Ultrasonography

 It’s a study of the physical foundation of ultrasound and its application to medical
diagnosis
Brief History of Ultrasound
 The use of ultrasound in medicine began during and shortly after the 2nd World
War in various centres around the world; used for sound navigation in ranging
 Obstetrician Ian Donald and engineer Tom Brown developed the first prototype
systems based on an instrument used to detect industrial flaws in ships; used to
detect submarines
o Ultrasound was also used for the researchers to detect bats in cave.
o Ultrasound was also used before during the research of the titanic way
back 1912 in North Atlantic Ocean.
 In the early hours of April 15, 1912, the British passenger liner,
RMS Titanic, sank in the North Atlantic Ocean after colliding with an
iceberg during her maiden voyage from Southampton, UK to New
York City.
 Immediately following the Titanic disaster, research on underwater
echo detection systems began advancing rapidly. Soon thereafter,
ultrasonic technology and the images it could produce were applied
to anatomical research and disease diagnosis, forever changing the
way we look at the human body.
 Over the past years there have been significant technological improvements
within the equipment specifically the structure, physical appearance as well as
development of new technologies that allowed ultrasound to become more widely
adopted, especially in medicine.
 It looks the same with the transducer but before, they will have to submerge it
into the water; even if you submerge it in water, it will not electrify you.
 First artificial sources of ultrasound were during 1870s and the basic principle
behind the concept of ultrasound producing an image was described and studied
by Jacques and Pierre Curie; these are the 2 person who first described
piezoelectric effect.
 Even the discovery of piezoelectric effect in ultrasound imaging, it was first
produced the first medical application of ultrasound way back 1930s and 1950s.
 Dr. Karl Theodore Dussik in Austria is the first person who decides for first
practical ultrasound imaging unit.
o Neurologist Karl Dussik is credited
with being the first to use
sonography for medical diagnoses.

Ultrasound machine (parts)

  This is the existing ultrasound imaging unit.
 Portable
o If you’re going to compare ultrasound modality to the other modalities like
CT scan, MRI, that’s the advantage of the ultrasound because the
modality itself is portable; you can move this machine to one place to
another.
 As to compare with the other modalities, it produces cross sectional image; when
compared to x-ray, x-ray produced frontal view, AP, Lateral (you can take any
exposure).
 Ultrasound best demonstrate cross section image. Best image to demonstrate in
Ultrasound is tissues structure. All organs or structures that is made up of tissue
can be suitable for ultrasound; not purely for the pregnant.
 Eye, baby’s brain (brain scan to detect if there are brain anomaly); the bone
formation isn't complete (fontanelle) or in other terms, baby’s head where the
skull bones haven't fused together yet.
Modalities Best structures that can be imaged
MRI Joints like knees, elbow, vertebrae
CT scan Brain
Mammography Breast
X-ray Bones

Advantages of Ultrasound Machine

 All modalities can produce an image, so what
makes ultrasound different to the other modalities?
1. It utilized sound waves (high frequency sound
waves)
2. It is non-ionizing; no radiation unlike MRI and
CT.
3. The equipment is very portable - It is easy to
perform because the allied healthcare
professional only manipulates the keyboard in
the other hand while the other hand is in the
ultrasound probe (ultrasound transducer)
 As an RT, you just need to master
anatomy, physiology and scanning
techniques like positioning.
4. It’s a non-invasive procedure – It’s easy to
perform because you don’t have to puncture,
you don’t have to slash it during the procedure,
you just let your patient lie down comfortably in
the patient’s bed
 5. It is safe for pregnant - while performing the procedure, you can ensure that the
patient is safe to any hazard radiation because we used and utilized high
frequency sound waves to produce pictures of
the inside of the body.

