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Principles of Echocardiography
CONTENTS
10
Physics of Ultrasound
11
2D Images
13
Artefacts
15
Optimizing 2D Images
15
MMode
16
Spectral Doppler
17
Flow Dynamics
18
Color Doppler
NOTES
The higher the ultrasound
PHYSICS OF ULTRASOUND
Ultrasound Wave
tissue.
Medical Ultrasound
Frequencies between 2 10 MHz are used.
SEND
RECEIVE
Diagnostic ultrasound
Safety of Ultrasound
Ultrasound Pulse
Pulse
The higher the US frequency, the higher the pulse repetition frequency.
10
2D IMAGE
NOTES
2D Image
Ultrasound is a cut-plane
technique. Several elements
are used to generate a 2D
image.
Types of Probes
In echocardiography we use
curvilinear probes. The
advantage of such probes is
their small footprint. Thus,
it is easier to image from
small intercostal spaces.
Image quality increases with
higher scan line densities.
Image Quality
What determines overall resolution?
Spatial resolution lateral
Contrast resolution
Temporal resolution
Axial resolution
Ultrasound frequency
Ultrasound frequency
Gain
Gray
11
NOTES
Harmonic imaging
2D IMAGE
Harmonic Imaging
SEND
RECEIVE
leading to better
image quality.
The frame rate describes the number of frames/sec that are displayed.
review function.
Sector width
Frequency
Scan lines
Depth
Limitations of 2D Imaging
Attenuation
Tissue properties (fibrosis, calcification)
Artefacts
Attenuation
Definition: Decrease in amplitude and intensity as the ultrasound wave travels
through a medium
Attenuation may be caused by:
Absorption (proportional to frequency)
Reflection
Refraction
Shadowing
Pseudoenhancement
beam to tissue
Enemies of Ultrasound
Air (reflection of ultrasound) and bone (absorption of ultrasound)
In both conditions you cannot see what is behind.
12
ARTEFACTS
NOTES
Types of Artefacts
Reverberation
Acoustic shadowing
Attenuation artefacts
Specific Forms
Side lobes
Reverberation
Main lobe
Side
lobe
US beam
and unfocused.
Wide
Narrow
13
NOTES
ARTEFACTS
Artefacts are
inconsistent.
Good image quality (e.g. mirror artefacts) Strong reflectors (e.g. calcification,
Poor image quality
prosthetic material)
More frequent in fundamental imaging
14
NOTES
Know your echo
Gain
Depth
Imaging frequency
Sector width
Focus
Post-Processing
machine!
Gray scale
Compression
Contrast
Color maps
MMODE
MMode
Advantage
Where is it used?
RV
IVS
Post.
wall
Diastole Systole
15
NOTES
MMODE
Other Forms of MMode
Anatomical MMode
Freedom of axis
Anatomical MMode
Myocardial function,
timing of events
Curved MMode
Conventional MMode
SPECTRAL DOPPLER
The measured velocity
Doppler Formula
v cos"
!d = 2!f
c 0
!d = frequency alteration between
direction of flow.
c = sound propagation
Doppler
Tissue Doppler
Doppler Aliasing
Depends on
Depth
Velocity
Doppler frequency
16
SPECTRAL DOPPLER
NOTES
PW DOPPLER ALIASING apical
four-chamber view/PW MV
Pulsed-wave Doppler in a patient
with mitral stenosis. The maximum velocity exceeds 2.5 m/s
and exceeds the aliasing limit.
Velocity profiles are noted both
above and below the zero line.
Tissue Doppler is
angle dependent.
Information
Myocardial velocity
Strain
Displacement
Strain rate
FLOW DYNAMICS
Bernoulli Equation
The simplified Bernoulli equation permits
easy estimation of pressure gradients
P(mmHg)
from velocities.
V(m/s)
P = 4xV2
P(mmHg)
17
NOTES
FLOW DYNAMICS
Where Can You Apply the Bernoulli
Equation in the Heart?
Direct applications (gradients)
Valvular stenosis
dP/dt (contractility)
Prosthetic valves
COLOR DOPPLER
The manner of displaying
Color Encoding
away
18
+ 62 m/s
- 62 m/s
COLOR DOPPLER
NOTES
The phenomenon of
aliasing provides good
delineation of jets
(red to blue, or blue to red). The color Doppler display will show
(e.g. PISA).
turbulant/high velocity
flow green
Aliasing border
(from orange to blue)
Flow towards
the transducer higher
velocity (orange)
quantification of regurgitation in
color gain).
Depth
19
NOTES
20