Brian Physics Notes July 2018

Physical Principles of Ultrasound
PAGE
Table of Contents
Physical Principles of Ultrasound 1 Module 1: Introduction to U.S., propagation of sound, binary numbers
9 Module 2: Decibels, power / intensity, sound tissue interactions, TGC
Brian Starkoff 21 Module 3: Basic transducer, pulse-echo imaging principles, bandwidth,
duty factor, intensity variation
These notes cover the principles of diagnostic ultrasound from 30 Module 4: Beam profile, side lobes, focussing, dynamic aperture
a basic background to more advanced theory. 38 Module 5: A-mode, B-mode, M-mode, line density, frame rate
45 Module 6: Resolution
During revision do not attempt to work your way through the 53 Module 7: Acoustic windows, real-time transducers,
material too quickly unless you are familiar with the content. A 62 Module 8: Signal pathways, scan conversion, analog-digital conversion
suggested schedule of study is included on the CD. 68 Module 9: Pre and post processing, measurements, quality control
79 Module 10: Imaging artifacts
91 Module 11: Doppler: Basic principles, continuous wave, pulsed wave,
colour Doppler, power Doppler
100 Module 12: Doppler controls, Doppler artifacts, Doppler quality control
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound 111 Module 13: Contrast agents, harmonics, biological effects, recording
are licensed to use this program and files for personal study purposes only. methods, new / future developments
Copying (in whole or in part), use for any other purpose, or use by any other 125 Answers Answers to module questions and multiple choice questions
person is prohibited without the prior, express permission of the author.
132 Index
6.8 Ver.29
Study program
Week Study program
The following is a suggested
1 Module 1
Module 1
course of study leading up to 2 Module 2
the formal assessment on 3 Module 3
this topic. Start the course 20 4 Module 4 Topics:
5 Revision Modules 1 to 4
• Introduction to ultrasound
weeks prior to the final exam 6 Module 5
and set aside at least 2 7 Module 6
• Physics fundamentals
hours per week, preferably at 8 Module 7 • Wave physics
the same time each week. 10 Module 8 • Propagation of sound
If there is less than the 11 Module 9
suggested 20 week time 12 Module 10
• Velocity variation
frame then you will need to 14 Module 11
modify the schedule 15 Module 12
• Binary numbers
appropriately. 16 Module 13
20 Final assessment
Overview: Terminology:
• Ultrasound is another imaging modality (like CT, MRI, An ultrasound image is described in terms of its echo
Nuclear Medicine, Angiography). characteristics:
Echogenicity - the brightness of the echoes.
• It is a method of producing images by interpreting
sound reflections (echoes) from the body. Where there are no echoes such as from the liquid in this
bladder, the area is called “anechoic” (no echoes).
The image is made up of a
mosaic of white or grey dots. Regions of low level echoes
Each dot represents an echo of (dark on the screen), are called
a structure in a patient. “hypoechoic” (low echoes).
Ultrasound is performed in Intense echo regions (bright on

‘real-time’: i.e. a moving image the screen) are termed
is produced (something like a “echogenic” (echo rich) or
fluoroscopy examination in ultrasound image of a “hyperechoic” (high echoes).
bladder and uterus ultrasound image of a
radiography). bladder and uterus
Module 1 Page 1 Brian Starkoff

Terminology: Overview:
Echotexture - the pattern of the echoes. • Ultrasound is an integral & important part of a
medical imaging department.
• Coarse or fine
• It is poorly understood by patients.
• Homogeneous
• The images are often poorly understood by
or Heterogeneous
Coarse referring doctors.
• Examinations are carried out by professionals

called sonographers and sonologists.
Fine
Sonographer Sonologist
A medical specialist (doctor)
A person trained and qualified in ultrasound. trained and experienced in ultrasound techniques and
He / she performs the examination and records the images in the interpretation of sonographic images.
(on films or recorded digitally). He / she interprets the images and provides a written report.
Sonographers may come from a variety of backgrounds:
- radiologist
e.g. - medical imaging As with sonographers, sonologists may -nuclear physician
- nursing sister come from a variety of backgrounds: - vascular physician
- obstetrician
- para-medical fields
- cardiologist
Sonographers have a high degree of decisional • In a general medical imaging department, a radiologist is
latitude in diagnosis. the most common person to undertake this role.
– They may make independent decisions of the • The sonologist / radiologist usually relies heavily on
course of the examination such as extending the the sonographer’s observations.
examination beyond the region requested. • Sonographers & sonologists work closely together.
Ultrasound advantages Ultrasound disadvantages
• Large areas of the body are unsuitable for imaging:

• no ionising radiation - bone - adult cranium
• no contrast agents are needed - lungs - G-I tract
• mobile equipment - abdominal structures covered by bowel
• relatively quick and cost effective • Hand held transducer
• well tolerated by patients This leads to scan plane variability. It is very
• very good soft tissue representation difficult to reproduce an exact scan plane at a
• operates in real-time (motion seen) later time.
• accurate measurements of organs / structures • Highly operator dependent
• blood flow studies may be performed
• Interpretation of the images is difficult