Ultrasound Waves
Why does each wave look differently?
Because the medium is not equal to the system,
sound can flow through fats, liquid-filled structures,
bone, fatty tissue, and lean muscle as it travels to
the medium. This is why waves are not equal.
There are variations in the appearance or
presentation of waves due to the non-uniform structure of the medium and that waves
are called frequency (in the sound of physics).
 Parameters is frequency
o Unit of frequency – Hz (Hertz)
 Velocity – m/s (meter per second)
 Velocity of light – c = 3 x 108 m/s

Ultrasonics Range Diagram

Ultrasound - sound frequency of ultrasound is measured and must in megahertz (or
MHz)
 Only sound which is useful in the medical examination, both for diagnostic and
therapeutic, should reaches megahertz (MHz); millions of hertz
Infrasound – Not audible (like insects, we cannot hear their sound as human);
considered infrasound if it’s below 20 Hz
 Audible sound: Humans can detect sounds from animals in a frequency range
from about 20 Hz to 20 KHz (20 - 20,000 KHz)
Question: how many hertz required for the audible sound? (directly)
 20 KHz
For the medical application diagnostic ultrasound, you can see the yellow to orange;
starts from 2 MHz and above
 Actually, you can consider from because some diagnostic ultrasound, transducer
uses 1 to 5
Note: A service that we provide to our patients is diagnostic (since mag image lang
man ta, in our scope of duty, we perform this procedure, we produce image but the
limitation is we cannot interpret that image because only doctors [radiologist] are
licensed to do that but we should remember that we need to know of what’s normal and
what is not since doctors and radiologic technologist are partners)
Note: DIAGNOSIS is the determination of the disease an individual is believed to have.
PROGNOSIS is the predicted course of disease & the prospects for the patient’s
recovery.
 Physician or clinician gave the prognosis, not you as an allied health care
provider
 Expected outcome, expected duration of a disease
 For example: “The prognosis of your cough might take 3 weeks if you will not
treat it.
What is an Ultrasound?
 Ultrasound is defined as any sound that is above the range of human hearing; a
device used to diagnose a certain condition specifically if the structure is soft
tissue
 This human limit is 20 KHz
Illustration of the ranges of sound
2 types of Ultrasound waves
1. Pulsed Wave
2. Continuous Wave
Note: In terms of waves, the height of waves is called amplitude.
Pulsed Wave
 The source of the sound (energy) is from the transducer
 You can have sound waves once you have an object.
 The role of transducer or probe is it converts electric signal into sound energy
and back again, based on the piezoelectric effect. which it travels to the object.
Transducer will serve as transmitter and receiver of energy.

As the sound travel reaching

the medium, from the source,
the original wave will reflect
back to the source.

The reflected wave is called

echo; carrier of the source in
an object.
The object can be in any structure in our body; it can be kidney, liver, heart. If it reaches
the desired structure and reflects back to the source, the reflected way is responsible to
produce an ultrasound image.

Continuous Wave
 It doesn’t have the number of pulses that can be identified.
 Cycles - considered as frequency
 Wavelength – distance from one cycle to another
 Amplitude – the height of each cycle from the midline
 Velocity – it’s the movement of the wave (how fast the sound travels)
Note: Highlighted color yellow – basic parameters of the sound waves.
Note: The peak is the crest, or top point of the wave and the trough is the valley or
bottom point of the wave.
Spatial Pulse Length (SPL)
 The length of the sonic pulse
 The number of waves multiplied by their wavelengths
 The backing block is incorporated to quench the vibrations and to shorten the
sonic pulse.
Pulse Repetition Period or PRP
 It is the time between the onset of one pulse till the onset of the next pulse.
Again, it is measured in units of time. This parameter includes the time the pulse
is “on” and the listening time when the ultrasound machine is “off”.
 “Distance after first pulse”
Pulse Repetition Frequency or PRF
 PRP and PRF are reciprocal to each other. PRF is the number of pulses that
occur in 1 second. This parameter is not related to the frequency of ultrasound.
PRF can be altered by changing the depth of imaging.
 “Succeeding pulse”
Note: Right after pulse, there is a distance
that is called period.
Frequency – the number of cycles occur
in a second
Cycle – it’s a complete path of the wave. 1
cycle per second is known as 1 Hz (Hertz).
  1 Hz = 1 cycle per second
Transducers – spend over 99% of the time listening for returning waves; this cycle is
repeated several million times per second; returning sound waves are converted into
images on the ultrasound monitor. Based off direction, timing and amplitude of returning
waves.
 Example: The period for 5 MHz ultrasound is 0.2 usec. = 5 million cycles

