CHAPTER

Basic equipment, components

and image production
Kevin Martin
2
Figure 2.1 shows a typical general purpose ultrasound imaging
INTRODUCTION  16 system being used to acquire images of anatomical features within
PRINCIPLES OF B-MODE IMAGE FORMATION  17 a patient’s abdomen. The transducer is held by the operator in
contact with the skin surface. The transducer produces short
TRANSDUCERS AND BEAM FORMING  18 bursts, or pulses of ultrasound, which travel into the abdomen and
Transducer construction  18 are reflected from the abdominal tissues and organs back to the
Image formats  18
transducer. These returned echoes are converted into electrical
The stepped array  20
The steered array  20
signals by the transducer and used to produce an image of echo-
Other beam steering applications  20 producing features within the patient. From information such as
Electronic focusing  21 the direction of travel of the pulse, the time of arrival of the echoes
Aperture control  21 and the strength of the reflection, the system processor forms
The beam former  21 scaled images of these internal anatomical features. The operator
Elevation focusing  21 uses the controls available on the console to optimise the system
3/4D transducers  21 operation for different anatomical targets and moves the trans-
Mechanical transducers  22 ducer around the skin surface to interrogate different areas within
IMAGE PROCESSING  23 the abdomen. The ultrasound images are viewed continuously as
Time gain compensation (TGC)  23 they are formed on the display monitor and may be recorded as
Dynamic range  23 hard copy still images or cine clips or stored remotely in a picture
Harmonic imaging  24 archiving system (PACS).
Pulse coding  25
Demodulation  25
Image memory  25
Field of view and zoom  25
Post processing  26

DOPPLER ULTRASOUND  26
Continuous wave Doppler (CW)  26
Pulsed wave Doppler (PW)  26
High pass filtering  28
Aliasing  28
Doppler frequency estimation and display  28
Colour flow imaging  28
Limitations of colour flow imaging  29
Power Doppler  30

INTRODUCTION
The clinical use of ultrasound is an interactive process, which
requires the user to manipulate the ultrasound transducer in contact
with the patient’s skin surface, while viewing and interpreting the
image in real-time. Before the examination, the user must select the
transducer, operating mode and system settings most relevant to
the investigation and thereafter make regular adjustments to the
system controls to optimise the diagnostic quality of the image. To
make informed choices of system components and settings, it is
essential to have an understanding of their function and how
making changes is likely to affect the resulting image. This chapter
describes the main components of the ultrasound imaging system
and explains how they operate to produce ultrasound images and
other useful diagnostic information. The aim of the chapter is to
provide a basic understanding of system function, which will help
users to produce optimum quality diagnostic information when
scanning. The intention is that these explanations should be acces-
sible to all without any detailed knowledge of physics or Figure 2.1  An ultrasound imaging system in use. (Courtesy of
technology. Siemens Healthcare.)
16

Organ boundary Gas echo
Tissue echoes
Cystic area
Figure 2.2  A B-mode image using a curvilinear array
transducer.
Figure 2.2 shows a typical ultrasound image from within the
upper abdomen. As the ultrasound beams, which are used to inter-
rogate the anatomy, are all constrained by the transducer to lie in
the same plane, the resulting image is a two-dimensional cross-
sectional image. The upper, curved edge of the image corresponds
to the surface of the skin, which has been deformed to the shape of
the curved transducer face. Distance down the image from this
surface corresponds to increasing depth within the patient. The
ultrasound beams from this transducer are transmitted at right
angles to its curved surface resulting in a sector-shaped image.
The image is a greyscale image. As the ultrasound pulse travels
into the tissues, some of its energy is reflected, whenever it encoun-
ters a change in acoustic impedance, as described in Chapter 1.
Relatively strong reflections are produced at organ and tissue
boundaries, which appear as bright features in the image. Much
weaker echoes are produced by scattering from small-scale features
within organ tissues, e.g. liver parenchyma, which are displayed as
a darker shade of grey. Cystic regions contain no changes in acous-
tic properties and so generate no echoes. These appear as black in
the image. As described in Chapter 1, an interface between tissue
and gas will reflect so strongly that the ultrasound pulse is unable
to travel any further. With a tissue–bone interface there will also be
a strong reflection, and high attenuation in the bone. Such interfaces
will be displayed as a very bright echo with a black shadow behind
it. The greyscale image is also known as a B-mode image (B for
brightness) as the strength of the echo is displayed in terms of
image brightness.
To allow fine detail and closely spaced targets to be resolved in
the image, it is essential that the ultrasound beam is narrow and
the ultrasound pulse short. Better resolution is achieved by trans-
mitting higher ultrasound frequencies. Unfortunately, higher fre-
quencies are attenuated more rapidly, as explained in Chapter 1,
leading to reduced depth of penetration of the ultrasound pulse into
tissues. It is this phenomenon that determines the maximum depth
from which ultrasound echoes can be received and displayed in the
image.
PRINCIPLES OF B-MODE IMAGE
FORMATION
The two-dimensional (2D) B-mode image is composed of a large
number of individual, adjacent B-mode lines. In the simplest image
forming process, each line is formed by a single pulse-echo cycle as
illustrated in Figure 2.3.
Principles of B-mode image formation
A The transmit pulse travels along the ultrasound beam into tissues.
Echoes generated at interfaces return to the transducer
Transducer Transmit Returning
pulse echo
Depth
Received
echo signal
0 Time
B The time of arrival of echoes after transmission increases
with the depth of the reflector
Figure 2.3  The pulse-echo cycle.
Linear array transducer
Anatomical target
Line sweep
Ultrasound beams Image lines Echoes
A Pulse-echo cycles are initiated at a B The line of echoes produced
series of adjacent beam positions by each cycle is used to form a
along the transducer face B-mode line in the image
Figure 2.4  B-mode image formation from a sequence of
lines.
The transducer produces a pulse of ultrasound, consisting of a
few cycles at the selected transmit frequency, e.g. 5 MHz. The pulse
propagates through the tissues along a beam-shaped corridor at the
speed of sound c for the particular tissue. Upon reaching a reflecting
interface, an echo is produced, which travels back to the transducer,
also at speed c. Meanwhile, the pulse has travelled on to deeper
interfaces, generating further echoes, which also travel back to the
transducer, but arrive at later times. The total time after transmis-
sion of the pulse for each echo to arrive back at the transducer is
called the ‘go and return’ time, which is simply twice the depth (go
and return) divided by the speed c, i.e. 2d/c. As described in
Chapter 1, the speeds of sound in the soft tissues of the body are
all (excluding fat) within 5% of the average value of 1540 m/s. The
image processor assumes this value to calculate the depth of origin
of each echo-producing feature from the time of arrival.
In real tissues, there is an almost continuous series of interfaces
and scatterers along the ultrasound beam, which generate a con-
tinuous series of echoes, following transmission of the pulse. The
line of echoes is used to form a B-mode line in the image, with echo
strength displayed in terms of image brightness at each point on
the line and time of arrival of the echo by distance down the line.
Once echoes have been received from the maximum depth, another
pulse-echo cycle is initiated along a beam in an adjacent position to
the first, generating an adjacent B-mode line in the image (Fig. 2.4).
By repeating this process along the entire length of the transducer
face, a large number of adjacent image lines (typically 256) are
formed, resulting in a 2D B-mode image.
Once the last line in the image has been formed, the process is
repeated to form a continuous series of images or frames. The
17
 CHAPTER 2 • Basic equipment, components and image production