B-Mode controls
Ultrasound equipment
Numerous controls are available for the
sonographer to produce the best possible image.
All imaging ultrasound
The list below has the more common ones:
equipment consist of three
basic components: • Power • Pre-processing
• Gain – dynamic range
1. Housing with electronics – edge enhancement
– Overall
and controls
– TGC – frame averaging
2. Monitor for display • Freeze – reject
– Hi Res Zoom
3. Transducer • Depth
• Post processing
• Callipers
– read zoom
? 4. Recording device • Frame rate /
- Separate or integrated – grey scale maps
resolution
Historical
Nature of Ultrasound
1880 Piezoelectric effect discovered by
Jacques & Pierre Curie
• Ultrasound is a form of energy consisting of - Certain crystals produce an electric potential
mechanically produced waves. when subjected to mechanical pressure.
• The frequencies are above the range of 1881 Reverse piezoelectric effect demonstrated
human hearing. - These crystals will expand and contract when
– (human hearing is in the range of 20 - 20,000 Hz) their faces are subjected to an electric potential.
• Diagnostic ultrasound uses frequencies in the 1916 Underwater detection attempted

range of 1 to 20 MHz.
– commonly 3 to 12 MHz
Historical Physics fundamentals

To gain a good understanding of how ultrasound
Late 1930’s First medical U/S unit
works, it is necessary to perform some calculations
Used transmission through the head and to understand what the results of the
- The diagnostic information was extremely limited. calculations mean.
• Simple maths:
1940’s Development of 1st B-mode scanner 2
(water immersion) m 2
Question 1: solve =
6 3
1950’s Development of compound B-mode
scanner (water immersion)
If you have any problems with the mathematics, you
1960’s Contact B-mode scanners in use may need to revise these simple mathematical
principles.

Physics fundamentals Physics fundamentals

• Scientific notation:
Because many of the numbers associated with
• Scientific notation:
ultrasound principles are either very large or very Fractional Decimal Exponential
small, many of the calculations use scientific notation: form form form
10,000 10,000 10 4
4 1,000 1,000 10 3
eg: 10,000 = 10 x 10 x 10 x 10 = 10
1 1 -4 100 100 10 2
0.0001 = 10 4 = = 10 10 10 10 1
10,000
2 1 1 10 0
500 = 5 x 10 1 / 10 0.1 10 -1
scientific notation
-4 1 / 100 0.01 10 -2
0.0004 = 4 x 10 -3
1 / 1,000 0.001 10
-4
1 / 10,000 0.0001 10
Physics fundamentals BASIC DEFINITIONS

Question 2: These are some standard prefixes used in science /
The distance to the fictional planet Krypton is 21 maths.
billion (21,000,000,000) km. The common ones used in ultrasound are marked
Express this in scientific notation. with arrows:
Question 3: Multiple Prefix Symbol
A moustache hair has a diameter of 0.00075 9
10 giga- G
metres. What is its diameter in mm. expressed in
106 mega- M
scientific notation? 103 kilo- k
10-2 centi- c
a = 6 x 10-27 b = 4 x 1012 10-3 milli- m
10-6 micro- µ
Question 4(a): solve: axb
10-9 nano- n
10-12 pico- p
Question 4(b): solve: a : b
Wave Physics
BASIC DEFINITIONS
There are two basic types of wave by which energy can
Two basic definitions related to ultrasound are: be transmitted from one point to another:
d -1 Electromagnetic waves
* Velocity v = t m.s (metres per second) - travel at the speed of light
P -2 - no medium is required for propagation
*Several
Intensity I = area W.cm (watts per square centimetre)
different metric measurement systems are
- distinguished by energy, frequency and wavelength
commonly used: Light and x-rays are electromagnetic waves.
CGS (centimetre / gram / second)
MKS (metre / kilogram / second) Mechanical waves
SI (Système International) Defined as the propagation of energy through a
In this course, the SI system will be used primarily. medium by cyclic pressure variations.
This is now the international standard in the - Need a deformable elastic medium for
science community and is a minor variation on the propagation (such as air, water, soft tissue).
MKS system.
Ultrasound propagates by mechanical waves.

Wave Physics PROPAGATION OF SOUND
There are two types of mechanical waves:

1. Transverse waves (e.g. waves in water)
When sound propagates through a medium, it
Wave motion Particle motion does so in the form of compression waves. A
good analogy is to represent the molecular forces
With transverse waves, the particle motion in the
that hold the molecules of the medium apart as
medium is at 90º to the direction of the wave.
springs. The compression wave causes a force
that pushes a molecule towards the next one,
2. Longitudinal waves (eg sound) thus compressing the spring. This force then
Wave motion Particle motion pushes the next molecule, and so on. As the
wave passes, an area of rarefaction (reduced
With longitudinal waves, the particle motion in the
pressure) occurs immediately behind the wave
medium is in the same plane as the direction of the
front.
wave.
PROPAGATION OF SOUND WAVE TERMINOLOGY
Immediately behind the Immediately in front of the

compression wave is a compression wave is an A
area of low pressure area of increased pressure
distance
- a region of rarefaction. - a region of compression.
A
Difference between the

AMPLITUDE (A) - maximum or minimum value
and the equilibrium value
WAVELENGTH ( ) - Length of one cycle
WAVE TERMINOLOGY WAVE TERMINOLOGY

PERIOD (T) - Time for one cycle
T
time
T
T
VELOCITY ( v ) - Speed of the sound wave as
FREQUENCY ( f ) - Number of cycles that occur per it passes through the tissue
second
Frequency and period are related to 1 1 Average speed of sound in soft tissue (Propagation speed)
f = T or T = f
each other (as shown by the formula): = 1540 metres per second
If you know ‘f’ or ‘T’ then the other one can be calculated.

Symbol Measurement units

Question 5:
1 sec
Wavelength Metres Referring to the 5
diagram give volts
Frequency f Hertz (Hz) numerical 0
answers with
the correct 0.5 m
Period T Seconds units:
Velocity v Metres / sec (a) How many wavelengths are shown?

