Medical Ultrasound - Wikipedia

1/27/2021 Medical ultrasound - Wikipedia
Medical ultrasound
Medical ultrasound (also known as diagnostic
sonography or ultrasonography) is a diagnostic imaging Medical ultrasound
technique, or therapeutic application of ultrasound. It is used
to create an image of internal body structures such as
tendons, muscles, joints, blood vessels, and internal organs.
Its aim is often to find a source of a disease or to exclude
pathology. The practice of examining pregnant women using
ultrasound is called obstetric ultrasound, and was an early
development and application of clinical ultrasonography.
Ultrasound are sound waves with frequencies which are

higher than those audible to humans (>20,000 Hz).
Ultrasonic images, also known as sonograms, are made by
sending pulses of ultrasound into tissue using a probe. The Sonographer doing echocardiography on a
ultrasound pulses echo off tissues with different reflection child
properties and are recorded and displayed as an image.
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Many different types of images can be formed. The most PCS
common is a B-mode image (Brightness), which displays the ICD-9- 88.7 (http://icd9cm.chrisendres.c
acoustic impedance of a two-dimensional cross-section of CM om/index.php?srchtype=procs&s
tissue. Other types can display blood flow, motion of tissue
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over time, the location of blood, the presence of specific
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molecules, the stiffness of tissue, or the anatomy of a three-
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Compared to other dominant methods of medical imaging,
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ultrasound has several advantages. It provides images in
real-time and is portable and can be brought to the bedside.
It is substantially lower in cost than other imaging modalities and
does not use harmful ionizing radiation. Drawbacks include various
limits on its field of view, such as the need for patient cooperation,
dependence on physique, difficulty imaging structures behind bone
and air or gases,[note 1] and the necessity of a skilled operator,
usually trained professional.
Contents
By organ or system
Anesthesiology
Angiology (vascular) Ultrasound of carotid artery
Cardiology (heart)
Emergency medicine
Gastroenterology/Colorectal surgery
Gynecology and obstetrics
https://en.wikipedia.org/wiki/Medical_ultrasound 1/30
Hemodynamics (blood circulation)

Otolaryngology (head and neck)
Neonatology
Ophthalmology (eyes)
Pulmonology (lungs)
Lung ultrasound basics
Lung pathology assessed with ultrasound
Urinary tract
Penis and scrotum
Musculoskeletal
Kidneys
From sound to image
Producing a sound wave
Receiving the echoes
Forming the image
Displaying the image
Sound in the body
Modes
Expansions
Doppler ultrasonography
Contrast ultrasonography (ultrasound contrast imaging)
Molecular ultrasonography (ultrasound molecular imaging)
Elastography (ultrasound elasticity imaging)
Interventional ultrasonography
Compression ultrasonography
Panoramic ultrasonography
Attributes
Strengths
Weaknesses
Risks and side-effects
Studies on the safety of ultrasound
Regulation
History
France
Scotland
Sweden
United States
Manufacturers
See also
Notes
References
External links
By organ or system
Sonography (ultrasonography) is widely used in medicine. It is
possible to perform both diagnosis and therapeutic procedures,
using ultrasound to guide interventional procedures such as biopsies
or to drain collected fluid. Sonographers are medical professionals
who perform scans which are then traditionally interpreted by
radiologists, physicians who specialize in the application and
interpretation of a wide variety of medical imaging modalities, or by
cardiologists in the case of cardiac ultrasonography
(echocardiography). Increasingly, clinicians (physicians and other
healthcare professionals who provide direct patient care) are using
the ultrasound in office and hospital practice (point-of-care
ultrasound).
Sonography is effective for imaging soft tissues of the body.

Superficial structures such as muscle, tendon, testis, breast, thyroid
and parathyroid glands, and the neonatal brain are imaged at a
higher frequency (7–18 MHz), which provides better linear (axial)
and horizontal (lateral) resolution. Deeper structures such as liver An ultrasound result in a piece of
and kidney are imaged at a lower frequency 1–6 MHz with lower paper.
axial and lateral resolution as a price of deeper tissue penetration.
A general-purpose ultrasound transducer may be used for most imaging purposes but specialty
applications may require the use of a specialty transducer. Most ultrasound procedures are done using a
transducer on the surface of the body, but improved diagnostic confidence is often possible if a
transducer can be placed inside the body. For this purpose, specialty transducers, including endovaginal,
endorectal, and transesophageal transducers are commonly employed. At the extreme, very small
transducers can be mounted on small diameter catheters and placed into blood vessels to image the walls
and disease of those vessels.
Anesthesiology
In anesthesiology, ultrasound is commonly used to guide the placement of needles when placing local
anaesthetic solutions near nerves. It is also used for vascular access such as central venous cannulation
and difficult arterial cannulation. Transcranial Doppler is frequently used by neuro-anesthesiologists for
obtaining information about flow-velocity in the basal cerebral vessels.
Angiology (vascular)
In angiology or vascular medicine, duplex ultrasound (B Mode imaging combined with Doppler flow
measurement) is used to diagnose arterial and venous disease. This is particularly important in
neurology, where carotid ultrasound is used for assessing blood flow and stenoses in the carotid arteries,
and transcranial Doppler is used for imaging flow in the intracerebral arteries.
Intravascular ultrasound (IVUS) uses a specially designed catheter, with a miniaturized ultrasound
probe attached to its distal end, which is then threaded inside a blood vessel. The proximal end of the
catheter is attached to computerized ultrasound equipment and allows the application of ultrasound
technology, such as piezoelectric transducer or CMUT, to visualize

the endothelium (inner wall) of blood vessels in living individuals.[1]
In the case of the common and potentially, serious problem of blood

clots in the deep veins of the leg, ultrasound plays a key diagnostic
role, while ultrasonography of chronic venous insufficiency of the
legs focuses on more superficial veins to assist with planning of
Intravascular ultrasound image of a
suitable interventions to relieve symptoms or improve cosmetics.
coronary artery (left), with color-
coding on the right, delineating the
lumen (yellow), external elastic
Cardiology (heart)
membrane (blue) and the
atherosclerotic plaque burden
Echocardiography is an essential tool in cardiology, assisting in (green).
evaluation of heart valve function, such as stenosis or insufficiency,
and strength of cardiac muscle contraction. such as hypertrophy or
dilatation of the main chambers. (ventricle and atrium)
Emergency medicine
Point of care emergency ultrasound has many applications in