B-mode image formation

• The 2D B-mode image is formed from a set (>100) of B-mode
lines.
• Each line is formed from one pulse-echo cycle.
• The pulse travels along a beam-shaped corridor. Electrical
• Echoes received are displayed along the line according to their connections Lens
Matching layer
time of arrival.
• The strength of the echo is displayed in terms of brightness. Piezoelectric wafer

Backing layer
A Electrodes
ultrasound images are displayed as they are formed, resulting in a
real-time display of moving images.
Focal length F
The finite travel time of the ultrasound pulses and echoes to and
from the reflecting target results in a fundamental limitation of
ultrasound imaging systems. The time to form each image line is Focal region
the ‘go and return’ time to the maximum depth. Large imaging
depths result in long line times. When coupled with a large number
B Transducer Acoustic lens
of image lines, this leads to a long frame time and low image repeat
rate or frame rate. If a high frame rate is needed to image a rapidly Figure 2.5  Transducer construction. A: A cross-section through
moving target, e.g. the heart, it may be necessary to restrict the an ultrasound transducer. B: The beam can be focused by adding
imaged depth and/or the width of the image. an acoustic lens to the transducer face, resulting in a narrower
beam in the focal region.

TRANSDUCERS AND BEAM FORMING

Ultrasound transducer construction
• Ultrasound pulses of the required frequency are produced by the
Transducer construction transducer using the piezoelectric effect.
• The piezoelectric element within the transducer is a thin wafer of
The transducer is one of the most important components of the PZT.
ultrasound system and its performance is critical to the quality of • A matching layer must be used to improve transmission of
the ultrasound image. ultrasound into soft tissue.
Ultrasound pulses are produced by the transducer, which con- • A backing layer is used to reduce ringing in the PZT wafer and
verts the electrical signal supplied by the processor into a corre- give a short pulse.
sponding ultrasound wave. At the heart of the transducer is a thin • Transducer bandwidth can be improved by reducing the acoustic
wafer of piezoelectric material with metal electrodes on each side impedance of the PZT wafer.
of it as illustrated in Figure 2.5A. The piezoelectric material is • A lens on the front face of the transducer focuses the beam to
normally a ceramic made from lead zirconate titanate (PZT). A make it narrower.
fluctuating electrical voltage applied to the electrodes causes a cor-
responding change in the thickness of the element, generating a
sound wave in the adjacent medium. When an echo is received back
added to the wafer, which absorbs some of the vibrational energy
at the transducer, the thickness changes induced by the sound wave
and causes any resonance to die out quickly. Modern transducers
are converted back into an electrical signal at the electrodes.
extend this process by employing more effective techniques for
A major challenge in the design of the ultrasound transducer is
transmitting ultrasound energy through the front face of the trans-
that of transmitting the ultrasound energy from the PZT element
ducer into the tissues. For example, by cutting a cross hatch of slots
into the soft tissues of the body. As described in Chapter 1, when
through the PZT wafer and filling them with materials of low
a travelling ultrasound wave encounters an interface where there
acoustic impedance, the overall acoustic impedance of the wafer
is a large change in acoustic impedance, most of the energy is
can be reduced, reducing the mismatch to the soft tissues. By
reflected back and little is transmitted into the next medium. As the
extracting more acoustic energy from the transducer into the tissues,
mismatch between the impedance of the PZT (approximately 3000
the tendency to resonate is reduced and the bandwidth is increased.
rayls) and soft tissue (about 1.5 rayls) is very large, a matching layer
Modern transducers can have bandwidths that extend to ±70% of
must be used between the two, which has an intermediate value of
the centre frequency. Wide bandwidth transducers can be driven at
acoustic impedance. If the thickness of this layer is also equal to one
a range of frequencies selected by the user (multi-frequency trans-
quarter of the wavelength of the ultrasound wave, transmission
ducers) and make techniques such as harmonic imaging possible
efficiency is further improved. Normally, several matching layers
(see ‘Image processing’ section, below).
are used to optimise transmission over a range of frequencies. Such
The width of the ultrasound beam that is produced by the trans-
improvements in coupling to tissue convert electrical energy more
ducer can be reduced by focusing. In a simple transducer as in
efficiently into transmitted ultrasound energy and improve the sen-
Figure 2.5A, this can be achieved by adding an acoustic lens to the
sitivity of the transducer to weak returned echoes.
front surface. This acts like an optical lens, forming a focal region
The range of frequencies that a transducer can respond to effi-
about a specific focal length F (Fig. 2.5B) in which the beam is nar-
ciently is referred to as its bandwidth. A short ultrasound pulse, as
rower than an equivalent unfocused beam. The reduction in the
required for imaging, contains a relatively wide range of ultrasound
width of the ultrasound beam gives improved resolution of small,
frequencies above and below the nominal transmit frequency
adjacent targets.
(approximately ±20%) and the transducer must be able to respond
to these to maintain a short pulse. When stimulated by an electrical
signal, the piezoelectric wafer has a tendency to resonate or ring Image formats
like a bell at its natural frequency, giving a narrow bandwidth and
a long ultrasound pulse. To maintain a short pulse, suitable for To form a 2D ultrasound image, the ultrasound beam produced by
imaging purposes, a backing layer (also called a damping layer) is the transducer must be moved in sequence, to a large number of
18
 Transducers and beam forming

Linear array Trapezoidal array

Curvi-linear array
Curvi-sector array
Sector phased (steered) array

Figure 2.6  Common types of array transducer shape and image format.

B
A

Figure 2.7  Endo-cavity transducers. A: An 8–4 MHz curved

array endo-vaginal transducer. (Courtesy of Siemens Healthcare.)
B: A 7–3 MHz trans-oesophageal phased array transducer, which
can be rotated to acquire a 3D data set. (Courtesy of Siemens
C Healthcare.) C: An endo-anal transducer for urological studies.
(Courtesy of BK Medical.)