(b) What is the wavelength?
Amplitude A variable (c) What is the frequency?
(d) What is the amplitude?
Frequency, wavelength and velocity can be related
(e) What is the wave velocity?
via the wave equation:
Wave equation v = f
Question 6: Question 10:

If an ultrasound beam has a frequency of 5 MHz, what
is its wavelength in soft tissue in millimetres? A 4 MHz ultrasound beam produces a 1 mm
wavelength in a certain material.
Question 7:
What is the period of a 10 MHz ultrasound wave? (a) What is the ultrasound velocity in the medium?
Question 8: (b) If the transducer frequency is increased, what

What is the wavelength of a 2 MHz ultrasound will happen to the velocity?
beam in soft tissue?
Question 9: (c) What frequency would be required to produce
-4
If the wavelength of a sound wave is 15 x 10 m, a wavelength one third the length in the same
what is its wavelength in mm.? material? (i.e. 1/3 mm)
VELOCITY VARIATION VELOCITY VARIATION

The speed of sound varies through different materials. The intercellular or intermolecular forces are
This can be because of variations in: represented by the springs in these diagrams.
• The compressibility of the intermolecular or
{ intercellular forces.
• The existing degree of compression of these
forces.
• The weight (mass) of the molecules With more compressible materials, (eg air) the sound
transmits with lower velocity. In this case the
preceding molecules / cells must move further before
enough force is applied to the next molecule / cell
because of the weaker ‘springs’.
It takes slightly longer for this extra compression to
occur.


Also, if the medium is already compressed to some
degree, the ‘springs’ will become less compressible
(stiffer) and the sound will transmit with higher velocity.
Conversely, with less compressible (stiffer) materials, increased compression = higher velocity
(e.g. bone) the sound transmits with higher velocity.
The increased speed of sound in more compressed
This property of the material is sometimes called its
material will become very important when harmonic
“stiffness”.
imaging is discussed in Module 13.

With heavier molecules, the sound transmits with Compressibility and molecular weight are interdependent
lower velocity. This is because of the inertia of the attributes of a material. For example some compressible
heavier molecules. (The ‘springs’ have to compress materials can have heavy molecules and others might have
more before the following molecule / cell moves away, light molecules.
and this takes a slightly longer time).
heavier molecules Compressibility (or stiffness) will usually over-ride the
effects of increased molecular weight.
lighter molecules
Therefore sound will very often travel faster through
materials with heavy molecules (such as bone) because
they are much stiffer (or less compressible).
With lighter molecules the sound transmits with higher
velocity. Because they are light (therefore with less Also sound will very often travel slower through materials
inertia) the following molecule / cell moves away very with light molecules (such as air) because they are much
quickly under the influence of the preceding force. more compressible.

Listed below are the velocities of sound through a variety
of materials. Note that the speed of sound through
Most higher density materials have significantly various soft tissues varies only slightly, and that the
lower compressibility (i.e. they are usually stiffer). average for soft tissue is 1540 m.s-1.
Material Velocity (m/s)
Air 330
Fat 1450
Therefore a general statement that “Higher density
Water 1540
materials exhibit a higher velocity of sound” is Soft tissue (average) 1540
generally true.1 Blood 1570
Muscle 1585
Skull (bone) 4080
Mercury 1450
Castor oil 1500
PZT (piezoelectric element) 4000
Steel 5850

Introduction to the binary number system: Introduction to the binary number system:
Modern ultrasound machines use computers Similarly, the number 1,011 could be broken down
extensively for their operation. Because computers to its individual components. (Our brains, of
use binary numbers, and because a number of course, do this automatically because this is the
computer terms reflect this binary number system, system we have learned all our lives).
a basic knowledge of this system is required.
1011
This is a decimal number
(based on the power of 1251
3 2 1 0
10). Each column 10 1010 10
represents numbers with 3 2 1 0
increasing power of 10 10 10
10 10 1000 + 0 + 10 + 1 = 1,011
(from right to left)
1000 + 200 + 50 + 1 = 1,251
Introduction to the binary number system: Introduction to the binary number system:
To convert from binary to decimal: e.g. 10011010

Binary numbers, however, are based on the power
of 2, not 10. This is because a computer can only (a) Write down the decimal value of each column and put
store two numbers in each memory cell (0 or 1). the binary number under it in the appropriate columns.
Therefore, if 1011 256 128 64 32 16 8 4 2 1
was a binary
1011 1 0 0 1 1 0 1 0
number, its value
would become: 3 2 1 0 (b) Place the decimal value of the binary digit under
2 2 2 2 the column (if there is a ‘1’ in the column) and add
+ the decimal values together.
8 0 + 2 + 1 = 11
Each numeral is called a bit. 1011 is a 4 bit binary 256 128 64 32 16 8 4 2 1
number. A byte is an 8 bit binary number. 1 0 0 1 1 0 1 0
128 + 0 + 0 + 16 + 8 + 0 + 2 + 0
(A binary number is sometimes called a ‘word’).
= 154
Introduction to the binary number system:

Question 11:
This is how
Decimal No. Binary equivalent Binary No. How many different values can be represented by a
the computer
0 0 0000
stores the 6 bit binary number?
1 20 0001
2 1
2 +0 0010 grey scale
3 21 + 2 0 0011 values in the
4 2
2 +0+0 0100 image Question 12:
5 2 2 + 0 + 20 0101 memory.
6 22 + 21 + 0 0110 Convert the binary number 1011010 to decimal form.
7 22 + 21 + 20 0111
8 23 + 0 + 0 + 0 1000
9 2 3 + 0 + 0 + 20 1001
10 2 3 + 0 + 21 + 0 1010 Note that
11 2 3 + 0 + 21 + 20 1011 there are 16 References
12 2 3 + 22 + 0 + 0 1100
different 1. Hedrick R, Hykes D. Starchman D: Ultrasound Physics and Instrumentation
13 2 3 + 22 + 0 + 20 1101
14 2 3 + 22 + 21 + 0 1110 values in a 3rd ed. Mosby 1995
15 2 3 + 22 + 21 + 20 1111 4 bit
number.