emergency medicine. This includes differentiating cardiac causes of
acute breathlessness from pulmonary causes, and the Focused
Assessment with Sonography for Trauma (FAST) exam for assessing
significant hemoperitoneum or pericardial tamponade after trauma.
Ultrasound of human heart showing
Other uses include assisting with differentiating causes of abdominal
the four chambers and mitral and
pain such as gallstones and kidney stones. Emergency Medicine
tricuspid valves.
Residency Programs have a substantial history of promoting the use
of bedside ultrasound during physician training.
Gastroenterology/Colorectal surgery
Abdominal and endoanal ultrasound are frequently used in gastroenterology and colorectal surgery. In
abdominal sonography, the solid organs of the abdomen such as the pancreas, aorta, inferior vena cava,
liver, gall bladder, bile ducts, kidneys, and spleen are imaged. However, sound waves are blocked by gas
in the bowel and attenuated to differing degrees by fat, sometimes limiting diagnostic capabilities in this
area. The appendix can sometimes be seen when inflamed (as in e.g.: appendicitis) and ultrasound is the
initial imaging choice, avoiding unnecessary radiation, although it frequently needs to be followed by
other imaging methods such as CT. Endoanal ultrasound is used particularly in the investigation of
anorectal symptoms such as fecal incontinence or obstructed defecation. It images the immediate
perianal anatomy and is able to detect occult defects such as tearing of the anal sphincter.
Ultrasonography of liver tumors allows for both detection and characterization.
Gynecology and obstetrics
Gynecologic ultrasonography examines female pelvic organs (specifically the uterus, ovaries, and
Fallopian tubes) as well as the bladder, adnexa, and Pouch of Douglas. It commonly uses transducers
designed for approaches through the lower abdominal wall, curvilinear and sector, and specialty
transducers such as endovaginal.
Obstetrical sonography was originally developed in the late 1950s

and 1960s by Sir Ian Donald and is commonly used during
pregnancy to check on the development and presentation of the
fetus. It can be used to identify many conditions that could be
potentially harmful to the mother and/or baby possibly remaining
undiagnosed or with delayed diagnosis in the absence of
sonography. It is currently believed that the risk of leaving these
conditions undiagnosed is greater than the small risk, if any,
associated with undergoing an ultrasound scan. But its use for non-
medical purposes such as fetal "keepsake" videos and photos is
discouraged.[4] Orthogonal planes of a 3
dimensional sonographic volume
Obstetric ultrasound is primarily used to: with transverse and coronal
measurements for estimating fetal
Date the pregnancy (gestational age) cranial volume.[2][3]
Confirm fetal viability
Determine location of fetus, intrauterine vs ectopic
Check the location of the placenta in relation to the cervix
Check for the number of fetuses (multiple pregnancy)
Check for major physical abnormalities.
Assess fetal growth (for evidence of intrauterine growth restriction (IUGR))
Check for fetal movement and heartbeat.
Determine the sex of the baby
According to the European Committee of Medical Ultrasound Safety (ECMUS)[5]
Ultrasonic examinations should only be performed by competent personnel who are trained
and updated in safety matters. Ultrasound produces heating, pressure changes and
mechanical disturbances in tissue. Diagnostic levels of ultrasound can produce temperature
rises that are hazardous to sensitive organs and the embryo/fetus. Biological effects of non-
thermal origin have been reported in animals but, to date, no such effects have been
demonstrated in humans, except when a micro-bubble contrast agent is present.
Nonetheless, care should be taken to use low power settings and avoid pulsed wave scanning of the fetal
brain unless specifically indicated in high risk pregnancies.
Ultrasound scanners have different Doppler-techniques to visualize arteries and veins. The most
common is color Doppler or power Doppler, but also other techniques like b-flow are used to show blood
flow in an organ. By using pulsed wave Doppler or continuous wave Doppler blood flow velocities can be
calculated.
Figures released for the period 2005–2006 by the UK Government (Department of Health) show that
non-obstetric ultrasound examinations constituted more than 65% of the total number of ultrasound
scans conducted.
Hemodynamics (blood circulation)
Blood velocity can be measured in various blood vessels, such as middle cerebral artery or descending
aorta, by relatively inexpensive and low risk ultrasound Doppler probes attached to portable monitors.[6]
These provides non-invasive or transcutaneous (non-piecing) minimal invasive blood flow assessment.
Common examples are, Transcranial Doppler, Esophogeal Doppler and Suprasternal Doppler.
Otolaryngology (head and neck)
Most structures of the neck, including the thyroid and parathyroid

glands, lymph nodes, and salivary glands, are well-visualized by
high-frequency ultrasound with exceptional anatomic detail.
Ultrasound is the preferred imaging modality for thyroid tumors and
lesions, and ultrasonography is critical in the evaluation,
preoperative planning, and postoperative surveillance of patients
with thyroid cancer. Many other benign and malignant conditions in
the head and neck can be evaluated and managed with the help of
diagnostic ultrasound and ultrasound-guided procedures.
Neonatology Neck ultrasound.
In neonatology, transcranial Doppler can be used for basic

assessment of intracerebral structural abnormalities, bleeds, ventriculomegaly or hydrocephalus and
anoxic insults (Periventricular leukomalacia). The ultrasound can be performed through the soft spots in
the skull of a newborn infant (Fontanelle) until these completely close at about 1 year of age and form a
virtually impenetrable acoustic barrier for the ultrasound. The most common site for cranial ultrasound
is the anterior fontanelle. The smaller the fontanelle, the poorer the quality of the picture.
Ophthalmology (eyes)
In ophthalmology and optometry, there are two major forms of eye exam using ultrasound:
A-scan ultrasound biometry, commonly referred to as an A-scan (short for Amplitude scan). It is an
A-mode that provides data on the length of the eye, which is a major determinant in common sight
disorders, especially for determining the power of an intraocular lens after cataract extraction.
B-scan ultrasonography, or B-scan, which is a B-mode scan that produces a cross-sectional view of
the eye and the orbit. It is commonly used to see inside the eye when media is hazy due to cataract
or any corneal opacity.
Pulmonology (lungs)
Modern ultrasound is used to assess the lungs in a variety of settings including critical care, emergency
medicine, trauma surgery, as well as internal medicine. This imaging modality is used at the bedside to
evaluate a number of different lung abnormalities as well as to guide procedures such as thoracentesis,
pleural drainage, needle aspiration biopsy, and catheter placement.[7]
Lung ultrasound basics

