Appendix: System Controls and Their Uses
Paul L. Allan
In addition to the basic choice of transducer type and
frequency for the examination in hand, there are many
other factors on a Doppler ultrasound system which
need to be adjusted. Despite the efforts of the manufac-
turers to automate and simplify things, it is still neces-
sary to adjust continually many of the scan and Doppler
parameters during the course of an examination. Is the
vessel superficial or deep? Is flow fast or slow, high vol-
ume or low volume? Most systems now come with a
variety of preset programs for different situations:
peripheral arteries, veins, cerebrovascular, etc.; together
with automatic image and spectral display optimisation.
Many also have the facility to allow users to save their
own program preferences, which is a convenient option
to store preferred settings once a satisfactory set up has
been achieved for a particular type of examination.
Whilst the manufacturer’s presets allow the basic appro-
priate settings to be employed at the start of an exami-
nation, fine adjustments will still be required during the
course of the examination to make the most of the avail-
able information. Familiarity with the ultrasound
system, together with experience, enable skilled opera-
tors to set up their system appropriately for the exam-
ination being performed. Different manufacturers
sometimes use different names for the same controls
or functions; it is not possible to give an exhaustive list
of all the possible options on the range of modern
equipment now available but the following notes
describe the basic controls, or parameters on most sys-
tems that can be adjusted during the course of an exam-
ination to improve and maximise the information that is
obtained from the examination.
General Principles
TRANSDUCER FREQUENCY
The highest frequency which will achieve the highest
resolution consistent with adequate penetration for
370
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imaging is normally chosen. The Doppler fre-
quency used by any transducer is often 1–2 MHz
below the imaging frequency, although modern
equipment has a wide range of receive frequencies
such as 5–14 MHz. In addition to the basic imaging
requirements, it should be remembered that the
deeper a vessel lies, the longer it takes a sound pulse
to travel there and back, so that the Nyquist limit
becomes very relevant (Chapter 1), limits the
Doppler frequencies that can be used and therefore
the frequency shifts/velocities that can be recorded
accurately.
B-MODE IMAGE
For colour Doppler examinations this should be set
up with relatively low overall gain, so that the image
is a little on the dark side as the software tends to
allocate colour to darker areas, rather than to areas
which contain echoes. See ‘Colour write priority’
below.
TRANSMIT POWER
The transmit power of the system should be set at
the lowest level consistent with an adequate exam-
ination, especially during obstetric and gynaecolo-
gical examinations. It is better to start at a medium
level and increase the power only after other mea-
sures to improve system sensitivity have been tried,
such as adjusting colour gate size, removing filters,
adjusting the scale/pulse repetition rate. For low
mechanical index (MI) contrast studies (see
Chapter 17) the transmit power should be set as
low as possible and the MI reading ideally should
be less than 0.4. Modern systems often have con-
trast-agent-specific programs already installed, or

the relevant settings can be obtained from the supplier
of the contrast agent.
UPDATE/DUPLEX/TRIPLEX
In duplex ultrasound there is the ability to acquire and
display both real time imaging and spectral Doppler
information either simultaneously, or alternately.
Simultaneous display results in degradation of both
the image and the spectral display as the computer
has to process data from both sources. The update
facility allows the operator to set the system to handle
either imaging data, or Doppler data. This results in a
higher quality of display for the selected mode and it is
usually used for acquisition of the best-quality spectral
display for analysis. Simultaneous duplex scanning is
of some value in the initial stages of an examination in
order to position the sample volume in a specific area
of interest. Triplex mode refers to the simultaneous
acquisition, processing and display of colour Doppler,
spectral display and imaging information. As with
duplex scanning, this requires significant division of
processing power and consequent compromise in
the quality of the display. Newer systems with more
powerful computers are less prone to these problems
but there is still a division of processing power and
experienced operators will still tend to switch between
imaging and spectral Doppler for optimal results.
AUTOMATIC IMAGE OPTIMISATION
Many systems now have automatic image optimisation
controls which adjust factors such as time gain com-
pensation, receiver gain and colour Doppler gain to
improve the image. In some cases this facility can also
be applied to the spectral display. These can be useful
in getting a reasonable initial display but should not be
relied upon entirely and the operator needs to make
the final adjustments to obtain the best images.
Colour Doppler Controls
COLOUR BOX
This defines the area of the image over which colour
Doppler data are acquired. It can be adjusted for size,
position and direction/angulation. It is better to keep
the box as small and as superficial as practical because
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Appendix: System Controls and Their Uses 371
larger areas take more processing power and time.
Larger sizes and greater angulations may therefore
reduce frame rates. Greater angulation also reduces
sensitivity, which can therefore be improved by reduc-
ing the degree of angulation of the colour box, for
instance when examining deeper segments of the fem-
oral vein in larger legs. Deeper boxes need slower
pulse repetition frequencies, therefore limiting the size
of shift that can be measured without aliasing.