19
 CHAPTER 2 • Basic equipment, components and image production
adjacent positions within the tissues, as described earlier. For most
applications, this movement is achieved electronically using a
transducer, which has an array of elements (typically 128 or 256).
Array transducers are available in a variety of shapes, giving a
choice of image formats for different applications. Figure 2.6 shows
a range of common types of array transducers for transcutaneous
imaging. Sector transducers are used where access to the target
tissues is through a narrow acoustic window, e.g. approaching the
heart through an intercostal space between the ribs. Linear and
curved array transducers are used where a wide anterior field of
view is needed and access is not limited by regions of bone or gas,
e.g. in the upper abdomen, neck or peripheral vasculature. Endo-
cavity transducers use small transducer arrays mounted on a suit-
able stem for insertion into body cavities as shown in Figure 2.7.
These can bring the transducer into closer proximity to the target,
allowing the use of higher frequencies and avoiding intervening
obstructions such as gas or bone.
All array transducers make use of one or both of two methods to
scan the beam through the tissues. The beam can be electronically
stepped to different positions along the array or steered in different
directions.
The stepped array
Figure 2.8 illustrates the stepped array principle for a linear array
transducer. As explained in Chapter 1, in order to produce a rela-
tively parallel-sided ultrasound beam, the active transducer width
or aperture must be at least 10 times the wavelength of the ultra-
sound wave. As each element in a typical array is only about 1
wavelength wide, the electrical pulse waveform is applied simulta-
neously to a group of say 10 adjacent elements, e.g. elements 1–10.
The echo signals received back at these elements can be added
together also to form the first B-mode line. When this first pulse-
echo cycle is complete, the beam position is stepped along the array
by applying the pulse to elements 2–11 and adding the returned
echoes from these. By continuing this process, the beam can be
stepped along the whole array to form a large number of closely
spaced B-mode lines.
The stepped array process is used with linear array transducers
and with curved array transducers, which are simply an array
of elements mounted onto a curved surface to give a curved field
of view.
The steered array
In the steered array transducer (also known as the phased array
transducer), the beam is steered in adjacent directions rather than
stepped to adjacent positions. The array elements are very narrow,
so the total length of the array is only 1.5–2 cm. The electrical trans-
mission pulse is applied to all elements on each pulse-echo cycle
and the beam direction is controlled by staggering the times at
which the electrical pulse is applied to each element.
Matching layer Acoustic lens
Line 1
Line 2
Line 3
Transducer element array
Active aperture
A Cut-away of a linear array transducer, B The active aperture is stepped
showing array elements, matching along the array on each
layer and cylindrical lens pulse–echo cycle
Figure 2.8  The linear, stepped array transducer.
20
As the array elements are less than a wavelength wide, when
excited by the electrical pulse waveform, they produce a wave that
is roughly circular in shape (in the image plane). If the electrical
pulse is applied to all elements simultaneously, as illustrated in
Figure 2.9A, the circular waves merge to form a flat wavefront and
a collimated beam in the straight ahead direction. If element 1 is
fired first, followed after a very short delay by element 2, then
element 3 and so on, by the time the last element is fired, the circular
waves from the others have travelled various distances into the
tissue and they merge to form a wavefront that propagates at an
angle to the straight ahead direction (Fig. 2.9B).
When the echoes are received, similar delays are applied before
they are added together. By steadily increasing the delay between
elements on each successive pulse-echo cycle, the beam is steered
further away from the straight ahead position. Angles of up to ±45°
can be achieved by this technique.
Other beam steering applications
Beam steering is used with some linear arrays to form a trapezoidal
field of view (Fig. 2.6). Here, a half sector is added to each side of
the normal rectangular field of view using beam steering with a
group of elements at each end of the array.
Beam steering is used by some manufacturers with linear array
transducers to generate images of a target from a number of differ-
ent directions. The direction of the beams from the linear array may
be steered in up to nine different directions on successive image
frames, giving a so-called compound image. This technique helps
to give more complete images of curved organ or lesion boundaries
and helps to average out image speckle. However, the frame rate
is reduced, as each complete compound image takes longer to form.
Beam steering is used with pulsed Doppler systems (see ‘Doppler
ultrasound’ section, below) to improve the angle at which the
Doppler beam interrogates vessels that lie parallel to the skin
surface.
Flat wavefront
Transmit in straight ahead
pulse direction
Array elements Curved waves from
individual elements
A When the electrical pulse is applied to all elements simultaneously,
the circular waves from each merge to form a flat wavefront and a
collimated beam in the straight ahead direction
Time delays
Wave travels at an
angle to the straight
Transmit ahead direction
pulse
Array elements Curved wave from first element
B If each element is fired in turn after a short delay, a wave is formed
which propagates at an angle to the straight ahead direction
Figure 2.9  The steered array principle.

Time delays
Transmit
pulse
Array elements Curved wavefront
Focal depth F
A Transmit focus: if the outer elements are fired first with increasing delays
towards the central elements, a converging wavefront is formed which
produces a focused transmit beam
Time delays
Focal points on image line
Receive
signal
Current receive focus
Array elements
B Receive focus: in reception, delays are applied to the signals received at
each element before they are added together. The delays are calculated
for each target depth so that the receive focus tracks the current receive
depth, producing a much narrower receive beam
Figure 2.10  Electronic focusing.
Electronic focusing
Focusing of the beam in the scan plane can be achieved in both
stepped and steered arrays by controlling the timing of signals to
and from the active elements. In Figure 2.10A, the outer elements
of the active area are fired first, followed after small delays by
consecutive element pairs towards the centre. The circular waves
from the individual elements add together to form a concave wave-
front, which converges to a focus, reducing the width of the beam.
Increasing the delay time between elements reduces the distance of
the focus from the transducer.
The transmitted pulse is normally focused to a depth chosen by
the user via the machine console and has a single value for each
transmission. In reception, as the depth from which echoes are
being received is known from the time after transmission, dynamic
control of the echo delays is applied so that the receive focus effec-
tively tracks the echo source. Focusing is applied for each point
along the line by calculating the travel time to each receive element
and then aligning the received signals in time before adding them
together. The resulting receive beam is much narrower than the
transmit beam (Fig. 2.10B).
Aperture control
Focusing is most effective when the aperture width, i.e. the active
length of the transducer, is similar to the focal depth. If the focal
depth is much greater than the aperture width, then the focusing
effect is weak. As the depth of the focus is increased by the user,
the active aperture width would normally be increased to maintain
effective focusing. For linear array transducers, the aperture can be
increased potentially to the full length of the array, maintaining an
effective focus to large depths (Fig. 2.11). For curved arrays and
phased arrays, the maximum aperture is restricted by the geometry
Transducers and beam forming
Focus
a a
F
F
A The ratio of aperture a to focal depth B A higher ratio of aperture a to
F is restricted for sector transducers focal depth F can be maintained
leading to weak focusing in linear arrays by increasing the
active aperture at larger depths
Figure 2.11  Aperture control and focusing.
of the transducer and so focusing is less effective at large depths,
leading to poorer resolution in these regions of the image.
The beam former
In modern ultrasound systems, the beam manipulation techniques
described above are all implemented using digital techniques in a
component of the ultrasound system known as the beam former.1
The beam former is programmed to activate a chosen group of ele-
ments to transmit a focused pulse. Echo signals are then received
by the elements within the active aperture. These are converted into
digital format and stored temporarily as a data series for each
element. The beam former then uses the stored element data to
create B-mode lines by applying the techniques described above.
By using more than one beam former, the same stored element
signals can be used to form several adjacent B-mode lines at the
same time, reducing the time needed to form each image.
Elevation focusing
While electronic focusing techniques can be used to produce a beam
that is very narrow in the direction along the scan plane, focusing
at right angles to the scan plane, the slice thickness direction, often
relies simply on a fixed acoustic lens as shown in Figure 2.12A. This
fixed and relatively weak focusing results in a slice thickness that
is much greater than the in-plane beam width. A large slice thick-
ness can result in poor visualisation of small cysts and blood vessels.
Slice thickness can be reduced near to the transducer by the use of
arrays containing several parallel rows of elements rather than just
one. These are referred to as 1.25D, 1.5D, 1.75D, 2D multi-row or
matrix transducers according to the level of technology employed
(and manufacturer terminology). In a 1.25D array, the multiple
rows are used simply to give aperture control, reducing the number
of rows used for superficial targets (Fig. 2.12B). The 1.5D array also
employs electronically controlled focusing in elevation but the rows
are paired to give symmetric delays. The 1.75D array has independ-
ent control of delays to each row.
3/4D transducers
The beam manipulation techniques described so far result in a real-
time, cross-sectional image, which allows the anatomy to be exam-
ined, slice by slice, as the transducer is moved by the operator. The
21
 CHAPTER 2 • Basic equipment, components and image production

