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Chapter 1.

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1.1

April 30, 2000

1 Principles of medical ultrasound imaging and measurements
1.1 1.2 Introduction.................................................................................................................... 3 Ultrasound waves and transducers A. Ultrasound compression waves in biological tissue.............................................. 3 B. Spatial resolution and frequency........................................................................... 6 C. Ultrasound transducers and beams........................................................................ 7 D. Focusing and apodization.................................................................................. 13

1.3 Pulse echo amplitude imaging A. Reflection, refraction and scattering of ultrasound...............................................17 B. A-mode and M-mode imaging- Power absorption and TGC........................... 21 C. Two dimensional (2D) amplitude imaging...........................................................26 D. Resolution, speckle and frequency in ultrasound imaging................................... 28 E. Signal compression and processing.....................................................................31 F. Three-dimenaional (3D) imaging.........................................................................31 1.4 Beam forming with electronic arrays A. Phased linear arrays.............................................................................................35 B. Switched linear arrays..........................................................................................36 C. Curvilinear arrays................................................................................................ 37 D. Annular arrays.....................................................................................................40 E. Dynamic focus and aperture................................................................................ 40 Factors affecting image quality A. What is image quality?.........................................................................................44 B. Effect of side lobes on image quality................................................................... 45 C. Artifacts from inhomogeneities in the tissue........................................................46 D. Reducing the effect of reverberations and wave front aberrations....................... 51 Blood velocity measurements using the Doppler effect of back-scattered ultrasound A. Basic principle..................................................................................................... 52 B. PW and CW Doppler measurements................................................................... 53 C. Spectral analysis.................................................................................................. 55 D. Range ambiguity, frequency aliasing, and LPRF/HPRF PW Doppler.................57 E. Analysis of range ambiguity and velocity range with LPRF and HPRF PW Doppler............................................................................59 Multi range gated (MRG) Doppler and Color Flow Mapping (CFM) A. Measurement of velocity profile with MRG Doppler .........................................64 B. 2D color flow mapping of blood velocities..........................................................66 C. Methods of insonifying the image field ............................................................. 68 D. Comparison between tissue and flow imaging.....................................................69

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...... Ultrasound scanline processing for color flow imaging ............................. Introduction ...........95 Section 1..................75 1............................................................................. Need and problems with the combination................... Instrument block diagram and display interface .....77 C..........................9....8...................................................................................................................................................................2 April 30...............1 1................2.............................................................................. 2000 Combination of ultrasonic Doppler and amplitude imaging systems A.................................................................83 F....4...........................95 1................................... Ultrasound scanline processing for tissue imaging......................3................................................................................................................. 74 C........................... The Missing Signal Estimator (MSE) method of simultaneous tissue imaging and Doppler measurements...........7.............................................88 Section 1.........8 1................5........... 77 B..............................................11 Further reading on basic principles and clinical applications.............................92 Section 1...................................................... Instrument optimization............92 Section 1..............................................................6.................9 Ultrasound instrumentation A.......81 E................................... 80 D.............................................................................................91 Section 1.................................. 84 G.... 86 1..................................10 Quick reference of important concepts Section 1......................................................... Ultrasound scanline processing for PW/CW Doppler .................................................... Dynamic range and digital representation of signals................... Interfacing to a computer...................................Chapter 1...........................71 B.....................90 Section 1.................................................. 99 ..........................................................................................94 Section 1.......

