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This chapter presents the basic concepts of sound the adjacent medium, so the molecules of the medi-
and ultrasound propagation and discusses the physi- um become crowded. As the source moves backward
cal principles of the Doppler effect and Doppler there is a pressure drop in the medium, so the mole-
sonography, which are essential for understanding cules now move apart. This phenomenon of alternat-
their diagnostic uses. Although this book focuses pri- ing molecular compression and rarefaction accompa-
marily on clinical utilization of the diagnostic Dop- nies the waves of sound energy as they propagate
pler technology, developing an understanding of the along the medium (Fig. 2.2). Although the molecules
basic principles is imperative for its proficient use. vibrate, they remain in their original location and are
The following is a brief introduction and is not in- not displaced. Sound travels faster in solids than in
tended to be a comprehensive treatise on the subject. liquids and faster in liquids than in gases.
For a more in-depth discussion, there are several ex- Although usually considered in a unidimensional
cellent textbooks that comprehensively examine the plane, in reality sound is transmitted in a three-di-
physics of Doppler ultrasonography [1±4]. mensional space. Sound waves from a vibratory
source or from a reflector are moving surfaces of
high and low pressures. These surfaces are called
Propagation of Sound waveforms. The shape of a waveform depends on the
shape of the source or the interface. Thus a plane
Sound is a form of mechanical energy that travels waveform emanates from a flat source and a spherical
through solid or liquid media as pressure waves waveform from a spherical source. With Doppler
(Fig. 2.1). Sound waves are generated when an object ultrasonics, the scattered waveform is spherical, as
vibrates in a medium. For example, percussion causes red blood cells (RBCs) behave as spherical sources
a drum membrane to vibrate and to generate sound during the scattering of an incident beam.
waves in the air. During vibration the forward move-
ment of the sound source causes a pressure rise in
T = 1/f
Amplitude
Distance
Fig. 2.3. Wavelength of sound. Horizontal axis represents
Fig. 2.2. Propagation of sound. Compression and rarefac- the distance and the vertical axis the magnitude of pres-
tion of the molecules in a medium associated with the sure wave deflections around the baseline. The peak-to-
propagation of a pressure wave related to sound or ultra- peak distance (k) between the consecutive pressure waves
sound transmission. Horizontal axis represents the distance; is one wavelength
vertical axis represents the magnitude of pressure wave de-
flections around the baseline. Upward deflection represents
the positive pressure changes and downward deflection of sound in tissue is known and is relatively constant,
the negative pressure changes one can determine the frequency from the wavelength
and vice versa (Table 2.1). The duration of one cycle,
or wavelength, of sound is called its period (Fig. 2.4).
Propagation Speed of Sound Period is measured in seconds and microseconds. It
is inversely related to the frequency:
The propagation speed of sound in a medium is the rate
of change of position of the sound wave in unit time in T 1=f
that medium. It is called velocity when the direction of
motion is also specified. The speed of ultrasound pro- where T is the period, and f is the frequency of
pagation in a medium is directly related to the bulk sound.
modulus of elasticity and density of the medium. A Pulsed Doppler (both spectral and color flow map-
change in transmitting frequency within the range of ping) and pulse echo imaging systems transmit ultra-
clinical usage does not alter the speed. Although speed sound waves in pulses. The number of such pulses
of sound is affected by temperature, no appreciable ef- transmitted per second is known as the pulse repeti-
fects are known in clinical applications. With diagnos- tion frequency (PRF) (Fig. 2.5). The length of one ul-
tic ultrasonography, the propagation speed informa- trasound pulse is known as the spatial pulse length
tion is used to compute the depth distance from the (Fig. 2.6). Pulse length varies according to the mode
echo return time. It is also a component of the Doppler of ultrasound. With pulsed Doppler ultrasound, the
equation that allows determination of speed of the scat- pulse length ranges from 5 to 30 cycles. In contrast,
terer from the Doppler frequency shift. The average the length is much shorter for pulsed echo imaging
propagation speed of ultrasound in soft tissues is ap- system, as they generate two to three cycles per pulse.
proximately 1,540 meters per second (m/s).