3D transducer is used to acquire image data from a 3D volume of
tissue. Here, the transducer is held in a fixed position by the opera-
tor as the image plane is swept sideways automatically through the
target volume and a set of 2D images stored.
Two types of transducer designs are available to carry out 3D
volume acquisitions. The most common type contains a curvilinear
array mounted on a swivel within a small water bath in the trans-
ducer head (Fig. 2.13A). To acquire a 3D volume, the array is
rotated slowly by an electric motor, sweeping the image plane
sideways through the tissues. The orientation of the scan plane is
measured by an angle sensor coupled to the motor. The operator
holds the transducer assembly steady as a set of 2D curvilinear
images is acquired.
The alternative type of transducer that can be used for 3D acquisi-
tion is the square array transducer, which uses a square matrix of
transducer elements, e.g. 128 × 128 (Fig. 2.13B). This type of trans-
ducer can be used in phased array mode to produce a sector image
in one plane as described earlier. Using beam steering in the orthog-
onal plane, the sector image can then be swept sideways on each
successive frame to interrogate a pyramid-shaped 3D volume of
tissue.
Both types of transducer can be used to produce continuously
updated volume data sets by repeating the volume acquisition
process. The repeat rate of the resulting 4D images may be quite
low due to the time required to form a set of 2D images. By restrict-
ing the depth of the images and the angle of the acquired pyramid
of data, image update rates of up to 30 per second can be achieved
using a square array transducer.
Perhaps the most widely useful application of 3D transducers is
in the acquisition of a single volume data set from the target tissues
in the form of multiple adjacent planes. If the 3D volume data set
is stored, it can be interrogated and displayed in several ways. The
set of 2D views of the original scan plane being swept through the
tissues can be reviewed. Similar views can be displayed of a set of
sections orthogonal to the original 2D plane. 2D images can also be
created at a range of depths in a plane parallel to the transducer
face (C-scan). This plane is one that is not normally accessible with
a standard 2D transducer. The 3D data set can also be processed
for display in various viewing modes including see through
view and surface rendering, where a 3D surface corresponding to
the skin surface, for example, is segmented from the data and
displayed.2 Surface rendering is most effective where the surface of
interest is adjacent to a region of fluid (e.g. in obstetrics), so that the
surface echo can be detected automatically by the system
processor.

A The slice profile for a linear array

transducer with a single row of
B The slice thickness can be reduced Mechanical transducers
near to the transducer in the 1.25D
elements array by using only the middle row
The 2D transducers described so far have all used multi-element
of elements for superficial targets
arrays, which stepped or steered the beam position by manipulat-
Figure 2.12  Elevation focusing and slice thickness. ing the active aperture or the timing of the transmit waveforms and

Central scan plane

Image plane
swept sideways
through tissues
Acoustic window

Coupling fluid

Array
Gear
Motor
Position
sensing device
Cables

Housing

A A 3D volume can be imaged using a 2D curvilinear B The square array transducer has a square matrix
transducer which is rotated by an electric motor of elements, which can steer the beam to image
a pyramidal volume

Figure 2.13  3/4D transducers.

22
 Image processing

B-mode system
Transmit beam former processor

Receive/
digitise

Channel
Post-processing
memory

Receive beam
Cine memory
former
Display

Echo signal
Image formation
processing
Transducer

Figure 2.14  B-mode system block diagram.