The Normal Lung Surface: The lung surface is made up by the visceral pleura and the parietal
pleura. These two surfaces are typically pushed together and make up the pleural line, which is the
basis of lung ultrasound. This line is visible less than a centimeter below the rib line in most adults.
On ultrasound, it is visualized as a hyperechoic horizontal line if the ultrasound probe is applied
perpendicularly to the skin.
Artifacts: Lung ultrasound relies on artifacts, which are usually considered a hindrance in this type
of imaging. Air blocks the ultrasound beam and thus visualizing healthy lung tissue itself with this
mode of imaging is difficult. Consequently, physicians and sonographers have learned to recognize
the patterns that ultrasound beams create when imaging healthy and diseased lung tissue. Three
commonly seen and utilized artifacts in lung ultrasound include lung sliding, A-lines, and B-lines.[8]
§ Lung Sliding: The presence of lung sliding, which indicates the shimmering of the pleural line
that occurs with movement of the visceral and parietal pleura against one another that occurs
with respiration, is the most important finding in normal aerated lung.[9] Lung sliding indicates
both that the lung is present at the chest wall and that the lung is functioning.[8]
§ A-lines: When the ultrasound beam makes contact with the pleural line, it is reflected back
and thus creates a bright white horizontal line. The subsequent reverberation artifacts that
appear as equally spaced horizontal lines deep to the pleura are A-lines. Ultimately, A-lines are a
reflection of the ultrasound beam off of the pleura with the space between A-lines corresponding
to the distance between the parietal pleura and the skin surface.[8] A-lines indicate the presence
of air, which means that these artifacts can be present in normal healthy lung and also in patients
with pneumothorax.[9]
§ B-lines: B-lines are reverberation artifacts. They can be visualized as hyperechoic vertical
lines extending from the pleura to the edge of the ultrasound screen. These lines are sharply
defined and laser-like and they typically do not fade as they progress down the screen.[8] A few
B-lines that move along with the sliding pleura can be seen in normal lung due to acoustic
impedance differences between water and air. However, excessive B-lines are abnormal and are
typically indicative of underlying lung pathology.[9]
Lung pathology assessed with ultrasound

Pulmonary edema: Lung ultrasound is a diagnostic imaging methodology that has been shown to
be very sensitive for the detection of pulmonary edema. When used in combination with
echocardiography, it allows for the improvement in diagnosis and management of critically ill patients
with this condition. The sonographic feature that is present in pulmonary edema is B-lines. B-lines
can occur in a healthy lung; however, the presence of 3 or more B-lines in the anterior or lateral lung
regions is always abnormal. In pulmonary edema, B-lines indicate an increase in the amount of
water contained in the lungs outside of the pulmonary vasculature. B-lines can also be present in a
number of other conditions including unilateral pneumonia, pulmonary contusion, and lung
infarction.[10] Additionally, it is important to note that there are multiple types of interactions between
the pleural surface and the ultrasound wave that could generate artifacts similar to B-lines.[11]
Pneumothorax: In clinical settings when pneumothorax is suspected, lung ultrasound can be used
to aid in diagnosis.[12] In pneumothorax, air is present between the two layers of the pleura and lung
sliding on ultrasound is therefore absent. The negative predictive value for lung sliding on ultrasound
is reported as 99.2–100%, which indicates that if lung sliding is present, a pneumothorax is
effectively ruled out.[9] The absence of lung sliding, however, is not necessarily specific for
pneumothorax as there are several other conditions that also cause this ultrasound finding. Some of
these conditions include acute respiratory distress syndrome, lung consolidations, pleural adhesions,
and pulmonary fibrosis.[9]
Pleural effusion: Lung ultrasound is a cheap, safe, and non-invasive imaging method that can aid in
the prompt diagnosis and visualization pleural effusions. Pleural effusions can be diagnosed via the
physical exam, percussion, and auscultation of the chest. However, these exam techniques can be
complicated by a variety of factors including the presence of mechanical ventilation, obesity, or
patient positioning. Consequently, lung ultrasound can be an additional tool to augment plain chest
Xray and chest CT.[13] Pleural effusions on ultrasound appear as a structural image within the thorax
and not an artifact. They will typically have four distinct borders including the pleural line, two rib
shadows, and a deep border.[8] In critically ill patients with pleural effusion, ultrasound can be a
helpful tool that may be used during several different procedures including needle insertion,
thoracentesis, and chest-tube insertion.[13]
Lung cancer staging: In pulmonology, endobronchial ultrasound (EBUS) probes are applied to
standard flexible endoscopic probes and used by pulmonologists to allow for direct visualization of
endobronchial lesions and lymph nodes prior to transbronchial needle aspiration. Among its many
uses, EBUS aids in lung cancer staging by allowing for lymph node sampling without the need for
major surgery.[14]
Urinary tract
Ultrasound is routinely used in urology to determine, for example,

the amount of fluid retained in a patient's bladder. In a pelvic
sonogram, organs of the pelvic region are imaged. This includes the
uterus and ovaries or urinary bladder. Males are sometimes given a
pelvic sonogram to check on the health of their bladder, the prostate,
or their testicles (for example to distinguish epididymitis from
testicular torsion). In young males, it is used to distinguish more
benign testicular masses (varicocele or hydrocele) from testicular
cancer, which is highly curable but which must be treated to
preserve health and fertility. There are two methods of performing a
pelvic sonography – externally or internally. The internal pelvic
sonogram is performed either transvaginally (in a woman) or
transrectally (in a man). Sonographic imaging of the pelvic floor can
produce important diagnostic information regarding the precise
relationship of abnormal structures with other pelvic organs and it
represents a useful hint to treat patients with symptoms related to
pelvic prolapse, double incontinence and obstructed defecation. It is
used to diagnose and, at higher frequencies, to treat (break up)
kidney stones or kidney crystals (nephrolithiasis).[15]
Urinary bladder (black butterfly-like
shape) and hyperplastic prostate
Penis and scrotum (BPH) visualized by medical
sonographic technique
Scrotal ultrasonography is used in the evaluation of testicular pain,
and can help identify solid masses.[16]
Ultrasound is an excellent method for the study of the penis, such as indicated in trauma, priapism,
erectile dysfunction or suspected Peyronie's disease.[17]
Musculoskeletal
Musculoskeletal ultrasound in used to examine tendons, muscles, nerves, ligaments, soft tissue masses,
and bone surfaces. [18] It is very helpful in diagnosing ligament sprains, muscles strains and joint
pathology. Ultrasound is an alternative to x-ray imaging in detecting fractures of the wrist, elbow and
shoulder for patients up to 12 years (Fracture sonography).
Quantitative ultrasound is an adjunct musculoskeletal test for myopathic disease in children;[19][20]

estimates of lean body mass in adults;[21] proxy measures of muscle quality (i.e., tissue composition)[22]
in older adults with sarcopenia[23][24]
Ultrasound can also be used for guidance in muscle or joint injections, such as in ultrasound-guided hip
joint injection.
Kidneys
In nephrology, ultrasonography of the kidneys is essential in the diagnosis and management of kidney-
related diseases. The kidneys are easily examined, and most pathological changes in the kidneys are
distinguishable with ultrasound. US is an accessible, versatile, inexpensive, and fast aid for decision-
making in patients with renal symptoms and for guidance in renal intervention.[25] Renal ultrasound
(US) is a common examination, which has been performed for decades. Using B-mode imaging,
assessment of renal anatomy is easily performed, and US is often used as image guidance for renal
interventions. Furthermore, novel applications in renal US have been introduced with contrast-
enhanced ultrasound (CEUS), elastography and fusion imaging. However, renal US has certain
limitations, and other modalities, such as CT (CECT) and MRI, should always be considered as
supplementary imaging modalities in the assessment of renal disease.[25]
From sound to image

