@uyTmm = Physics and Instrumentation Sound is a mechanical vibration transmitted through an elastic medium, When it propagates through the air at the appropriate frequency, sound may produce the sensation of hearing, Ulirasound includes that portion of the sound spectrum having a frequency greater than 20,000 cycles per second (20 KHz), which is considerably above the au- dible range. The use of ultrasound to study the structure and function of the heart and great vessels defines the field of echocardiography. The production of ultrasound for diagnostic purposes involves physical principles and instrumentation that are both complex and sophisticated As technology has evolved, a thorough understanding of these principles mandates an extensive background in physics and engineering. Fortunately, the use of echocar- diography for clinical purposes does not require a com- plete mastery of the physics and instrumentation involved in the creation of the ultrasound image. However, a basic understanding of these facts is necessary to take full ad- vantage of the technique and to appreciate the strengths and limitations of the technology. This book is intended principally as a clinical guide to the broad field of echocardiography, to be used by clini- cians, students, and sonographers concerned more about the practical application of the technology than the under- lying physics. For this reason, an extensive description of the physics and engineering of ultrasound is beyond the scope of this book. Instead, this chapter focuses on those aspects of physics and instrumentation that are relevant to the understanding of ultrasound and its practical applica- tion to patient care. In addition, many of the newer techni- cal advances in ultrasound instrumentation are presented briefly, primarily to provide the reader a sense of the chang- ing and ever-improving nature of echocardiography. PHYSICAL PRINCIPLES Ultrasound (in contrast to lower, ic., audible, frequency sound) has several characteristics that contribute to its diagnostic utility. First, ultrasound can be directed as a beam and focused. Second, as ultrasound passes through a medium, it obeys the laws of reflection and re- fraction. Finally, targets of relatively small size reflect ul- trasound and can therefore be detected and character- ized. A major disadvantage of ultrasound is that it is poorly transmitted through a gaseous medium and at- tenuation occurs rapidly, especially at higher frequen- cies. As a wave of ultrasound propagates through a medium, the particles of the medium vibrate parallel to the line of propagation, producing longitudinal waves Thus, a sound wave is characterized by areas of more densely packed particles within the medium (an area of compression) alternating with regions of less densely packed particles (an area of rarefaction). The amount of reflection, refraction, and attenuation depends on the acoustic properties of the various media through which an ultrasound beam passes. Tissues composed of solid material interfaced with gas will reflect most of the ul- trasound energy, resulting in poor penetration. Very dense media also reflect a high percentage of the ultra- sound energy. Soft tissues and blood allow relativel more ultrasound energy to be propagated, thereby in- creasing penetration and improving diagnostic ulility. Bone also reflects most ultrasound energy, not because it is dense but because it contains so many interfaces. The ultrasound wave is often graphically depicted as a sine wave in which the peaks and troughs represent the areas of compression and rarefaction, respectively (Fig. 2.1), Microscopie pressure changes occur within the medium, corresponding to these areas, and result in tiny oscillations of particles, although no actual particle mo- tion occurs, Depicting ultrasound in the form of a sine wave has some limitations but allows the demonstration of several fundamental principles. The sum of one com- pression and one rarefaction represents one cycle, and the distance between two similar points along the wave cor- responds to wavelength (see Table 2.1 for definitions of commonly used terms). Over the range of diagnostic ul- trasound, wavelength varies from approximately 0.15 to 1.5 mm in soft tissue. The frequency of the sound wave is 1112 Feigenbaum’s Echocardiography Rarefaction fompression =z t i No" Pressure apmyjdury Wavelength Reread FIGURE 2.1. This schematic illustrates how sound can be de- picted as a sine wave whose peaks and troughs correspond to at eas of compression and rarefaction, respectively. As sound et ergy propagates through tissue, the wave has a fixed wavelength that is determined by the frequency and amplitude that is a measure of the magnitude of pressure changes. See text for fur- ther details, D TABLE 2.1 Definitions of Basic Terms Term Definition the number of wavelengths per unit of time. Thus, wave- length and frequency are inversely related and their prod- uct represents the velocity of the sound wave: (Eq. 2.1) where v is velocity, f is frequency (in eycles per second or hertz) and A is wavelength. Velocity through a given medium depends on the density and elastic properties or stiffness of that medium. Velocity is directly related to stiffness and inversely related to density. Ultrasound trav- els faster through a stiff medium, such as bone. Velocity also varies with temperature, but because body tempera- ture is maintained within a relatively narrow range, this phenomenon is of little significance in medical imaging. Table 2.2 provides a comparison of average velocity values in various types of tissues, Within soft tissue, velocity of sound is fairly constant at approximately 1,540 m/sec (or 1.54 m/msec, or 1.54 mm/sec). Thus, to find the wave- Absorption Acoustic impedance Half-layer value original value Intensity analogous to loudness Longitudinal wave Near field Period Piezoelecticity The proximal cylindric ‘Wavelength ‘The transfer of ultrasound energy tothe tissue during propagation The product ofthe density of the medium and the velocity of soune; differences in Al between 2 media determine the ratio of transmitted versus reflected sound at the interface so, the strength of the wave (in decibels) ‘Amplitude The magnitude of the pressure changas along the wai Attenuation The net loss of ultrasound energy as a wave propagates through a medium Cycle The combination or sum of | compression and 1 rarefaction of a propagating wave Dead time The time in between pulses that the echograph is not emitting ultrasound Decibel A logarithmic measure of the intensity of sound, exprassad as a ratio to a reference value (dB) Duty factor ‘The fraction of time thatthe transducer is emitting ultrasound, a unitless number