the transducer elements to prepare the signal for digitising. All

Array transducers and beam formation
• The transducer contains an array (>100) of elements, which are
used to move the beam electronically.
• The beam may be manipulated to form sector, rectangular or
trapezoidal fields of view.
• The beam may be stepped along the array by moving the active
aperture.
• The beam may be steered in different directions by phasing the
signals to and from each element.
• Electronic focusing is achieved by varying the signal timing across
the active aperture.
• The transmit beam is focused electronically to a depth selected
by the user.
• In receive, focusing tracks the depth of the target.
received echoes to and from the elements. The earliest real-time
scanners used single element transducers, which were physically
moved to sweep the ultrasound beam through the target tissues.
This technique is now confined to less common applications such
as intravascular ultrasound scanning and specialist applications
such as high-frequency (40–60 MHz) imaging of the skin or small
laboratory animals. The fabrication of arrays to work at high fre-
quencies is difficult, but the small size and weight of high-frequency
transducers makes them suitable for intravascular work and linear
mechanical scanning at high frame rates. For intravascular applica-
tions, a single element transducer mounted on a catheter tip is
rotated with the beam at 90° to the axis of rotation, as for the beam
from a lighthouse, sweeping out a circular field of view. Miniature
cylindrical arrays have also been used for this purpose.
IMAGE PROCESSING
Figure 2.14 is a simplified block diagram of the main components
of an ultrasound imaging system. The beam former and transducer
produce the sets of B-mode lines required to construct each indi-
vidual frame as described above. To form a useful B-mode image,
the lines of echo signals must be processed in a number of ways
before the image is built up and stored in the image memory.
Further image processing takes place when the image is read out
of the image memory, before it reaches the display screen. Although
the diagram implies that the processing steps follow beam forma-
tion, some signal conditioning must take place immediately after
subsequent processing operations, including beam forming, are
then carried out using digital techniques.
Time gain compensation (TGC)
As explained in Chapter 1, ultrasound waves are attenuated as they
propagate through tissues. Hence echoes arising from deep targets
are weaker than those from similar targets nearer to the transducer
(Fig. 2.15A). The B-mode image is required to display similar targets
with the same brightness regardless of their depths. As the target
depth is known to increase with time of arrival of the echo, attenu-
ation can be compensated for by increasing the amplification or
gain applied to the echoes with increasing time of arrival after
transmission (Fig. 2.15B). The technique is called time gain compen-
sation (TGC). The machine normally applies a base level of TGC
appropriate to the frequency of the transducer, but the operator can
make further adjustments to the gain level applied to each depth
via controls (usually slide controls) on the console as shown in
Figure 2.15C. The operator can also adjust the overall brightness of
the displayed echoes via an overall gain control.
Dynamic range
Echoes received at the transducer may arise from a range of pos-
sible target types giving rise to a wide range of echo strengths. An
interface between tissue and gas reflects almost 100% of the pulse
energy and gives rise to a very strong echo (assuming it is directed
back to the transducer). A tissue/tissue interface, e.g. liver/kidney,
can reflect up to 1% of the energy and is still considered to be a
relatively strong reflector. Most of the echoes that form the image
are due to scattering from small structural details within tissues.3
These are very much weaker than interface echoes (by a factor of
about 1 million), but still contain important diagnostic information
(Fig. 2.16A).
Echoes from large interfaces, such as organ boundaries, show
anatomical structure and organ size and shape, while scattered
echoes from organ parenchyma can show internal pathology or
lesions. For effective ultrasound diagnosis, it is necessary to display
both types of information at the same time.
Echo strengths are normally expressed in decibels (dB) with
respect to a reference level rather than a percentage or factor. The
dB simply expresses a ratio on a logarithmic scale, allowing the
numbers to be added rather than multiplied, as for factors and
percentages. A factor of 10 (in energy or intensity) is equivalent to
23
 CHAPTER 2 • Basic equipment, components and image production

Echo size

Time/depth
A Echo signals received at the transducer
become weaker with increasing
depth/time of arrival due to attenuation
Echo size
Time/depth
B TGC is used to compensate for attenuation C The user can adjust the TGC
so that echoes from similar targets are the via slide controls on the
same size regardless of target depth console

Figure 2.15  Time gain compensation (TGC).

0 dB Tissue–gas interface

-20 dB
Large tissue–tissue
-40 dB interfaces
Echo size

Echo size
-60 dB

Tissue scattering
-80 dB

-100 dB Blood
Time/depth Time/depth

A Echo sizes from different target types. B Echo signals before compression C Echo signals after compression
A 60 dB range of echo strengths must
be displayed to include tissue interfaces
and scattering

Figure 2.16  Dynamic range (compression).

Harmonic energy is higher in high

amplitude parts of the beam

10 dB and a factor of 100 (= 10 × 10) to 20 dB (= 10 + 10) and so on. A

factor of 1 million in pulse energy equates to 60 dB. Reverberations from strongly
To be able to display large interface echoes at the same time as reflecting targets result in
scattered internal echoes, the system must be able to display a 60 dB image clutter due to weak
echoes at f0 f0 2f0 Frequency
range of echo strengths as brightness variations on the display
screen. However, this is far greater than the typical maximum range
of brightness levels (about 30 dB) that can be displayed by a typical
modern flat screen display. The dynamic range of received echo
signals must be compressed by the system processor to fit into the
available dynamic range of the display. This is achieved by amplify-
ing the weak echoes more than the large echoes (Fig. 2.16B and C).
The user is able to alter the dynamic range of echoes displayed
(sometimes labelled compression) for different applications via the
machine controls.

Harmonic imaging
The processing described so far has assumed that the transmitted
pulse consists of a few cycles of the chosen transmit frequency, e.g.
5 MHz, and that the returned echoes are simply miniature versions
of the same thing. However, at the relatively high pulse amplitudes
transmitted by modern ultrasound imaging systems, propagation
through soft tissues is non-linear and the transmitted pulse becomes
distorted as it travels into the tissue. The effect is strongest in the
centre of the ultrasound beam where the amplitude is highest.
Distortion of the waveform is associated with the generation of
harmonics or multiples of the original fundamental frequency that
was transmitted.
24
2f0 Frequency
Clutter can be suppressed by removing
the fundamental frequencies and forming
the image from the first harmonic
Figure 2.17  Harmonic imaging.
When an image is formed from the original fundamental fre-
quency that was transmitted, it may contain clutter due to weak
echoes from beam side lobes or multiple reflections (reverberation)
of the pulse between strongly reflecting features (Fig. 2.17). As
harmonic generation is only significant where the pulse amplitude
is high, the clutter can be reduced by removing the fundamental