The creation of an image from sound is done in three steps – producing a sound wave, receiving echoes,
and interpreting those echoes.
Producing a sound wave
A sound wave is typically produced by a piezoelectric transducer

encased in a plastic housing. Strong, short electrical pulses from the
ultrasound machine drive the transducer at the desired frequency.
The frequencies can be anywhere between 1 and 18 MHz, though
frequencies up to 50–100 megahertz have been used experimentally
in a technique known as biomicroscopy in special regions, such as
the anterior chamber of the eye.[26] Older technology transducers
focused their beam with physical lenses. Newer technology
transducers use digital antenna array techniques to enable the
ultrasound machine to change the direction and depth of focus.
The sound is focused either by the shape of the transducer, a lens in

front of the transducer, or a complex set of control pulses from the
ultrasound scanner, in the (beamforming) technique. This focusing
produces an arc-shaped sound wave from the face of the transducer.
The wave travels into the body and comes into focus at a desired
depth.
Materials on the face of the transducer enable the sound to be Medical ultrasound scanner
transmitted efficiently into the body (often a rubbery coating, a form
of impedance matching). In addition, a water-based gel is placed
between the patient's skin and the probe.
The sound wave is partially reflected from the layers between different tissues or scattered from smaller
structures. Specifically, sound is reflected anywhere where there are acoustic impedance changes in the
body: e.g. blood cells in blood plasma, small structures in organs, etc. Some of the reflections return to
the transducer.
Receiving the echoes
The return of the sound wave to the transducer results in the same process as sending the sound wave,
except in reverse. The returned sound wave vibrates the transducer and the transducer turns the
vibrations into electrical pulses that travel to the ultrasonic scanner where they are processed and
transformed into a digital image.
Forming the image
To make an image, the ultrasound scanner must determine two things from each received echo:
1. How long it took the echo to be received from when the sound was transmitted.
2. How strong the echo was.
Once the ultrasonic scanner determines these two things, it can locate which pixel in the image to light
up and to what intensity.
Transforming the received signal into a digital image may be explained by using a blank spreadsheet as
an analogy. First picture a long, flat transducer at the top of the sheet. Send pulses down the 'columns' of
the spreadsheet (A, B, C, etc.). Listen at each column for any return echoes. When an echo is heard, note
how long it took for the echo to return. The longer the wait, the deeper the row (1,2,3, etc.). The strength
of the echo determines the brightness setting for that cell (white for a strong echo, black for a weak echo,
and varying shades of grey for everything in between.) When all the echoes are recorded on the sheet, we
have a greyscale image.
Displaying the image
Images from the ultrasound scanner are transferred and displayed using the DICOM standard.
Normally, very little post processing is applied to ultrasound images.
Sound in the body

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 Linear array transducer
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.
The frequencies used for medical imaging are generally in the range of 1 to 18 MHz. Higher frequencies
have a correspondingly smaller wavelength, and can be used to make sonograms with smaller details.
However, the attenuation of the sound wave is increased at higher frequencies, so in order to have better
penetration of deeper tissues, a lower frequency (3–5 MHz) is used.
Seeing deep into the body with sonography is very difficult. Some acoustic energy is lost every time an
echo is formed, but most of it (approximately ) is lost from acoustic absorption. (See
also Acoustic attenuation for further details on modeling of acoustic attenuation and absorption.)
The speed of sound varies as it travels through different materials, and is dependent on the acoustical
impedance of the material. However, the sonographic instrument assumes that the acoustic velocity is
constant at 1540 m/s. An effect of this assumption is that in a real body with non-uniform tissues, the
beam becomes somewhat de-focused and image resolution is reduced.
To generate a 2-D image, the ultrasonic beam is swept. A transducer may be swept mechanically by
rotating or swinging. Or a 1-D phased array transducer may be used to sweep the beam electronically.
The received data is processed and used to construct the image. The image is then a 2-D representation
of the slice into the body.
3-D images can be generated by acquiring a series of adjacent 2-D images. Commonly a specialized
probe that mechanically scans a conventional 2-D image transducer is used. However, since the
mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2-D phased
array transducers that can sweep the beam in 3-D have been developed. These can image faster and can
even be used to make live 3-D images of a beating heart.
Doppler ultrasonography is used to study blood flow and muscle motion. The different detected speeds
are represented in color for ease of interpretation, for example leaky heart valves: the leak shows up as a
flash of unique color. Colors may alternatively be used to represent the amplitudes of the received
echoes.
Modes
Several modes of ultrasound are used in medical imaging.[27][28] These are:
A-mode: A-mode (amplitude mode) is the simplest type of ultrasound. A single transducer scans a
line through the body with the echoes plotted on screen as a function of depth. Therapeutic
ultrasound aimed at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus
of the destructive wave energy.
B-mode or 2D mode: In B-mode (brightness mode) ultrasound, a linear array of transducers
simultaneously scans a plane through the body that can be viewed as a two-dimensional image on
screen. More commonly known as 2D mode now.
B-flow is a mode that digitally highlights moving reflectors (mainly red blood cells) while
suppressing the signals from the surrounding stationary tissue. It can visualize flowing blood
and surrounding stationary tissues simultaneously.[29] It is thus an alternative or complement to
Doppler ultrasonography in visualizing blood flow.[30]
C-mode: A C-mode image is formed in a plane normal to a B-