1 1. In the display.1 Introduction This chapter gives an overview of the basic principles of medical ultrasound imaging. By pulsing the beam. With scanning of the ultrasound beam. To avoid this limitation a continuously transmitted wave (CW) must be used. blood velocities in a specific area can be measured. the Doppler effect can be used to image the spatial variation of the blood velocities. This can be used for the measurement of the velocity of moving targets. Further in depth presentations are also found in the reference list at the end of this Chapter. but many practical problems is still left due to the high noise level in clinical clinical ultrasound images. This allowed for detailed examination of the fast movement of the cardiac valves and the cardiac wall. However. This was first done by manual scanning of the non-moving organs. the blood velocities are usually shown in a color scale. was first introduced in the 50'ies. 1. that means any sound wave with a frequency in excess of 15-20 kHz.3B was invented.Chapter 1. Medical diagnostic ultrasound usually operates in the range 2-10 MHz for transcutaneous measurements. the back-scattered signal will also have a change in frequency in accordance with the Doppler effect. and the M-mode display described in Section 1. there is a problem with the pulsed beam since the Doppler signal is sampled for each pulse only. . and signal processing presented in the following chapters. first by fast mechanical rotation of the transducer. When the scatterer is moving. the manual scanning was to slow. This limits the maximum velocity that can be measured with pulsed wave (PW) Doppler. Processing to visualize volumetric data is also time consuming. Then the range resolution in the measurement is lost. The power of todays computers and displays now has spurred new life into 3D imaging. scattering. 2000 1 Principles of medical ultrasound imaging and measurements 1. which limits the maximum Doppler frequency that can be analyzed by the sampling theorem.2 Ultrasound waves and transducers A. and later by beam steering with electronic arrays. the real time scanning has proven to have so many practical advantages that it has also taken over from the manual scanning of non-moving structures. for example the blood.3 April 30. as an introduction to the more elaborate mathematical treatment of wave propagation. Ultrasound compression waves in biological tissue Ultrasound is a term used to describe sound waves that have frequencies above the audible range. Over the years. Ideas of three-dimensional (3D) imaging of organs by beam scanning in 3D directions. The amplitude of the back-scattered ultrasound from a transmitted pulse was first used to identify organ structures along a fixed beam direction using the A-mode display described in Section 1. Real time 3D imaging is also a problem due to the low speed of sound in tissue and the large number of beam directions that must be used. which has given the name color flow mapping (CFM) to the technique. but frequencies up to 40 MHz have been used intraoperatively and with intraarterial imaging with ultrasound catheters.3B. The development continued by scanning the beam in a plane to obtain two dimensional (2D) images of tissue structures. but severe practical problems arouse from the lack of adequate 3D display technology. With the moving structures of the heart. The need for real time imaging of the heart spurred the development of real time ultrasound beam scanning.

1) At each spatial position. the spatial variations in the pressure will pass by with the wave propagation velocity. In soft tissue. For the compression type. at interfaces conversion of longitudinal to shear waves introduces extra energy losses. respectively. For a frozen instant in time. and acoustic impedance of some biological and nonbiological materials. Â. The relationship between the wavelength and the frequency is  = c/f (1. and an oscillation in the pressure with frequency f can be observed. the distance between neighboring pressure maxima) of the wave is called the wavelength. compressibility. c. except for bone where the solid structure is predominant. The medium is compressed and decompressed with a defined spatial period along the propagation direction. At any fixed point along the wave. produced by an increase and a decrease in the pressure. Schematic illustration of a longitudinal compression wave.Chapter 1. c Figure 1-1. the shear waves have low propagation velocity (100m/s) and are heavily attenuated (f>1MHz) and can therefore be neglected. the particle movement is transverse to the wave propagation. 2000 distance l compression decompression pressure distance Moves with wave velocity. the material points are oscillating around their equilibrium position. the wave propagation velocity varies little between different types of soft tissue. However.g. Acoustic waves can be of the compression type or of the shear type. The compression/decompression pattern moves with the wave velocity along the propagation direction. termed compression or longitudinal waves.2 1. mass density. Therefore. . the particle movement is along the direction of wave propagation.4 April 30. compression type acoustic wave. For the shear type. Table 1-1 shows the sound velocity. and is only slightly above that of water. producing deformation of the material. the spatial period (e. Soft tissue is mainly water with some solids added. termed shear or transverse waves. The oscillatory particle movement is along the propagation direction of the wave. Figure 1-1 illustrates a plane.