The wavelength of sound is comprised of one cycle of Frequency (MHz) Wavelength (lm)
compression and rarefaction. Therefore it is the dis- 2.0 770
tance between a pair of consecutive peaks or troughs 2.5 616
of adjacent pressure waves (Fig. 2.3). The frequency of 3.0 513
sound is the number of such cycles occurring in 1 s. 3.5 440
One cycle is called a hertz (Hz). Wavelength and fre- 4.0 385
4.5 342
quency are inversely related:
5.0 308
5.5 280
k c=f 6.0 257
6.5 236
where k represents the wavelength, c the speed of 7.0 220
sound, and f the frequency. As the propagation speed 7.5 205
a Chapter 2 Physical Principles of Doppler Ultrasonography 11
T
Amplitude
Time
Fig. 2.4. Period of sound. The duration of one wavelength
of sound is its period. Horizontal axis represents the time ±
and the vertical axis the magnitude of pressure wave de- Fig. 2.7. Pressure amplitude of a sound wave. Horizontal
flections around the baseline axis depicts distance or time. Vertical axis represents varia-
tions in the acoustic pressure. The plus and minus signs in-
dicate the positive and negative fluctuations of the pres-
sure, respectively. P, the amplitude that is the maximum
change in the pressure above or below the baseline value
represented by the horizontal line
I p2 =c
Acoustic Medium 1
Interface
Medium 2
Transmitted Beam
shadowº affects optimal imaging of structures lying lar structures. These considerations influence the
posterior to the bone. At most tissue interfaces, an choice of a transducer for a specific use. Thus for
incident beam is echoed in different directions, a pro- Doppler examinations of fetal circulation, a 5-MHz
cess known as diffuse reflection. In relation to Dop- transducer may by less efficient for obtaining ade-
pler ultrasonic reflections, however, an entirely differ- quate signals than a 2-MHz transducer.
ent phenomenon occurs, known as scattering. This
phenomenon is discussed below.
When an ultrasound beam travels with an oblique Doppler Effect
angle of incidence across an interface, the beam path
deviates and the angle of transmission differs from The Doppler effect is the phenomenon of observed
the angle of incidence (Fig. 2.10). The phenomenon is changes in the frequency of energy wave transmission
similar to refraction of light. Refractive deviation in when relative motion occurs between the source of
the beam path may compromise image quality. For wave transmission and the observer. The change in
pulsed Doppler duplex applications, where two-di- the frequency is known as the Doppler frequency
mensional gray-scale imaging is used for placing the shift, or simply the Doppler shift:
Doppler sample volume in deep vascular locations,
refraction may lead to error. However, the propaga- fd ft fr
tion speed of sound does not vary appreciably in
most soft tissues; therefore only minimal refraction where fd is the Doppler shift frequency, ft is the
occurs at most tissue interfaces. For example, an ul- transmitted frequency, and fr is the received fre-
trasound beam passing through a muscle-blood inter- quency. When the source and the observer move clos-
face at an incident angle of 308 undergoes only a er, the wavelength decreases and the frequency in-
08 47' refractive deviation [2]. creases. Conversely, when the source and the observer
Progressive decline in the pressure amplitude and move apart, the wavelength increases and the fre-
intensity of a propagating ultrasonic wave is known quency decreases. The Doppler effect is observed ir-
as attenuation. Attenuation is caused by many factors, respective of whether the source or the observer
including absorption, scattering, reflection, and wave- moves (Fig. 2.11). The principle is applicable to all
front divergence. Absorption is the phenomenon forms of wave propagation. The utility of the Doppler
whereby sound energy is converted to heat and is effect originates from the fact that the shift in fre-
therefore responsible for thermal bioeffects. Attenua- quency is proportional to the speed of movement be-
tion is also affected by the transmitting frequency of tween the source and the receiver and therefore can
a transducer: the higher the frequency, the greater be used to assess this speed. The Doppler effect is ob-
the attenuation. It limits the use of high-frequency served irrespective of whether the source or the ob-
transducers for Doppler interrogation of deep vascu- server moves.
Doppler Ultrasound
Incident Beam Reflected Beam
For sound transmission, the Doppler shift sound is of
a higher frequency when the source and the receiver
i r move closer and of a lower frequency when they re-
Acoustic Medium 1
Interface
Meduim 2
t
Transmitted Beam
Backscattering
We briefly alluded to a special category of sound re-
flection called scattering. The process of ultrasonic
scattering is analogous to scattering of light by gas
molecules and is known as Rayleigh scattering [7, 8].
