Ultrasound Physics and Instrumentation, 5e

Final Exam: Version A Answers

(Questions 1-8: T/F)

1) The Doppler Effect is an apparent change in frequency, because of a change in wavelength,

due to relative movement between a source and an observer.
Answer: True

2) Sound waves cannot exist in a vacuum.

Answer: True

3) If you reduce the amplitude from 6 Volts to 2 Volts, the power decreases by a factor of 4.

Answer: False (a factor of 3 (6/2= 3) ).

4) Rayleigh scattering is highly angle dependent.

Answer: False

5) A shorter wavelength represents a higher frequency and occurs when relative motion is
toward an observer.

Answer: True (pg. 519)

6) A linear array transducer always has some portion of the image that was created with parallel
beams.

Answer: True

7) If the transmit frequency is 5.000 MHz, and the returning frequency is 4.999 MHz, the
Doppler shift would be considered positive, or toward the transducer.

Answer: False (Returning frequency is below transmitted frequency implying a negative

shift, or, away from the transducer.)

8) The PRF equals 1 divided by the imaging depth in cm multiplied by 13 msec.

Answer: False (13 microseconds)

9) The fact that a higher pitch whistle would result in a greater Doppler shift (for the same
relative motion) indicates that:

a) the Doppler shift is directly related to the velocity.

b) the Doppler shift is directly related to the wavelength.
c) the Doppler shift is inversely related to distance.
d) the Doppler shift is inversely related to the amplitude.
e) the Doppler shift is proportional to the transmit frequency.

Answer: E

10) If the transmitted frequency is 3.0 MHz and an observer hears a signal at 2.993 MHz, the
Doppler shift is:

a) – 3 kHz
b) + 2.993 MHz
c) + 7 kHz
d) – 7 kHz
e) – 3.0 MHz

Answer D (2.993 MHz – 3.000 MHz = – 0.007 MHz = – 7 kHz) (page 524)

11) Write the wavelength equation.

c
Answer: λ
f

12) For a given interrogating frequency, if the velocity doubles, what happens to the Doppler
shift frequency?

Answer: The Doppler shift doubles since the Doppler frequency is proportional to the
operating frequency.

13) In the Doppler equation:

a) the cosine is in the numerator.

b) the sine is in the numerator.
c) the cosine is in the denominator.
d) the sine is in the denominator.

Answer: A (page 533)

14) Describe the Rayleigh scattering/frequency paradox:
Answer: Although scattering increases with increasing frequency (making it appear as if
stronger Doppler signals would be achieved with higher operating frequency), stronger
Doppler signals are generally achieved using lower operating frequencies. (Page 534)

15) What word refers to the aggregate form of red blood cells responsible for the appearance of
spontaneous contrast?

a) clotus
b) erythrocytitis
c) hemoglobulus
d) rouleau
e) hemoagrarian

Answer: D (535)

16) What is the best estimate of the Doppler angle in the associated figure?

a) 0 degrees
b) 30 degrees
c) 90 degrees
d) 120 degrees
e) 150 degrees

Answer: E (page 537)

17) Write the Doppler equation:

Answer:
2 f ov cos(θ )
f Dop 
c
18) Given that the major tick marks for the sweep speed represent 1 second, what is the best
estimate for the heart rate represented in this Doppler spectrum?

a) 60 bpm
b) Slightly less than 60 bpm
c) 75 bpm
d) Slightly greater than 75 bpm
e) cannot be determined

Answer: B (notice that the cardiac cycle lasts just slightly longer than 1 second. A period of 1
second represents 60 beats in 60 seconds, or 60 beats per minute. Since the time is slightly
greater than 60 seconds the heart rate is slightly less than 60 bpm.)

19) Using a 7.5 MHz Doppler, a Doppler shift of –6.3 kHz was measured. If the frequency is
decreased to 2.5 MHz (with no other changes), what would the Doppler shift be?

Answer: –2.1 kHz

f Dop  f o  so decreasing the transmit frequency by a factor of 3,
reduces the Doppler shift by a factor of 3.

20) Describe the advantages and disadvantage of PW relative to CW Doppler.