3% so that the wave propagates approximately like in a homogeneous and isotropic elastic material. Araldit 1 200 Silicon. The wave velocity and impedance of fat is so much lower than for muscular tissue.472 1. Figure 1-2 shows the compressibility of the soft tissues as a function of the mass density.59 1. Material Mass density kg/m3 Compressibility 10-12 m2 /Nt 508 410 396 396 375-394 380-389 353-393 25-100 8³10-6 438 452 416 117 143 175 160 793 11.0004 1.94 Sound velocity Acoustic impedance m/s 106 kg/(m2 s) 1 440 1 540 1 570 1 557 1 547-1 585 1 556-1 575 1 542-1 626 2 700-4 100 330 1550 1 497 1 531 2 670 2 500 2 060 2 300 1 000 5 750 5 900 4 350 3 650 3 240 6 260 4 430 1.2 2.e.5 18 38 Biological material: Fat 950 Neurons 1 030 Blood 1 025 Kidney 1 040 Liver 1 060 Spleen 1 060 Muscles 1 070 Bone 1 380-1 810 Non biological material: Air (0¼ C) 1.4 13 5.26 15. .67 1. the variation of the sound velocity is only .61 1. that it causes a strong scattering of the ultrasound together with a refraction (bending) of the beam. By homogeneous we mean that the acoustic parameters are independent of the location and by isotropic we mean that they are independent of the direction in the material. RTV-11 1 260 Quartz 2 650 Fused quartz 2 200 PZT-5A 7 750 Silver 10 410 Gold 19 290 Aluminium 2 875 Brass 8 578 The sound velocity is related to the mass density ¨ and the volume compressibility û (defined i Section 2.2 -.569 3.3) Variations in acoustic impedance between two materials causes a reflection of the ultrasound as discussed in Section 1.74 3. Acoustic parameters for typical isotropic.64-1.2 4.65 7.2) A typical biological material is inhomogeneous . The Figure demonstrates the compressibility is reduced as the materials get denser.5.71 38 62. Although the wave velocity is isotropic. by excluding fat.68 1.8 2.2 13 33.75-7.37 1.2 1. However the material is inhomogeneous enough to scatter the ultrasound from the bulk of all biological materials.48 1. This causes strong artifacts in the image and is discussed in Section 1. as is further discussed in Chapter 7. 9% for the velocity and 19% for the impedance.2A) of the material as c =1 rk (1.5 April 30.3A.Chapter 1. 2000 Table 1-1. elastic materials [6].8 1. homogeneous.65-1.2 Rubber 950 Fresh Water (25¼ C) 988 Salt Water 1 025 Lucite 1 198 Polystyrene 1 120 Hard PVC 1 350 Typ.78 2.62 1. However. The acoustic or characteristic impedance is Z = ¨c (1. as discussed in Section 1.65-1. one have found absorption to depend on direction in fibrous and muscular tissue.93 9 5.4 0. composed of different types of soft tissues in defined small regions.3B. i.

5 .Chapter 1. . For intravascular imaging of atherosclerosis. one should use as high a frequency as possible. Spatial resolution and frequency The resolution in an ultrasound image is proportional to the wavelength. i. Compressibility of soft tissues as a function of their mass density. frequencies up to 7. as further analysed in Chapter 7. This line gives an approximate linear relationship between the compressibility and the mass density dû û ò û0 + ®® ¨ ò {1545 . (1. The variability of the data in Table 1-1 is demonstrated together with the line showing the linear least square approximation. it is necessary to lower the frequency and therefore frequencies in the range 2.15 MHz have been used. To get adequate penetration.0.5 MHz are used and for imaging of peripheral vessels and during surgery.6 April 30. 2000 500 Compressibility 10-12 m2 /Nt 400 300 200 100 0 940 960 980 1000 1020 1040 1060 1080 Mass density kg/m3 Figure 1-2.9³101 2 û kg/m3 dû This relationship between compressibility and mass density has implications for the angular variation of the scattered intensity from tissue. frequencies up to 40 MHz (Â = 39 µm) have been used producing a spatial resolution around 100 µm.1 ¨}³10-12 m2 /Nt d¨ d¨ ¨ ò ¨0 + ®® û ò 1405 .e.5 MHz are used in adult cardiology and imaging of deep organs. frequencies up to 10 .3B.2 600 1. Therefore to get good resolution. Typical frequencies used in ultrasound imaging together with the wavelengths for a wave velocity c = 1580 m/s are shown in the Table 1-2. inversely proportional to the frequency.1. For pediatric cardiology.4) B. Unfortunately the attenuation of the ultrasound also increases with frequency as discussed in Section 1.