Light so reflected is called Tyndall light and is re-
sponsible for the blue sky. Interestingly, it was in-
quiry into the cause of blue sky at the turn of the
century by a group of scientists, including Lord Ray-
Fig. 2.12. Doppler effect when an ultrasound beam inter- leigh and Tyndall, that led to our understanding of
rogates circulating blood. fd Doppler shift, ft transmitted this phenomenon [9]. Rayleigh scattering occurs
beam, V velocity of blood flow, c speed sound propagation
when energy waves traveling through a medium en-
in tissue, h angle of incidence between the ultrasound
beam and the direction of blood flow counter reflectors whose size is much smaller than
the wavelength of the propagating energy; a portion
of the energy is then reflected in all directions. The
cede. The phenomenon of the Doppler effect is also scattered energy wave is spherical in shape irrespec-
observed when an ultrasound beam encounters blood tive of the shape of the scatterer.
flow (Fig. 2.12). With blood circulation, millions of One characteristic of Rayleigh scattering is that
red blood cells (RBCs) act as moving scatterers of the the power, or intensity, of the scattered energy (I) is
incident ultrasound. In this circumstance the erythro- proportional to the fourth power of the frequency (f).
cytes act first as moving receivers and then as mov-
ing sources [6], forming the basis for the Doppler I f4
equation:
The frequency dependence of scattering power has
fd 2ft v=c
important consequences for selecting the appropriate
transducer frequency for Doppler applications. In-
where fd represents the Doppler frequency shift, ft the creasing the incident ultrasonic frequency immensely
frequency of the incident beam (transducer fre- amplifies the power of the reflected echoes. Thus rais-
quency), v the velocity of the scatterer in a given di- ing the transducer frequency from 3 MHz to 4 MHz
rection, and c the propagation speed of sound in the leads to fivefold augmentation of the scattered echo
medium. Note that the transmitted ultrasound under- intensity. Ironically, this increase also limits the abil-
goes double Doppler shift before returning to the re- ity of the transducer to sample deep-lying circula-
ceiving transducer, the scatterer acting first as a re- tions, as a higher frequency leads to greater attenua-
ceiver and then as a transmitter. This phenomenon tion. Obviously, one must balance these contrary ef-
accounts for the factor of 2 in the above equation. fects when selecting the optimal frequency for a spe-
If the direction of the incident beam is at an angle cific application. For example, for most fetal Doppler
(h) to the direction of blood flow, the v in the Dop- insonations via the maternal abdomen, transducers
pler equation is replaced by the component of the with a frequency range of 2±4 MHz are commonly
velocity in the direction of the flow (obtained by the used to reach the deep-lying vascular targets in the
cosine of the angle, cos h): fetus. In contrast, with a transvaginal approach,
where the transducer lies in close proximity to pelvic
fd 2ft cos h v=c structures, such as the uterine or ovarian arteries, the
use of a higher frequency (e.g., 5 MHz) increases the
To determine the velocity of the scatterer, the equa- Doppler sensitivity without significant attenuation of
tion can be rewritten as follows: the beam.
When a propagating ultrasonic wave encounters an
v fd c=2ft cos h acoustic interface, reflection occurs. Scattering takes
a Chapter 2 Physical Principles of Doppler Ultrasonography 15
place when the size of the interface is smaller than the scattering power becomes maximum at a hemato-
the incident sound wavelength. Such an interface is crit range of 25%±30% [10]. At higher hematocrit
known as a point target. In regard to Doppler shift, values, the scattering behavior of blood becomes
the scatterer is significantly smaller than the wave- more complex as the RBCs become too crowded and
length and is in motion. The Doppler-shifted ultra- can no longer be treated as randomly distributed
sound reflecting from such a moving scatter propa- scatterers.
gates in all directions (Fig. 2.13). Obviously, it also In addition to hematocrit, scattering is also af-
reaches any receiving transducer at the source of fected by the state of red cell aggregation. Spatial var-
transmission. The process of scattered ultrasound re- iations in the flow field can result in changes in the
turning to the source-receiver is called backscattering. variance of red cell packing and backscattering cross
It is well accepted that the primary sources of scat- section which will influence the Doppler power at a
tering in blood are the circulating RBCs [10]. These given frequency [11]. In this circumstance, the mean
cells are so numerous that the contribution of the Doppler frequency will not necessarily be propor-
other formed elements of blood, such as white blood tional to the mean flow through the sample volume
cells and platelets, to scattering ultrasound is inconse- and may affect volumetric flow quantification and the
quential. An RBC has a biconcave discoid shape with power mode display of color Doppler. Scattering is
a mean diameter of 7.2 lm and a mean thickness of also dependent on certain characteristics of the trans-
2.2 lm. In comparison, the wavelength of Doppler mitted ultrasound including the frequency and the
ultrasound for diagnostic applications varies from angle of insonation [12]. The phenomenon is a com-
1540 lm to 154 lm, corresponding to 1±10 MHz plex subject and a comprehensive review is beyond
transducer frequency. As is apparent, the RBCs are the scope of this chapter.