COLOUR MAP
Choose a colour map that has good contrast for the
identification of aliasing. Maps which grade to white
at each end, or to very pale colours, do not give as much
information about aliasing as those which have signifi-
cantly different colours, such as pale green and pale
orange. Variance maps were said to register the amount
of spectral broadening in the colour map, although this
is not easy to appreciate and may, in fact, not be true as
this ‘variance’ seems to reflect the velocity, rather than
spectral broadening. Variance maps are most frequently
used in cardiological examinations. In addition, colour
tags can be put into the scale so that velocities above or
below the chosen range can be identified.
COLOUR GAIN
The colour gain is set to the optimal level. This can be
identified by turning up the gain until noise/colour
speckle is seen in the colour box and then backing
off slightly on the overall colour gain. It should also
be adjusted to remove any spill of the colour map over
the boundaries of the vessel seen on the B-mode
images; this is sometimes called colour bleeding. Col-
our gain often needs to be increased if the colour box is
moved to a deeper location.
COLOUR SCALE
The colour scale should be set to levels appropriate
for the range of velocities under investigation. It
should be remembered that colour Doppler only gives
information on the mean Doppler shift in a pixel;
the mean velocity in a pixel is only calculated when
an angle correction for that pixel is performed. The
colour scale is closely related to the pulse repetition
frequency, or sampling rate; this has to be above the
Nyquist limit for the frequency shift being measured.
372 Appendix: System Controls and Their Uses
If it is set too low then aliasing will occur; this can be
rectified by increasing the colour scale range, also
known as the pulse repetition frequency. If it is set
too high then there will be poor colour sensitivity
for slower velocities, resulting in inadequate colour
fill-in across the vessel.
COLOUR INVERSION
This changes the colour map display for mapping the
direction of blood flow in relation to the transducer,
e.g. red for flow towards the transducer and blue for
away from the transducer, or vice versa.
COLOUR GATE
This relates to the size of the colour pixels, a smaller
size gives better spatial resolution, whereas a larger
size provides better sensitivity at the expense of spatial
and sometimes temporal resolution.
COLOUR BASELINE
The colour baseline can be adjusted to provide a wider
range of shifts on one side or the other, depending on
the characteristics of the blood flow in the vessel being
examined and particularly if the flow is in only one
direction.
COLOUR FILTERS
These help remove low-frequency noise and clutter
from the image. It is best to set filters at the lowest level
compatible with an acceptable image as they also
remove low-frequency shift information from the
image.
COLOUR WRITE PRIORITY
A pixel in the image can display either B-mode imaging
information, or colour Doppler information. The col-
our write priority facility allows the relative priorities
for these two types of information to be defined. High
colour priority results in colour information being
displayed in areas which might contain low-intensity
imaging information, for instance at the margins of
vessels. Alternatively, high imaging priority results
in grey scale information displacing colour informa-
tion, such as might occur with reverberation artefacts
appearing within the vessel lumen amongst the colour
Doppler information.
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COLOUR PERSISTENCE
This reflects the amount of frame-averaging which
occurs. A low level of persistence results in an image
which has a fast temporal response but may have a
poor signal-to-noise ratio. A high level of persistence
improves the signal-to-noise ratio by summating data
from several frames, but this results in an impaired
temporal response, so that pulsatile flow information
is dampened.
Power Doppler Controls
Although the power mode is intrinsically simpler than
velocity mode, there are still several controls and
options which influence the power image.
POWER MAPS
Most systems offer a variety of colour maps from which
the operator can select according to personal prefer-
ence, usually a yellow- or magenta-based scale is used
for display of power Doppler information. The thresh-
old or sensitivity can be varied; this results in changes
in the transparency of the power box. When the power
map background is opaque the sensitivity is maximal.
Various degrees of increasing translucency are avail-
able so that sensitivity can be traded for imaging and
anatomical information.
POWER GAIN
This is similar to colour gain and amplifies the received
Doppler signal. Excessive gain will result in unneces-
sary noise and artefact in the image.
SCALE
The energy scale affects the sensitivity of the system for
signal intensities of varying strengths: lower scales are
more sensitive to lower-intensity signals, which will
also increase flash artefact. On some systems the
power Doppler scale is linked to the filter settings.
DYNAMIC RANGE
As in spectral Doppler, this affects the range of signal
intensities over which the available colour scale is
spread and the appearance of the Doppler information
on the screen: increasing the dynamic range will tend
to increase the amount of colour on the screen.

POWER BOX STEERING ANGLE
As with the colour box, the power box can be adjusted
for size, position and direction/angulation. Although
the power display is much less dependent on angle
than the velocity display, there may still be loss of
the power signal at 90 because these low Doppler fre-
quencies fall below the motion discrimination filter
cut-off level. In most situations, steering the power
Doppler box does not have much effect on the display;
however, the loss of signal at 90 may be overcome by
having a degree of angulation of the transducer.
