Ultrasound (introduction)

Last revised by Dr Daniel J Bell◉ on 17 Nov 2021

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Ultrasound (US) is an imaging technology that uses high-frequency

sound waves to characterize tissue. It is a useful and flexible modality in
medical imaging, and often provides an additional or unique
characterization of tissues, compared with other modalities such as
conventional radiography or CT.

Ultrasound relies on properties of acoustic physics

(compression/rarefaction, reflection, impedance, etc.) to localize and
characterize different tissue types. The frequency of the sound
waves used in medical ultrasound is in the range of millions of cycles per
second (megahertz, MHz). In contrast, the upper range of audible
frequencies for human is around 20 thousand cycles per second (20 kHz).

An ultrasound transducer sends an ultrasound pulse into tissue and then

receives echoes back. The echoes contain spatial and contrast
information. The concept is analogous to sonar used in nautical
applications, but the technique in medical ultrasound is more
sophisticated, gathering enough data to form a rapidly moving two-
dimensional grayscale image.

Some characteristics of returning echoes from tissue can be selected out

to provide additional information beyond a grayscale
image. Doppler ultrasound, for instance, can detect a frequency shift in
echoes, and determine whether the tissue is moving toward or away from
the transducer. This is invaluable for evaluation of some structures such
as blood vessels or the heart (echocardiography).

Ultrasound continues to evolve additional functions, including 3D

ultrasound imaging, elastography, and contrast-enhanced
ultrasound using microbubbles.
Why use ultrasound
Advantages
1. ultrasound uses non-ionizing sound waves and has not been
associated with carcinogenesis - this is particularly important for
the evaluation of fetal and gonadal tissue
2. in most centers, ultrasound is more readily available than more
advanced cross-sectional modalities such as CT or MRI
3. ultrasound examination is less expensive to perform than CT or
MRI
4. ultrasound is straightforward to perform portably, unlike CT/MRI
5. there are few (if any) contraindications to the use of ultrasound,
compared with MRI or contrast-enhanced CT
6. the real-time nature of ultrasound imaging is useful for the
evaluation of physiology as well as anatomy (e.g. fetal heart rate)
7. Doppler evaluation of organs and vessels adds a dimension of
physiologic data, not available on other modalities (with the
exception of some MRI sequences)
8. ultrasound images may not be as adversely affected by metallic
objects, as opposed to CT or MRI
9. an ultrasound exam can easily be extended to cover another
organ system or evaluate the contralateral extremity

Disadvantages
1. training is required to accurately and efficiently conduct an
ultrasound exam and there is non-uniformity in the quality of
examinations ("operator dependence")
2. ultrasound is not capable of evaluating the internal structure of
tissue types with high acoustical impedance (e.g. bone, air). It is
also limited in evaluating structures encased in bone (e.g.
cerebral parenchyma inside the calvaria)
 3. the high frequencies of ultrasound result in a potential risk
of thermal heating or mechanical injury to tissue at a microscopic
level, this is of most concern in fetal imaging
4. ultrasound has its own set of unique artifacts (US artifacts), which
can potentially degrade image quality or lead to
misinterpretation
5. some ultrasound exams may be limited by abnormally large body
habitus

References
• 1. Frederick W. Kremkau. Sonography Principles and Instruments. (2010) ISBN:
9781437709803

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