several magnitudes smaller than the wavelengths, so
they can be regarded as point targets. In reality, how-
ever, circulating erythrocytes do not act as discrete Magnitude of Doppler Shift
scatterers but as volumes of randomly distributed
point targets. The number of RBCs in such a scatter- Relative velocities of the sound and the scatterers are
ing volume fluctuates around a mean value and important determinants of the magnitude of the Dop-
causes fluctuations in the scattering power. Turbulent pler frequency shift. In regard to blood flow, the
blood flow increases fluctuations in the RBC concen- speed of RBCs is significantly less than the speed of
tration and is therefore associated with increases in sound in a biologic medium. Consequently, the Dop-
the scattering power and consequently the power of pler shift is much smaller than the incident ultrasonic
the Doppler shift signal [10]. In regard to whole frequency. Assuming a sound propagation speed of
blood, it has been experimentally demonstrated that 1,540 m/s in soft tissues, the Doppler shift for a given
blood flow speed and the transducer frequency can
be calculated from the Doppler equation. This exer-
cise is illustrated in Table 2.2, which lists the Doppler
frequency shifts for most obstetric transducer fre-
quencies (2±7 MHz) at blood flow speeds of 25, 50,
and 75 cm/s. As is evident, the frequency shifts are
approximately 1/1,000 their corresponding transducer
frequencies. Furthermore, the Doppler shifted sound
at 25 at 50 at 75
cm/s cm/s cm/s
is well within the limits of human hearing as its fre- occurs at the interface between blood and the vessel
quency is in the kilohertz range. wall, and the Doppler sensitivity becomes seriously
compromised. Thus the lower limit of the angle for
desirable Doppler interrogation is 308. In contrast to
Angle Dependence of Doppler Shift general vascular applications, the phenomenon of loss
of sensitivity with a low angle is not observed in car-
It is evident from the Doppler equation that the diac Doppler insonations. With fetal and postnatal
greatest frequency shift occurs when the transmitted Doppler echocardiography, optimal Doppler wave-
ultrasound beam is parallel to the flow axis; and forms are obtained when the incident beam is aligned
when the beam intersects the vessel, it is the compo- with the vessel axis in pulmonic or aortic outflow
nent or the vector of the RBC velocity along the beam tracts. Apparently, complex cardiac anatomy does not
path that contributes to the Doppler effect. This vec- reflect the incident beam the same way as do periph-
tor is determined from the cosine of the beam-vessel eral vessel walls.
angle and is incorporated into the Doppler equation As is apparent from the Doppler equation, the esti-
(see above). As the angle increases, the frequency mation of blood flow speed from the Doppler shift re-
shift proportionately decreases. When the angle ex- quires a reliable measurement of the angle of insona-
ceeds 608, the fall in the Doppler shifted frequency tion. Although the Doppler shift is angle-dependent,
exceeds 50%. When the angle reaches 908, the Dop- flow speed calculated from the Doppler shift is not af-
pler shift is virtually nonexistent. However, minimal fected, in theory, by the magnitude of the angle. This
Doppler signals may still be generated because of situation, however, assumes ideal circumstances ±
beam divergence and nonuniform flow in the vessel. such as insonation of a uniform flow in a straight
As the angle of insonation decreases, the frequency vessel of uniform diameter ± which one does not en-
shift increases; and maximum Doppler shift is ob- counter often in reality. Therefore the desirable angle
tained, at least in theory, when the angle becomes range for flow speed estimation remains, as indicated
zero with the ultrasound beam being parallel to the above, 308±608. Measurement of the angle in a duplex
flow axis. In reality, however, as the angle drops be- Doppler device is usually accomplished with apparent
low 308, significant reflection of the incident beam ease. The operator uses the two-dimensional image to