mode image. A gate that selects data from a specific depth from
an A-mode line is used; then the transducer is moved in the 2D
plane to sample the entire region at this fixed depth. When the
transducer traverses the area in a spiral, an area of 100 cm2 can
be scanned in around 10 seconds.[28]
M-mode: In M-mode (motion mode) ultrasound, pulses are
emitted in quick succession – each time, either an A-mode or B-
mode image is taken. Over time, this is analogous to recording a B-flow image of venous reflux.
video in ultrasound. As the organ boundaries that produce
reflections move relative to the probe, this can be used to
determine the velocity of specific organ structures.
Doppler mode: This mode makes use of the Doppler effect in measuring and visualizing blood flow
Color Doppler: Velocity information is presented as a color-coded overlay on top of a B-mode
image
Continuous wave (CW) Doppler: Doppler information is sampled along a line through the body,
and all velocities detected at each time point are presented (on a time line)
Pulsed wave (PW) Doppler: Doppler information is sampled from only a small sample volume
(defined in 2D image), and presented on a timeline
Duplex: a common name for the simultaneous presentation of 2D and (usually) PW Doppler
information. (Using modern ultrasound machines, color Doppler is almost always also used;
hence the alternative name Triplex.)
Pulse inversion mode: In this mode, two successive pulses with opposite sign are emitted and then
subtracted from each other. This implies that any linearly responding constituent will disappear while
gases with non-linear compressibility stand out. Pulse inversion may also be used in a similar
manner as in Harmonic mode; see below:
Harmonic mode: In this mode a deep penetrating fundamental frequency is emitted into the body
and a harmonic overtone is detected. This way noise and artifacts due to reverberation and
aberration are greatly reduced. Some also believe that penetration depth can be gained with
improved lateral resolution; however, this is not well documented.
Expansions
An additional expansion or additional technique of ultrasound is bi-planar ultrasound, in which the
probe has two 2D planes that are perpendicular to each other, providing more efficient localization and
detection.[31] Furthermore, an omniplane probe is one that can rotate 180° to obtain multiple
images.[31] In 3D ultrasound, many 2D planes are digitally added together to create a 3-dimensional
image of the object.
Doppler ultrasonography
Doppler ultrasonography employs the Doppler effect to assess whether structures (usually blood)[32] are
moving towards or away from the probe, and its relative velocity. By calculating the frequency shift of a
particular sample volume, for example flow in an artery or a jet of blood flow over a heart valve, its speed
and direction can be determined and visualized. Color Doppler is the measurement of velocity by color
scale. Color Doppler images are generally combined with gray scale (B-mode) images to display duplex
ultrasonography images.[33] Uses include:
Doppler echocardiography, the use of Doppler ultrasonography

to examine the heart.[34] An echocardiogram can, within certain
limits, produce accurate assessment of the direction of blood
flow and the velocity of blood and cardiac tissue at any arbitrary
point using the Doppler effect. Velocity measurements allow
assessment of cardiac valve areas and function, any abnormal
communications between the left and right side of the heart, any
leaking of blood through the valves (valvular regurgitation),
calculation of the cardiac output and calculation of E/A ratio[35] (a
measure of diastolic dysfunction). Contrast-enhanced ultrasound Duplex scan of the common carotid
using gas-filled microbubble contrast media can be used to artery
improve velocity or other flow-related medical measurements.
Transcranial Doppler (TCD) and transcranial color Doppler
(TCCD), which measure the velocity of blood flow through the brain's blood vessels transcranially
(through the cranium). They are used as tests to help diagnose emboli, stenosis, vasospasm from a
subarachnoid hemorrhage (bleeding from a ruptured aneurysm), and other problems.
Doppler fetal monitors, although usually not technically -graphy but rather sound-generating, use the
Doppler effect to detect the fetal heartbeat for prenatal care. These are hand-held, and some models
also display the heart rate in beats per minute (BPM). Use of this monitor is sometimes known as
Doppler auscultation. The Doppler fetal monitor is commonly referred to simply as a Doppler or fetal
Doppler. Doppler fetal monitors provide information about the fetus similar to that provided by a fetal
stethoscope.
Contrast ultrasonography (ultrasound contrast imaging)
A contrast medium for medical ultrasonography is a formulation of encapsulated gaseous

microbubbles[36] to increase echogenicity of blood, discovered by Dr Raymond Gramiak in 1968[37] and
named contrast-enhanced ultrasound. This contrast medical imaging modality is clinically used
throughout the world,[38] in particular for echocardiography in the United States and for ultrasound
radiology in Europe and Asia.
Microbubbles-based contrast media is administrated intravenously in patient blood stream during the
medical ultrasonography examination. Thanks to their size, the microbubbles remain confined in blood
vessels without extravasating towards the interstitial fluid. An ultrasound contrast media is therefore
purely intravascular, making it an ideal agent to image organ microvascularization for diagnostic
purposes. A typical clinical use of contrast ultrasonography is detection of a hypervascular metastatic
tumor, which exhibits a contrast uptake (kinetics of microbubbles concentration in blood circulation)
faster than healthy biological tissue surrounding the tumor.[39] Other clinical applications using contrast
exist, such as in echocardiography to improve delineation of left ventricle for visually checking
contractibility of heart after a myocardial infarction. Finally, applications in quantitative perfusion[40]
(relative measurement of blood flow[41]) emerge for identifying early patient response to an anti-
cancerous drug treatment (methodology and clinical study by Dr Nathalie Lassau in 2011[42]), enabling
to determine the best oncological therapeutic options.[43]
In oncological practice of medical contrast ultrasonography, clinicians use the method of parametric
imaging of vascular signatures[44] invented by Dr Nicolas Rognin in 2010.[45] This method is conceived
as a cancer aided diagnostic tool, facilitating characterization of a suspicious tumor (malignant versus
benign) in an organ. This method is based on medical computational science[46][47] to analyze a time
sequence of ultrasound contrast images, a digital video recorded in real-time during patient
examination. Two consecutive signal processing steps are applied to each pixel of the tumor:
1. calculation of a vascular signature (contrast uptake difference