POWER AND INTENSITY

Power is the rate of doing work Work (unit: watts)
time
Brian Starkoff
In U/S power is usually measured in milliwatts (mW) (10-3 W)
Module 2 The area of an ultrasound beam is not constant. It changes over

distance as shown by the diagram below of a focussed beam.
Topics: • Power and Intensity
• Decibels
• Sound-tissue interactions
• TGC Intensity is therefore the preferred unit of measurement of a
beam.
mW
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound Intensity = Power per area (mW cm-2)
are licensed to use this program and files for personal study purposes only. cm 2
Copying (in whole or in part), use for any other purpose, or use by any other
person is prohibited without the prior, express permission of the author. Question 13:
6.2
How can a sonographer increase the intensity of the beam?
16
Intensity is related to loudness (in audio terms) In the following sequence, the ‘y’ axis
and to the strength of an echo (which relates to 14 shows the intensity of the received echo
the brightness of the echo on the screen) in from within the patient. The ‘x’ axis
INTENSITY 12 indicates the brightness of the pixel of
ultrasound terms.
mW cm
-2 light on the monitor (or in sound
10
applications, the loudness of sound that
8 your ear would hear).
For ultrasound, the ‘x’ axis also has a
6 grey scale bar which would show the
changes to the different degrees of
Intensity varies by very large amounts and in a 4 brightness on the display. Only six
non-linear fashion. shades of grey are shown.
2
1
1 2 3 4 5
BRIGHTNESS / LOUDNESS
16 16
Let us assume it requires an echo For the display to change to the next
14 14
intensity of 1 mW.cm-2 intensity to shade, the echo intensity must double
INTENSITY 12
produce a particular shade of grey. INTENSITY 12 (i.e. have an intensity of 4 mW.cm-2).
mW cm
-2
mW cm
-2 This is the way the sensitivity works with
10 10 our eyes (and our ears).
8 8
Then let us say that at 2 mW.cm-2
6 intensity, the pixel will change to 6
the next lightest shade of grey.
4 4
2 2
1 1
1 2 3 4 5 1 2 3 4 5
BRIGHTNESS / LOUDNESS BRIGHTNESS / LOUDNESS

The relationship between the echo intensity and the pixel

brightness is non-linear. A doubling of intensity is required each
16
time to produce equal changes in display brightness (which is the
Similarly, for the next
basis of formation of the image).
shade of grey, the
14
intensity of the echo 16
INTENSITY 12
would again need to be 14
mW cm 10 doubled to 8 mW.cm-2
-2
And so on:
INTENSITY 12
8 mW cm
-2
10
6 8
4 6
The graph is
2 4
1 exponential in nature.
2
1 2 3 4 5 1
1 2 3 4 5
To overcome this non-linear relationship and to directly relate

16
echo intensity and image brightness, the ‘y’ axis can be changed
Also: The 1 mW.cm-2 change at the to the logarithm of the intensity.
14 start of this example has the same 2
effect as the 8 mW.cm-2 change at Now let us change the scale and repeat
INTENSITY 12
the end. (each change in intensity the last sequence.
-2
mW cm 10 causes a single shade of grey 1.5
change in the display) LOG
8 INTENSITY
6 1 The intensity for the first shade of grey

was 1 mW.cm-2. The log of 1 is ‘0’, so
4 this point can be plotted:
0.5
2
1
1 2 3 4 5 0
1 2 3 4 5
2 2 The log. of
It required an intensity of 2 mW.cm-2 to The next grey level 16 is 1.2
change to the next shade of grey. The log. required an intensity
of 2 is 0.3 of 8 mW.cm-2, the log.
1.5 1.5
LOG LOG
of which is 0.9
INTENSITY INTENSITY1.2
For the next grey scale
1 level, an intensity of 4 1 and for 32
0.9 it is 1.5
mW.cm-2 was required. The
0.6 log. of 4 is 0.6 0.6
0.5 0.5
0.3 0.3
0 0
1 2 3 4 5 1 2 3 4 5
BRIGHTNESS / LOUDNESS BRIGHTNESS / LOUDNESS

2 The relationship between the brightness and Power and amplitude also vary by very large amounts
the echo intensity is now linear. By using the and in a similar non-linear fashion.
logarithmic values, intensity and changes to
Therefore a new unit of measurement is required to
1.5 image appearance
can be directly related. consider these variations (for Power, Intensity or Amplitude)
LOG
INTENSITY1.2 The Decibel
1 The primary reason why decibels
0.9 are used for this type of
measurement is that this unit 1.5
0.6
0.5 automatically compensates for 1.2
the non linear variations / dB

