimaginginassessingmorphologicalandhaemodynamic processes. For example, volumetric echocardiography provides quantitative diagnosticinformation, or at least semi-quantitative diagnostic information, such as cardiac function assessment;Doppler ultrasound has been utilized to analyze blood flow patterns and has played a crucial role inassessing cardiovascular diseases.The main disadvantageof ultrasound is its difficulty in the presenceof bone or gas. Since the acousticimpedanceof bone or gas is significantly different from the acoustic impedance of soft tissue, a majorityof the ultrasound is reflected at any interface encountering bone or gas. A so-called “acoustic” imagingwindow is needed where no bone or gas is in the path of the ultrasound beam. Such an acoustic imagingwindow is not always available. In cardiovascular imaging, small footprint transducers (see Fig. 1a) areutilized to fit in the space between the ribs for the acoustic window. Consequently, the visualizationof the heart is limited from certain angles due to the restricted acoustic window. There are alternativeways for ultrasound transducers to approach the heart. For example, a transesophageal transducer canbe intubated through the esophagus (see Fig. 1b) [2]. This type of transducer, however, is relativelyinvasive, and the procedure can be time-consuming.Another disadvantage of ultrasound is its operator and instrumentation dependence. Since ultrasoundtechnique is extremely interactive, both image acquisition and interpretation require a high level of skill.Although there may be “presets” on the system, adjustment has to be made in order to optimize imagequality according to each individual exam condition.
0895-3996/03/$8.00
2003 – IOS Press. All rights reserved
 
134
Z.F. Lu / Cardiovascular ultrasound imaging – A survey of technical development 
(a)(b)
Fig. 1. (a) Picture of an adult transthoracic echocardiography transducer (courtesy of Siemens Medical Solutions). (b) Pictureof a transesophageal biplane echocardiography transducer. The tip diameter is only 9 mm. (courtesy of Siemens MedicalSolutions).
2. Current technology of 2-D echocardiogram
The 2-D echocardiogram is based upon pulse-echo techniques that map the acoustic properties of insonified tissues [3]. An ultrasound transducer converts electric energy into ultrasound energy and viceversa. The transducer emits a very short ultrasound pulse, usually only 1–2
µ
sec long, into the patient’sbody. As the ultrasound pulse propagates through tissue, echo signals are generated as a result of mechanical interactions of the sound waves and reflections occurring in the patient’s body. The returnedecho signals are acquired by the same transducer and utilized to form an acoustic line. The brightnessalong the display line is modulated according to the amplitude of the received echoes. The locationwhere the echo signal is generated is determined based upon the time delay between the pulse emittingand the echo receiving. If 
D
is the depth where the echo signal is generated,
t
is the time delay and
c
isthe speed of sound propagation, then
D
=
ct
2
.
(1)This is called the range equation upon which echo signals are localized. For ultrasound systems, thespeed of sound propagation is assumed to be 1.54 mm/ 
µ
s – the average speed of sound for soft tissues.In order to form a 2-D image, the acoustic line is swept through a cross-sectional region of interest. The
 
 Z.F. Lu / Cardiovascular ultrasound imaging – A survey of technical development 
135Fig. 2. A 2-D echocardiogram along with the M-mode image visualizing a left ventricle from a parasternal long axis view(courtesy of GE Medical Systems).
sweeping lines are utilized to create a tomographic slice of the acoustic map of the cross-section that iscalled 2-D echocardiogram (see the upper panel in Fig. 2).The frame rate of a 2-D echocardiogram is ultimately limited by the sound propagation speed. Themaximum frame rate is inversely proportional to the time needed for ultrasound pulses traveling downand echo signals propagating back from the maximum depth of the field of view, and the total numberof acoustic lines per frame. Compared to the 2-D echocardiogram, the M-mode has a much bettertemporal resolution, becausein M-mode, only oneacousticline is repeatedlycollectedoverthe scanningtime. The brightness of the display line is modulated according to the amplitude of the received echoes,similar to the 2-D echocardiogram [3]. Figure 2 shows a 2-D echocardiogram of a left ventricle from aparasternallongaxisviewin theupperportion ofthe imagedisplay,andthe M-modein thelower portionof the display. The acoustic line depicted by the M-mode is localized on the 2-D echocardiogram by thedashed line. In the M-mode configuration, the echo signals of a single acoustic line are presented alongthe vertical axis of the display, and the successive lines over the scanning time are displayed along thehorizontal axis progressively. For a stationary object, its trace is a straight horizontal line. However, if an object is moving, the movement is shown as vertical displacements recorded by the successive linesand appear on the image as wavy patterns. These patterns can be utilized to calculate the velocity of motion.
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