with respect to healthy tissue surrounding the tumor);
2. automatic classification of the vascular signature into a unique
parameter, this last coded in one of the four following colors:
green for continuous hyper-enhancement (contrast uptake
higher than healthy tissue one),
blue for continuous hypo-enhancement (contrast uptake
lower than healthy tissue one),
red for fast hyper-enhancement (contrast uptake before
healthy tissue one) or
yellow for fast hypo-enhancement (contrast uptake after
healthy tissue one). Parametric imaging of vascular
signatures (diagram)
Once signal processing in each pixel completed, a color spatial map
of the parameter is displayed on a computer monitor, summarizing
all vascular information of the tumor in a single image called parametric image (see last figure of press
article[48] as clinical examples). This parametric image is interpreted by clinicians based on predominant
colorization of the tumor: red indicates a suspicion of malignancy (risk of cancer), green or yellow – a
high probability of benignity. In the first case (suspicion of malignant tumor), the clinician typically
prescribes a biopsy to confirm the diagnostic or a CT scan examination as a second opinion. In the
second case (quasi-certain of benign tumor), only a follow-up is needed with a contrast ultrasonography
examination a few months later. The main clinical benefits are to avoid a systematic biopsy (risky
invasive procedure) of benign tumors or a CT scan examination exposing the patient to X-ray radiation.
The parametric imaging of vascular signatures method proved to be effective in humans for
characterization of tumors in the liver.[49] In a cancer screening context, this method might be
potentially applicable to other organs such as breast[50] or prostate.
Molecular ultrasonography (ultrasound molecular imaging)
The future of contrast ultrasonography is in molecular imaging with potential clinical applications
expected in cancer screening to detect malignant tumors at their earliest stage of appearance. Molecular
ultrasonography (or ultrasound molecular imaging) uses targeted microbubbles originally designed by
Dr Alexander Klibanov in 1997;[51][52] such targeted microbubbles specifically bind or adhere to tumoral
microvessels by targeting biomolecular cancer expression (overexpression of certain biomolecules occurs
during neo-angiogenesis[53][54] or inflammation[55] processes in malignant tumors). As a result, a few
minutes after their injection in blood circulation, the targeted microbubbles accumulate in the malignant
tumor; facilitating its localization in a unique ultrasound contrast image. In 2013, the very first
exploratory clinical trial in humans for prostate cancer was completed at Amsterdam in the Netherlands
by Dr Hessel Wijkstra.[56]
In molecular ultrasonography, the technique of acoustic radiation force (also used for shear wave
elastography) is applied in order to literally push the targeted microbubbles towards microvessels wall;
firstly demonstrated by Dr Paul Dayton in 1999.[57] This allows maximization of binding to the
malignant tumor; the targeted microbubbles being in more direct contact with cancerous biomolecules
expressed at the inner surface of tumoral microvessels. At the stage of scientific preclinical research, the
technique of acoustic radiation force was implemented as a prototype in clinical ultrasound systems and
validated in vivo in 2D[58] and 3D[59][60] imaging modes.
Elastography (ultrasound elasticity imaging)
Ultrasound is also used for elastography, which is a relatively new imaging modality that maps the
elastic properties of soft tissue.[61][62] This modality emerged in the last two decades. Elastography is
useful in medical diagnoses as it can discern healthy from unhealthy tissue for specific organs/growths.
For example, cancerous tumors will often be harder than the surrounding tissue, and diseased livers are
stiffer than healthy ones.[61][62][63][64]
There are many ultrasound elastography techniques.[62]
Interventional ultrasonography
Interventional ultrasonography involves biopsy, emptying fluids, intrauterine Blood transfusion

(Hemolytic disease of the newborn).
Thyroid cysts: The high frequency thyroid ultrasound (HFUS) can be used to treat several gland
conditions. The recurrent thyroid cyst that was usually treated in the past with surgery, can be treated
effectively by a new procedure called percutaneous ethanol injection, or PEI. With ultrasound guided
placement of a 25 gauge needle within the cyst, and after evacuation of the cyst fluid, about 50% of
the cyst volume is injected back into the cavity, under strict operator visualization of the needle tip.
The procedure is 80% successful in reducing the cyst to minute size.
Metastatic thyroid cancer neck lymph nodes: The other thyroid therapy use for HFUS is to treat
metastatic thyroid cancer neck lymph nodes that occur in patients who either refuse surgery, or are
no longer a candidate for surgery. Small amounts of ethanol are injected under ultrasound guided
needle placement. A blood flow study is done prior to the injection, by power doppler. The blood flow
can be destroyed and the node become inactive, although it may still be there. Power doppler
visualized blood flow can be eradicated, and there may be a drop in the cancer blood marker test,
thyroglobulin, TG, as the node become non-functional. Another interventional use for HFUS is to
mark a cancer node one hour prior to surgery to help locate the node cluster at the surgery. A minute
amount of methylene dye is injected, under careful ultrasound guided placement of the needle on the
anterior surface, but not in the node. The dye will be evident to the thyroid surgeon when opening the
neck. A similar localization procedure with methylene blue, can be done to locate parathyroid
adenomas at surgery.
Joint injections can be guided by medical ultrasound, such as in ultrasound-guided hip joint
injections.
Compression ultrasonography
Compression ultrasonography is when the probe is pressed against the skin. This can bring the target
structure closer to the probe, increasing spatial resolution of it. Comparison of the shape of the target
structure before and after compression can aid in diagnosis.
It is used in ultrasonography of deep venous thrombosis, wherein absence of vein compressibility is a

strong indicator of thrombosis.[66] Compression ultrasonography has both high sensitivity and
specificity for detecting proximal deep vein thrombosis only in symptomatic patients. Results are not
reliable when the patient is symptomless and must be checked, for example in high risk postoperative
patients mainly in orthopedic patients.[67][68]
A normal appendix without and with

compression. Absence of
comprehensibility indicates
appendicitis.[69]
Ultrasound-guided hip joint