0.9
0.3
relationships in this type of 0.6
0 medium enabling a linear 0.3
relationship between the grey 0
5
1 2 3
4 scale changes on the images 1 2 3
BRIGHTNESS
4 5
and the settings on the machine.
2
THE DECIBEL THE DECIBEL
The Bel is the logarithmic ratio (to base 10) of the
relative intensity or power in two acoustic beams.
(The ’10’ indicates ‘to base 10”.
A decibel is 1/10 of a Bel. However it is often not used
because base 10 is assumed).
Logarithms:
Logarithms: Power Number Log 10
10 4 10,000 4
All logarithms in this course (and for most 10 3 1,000 3
mathematical uses) are to “base 10”. This means 10 2 100 2
that a logarithm is simply the number that 10 has 10 1 10 1
10 0 1 0
to be raised to, to get that number.
10 - 1 0.1 -1
e.g. 10,000 is the same as 104. This means that the 10 - 2 0.01 -2
logarithm of 10,000 is 4 10 - 3 0.001 -3
-4
10 0.0001 -4
THE DECIBEL THE DECIBEL

The decibel is used in ultrasound applications to
compare the differences in intensity, power or If the amplitude (eg voltage) of a signal / beam is to
amplitudes of two beams (or two different parts of the be considered, a different formula must be used:
same beam). because I A2
the formula to be used is: dB = 20 log ( )
A
The following formula is used to calculate the Ao
decibel change between two chosen values:
dB = 10 log ( ) or dB = 10 log ( PPo )
I
Io where
where
A = the amplitude of the beam at the point being
I = the intensity (or P = power) of the beam at the point
considered.
being considered.
Io = the initial intensity (or Po = power) of the beam (or Ao = the initial amplitude of the beam (or reference
reference intensity (or power) of the beam). amplitude of the beam).
dB = the decibel change between the two intensities (or dB = the decibel change between the two amplitudes.
powers).

THE DECIBEL Decibels vs. intensity of reflected wave

This working shows why the dB = 10 log ( II o ) Intensity Intensity Intensity
formula changes when 2
change remaining in lost from
amplitudes are used. dB = 10 log ( AAo2 ) in dB reflected beam original beam
2 Let’s look at the intensity remaining in a reflected

In this course, voltage is dB = 10 log ( AAo) beam, compare it with what was sent out and see what
the most common amplitude decibel change occurred between the two values.
that will be considered. dB = 20 log ( AAo )
Intensity Intensity Intensity
change remaining in lost from
NOTE in dB reflected beam original beam
Decibels are relative units, not absolute units. 0 dB 100% 0%
In this first example, 100% of the beam remains,
Two intensities (or powers, or amplitudes) are so there has been no change at all which means
required for a calculation of decibel change. that there has been a zero decibel change.
Decibels vs. intensity of reflected wave Decibels vs. intensity of reflected wave
Intensity Intensity Intensity Intensity Intensity Intensity
change remaining in lost from change remaining in lost from
in dB reflected beam original beam in dB reflected beam original beam
0 dB 100% 0% 0 dB 100% 0%
-1 dB 79% 21% -1 dB 79% 21%
-2 dB 63% 37% -2 dB 63% 37%
-3 dB 50% 50% -3 dB 50% 50%
-6 dB 25% 75%
As the beam reduces in intensity, there is a -10 dB 10% 90%
significant difference between the two states (what
was sent out and what remains). When the beam When the beam has fallen to 10% of its original
has reduced to 50% of its original value, it can be value, there has been a -10 dB change.
calculated that there has been a -3 dB change.
Note that it is minus 3 dB because the beam has
become weaker (i.e. it has reduced in intensity).
in dB reflected beam original beam in dB reflected beam original beam
0 dB 100% 0% 0 dB 100% 0%
-1 dB 79% 21% -1 dB 79% 21%
-2 dB 63% 37% -2 dB 63% 37%
-3 dB 50% 50% -3 dB 50% 50%
-6 dB 25% 75% -6 dB 25% 75%
-10 dB 10% 90% -10 dB 10% 90%
-20 dB 1% 99% -20 dB 1% 99%
When the beam has fallen to 1% of its original value,
it means that it has fallen another 10% of its Therefore for every -10 dB of change, the final
remaining value (i.e. 10% of the remaining 10%). value falls to a further 10% (or 1/10) of what
This means that there has been another -10 dB remained before.
change (making a total of -20 dB change).

In dB reflected beam original beam In dB reflected beam original beam
0 dB 100% 0% -3 dB 50% 50%
-1 dB 79% 21%
-2 dB 63% 37% Note: • A -3 dB change means a 50% loss (i.e. the
-3 dB 50% 50% value falls to ½ the original value.
-6 dB 25% 75% • If the value decreases, the decibel change is -ve.
-10 dB 10% 90%
-20 dB 1% 99%
Question 15:
-30 dB
-40 dB If the received U/S beam is half the intensity of the
transmitted beam, what is the dB loss?
Question 14: Fill in the blank boxes
Dynamic range
Question 16: A term used to express a range of values.
In ultrasound, this is usually the maximum and
If a beam with initial intensity of 12 mW cm is minimum signal levels. - expressed in dB
reduced by 6 dB, what is the final intensity? May be used in different contexts in U/S:
1. The range of echoes able to be detected
100 mW.cm-2 by the transducer as variable output. 1V
You will need a calculator to do this problem
mathematically, however In the answer slides, there (In the example here, anything below 0.001
mW.cm-2 will not be detected, and anything
is an explanation on how to do this question very echo above 100 mW.cm-2 will simply produce Signal
quickly and without a calculator. intensity the maximum possible electrical voltage on levels
the transducer element).
0.001 mW.cm-2 2. The range of signals that the 0.01 mV

electronics can handle.
Dynamic range Dynamic range

3. It could also mean the range of echoes on the display: As a guide, the following shows the dynamic range
from: the lowest level displayed that various components of an ultrasound system
to: the highest level before saturation can handle1,2.
-2
50 mW cm
Question 17: Echoes from
Transducer Electronics Display
patient
Calculate the dynamic range of a display 80 – 100 dB 60 – 80 dB 20 – 40 dB
100 – 150 dB
in which the shades of grey of the image Signals
are created by echoes between 0.005 as
mW.cm-2 and 50 mW.cm-2 shades
of grey
(In this example, echoes below 0.005 mW.cm-2
do not produce any light on the screen and all
echoes above 50 mW.cm-2 result in maximum
white.) 0.005 mW cm-2