Coded pulse
waveform
1 1 0 1
Phase
Time
Figure 2.18  Pulse coding. The phase of the elongated transmit
pulse is alternated according to a chosen digital code. The same
code is embedded in a digital filter applied to returned echoes to
pinpoint their time of arrival.
frequency from the returned echoes and forming an image from the
harmonic frequency. This is known as harmonic imaging.4 As
the energy at the harmonic frequency is always less than that at the
fundamental, the system penetration may be reduced to some
extent when operating in harmonic mode.
To form a harmonic image, the transducer must be able to trans-
mit the fundamental frequency, but also receive the second har-
monic (twice the fundamental). Hence a transducer with a wide
frequency response is required. The harmonic image can be formed
by applying a frequency-selective filter to the returned echoes,
which rejects the fundamental frequency but allows through the
harmonic frequency.5
Harmonic images can also be produced using a method called
pulse inversion. In this method, two pulse-echo cycles are used to
form each B-mode line. In the first cycle, a short imaging pulse is
transmitted and echoes received as normal and stored. Then a
second pulse, which is an inverted version of the first, is transmitted
along the same path and echoes received. The second line of echoes
is subtracted from the first. In low amplitude parts of the beam,
where there is little distortion of the transmitted pulse, the lines of
echoes cancel out. In the high-amplitude regions, the lines of echoes
generated from the distorted normal and inverted pulses contain
energy at the fundamental and second harmonic frequencies. The
fundamental parts cancel out leaving the second harmonic parts to
form the image.
Pulse coding
The maximum depth from which echoes can be received is deter-
mined by the attenuation of the pulse and returning echoes by the
tissues they pass through. Higher frequencies give improved image
resolution but suffer more rapid attenuation and hence reduced
penetration of tissues. For a given frequency, penetration can be
improved by using a longer transmitted pulse, making its echoes
easier to detect. However, the increased pulse length degrades
the axial resolution of the system. Pulse coding techniques allow
the use of long transmit pulses while maintaining good axial
resolution.6
The long transmit pulse is divided into time segments in which
the phase of the wave is alternated according to a predetermined
code (Fig. 2.18). When the echoes are received, they are passed
through a digital filter which is programmed to search for the code.
When a match is detected, the time at which it occurs gives the
effective time of arrival of the echo, restoring the axial resolution.
Pulse coding allows greater penetration to be achieved at higher
frequencies.
Demodulation
All of the processing steps described so far have been applied to
signals that contain the original ultrasound transmit frequency or
Image processing
Echo amplitude
RF signal
A Undemodulated RF echo signal B Demodulated echo signal
Figure 2.19  Demodulation.
B-mode instrumentation and processing
• Time gain compensation (TGC) is used to compensate for
increasing attenuation of echoes with depth.
• The dynamic range of echoes must be compressed to display
reflected and scattered echoes simultaneously.
• Harmonic imaging may be used to reduce reverberations and
clutter in the image.
• Pulse coding may be used to increase penetration for a given
frequency.
• Echoes must be demodulated to remove the transmit frequency
before image formation.
• Post-processing is applied as the image is read out from the
image memory.
its harmonics. This is referred to as the radio-frequency or RF signal.
The brightness value that is displayed at each point in the image is
related to the amplitude or envelope of the RF signal. The final
processing step in forming the B-mode image is to remove the
radio-frequency element of the signal to leave the envelope signal.
This process is referred to as demodulation (Fig. 2.19).
Image memory
Following the various processing steps described above, the B-mode
lines are written into the image memory to form the image as an
array of pixels similar to an image in a digital camera. The dimen-
sions of the image in the memory array are typically 1200 × 1200
pixels, with each pixel capable of storing up to 256 different grey
levels (8 bits). As for a digital camera, the system is capable of
storing many images (over 2000 for some models) and successive
frames are stored in a cine memory until the memory is full. The
first image stored is then overwritten so that the last frames are
always stored. The chosen image is read out from the image
memory in a raster pattern which is synchronised to that of the
display monitor.
The image can be written to the image memory and read out in
a number of different ways. If the image memory is being con-
stantly updated with new images and the last image to be formed
is always read out to the display, a real-time, moving image is
displayed. In freeze mode, new images are not written into the
memory and the last image stored is read out repeatedly to the
display monitor. In cine loop mode, the writing process is again
frozen but the whole sequence of stored images is read out in a
repeated cycle showing the last 30 seconds or so of the real-time
image.
Field of view and zoom
When images are written to the image memory, they are scaled to
match the field of view, chosen by the operator, to the memory
25
 CHAPTER 2 • Basic equipment, components and image production

n-7 n-6 n-5 n-4 n-3 n-2 n-1 n

Displayed grey level

Displayed grey level

Rolling average of 5 frames

Figure 2.20  Frame averaging (persistence). A Stored level B Stored level

dimensions. A specific region of interest within the image can also

Displayed grey level

Displayed grey level

be chosen by the operator to fill the memory space, leading to the
storage of a zoomed-in image (write zoom), rather like using a
telephoto lens with a camera. A similar process can be applied
when the image is read out. Here a region of the stored image can
be chosen to be read out and fill the display screen. This is referred
to as read zoom. The zoomed area can be moved around the stored
image but may appear pixelated at large magnifications.
C Stored level D Stored level
Post processing Figure 2.21  Post-processing gamma curves. A: Linear.
B: Enhancement of weak echoes. C: Enhancement of higher
When images are read out from the image memory, a number of level echoes. D: Enhancement of mid-range echoes (s-curve).
further processing steps may be applied before they are sent to the
display. These steps are referred to as post processing as they take
place after image storage. the reflecting or scattering targets remain stationary. The rapid suc-
Persistence is used to suppress fluctuating noise patterns in the cession of images, which forms the real-time display, shows tissue
image. As described earlier, the echo signals received by the trans- movements, e.g. the heart wall, as a progressive change in position
ducer from scattering within tissues, especially those from large through consecutive frames. Ultrasound is an important diagnostic
depths, are very weak and may be contaminated by random elec- tool in the study of blood flow in arteries and veins but, due to the
tronic noise produced in the processing electronics. The pattern of homogeneous nature of blood and its weak scattering, makes use
noise signals stored within each image is different and can be dis- of the Doppler effect to detect movement.
tracting as it fluctuates when images are displayed in real-time
mode. The random noise patterns can be suppressed by frame Continuous wave Doppler (CW)
averaging, also known as persistence. This is achieved by display-
ing an average of the last four or five images stored in the image
As explained Chapter 1, when a transmitted continuous wave of
memory (Fig. 2.20). Instead of displaying a given image pixel from
ultrasound is scattered by flowing blood, the frequency of the
the last frame, the average of the corresponding pixels from the last
received echo signal is shifted due to the Doppler effect, by an
four or five frames is sent to the display. Random image noise
amount related to the velocity of the blood. The Doppler shift fre-
is suppressed but moving targets may be smeared in the image if
quency fD can be used to measure and monitor the blood flow
too many frames are averaged. The degree of persistence may be
velocity. In the simplest Doppler ultrasound system, a dual element
chosen by the operator.
transducer is used with one element transmitting continuously and
The gamma curve (also referred to as the grey map) is a form of
the other receiving, as shown in Figure 2.22A. Blood movement can
post processing chosen by the user to emphasise particular ranges
be detected in vessels that pass through the region where transmit
of echo amplitudes in the image. The amplitude values stored in
and receive beams overlap. To extract the Doppler shift frequency,
the pixels of the image memory are represented in the image in
the received echo signal (at frequency fR) is mixed with a sample of
terms of displayed image brightness or grey level. The way that the
the transmit frequency ( fT). The resulting signal contains compo-
displayed grey levels relate to the stored values is controlled by the
nents at frequencies fT + fR (at several MHz) and fT − fR (at several
gamma curve. Different curves are available for the user to choose
kHz), which is the Doppler shift frequency fD. The MHz compo-
from according to the clinical application (Fig. 2.21). For example,
nents are then filtered out to leave the Doppler shift frequency, as
a curve that assigns more grey levels to the lower amplitude signals
shown in Figure 2.22B. As this frequency is in the audible range,
(Fig. 2.21B) may be more suited to imaging of the liver where the
the observer can listen to it via headphones or a loudspeaker. Con-
most useful information is obtained from weak echoes scattered
tinuous wave Doppler is used widely to monitor blood flow in
from the liver parenchyma.
superficial arteries, which can be located without image guidance,
Various other post-processing techniques have been employed
or in vessels with very high flow velocities, such as the ascending
by manufacturers to enhance the displayed image. These include
aorta. However, it cannot separate signals from multiple blood
smoothing to reduce noise and speckle and edge enhancement to
vessels which fall within the beam overlap region. Locating deeper
emphasise boundaries such as vessel walls. Adaptive processing
vessels is also difficult with CW Doppler.
techniques analyse the image to identify features such as bounda-
ries. These can then be enhanced by smoothing along the boundary.
Other areas are smoothed to reduce noise and speckle. Pulsed wave Doppler (PW)
Pulsed wave Doppler is used in conjunction with a B-mode image,
facilitating the location and identification of vessels. This is referred
DOPPLER ULTRASOUND to as duplex imaging. The pulsed wave method also allows spatial
separation of signals from adjacent vessels. In pulsed Doppler
The ultrasound imaging techniques described so far have all been systems, a relatively long pulse of ultrasound (say 10 cycles) is
based on the assumption that during the formation of each image, transmitted. As for B-mode imaging, a continuous series of echoes
26
 Doppler ultrasound

