Biomedical Engineering Module V S5-ECE, 2017

Syllabus
Medical Imaging systems (Basic Principle only): X-ray imaging - Properties and production
of X-rays, X-ray machine, applications of X-rays in medicine. Computed Tomography:
Principle, image reconstruction, scanning system and applications. Ultrasonic imaging
systems: Basic pulse echo system, propagation of ultrasonic through tissues and reflections,
display types, A-Scan, B-Scan, M-Scan, applications, real-time ultrasonic imaging systems
and probes.

I. X-ray imaging:
Equipments that replace certain critical physiological functionalities, or provide needed pain
therapy.

Properties of X-rays

 The X-rays in the medical diagnostic region have wavelength of the order of 10-l0m. They
propagate with a speed of 3 x 1010 cm/ s and are unaffected by electric and magnetic fields.
 They have short wavelength and extremely high energy.
 X-rays are able to penetrate through materials which readily absorb and reflect visible light.
 X-rays are absorbed when passing through matter. The extent of absorption depends upon the
density of the matter.
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X-rays produce secondary radiation in all matter through which they pass. This secondary

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radiation is composed of scattered radiation, characteristic radiation and electrons.
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X-rays produce ionization in gases and influence the electric properties of liquids and solids.
The ionizing property is made use of in the construction of radiation-measuring instruments.
X-rays also produce fluorescence in certain materials to help them emit light. Fluoroscopic
screens and intensifying screens have been constructed on the basis of this property. X-rays
affect photographic film in the same way as ordinary visible light.

Production of X-rays

 X-rays are produced whenever electrons collide at very high speed with matter and are thus
suddenly stopped. The energy possessed by the electrons appears from the site of the
collision as a parcel of energy in the form of highly penetrating electromagnetic waves (X-
rays) of many different wavelengths, which together form a continuous spectrum.
 X-rays are produced specially constructed glass tube, which basically comprises,
(i) a source for the production electrons,
(ii) a energy source to accelerate the electrons,
(iii) a free electron path,
(iv) a mean t focusing the electron beam and
(v) a device to stop the electrons.

Stationary mode tubes and rotating anode tubes are the two main types of X-ray tubes:

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Stationary Anode Tube

 Fig. shows the basic components of a stationary anode X-ray tube. The normal tube is a
vacuum diode in which electrons are generated by thermionic emission from the filament of
the tube.
 The electron stream is electrostatically focused on a target on the anode by means of a
suitably shaped cathode cup.
 The kinetic energy of the electrons impinging on the target is converted into X-rays. Most
electrons emitted by the hot element become current carriers across the tube.

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Some X-ray tubes function as a triode with a bias voltage applied between the filament and
the cathode cup.
 The cathode block, which contains the filament, is usually made from nickel or from a form
of stainless steel. The filament is a closely wound helix of tungsten wire, about 0.2 mm thick,
the helix diameter being about 1.0-1.5 mm.
 The target is normally comprised of a small tablet of tungsten about 15mm wide, 20mm long
and 3mm thick soldered into a block of copper. Tungsten is chosen since it com bines a high
atomic number (74)—making it comparatively efficient in the production of X-rays. It has a
high melting point (3400°C) enabling it to withstand the heavy thermal loads.
 Copper being an excellent thermal conductor, performs the vital fu nction of carrying the heat
rapidly away from the tungsten target. The heat flows through the anode to the outside of the
tube, where it is normally removed by convection. Generally, an oil environment is provided
for convection current cooling.
 In addition, the electrodes have open high voltages on them and must be shielded. The tube
will emit X-rays in all directions and protection needs to be provided except where the useful
beam emerges from the tube.
 In order to contain the cooling oil and meet the above-mentioned requirements, a metal
container is provided for completely surrounding the tube. Such a container is known as a
‘shield’.

Rotating Anode Tube

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The construction of a rotating-anode x-ray tube

 The filament is constructed from a spiral of tungsten wire (melting point 3410 °C), which is
set in a nickel block. This block supports the filament and is shaped to create an electric field
that focuses the electrons into a slit beam.
 The anode has a bevelled edge, which is at a steep angle to the direction of the electron beam.
The exit window accepts x-rays that are approximately at right angles to the electron beam so
that the x-ray source as viewed from the receptor appears to be approximately square even
though the electron beam impinging on the target is slit-shaped.
 The choice of the anode angle will depend upon the application, with the angle being varied

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according to the requirements of field and focal spot sizes and tube output. For general-

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purpose units, an angle of about 17° is appropriate.
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Most of the energy in the electron beam is deposited in the target in the form of heat. The use

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of a slit source of electrons helps by spreading out the target area and this idea can be
extended by using a rotating anode, so that the electron beam impinges on the bevelled edge
of a rotating disc and the target area is spread out over the periphery of the disc.
 A rotation speed of about 3000 RPM and an anode diameter of 10 cm are used in general-
purpose units.

X-RAY MACHINE

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Block diagram of basic x-ray machine.

Parts

1. X-Ray tube 2. High Tension Supply 3. Collimator

4. Patient Table. 5. Grid. 6. Radiographic film

1. X ray Tube – For details refer stationary anode tube and rotating anode tube given above.

It is an important component of x-ray machine which is inaccessible as it is contained in a

protective housing. It is a vacuum tube.
There are two primary parts.
1) the cathode
2) the Anode.

2. Operating Console

It is an apparatus in X-Ray machine that allows to control the x-ray tube current and voltage.
The Console Controls are: -

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1. Voltage compensator. 2. kV Meter. 3. mA Meter. 4. Exposure time.

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1. Voltage Compensator

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Because of variations in power distribution to the hospital and in power consumption by the
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various sections of the hospital, the voltage to the x-ray unit may vary by 5%, which will
result in large variations in x-ray output.

High Tension Supply with Rectifier

Power supply system consists of Autotransformer

 The power supplied to x-ray machine is delivered to a special transformer called an

Autotransformer. It works on the principle of electromagnetic induction but is very different
from conventional transformer.
 It has only one winding and one core. The single winding has number of connections, or
electric taps. The purpose to use the Autotransformer is to overcome induction losses. Its
value ranges from 0 to 400V.
 Used for producing high voltage which is applied to the tube’s anode and cathode and
comprises a high voltage step-up transformer followed by a recifier.

