Artifacts in Echo

Dr Dilzith
Contents
• Artifacts

• In 2D Echo

• In Doppler

• In Colour flow

• In TEE
Artifacts

1. Extraneous US signal that results in appearance of structures that

are not actually present

2. Failure to visualize structures that are present

3. An image of a structure that differs in size or shape or both from its

actual appearance
2-D Echo
Suboptimal Imaging
• Cause is poor ultrasound tissue penetration

• Body habitus with interposition of high attenuation tissue. (Lung,

Bone)
• Increased distance ( Adipose tissue)

• THI can improve the image quality

• TEE may be required
Acoustic Shadowing
• Reflection of entire US signal by a
strong specular reflector
• Ex:
• prosthetic valves.
• Heavily calcified Native structures
• Contrast containing blood also
produces shadowing.

• Try alternate acoustic window or

different transthoracic view
• TEE may be required
Reverberations
• Multiple linear high amplitude
echo signals originating from two
strong specular reflectors

• Results in back and forth reflection

• Typically, a reverberation artifact

that originates from a fixed
reflector will not move with the
motion of the heart.
Beam Width
• Superimposition of structures within the beam profile (Including side
lobes) into a single tomographic image
• Can be due to strong reflectors at the edge of a larger beam will be
superimposed on structures in central zone.
• Can be due to consequences of varying lateral resolution
Range Ambiguity
• Echo from previous pulse reaches transducer on next cycle.
• Results in appearance of deep structures closer to the transducer than their actual
location
• Second type of range ambiguity is a double image on the vertical axis
• Echoes being re-reflected by a structure close to the transducer (ex. Rib)
• Results in signal received twice normal and can form double image.
• Range ambiguity can be eliminated by decreasing depth or adjusting the transducer
position
Refraction
• Deviation of US signal from a
straight path along the scan line.
• Appearance of side-by-side
double image
• Commonly seen in parasternal
short axis view
Near Field clutter
• Also called as “Ringdown artefact”
• Arises from high amplitude oscillations
of the piezoelectric elements.
• The artifact is troublesome when trying
to identify structures that are
particularly close to the transducer
• Greatly reduced in modern day systems
Doppler Artifacts
Velocity Underestimation
• Due to non-parallel intercept angle between the US beam and
direction of blood flow
Signal Aliasing
• Inability to measure maximum
velocity
• Can be due to non-laminar
disturbed flow and high velocity
laminar flow
• Can be controlled by using low-
frequency, change Nyquist limit
and use of CW doppler
Beam width
• Superimposition of Doppler signals from adjacent
flows

• Beam width artifacts in Doppler imaging can be

clinically useful.

• beam width artifact often has less desirable effects.

Ex: a large sample volume may hinder

one's ability to distinguish aortic stenosis from mitral
regurgitation.
Range ambiguity
• It’s a speed of sound artefact
• Doppler signals from more than one depth along the US
beam are recorded.
1.misregistration of targets
2.distortion of interfaces
3.errors in size and
4.defocusing of the ultrasound beam.
• It can be reduced by decreasing the depth or width to the
minimum required
Mirror Imaging

• Also called as “Cross Talk”

• Such mirror images are usually less
intense but similar in most other
features to the actual signal.
• can be reduced by decreasing the
power output or gain and optimizing
the alignment of the Doppler beam
with the flow direction.
Transit Time Effect
• Change in the velocity of the US wave as it passes through a moving
medium results in overestimation of Doppler shifts
• Results in broadening of the velocity range at a given time point.
(Blurring on the vertical axis)
Colour Doppler
Shadowing and Ghosting
Shadowing:-
• may occur, masking color flow information beyond strong reflectors.
Ghosting:-
• is a phenomenon in which brief patterns of color are painted over
large regions of the image.
• Ghosts are usually a solid color (either red or blue) and bleed into the
tissue area of the image.
• These are produced by the motion of strong reflectors such as
prosthetic valves.
Background Noise
• Also called as Gain setting artifacts
• Too much gain can create a mosaic distribution of color signals
throughout the image.
• Too little gain eliminates all but the strongest Doppler signals and
may lead to significant underestimation.
• Gain level just below the random background noise can optimize the
flow signal
Other artifacts..
• Intercept angle: Change in
colour (or absence at 90
degrees) due to angle between
flowstream and US beam
• Aliasing: On colour flow results
in “wraparound” of the velocity
signal.
• Electronic interference:
Instrument dependent
In TEE
Multiple reflections
Misplaced reflections
Thank You!!