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MBP1007/1008, Fundamentals in Medical Biophysics November 2005


Peter N Burns PhD
Professor of Radiology and Medical Biophysics, University of Toronto
Senior Scientist, Sunnybrook &Women’s College HSC

Sunnybrook Health Science Centre
2075 Bayview Avenue S660,
Toronto, Ontario, Canada M4N 3M5

Left: Real time ultrasound image of the four chambers of the heart, with colour Doppler showing regurgitation of
the mitral valve. Right: 3D Power Doppler image of the arterial circulation of the kidney.

Introduction many. The purpose of these notes is to describe the
The spectacular progress in image quality that has common basis for ultrasound imaging and Doppler
marked the development of diagnostic ultrasound instrumentation, so laying a foundation for its
in the last three decades has given way to a period clinical application.
in which the focus of development has been in
new technical capabilities, such as colour Doppler,
intra-cavity transducers and high bandwidth I: IMAGING
transducer arrays, and in new clinical applications,
such as intravascular imaging, transcranial Ultrasound imaging is based on the 'pulse-echo'
Doppler and venous imaging. While many of principle in which a short burst of ultrasound is
these technical developments have marked emitted from a transducer and directed into tissue.
exciting new applications for the ultrasound Echoes are produced as a result of the interaction
diagnostian, they have also resulted in a rather of sound with tissue, and some of these travel back
bewildering array of new instruments, some to the transducer. By timing the period elapsed
employing techniques which are still unfamiliar to between the emission of the pulse and the

Peter N Burns 1

reception of the echo, the distance between the alternating voltage of the appropriate frequency
transducer and the echo-producing structure can be (say 3MHz) corresponding mechanical oscillations
calculated and an image formed (Figure 1). In and hence ultrasound waves (in this case
diagnostic imaging, frequencies vary from about consisting of 3 million compressions/second) are
2MHz for some cardiac, transcranial and deep produced. From the point of view of ultrasound
abdominal applications, through 10MHz for the imaging instrumentation, it is equally significant
imaging of superficial structures such as blood that the piezoelectric effect works in the opposite
vessels, to 20MHz or higher for intravascular sense, that is, varying mechanical pressure on the
imaging. At these frequencies, ultrasound has a face of the transducer will be converted into a
wavelength of between 1.5 and 0.08 mm, a corresponding variation in electrical potential
dimension which sets a fundamental limit on the across two faces. It is this voltage which results
potential spatial resolution of the resulting image. when the reflected portion of a pulse of ultrasound
Better resolution is associated with a higher findings its way back to the transducer and which
ultrasound frequency, but absorption of the sound is referred to as the echo signal.
energy by tissue also increases with frequency.
Optimum imaging is thus obtained by choosing Echoes arise when a burst of ultrasound (which
the highest frequency transducer which will permit travels through tissue at about 1500 metres/
adequate acoustic penetration to identify the
region of interest. To this end considerable effort medium 1 medium 2
has been expended to develop technologies which
will allow the transducer to be positioned nearer to
the structure of interest and hence achieve higher

Sound consists of longitudinal vibrations which
propagate through a medium such as water or soft
tissue in much the same way as a compression can
be seen to travel along the length of a spring.
Sound consists of the repetitive (or periodic)
production of such compressions which travel in
regular succession. The number of compressions
produced each second is known as the frequency
(measured in Hertz, Hz, where 1MHz =
1,000,000Hz) and the distance between successive
compressions (which depends on the speed at
which the sound travels in the medium) is known
as the wavelength.

Ultrasound for use in diagnostic imaging
instruments is generated using some form of transducer
acousto-electric transducer. Piezoelectric crystals
exhibit the extraordinary physical property that
when an electrical voltage is applied across two Figure 1 The pulse-echo principle is used to produce
faces, a mechanical deformation takes place. The an ultrasound A-scan. A pulse is emitted from the
effect is rather small, but if the voltage is reversed transducer at the same time as a dot is set in motion
in polarity (that is the positive and negative wires from left to right on the A-scan screen. When an echo
to the crystal are transposed), the material deforms reaches the transducer, the received signal causes a
in the opposite direction. Thus by applying an vertical deflection of the trace. The distance between
deflections on the A-scan corresponds to the depth of
the interface from the transducer.

Peter N Burns 2

The speed of sound is straight line. the major components of an ultrasound imaging Ultrasound instrumentation system. property which for bulk tissue is defined as the product of its density and the speed at which The echoes can also be displayed as dots in a sound propagates through it. The direction in ultrasound pulse will be reflected back toward the which the transducer is oriented is registered by transducer. it turns out that many modifications to cross-section of the interface within tissue (Figure the structure of tissue at the cellular level also 2e). result in changes of its acoustic properties. enough images can be encounters an interface which the acoustic produced every second for motion of tissue impedance changes.second. As the scale over which these modulated A-scan line on the display screen. an image of this interface is formed. Thus. so an image applied to the transducer. Thus ultrasound is image forms the basis for almost all those of an excellent method for the imaging of soft tissue modern ultrasound instruments. The stream of echoes interfaces. As soon as all the echoes are received. with brightness proportional to echo itself influenced by. amongst other factors. The clock initiates the sequence which If the difference in acoustic impedance between results in a single image being constructed on the two structures is small (as it is in most soft tissue screen: A pulse is created by the pulse generator interfaces). Echoes arrive information to the scan converter. If the transducer is then stiffness of tissue. gives rise to an echo which travels back to the transducer. in which case the reflection of ultrasound tube screen. the distance striking a glass interface. A one-dimensional trace equipment was able to demonstrate only these Peter N Burns 3 . The simplest (and in fact the most is then presented to the scan converter. These data are ray tube. Thus in figure 1. the to cause a vertical deflection. most of it will be transmitted and the coordinate computer. which is a accurate) way to measure this time is by memory capable of storing the echoes along with displaying the echoes as deflections on a cathode their time of arrival and direction. Echoes will only be seen between the transducer and the interface can be if the beam is near perpendicular to the surface measured from the distance between the two (Figure 4b). mechanical properties affect ultrasound are Moving the arm across the skin's surface will then comparable or greater than the wavelength of produce a series of dots corresponding to the sound used. When the echo reaches the transducer Variations in acoustic impedance may take the an electrical signal is produced which causes a form of a smooth surface (such as the bladder second deflection of the spot on the cathode ray wall). Figure 3 shows structures. As the echoes back at the transducer separated in time by a are received. The acoustic pulse which is formed. the clock initiates another. identical sequence. or 3500 mph) encounters an interface such as this with echo amplitude on the vertical between structures of differing acoustic axis and depth on the horizontal axis is known as impedance. the line of fundamentally a modality which maps the changes view of the acoustic beam can be made to in a mechanical (rather than nuclear or atomic) correspond with the orientation of the brightness property of tissue. known as a B-mode image. If the scanning process is automated at results from this travels into tissue until it a sufficiently rapid rate. only a tiny proportion of the and emitted by the transducer. they are amplified and demodulated period proportional to the distance between to determine their strength. Acoustic impedance is a mechanical an A-mode scan (Figure 1). Older "bi-stable" ultrasound deflections on the screen. the amplitude (Figure 2c). Thus ultrasound imaging is mounted on a position sensing arm. If we assume sound to have traveled will be specular (Figure 4a) in analogy with light at a steady speed in the tissue. which feeds this continue on to the next interface. This cross-sectional including acoustic impedance. from where the reflection structures to be followed in “real time”. As the first deflection occurs as the electrical pulse is transducer is scanned over the patient. A spot is made to traverse the screen of then read from the memory in a television raster the cathode ray tube rapidly from left to right and format and fed as a video signal to the imaging the electrical signal from the transducer arranged monitor.