Receive beam Transmit beam

Receiver fT
amplifier fR

Mixer Transmit frequency fR

(fT × fR) generator fT

Low pass filter

(fT + fR) fT × fR
(fT – fR)

Doppler shift fD
A frequency fD B

Figure 2.22  Continuous wave Doppler. A: System block diagram. B: The demodulation process.

PRF Doppler beam

clock

Transmit
Gate frequency Delay
Sample
fT
volume
Blood vessel
Low pass filter
Receiver Mixer
(fT + fR) Sample Angle cursor
amplifier fR (fT × fR)
(fT – fR)

Low pass
filter
Transducer

Sample volume
Doppler shift
frequency fD Figure 2.24  The pulsed Doppler sample volume and angle
cursor are adjusted by the operator to align with the vessel of
Figure 2.23  A pulsed wave Doppler system block diagram. interest.
PRF, pulse repetition frequency.

of the pulse is then received from increasing depths, following each
transmission. The returned signals are processed as for CW Doppler
to extract the Doppler shift frequencies. Doppler signals from a
specified blood vessel are then isolated for further processing by
the use of a time gate, which allows through only those signals
corresponding to the depth of interest (Fig. 2.23). The position of
the time gate (the sample volume) is indicated on the B-mode image
by cursors (Fig. 2.24). The user adjusts the position of the Doppler
beam and the depth (or range) of the sample volume along it, so
that the sample volume is located over the vessel of interest. As this
is a pulse-echo technique, the same transducer or active aperture
can be used to transmit and receive. The user also adjusts the angle
of a cursor in the centre of the sample volume to indicate the direc-
tion of blood flow to the system.
The process for extracting the Doppler shift frequency is similar
in principle to that used for CW Doppler. However, the received
signal now consists of one brief sample of the Doppler frequency
from the depth corresponding to the target vessel, for each trans-
mitted pulse (Fig. 2.25). These can be thought of as a set of samples
of the equivalent CW Doppler shift frequency. The value of each
sample is determined by the phase relationship between the cor-
responding fR sample and the reference transmit frequency fT. The
continuous Doppler shift frequency signal is constructed from the
samples by low pass filtering.7
27
 CHAPTER 2 • Basic equipment, components and image production
The pulsed Doppler gating process gives a sample
of the Doppler shift frequency for each pulse echo cycle
The Doppler frequency is reconstructed
by further smoothing and filtering
Figure 2.25  Pulsed Doppler demodulation.
Strong signal from stationary
tissue and vessel walls
Blood signal
Doppler frequency (kHz)
–2 –1 0 1 2
A The Doppler signal contains strong, low frequency
echoes from stationary tissue and vessel walls
Vessel wall High pass (wall) filter
echoes removed
Blood signal
Doppler frequency (kHz)
–2 –1 0 1 2 are analysed, they are displayed as adjacent vertical lines creating
B These are removed using a high pass filter
Figure 2.26  High pass filtering of the Doppler signal.
For both CW and pulsed Doppler, further signal mixing and
processing is then used to separate signals from flow towards the
transducer and flow away from the transducer.
High pass filtering
The Doppler shift signal in CW and pulsed Doppler systems con-
tains several components as illustrated in Figure 2.26. The strongest
signal components are those due to reflection and scattering from
stationary or slowly moving tissues and tissue boundaries. These
are associated with low Doppler shift frequencies. Blood flow veloc-
ities can range from zero (during parts of the cardiac cycle) to
several metres per second, giving rise to Doppler shift frequencies
up to several kHz. The signal due to scattering from blood is much
weaker than that from tissue, however. A particular problem in
arterial signals is the large signal from the slowly moving arterial
wall which gives rise to a ‘wall thump’ in the audio signal. Such
large signals from slowly moving tissues must be removed by filter-
ing to allow the smaller blood signal to be analysed. This is done
using a high pass filter, also known as a wall thump filter, which
rejects the low-frequency Doppler shift signals. The cut-off fre-
quency of this filter may be selected by the operator to reject the
arterial wall signal with minimum loss of blood signal.8
28
Aliasing
The sampled nature of the reconstructed pulsed Doppler signal
leads to a major limitation of pulsed Doppler systems at high blood
flow velocities. Each transmitted pulse leads to one sample of the
Doppler shift signal. Hence the number of samples produced per
second, the sample rate, is the same as the number of Doppler
pulses transmitted per second, the pulse repetition frequency (PRF).
To reconstruct a sine wave of a given frequency, it is necessary to
have at least two samples for each cycle of the wave, i.e. the PRF
must be at least 2fD. If the Doppler frequency for flow towards the
transducer (forward flow) increases to the point where the PRF is
too low, it will appear instead as an aliased, reverse flow frequency,
shifted downwards by an amount equal to the PRF.
Aliasing is most likely to be a problem when the Doppler shift
frequency is high (high blood flow rates and high transmit fre-
quency) and the PRF is low (due to large target depth).
Doppler frequency estimation and display
Doppler signals can be observed by listening via headphones or
loudspeakers, and the expert user can infer much about blood flow
and disease states in blood vessels using this approach. However,
objective assessments of many disease states can only be made by
quantifying the blood flow velocity and other flow characteristics.
This is done via the sonogram, which is a time varying display of
the flow velocities within the Doppler sample volume (Fig. 2.27A).
To generate the sonogram, the continuous Doppler signal is
divided into a set of fixed time intervals, typically 10 ms in dura-
tion. Each 10 ms section is then analysed, using digital Fourier
transform methods, to create a distribution or histogram of Doppler
frequencies. The distribution is displayed as a vertical line with the
power of the signal at each frequency represented on a greyscale
(Fig. 2.27B). Using the Doppler angle set by the user and the Doppler
equation (Chapter 1), the system converts the Doppler frequencies
to a velocity scale. Light grey or white areas in the display indicate
velocities at which there are many blood cells flowing and
dark grey areas where there are few. As consecutive 10 ms intervals
a time-varying display of blood flow velocities and their
distribution.
The user can adjust the velocity and time scales of the display.
As the precision of the frequency estimate is given by the inverse
of the time interval (e.g. 100 Hz for a 10 ms sampling interval), slow
sweep speeds (which use longer time intervals) give greater fre-
quency (velocity) precision and vice versa.
Doppler ultrasound instrumentation
• The frequency of ultrasound scattered from moving blood is
shifted due to the Doppler effect.
• For typical transmit frequencies and blood velocities, the Doppler
shift frequency is in the audible range.
• Continuous wave Doppler may be used to study blood flow in
superficial vessels.
• Pulsed Doppler uses time gating to isolate Doppler signals from
deeper vessels using B-mode image guidance.
• High-amplitude low-frequency signals from slowly moving tissues
and vessel walls must be filtered out using a wall thump filter.
• The PRF used in pulsed Doppler systems must be at least twice
the Doppler shift frequency to avoid aliasing.
• The sonogram is used to display the time varying distribution of
flow velocities within the Doppler sample volume.
Colour flow imaging
Pulsed Doppler systems, in conjunction with a sonogram display,
are widely used to make detailed studies of flow velocities and their