Answer:
PW has good range specificity, whereas there is no inherent range specificity with CW.
However, CW can detect virtually unlimited velocities whereas PW is limited by Nyquist
and aliasing.
21) Which statement best describes the flow at the specific time indicated by the white arrow?

a) Accelerating flow toward the transducer

b) Accelerating flow away from the transducer
c) Decelerating flow toward the transducer
d) Decelerating flow away from the transducer
e) Constant flow away from the transducer

Answer: C: Note that the spectrum is inverted so flow below the baseline represents flow toward
the transducer. At the specific time indicated by the arrow, the velocity is decreasing, indicating
deceleration.

22) If at a stenosis the blood velocity increased from 0.3 m/sec to 1.5 m/sec, what would
happen to the Doppler shift?

a) Would not change

b) Increased by a of 1.2
c) Increase by factor of 5
d) Decrease by a factor of 1.2
e) Decrease by a factor of 5

Answer: C
f Dop  v  so increasing the velocity by a factor of 5 (1.5/0.3),
increases the Doppler shift by a factor of 5.

23) For adult echo Doppler, at what setting would you expect to set the spectral Doppler wall
filters?
a) About 25 Hz
b) About 50 Hz
c) About 200 Hz
d) About 800 Hz
e) About 1600 Hz

Answer: C
24) In which direction is the blood flowing?

a)

b)

c)

d)

e) Cannot be determined

Answer: C

25) Describe what high color priority means

Answer:
Color priority is a threshold technique such that when a pixel has both a grayscale value
and a color signal, the color priority threshold determines whether the pixel will be
presented in grayscale or in color. Higher color priority gives higher preference to color
over grayscale. When a grayscale amplitude is above the set threshold, the pixel is
displayed as grayscale, but when the grayscale amplitude is below the threshold the pixel is
displayed as color. Therefore, turning up color priority moves the grayscale threshold up,
making it more likely that color will be displayed.
26) Which statement is best regarding the dark blue flow indicated by the white arrow?

a) The mean velocity is below 23 cm/sec

b) The peak velocity is below 23 cm/sec
c) The mean velocity is close to 0 cm/sec
d) The mean velocity is close to 40 cm/sec
e) The peak velocity is 40 cm/sec
f) The peak velocity is 0 cm/sec

Answer: D (Aliasing – the mean velocity is somewhere between 35 and 46 – making 40 the
best answer.)

27) The fact that the flow is predominantly above the baseline in this spectrum is the result of

a) aliasing.
b) the Doppler angle was less than 90
degrees.
c) spectral invert.
d) the Doppler angle was less than 90
degrees and spectral invert.
e) the Doppler angle was less greater than
90 degrees and aliasing.

Answer: C: Notice that the flow above the baseline is labeled as -47 cm/sec implying that
spectral invert was active (Note that the angle was greater than 90 degrees since the flow is
predominantly above the inverted baseline i.e. the cosine was negative since the angle was
greater than 90 degrees).

28) At a clinical rotation, you are told by the clinical coordinator that your color PRF is too
high while performing a venous study. Which two characteristics of the color image would
most likely have indicated this to the clinical coordinator?
a) Color aliasing
b) Color speckle
c) Color blossoming
d) Regions of color dropout in the image

Answer: D
If the color scales are too high, the color wall filters will be too high, potentially eliminating
detection of low velocity flow.
29) In which direction is the blood flowing?

a)

b)

c)

d)

e) Cannot be determined

Answer: C

30) Write the Nyquist relationship in terms of the maximum Doppler shift and the PRF.

Answer:
PRF
f Dop (max) 
2
31) The aliasing shown in this image is best described as

a) beneficial in that is helps identify the jet.

b) obscuring in that it obscures the true flow through the
valve.
c) neither beneficial nor obscuring.

Answer: A (the aliasing color makes the jet stand out against
the normal flow.)

32) In which direction is the blood flowing?

a)

b)

c)

d)

e) Cannot be determined

Answer: E (this is non-directional power Doppler – direction cannot be determined.)

33) When imaging a patient with the Doppler gate at 6 cm deep using a transmit frequency of 6
MHz, which of the following changes would be most appropriate?
a) No change needed.
b) The frequency should be increased to 8 MHz or higher.
c) The frequency should be decreased to 4 MHz.
d) The frequency should be decreased to 3 MHz.
e) The frequency should be decreased to 2 MHz.