the parenchyma of an organ is are directed toward the transducer. The small to form a pattern of crests and troughs. transducer if the angle of incidence is one of a range of values(Figure 5a). brightness modulated on the image monitor. an image b. Finally. Figure 4 An ultrasound pulse encounters an interface strong. of organs as well as from brightly reflecting Specular reflection. millimetres in width) and echoes are produced in b. in which case undeviated. As the transducer is moved. a. Specular reflection . and these give rise to low-level. Video z1 receive amplifier ulator amplifier switch Medium 2 z z2 t x Coordinate Image memory computer (Scan converter) y a. Pulse generator Time-gain compensation CLOCK Medium 1 i r Transmit/ Radiofrequency Demod. The angle of incidence (i). they are amplitude and demodulated to determine their strength. In this special case of specular many directions. The z1 direction of orientation of the transducer is registered by the coordinate computer and fed to the Medium 2 scan converter. small variations in echoes are coherent in phase and interfere with acoustic impedance are present within the tissue each other in just the same way as ripples on water parenchyma itself. scattering from characterized by a distinct shade of gray.normal incidence is produced on the monitor. The diaphragm is an example of such a ultrasonography. A small portion of the ultrasound smooth areas such as the walls of major vessels. such backscattered structure in the body. Individual streams of echoes are then represented as lines in the appropriate direction. beam is reflected but most passes across the interface Other interfaces may be irregular. and the angle of transmission (t) are all the ultrasound beam (which is of the order of equal. the angle of reflection will take place over many angles within reflection (r). If these weak echoes of the imaging process allows only relatively few are displayed by the gray scale of the ultrasound structures to give rise to specular reflections which imaging system. Such scattering gives rise to reflection the angle of incidence is zero and the echo is echoes. In fact. specular echoes. The uneven interfaces is the principal mechanism for structure and intensity of backscattered the visualisation of tissue margins using parenchymal echoes form the basis of gray scale ultrasound. They are seen at interfaces between soft tissues of differing acoustic impedance. some of which travel back to the received by the transmitting transducer. caused by many small disturbances will combine isotropic scattering (Figure 5b). A pulse is issued by the pulse Medium 1 generator and emitted by the transducer. As the echoes are received from z2 tissue. Specular relection Image Monitor Figure 3 The major components of an ultrasound imaging system. Because the geometry received by the transducer. Normal incidence. In proportion of this echo which is backscattered is Peter N Burns 4 .

a properly if the relative echogenicity of organs at factor which determines the apparent texture of an differing depths is to be assessed. To compensate for this. The gain is automatically increased are scattered in all directions. In practice. characterizing information since texture is determined primarily by a combination of the Since the difference in echo intensity between the acoustic characteristics of the ultrasound beam and bright specular reflector and weakest parenchymal the mechanical structure of tissue. strength echoes from different depths are displayed with the same intensity on the screen. When the last echo has arrived the next pulse of b. is characterized by less intense parenchymal echoes Medium 1 than that of the contiguous liver. spleen and z1 pancreas. small quantities of ultrasound first echo. the relative scatter might be as much as 60dB and a television appearance of different organs will be constant. specular echoes from Medium 2 the renal sinus in the adult are more intense than z2 t those from within the cortex. Gas and bone attenuate ultrasound rapidly: in addition. and must be set gives rise to the speckle of a gray scale image. the intensity of a 5MHz beam is reduced to half its initial value by 6mm of liver. In addition. for example. Peter N Burns 5 . their acoustic impedance results in almost total reflection from interfaces with soft tissue. including back toward throughout the subsequent period in which echoes the transducer. a. The effect of attenuation on returning echoes is seen as a b. equal appearance of the organ. Attenuation is strongly dependent on frequency and reduces the intensity of the beam logarithmically as it travels through tissue. real intensity (or echogenicity) and texture from a lesions may be obscured by incorrect TGC settings given region cannot be used to obtain tissue in the area of the abnormality. Inhomogeneous medium dramatic reduction in intensity of echoes from deeper structures. 2mm of muscle or 0. As sound propagates through the parenchyma of ultrasound is emitted from the transducer and the an organ which contains microscopic fluctuations in gain reset to its lowest level for reception of the acoustic impedance.3mm of bone. This is responsible for the gray-scale from deeper structures arrive. Although the absolute appearance of artifactual lesions. the gain Figure 5 Scattering of ultrasound. conversely. For example. The normal cortex of the kidney. thus allowing the diagnosis of abnormality. Rough Interface energy to what is generally an immeasurably small quantity of heat. interfaces gives rise to echoes over a range of angles. The parenchymal texture of these organs is also different. converting its a. Attenuation of the ultrasound beam in normal tissue is a result primarily of the absorption of the acoustic wave motion by tissue. Specular of the receiver is increased logarithmically as reflections from a multiplicity of irregularly oriented echoes arrive from progressively deeper structures. scattering is thought to contribute a negligible amount of attenuation. Inappropriate organ imaged with ultrasound. In this way. Different organs setting of the TGC curves can lead to the have characteristic textures. The control of this time gain compensation (TGC) ultrasound this stationary interference pattern is at the operator's disposal.

With the post ultrasound imaging. although lending predictability to characteristic. the contrast between echoes A and B is greater than the contrast between echoes C and D. Dynamic information characteristic (known as the display compression may be recorded on videotape or "frozen" by an or post-processing curve) may be adjusted to operator control and stored in an image memory. a processing facility built into many from a single transducer is moved by the rotation modern abdominal scanners. The display of these images in quick processing) curve demonstrates the relationship succession and the elimination of flicker by between the echo amplitude returning to the transducer switching between image memories. For example. Display Brightness (dB) B' 1 Real time ultrasound imaging The process of moving a transducer attached to an A' arm has been largely replaced in modern real-time scanners by the movement of a transducer using a mechanical rotator or translator. be difficult as the Thus. the abdomen can. however. Multiple views in standard C and D. the beam signal. In selecting post. In many many of the qualities unique to real-time instruments. Movement of a lesion during processing curve 3 however. driven under servo control such that the display of scan line is moved in exact correspondence with the position of the beam (Figure 7). Employing a different post-processing planes. This they empty into the bladder. be adjusted after the image has been acquired and held in the scan-converter. the C' 2 range of gray shades) in the display.screen capable of displaying no more than about respiration can identify it as arising from the 30dB. The beam is swept with sufficient speed that an entire image can be A B C D produced in a fraction of a second. and between echoes C and D are impossible to record. amplitudes is necessary. however. enhance the contrast between a lesion and Review of a real-time ultrasound examination of surrounding tissue of almost similar echo intensity. This is achieved by fluid-filled structures which pulsate may be amplifying the low level echoes linearly. With post processing curve 1 these movement of tissue in the abdomen yields would result in an equal difference between the display additional diagnostic information unique to brightness of these two sets of echoes. one should attempt to optimize the contrast between structures of interest 3 D' without sacrificing the dynamic range (that is. In the electronic differentiation of the demodulated mechanical sector scanner (Figure 7a). result in the sacrifice of will cause the display contrast to vary. the images produced. and an appreciation of the similar. of the ceramic element itself or of acoustic mirrors processing characteristics. so that Echo Amplitude (dB) independent images may be acquired at a rapid Figure 6 The compression amplification (or post- rate. some compression of the range of echo peritoneal or retroperitoneal space. Note that there is a constant device capable of visualizing structures which are difference in echo amplitude between echoes A and B moving a real time. in Figure 6. Peter N Burns 6 . creates a and the display brightness. such as that of curve 1 in Figure 6. the intensity ratio between hand-eye coordination of the scanning process is echoes A and B. post-processing characteristics may ultrasound imaging. The assessment of the move and echoes C and D. but the identified as arteries and ureteric jets may be high level echoes in a manner which compresses visualized directly with real-time ultrasound as them into a narrow dynamic range (Figure 6). but on the display the contrast between precise plane of visualization is often difficult to echoes A and B is greater than that between echoes gather in retrospect. Additional A variety of techniques may be used to move the enhancement of edges may be provided by ultrasound beam in a real-time scanner.

The beam is swept which attenuate the ultrasound beam). One of the limitations of this configuration is that is within the beam. Thus. Four size of the field of view. the Figure 7 Above: Real time scanners. Such "steering" of the ultrasound beam can be achieved very rapidly by the phased array system. the frame-rate and the configurations of an ultrasound transducer assembly resolution of the image are all related in a real- which permit the echoes to be collected as a sufficient time scanner. discrete transducer elements are cannot be applied to intercostal scanning or arranged in a line (Figure 7c) and a small number scanning through other small acoustic windows (a excited together to form a beam. and the time taken for the last echo to return to the transducer once the pulse has been transmitted (this is related to the maximum depth of the field of view). On the Peter N Burns 7 . When all the window refers to a superficial area through which echoes have been received along the resulting line deeper structures can be visualized and which is of sight. The optimum choice of those speed to produce real-time images. and so on. so forming an image. rapidly from one end of the transducer array to the other. the next pulse is issued from the adjacent not comprised of structures such as gas or bone series of elements. A similar transmit pulse is fed to each of the array elements but after a delay which increases progressively from one end of the array to the other. parameters is inevitably a matter of compromise. In the linear array a large requires a relatively large transducer and therefore number of small. The result is an ultrasound wavefront whose direction of motion is at an angle to the axis of the probe. Mechanical Sector Electronic Sector Ultrasound wavefront Linear Array Curvilinear Arrray Electronic Array delays elements Figure 8 The principle of the phased array. The frame rate of such an image is determined by a combination of the number of lines within the field of view (this is related to the image resolution). Below: Curvilinear array image of fetal face Electronic switching precludes the need for moving parts in the linear array scanner.