Sound-tissue interactions Sound-tissue interactions

Refraction
This next section will cover the general ways in which
the sound beam interacts with tissue.
- change in direction of an ultrasound beam when
it crosses a boundary at an angle
Knowledge of these is important to gain an V1 V1
understanding of image formation and the production Higher velocity Lower velocity
of artifacts.
The interactions covered are:
• Refraction
• Absorption V2
• Divergence V2
Attenuation Lower velocity
Higher velocity
• Scattering
• Reflection - The direction of the beam deviation depends on
which tissue has the higher sound velocity.

Refraction Refraction
If the sound passes from a higher
velocity to lower velocity material, - Note that the machine does not know that the beam has
the sound will bend towards the changed direction so that any echoes that are received are
V1 Normal normal. It is because the edge of placed along the assumed path (in the incorrect location).
(90o line)
Higher the beam that strikes the interface
velocity first, slows down before the other
edge. The beam will then skew in V1 V1
Higher Lower
the same way a bulldozer would velocity velocity
turn if one of its tracks is slowed
V2 down.
Lower
velocity (To turn the bulldozer to V2 V2
the right, slow the right Lower Higher
velocity velocity
hand track).
Structure in Echo placed
patient here
The opposite happens when going from lower to higher velocity.

Refraction Refraction
sin 01 v1
- Refraction obeys Snell’s Law: = If v2 > v1,
sin 02 v2 0
then as 01 increases, 02 will approach 90
0 V1 V1
1
Lower velocity
0 1
Lower velocity
angle of
incidence
angle of
refraction 0 2 0 2
V2 V2
Higher velocity Higher velocity

Sound-tissue interactions
Sound-tissue interactions
Refraction
o θ1 V1 Attenuation
When 02 = 90 , no sound is Lower velocity
transmitted through the - Reduction in intensity of an ultrasound beam as it

interface, and 01 is called the θ2 passes through a medium.
V2
critical angle. Higher velocity
- These attenuation processes include:

At the critical angle - absorption
v1
the equation becomes: sin 0 1 =
v2 (because sin 0 2 = 1) - divergence
- scattering
Question 18: - reflection
What is the critical angle at a fat - The degree of attenuation depends on the
1450 m/s
fat/muscle interface? material involved, the distance travelled and the

frequency of the beam.
Note: You will need a calculator for
muscle
this question. 1585 m/s
Sound-tissue interactions Attenuation coefficients

Attenuation Material dB cm-1MHz-1 The attenuation
Lung 41 coefficient for soft
- Attenuation coefficients are numerical values that tissue is very easy to
express how different materials will attenuate an Bone 20
Air 12 remember: It is 1
ultrasound beam. Soft tissue (average) 1.0 dB.cm-1.MHz-1.
Kidney 1.0
- Symbol (alpha) The attenuation
Liver 0.94 coefficient for liquids
- Units: decibels per centimetre per MHz Brain 0.85 (e.g. blood and
(dB cm-1 MHz-1 ) Fat 0.63 water) is extremely
Blood 0.18 low. They attenuate
The amount of attenuation (in decibels) that occurs to a Water 0.0022 the sound very little.
beam as it passes through tissue can be calculated by Note:
multiplying the attenuation coefficient of the tissue by the The published values vary between research groups.
distance travelled (in cms.) and by the MHz of the beam. For example, the value for average soft tissue varies
from 1 dB.cm-1.MHz-1 to as low as 0.5 dB.cm-1.MHz-1.
(Attenuation (dB) = x cm x MHz)
Question 19:
Principal elements of attenuation
What is the attenuation (in dB) of a 4 MHz beam after it is
received back at the transducer after travelling to a depth Absorption
of 5 cm in soft tissue assuming total reflection? Depends on:
1. The material itself
Absorption Various properties of the material

such as density, viscosity, etc.,
- Primary component of attenuation3
will affect how much energy is
- Result of internal frictional forces expended in moving the
- Directly removes energy from the beam molecules as the compression
wave passes through it.
- Ultrasound energy is converted into heat


Absorption Depends on:
Divergence (diffraction)
2. The frequency of the beam. (Diffraction is an older term and is not used much
any more).
The higher the frequency, the
faster the molecules are moved, - The spreading of the ultrasound
and the more energy is expended beam as it moves further from the
as heat. source.
(Intensity = Power per unit
3. The depth of the tissue. area. As the area of the beam
increases, the intensity
The further the beam travels, the becomes less: I = P
more the absorption. a )
- Increased divergence causes
increased attenuation.

Beam divergence occurs:
1. 2. 3. 4. Beam divergence occurs:
In the far field of Beyond the After After refraction
a non-focussed focal zone of reflection at a curved 5. After passing through a small aperture.
transducer. a focussed from a convex interface.
transducer. interface.
- If the beam passes
through a small aperture,
the aperture acts like a
radiating source.
(Beams from smaller sources
have increased divergence).
NOTE:
Reflected wavefronts may also
undergo divergence.
Principal elements of attenuation Principal elements of attenuation

Reflection and scattering Scattering
The interactions primarily responsible for
ultrasound images. When the interface is much less than
1 wavelength in size, scattering
Scattering
occurs equally in all directions.
• The dispersion of the ultrasound beam in many directions. .
• Occurs when the sound waves strikes a very small object. In this case, the scattering
structure acts like a point source
• Scatter pattern depends on the size of of sound.
.
the interface relative to the wavelength.
This type of scattering has a
• It is very frequency dependent – scattering special name. It is called
increases with higher frequencies. Rayleigh scattering.
This is the type of scattering that occurs from blood cells.