injection.[65]
Compression is used in this

ultrasonograph to get closer to the
abdominal aorta, making the
superior mesenteric vein and the
inferior vena cava look rather flat.
Panoramic ultrasonography
Panoramic ultrasonography is the digital stitching of multiple ultrasound images into a broader one.[70]
It can display an entire abnormality and show its relationship to nearby structures on a single image.[70]
Attributes
As with all imaging modalities, ultrasonography has its list of positive and negative attributes.
Strengths
It images muscle, soft tissue, and bone surfaces very well and is
particularly useful for delineating the interfaces between solid
and fluid-filled spaces.
It renders "live" images, where the operator can dynamically
select the most useful section for diagnosing and documenting Panoramic ultrasonography of a
changes, often enabling rapid diagnoses. Live images also allow proximal biceps tendon rupture. Top
for ultrasound-guided biopsies or injections, which can be image shows the contralateral
cumbersome with other imaging modalities. normal side, and lower image shows
It shows the structure of organs. a retracted muscle, with a
It has no known long-term side effects and rarely causes any hematoma filling out the proximal
discomfort to the patient. space.
It is capable of imaging local variations in the mechanical
properties of soft tissue.[71]
Equipment is widely available and comparatively flexible.
Small, easily carried scanners are available; examinations can be performed at the bedside.
Relatively inexpensive compared to other modes of investigation, such as computed X-ray
tomography, DEXA or magnetic resonance imaging.
Spatial resolution is better in high frequency ultrasound transducers than it is in most other imaging
modalities.
Through the use of an ultrasound research interface, an ultrasound device can offer a relatively
inexpensive, real-time, and flexible method for capturing data required for special research purposes
for tissue characterization and development of new image processing techniques
Weaknesses
Sonographic devices have trouble penetrating bone. For
example, sonography of the adult brain is currently very limited.
Sonography performs very poorly when there is a gas between
the transducer and the organ of interest, due to the extreme
differences in acoustic impedance. For example, overlying gas in
the gastrointestinal tract often makes ultrasound scanning of the
pancreas difficult. Lung imaging however can be useful in
demarcating pleural effusions, detecting heart failure, and
detecting pneumonia.[72]
Even in the absence of bone or air, the depth penetration of Double aort artifact in sonography
ultrasound may be limited depending on the frequency of due to difference in velocity of
imaging. Consequently, there might be difficulties imaging sound waves in muscle and fat.
structures deep in the body, especially in obese patients.
Physique has a large influence on image quality. Image quality
and accuracy of diagnosis is limited with obese patients, overlying subcutaneous fat attenuates the
sound beam and a lower frequency transducer is required (with lower resolution)
The method is operator-dependent. A high level of skill and experience is needed to acquire good-
quality images and make accurate diagnoses.
Users of ultrasound might have challenges with keeping the ultrasound probe on the same position
during an examination.
There is no scout image as there is with CT and MRI. Once an image has been acquired there is no
exact way to tell which part of the body was imaged.
80% of sonographers suffer from Repetitive Strain Injuries (RSI) or so-called Work-Related
Musculoskeletal Disorders (WMSD) because of the bad ergonomic positions.
Risks and side-effects

Ultrasonography is generally considered safe imaging,[73] with the World Health Organizations
saying:[74]
"Diagnostic ultrasound is recognized as a safe, effective, and highly flexible imaging modality
capable of providing clinically relevant information about most parts of the body in a rapid and cost-
effective fashion".
Diagnostic ultrasound studies of the fetus are generally considered to be safe during pregnancy. This
diagnostic procedure should be performed only when there is a valid medical indication, and the lowest
possible ultrasonic exposure setting should be used to gain the necessary diagnostic information under
the "as low as reasonably practicable" or ALARP principle.[75]
Although there is no evidence ultrasound could be harmful for the fetus, medical authorities typically
strongly discourage the promotion, selling, or leasing of ultrasound equipment for making "keepsake
fetal videos".[4][76]
Studies on the safety of ultrasound