synthesized the effect of a single curved disk transducer oriented in the desired direction. the relatively small size of the transducer footprint (perhaps 2cm square) and their particular ability to produce beams whose focus may be controlled electronically. which are controlled by transmitted pulse applied to each of the array elements common high-speed computer logic. the resulting improvement in resolution at the focal depth is at the expense of image quality of shallower and deeper structures. the lateral resolution of an ultrasound image depends mainly on the width of the ultrasound beam. Although it is easy to focus the ultrasound beam so that it is narrow at a particular depth (for example by the use of an acoustic lens attached to the surface of the probe). The Peter N Burns 8 . A lens Figure 9a Phased array realtime image of the heart. By controlling this phase between successive bursts. The array may be thought of as having transmits. The size and direction of this difference determines the direction in which the main lobe of the ultrasound beam will emerge. The advantage of the electronically steered arrays are their lack of moving parts. in the electronically steered or phased array scanner (Figure 7b the sector format is produced by precise control of the instant at which Ultrasound wavefront each element in a small rectangular array of transducers is excited. but shares many of its advantages. Swept focusing exploits the ability of a phased array to emulate a lens. 64. The curvilinear array (Figure 7d) creates a trapezoidal field of view with a somewhat smaller acoustic footprint than the linear array. progressive time (or phase) difference from one side to the other.other hand the linear array has proved to be ideal for scanning areas with large windows and a smooth abdominal surface such as the pregnant uterus. and also has a radius of curvature creating a the array enables the beam to also be manipulated focus at the desired axial distance from the array so as to receive in the same direction as it phase. Figure 9 The electronically focused "steered" phased independent electronic delay circuits in the path of array. Precise control of the individual delays of the each transducer element. Figure 9 illustrates the method used to achieve this. the beam Electronic Array may be 'steered' electronically (Figure 8). Here all the elements (typically there may be 48. 96 or 128) are excited together but with a small. Control delays elements is achieved by the implementation of small. Finally. As will be seen presently. focuses a beam simply by delaying the passage of produced at 60 images per second sound at its center relative to that at its edge. Applying results in a wave front that is oriented in the desired delays to the signal received by each element in direction.

An annular array might typically be composed of five delays rings. b. as compared to the phased array. delays target the array will be focused at a slightly greater depth. the period elapsed after the transmission of the pulse can be used to determine the depth from which the received echoes are Echo ∑ originating at any one time. and so on (Figure 10). Here the ultrasound beam is array A moved mechanically. is capable of synthesizing a focus at echoes arrive from progressively deeper structures. the annular array system. A moment later. Peter N Burns 9 . Far targets array Annular arrays may be used at higher ultrasound Figure 10 The principle of the swept focus array. allows the electronic focusing of mechanically manipulated transducer elements. dimensions. High frequencies are usually points on a curved surface. which controls the focus in the image plane only. delays Echo A hybrid of the mechanical sector scanner and the signal ∑ target phased array. Far targets annular B high speed) of elements in either a linear or phased array array when receiving allows an electronic focus to Figure 11 The annular array. echoes are being received from the greater distance B within tissue. whose axial Use of electronically focused beams improves the location can then be swept during the reception of each uniformity of image quality at different depths. large delays are imposed which emulate array scanner may be particularly advantageous. When echoes are being received from a distance A from sector or the high frequency. train of echoes. However. Control (at quite b. the main benefit from swept focusing is during a. Because echoes from each depth arrive at a different time. The array may then be signal instructed to focus at that depth. focuses the ultrasound beam in two near the transducer face. The frequencies. Note that the effect of this configuration is Echo to control the focus in two dimensions (that signal defined by the image plane and that of the scan ∑ thickness). and here the annular array mechanical a. Near targets determined by electronic delays (Figure 11). This creates a desired focal depth for delays the transmitted pulse (Figure 9). testes. The delayed received signals chosen where high resolution imaging of are then summed together and fed to the ultrasound superficial structures is required. The annular array. where it may be difficult to create echo received by each of the array elements is delayed so multi-small element phased array systems which as to emulate the time of arrival of the echo at different performs so well. but the focal depth is a. Delays are imposed on Imaging transducers the array elements which create a focus at the further delays used to steer the beam can also impose Echo ∑ signal programmed delays which specify a focal distance target for the beam. B b. The annular array. the desired distance from the transducer. like be formed whose position sweeps downwards as the phased array. A short time later. Near targets annular A array reception. swept focus linear the array phase. such as in the receiver. unlike the linear especially enhancing visualization of structures phased array. a single transducer focused at the axial distance A.

c. a handle. c. the walls of the bladder. while lying in an have been designed for intra-operative use. while fixed at 90° to the probe axis. The axial sector scanner. whose plane lies at right angles to that of the probe. b. d. Figure 12b shows a mechanical sector scanner whose plane contains the axis of a. a. radial scan. An axial sector scanner with adjustable scan plane. based on the mechanical Figure 13 Some configurations of electronic array sector. c. These a radial orientation. Ultrasound transducers. Transducers designed for array scanner with a rectangular field of view. the probe (an axial plane). can be rotated from an axial to a radial Figure 12 shows a sample of intracvity probe direction. In Figure 12a. d. Axial linear sizes and shapes. Transurethral transducers are available plane. it can be oriented to face angles from Transducers of all types are also available with forward to perpendicular to the probe. A phased/linear array are used routinely for prostate and bladder hybrid. Figure 12d attachments to guide a biopsy needle under shows a similar arrangement. b. have been produced in a wide variety of axial phased array sector scanner. d. a. the linear array providing the axial scan imaging. Electronic arrays have the advantage for single transducer rotates so as to produce a 360° intracavity imaging that they require no moving Peter N Burns 10 . a. d. b. small electronically steered sectors and high frequency linear array systems sector can be adjusted so that. c. the motor driving configurations which employ mechanically the transducer motion is housed within the probe translated ultrasound beams. The 360 degree radial scanner. The array. Figure 12 Some configurations of mechanical real time scanners used for transrectal scanning. the phased sector. A mechanical sector scanner whose scan plane may be adjusted between axial and radial planes. Finally. In all of these systems. for example. giving an axial and array or rotating mechanical sector designs. transrectal scanning have been built using linear Two phased array sector scanners. but in which the ultrasound imaging control. for the examination of. In Figure 12c the 115° b. linear and curvilinear scanners used for transrectal scanning. axial plane. plane of the sector.

extending deep into the image. so can be made smaller. many artifacts are useful in diagnosis. the Reflections image shows a "comet tail" of bright echoes distal to the foam. Different transit time of the linear array axial scanner and a 360° mechanical ultrasound pulse through the low velocity region radial scanner. a solid Foam tumour. for sound traveling from the transducer will be example. in this case of an axial linear array with a radial sector phased array. for example. Conversely. Transducer Transducer parts. Figure 13b an axial linear Target array with a rectangular field of view. for example. such as a highly attenuating (and thus usually calcified) as that found in the bowel. Artifacts in Ultrasound Imaging b. As the scanner assumes that echoes arriving after a longer interval originate from deeper in tissue. Here. contains many highly lesion. Virtually all lengths of echoes reflected many times within a ultrasound instruments are calibrated to an average foaming air-fluid mixture results in a high intensity speed of ultrasound in human soft tissue (usually vertical streak in the image. a velocity interface. 1540 metres/second). identifies the contents of the cyst as reflected many times back and forth within the having a lower attenuation than that of foam before all its energy has been lost. linear or curvilinear arrays offer a larger field of view ity which may make anatomic orientation of the c lo Low velocity ve w Refracted operator less difficult. The pulse of ultrasound image distal the a cystic region. Non-normal incidence on the region of different Ultrasound images are prone to several sources of velocity. The mounting of Image Correct Distorted linear structure separate transducer assemblies on the same probe of target location of target allows visualization of different anatomic planes without exchanging the probe itself during the examination. In most machines. There is. Image Image In Figure 13c two phased sector arrays are providing images in the axial and radial directions and Figure 13d typifies the many hybrids available. Mechanical / array hybrids are becoming more a. Normal incidence of the ultrasound beam on the common. understood. and might comprise. causes axial distortion of the registration of structures distal to the region. the enhancement of the reflecting interfaces (Figure 14). Thus the "shadowing" distal to a stone identifies it a watery fluid. Another artifact can result from the assumption made in the imaging process that sound travels at Figure 14 The reverberation artifact. because of the Incident varying lengths of the ultrasound path. Figure 13a shows an axial Lo beam phased array sector. Multiple path the same speed through all tissue. take Image pulse differing amounts of time to reach the transducer. The result surrounding tissue. A foaming fluid gas mixture. suggesting that it is filled with is a series of reflections which. Also. however a Peter N Burns 11 . imaging field. refraction causes lateral misregistration artifact. This "comet tail" artifact can be used to distinguish bowel containing gas from. simultaneous Figure 15 Two effects of varying velocity within the imaging of the two fields of view is not possible. When recognized and properly of targets distal to the low velocity area.

