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The speed of sound in tissue is determined by its density and stiffness.

Low density and high stiffness

lead to high speed of sound whereas high density and low stiffness lead to low speed of sound.
Mathematically you can calculate the speed of sound by knowing the physical values of the tissue
and solving:

Sound speed =

Tissue stiffness
Tissue density

However, ultrasound systems are designed to assume an average speed of sound in soft tissues of
1540m s-1 . In reality true soft tissue velocities vary slightly by approximately 5%. This might create
certain image distortion artifacts if the average speed of an organ is not 1540m s-1 . However, as long
as the referential velocity is the same in all other patients there will be no error of interpretation
between patients.
First of all it is important to know that among all imaging techniques ultrasound (US) has a privileged
record for safety. Hence this imaging modality has been used widely for almost four decades in
health centres all around the world.
Numerous studies have been published investigating the possible association between ultrasound
exposure and the occurrence of disease in human populations. These studies have been particularly
dedicated to determine whether the use ultrasound is safe in susceptible population. (e.g. in utero,
newborn and during childhood development).
The findings revealed that:
1. There is no evidence to suggest an association between exposure to ultrasound and birth
2. No association with childhood malignancy has been found in any study after US exposure.
3. A vast number of neurological function have been clinically assessed and so far NO
association between US exposure in utero and subsequent visual, hearing, behavioural or
cognitive impairment has been found.
To sum up, there is no verified evidence to suggest that US exposure in utero has caused an
alteration of growth and natural development (1)(2).
It is worth knowing that every time that an ultrasound examination is carried out a part of the
patient is exposed to the influence of the beam of mechanical waves. As these waves travel through
the patients body they interact with the tissue giving rise to two type of biological effects: thermal
and non-thermal effects
1. Thermal effects:
a. As the mechanical waves travel through the tissue, some of the ultrasound energy is
absorbed by the tissue and is converted to heat causing a local rise of the temperature.
This increase of temperature depends on the region of the body that is scanned and the
parameters used to perform the ultrasound. If we perform an ultrasound with the
transducer in a fixed position (e.g. pulsed Doppler study) the increase of temperature
will be fastest at the focus of the field of view. However, as time passes the regions
where the increase was highest will start to lose some of the absorbed energy. This
thermal energy will be dissipated to adjacent cooler regions by thermal conduction.
Among all tissues, bones have shown a strong ultrasound waves absorption at all

frequencies. This leads to a focal rapid increase of the temperature to its final value
since the US energy is almost completely absorbed.
b. A second consequence related with thermal effect is that the transducer itself begins to
heat up as it generates the mechanical waves. This rise of temperature will be perceived
at the contact surface between the transducer and the patients skin.
Does the rise of temperature matters?
Studies have shown that after been exposed to Doppler examination it appeared to
be unlikely that a temperature rise of more than 1.5C would occur in soft tissue. While for
bone tissue the evidence showed a temperature rise between 1.5 and 4C. However, it is
important to consider that the human body is quite capable to recover from this local
increase of temperature (3).
Besides from the fact that temperature rise is localized and normally well-tolerated
by patients safety, for more than 20 years all ultrasound manufacturers have been following
the FDA regulation that limits the energy output of the equipment. The regulation also
introduced the output display standard which are biophysical indicators (thermal index (TI)
and mechanical index (MI)) for real-time display of safety information during scanning.
2. Non-thermal effects
a. Mechanical waves might create cavitation effect in micro bubbles within the tissue.
Theoretically, bubbles with a diameter of 2m can resonate with typical diagnostic
frequencies giving rise to a rapid collapse of the bubble, high localized increase of
pressure and temperature. However, this theoretical local destructive outcome have
never been evidenced in the clinical settings.
(1) Hoskins, P., Kevin, M., Abigail, T., 2010. Diagnostic Ultrasound: Physics and Equipment, 2 ed.
(2) Salvesen, K. ., and C. Lees. "Ultrasound is not unsound, but safety is an issue." Ultrasound
in Obstetrics & Gynecology 33.5 (2009): 502-505.
(3) Shaw, A., N. M. Pay, and R. C. Preston. Assessment of the likely thermal index values for
pulsed Doppler ultrasonic equipment-Stages II and III: experimental assessment of
scanner/transducer combinations. National Physical Laboratory. Great Britain, Centre for
Mechanical and Acoustical Metrology, 1998.