the sound tends to move in straight lines. The pressure in the plate is zero on the surfaces when the plate is vibrating freely in air. We can hear the train before it comes around the bend. it causes the plate to vibrate and the piezoelectric effect produces a voltage between the metal electrodes. Adult heart ®®®®®®®®®®®®® Pediatric heart ®®®®®®®®® Periph.Chapter 1. The critical factor for how much the wave bends. The transducer is thus an electrical capacitor.. However. .11. When a voltage source is coupled to the electrodes. is the size of the transducer face in number of wavelengths. C. The middle of the plate is then a vibration node. we see that these transducers are many wavelengths wide. 2000 Table 1-2. With loud-speakers we find that the treble sound is more directive than the base. Typical non invasive diagnostic transducers are 15-25 mm in diameter.21]. How well the treble sound is heard often depends upon where in the room one is standing. When an incoming wave hits the transducer surface. When the plate thickness is one half wavelength.5 632 3 527 3. For example. µm 790 2. Ultrasound transducers and beams An ultrasonic transducer can be made of a plate of piezoelectric material with thin metal electrodes on each face as illustrated in Figure 1-3. If we connect an oscillating voltage source to the electrodes. vessels ®®®®®®®® Intravascular Doppler: ®®®®®®®®®®®®® Deep vess.5 211 10 158 20 79 40 39 Tissue image: ®®®®®®®®®®®®®®®®®® Deep organs. MHz 2 Wavelength. the plate thickness will vibrate. as the frequency increases and the wavelength reduces.heart ®®®®®®®®®®® Periph. not moving.2 1. can be used to receive ultrasonic waves. The transducer can also be used to transfer energy from acoustic vibrations into an electric voltage and in this mode. The bending of waves around corners is called diffraction . This makes it possible to generate beams of ultrasound. the sound tends to move along straight lines. Thus the pressure has antinodes where the material vibration has nodes. while the base bends around all corners. we are used to sound waves bending around corners.16.e. and nodes where the vibration has antinodes. while the surfaces of the plate are vibration antinodes moving to and from each other with large amplitude. heart ®®®®®®®®® Ped. the plate either increases or decreases its thickness depending on the polarity of the voltage. Ad.7 April 30. a circular transducer of 15 mm diameter will be approximately 20Â at 2 MHz and 48Â at 5 MHz. we get a resonance in the thickness vibration with increased vibration amplitude.5 451 5 316 7. If this number is large. Typical wavelengths with diagnostic ultrasound [6. as illustrated in Figure 1-3b and c. and maximum in the center of the plate as illustrated in Figure 1-3d. i. vessels ®®®®®®® Intravasc. The size of the transducer is called its aperture. and from Table 1-2. Frequency. At audible frequencies.

d).2 1. d) Figure 1-3. and c) compression of the plate thickness by applying a voltage of opposite polarity to the plate. b) Expansion of the plate thickness by applying a voltage across the plate. pressure ampl. . The lowest panel.8 April 30. 2000 piezo-electric material metal electrodes a) + + + + + + + + b) + + + + c) + + + + velocity ampl.Chapter 1. a) Cross-section of schematic piezoelectric transducer plate with thin metal electrodes. shows the amplitude of the particle velocity and the pressure in the plate for a free vibrating plate in air.

ii) By using a thin plate between the transducer and the tissue which has a stiffness and mass density between that of the transducer and that of the tissue. 2000 time Bw Tp Pressure frequency a) 1 Tp ~ Bw time Tp b) frequency Bw Figure 1-4. This is undesirably long for pulse echo applications where we want a short pulse for high range resolution. the ringing is dampened because energy is transmitted into the backing. There are two ways to reduce the ringing: i) By mounting the transducer plate on a heavy.2 Pressure 1. which gives the distribution of frequencies in the pulses. The disadvantage of this method is that it introduces acoustic power losses into the backing. This is called the ring-down . Since the transducer is at resonance. the energy coupling between the transducer and the tissue will be stronger. However. where  is the wavelength in the plate. and the ringing will die out more quickly. The width of these distributions is the bandwidth of the transducer. stiff and absorbing backing .Chapter 1. and b) a transducer with air backing and quarter wave matching. and reduces the amplitude of the pulse transmitted into the tissue as well as the sensitivity of the transducer as a receiver. The panels to the right show the Fourier transform of the pulses. and illustrates the minimum length of the ultrasound pulse which can typically be transmitted with this design. Such a plate transforms the mechanical impedance of the tissue and is often referred to as a quarter wave impedance transformer . The plate should have a thickness of Â/4. The vibration of the surface will be somewhat reduced by the contact loading of the tissue. Figure 1-4a shows the velocity on i the transducer surface when the transducer is driven with a very short electric pulse (impulse response). it will ring for quite a few oscillations after we have removed the voltage source. The effect on the ring-down by such a quarter wave impedance matching is illustrated in Figure 1-4b. Connecting a vibrating transducer surface to the tissue. a) Examples of shortest possible pulses obtained from a transducer with air backing and no quarter wave matching. the plate is much stiffer than the tissue so that the reduction in the vibration at the surface of the transducer due to the load of the tissue is very low. . will cause the tissue surface to vibrate and thus radiate an ultrasound beam into the bulk tissue.9 April 30. and a pressure will develop on the surface.