the assumption implicit in instrument image of a point target depends on the length of the design that the ultrasound travels in a straight line pulse imaged from the ultrasound transducer. Thus. significant variation between velocities in different Image of soft tissues. This may be breached by the phenomenon of refraction varies with transducer construction and size. Long Pulse velocity all influence measurement: first. the axial extent of the region itself will be misrepresented Transducer Image because of the incorrect velocity. Figure 17 Axial resolution. as In many instances. Making Measurements from Ultrasound a. However. say. The effects of a region of tissue which has a different b. ultrasound is used to make the transmitted portion of the pulse continues into anatomic measurements of an organ or a lesion. As the scanner assumes ultrasound to travel in a straight line. while fluids have a lower velocity than the average. Among the factors which influences frequency. its path is deviated at the Certain limitations to the precision of such interface. and their spatial relationship to nearby Medium 2 structures which were imaged without refraction. as well as (Figure 16). on the part of the operator will alleviate these Peter N Burns 12 . any tissue interfaces distal to the tumour will be depicted in the wrong location. and the beam is incident at a non-perpendicular angle. which can be as much as 12 percent. The axial length of the Finally. but can be significant between fat and collagen. Thus a fatty tumour with a velocity of 5 percent below the Long pulse calibration velocity will be overestimated in axial length by 5 percent. and as the echoes return along the same path as the Medium 1 i r transmitted pulse. Second. The more dense and rigid tissues have Point point target target a higher velocity. If the velocity of sound c is Image Transducer different between two media. the acoustic impedance of a given tissue is the velocity at which sound travels in it. The largest difference encountered clinically is that between fat and collagen. because of the transit time of the pulse Point Image of point having been lengthened by the region (Figure target target 15a). Short Pulse Figure 16 Refraction. renal cortex and sinus. the angle of transmission Short pulse will be different to the angle of incidence. the deeper tissue. all structures distal to the c1 refracting interface will be shown in the wrong location. The degree of deviation from a straight measurements are a fundamental consequence of line depends on the difference in velocities across the physics of the image itself: no amount of care the interface: this may be negligible between. c2 t will be distorted (Figure 15b). an interface between two tissues of differing velocity Images will give rise to an echo by reflection.

results in a higher peak acoustic intensity. In particular. the size of the Looking at Figure 17. Moreover. so that lateral resolution improves Peter N Burns 13 .15mm. would nor the effective size of the transducer remains be equal to the wavelength. and determinant of lateral resolution is the width of the between the three directions defined by the scan ultrasound beam. Thus. narrower Lateral resolution is defined as the minimum beams are obtained from using higher frequency separation of two targets in tissue aligned along a transducers. In fact. Transducers have a tendency to "ring" after being excited by an electrical impulse. The wavelength of ultrasound that particular time are originating. the lateral resolution plane. the transducer array can be arranged to coincide producing structure. The result is that even a point target produces an echo which is sustained in time. This is known at 3 MHz (typical of that used in abdominal Pas swept focusing. lateral and slice with the precise depth from which the echoes at thickness directions. such as the one Axial resolution shown here. This is not usually uniform over the of average acoustical energy in tissue. achieve good lateral resolution in the Axial resolution is defined as the minimum separation of two targets in tissue in a direction parallel to the beam which results in their being Direction of scan imaged as two distinct structures. but require a ultrasound image is dependent on the width of the more powerful impulse to achieve the same level ultrasound beam. an image is created at imaging) is about 0. the axial resolution. which the echoes from every depth are detected with an optimally focused beam. at 10 MHz it is 0. Thus a compromise is reached between the peak pressure focal zone but poor lateral resolution in the near to which tissue is exposed and the effective axial and far field regions. In ultrasound images.5mm. Highly dampened transducers are capable of producing Figure 18 Lateral resolution. pulse achievable was one solitary cycle. Highly focused beams. and hence the axial resolution. in axial. Swept focusing is one way of shortening the length of an ultrasound pulse while minimizing the inhomogeneous lateral resolution that keeping the total energy of the pulse constant. is inferior to.constraints. depth of the image. the resolution of the direction perpendicular to the ultrasound beam. Thus the precision of a resolution of the ultrasound image. As echoes from different depths are received specifies the best resolution with which a pulse at different times. and the beam result is an image which is smeared in the direction of the ultrasound beam. This is interpreted by the ultrasound scanner as a Ultrasound structure which is extended in axial length. structures. In general. The result is an image with more uniform lateral resolution than Lateral resolution that illustrated in Figure 18. In general. the focus of the beam created by echo system is capable of defining an echo. or at best comparable to. neither the focus of this pulse. it is clear that if the shortest transducer and the degree of focusing achieved. the length With array transducer systems. the wavelength fixed. Figure 18 shows that the principal the resolution varies within each image. image determines the best precision of any which results in their being imaged as two distinct measurement made from it. distance measurement made in the lateral direction varies according to depth. results from such beam geometry. creating an Point Image of point acoustic pulse which has an extended length in targets targets space. Figure 17 shows Transducer Image that the main factor which determines axial resolution is the length of the ultrasound pulse. Lateral resolution of the pulses with a shorter spatial length.

producing less well defined margins to structures. In reality results in higher spatial resolution. Several factors are involved. such as time domain colour imaging. from an ultrasound image is also affected by the strength of Introduction the echo itself. If the gain is tissue. but increasing the receiver gain also imaging. the high bandwidth of that have the appearance of 'snow' but are in fact the pulse emitted from the transducer and the artifactual consequences of a low signal-to-noise tendency of tissue to absorb high ultrasound ratio. The result is that there is always some increased enough to detect a weak echo. Echoes arising from tissues located near the edge of the beam are presented in the image as if they are located on the central axis of the beam. When viewing the image. The optimum frequency with over the actual location from which an echo arises. Peter N Burns 14 . and edges employing techniques. Since most of the surfaces in the body are curved. it has also resulted in a amplitude to the noise.with increasing transducer frequency. If the echo is comparable in diagnostician. which arise from the central axis of the beam. reduce a 2. This provokes an inevitable conflict The ultrasound instrument assumes that all echoes between raising the ultrasound frequency. some impossible to detect it on the image. First. to has been marked both by technical developments. the observer is “looking through” a slice whose thickness is equivalent to the width of the beam which produced the image. the ultrasound image superimposes echoes from these curving surfaces. such as transcranial Doppler receiver. This expansion takes about 4mm of muscle.5MHz echo to one-half of its amplitude. which are unfamiliar to many. Contrast The effective resolution with which a structure can II: DOPPLER be delineated. it will be difficult or rather bewildering array of new instruments. Even if will be corrupted by randomly distributed signals swept focusing is employed. and new clinical A weak echo requires more amplification from the applications. This leads to an inevitable uncertainty contrast resolution. to reduce lateral resolution. For the sonographer and ultrasound increases noise. and lowering it. the center frequency of the pulse as it traverses the beam is effectively wider. for example. however. and thus measured. which to carry out a specific measurement is thus causing what may be described as a always a compromise. such as colour Doppler imaging. stronger degradation of both axial and lateral resolution echoes from the same depth will be 'smeared' so as with increasing depth. echoes are produced by the full cross-section of which improves signal amplitude and hence often the beam. This 'slice-thickness' is one source of the characteristic "fuzzy" edges of imaged spherical structures. The rapid expansion of the Doppler method in even a strong echo may arise from tissue ultrasound diagnosis reflects the breadth of sufficiently deep for attenuation to render it weak application that data from the noninvasive by the time it returns to the transducer: it only examination of blood flow offers. Second. Therefore. Thus the contrast resolution is affected by echo amplitude and tissue Slice thickness attenuation. "superimposition" effect. the ultrasound beam does not have a frequencies more rapidly results in a lowering of uniform sensitivity pattern: at greater sensitivities. any given point in the ultrasound image represents a summation of changes in tissue construction across a slice of tissue.