Answer: E (see figure 8 of page 534)

34) Which of the following would increase the likelihood of aliasing (choose all that apply)
a) Decrease the PRF
b) Decrease the Doppler gate depth
c) Measuring higher velocity flow
d) Decrease the operating frequency
e) Going from a 50 degree to a 30 degree Doppler angle

Answer: A, C, and E
 Choice A: Decreasing the PRF makes aliasing more likely
 Choice C: A higher velocity increases the Doppler shift and hence makes aliasing
more likely.
 Choice E: Using a smaller Doppler angle increases the Doppler shift, increasing the
likelihood of aliasing.

35) Assume that using an 9 MHz transmit frequency, with a PRF of 6 kHz, the Doppler shift is
measured as 9 kHz. At what transmit frequency would aliasing be eliminated?
a) 3 MHz
b) 4 MHz
c) 4.5 MHz
d) 6 MHz
e) 8 MHz

Answer: D
PRF 6 kHz
f Dop (max)    3 kHz
2 2
f Dop  f o
so decreasing the operating frequency by a factor of 3 (from 9 to 3 MHz)
results in a Doppler shift of (6 kHz)/3 = 3 kHz which is the limit where alias will end.

36) Referring to the associated color bar, assume that the wall filters are approximately
5% of the scales. Below what velocity would flow signals not present?
a) 8.4 cm/sec.
b) + 2.4 cm/sec
c) + 4.8 cm/sec
d) + 1.2 cm/sec
e) 0.24 cm/sec

Answer: D
(0.05) *(+ 24 cm/sec) = + 1.2 cm/sec
37) What is the best estimate of the Doppler angle in the assocaited diagram?
a) 30
b) 60
c) 20
d) 150
e) 120

Answer: D

38) Describe what happens if wall filters are set too high.

Answer:
If the wall filters are set too high, lower velocity signal that produce low frequency shifts
are eliminated. This means that low velocities cannot be appreciated.

39) Which of the following changes should be made to the associated Doppler spectrum?
a) Decrease transmit power
b) Increase contrast
c) Shift baseline down
d) Increase the PRF
e) Invert the spectrum

Answer: D

40) For the associated picture

a) What modality is presented?

Answer: HPRF
b) What do the diamonds represent?
Answer: Ambiguous gate locations
c) What is the advantage of this technique relative to standard PW?
Answer: Ability to detect higher velocities without aliasing (Higher PRF)
d) What is the disadvantage of this technique relative to standard PW?
Answer: There is ambiguity above the desired gate location (not just below)

41) Write Snell’s Law

Answer: Snell’s Law: ci  sin θt  ct  sin θi

42) Which of the ultrasound modalities generally has the lowest risk of causing a thermal
bioeffect? Why?

Answer:
2D (B-mode imaging). There are two principal reasons why 2D generally has the lowest
risk of causing a thermal bioeffect:
1. It is a scanned modality, distributing the energy in different directions over time
2. It has a very low duty factor (short pulse to achieve good axial resolution)

43) Referring to the associated image, what changes should be made to most improve temporal
resolution?

a) Narrow 2D image size.

b) Increase the color scales (PRF)
c) Narrow the color box width
d) Change the transmit frequency from 4
MHz to 3 MHz.
e) Crop the color box depth

Answer: E

44) What resolution is being tested by pin group 1?

a) Axial resolution
b) Grating lobe artifact
c) Elevation resolution
d) Lateral resolution
e) Contrast resolution
Face B

Answer: A
45) Which statement best summarizes this textbook’s description of artifacts?
a) Always useful
b) Never useful
c) Often useful
d) Rarely useful
e) Almost always never useful except on those rare occasions in which they sometimes are
(although normally not) useful.

Answer: C

46) Which artifact(s) can create a lateral displacement in an image? (more than one may apply)
a) Reverberation
b) Grating lobes
c) Shadowing
d) Mirror artifact
e) Refraction artifact

Answer: B and E

47) Given the incident beam as shown, which beam would be created through the medium
labeled “2”?
a) A
b) B
c) C
d) D Medium 1
e) E 1500 m/sec

Medium 2
1200 m/sec D
C E
Answer: A A B

48) The bright echoes (as indicated by the arrow) exemplify what artifact?
a) Reverberation
b) Grating lobes
c) Ring down
d) (Multiple) mirror artifacts
e) Enhancement

Answer: A
49) The following schematic (labeled Figure A) indicates a uniform block of tissue with two
structures as indicated. In the Figure B, draw what the ultrasound image would look like.
(Dotted lines (indicating depth) have been added to make your drawing easier and more
accurate.)