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Self Rectification Circuit for High Voltage Generation

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The high voltage is produced using a step-up transformer whose primary is connected to
auto-transformer. The secondary of the H.T. transformer can be directly connected to the
anode of the x-ray tube which will conduct only during the half cycles when the cathode is
negative with respect to anode or target.

 The current through the tube follow, the H.T. pathway and is measured by a mA meter.
 A kV selector switch enables to change voltage between exposures. The voltage is measured
with the help of a kV meter.
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The exposure switch controls the timer and thus the duration of the application of kV.

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 To compensate for mains voltage variations, a voltage compensator is used in the circuit.
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The filament is heated with 6 to 12 V of ac supply at a current of 3 to 5 amperes. The
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filament temperature determines the tube current or mA, and, therefore, the filament
temperature control has an attached mA selector. The filament current is controlled by using,
in the primary side of the filament transformer, a variable choke or a rheostat. The rheostat
provides a stepwise control of mA and is most commonly used in modem machines.
 These machines have maximum tube currents of about 20 mA and a voltage of about 100 kV.
When self-rectification is used, it is necessary to use a parallel combination of a diode and
resistance, in series with the primary of the H.T. transformer for suppressing higher inverse
voltage likely to appear during the non-conducting half-cycle of the x-ray tube. This helps to
reduce the cost and complexity of the x-ray machines.
 A preferred method of providing high voltage dc to the anode of the x-ray tube is by using a
bridge rectifier using four valve tubes or solid state rectifiers. This results in a much more
efficient system than with half wave of self-rectification methods.
 The kV meter is connected across primary of the H.T. transformer. It actually measures volts
whereas it is calibrated in kV by using an appropriate multiplication factor of turns-ratio of
the transformer.
 In order to obtain the load voltage which varies with the tube current, a suitable kV meter
compensation is provided in the circuit. The kV meter compensator is ganged to the mA
selector mechanically. Therefore, the mA is selected first and the kV setting is made
afterwards during operation of the machine.

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 Moving coil meters are used for making current I (mA) measurements, for shorter exposures,
a mAs meter is used which measures the product I of mA and time in seconds.
 The exposure time is generally controlled by using some form of timing arrangement coupled
with a contactor which supplies the H.T. to the anode of the x-ray tube only during that time.
 Collimator: The Collimator is attached to the x-ray tube below the glass window where the
useful beam is emitted. Lead shutters are used to restrict the beam. Its purpose is to minimize
field of view, to avoid un necessary exposure by using lead plates.
 Grid: By virtue of function and material, collimator and grid are same but they have different
location. It is made up of lead. It is located just after patient. It is used to destroy scattered
radiation from the body.
 Radiographic Film: Two types of x-ray photon are responsible for density, contrast and
image on a radiograph. Those that pass through the patient without interacting and those that
are scattered in the patient through compton interaction. Together these x-rays that exit from
the patient and intersect the film are called Remnant x-rays.

APPLICATIONS OF X-RAYS IN MEDICINE

1. X-rays are used in medicine for medical analysis. Dentists use them to find complications,
cavities and impacted teeth. Soft body tissues are transparent to the waves. Bones and teeth
block the rays and show up as white on the black background.

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2. A mammogram:

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(Also called a mammography exam) is a safe, low-dose x-ray of the breast. A high-quality

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mammogram is the most effective tool for detecting breast cancer early. Early detection of
breast cancer may allow more treatment options. Using a low-dose x-ray, the mammogram
machine takes a snapshot of the inside of a woman’s breast. The machine holds and
compresses the breasts so that images at different angles can be taken. Doctors and nurses
examine these snapshots, looking for signs of abnormalities such as lumps, which could be
tumors.

3. Skeletal system:
A standard radiograph is usually the first course of action when a patient is suffering from a
suspected bone injury. The excellent natural contrast provided by bone produces clear images
with good resolution. Two views at right angles to each other are generally required and can
lead to the diagnosis of fractures, dislocations, spinal injuries and so on. Other abnormalities,
ranging from tumours and cysts in the spine to arthritis (figure 2.23), can also indicated.

4. The chest:

A standard chest X-ray is the commonest means of detecting lung cancer and other
abnormalities (figure 2.24). Difficulties sometimes arise due to liie inevitable obstruction of
the heart.

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5. Circulatory system:
An artificial contrast medium, typically an organic iodine compound, is injected into the
blood vessel to be examined. The structure and effective flow diameter of both arteries and
veins can be examined, allowing the diagnosis of blood vessel blockages and heart disease

6. Dental studies:
Most dental practices now have small X-ray units, to investigate problems with the
overcrowding or uneven growth of teeth, particularly in juveniles, or with the growth of
wisdom teeth. Surgery or orthodontal treatment may then be recommended.

7. Foreign bodies:
It is amazing what people, particularly children, will swallow! A standard radiograph can
help to identify the shape and position of such objects to assist with their removal.

COMPUTED TOMOGRAPY

Limitations of X-rays

1. The super-imposition of the three-dimensional information onto a single plane makes

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diagnosis confusing and often difficult.

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2. The photographic film usually used for making radiographs has a limited dynamic range
and, therefore, only objects that have large variations in X-ray absorption relative to their

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surroundings will cause sufficient contrast differences on the film to be distinguished by the
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eye. Thus, whilst details of bony structures can be clearly seen, it is difficult to discern the
shape and composition of soft tissue organs accurately.
3. In such situations, growths and abnormalities within tissue only show a very small contrast
difference on the film and consequently, it is extremely difficult to detect them, even after
using various injected contrast media.
4. The problem becomes even more serious while carrying out studies of the brain due to its
overall shielding of the soft tissue by the dense bone of the skull.

Basic Principle of CT

 In computed tomography (CT), the picture is made by viewing the patient via X-ray imaging
from numerous angles, by mathematically reconstructing the detailed structures and
displaying the reconstructed image on a video monitor.
 Computed tomography differs from conventional X-ray techniques in that the pictures
displayed are not photographs but are reconstructed from a large number of absorption
profiles taken at regular angular intervals around a slice, with each profile being made up
from a parallel set of absorption values through the object.
 In computed tomography, X-rays from a finely collimated source arc made to pass through a
slice of the object or patient from a variety of directions. For directions along which the path

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length through-tissue is longer, fewer X-rays are transmitted as compared to directions where
there is less tissue attenuating the X-ray beam. In addition to the length of the tissue
traversed, structures in the patient such as bone may attenuate X-rays more than a similar
volume of less dense soft tissue.
 In principle, computed tomography involves the determination of attenuation characteristics
for each small volume of tissue in the patient slice, which constitute the transmitted radiation
intensity recorded from various irradiation directions. It is these calculated tissue attenuation
characteristics that actually compose the CT image.