the mere fact that the data cannot be towards the receiver causes the distance between presented as a conventional image can challenge compressions .being reduced. fewer compressions reach the factors related to the Doppler technique. the sonographer who relies on an intuitive The result is that more compressions reach the interpretation of an ultrasound study. the greater the The Doppler Effect Doppler shift in frequency. and simply add to each other. it will detect more interpretation of Doppler signals in clinical compressions per second and so register a higher practice entails the extraction of information about frequency. The motion of the source However. The acoustical Doppler effect fD (measured in Hz) to the velocity of the moving occurs whenever there is relative motion between blood v (in m/s). comprising a series of Doppler methods are unique among clinical compressions. two successive Doppler which the target is moving and whether the motion shifts are involved (Figure 21). if the receiver moves away the underlying blood flow from confounding from the source. Examples of from the stationary transmitting transducer is the Doppler effect abound. however. that which is transmitted. For example. an astronomer can is now a stationary receiver. compressions detected per second by the receiver. Conversely. and the cosine of the angle θ between the receiver is moving toward the source (Figure 19). A precisely analogous effect straightforward with the refinement of instruments occurs if the source moves away from a stationary for the acquisition and analysis of Doppler signals. First. Much of the toward the source (Figure 19b). the frequency of radio waves fD = 2 f v cosθ / c received from a moving aircraft is shifted due to This equation relates the Doppler shift frequency the Doppler effect. In the case of the source Doppler effect not only help extend such an moving away from the receiver (Figure 20c). This difference in frequency is known as the Doppler shift and In the case of ultrasound being scattered from depends on. approximation.the wavelength . which approaching or receding. the effect of a moving receiver is the frequency of the wave received differs from equal to that of a moving source. but is an essential wavelength is reduced so that a lower frequency is prerequisite for the quantitative interpretation of detected. perceives the pitch of a moving source of sound to the cells act as a moving source as they reradiate change according to whether the source is the ultrasound back toward the transducer. The potential to offer information related to the frequency received is simply the number of these function of an organ rather than its morphology. If. Sound waves. the frequency of the ultrasound f the source and the receiver of sound. travel toward the receiver at a techniques in ultrasound in that they have the steady speed determined by the medium. the sound is toward or away from the receiver. Consider the (in Hz). They account for the colour) of light between the advancing and factor 2 appearing in the Doppler equation. the speed at moving red blood cells. the velocity of sound c in the medium (in case in which the source is stationary and the m/s). To a first determine the speed of rotation of the sun by approximation. receiver (Figure 20). direction of motion and the axis of the ultrasound Peter N Burns 15 . the receiver moves combination of these two influences. This transducer per second and a lower frequency is process has been made progressively more detected (Figure 19c). An receiver per second and a higher frequency is appreciation of the physical principles of the detected (Figure 20b). receding edges. However. this is derived from the interaction of a beam of sound obviously equal to the frequency that is with a volume of tissue and therefore represents a transmitted. these two Doppler shifts are equal measuring the difference in frequency (that is. It is easy to see from figures 1 and 2 that Doppler signals. Second. they have in common with all In the example in which both the source and ultrasound techniques that the information is receiver are stationary (Figure 19a). among other things. the intuition into blood flow studies. the greater the speed of the relative motion between source and receiver. a listener received by the moving red blood cells. To a first When a wave is reflected from a moving target.

The size of the echo from blood is small compared to It is a purely fortuitous coincidence that. Doppler flowmeter to convert the shift frequency This is partly responsible for a dramatic difference into an audible signal that can be monitored by the in performance between Doppler instruments operator through a loudspeaker or a pair of detecting blood flow using different ultrasonic headphones. The Doppler effect is a consequence only of motion along this line. Thus. much less than the component of velocity along the beam and hence wavelength of the ultrasound. The mean diameter of an 90° and cos 90° is equal to 0. individual erythrocytes see that the target is neither approaching nor act as point scatterers. The Scattering of Ultrasound by Blood the optimum frequency for a Doppler examination The composition of blood is responsible for some lies below that which is likely to be chosen for important aspects of the Doppler signal. as is apparent from the echo-free MHz to 10 MHz). whose combined effect is receding from the transducer in this case.2 no Doppler shift. Of course. compromise based on the frequency employed and the depth of the structure of interest. if the motion is perpendicular to the beam. it is easy to mm-0. it will be moving in a direction at some angle θ to the line between it and the transducer. the backscattered echo has beam. it is generally assumed that the erythrocytes are responsible for the scattering of Peter N Burns 16 . doubling the ultrasonic frequency results is both convenient and customary. referred to as Rayleigh-Tyndall scattering. leukocytes (white blood cells). for a in an echo from blood that is 16 times stronger. the range of Doppler process is that the intensity of the scattered wave shift frequencies fD happens to lie within the increases with the fourth power of frequency (I ~ f audible range of frequencies up to about 15 kHz. attenuation in soft tissue the Doppler signal is not possible without further also rises with frequency. Cricket /µψπσβ Software  ⊇ υσερδιχτ χυρρεντποιντ /νεωΞΣχαλε /νεωΨΣχαλε /πσβ /πσε /µψπσε {} /µψπσβ στορε /πσβ /µδλοαδ νεωΩιδτη λοαδ νεωΗειγητ κνοων{/ΧριχκετΑδϕυστ /πιχΟριγινΨ ποπ /νεωΗειγητ /πσεστορε /νεωΩιδτη δεφ στορε {} στορε /µψπσε 422 412 εξχη διϖ εξχη διϖ εξχη /πσε δεφ πιχΟριγινΨ δεφ δεφπιχΟριγινΞ λοαδ /πιχΟριγινΞ τρυε δεφδεφ}{/ΧριχκετΑδϕυστ συβσυβ δεφ εξχη δεφ ποπ δεφ φαλσε δεφ}ιφελσε beam. which is about 0. The choice of the optimum such noises and that the seasoned Doppler ultrasonic frequency with which to perform a practitioner still derives benefit from listening Doppler examination is thus an inevitable carefully to the sounds themselves. One consequence of the Rayleigh-Tyndall velocity of sound in blood. this places an consists of a suspension of erythrocytes (red blood additional demand on the design of duplex cells). and cos 0 is equal a center frequency which is higher by an amount fD. Blood imaging the same structure. More generally. In spite of the fact that quantitation of frequencies. Conversely. In physical terms. It 4). is moving directly toward or away from the transducer. numbers of leukocytes and the small size of platelets. tending to offset the processing of this signal. then. to 1. for the that produced by specular reflection from solid range of ultrasound frequencies used clinically (2 tissue interfaces. so that the component of velocity responsible for the Doppler shift is simply v. so that there is no erythrocyte is 7 µm. θ is equal to ultrasound by blood. the range of tissue velocities appearance of blood-filled structures on ultrasound encountered physiologically (0 m/s-5 m/s).5 mm. and platelets scanners and their transducer assemblies (see in a liquid plasma. and the images. it should be noted that advantage of the increased efficiency of scattering the ear is capable of quite subtle discrimination of at higher frequencies. such as blood within a vessel. As a in which the motion is aligned precisely with the result of the Doppler effect. Therefore. Because of the relatively low below). This angle θ enters the equation because it is seldom that a target. the angle θ is equal to 0. It is therefore necessary to calculate the component of the velocity v along the direction of the ultrasound Figure 21 An incident ultrasound beam of frequency f beam: this is given by v cosθ. In general. In the extreme case is scattered by moving red blood cells in a vessel.