Principal elements of attenuation Principal elements of attenuation

Scattering Scattering
Rayleigh scattering is very With scattering, only a very small

frequency dependent. portion of the beam returns to the
. transducer. .
The intensity of the reflected
echo is approximately The many scattered waves
proportional to the fourth power . interact with each other (through
of the frequency 2,4. wave interference) to form
backscatter patterns.
4
I f
This contributes to organ ‘texture’
we see on the image and results
in the artifact called ‘speckle’.

Reflection
Reflection is the major contributor to the images we see. Reflection - specular
non-specular (diffuse)
There are two types This occurs when a sound wave strikes a large
specular
smooth surface. (similar to light striking a mirror).
- non-specular (diffuse) reflection
Occurs when a sound wave strikes a rough or irregular
surface.
The echo returned back to the transducer is small, but echo The reflection from a specular reflector is very large but
detection is not dependent on the angle of the incident detection of the echo is highly dependent on the angle of
beam. In other words, the sound beam can strike the incidence. If the beam does not strike at close to 90o, the
surface at a wide range of angles and some echoes will still reflected echo will not travel back to the transducer (and
return to the transducer. will not be detected).
Acoustic impedance is a property of a material which is

Reflection a measure of the resistance of the material to the
When an ultrasound beam is directed to an propagation of sound. It is the product of the material’s
density, and the velocity of ultrasound in the material2.
interface, some of the beam will be transmitted
across the boundary, and some will be reflected. Symbol Z
Z= v
where = density of a material
and v = velocity of sound in the material
The percentage of the beam reflected back to the Units: kg.m-2.s-1

transducer depends on the acoustic property or
differences of the two tissues. Rayls (1 Rayl = 1 kg.m-2.s-1)
(Acoustic Impedance is also know as Characteristic Impedance).

Acoustic impedance Reflection coefficient (R)

Material Acoustic impedance (Rayls x 10-6) The fraction of the ultrasound beam
Air 0.0004 intensity that is reflected at an interface is
Fat 1.38 given by the formulas:
Oil 1.43
( ) ( ) x 100
2 2
Water 1.48 Z2 - Z1 Z2 - Z1
Brain 1.58 R= or %R =
Blood 1.61
Z2 + Z1 Z2 + Z1
Kidney 1.62
Liver 1.65
Note: this formula is used for intensity changes. If
Muscle 1.7 amplitudes are being considered then the formulas to use
Bone 7.8 are:
Z2 - Z1 Z2 - Z1
R= or %R = x 100
Whenever an ultrasound beam strikes an Z2 + Z1 Z2 + Z1
interface between two materials with different
acoustic impedances, some sound is reflected This is because I A2.
and the remainder transmits through. (The same reason we have two decibel formulae)
Question 20:
Determine the percentage of the intensity of an ultra-
The fraction of sound transmitted through the interface sound beam that is transmitted from air into soft tissue.
can therefore be calculated: (Z soft tissue = 1.63 x 106 Rayls)
(Note: You will require a calculator for this question).
T=1-R or %T = 100 - %R What decibel loss of the intensity of the
Question 21: transmitted beam occurs at this air-soft
For example, if it was calculated that 0.8 (80%) of the
tissue interface?
sound beam was reflected, then 0.2 (20%) of the
sound beam is transmitted. Also keep in mind that the returning echo must cross
the same interfaces and suffers the same attenuation.
Note: It does not matter which interface is Z1 and which This this the primary reason that coupling gel is
one is Z2. (The same reflection/transmission will occur if required between the transducer and the skin. Even a
the beam comes from either direction). microfilm of air will reflect most of the sound entering
the soft tissue, and it will also reflect the same
percentage of echoes returning to the transducer.
Question 22:
Beam attenuation
A 5 MHz beam is transmitted into a body as demonstrated:
(a) What is the decibel loss of The ultrasound beam’s
the echo intensity intensity is attenuated at the
received by the 4 cm kidney rate of 1 dB.cm-1.MHz-1 in
transducer from the tissue (on average).
kidney / fat interface? 1 cm fat
Assume no losses at the bone Therefore the echoes
transducer-kidney interface.
returning from deeper
(b) If the initial (transmitted) intensity was structures become
3500 mW.cm-2, what is the final (received) intensity progressively weaker and
of the echo from the kidney / fat interface? weaker.
Assume no losses at the transducer / kidney interface.
patient
(Note: You will require a calculator for these questions).

Beam attenuation Beam attenuation

This attenuation would cause the To overcome this phenomenon, the
deeper echoes to be presented deeper echoes are amplified more
with less intensity on the B-mode than the closer echoes.
viewing monitor.
patient echo B-mode patient echo B-mode

amplitude amplitude
Time Gain Compensation Time Gain Compensation

There are several aspects of this amplification
This process is called T.G.C. (time gain compensation). under the control of the sonographer.
(Sometimes called Depth Gain Compensation – D.G.C.) Near gain represents the amount of gain applied
The purpose of TGC is to produce equal to the closest echoes.
brightness echoes from similar interfaces
regardless of their depth in the patient.
gain
depth (time)
Since these echoes are relatively strong, only a small

echo
patient
amplitude B-mode amount of gain is required.
Time Gain Compensation Time Gain Compensation

Slope adjusts the rate at which the amplification The Delay control regulates the time (depth) at which
the TGC begins to be applied.
is increased for the deeper echoes.
Tissues which attenuate the
signals more require an increase
in the TGC slope. eg. (fatty liver)
gain
gain
depth (time)
Delay would be used when strong echoes from
superficial echoes are of no interest or superficial
depth (time)
artifacts are present and amplification of this superficial
Far gain is the amount of gain applied to the distant area would be detrimental to the image.
echoes.