If a slice of heterogeneous tissue is irradiated given below, and we divide the slice into
volume elements or voxels with each voxel having its own attenuation coefficient, it is
obvious that the sum of the voxel attenuation coefficients for each X-ray beam direction can
be determined from the experimentally measured beam intensities for a given voxel width.
However, each individual voxel attenuation coefficient remains unknown. Computed

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tomography uses the knowledge of the attenuation coefficient sums derived from X-ray

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intensity measurements made at all the various irradiation directions to calculate the
attenuation coefficients of each individual voxel to form the CT image.

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X-rays incident on patient from different directions. They are attenuated by different
amounts, as indicated by the different transmitted X-ray intensities

Block Diagram of the CT System

Figure below shows a block diagram of the system. The X-ray source and detectors are
mounted opposite each other in a rigid gantry with the patient lying in between, and by
moving one or both of these around and across the relevant sections, which is how the
measurements are made.

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 The X-ray tube and the detector are rigidly coupled to each other. The system executes
translational and rotational movement and transradiates the patient from various angular
projections. With the aid of collimators, pencil thin beam of X-ray is produced.
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A detector converts the X-radiation into an electrical signal. Measuring electronics then

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amplify the electrical signals and convert them into digital values. A computer then processes
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these values and computes them into a matrix-line density distribution pattern which is

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reproduced on a video monitor as a pattern of gray shade.
In one system which employs 18 traverses in the 20s scanning cycle, 324,000 (18 x 30 x 600)
X-ray transmission readings arc taken and stored by the computer. These arc obtained by
integrating the outputs of the 30 detectors with approximately 600 position pulses.
 The position pulses are derived from a glass graticule that lies between a light emitting diode
and photo-diode assembly that moves with the detectors. The detectors arc usually sodium-
iodide crystals, which are thallium-doped to prevent an after-glow. The detectors absorb the
X-ray photons and emit the energy as visible light. This is converted to electrons by a photo-
multiplier tube and then amplified. Analog outputs from these tubes go through signal
conditioning circuitry that amplifies, clips and shapes the signals.
 A relatively simple analog-to-digital converter then prepares the signals for the computer.
Simultaneously, a separate reference detector continuously measures the intensity of the
primary X-ray beam .The set of readings thus produced enables the computer to compensate
for fluctuations of X-ray intensity. Also, the reference readings taken at the end of each
traverse are used to continually calibrate the detection system and the necessary correction is
carried out.
 After the initial pre-processing, the final image is put onto the system disc. This allows for
direct viewing on the operator’s console. The picture is reconstructed in either a 320 x 320
matrix of 0.73 mm squares giving higher spatial resolution or in a 160x 160 matrix of 1.5 mm

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squares which results in higher precision, lower noise image and better discrimination
between tissues of similar density.
 Each picture clement that makes up the image matrix has a CT number, say between -1000
and + 1000, and therefore, takes up one computer word. A complete picture occupies
approximately 100 K words, and u pto eight such pictures can be stored on the system disc.
There is a precise linear relationship between the CT numbers and the actual X-ray
absorption values, and the scale is defined by air at -1000 and by water at 0.

Image Reconstruction
The formation of a CT image is a distinct three phase process.

1. The scanning phase produces data, but not an image.

2. The reconstruction phase processes the acquired data and forms a digital image.
3. Digital-to analog conversion phase: The visible and displayed analog image (shades of
gray) is produced by the digital-to analog conversion phase.

1. The scanning phase

During the scanning phase a fan-shaped x-ray

beam is scanned around the body. The amount
of x-radiation that penetrates the body along
each individual ray (pathway) through the body
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is measured by the detectors that intercept the

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x-ray beam after it passes through the body.
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The projection of the fan-shaped x-ray
beam from one specific x-ray tube focal spot
position produces one view. Many
views projected from around the patient's body
are required in order to acquire the necessary
data to reconstruct an image.Each view produces one "profile" or line of data as shown here.
The complete scan produces a complete data set that contains sufficient information for
the reconstruction of an image. In principle, one scan produces data for one slice image.

2. Image Reconstruction Phase

Image reconstruction is the phase in which the scan data set is processed to produce an
image. The image is digital and consist of a matrix of pixels.

Filtered back projection is the reconstruction method used in CT.

"Filtered" refers to the use of the digital image processing algorithms that are used to improve
image quality or change certain image quality characteristics, such as detail and noise.

"Back projection" is the actual process used to produce or "reconstruct" the image.

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Back projection Principle

We start with one scan view through a body section

(like a head) that contains two objects. As we know,
the data produced is not a complete image, but
a profile of the x-ray attenuation by the objects.

Let's now take this profile and attempt to draw an

image by "back projecting" the profile onto our image

surface.

We have now rotated the x-ray beam around the

body by 900 and obtained another view. If we
now back project this profile onto our image area we
see the beginnings of an image showing the two
object. Two views does not give us a high-quality
image. Several hundred views are used to produce
clinical CT images. A part of the reconstruction
process is the calculation of CT number values for
each image pixel.

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Image Reconstruction Computer, used in CT scanners.

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This method enables pictures to be reconstructed within a few seconds. Figure shows a block
diagram image reconstruction computer, used in CT scanners.

SCANNING SYSTEM

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 The purpose of the scanning system is to acquire enough information to reconstruct a picture
for an accurate diagnosis. A sufficient number of independent readings must be taken to
allow picture reconstruction with the required spatial resolution and density discrimination
for diagnostic purposes. The readings are taken in the form of ‘profiles’.
 When a plane parallel X-ray beam is passing through a required section, a profile is defined
as the intensity of the emergent beam plotted along a line perpendicular to the X-ray beam.
This profile represents a plot of the total absorption along each of the parallel X-ray beams. It
thus follows that the higher the number of profiles obtained, the better is the resulting picture.