A PRF
Velocity
Time
B Mean
Velocity
Time
10 ms
intervals
Figure 2.27  A: A sonogram from the carotid artery. B: To
construct the sonogram, the velocity distributions in consecutive
10 or 20 ms samples are displayed as adjacent vertical lines.
The amount of blood flowing at each velocity is represented on
a greyscale.
distribution within a stationary sample volume placed within a
blood vessel. Colour flow imaging systems give a real-time 2D
image of blood flow patterns in blood vessels as a colour overlay
on a B-mode image. Here the colour of the display, at each point in
the image, represents the mean blood flow velocity at a given time.
Colour flow imaging systems can be seen as an extension of the
time gating approach from a single sample volume to multiple
adjacent sample volumes along the Doppler beam. The beam is also
swept through the region of interest as in B-mode image formation,
to form a 2D colour map. However, the time restrictions imposed
by real-time 2D image formation require different techniques to be
used for removal of stationary tissue echoes and for Doppler fre-
quency estimation. Whereas frequency analysis in the sonogram is
performed on a 10 or 20 ms sample of the Doppler signal, each line
in the colour flow map must be formed in about 1 ms to allow real-
time display.
For each line in the colour flow image, the beam is held in the
same position for a number of pulse-echo cycles (typically eight).
The number of pulses transmitted in this sequence is referred to as
the ensemble length. As illustrated in Figure 2.28, the received
echoes are mixed with the transmit frequency and filtered to extract
the Doppler shift frequency as for CW and pulsed Doppler systems.
No gating is applied as Doppler signals are required from all depths
Doppler ultrasound
clock
Transmit
Gate frequency
fT
Receiver Mixer
amplifier fR (fT × fR)
Low pass filter
(fT + fR)
Transducer (fT – fR)
Region of Delay line
interest canceller
frequency
Image
Autocorrelator Variance Display
Power memory
Figure 2.28  Colour flow imaging system block diagram.
PRF, pulse repetition frequency.
along the line. To remove the large echoes from stationary and
slowly moving tissues, a technique called delay line cancellation is
then used rather than filtering. Each line of echoes in the ensemble
is stored digitally and compared with the next one by subtracting
one from the other. This removes echoes from stationary targets,
which do not change, while preserving signals from those that are
moving, as they do not cancel out. Modern systems use more elabo-
rate versions of this technique to give enhanced separation of sta-
tionary echoes.
Estimation of the Doppler shift frequency is most commonly
carried out by a technique called autocorrelation.7 In essence, each
line of Doppler signals generated by each pulse-echo cycle in the
ensemble is compared with the one before it. The rate at which
the phase of the signal, at each point along the line, changes in the
interval between one line in the ensemble and the next leads to an
estimate of the Doppler frequency at that point in the line. By
extending this process over the ensemble of pulses, an estimate of
the mean frequency is obtained for each point along the line. Mean
frequency is represented in the image on a colour scale, commonly
using red for flow towards the transducer and blue for flow away
(Fig. 2.29). Low frequencies are displayed as dark shades of red or
blue leading, with increasing frequency, to lighter shades through
to white. The display normally includes a colour wedge showing
the range of available shades of red and blue next to a correspond-
ing velocity scale. The velocity scale indicates the component of
blood flow velocity in the direction of the Doppler beam (i.e. not
corrected for Doppler angle).
The autocorrelator can also give an estimate of the variability of
the Doppler frequency during the ensemble for each point along
the line. This is expressed in terms of the variance of the signal and
is used to display an alternative form of colour map which can
indicate the degree of disturbance in the blood flow in the vessel.
Limitations of colour flow imaging
As the mean frequency values displayed in each line of the colour
flow image are estimated from the set of samples obtained from
29
 CHAPTER 2 • Basic equipment, components and image production
Figure 2.29  A colour Doppler display, showing blood flow in
the carotid artery. Mean velocity with respect to the angle of the
Doppler beam is shown on a colour scale.
each ensemble, colour flow images are also affected by aliasing.
Aliasing of the red channel shows as a sudden inversion to dark
blue and vice versa. As for pulsed Doppler, aliasing occurs at high
flow velocity, high transmit frequency and low PRF. The colour
flow overlay is usually restricted to a region of interest to minimise
line/image formation time and maximise the PRF.
At the other end of the frequency scale, the precision of the fre-
quency estimate and sensitivity of the system to low velocities
is determined by the total sample time, which is the duration of
the ensemble. Expanding the velocity scale will ensure that
these parameters are optimised for detecting low frequencies
(velocities).
Power Doppler
Colour flow imaging systems are very effective at showing varia-
tions in flow velocity at different points and times in a blood vessel.
Early systems had poor sensitivity to signals from small vessels,
especially at low flow velocities. In cases where the requirement
was simply to demonstrate the presence or absence of flow in small
vessels, power Doppler was more effective. To create a power
30
Colour Doppler instrumentation and processing
• Colour flow imaging systems give a real-time 2D image of blood
flow patterns in blood vessels as a colour overlay on a B-mode
image.
• The colour of the display at each point represents the current
value of mean flow velocity.
• Large echoes from slowly moving tissues and vessel walls are
removed by delay line cancellation.
• Mean frequency at each point in the image is estimated by
comparing the phase of the Doppler signal on each line with the
previous one.
• Colour flow images are also affected by aliasing.
• Power Doppler gives a real-time 2D image of the amount of
blood flowing in a blood vessel.
Doppler image, the autocorrelator module carries out a different
calculation on the signals to give the power of the Doppler signal
at each point along the line, rather than the mean velocity. The
colour at each point is then related to the amount of blood flowing
through the Doppler beam and not to its velocity. The power
Doppler signal is less susceptible to noise and so can detect weaker
flow signals. As it is not related to Doppler shift frequency, it is not
affected by aliasing or by the Doppler angle.
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