Pulse Repetition Frequency

Wave Propagation
 An ultrasound wave is considered as longitudinal wave.
 The X-ray is considered as transverse wave.
In a longitudinal wave direction, we have compression and rarefaction.
Compression – it refers to the region of a longitudinal wave where the particles are
closest to each other.
Rarefaction – it refers to the region of a longitudinal wave where the particles are
farthest apart from each other. This basic foundation of a longitudinal wave, including
compression and rarefaction, differs from other waves containing crests and troughs.
Note: A longitudinal wave has rarefaction and compression while the transverse wave
has crest and trough or valley. Light travels in transverse wave, sound travels in
longitudinal wave.

Difference between Longitudinal and Transverse Waves

Transverse wave – moving up and down direction
Longitudinal wave – springs, moves from left to right in a same horizontal plane
Sonographic Parameters in Tissue
Parameters Symbol or Abbreviation
Frequency f
Period T
Wavelength (lambda)
Propagating Speed (velocity) c
Impedance z
Pulse Repetition Frequency PRF
Pulse Repetition Period PRP
Spatial Pulse Length SPL

Difference between X-ray and Ultrasound

X-ray Ultrasound
Electromagnetic wave Sound wave
Travel in a vacuum In terms of velocity, the ultrasound always
No medium needed depends on the medium
c = 3 x 10 m/sec c = 1540 m/s (tissue)
c = 330 m/s (air-filled structures)
Transverse wave Longitudinal wave

Basic parameters of the Sound

Parameter Equation Unit
Wavelength (λ; lambda) λ=c/f mm
Velocity (v) v=λxf m/s
Frequency (f) f=c/λ Hz
Period (T) T=λ/c SI

Sonographic Terminology
Note: Parenchyma refers to a tissue
Anechoic – means being without an echo or appearing without echoes. It appears
black on ultrasound image; purely black

Echogenic – capable of generating and reflecting sound waves; gray; tissue; it displays
good sonographic image of a certain structure
Hyperechoic – Term used to describe a structure which has increased brightness of its
echoes relative to an adjacent structure, it appears white of the sonographic image;
lighter

Hypoechoic – term used to describe an area that has decreased brightness of its
echoes relative to an adjacent structure; if the tissue growth appears darker than the
surrounding tissue
Homogenous – Uniform appearance and texture of a certain tissue

Inhomogeneous – or heterogeneous – organ parenchyma is not uniform in

echogenicity; not uniform appearance of a structure.

Parenchyma – The functional tissue of an organ as distinguished from the connective

and supporting tissue; “the liver parenchyma”
Shadowing – Failure of the sound beam to pass through an object. For example: a
bone does not allow any sound to pass through it and there is only shadowing seen
behind it.

Anterior and Posterior

Superior and Inferior

Medial and Lateral – Towards the midline and Away from the midline

Polycystic – Multiple cysts

Staghorn – Staghorn calculi, also sometimes called coral calculi are renal calculi that
obtain their characteristic shape by forming a cast of the renal pelvis and calyces, thus
resembling the horns of a stag; huge calculi
Cystic – This term is used to describe any fluid-filled structure.

Transudate – It is extravascular fluid with low protein content and a low specific gravity.
Exudate – It is a fluid leaks out of blood vessels into nearby tissues. The fluid is made
of cells, proteins and solid materials. Exudate may ooze from cuts or from area of
infection or inflammation. It is also called pus.
 Note: Transudate and Exudate are inflammatory fluids.
Ascites is a pathologic condition of a tissue that have a presence of inflammatory fluid
within your peritoneal cavity; you can see it in the abdominal wall.
These are the following procedures that can also be performed in Ultrasound
 Ultrasound of the Brain

 Ultrasound of the Heart

 Ultrasound of the eye

 Ultrasound of the Breast

 Ultrasound of the Thyroid

 Ultrasound of the Biliary

 Ultrasound of the prostate

 Ultrasound of the Uterus