Types of Scanning Systems

1. First Generation—Parallel Beam Geometry: In the

basic scanning process, a collimated X-ray beam passes
through the body and its attenuation is detected by a
sensor that moves on a gantry along with the X-ray tube.
The tube and detector move in a straight line, sampling
the data 180 times. At the end of the travel, a 1° tilt is
made and a new linear scan begins. This assembly travels
180°around the patient’s position. This arrangement is
known as Traverse and Index' and was used in the

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earliest commercial system. This procedure results in 32,400 independent measurements of

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attenuation, which are sufficient for the systems computer to produce an image. Obviously,

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this is a fairly slow procedure and requires a typical scan time of 5 minutes. It is essential for

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the patient to keep still during the entire scan period and for this reason, the early scanners
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were limited in their use to only brain studies.
2. Second Generation—Fan Beam, Multiple Detectors: An
improved version of the traverse-index arrangement
consists in using a bank of detectors and a fan beam of X-
rays. This system effectively takes several profiles with
each traverse and thus permits greater index angles. For
example, by using a 10° fan beam, it is possible to take 10
profiles, at 1° intervals, with each traverse and then index
through 10° before taking the next set of profiles.
Therefore, a fu II set of 180 profiles can be obtained with
18 traverses. This method has permitted a reduction in the
scan time, and at the rate of approximately 1 s for each traverse, it has led to the systems
operating in the 18-20 s range.
3. Third Generation—Fan Beam, Rotating
Detectors: The main obstacle for a further
increase in speed with the conventional
computer tomographs arises from the
mechanically unfavorable multiple alterations
between the translational and rotational

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movement of the measuring system. But using a fan-shaped beam and an array of detectors,
larger steps can be taken and the scanning process speeded up linear scanning movement can
be avoided by using a sufficiently wide fan-shaped X-ray beam which encompasses the
whole object cross-section, and a multiple detector system mechanically tied to the tube
which permits a simultaneous measurement of the whole absorption profile in one projection
direction (Fig. 20.6(c)). Also, on account of the largeness of the measuring system consisting
of X-ray tube and detectors, the rotational movement must not be stepwise but continuous.

4. Ultrafast Electron Beam CT Scanner

Comparison of Electron Beam Tomography and conventional CT

Electron Beam Tomography Conventional CT
In this electron beam sweeps back and In this X ray tube and X ray detector are
forth through a magnetic field. The mounted across each other on a circular
impact of electron beam on a semi frame and rotate around the patient.
circular tungsten array underneath the
patient generates X-rays and the X ray
detectors are mounted on a semi circular
array above the patient.
Light weight Heavy moving parts weighing 250 kg
Takes only 50ms with electron beam Takes 1 sec or more to take all the
tomography. snapshots

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Schematic of ultrafast electron beam CT scanner

 The detector array consists of two continuous ranges of 216° with 432 channels each.
Luminascent crystals coupled to silicon photo-diodes are used.
 The scanning electron beam emitted by an electron gun is accelerated by 130-140 kV,
electromagnetically focused and deflected over a target in a typical time of 50-100 ms.
 It was originally designed for cardiac examinations. The unit was equipped for this purpose
with four anode rings and two detector rings which enabled eight contiguous slices, an area of
approximately 8x8 mm. to be scanned without movement of the patient.
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5. Spiral /Helical Scanning. This is a scanning technique in which the X-ray tube rotates
continuously around the patient while the patient is continuously translated through the fan
beam. The focal spot therefore, traces a helix around the patient. The projection data thus
obtained allow for the reconstruction of multiple contiguous images. This operation is often
referred to as helix, spiral, volume, or three-dimensional CT scanning. This technique has
been developed for acquiring images with faster scan times and to obtain fast multiple scans
for three-dimensional imaging to obtain and evaluate the Volume at different locations.

Figure illustrates the spiral scanning technique, which causes the focal spot to follow a spiral
path around the patient. Multiple images are acquired while the patient is moved through the

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gantry in a smooth continuous motion rather than stopping for each image. The projection

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data for multiple images covering a volume of the patient can be acquired in a single breath

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hold at rates of approximately one slice per second. The reconstruction algorithms are more

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complex because they need to account for the spiral or helical path traversed by the X-ray
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source around the patient (Kalender,1993).

Detectors used in CT:

 For a good image quality, it is important to have a stable system response and in that,
detectors play a significant role. The detectors used in CT systems must have a high
overall efficiency in order to minimize the patient radiation dose, have large dynamic
range, he very stable with time and insensitive to temperature variations within the
gantry.
 Figure shows the three types of detectors commonly used in CT scanners. Fan-beam
rotational scanners mostly employ xenon gas ionization detectors. The schematic
diagram of the detector shows that X-rays enter the detector through a thin aluminium
window. The aluminium window is a part of a chamber that holds the xenon gas,
which fills the entire chamber. Only one gas volume is present so that all detector
elements arc under identical conditions of pressure and gas purity.

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Processing System
A typical data acquisition system is shown in Fig. It
consists of precision pre-amplifiers, current to
voltage convertor, analog integrators, multiplexers
and analog-to-digital convertors. Data transfer rates
of the order of 10 Mbytes/s are required in some
scanners. This can be accomplished with a direct
connection for systems having a fixed detector
array. The third generation slip ring systems make
use of optical transmitters on the rotating gantry to
send data to fixed optical receivers.

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Applications of CT
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1. Unlike other medical imaging techniques, such as conventional x-ray imaging (radiography),
CT enables direct imaging and differentiation of soft tissue structures, such as liver, lung
tissue, and fat.
2. CT is especially useful in searching for large space occupying lesions, tumors and metastasis
and can not only reveal their presence, but also the size, spatial location and extent of a
tumor.
3. CT imaging of the head and brain can detect tumors, show blood clots and blood vessel
defects, show enlarged ventricles (caused by a build up of cerebrospinal fluid) and image
other abnormalities such as those of the nerves or muscles of the eye.

4. Due to the short scan times of 500 milliseconds to a few seconds, CT can be used for all
anatomic regions, including those susceptible to patient motion and breathing. For
example, in the thorax CT can be used for visualization of nodular structures, infiltrations
of fluid, fibrosis (for example from asbestos fibers), and effusions (filling of an air space
with fluid).