1540 m/sec 1540 m/sec

770 m/sec

1540 m/sec

Figure A Figure B
Answer:

50) Given that the Doppler scales cannot

be increased, what change should be
made to eliminate the aliasing
artifact?

Answer:
Use a lower transmit frequency
51) The region below the vessel (as indicated by
the arrow) exhibits:

a) speed error
b) mirror error
c) reverberation
d) oversaturation
e) enhancement

Answer: E

52) Which statement(s) is/are true regarding the flow indicated by the arrow?

a) This flow is going from screen left to screen right.

b) This signal represents color aliasing.
c) This region would be encoded as orange if the
color baseline was shifted up.
d) This represents a flow reversal relative to the rest
of the vessel.
e) None of the above statements are true.

Answer: B and C

53) What velocity is indicated by the aqua color

encoded region of flow where the spectral
Doppler gate is placed. Explain the difference
between the measured Doppler peak velocity
of approximately 2.5 m/sec and the apparent
color velocity.

Answer: The color Doppler shows aliasing such

that the mean velocity is slightly higher than 48
cm/sec (probably about 60 cm/sec or so). Color
Doppler gives an estimate of the mean velocity,
not the peak velocity as given by spectral
Doppler. Additionally, the spectral Doppler
velocity is angle corrected whereas the color
Doppler mean velocity is not angle corrected.
54) Artifactual spectral broadening increases with (more than one may apply)?

a) Deeper sample volumes

b) Larger Doppler angles
c) Higher PRFs
d) Lower wall filters
e) Lower receive gain

Answer: B

55) Which of the following statements is not true regarding the gold standard test? (more than
one may apply)

a) The gold standard is always perfect.

b) The gold standard is the test recognized as the most consistent and accurate test for a
particular disease.
c) The gold standard is used as the reference against which other test results are compared.
d) Almost all gold standard tests are perfect or near perfect.
e) The gold standard is “assumed” to be perfect in terms of the statistical comparisons
made.

Answer: A and D

56) When the results of a comparison test match the results of the gold standard test, the results
are said to be TRUE.

57) Which statement is implied by a result which is called a true positive?

a) The comparison test is negative for disease and matches the gold standard.
b) The comparison test is positive for disease but does not match the gold standard.
c) The comparison test is positive for disease and matched the gold standard.
d) The comparison test is negative for disease but does not match the gold standard.

Answer: C

58) What statistical parameter is determined by the following equation?

TP
 100%
TP  FN

Answer: Sensitivity
59) What is the term for the parameter specified by the outlined box?

GOLD _
+
+
TEST
_

Answer: False Negative (FN)

60) Which statement is correct regarding the accuracy?

a) It must be greater than the PPV.

b) It must be less than the NPV.
c) It must be greater than both the NPV and the PPV.
d) It must be lower than both the NPV and the PPV.
e) It must be between the NPV and the PPV.

Answer: E

61) Stable cavitation occurs when the oscillation of the microbubbles does not lead to
collapse.

62) Which of the following statements is true regarding transient cavitation?

a) The best science to date indicates that it seems to be a threshold effect.

b) Theory indicates that it is much more likely to happen with lower frequency operation.
c) The best science to date indicates that it rarely, if ever, occurs with sound waves.
d) Theory indicates that it is much less likely to occur when the tissue temperature exceeds
between 40 and 50 degrees Celsius.
e) Acoustic measurements made with hydrophones indicate that it occurs more when the
transducer surface itself is warm.

Answer: A
63) What happens to the intensity of a beam if the acoustic power is increased from 50 mW to
200 mW and the beam area is doubled?

Answer:
The intensity increases by a factor of 2. Since the intensity equals the power divided by the
area and since the power quadrupled (increasing the intensity by a factor of four) and the
beam area doubled (decreasing the intensity by a factor of 2), the net result is an increase
by a factor of two.

64) Which common intensity has the lowest value?