A meta-analysis of several ultrasonography studies published in 2000 found no statistically
significant harmful effects from ultrasonography, but mentioned that there was a lack of data on long-
term substantive outcomes such as neurodevelopment.[77]
A study at the Yale School of Medicine published in 2006 found a small but significant correlation
between prolonged and frequent use of ultrasound and abnormal neuronal migration in mice.[78]
A study performed in Sweden in 2001[79] has shown that subtle effects of neurological damage
linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker
for brain problems when not hereditary) and speech delays.[80][81]
The above findings, however, were not confirmed in a later follow-up study.[82]
A later study, however, performed on a larger sample of 8865 children, has established a
statistically significant, albeit weak association of ultrasonography exposure and being non-right
handed later in life.[83]
Regulation
Diagnostic and therapeutic ultrasound equipment is regulated in the USA by the Food and Drug
Administration, and worldwide by other national regulatory agencies. The FDA limits acoustic output
using several metrics; generally, other agencies accept the FDA-established guidelines.
Currently, New Mexico, Oregon, and North Dakota are the only US states that regulate diagnostic
medical sonographers.[84] Certification examinations for sonographers are available in the US from
three organizations: the American Registry for Diagnostic Medical Sonography, Cardiovascular
Credentialing International and the American Registry of Radiologic Technologists. [85]
The primary regulated metrics are Mechanical Index (MI), a metric associated with the cavitation bio-
effect, and Thermal Index (TI) a metric associated with the tissue heating bio-effect. The FDA requires
that the machine not exceed established limits, which are reasonably conservative so as to maintain
diagnostic ultrasound as a safe imaging modality. This requires self-regulation on the part of the
manufacturer in terms of the machine's calibration.[86]
Ultrasound-based pre-natal care and sex screening technologies were launched in India in the 1980s.
With concerns about its misuse for sex-selective abortion, the Government of India passed the Pre-natal
Diagnostic Techniques Act (PNDT) in 1994 to regulate legal and illegal uses of ultrasound equipment.[87]
The law was further amended into the Pre-Conception and Pre-natal Diagnostic Techniques (Regulation
and Prevention of Misuse) (PCPNDT) Act in 2004 to deter and punish prenatal sex screening and sex
selective abortion.[88] It is currently illegal and a punishable crime in India to determine or disclose the
sex of a fetus using ultrasound equipment.[89]
History
After the French physicist Pierre Curie’s discovery of piezoelectricity in 1880, ultrasonic waves could be
deliberately generated for industry. Thereafter, in 1940, the American acoustical physicist Floyd
Firestone devised the first ultrasonic echo imaging device, the Supersonic Reflectoscope, to detect
internal flaws in metal castings. In 1941, the Austrian neurologist Karl Theo Dussik was in collaboration
with his brother, Friedreich, a physicist, likely the first person to ultrasonically echo image the human
body, outlining thereby the ventricles of a human brain.[90][91] Ultrasonic energy was first applied to the
human body for medical purposes by Dr George Ludwig at the Naval Medical Research Institute,
Bethesda, Maryland, in the late 1940s.[92][93] English-born physicist John Wild (1914–2009) first used
ultrasound to assess the thickness of bowel tissue as early as 1949; he has been described as the "father
of medical ultrasound".[94] Subsequent advances in the field took place concurrently in several countries.
It was not until 1961 when David Robinson and George Kossoff's work at the Australian Department of
Health resulted in the first commercially practical water path ultrasonic scanner.[95] Then in 1963
Meyerdirk & Wright launched production of the first commercial hand-held articulated arm compound
contact B-mode scanner, which made ultrasound generally available for medical use.
France
Léandre Pourcelot, who was a researcher and teacher at INSA (Institut National des Sciences
Appliquées) Lyon copublished in 1965 a report at the Académie des sciences, "Effet Doppler et mesure
du débit sanguin " ("Doppler effect and measure of the blood flow"), the basis of his design of a Doppler
flow meter in 1967.
Scotland
Parallel developments in Glasgow, Scotland by Professor Ian Donald and colleagues at the Glasgow
Royal Maternity Hospital (GRMH) led to the first diagnostic applications of the technique.[96] Donald
was an obstetrician with a self-confessed "childish interest in machines, electronic and otherwise", who,
having treated the wife of one of the company's directors, was invited to visit the Research Department
of boilermakers Babcock & Wilcox at Renfrew, where he used their industrial ultrasound equipment to
conduct experiments on various morbid anatomical specimens and assess their ultrasonic
characteristics. Together with the medical physicist Tom Brown.[97] and fellow obstetrician Dr John
MacVicar, Donald refined the equipment to enable differentiation of pathology in live volunteer patients.
These findings were reported in The Lancet on 7 June 1958[98] as "Investigation of Abdominal Masses by
Pulsed Ultrasound" – possibly one of the most important papers ever published in the field of diagnostic
medical imaging.
At GRMH, Professor Donald and Dr James Willocks then refined their techniques to obstetric
applications including fetal head measurement to assess the size and growth of the fetus. With the
opening of the new Queen Mother's Hospital in Yorkhill in 1964, it became possible to improve these
methods even further. Dr Stuart Campbell's pioneering work on fetal cephalometry led to it acquiring
long-term status as the definitive method of study of foetal growth. As the technical quality of the scans
was further developed, it soon became possible to study pregnancy from start to finish and diagnose its
many complications such as multiple pregnancy, fetal abnormality and placenta praevia. Diagnostic
ultrasound has since been imported into practically every other area of medicine.
Sweden
Medical ultrasonography was used in 1953 at Lund University by cardiologist Inge Edler and Gustav
Ludwig Hertz's son Carl Hellmuth Hertz, who was then a graduate student at the University's
department of nuclear physics.
Edler had asked Hertz if it was possible to use radar to look into the body, but Hertz said this was
impossible. However, he said, it might be possible to use ultrasonography. Hertz was familiar with using
ultrasonic reflectoscopes of the American acoustical physicist Floyd Firestone's invention for
nondestructive materials testing, and together Edler and Hertz developed the idea of using this method
in medicine.
The first successful measurement of heart activity was made on October 29, 1953, using a device
borrowed from the ship construction company Kockums in Malmö. On December 16 the same year, the
method was used to generate an echo-encephalogram (ultrasonic probe of the brain). Edler and Hertz
published their findings in 1954.[99]
United States
In 1962, after about two years of work, Joseph Holmes, William Wright, and Ralph Meyerdirk developed
the first compound contact B-mode scanner. Their work had been supported by U.S. Public Health
Services and the University of Colorado. Wright and Meyerdirk left the University to form Physionic
Engineering Inc., which launched the first commercial hand-held articulated arm compound contact B-
mode scanner in 1963. This was the start of the most popular design in the history of ultrasound
scanners.[100]
In the late 1960s Dr Gene Strandness and the bio-engineering group at the University of Washington
conducted research on Doppler ultrasound as a diagnostic tool for vascular disease. Eventually, they
developed technologies to use duplex imaging, or Doppler in conjunction with B-mode scanning, to view
vascular structures in real-time, while also providing hemodynamic information.[101]
The first demonstration of color Doppler was by Geoff Stevenson, who was involved in the early
developments and medical use of Doppler shifted ultrasonic energy.[102]
Manufacturers
The leading manufacturers of ultrasound equipment are Hitachi, Siemens Healthineers, FUJIFILM
SonoSite (https://www.sonosite.com), GE Healthcare, and Philips.[103] Companies such as Usono
design, develop, and sell accessories to make the use of ultrasound easier.[104]
See also
Doppler fetal monitor
Elastography
Polybiography
Radiographer
Ultrasound computer tomography
Ultrasound transmission tomography
3D ultrasound
Notes
1. It is for this reason that the person subjected to ultrasound of organs that can contain quantities of air
or gas, such as the stomach, intestine and bladder, must follow a food preparation designed to
reduce their quantity: specific diet and supplements for the intestine and intake of non-carbonated
water to fill the bladder; sometimes, during the examination, it may be required to fill the stomach
with non-carbonated water.
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External links
About the discovery of medical ultrasonography (http://www.ob-ultrasound.net/ingehertz.html) on ob-
ultrasound.net
History of medical sonography (ultrasound) (http://www.ob-ultrasound.net/history1.html) on ob-
ultrasound.net
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Medical Ultrasound - Wikipedia

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1/27/2021 Medical ultrasound - Wikipedia

Ultrasound are sound waves with frequencies which are

Hemodynamics (blood circulation)

Sonography is effective for imaging soft tissues of the body.

technology, such as piezoelectric transducer or CMUT, to visualize

In the case of the common and potentially, serious problem of blood

Point of care emergency ultrasound has many applications in

Gynecology and obstetrics

Obstetrical sonography was originally developed in the late 1950s

According to the European Committee of Medical Ultrasound Safety (ECMUS)[5]

Hemodynamics (blood circulation)

Otolaryngology (head and neck)

Most structures of the neck, including the thyroid and parathyroid

Neonatology Neck ultrasound.

In neonatology, transcranial Doppler can be used for basic

Lung ultrasound basics

Lung pathology assessed with ultrasound

Ultrasound is routinely used in urology to determine, for example,

Quantitative ultrasound is an adjunct musculoskeletal test for myopathic disease in children;[19][20]

From sound to image

Producing a sound wave

A sound wave is typically produced by a piezoelectric transducer

The sound is focused either by the shape of the transducer, a lens in

Receiving the echoes

Forming the image

Displaying the image

Sound in the body

C-mode: A C-mode image is formed in a plane normal to a B-

Doppler echocardiography, the use of Doppler ultrasonography

Contrast ultrasonography (ultrasound contrast imaging)

A contrast medium for medical ultrasonography is a formulation of encapsulated gaseous

1. calculation of a vascular signature (contrast uptake difference

Molecular ultrasonography (ultrasound molecular imaging)

Elastography (ultrasound elasticity imaging)

There are many ultrasound elastography techniques.[62]

Interventional ultrasonography involves biopsy, emptying fluids, intrauterine Blood transfusion

It is used in ultrasonography of deep venous thrombosis, wherein absence of vein compressibility is a

A normal appendix without and with

Ultrasound-guided hip joint

Compression is used in this

Risks and side-effects

Studies on the safety of ultrasound

97. Looking at the Unborn: Historical aspects of obstetric ultrasound (https://archive.org/details/lookingat

Retrieved from "https://en.wikipedia.org/w/index.php?title=Medical_ultrasound&oldid=1001922889"

This page was last edited on 22 January 2021, at 00:28 (UTC).

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