5. CT has been the basis for interventional work like CT guided biopsy and minimally
invasive therapy. CT images are also used as basis for planning radiotherapy cancer
treatment. CT is also often used to follow the course of cancer treatment to determine how
the tumor is responding to treatment.

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6. CT imaging provides both good soft tissue resolution (contrast) as well as high spatial
resolution. This enables the use of CT in orthopedic medicine and imaging of bony
structures including prolapses (protrusion) of vertebral discs, imaging of complex joints
like the shoulder or hip as a functional unit and fractures, especially those affecting the
spine. The image postprocessing capabilities of CT - like multiplanar reconstructions and
3-dimensional display (3D) - further enhance the value of CT imaging for surgeons. For
instance, 3-D CT is an invaluable tool for surgical reconstruction following facial trauma.

ULTRASONIC IMAGING SYSTEMS

 The term ultrasound refers to acoustical waves above the range of human hearing
(frequencies higher than 20.000 Hz).
 Medical ultrasound systems operate at frequencies of up to 10 MHz or more.
 An ultrasonic wave is acoustical; i.e., it is a mechanical wave in a gaseous, liquid, or solid
medium. Such mechanical waves consists of alternating areas of higher and lower pressures,
called compression and rarefaction zones, respectively.
 Ultrasonic imaging is used in medicine, engineering, geology, and other scientific areas.
Radio signals are electromagnetic waves, while medical ultrasound signals are acoustical.

Comparison of Ultrasound and Radio Waves

Ultrasound Waves Electromagnetic Waves

. I N
1. The acoustical signal requires a medium 1. Electromagnetic signal can propagate in

S
OTE
in which to propagate. outer space, where no known medium
exists.

T U N
If an alternating current (ac) oscillation of, But if that same 2500 kHz ac signal were
K
say, 2500 kHz, were connected to an applied to an ultrasound transducer, then an
appropriate antenna, then an acoustical signal would be launched.
electromagnetic (radio) wave would be
launched.

Properties of Ultrasound and X-rays

1. Ultrasound rays are Non-invasive, While X-rays are invasive.

2. Ultrasound rays are Externally applied and non-traumatic, also apparently safe at the
acoustical intensities. While X-rays only respond to atomic weight differences and often
require the injection of a more dense contrast medium for visualization of non-bony tissues.
3. Diagnostic ultrasound is applied for obtaining images of almost the entire range of internal
organs in the abdomen
4. These include the kidney, liver, spleen, pancreas, bladder, major blood vessels and of
course, the foetus during pregnancy.
5. It has also been usefully employed to present pictures of the thyroid gland, the eyes, the
breasts and a variety of other superficial structures.
6. In a number of medically meaningful cases, ultrasonic diagnostics has made possible the
detection of cysts, tumours or cancer in these organs.

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7. The main limitation of ultrasound is that it is almost completely reflected at boundaries

with gas and is a serious restriction in investigation of and through gas-containing structures.
8. Ultrasonic waves are sound waves associated with frequencies above the audible range and
generally extend upward from 20 kHz.

Characteristics

1. Ultrasonic waves can be easily focused, i.e., they are directional and beams can be
obtained with very little spreading.
• They are inaudible and are suitable for applications where it is not advantageous
to employ audible frequencies.
• By using high frequency ultrasonic waves which are associated with shorter
wavelengths, it is possible to investigate the properties of very small structures.
• Information obtained by ultrasound, particularly in dynamic studies, cannot be
acquired by any other more convenient technique.

Use of ultrasound in Medical Field

 The use of ultrasound in the medical field can be divided into two major areas: the


therapeutic and the diagnostic.

S . I N
OTE
The major difference between the two applications is the ultrasonic power level at which the

N
equipment operates.

K T U
In therapeutic applications, the systems operate at ultrasonic power levels of up to several
watts per square centimeter while the diagnostic equipment operates at power levels of well
below 100 in W/ cm'.
 The therapeutic equipment is designed to agitate the tissue to the level where thermal heating
occurs in the tissue, and experimentally has been found to be quite successful in its effects for
the treatment of muscular ailments such as lumbago.
 For diagnostic purposes, on the other hand, as long as a sufficient amount of signal has
returned for electronic processing, no additional energy is necessary. Therefore, considerably
lower ultrasonic power levels are employed for diagnostic applications.

BASIC PULSE ECHO SYSTEM

The basic layout of the apparatus based on this principle is shown in Fig. given below.

 The pulse-echo technique, basically, consists in transmitting a train of short duration

ultrasonic pulses into the body and detecting the energy reflected by a surface or
boundary separating two media of different specific acoustic impedances.
 With this technique, the presence of a discontinuity can be conveniently established
and its position located if the velocity of travel of ultrasound in the medium is known.

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Also, it is possible to determine the magnitude of discontinuity and to assess its

physical size.

Basic Principle
 The transmitter generates a train of short duration pulses at a repetition frequency determined
by the PRF generator.
 These are converted in to corresponding pulses of ultrasonic waves by a piezoelectric crystal
acting as the transmitting transducer.
S . I N


T U N OTE
The echoes from the target or discontinuity are picked up by the same transducer and
amplified suitably for display on a cathode ray tube.

K
The X plates of the CRT are driven by the time base which starts at the instant when the
transmitter radiates a pulse.
 In this way, the position of the echo along the trace is proportional to the time taken for a
pulse to travel from the transmitter to the discontinuity and back again. Knowing the velocity
of ultrasonic waves and the speed of the horizontal movement of trace on the CRT, the
distance of the target from the transmitting end can be estimated.

1. Transducer
 The transducer consists of a piezo-electric crystal which generates and detects ultrasonic
pulses.
 The piezo-electric materials generally used are barium titanate and lead zirconate titanate.
 When the transducer is excited at its resonance frequency, it will continue to vibrate
mechanically for some time after the electrical signal ceases. This effect is known as 'after
ringing' and destroys the precision with which the emission or detection of a signal can be
timed. To reduce it, the transducer must have a good transient response and consequently a
low Q is desirable. To achieve this, the transducers are normally damped.
 The probes are designed to achieve the highest sensitivity and penetration, optimum focal
characteristics and the best possible resolution. This requires that the acoustic energy be
transmitted efficiently into the patient.