have a phase relationship determined by Doppler blood flow signals. a maximum and a minimum combining which is capable of distinguishing between signals to form zero. whose output is amplified and fed to long as the erythrocytes are not too close together. A continuous arises from the combination of many individual stream of echoes arrives at the receiving scattered waves produced by the erythrocytes. Such a directional Doppler signal both in space and with time. This pattern moves at the same Transmitting velocity as the blood itself and provides the basis transducer Receiving To spectrum for a non-Doppler method of measuring blood transducer analyzer flow velocity. Further. but of a much lower strength than. As these give rise to echoes whose frequency is identical to waves meet each other. maximum. As transducer. the demodulator.Another important effect that the composition of backing. Their beams are arranged to overlap so as to form a sensitive volume defined ear are the Doppler shifts corresponding to motion by their spatial product. Finally. which has the effect of increasing the blood has on the nature of the Doppler signal overall sensitivity of the system). The resulting interference whose frequency is higher and those whose pattern extends back to the receiving transducer frequency is lower than that of the transmitted face and moves along with the moving blood. two maxima combining to form a technique known as phase quadrature detection. Headphones Instrumentation Figure 22 The continuous wave Doppler system. The output of the demodulator is the assembly houses two elements. The function of the demodulator each behaves as though it were an independent is to compare the frequency of the received echoes receiver and scatterer of the sound. The oscillator produces an toward the transducer and the sounds in the other electrical voltage varying at the resonant corresponding to shifts away from the transducer. and demodulator produces two outputs that. and so on. The transducer demodulation. after accounts for the distinctive noise like character of filtering. perhaps with only air beams used in a typical CW system begins a short Peter N Burns 17 . It also allows a the direction of flow. a narrow The overlapping volume of the two ultrasound band transducer is used. the other to receive. using a scheme known as coherent shows a schematic diagram. Most demodulators employ a example. analogous to. where the sounds in one the Doppler signal is related to the quantity of blood lying within the sensitive volume of the Transmitter Doppler beam. audible Doppler shift signal.this their many sources much as ripples do from small is the Doppler shift signal. The waves to that of the oscillator and to derive a signal resulting from these interactions spread out from whose frequency is equal to their difference. Stationary interfaces stones falling onto the surface of a pond. frequency of the transducer (because the transmitter is operating continuously. Signals The simplest Doppler instrument is the continuous from the receiving transducers are compared in frequency wave (CW) Doppler shift detector. corresponding to Doppler shifts toward or gives rise to fluctuations in the strength of the away from the transducer. one to transmit. the speckle pattern seen in the Receiver Demodulator parenchymal echoes from a heterogeneous organ amplifier such as the liver. these spatial fluctuations give rise to a speckle pattern in the sin wt cos wt blood echo. minor processing prediction to be made about the average strength can be used to produce a stereo audio signal to of the signal: theory predicts that the intensity of feed to the headphones. This forms the basis of the most amplifier Oscillator common method for volume flow estimation using Doppler ultrasound. This signal. Figure 22 to those transmitted. for demodulator. they combine according to that of the oscillator: these are rejected by the their phase at the point of interception with.

The continuous wave method is also capable of very high sensitivity to weak signals. the electronic gate is generally placed after the Even where clutter is not a problem. and to employ a sufficiently high ultrasound frequency so that attenuation limits the penetration of the beam and hence the extent of the sensitive volume. Quadrature detection. the presence demodulator and is governed by these two delays. The length of time for which the received wave systems to be very helpful. For this reason most receive. The axial length of the sensitive volume instruments incorporate high-pass filters that help thus produced is determined by the length of time eliminate Doppler signals below a certain for which the gate is open. If the pulses are received in detector will be sensitive to any moving target sufficiently rapid succession. In practice. probes to be clipped onto vessels at surgery. The discrimination of a pulse-echo system. Should demodulator (which compares the phase of the there be moving solid structures as well as blood received pulse with that of the oscillator) consists (for example. Thus. although the range of their identification. the output of the within this volume that produces an echo. Figure 24 shows that predetermined frequency (typically 25-250 Hz). Transmit to the examination of superficial structures.5 mm and 15 mm. and are consequently Peter N Burns 18 . If these are simply an artery-vein pair (say emission of pulses and the operation of the delays the carotid artery and jugular vein). 7 MHz-10 MHz systems are often used without imaging for the examination of the carotid 2. so that it is Figure 23 The principle of the pulsed Doppler method. The preferred for the examination of smaller vessels range of the flow-sensitive volume is determined by the such as those found in the extremities. The return (Figure 23). Receive and superficial vessels of the limbs. Many configurations of the continuous wave transducer assembly have been made. there are usually sensitive volume itself is influenced by a variety of too many vessels present to allow continuous factors. This may be more than an range in tissue at which Doppler signals are inconvenience: if the dynamic range of the detected can be controlled simply by changing the receiver is limited. for example. low-frequency Doppler shifts are obtained signal can be synthesized. which may detection of a CW Doppler with the range be varied between about 1. transit time of the pulse in tissue. of several vessels within the sensitive volume which are under the control of the operator. The usual solution is to confine continuous wave techniques 1. The blood flow itself. as before. depend on the bursts of ultrasound are transmitted at regular ultrasound beam width. allowing. The same transducer is whose strength is much greater than that of the generally used for transmitting and receiving. however. The Pulsed Doppler Pulsed Doppler ultrasound combines the velocity gate is open determines its axial extent. from the pulsation of an arterial of a sequence of samples from which the Doppler wall). however. the form of the In the upper abdomen. with the result that part of the blood pulse before opening the gate that allows it to flow signal itself is lost.distance from the transducer face and extends to intervals and the echoes are demodulated as they the limit of the beams due to attenuation. the sample volume from the transducer is under the control of the operator. overloading of the demodulator length of time the system waits after sending a can occur. A gives rise to a superposition of several Doppler master clock ensures synchrony between the signals. Short lateral dimensions. resolution of the spectral display and the distinct produces a directional Doppler signal as the output characteristics of arterial and venous flow allow of the system. Wait 3. the directional and gates.

The output of (Figure 26). such as in the diagnosis of valvular stenosis in the heart. One is to themselves) or to resort to continuous wave simply increase the pulse repetition rate above the Doppler. The result is Headphones that the system produces an incorrect. Samples that are created rapidly when compared with the rate of variation of the T/R Transmit CLOCK Doppler shift signal itself have no problems: a switch gate perfectly good representation. Doppler. Judicious One fundamental shortcoming of the pulsed operation can manipulate this second sensitive Doppler system arises from the way in which the volume into a region from which no Doppler audible Doppler shift is in fact made from a large signals are anticipated to arise. The Doppler shift frequency. the angle of insonation and the depth from the range of depths of interest. which depend on the ultrasound the receive gate opens so as to accept only those echoes frequency. Echoes Doppler shift frequency. seen as a "folding over" clock determines the pulse repetition frequency. This fundamental limitation of the successive pulses is deposited in a sample and hold pulsed Doppler method imposes restrictions which circuit. a second sensitive with the location of the sample volume. or aliased. one of which is straightforward. In fact. thus forming the Doppler signal. As they emerge from the demodulator. the depth of Sample length Sample the target being interrogated for motion imposes a range Sample limit on the pulse repetition frequency: an & hold ultrasound pulse cannot normally be emitted before the last echo caused by the preceding pulse Filter has been received. The aliasing artifact received by the transducer are amplified and defines a set of absolute maximum velocities that demodulated to detect change in phase due to the it is possible to detect unambiguously using pulsed Doppler effect. occasions arise when the To spectrum Doppler shift frequency of the moving blood is analyzer above the Nyquist limit for the depth. Signals are obtained simultaneously from both locations. Other. thus volume is created. solutions to the problem of created each time an ultrasound pulse is received aliasing are to lower the ultrasound frequency by the transducer. which does not suffer from the aliasing limit imposed by the transit time of the ultrasonic limitation. In effect. Some scanners using electronic beam ambiguity as to the location of echoes received focusing adjust the focus of the beam to coincide when the gate is open.affected by the position of the sample volume in pulse to the target and back. This may remedy the the beam as well as the transducer frequency and aliasing of the Doppler signal but creates a new design. which of the spectral display. Figure 24 The single gate pulsed Doppler system. Various methods are (hence lowering the Doppler shift frequencies available for circumventing the problem. ultrasound beam. The clock initiates a the ambiguous relationship release of a burst of ultrasound produced by the between velocity of motion and the displayed oscillator as the transmit gate is opened. Peter N Burns 19 . sampling theory RF amp Demod- ulator shows that a signal can be reconstructed unambiguously from a sequence of samples as Transducer long as the frequency of the signal is no greater Receive Length Range than half the sampling rate (this is known as the gate delay delay Nyquist limit) (Figure 25). located somewhere along the influencing its lateral extent. for example of a 1- kHz Doppler shift signal can be made with the Oscillator 5000 samples per second obtained using a 5-kHz pulse repetition frequency. which now shows an might typically be 10 kHz. more number of discrete samples. are most severe when interrogating fast moving blood deep in tissue. Thus. However.