Answer: ISATA (Spatial Average, Temporal Average)

65) If the fundamental is 2.2 MHz, what is the second harmonic frequency?

Answer:
4.4 MHz

66) By approximately how many dB does contrast agent increase the signal of blood?

a) 5 dB
b) 10 dB
c) 20 dB
d) 30 dB

Answer: D (see page 663)

67) Which statement is NOT true regarding harmonics?

a) Harmonic generation is very non-linear.

b) Harmonic generation is weaker in the immediate near field.
c) Harmonic generation is not very dependent on focus.
d) Lateral resolution improves with harmonics.

Answer: C
68) Which of the following is NOT considered a drawback to conventional tissue harmonic
imaging?

a) Degradation in axial resolution.

b) Less penetration in the far field
c) Increased phase aberration
d) increased clutter artifacts
e) More than one choice are not drawbacks

Answer: e (both choices C and D)

69) How does pulse inversion harmonics work?

a) Transmit one fundamental and one harmonic beam with same phase, invert harmonic
beam, and add.
b) Transmit two beams with inverted phases and subtract.
c) Transmit two beams with inverted phases and add.
d) Transmit one fundamental beam, receive the harmonic signal, and invert the phase.

Answer: C)

70) In the following statistical grid, fill in the appropriate values according to the following
information.

Talamungo Lab tests a series of patients for a specific disease with the following results:
 500 total patients tested
 87 positive for disease of which 7 do not match the gold standard
 50 of the negative tests do not match the gold standard

GOLD _
+
+ 80 7
TEST

_
50 367
71) Given the follow statistical table, how many patients in the patient population do not have
disease?

GOLD _
+
+ 21 4
TEST

_
3 72

Answer: 4 + 72 = 76

72) Given the follow statistical table, what is the prevalence of disease for the patients tested?

GOLD _
+
+ 42 8
TEST

_
6 44

Answer: 48/100 = 48%

73) If the sensitivity of a test if 74% and the specificity is 91%, which cannot be said about the
accuracy?

a) The accuracy could be 84%

b) The accuracy cannot be 93%
c) The accuracy could not be 73%
d) All of the above are true
e) None of the above are true

Answer: D (accuracy must be somewhere between sensitivity and specificity)

74) Overall, how many times was this test correct?

GOLD _
+
+ 42 6
TEST
_
8 144

Answer: 186 (42 + 144)

75) Match the following:

Sterilization __A___ A) Complete elimination of all forms of microbial life
including spores and viruses.

Low-level disinfection __D___ B) Destruction/removal of all micro-organisms except

bacterial spores.

Intermediate-level disinfection __C___ C) Inactivation of Mycobacterium Tuberculosis, bacteria,

most viruses and most fungi, and some bacterial spores.

High-level disinfection __B___ D) Destruction of most bacteria, some viruses, and some
fungi. Low-level disinfection will not necessarily inactivate
Mycobacterium Tuberculosis or bacterial spores.

76) The phantom in the associated image would be MOST

likely used for which of the following tests (assume
tissue mimicking material)?

a) axial resolution
b) contrast resolution
c) peak velocity accuracy
d) dead zone

Answer: C
77) Using the associated phantom, which of the following test(s) could NOT be performed with
the transducer placed on Face A (assume tissue
mimicking material)? – NOTE THAT MORE THAN
ONE ANSWER MAY APPLY

a) Depth accuracy
b) Lateral Resolution
c) Sensitivity
d) Axial resolution
e) Contrast Resolution

Answer: B, D, and E

78) Referring to the following phantom structures, which structure or

structures would be easiest to visualize in an ultrasound image?
Explain why.

Answer: The -15 dB cystic structure since it has the greatest difference
relative to the surrounding medium (which is at 0 dB).

79) Given the incident beam as shown, which beam would be created in the medium labeled
“2”?
a) A
b) B C
B E
c) C A
d) D
e) E D
Medium 2
1700 m/sec

Medium 1
1300 m/sec

Answer: D
80) Imagine that the pin labeled “3” in the associated image was not distinguishable from the
background. What would be indicated?
a) Limited axial resolution
b) Limited lateral resolution
c) Limited temporal resolution
d) Limited contrast resolution
e) Limited sensitivity

Face B
Answer: E