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2. Pulse Repetition Frequency Generator

 This unit produces a train of pulses which control the sequence of events in the rest of the
equipment. The PRF is usually kept between 500 Hz to 3 kHz.
 Oscillator or some form of the astable multi-vibrator can be used as the PRF Generator.
 The width of the output pulse from the PRF generator should be very small, preferably of the
order of a micro-second, to generate short duration ultrasonic pulse.
 Generally astable circuit is used to generate train of pulses with the required frequency and
then to use them to trigger a mono-stable multi-vibrator which produces pulses of the
required width. With the short pulse duration and the repetition rate of 1 kHz, only a few
micro-seconds are occupied by the emission of the pulse, and the transducer is free to act as a
receiver for the remainder of the time.

3. Transmitter
The transmiter is driven by a pulse from the PRF generator and is made to trigger an SCR
circuit which discharges capacitor through the piezo-electric crystal in the probe to generate
an ultrasonic signal. The circuit typically employed is shown in Fig. 23.7.

S . I N
T U N OTE

K
Circuit diagram of a transmitter used in pulse-echo application
Under normal conditions, the SCR is non-conducting. The capacitor C, can charge through
the resistance R to the +V potential.
 If a short triggering positive pulse is applied to the gate of the SCR. it will fire and conduct
for a short time. Consequently, the voltage at ‘A’ will fall rapidly resulting in a short
duration, high voltage pulse at ‘B*.
 This pulse appears across the crystal which generates short duration ultrasonic pulse. For
producing a pulse with a very short duration it is necessary to use an SCR with a fast turn ’on'
time and high switching current capability, which can be able to withstand the required
supply voltage.

4. Receiver:

 The function of the receiver is to obtain the signal from the transducer and to extract from it
the best possible representation of an echo pattern.
 To avoid significant worsening of the axial resolution, the receiver bandwidth is about twice
the effective transducer bandwidth.

5. Wide Rand Amplifier:

 The echo-signals received at the receiving transducer may be as small as a few microvolts.

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 This is achieved in a wide-band amplifier, which is wide enough to faithfully reproduce the
received echoes and to permit the use of different transducers operating at several different
frequencies.
 A desirable gain of wide hand amplifier is of the order of 80-100 dB. It must also have a very
wide dynamic range.
 The amplifier must also have a low noise level to receive echoes from deep targets. The
Input amplifier is usually a dual gate MOSFET which is very suitable lor high frequency
signals and provides a high input impedance to the signals from the transducer.
 Due to the wide dynamic range of echo-amplitudes that are contained in an ultrasonic image,
a log amplifier is usually utilized. By utilizing a log amplifier, one can see small relative
differences in both low amplitude and high amplitude echoes in the same image.

6. Swept Gain Control:

The receiving amplifier can only accept a limited range of input signals without overloading
and distortion. Abrupt changes in tissue properties that shift the acoustical impedance can
cause the echo amplitudes to vary over a wide dynamic range, perhaps 40 to GO dB.

7. Detector:


I N
Alter the logarithmic amplification, the echo signals are rectified in the detector circuit. The

S .
OTE
detector employed could he of the conventional diode-capacitor type with an inductive filter


K T U N
to have additional filtering of the earner frequency.
In this rectification process, the negative half-cycles in the echo voltage waveforms are
convened into positive half-cycles. This is followed by a demodulation circuit in which the
fundamental frequency signal upon which the echo amplitude information has been riding, is
eliminated.
 The output of the demodulator circuit is in the form of an envelope of the echo signal.

8. Video Amplifier:

 The signal requires further amplification after its demodulation in detector circuit before it
can be given to the Y- plates of the Cathode ray tube (CRT). The output of the detector
circuit is typically around I V. but for display on the CRT. the signal must be amplified to
about 100 to 1000 V. In addition to this, the amplifier must have a good transient response
with minimum possible overshoot. The most commonly used video amplifier is the RC
coupled type, having an inductance in series with the collector load.

9. Time Delay Unit:

 Time base will begin to move the spot across the CRT face at the same moment as the SCR is
fired. If desired, in special cases, the start of the trace can be delayed by the time delay unit so
that the trace can be expanded to obtain better display and examination of a distant echo.

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10. Time Base:

 The Time base speed is adjusted so that echoes from deepest structures of interest will appear
on the screen before the beam has completely traversed It.
 Taking the speed of ultrasound in soft tissue to be about 1500 m/s, a time of 13.3 micro sec.
must be allowed for each centimeter that the reflecting interlace is below the surface.
 In many applications, distance markers appropriate to each time-base setting appear directly
on the screen, which greatly simplifies distance measurements.
 Several standard circuits are available for generating the sawtooth waveform to provide a
time base suitable for horizontal deflection of the spot on the CRT screen. The horizontal
sweep generator is controlled by the PRF generator as die sweep starts at the moment that the
transmitting pulse is applied to the transducer.

11. Time Marker:

 The time marker produces pulses that are a known time apart and, therefore, respond to a
known distance apart in human tissues. These marker pulses are given to the video amplifier
and then to the Y plates for display along with the echoes.

12. Display:
 After amplification in the video amplifier, the signal is given to die Y plates of die CRT. CRT

. I N
is not only a fast-acting device but also gives a clear presentation of the received echo

S
OTE
signals.

K T U N
PROPAGATION OF ULTRASONIC THROUGH TISSUES AND REFLECTIONS

Ultrasound waves are vibrations or disturbances consisting of alternating zones of

compression and rarefaction in a physical medium such as gas, liquid, or solid matter.

Wavelength, frequency, and velocity

Frequency is defined as cycles per unit of time.

All waves, including both acoustical and electromagnetic (or ocean waves, for that matter)
possess three related attributes: frequency (F). wavelength (X), and velocity (V).
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Frequency: is defined as the number of complete cycles per unit of time. Figure given above
shows one complete cycle.
In terms of alternating current, the cycle consists of one entire positive excursion followed by
one complete negative excursion of the voltage or current. In terms of sound and ultrasound
waves, the cycle consists of one complete zone of compression followed by one complete
zone of rarefaction.
The basic unit of cycles is the hertz (Hz), which equals one cycle per second (1 Hz = 1 cps);

Wavelength: is the distance traveled by one cycle propagating away from the source and is
expressed in meters (m), or subunits centimeters (cm) or millimeters (mm). The wavelength
is also the distance between successive identical features on successive cycles.
one wavelength is expressed in terms of the distance between two positive peaks, between
two negative peaks, or between negative- going crossings of the zero baseline.