between 0 and 1 Far fil Tha diverging conical portion of the beam beyond the naar field Frequency The number of cycles per second, measured in Hertz (Hz) ‘The distance an ultrasound beam penctratos into a medium bafore its intonsity has attenuated to one-half the ‘The concentration or distribution of power within an area, often th cross-sectional area of the ultrasound beam, Acyclic disturbance in which the eneray propagation is parallel tothe direction of particle motion shaped portion of he ultrasound beam before divergence begins to occur The time required to complete 1 cycle, usually expressed in micraseconds (usec) The phenomenon of changing shape in response to an applied electric current, resulting in vibration and the pro- duction of sound waves; the ability to produce an electric impulse in response to @ mechanical deformation; thus, the interconversion of electrical and sound eneray ‘The rate of transfer overtime of the acoustic energy from the propagating wave to the medium, measured in Watts AA burst or packet of emitted ultrasound of finite duration, containing a fixed number of cycles traveling together The rate at wihich pulses are emitted from the transducer, ie, the number of pulses emitted within @ period of Power Pulse Pulse length ‘The physical length or distance that a pulse occupies in space, usually expressed in millimeters (mm) Pulse repetition frequency time, usually 1 second Resolution The smallest distance between 2 points that allows the points to be distinguished as separate Sensitivity The ability of the system to image small targets at a given depth Ultrasound ‘A mechanical vibration in a physical medium, characterized by a frequency > 20,000 He Velocity The speed at which sound moves through a given medium ‘The length of s single cycle ofthe ultrasound wave; a measure of distance, not time2. Physics and Instrumentation 13 D TABLE 2.2 Velocity of Sound in Air and Various Types of Tissues Medium Velocity (m/sec) Air 330 Fat 1450 Water 1480 Soft tissue 1540 Kidney 1560 Blood 1570 Muscle 1580 Bone 4080 length of a 3.0-MHz transducer, the solution would be given by: vepen hovel A = 1,540 m/sec + 3,000,000 cycles/sec = 0.51 mm (Eq. 2.1] A simpler version of this equation is given by d (in mil- limeters) = 1.54/f, where fis the transducer frequency (in megahertz). This converts 1,540 m/sec to 1.54 mm/sec, expresses frequency in megahertz, and yields wavelength in millimeters. Thus, vf d= 154+ 3.0* 0.51 mm If an ultrasound wave encounters an area of higher stiffness, for example, velocity will increase, Because fre- quency does not change, wavelength will also increase, As is discussed later, wavelength is a determinant of resolu- tion: the shorter the wavelength is, the smaller the target that is able to reflect the ultrasound wave and thus the greater the resolution. Another fundamental property of sound is amplitude, which is a measure of the strength of the sound wave (Fig. 2.1). It is defined as the difference between the peak pres- sure within the medium and the average value, depicted as the height of the sine wave above and below the base- line. Amplitude is measured in decibels, a logarithmic unit that relates acoustic pressure to some reference value. The primary advantage of using a logarithmic scale to play amplitude is that a very wide range of values can be accommodated and weak signals can be displayed along side much stronger signals. Of practical use, an increase of 6 dB is equal to a doubling of signal amplitude, and 60 4B represents a 1,000-fold change in amplitude or loud- ness. A parameter closely related to amplitude is power, which is defined as the rate of energy transfer to the medium, measured in watts. For clinical purposes, power i usually represented over a given area (often the beam area) and referred to as intensity (watts per centimeter squared or Wem), This is analogous to loudness. Inten- sity diminishes rapidly with propagation distance and has important implications with respect to the biologic effects of ultrasound, which are discussed later INTERACTION BETWEEN ULTRASOUND AND TISSUE These basic characteristics of ultrasound have practical implications for the interaction between ultrasound and tissue. For example, the higher the frequency of the ul- trasound wave (and the shorter the wavelength), the smaller the structures that can be accurately resolved, Because precise identification of small structures is a goal of imaging, the use of high frequencies would seem desirable, However, higher frequency ultrasound has less penetration compared with lower frequency ultrasound, The loss of ultrasound as it propagates through a medium is referred to as attenuation. This is a measure of the rate at which the intensity of the ultrasound beam di- minishes as it penetrates the tissue. Attenuation has three components: absorption, scattering, and reflection Attenuation always increases with depth and is also af- fected by the frequency of the transmitted beam and the type of tissue through which the ultrasound passes. The higher the frequency is, the more rapidly it will attenu- ale, Attenuation may be expressed as the *half-value layer” or the “half-power distance,” which is a measure of the distance that ultrasound travels before its amplitude is attenuated to one half its original value. Representative half-power distances are listed in Table 2.3. As a rule of thumb, the attenuation of ultrasound in tissue is between 0.3 and 1.0 dBicm/MHz, This approximation describes the expected loss of energy (in decibels) that would occur over the round-trip distance that a beam would travel af- ter being emitted by a given transducer. For example, if a 3-MHz transducer is used to image an object at a depth of 12 cm (24-cm round trip), the returning signal could be attenuated as much as 72 dB (or nearly 4,000-fold). As expected, attenuation is greater in soft tissue compared with blood and is even greater in muscle, lung, and bone, The velocity and direction of the ultrasound beam as it passes through a medium are a function of the acoustic wpedance of that medium, Acoustic impedance (Z, measured in rayls) is simply the product of velocity (in meters per second) and physical density (in kilograms per cubic meter). As impedance increases, a greater acoustic mismatch is created and relatively more ultrasound en- ergy will be reflected rather than transmitted. Within a homogeneous structure, the density of the medium pri- marily determines these parameters. In such a structure, sound would travel in a straight line at a constant veloc- ty, depending on the density and stiffness. Within the body, the tissues through which an ultrasound beam passes have different acoustic impedances. When the