POWER/COLOUR HYBRID IMAGES
Many systems now allow a hybrid image containing
both power Doppler and colour Doppler data to be
displayed. This aims to combine the sensitivity of
power Doppler with the directional and velocity infor-
mation from colour Doppler. On some systems, the
relative contributions from the two sources can be
adjusted.
FILTERS
Motion discrimination filters in power Doppler are
used to filter out excessive signal noise from structures,
other than blood, which are moving in the Doppler
box. Low filter settings provide more sensitivity but
are more prone to flash artefacts, whereas higher filter
settings reduce flash artefacts but will also filter out
some blood flow information.
Spectral Controls
SPECTRAL GAIN
This affects the receiver gain for the spectral display. As
in B-mode imaging, the level should be adjusted in
order to give a balanced distribution of grey shades
across the displayed spectra. Excessive or inadequate
levels of gain will produce erroneous estimates of
Doppler shift/velocity.
SPECTRAL DYNAMIC RANGE
This can be varied to optimise the display of particular
frequency shifts. A narrow dynamic range results in
the loss of low-intensity shifts above and below the
main shift frequencies. Conversely a wide dynamic
range, particularly if associated with a high level of
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Appendix: System Controls and Their Uses 373
spectral receiver gain, can result in artefactual broad-
ening of the spectra displayed. Further manipulation
of the spectral display can be performed by altering
the postprocessing algorithms on some systems in
order to emphasise, or suppress, particular frequency
shifts. In normal practice a simple linear allocation is
most convenient.
SPECTRAL SCALE
Altering the scale affects the pulse repetition frequency
and thus the range of shifts which can be registered
without aliasing. In practice the scale is adjusted so
that the Doppler waveform is displayed without
wrap-around, which indicates aliasing. The scale
may be displayed as either a KHz scale for frequency
shift, or a velocity scale. The use of velocity, rather than
frequency shift, allows some comparison of different
examinations, performed with different transducer
frequencies and with different angles of insonation.
SPECTRAL INVERSION
This allows the operator to change the orientation of
the display. Many operators prefer to display both arte-
rial and venous waveforms above the baseline, even if
flow is away from the transducer. However, care is
therefore required when assessing the vertebral arter-
ies for reverse flow, or the leg veins for reflux, as errors
may occur if spectral inversion is not recognised. Some
centres do not allow spectral inversion because of the
potential for misinterpretation, particularly in relation
to examinations for venous insufficiency.
SPECTRAL SWEEP SPEED
A medium speed is adequate for most arterial work,
with a slower speed better for venous flow. A fast
sweep speed is useful for acceleration time measure-
ment and waveform analysis, particularly if there is
tachycardia.
ANGLE CORRECTION
The measurement of the angle of insonation relative to
the direction of flow is required in spectral Doppler in
order to convert frequency shift information into
velocity information and also in colour Doppler to
convert mean pixel shifts into mean velocities. The
main direction of flow may not necessarily be parallel
to the vessel wall and colour Doppler is useful in
374 Appendix: System Controls and Their Uses
precise positioning of the angle-correction cursor
along the line of the jet. The angle of insonation should
be less than 60 or the errors in velocity calculation
become significant.
GATE SIZE
This defines the range of depths from which Doppler
data are collected. The gate should be positioned
across the lumen of the vessel but clear of the walls
in order to reduce wall thump artefact. The position
of the gate which corresponds to the maximum Dopp-
ler shift is located using a combination of the colour
map for initial positioning and then refining this using
the operator’s ears, which are the most sensitive and
efficient spectral analyser available; with experience,
your ears will register when the peak frequency shift
is obtained. If an assessment of volume flow is being
made, the gate should be wide enough to encompass
the entire vessel width so that all the flow contributes
to the signal and the time-averaged mean velocity will
be most representative. Smaller gates give a cleaner sig-
nal, especially with laminar flow, but at the expense of
a reduction in sensitivity.
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FILTERS
Removal of low-frequency noise and clutter arising
from the vessel wall and surrounding tissues contrib-
utes to a cleaner signal, but filters should be set as low
as is practical, otherwise low-frequency shifts from
slow blood flow will be filtered out, which could result
in the mistaken impression of absent diastolic flow in
arteries, or occlusion in veins. In practice it is best to
keep the filters set at the lowest setting and only
increase filtration as required during an examination.
Conclusions
Modern systems allow the operator to preset many of
these parameters and create different personal pro-
files/setups for different types of examination such as
veins, carotids, renal, etc. However, it should be
remembered that ultrasound is a dynamic examination
and, even with modern equipment, the best results will
be obtained if the system controls are adjusted to opti-
mum settings for the task in hand, rather than relying
on the preset profiles alone.