Velocity: is the speed of propagation of the wave. In radio signals, the velocity is the speed
of light (c), or 300.000,000 m/s. In human tissue, ultrasound propagates at a much slower
rate. i.e.. around 1500 m/s.
For all forms of wave, the relationship between frequency, wavelength, and velocity is:
V=F (17-1)

N
Where

S . I
OTE
V is the velocity of the wave in meters per second (m/s)
Lambda is the frequency in hertz (Hz)

T U N
is the wavelength in meters (m)
K
The period of the wave is die lime required to complete one cycie and can be measured in
terms of either time (T) or angle (one cycle = 2pi radians).
The type of the wave refers to the method of propagation.

The two forms are

1. Longitudinal Propagation
In the longitudinal form, the waves propagate in the same direction as the zones of
compression and rarefaction.

2. Transverse Propagation
In transverse propagation, the waves propagate in a direction orthogonal (at right angles) to
the direction of the zones of compression and rarefaction. Transverse propagation occurs
when the wave propagate along the surface of the medium, as on the surface of a container of
water or the surface of a bone.

In medical ultrasound both forms are seen. While the main mode is longitudinal propagation,
a mode conversion to transverse propagation can occur. Mode conversion is associated with a
significant loss of signal level.

Reflection of Ultrasound
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Ultrasound travels freely through fluid and soft tissues. However, ultrasound bounces back (is
reflected back) as echoes when it hits a more solid (dense) surface.
For example, the ultrasound will travel freely though blood in a heart chamber. But, when it
hits a solid valve, a lot of the ultrasound echoes back. Another example is that when
ultrasound travels though bile in a gallbladder it will echo back strongly if it hits a solid
gallstone. So, as ultrasound 'hits' different structures of different density in the body, it sends
back echoes of varying strength.

Ultrasonography (sonography) uses a probe containing multiple acoustic transducers to send

pulses of sound into a material. Whenever a sound wave encounters a material with a
different density (acoustical impedance), part of the sound wave is reflected back to the probe
and is detected as an echo. The time it takes for the echo to travel back to the probe is
measured and used to calculate the depth of the tissue interface causing the echo. The greater
the difference between acoustic impedances, the larger the echo is. If the pulse hits gases or
solids, the density difference is so great that most of the acoustic energy is reflected and it
becomes impossible to see deeper.

Figure given below illustrates the situation for reflection and refraction.

N
Reflection and refraction of waves

S . I

T U N OTE
At the boundary between two zones of different density,
K
some of the wave energy is reflected back into the
original medium, and some propagates into the second
medium but is refracted (i.e.. changes its direction of
travel).


 if the incident wave impinges on the surface or boundary at an angle of 90 degrees (i.e.. it is
coincident with the normal line), it will be reflected back on itself. But if the angle is other
than 90 degrees, then the reflected wave will travel away from the surface at the same angle.
 Refraction phenomena affect the portion of the incident wave that enters the second medium.
We may infer the behavior of ultrasound waves

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Specular reflection, diffuse reflection, and scattering

A single incident ray resulting in a single reflected mi is termed specular reflection.

In medical ultrasound systems this rarely occurs because it requires a flat surface that is large
compared with the wavelength of the signal. In most situations, however, the 1 surface is
rough and thus so produces diffuse reflections.

DISPLAY TYPES OR IMAGING MODES

Various imaging modes or display types found in today's ultrasound systems are:

1. A-mode (Amplitude Mode):

 A-scan mode uses a stationary transducer to fire a pulse into tissue. The oscilloscope or hard-
copy readout scans time along the horizontal axis and plots the signal amplitude along the
vertical axis. A large spike at the left corner (unless it is suppressed) represents the transmit
spike. The tissue at the interface with the transducer will produce some near-field scatter
immediately to the right of the transmit spike. Other spikes represent reflections from targets
within the tissue.

S . I N
T U N OTE
K

 This mode displays the amplitude of a sampled voltage signal for a single sound wave as a
function of time. This mode is considered One Dimensional and used to measure the distance
between two objects by dividing the speed of sound by half of the measured time between the
peaks in the A-mode plot.

 For A-scan applications, the CRT is usually of the electrostatic deflection type. It is better to
use CRT with post-deflection acceleration of the electron beam so that a very bright trace is
obtained with lower deflecting voltages on the plates. The cathode ray tube should preferably
be a flat face type to eliminate sereen curvature error. A variable persistence scope with
storage facilities would be useful for prolonged viewing.

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Applications

1. Echoencephalograph:

In the normal brain, the mid-line surfaces are parallel to the flat areas of the bone near the ear.
When there is a head injury, the brain gets tilted to one side or the other due to bleeding, but
it still retains its normal shape. In such cases, the echoes can be easily obtained but they are
placed at different distances from the probe, when the probe is placed first on one side and
then on the other side of the skull like the figure given below

S . I N
OTE
Echoes received from the brain (a) in the normal brain, the mid-line echoes coincide for each

K
2. Echo-ophthalmoscope T N
way (b) in the abnormal case, and there is a shift between the two echoes.

U
A-mode ultrasonic technique was found to be useful in ophthalmology for the diagnosis of
retinal detachments, intra-ocular tumours, vitreous opacities, orbital tumours, and lens
dislocation. It helps in the measurement of axial length in patients with progressive myopia,
localization of intra-ocular foreign bodies and extraction of nonmagnetic foreign bodies.

Echo-ophthalmoscopy employs a 7.5-15 MHz pencil type transducer. The transmitted pulse
should be of very small width (in nanosec) and range.

2. B-mode (Brightness) imaging is the same as A-mode, except that brightness is used to
represent the amplitude of the sampled signal. B mode imaging is performed by sweeping the
transmitted sound wave over the plane to produce a 2D image.
A-Mode display is very difficult to interpret when many echoes are present simultaneously
and often potentially useful information is wasted. A pictorial display can be conceived as a
means of simultaneously presenting the echo information as well as information about the
position of the probe and the direction of propagation of the sound. This is achieved in the B-
scan display which results from brightness modulation with amplitude of the echoes obtained
for various probe positions and orientations to produce a cross-sectional image of the object
integrated by a storage display from individual scans.