This accounts for a less than optimal sensitivity noted with the linear phased array compared to some other types of transducers. In the farfield. . the shorter the pulse. we can use Huygens' principle where each point on the surface acts as a source of a spherical wave.Chapter 1.10 April 30. and we see that the bandwidth is inversely proportional to the pulse length. According to Huygens' principle. The beam is composed of three regions: The farfield region where. the beam is composed of a typical main lobe with surrounding side lobes. In some cases the backing is required for mechanical support.8 D /4Â 2 2 Side lobe D=2a Main lobe Q12dB Side lobe Extreme near field Transition region Near field Far field Figure 1-5. The width of these distributions is called the bandwidth of the transducer. The resulting beam has a characteristic farfield region where it expands with a defined opening angle. for example with linear phased arrays. is the nearfield region. With the second method. and a transition zone between the extreme nearfield and the farfield. Since the backing introduces a reduction in receiver sensitivity. the ring-down is reduced through a better coupling of the energy into the tissue. Schematic illustration of the formation of an ultrasonic beam from a circular vibrating plate. According to Huygens' principle. The beam amplitude falls gradually off from the axis. these partial waves will interfere and generate the resulting beam as illustrated in Figure 1-5. 2000 The right panel in Figure 1-4 shows the Fourier transform of the pulses which shows the distribution of frequencies in each pulse.2 1. This is composed of the extreme nearfield where the beam is a cylindrical extension of the transducer.e. Between the transducer and the farfield. To analyze the radiated beam from such a transducer plate. and cannot be avoided. due to diffraction the beam expands with a fixed opening angle. the wider the bandwidth. Two or more Â/4 layers are also used to improve the bandwidth at the cost of more difficult machining. it is avoided if possible. the beam is composed of a central main lobe with side lobes as skirts around. In the farfield. D /2Â D2/4Â 0. The best transducer is then obtained with air backing and quarter wave matching of the transducer to the tissue load. and we can define the width of the main lobe as where the amplitude has fallen X dB off from the axial value. the beam is formed by the interference between spherical waves from each point on the transducer surface. i.

0 0. For continuous wave (CW) excitation.4 1. X dB kX 3 1 10 1. 2000 Table 1-3.2 1.8 12 2 ‚ 2. the shape of the far field side lobes depends upon the length of the transmitted pulse. Values of kX for different reductions X in beam amplitude are shown in Table 1-3. Values of kX for various definitions of the beam width.3 2.0 1. Between the transducer and this limit is the nearfield region which is composed of the extreme nearfield for x3 < 0.4 1.3 (5MHz) Â=0.2 (7. while with a short p u l s e d w a v e (PW) excitation the zeros disappear and we get an angular variation of the field amplitude as illustrated in Figure 1-6b.9 0.6 4. X = ‚ is obtained at the zero between the main lobe and the first side lobe. This is discussed at length in Sections 5. and the whole concept of dividing the beam into a near field and a far field region is a simplified means of enhancing some aspects of the character of the beam rather than describing well defined regions.3 1.3 2.7) where the beam is approximately the cylindrical extension of the transducer.1 0.5 2 3 4 5 6 8 10 12 15 17 5.6) This can be defined geometrically as the intersection between the cylindrical extension of the transducer and the 12dB opening angle of the beam.1 3.9 1. causing an apparent focusing that is referred to as diffraction focusing.1 1.5) where D = 2a is the diameter of the transducer.8 3.Chapter 1.7 1.7 1.7 1.75 (2MHz) Â=0.11 April 30. we have directions of zero field between each lobe with an amplitude variation as illustrated in Figure 1-6a.4 2. The transition between the near field and the far field is not sharp.9 1.0 4.7 0.6 1.95 33 2.9 1.9 4.8 2.9 4.1 0.6 20 4. The region between the extreme nearfield and the farfield is called the transition region .9 4.0 2.7 2.6 3. Table 1-4.44 The dual sided opening angle of the main lobe for a plane circular transducer is then ¯XdB = kX Â/D (1.8 3. circular transducer x3 = 2a2 /Â = D2 /2Â (1.6 3.4 1.7 0.1 0.4-6.15 (10MHz) Â= 75µ (20MHz) Â= 50µ (30MHz) Â= 37µ (40MHz) Â= 30µ (50MHz) 1 1.7 3.4 0.2 D2 /Â (1. This is further analyzed in Section 5.9 1.8 2.9 1.6 0. Typical values of 12dB opening angles are shown in Table 1-4.1 2.1 1.5 1.7. The distance x3 along the transducer axis to the start of the farfield region is for a plane.9 2.2 0.7 3.9 0.9 2.2 2.5 (3MHz) Â=0. Also. D=2a mm Â=0.3 5.3 1.7 1.4 1. In this region the beam contracts before it starts to expand in the farfield.4 2.1 0.7 0.3 1.4 1.1 1.9 0.5MHz) Â=0.2 1.3 2.9 2.9 24 28 3.8 a2 /Â = 0.4 3.4 2. as illustrated in Figure 1-5. Dual sided 12 dB opening angle in degrees for practical circular transducers in the range 2-50 MHz.3 2.5 .