Generally. Manufacturers often address this problem by Max velocity m/sec increasing the power of the transmitted pulse. Note that this velocity is guidance to the structures in the region of the dependent on both the beam flow velocity angle and the sample volume. The 45° practical implication of this is that the highest 3 SPTA (spatial peak temporal average) exposure 30° intensities used in diagnostic ultrasound are 2 0° generally associated with pulsed Doppler systems. of real-time ultrasound imaging for such guidance. the combination of real-time imaging and Doppler techniques is referred to as duplex scanning. it must dwell for a much longer period in one orientation in order to Correct signal obtain Doppler information: a duplex scanner Aliased signal Samples at rate above nyquist frequency (no aliasing) Samples at rate below nyquist frequency (aliasing) rarely performs imaging and Doppler Figure 25 Aliasing. however. Peter N Burns 20 . then. in spite of the implication of its adequately sampled analog signal. it is not possible to switch between noise ratio of a pulsed system is inherently poorer imaging and Doppler modes very rapidly: the than that of a continuous wave system because of image is usually "frozen" on the screen while the its higher bandwidth. Because of rotational inertia to emit pulses of a higher average intensity than of mechanically steered systems such as that of their continuous wave counterparts. that is. Figure 26 Aliasing and the range velocity limit. pulsed Doppler instruments tend have been combined. machine aligns the beam in the appropriate direction and sets the range delays accordingly. At 5 Beam-flow angle comparable intensities. It is the 1 general experience. the real-time image is used to represent sampling at too low a rate to allow accurate select the location for interrogation with the reproduction of the analog signal. The smaller dots illustrate an simultaneously. These levels can be as great as 1 W/cm2. The signal-to- Figure 27a. The larger dots name. duplex scanners consist of a combination of real-time sector imaging and a pulsed Doppler. Shown in The Duplex Scanner this graph are the maximum velocities that it is possible to Control of the location of the sensitive volume in detect unambiguously using a 5 MHz pulsed Doppler tissue is of little use without some form of system at a given depth. Whereas the ultrasound beam moves rapidly in order to create a real-time image. operate in Doppler mode. that virtually all Doppler examinations. Figure 27 shows some typical configurations of real-time scanners with which Doppler methods Less obviously. As these dots are Doppler system and the scanner is switched to joined together. Narrowing this range improves signal-to-noise performance but degrades spatial resolution. pulsed Doppler systems generally offer a poorer signal-to-noise 60° Range-velocity limit: 5MHz 4 ratio. during which the frequency is produced. It is natural to contemplate the use operating frequency of the transducer. can be 0 2 4 6 8 10 12 14 performed successfully with modern instruments Depth cm at considerably lower exposure intensities. a signal of the incorrect. including those of small deep-lying vessels in the abdomen. Most commonly. or aliased. the pulses transmitted contain a wider range of ultrasound frequencies.

make the positioning of the Doppler volume Although this is sometimes at the expense of difficult. and possibly different frequencies. These might exploit the superior performance of a swept focus annular array for imaging and a single disk or dual element (for continuous wave) transducer for Doppler. advantages of the of the electronic sector and d: The curvilinear array. alternations as to allow real-time examination of b: The electronically steered sector scanner. some of them are able to use different transducers. delivering the transmit pulse to each of the elements in the group with very small successive delays. Using an array for the pulsed Doppler system allows electronic control of the lateral extent of the beam in the direction of Doppler is useful where there are slow movements the array elements. Because many mechanical scanners employ more than one transducer for imaging. Doppler signal is acquired. One ingenious approach to the implementation of such a method is to employ a number of elements within the linear array as a "phased" system. Typical combinations might be 7 MHz-10 MHz for imaging and 4-6 MHz for Doppler in the carotid. Doppler. Electronic arrays may also address the problem of the different optimum imaging and Doppler frequencies by employing sufficiently broadband transducers so that the two functions can be served by the same array operating at different frequencies. but places quite heavy (such as those of respiration or of a fetus) that can Peter N Burns 21 . the heart. Such systems may be used in the examination of the carotid and other superficial vessels lying parallel to the skin surface. or 5 MHz imaging together with 3 MHz Doppler in the abdomen. The agility of the beam produced by Figure 27 Four common configurations of the duplex such arrays is capable of providing imaging. scanner. The curvilinear array of Figure 27d is a c: The linear array with electronically steered Doppler useful compromise between the relative beam. for the two functions of Doppler interrogation and imaging. the facility of simultaneous imaging and The linear array configuration with an offset Cricket /mypsb{}Software  userdict currentpoint /newXScale /newYScale /psb /pse /mypsb /mypse store /psb /md newHeight /picOriginY pop /newHeight newWidth /pse load known{/CricketAdjust /newWidth {} defstore store/mypse 468 471 exch exch div exch div /pse def picOriginY def def /picOriginX picOriginX load true def def}{/CricketAdjust subsub exch def def pop def false def}ifelse Doppler is particularly useful when low angles of insonation are desired for vessels lying parallel to the transducer face. linear array duplex scanner. and M-mode functions at such rapid a: The mechanical sector scanner. Electronic sector scanners (Figure 27b) are capable of switching Figure 27a Duplex scan of ophthalmic artery between imaging and Doppler modes at a sufficiently high rate to permit real-time "duplex" imaging at a somewhat reduced frame rate. which have the effect of steering the Doppler beam in a direction that differs from that of the beams used for imaging (Figure 27c). signal-to-noise performance of the Doppler system.

. it is possible corresponding to a series of discrete depths. errors are associated with the measurement: the vessel axis may not lie exactly Oscillator within the scanned plane. .the velocity the angle between the ultrasound beam and the profile. it is easy to see how the measured. but also on the estimate of the variation of flow velocity across ultrasound frequency. As has already been sample volume. Many duplex systems are velocity profile in a carotid artery might operate at equipped to calculate velocity from Doppler shift 5 MHz and contain 16 or 32 gates. for example. each with its own receive gate providing a number of parallel Doppler outputs controlled by a different range delay... the error in amp ulator delays velocity estimation resulting from such an inaccuracy is strongly dependent on the beam- Transducer vessel angle itself. each frequency and hence allow for these factors. however. A typical system for measuring the direction of flow. Doppler system. several a number of parallel channels. however. the velocity of sound and the diameter of the vessel lumen... the vessel may be curved. Assuming that flow is parallel to the information from a multigate system could be used wall of the vessel (that there are not. Filter than Doppler shift frequency... velocity estimates eliminate one volumes factor that may vary between individual duplex Sample instruments... the Doppler shift frequency depends may be combined to yield an instantaneous not only on the velocity of flow. or the flow may not be aligned with the RF Demod- n range & length axis of the vessel.. even if a constant value of Sample Sample . varying with that the Doppler shift frequency. in another way: to map the extent of Doppler substantial helical components to flow).. then fed into some form of velocity estimator. Channel n The single range-gate system of Figure 24 is only Figure 28 The multigate Doppler system. velocity of sound and the frequency of the scanner are known and may be programmed into the Colour Flow Imaging machine. this angle Peter N Burns 22 .. Inevitably. large using such arrays have only become available blood vessel. Sample & hold & hold & hold & hold insonation is used in the examination. to produce a large number of Doppler signals simultaneously from different selected points along the ultrasound beam. The Doppler angle.. As discussed below. the range cells are arranged to be close to electronics. In Rx Rx Rx Rx correcting for the operating frequency of the gate gate gate n sample gate . If. gives the instantaneous A powerful advantage of the duplex system is that average Doppler shift frequency. the estimated velocity is a better parameter to report Filter Filter Filter . The Doppler signal from each gate is relatively recently.. may be measured directly from the ultrasound T/R Transmit switch gate CLOCK image.whose output it allows estimation of the velocity of flow from consists of a single number. The approximately 1 mm in axial length. The Multigate Pulsed System Channel 1 Channel 2 Channel 3 . The outputs from all the channels explained. Velocity should not be estimated when this angle is above 60°. must be Looking at Figure 28. In a typical demands on aspects of the performance (such as configuration for such a multigate system (Figure the dynamic range) of the beam-forming 28). Thus. The basic capable of detecting Doppler signals from one configuration of the pulsed Doppler is supplemented by sample volume at a time.. demodulator. for example.a device that. High-performance Doppler systems each other within the lumen of a single. each with an parallel channels are connected to the output of the independent control of the sample range and length..