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The B-scan mode may use the same lime base as the A-scan but plots the strength of the

S . I N
returning signal as changes in brightness, i.e., a strong reflection is brighter than the weaker

T U OTE
reflection. When the transducer is mechanically scanned back and forth, successive images
N
are built up. allowing a two-dimensional (2-D) view of the underlying structure. Again, the
K
strength of the reflection is graphed by the brightness of the cathode ray tube display.

Figure represents the difference between A-scan and B-scan.

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Figure above is a hypothetical body with the probe placed upon its surface. The probe is
positioned in such a way that it transmits a beam obliquely inwards. The beam encounters
three interfaces in its travel.

A-scan representation of this structure consists of vertical peaks (2,3,4) received as echoes at
the receiving crystal in response to the transmitted pulse (1). The same structure in B-scan
appears as light dots whose position is related to the echoing interface within the body.

Types of Scans

Three types of scanning arrangements are utilized for building cross-sectional images using
ultrasound.

S . I N
T U N OTE
K
1. Linear Scan: The most common scan used for abdominal studies is the linear scan.

A linear scan is when the ultrasonic transducer remains parallel to the surface of the object
being examined and the sound beam is perpendicular to the transducer movement. Only the
location of the transducer is changed but the angle of the beam is held constant.

2. Sector Scan

The most common scan used in echocardiography is the sector scan. The scan is made by
rocking the transducer about a fixed point such that the sound beam covers a sector.

3. Compound scanning is merely a combination of linear and sector scans.

3. M-mode (Motion) display

M-mode (Motion) display refers to scanning a single line in the object and then displaying
the resulting amplitudes successively. This shows the movement of a structure such as heart.
Because of its high pulse frequency (up to 1000 pulses per second), this is useful in assessing
rates and motion and is used extensively in cardiac and foetal cardiac imaging.

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M-mode (M for motion) is a technique that uses B-mode information to display the echoes
from a moving organ, such as the myocardium and valve leaflets, from a fixed transducer
position and beam direction on the patient.
The echo data from a single ultrasound beam passing through moving anatomy are acquired
and displayed as a function of time, represented by reflector depth on the vertical axis (beam
path direction) and time on the horizontal axis.
M-mode can provide excellent temporal resolution of motion patterns, allowing the
evaluation of the function of heart valves and other cardiac anatomy.
Only anatomy along a single line through the patient is represented by the M-mode
technique.

S . I N
T U N OTE
K
Principle of time-motion (M-mode) display
If one of the echo sources is a moving structure, then the echo dots of light from that structure
will also move back and forth. If the dots are made to move with an electronic sweep, from
bottom to the top of the screen at a pre-selected rate of speed, the moving dots will trace out
the motion pattern of the moving structure. This display is known as M-mode display. If a
photographic film is continuously exposed to one sweep cycle of this display, a composite
picture will result, providing a waveform representation of the motion pattern of the moving
structure. Alternately, thermal video printers are used for recording the M-mode information.

REAL-TIME ULTRASONIC IMAGING SYSTEMS

 One of the serious limiting factors in B-scanning is the length of time taken to complete a
scan. This results in blurring and distortion of the image due to organ movement, as well as
being tedious for the operator.
 Elimination of motion artifact is important in conventional B-scanning but is critical if
rapidly moving areas such as the chambers of the heart are to be made visible.
 Rapid scanning techniques have been developed to meet these needs. The approaches used
include fast physical movement of a single transducer.
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 Alternatively, electronic methods using arrays of transducers which can be triggered in

sequence or in groups, may be utilized. In these systems, electronic manipulation allows the
beam to be swept rapidly through the area of interest.
 Finally, instruments in which an array of transducers is combined with mechanized motion,
have also been introduced. These instruments are called real-time scanners as there is
negligible time delay between the input of data and the output of processed data in such
systems.
 A very important property of ultrasonography is the short image reconstruction time of about
20 to 100 ms, permitting the real-time scanning and observation of processes in the organs of
the body. Consequently, sonography is well-suited to the fast, interactive screening of even
larger organ regions and the display of dynamic processes, such as cardiology.

The real-time systems, therefore, have the following characteristics:

Possibility of studying structure in motion—this is important for cardiac and foetal structures.

During observation, the scan plane can be easily selected since the echo image appears
instantaneously on the display.

Requirements of Real Time Ultrasonic Imaging Systems

The primary requirements of an ultrasonic imaging system are:

S . I N
OTE
1. High resolution

T U N
High resolution or the ability of the system to resolve fine spatial dimensions is a key
K
performance requirement. A resolution of 1-3 mm in all three spatial dimensions is desirable
for a number of diagnostic studies like the early detection of tumours or other pathological
conditions.

2. Long range

The required depth range varies considerably for different anatomical studies. For example, a
range of 25-30 cm is desirable for abdominal and obstetrical studies. For cardiac studies, the
distance from the chest wall to the posterior heart wall is 15 cm or more. In superficial organs
like the breast, thyroid, carotid and femoral arteries and in infant studies, the range of depth is
3-10 cm.

3. Adequate field of view

The field of view should be large enough to display the entire region under examination and
to provide a useful perspective view of an organ of interest. When viewing small superficial
structures such as the thyroid, a field of approximately 5 cm * 5 cm can encompass the
desired region. For cardiac imaging, sector scans are preferable to rectilinear scans since a
large structure is to be viewed through a small window. An angle ol 60° is adequate to
simultaneously view most of the heart.

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4. Sufficiently high frame rate and high detectivity

In real-time imaging systems, the frame rate (the rate at which the image is retreated) should
Ire rapid enough to resolve the important motions and to obtain the image without
undesirable smearing. Most of these requirements arc met with a frame rate of about 30
frames/s.

This also satisfies the requirements for flicker-free display and is compatible with standard
television formats. For some special studies, greater frame rates are often required for the
data acquisition mode. These frames would then be stored and played back at about 30
frames/s to provide a slow motion presentation.

5. Detectivity

It is the ability of an imaging system to effectively capture, process and display the very wide
dynamic range of signals which may, in turn, help to detect ah image, lesion or other
abnormal structure or process. Poor system detectivity manifests itself in lack of fidelity or
picture quality which is often apparent in the visual displays of ultrasonic images.

S . I N
T U N OTE
K

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