F side lobe D=2a main lobe DF x3 QF =Q12dB Qg LF (1dB) Figure 1-7. circular 3MHz transducer with 15 mm diameter.Chapter 1.12 April 30. . CW excitation of the transducer is shown in a). Far field angular variation of the amplitude of the transmitted wave for a plane. and PW excitation in b).2 dB 1. Focusing of an ultrasound beam by shaping the transducer disc as a spherical shell. 2000 0 -10 -20 -30 -10 0 dB 0 a) 10 degrees -10 -20 -30 -10 0 b) 10 degrees Figure 1-6.

CW excitation with uniform vibration amplitude over the disc is shown in a). the PW excitation produces the field shown in d). the width of the main lobe increases. With a variation of the vibration amplitude as shown in Figure 1-8c.5. The zeros between the sidelobes with CW excitation have disappeared.0 April 30.5 0 20 0 10 0 a) 10 20 mm 20 10 0 b) 10 20 mm 1. When apodization of the excitation amplitude over the transducer surface is done.0 0. with some variations depending on how the transducer is excited.2 1. Figure 1-8a shows the cross sectional distribution of the amplitude at the focal point for CW excitation of the beam with equal vibration amplitude over the disc. This reduces the contrast resolution of the instrument. and PW excitation with uniform vibration amplitude over the disc is shown in b).5 0 transducer diameter c) 0 20 10 0 d) 10 20 mm Figure 1-8. we get diffraction of the sound and the focus will not be as sharp as the focus obtained with geometrical beams. One reason to do this is that the sidelobes generate acoustic noise since they detect targets that are not along the beam direction. the sidelobes contain a fair amount of energy because they form a skirt around the main lobe. The geometrical focus will be in the center of curvature of the shell. The field is composed of a main lobe and side lobes with clear zeros in between. D. With an apodization of the vibration amplitude over the disc as in c). Figure 1-8b shows the amplitude variation with PW excitation of the disc producing a transmitted pulse as in Figure 1-4b with uniform vibration amplitude over the whole disc.0 1. Focal field distribution from a 3 MHz spherical shell with diameter 15 mm and focal radius 75 mm.0 1. It can be advantageous to let the amplitude of the plate vibration degrade from the center to the edges.5 0.Chapter 1. Focusing and apodization The beam can be focused in a simple way by forming the transducer as part of a spherical shell as illustrated in Figure 1-7. which is the ability to discriminate a weak target that is close to a strong one. . This is called apodization . However. we get a variation of the field in the focus with PW as shown in Figure 1-8d. 2000 0. The effect of the sidelobes is further discussed in Section 1. because the transducer disc is a limited number of wavelengths in diameter.13 1. but the amplitude of the sidelobes decreases.5 0. Although the amplitude of the sidelobes is much lower than for the main lobe. The field distribution will be as shown in Figure 1-7.