where the latter has been Array delayed by a length of time equal to the interval Transducer between the two pulses. the output from the autocorrelation detector is zero. a very large number of parallel parameter (for example. However. What is Scan Converter required is a method for obtaining not necessarily Digital the Doppler signal itself. a simple calculation shows that the beam This is the principle of colour flow mapping. A number of parallel channels in a multigate system Figure 30 Colour Doppler image of the common is. the ultrasound beam must remain stationary for an appreciable length of time (typically about 10 ms) while Doppler information is collected and the signal constituted from the series of sample phase measurements made by the demodulator. the electronically over the field of view. and a sufficient as to form an image rapidly enough to be part of a number of range gates to map a single Doppler real-time system. The Flow detector System autocorrelation detector serves precisely this function. say. from the entire Color Display length of the scan line quickly and simultaneously Doppler Pulse-echo Autocorrelation Duplex without the use of parallel channels. the average Doppler shift channels must be used. with the the scan line simultaneously. would not be practical. It is prohibitively frequency) from near the transducer face to the expensive in hardware and software to deepest point in each scan line. In a typical display.signals obtained over an entire cross-sectional from each of its range gates in the same period of image. autocorrelation detector produces Doppler information with which to encode the image in colour. Electronic The autocorrelation processor is a form of Doppler Beam detector that is capable of processing an entire line Former of echo data derived from the quadrature demodulator echoes of one pulse with that derived Steered from the previous pulse. At the same time. Even if this were different velocities encoded using a colour scale. of course. but could not dwell for 10 ms on each line and still produce a real-time Doppler image. The problem is time. the Doppler information could be obtain Doppler signals from the entire length of superimposed on the real-time image. possible. flow towards the probe is represented in hues of red and flow away from the probe in hues of blue. As has been stated. If there are not gray scale real-time display by manipulating the beam moving structures giving rise to the echoes. All that would be required is a scanning time. If a duplex system manufacture the. 128 channels required to were to be used. The array imaging system produces a phase due to the Doppler shift. The result is that the two Figure 29 The major components of a colour flow streams of echoes are "compared" for changes in mapping system. but an estimate of a & control Image Formatter Doppler parameter such as the instantaneous average Doppler shift frequency. capable of obtaining this information carotid artery and jugular vein Peter N Burns 23 . although possible. its implementation using such a system. in order to obtain Doppler arrangement capable of steering the Doppler beam information along a large number of scan lines so and registering its direction.

Therefore. spectrum. Indeed. generally ULTRASOUND EXPOSURE between four and eight pulses might be used. target area for a longer period than for imaging. This uncertainty has become more and appealing way. if any. the detected. but scanners than in most imaging instruments.e. One does not describe. Given its known benefits and time over which the Doppler signals are sampled recognized efficacy for medical diagnosis. The agility of the examination each year. One requirement of a colour flow mapping that the benefits to patients of the prudent use of system is that the beam remains stationary for a ultrasound outweigh the risks. longer scanning times per line American Institute of Ultrasound in Medicine of colour data leave less time to create each frame herein addresses the clinical safety of such use: of the colour image. it seems likely that spectral but some pulsed Doppler systems are known to analysis should remain an essential component of deliver SPTA intensities as high as 1. sometimes for a period of minutes. the beam must be stationary instruments offer the flow mapping facility as an during a Doppler examination will 'dwell' on a addition to. per line. The superposition of flow uncertainty as to the nature of potential risk to information as colours on a gray scale real-time living tissue during a clinical ultrasound image presents the Doppler information in a novel examination. The longer the length of than 40 years. In addition.000 to 2. Finally. moves to the next scan line and present" remains stationary there. These systems are clearly pronounced with the advent of pulsed Doppler well-suited to identifying the location of high. An important aspect of the performance of a moving American Institute of Ultrasound in Medicine target indicator is its ability to detect the tiny (AIUM) Statement on clinical safety: changes in phase between the Doppler samples from successive pulses which correspond to "Diagnostic ultrasound has been in use for more slowly moving targets. that may be brief time. present colour mW/cm2. current data indicate 29). The problem of clutter is crucial in such a system because the very large No confirmed biological effects on patients or echoes from solid structures moving slowly can instrument operators caused by exposures at inhibit the detection of the weaker Doppler shifted intensities typical of present diagnostic echoes from moving blood. the intensity averaged over time (the Spatial Peak Doppler information presented is that of a single Temporal Average intensity. the acoustic the extent of flow in a certain region. the method is sometimes referred conventional duplex scanning and spectral to as a "moving target indicator. Although over one million pregnant women now the flow mapping function must be alternated with receive at least one diagnostic ultrasound imaging conventional imaging.000 most Doppler examinations. However.For this reason. Second. There are several velocity flow (such as in a stenosis) or of mapping possible reasons for this. device is capable in principle of yielding the instantaneous Doppler shift along a whole scan line after only three pulses (i.. there is still some colour flow mapping. Colour flow mapping instruments have ever been reported. the smaller the Doppler shift that can be including use during human pregnancy. methods. it is Peter N Burns 24 . less than 1 ms at a SAFETY AND BIOLOGICAL EFFECTS OF pulse repetition frequency of 4 kHz). including colour. SPTA) is considerably parameter encoded in colour. whether or not colour flow mapping is included. However. a parameter whose higher in pulsed Doppler mode with many duplex value is changing rapidly and is derived from. and several hundred electronically switched beam of a linear array (or a investigations of bioeffects on plant and animal hybrid of the two) is therefore ideally suited to tissue have been undertaken. Although the systems employ digitally controlled filters possibility exists that such biological effects may designed to eliminate the effect of clutter (Figure be identified in the future. rather than a replacement of. First. and so on. the full Doppler frequency survey reports values up to 750 mW/cm2 ISPTA." Although such a analysis.

it is our experience that all obstetrical by physiological factors such as local blood flow. concern over the use of Doppler in These are found in continuous-wave but not some clinical applications has been a consequence pulsed Doppler systems. At present. Although fetal tissue is sensitive to they are marketed in the United States. minimized without prejudice to diagnostic quality. Furthermore. and Doppler has begun to exposure time. for pulsed Doppler. however. so that if there is a subject of the 'output labeling' standard currently risk it will be greater for ultrasound imaging than proposed by the AIUM and the FDA. Finally. at exposure levels below those of ultrasonic fetal Such stable cavitation can modify cell function or heart monitors now in routine use.Food and Drug the possibility of subtle effects on tissue from Administration approved the marketing of a ultrasound exposure. SPTP) intensities. In summary. Local temperature rise will increase Doppler system to the desired level. it remains prudent single-gate pulsed Doppler duplex system for fetal to employ as low an ultrasound intensity and as use. those of the fetus are centers on the possibility of temperature rise in likely to be among the most sensitive to biological tissue. Doppler examinations can be performed easily at SPTA exposure levels of less than 100 mW/cm2 Nonthermal effects in tissue can be caused by the without noticeable loss of signal quality. Fortunately. As long as there is fetus.widely felt that of all tissues. the FDA requires with higher frequencies associated with more rapid calibration of all ultrasound instruments before absorption. pulsed Doppler systems are able to function well stimulated by the presence of the ultrasound field. adjusting the output of such systems to as low a spatial peak temporal peak. it is generally assumed that induced data are known by the manufacturer and should be temperature changes that are less than those of made available to the user. Sensitive growth of oscillating microbubbles in tissue fluids. With the help of these. that concern over the use of pulsed Doppler systems in the fetus Peter N Burns 25 . procedure. bringing questions to many users’ minds as to short an examination time as are consistent with whether this modality is indeed safe for clinical obtaining clinically useful data. production is affected by the tissue type as well as Calibration of machine intensity is not a trivial the form and frequency of the ultrasound beam. conventional imaging employs higher SPTP Precisely how such levels can be minimized is the intensities than pulsed Doppler. value as possible and reducing Doppler Transient cavitation is not known to take place in examination time. the is a consequence of the progressive absorption of exposure level of all examinations is limited to ultrasound energy as it travels through tissue. By but can only occur at high instantaneous (that is. By reducing both SPTA intensity and effects of ultrasound. there use. have been no independently confirmed significant biological effects noted in mammalian tissues There are two classes of interaction of ultrasound exposed to ultrasound SPTA intensities below 100 with tissue that it is relevant to consider.S. It would be fair to conclude. such potential risk may be tissue at diagnostic intensities. Using modern with the SPTA intensity but will also be affected machines. the likelihood of such an effect play a part in the ultrasound examination of the taking place can be minimized. destroy cells. Heating mW/cm2 At this and many other institutions. so these heat. the potentially of the relatively high acoustic output of some more dangerous phenomenon of transient duplex scanners designed for peripheral vascular cavitation is certainly capable of destroying tissue use rather than of any known risk of hazard. stable cavitation requires relatively long "on" times of the ultrasonic field. Heat below this value. normal diurnal variation (about 1°C) are of no it is a simple matter to reduce the output of the consequence. then. However. Only recently has the U.

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