Time Gain Compensation Multiple choice questions

There are two main systems of TGC control: Attempt these questions without referring to your notes.
3 or 4 function system • Segmental system 1. The percentage reflection of the intensity of sound at a large
a single control for a separate control for a smooth interface between muscle and fat is:
each of the following number of individual
(a) 1
adjustments depths in the patient
(b) 10
(c) 50
– near gain (d) 100
– delay
– slope 2. When going from tissue with lower acoustic velocity to tissue
– ? far gain with higher acoustic velocity, the wavelength of the sound
beam:
Most U/S units have a degree of TGC preset, and the TGC
(a) Decreases
controls are designed to adjust the settings for individual
(b) Increases
patients.
(c) Remains the same
The clinical aspects of TGC adjustment will be (d) Cannot be determined without the specific figures
discussed in other areas of the ultrasound course.
Multiple choice questions Multiple choice questions

3. An ultrasound beam is directed at an interface between two 5. All other factors being constant, a more compressible tissue
tissues as shown to the right. When the beam passes into the will have a __________ speed of sound:
deeper tissue, it will: Higher o (a) Lower
(a) Continue in a straight line 20
velocity
(b) Higher
(b) Bend away from the normal (c) Same (speed of sound is constant in tissue)
(c) Bend towards the normal (d) Cannot be determined without more information
(d) Cannot be determined without the Lower
specific speed of sound figures velocity
6. TGC applies variable amplification to the received echo signals
to correct for signal level differences caused by:
4. The period of a 5 MHz ultrasound wave in soft tissue is: (a) Reflection
(a) 0.02 microseconds (b) Refraction
(b) 0.2 microseconds (c) Scattering
(c) 2 microseconds (d) Attenuation
(d) 5 microseconds
Answers to these questions are at the end of the notes.
References
1. Hoskins P, Martin K, Thrush A: Diagnostic Ultrasound Physics and Equipment

2nd ed. Cambridge University Press 2010
2. Hedrick R, Hykes D. Starchman D: Ultrasound Physics and Instrumentation 3rd

ed. Mosby 1995
3. Gill, R: The Physics and Technology of Diagnostic Ultrasound: A Practitioner’s

Guide. High Frequency Publishing, Sydney, Australia 2012
4. A Brief Introduction to Ultrasound,

www.us-tip.com.serv1.php?type=db1&dbs=Rayleigh%20Scattering

Simple transducer
Physical Principles of Ultrasound Although the real-time transducers used with
Brian Starkoff modern ultrasound units are very complex (and
are covered in a later section of the notes), they
Module 3 all contain the following basic components:
Basic components
Topics: • Basic transducer
• Pulse echo imaging
• Duty factor
• Bandwidth
• Beam Intensity variation
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound
are licensed to use this program and files for personal study purposes only. Case: • usually made of plastic
• robust
6.1 • sealed to prevent entry of fluids or dirt
Simple transducer Piezoelectric element

Suitable materials have a
The main functional component is PZT Naturally occurring - +
(Lead Zirconate Titanate) piezoelectric crystals dipole type structure,
the piezoelectric (PZT) element. +
each dipole has a slightly
are unsuitable for - -
manufacture into different electrical
PIEZOELECTRIC -
potential at each end.
ELEMENT functional diagnostic ++
ultrasound crystals, +
- When first formed, the
therefore piezoelectric -
material is now material has dipoles
+ + which are randomly
manufactured.
Ceramic material is aligned, and therefore
+ -
now commonly used. -
have no piezoelectric
properties.
The material expands
and contracts, sending Because the original elements were made out of crystal
out the ultrasound wave. material, the elements are still often called “piezoelectric
crystals”.
Piezoelectric element Piezoelectric element
+
- - - + + + The positive - - + + The heat is then
The material is +
- - ends of the - - + removed and the
+ -
then heated to a - + + +
- - - dipoles are - - + - material is
predetermined + + + +
- - - attracted to the - - allowed to cool.
temperature + + + - + + The dipoles
- - ++ negative electric - -
(called the “Curie + + + or magnetic field + - + + maintain their
temperature”) and - - -
+ + - - + + alignment under
- (and vice versa) + -
placed in a very - - + + so that the - - + + the continuing
+
strong electric or - - + - - -
+ + + dipoles align + + influence of the
magnetic field.
+ field.
+
- - + + themselves as - - -
+
-
- - +
+ + heat applied shown. - - -
+ +
-

Piezoelectric crystal Piezoelectric crystal

+ When an electric potential is placed on the faces of the
Once the material has cooled, the element in the manner presented in diagram 1, the +ve
+ -
electric / magnetic field is removed. and -ve aspects attract, and the element expands.
+ -
+
The material now has piezoelectric - + + + -
+ -
In the case presented in - -
++ -
properties. +
+ - diagram 2, the +ve’s and – -
+
- -
+ ++ -
Note: + - ve’s would repel, causing -
+
- + + --
+ - the element to contract. - +
+
+ --
If the transducer is heated to higher - +
+ - - + ++ - -
than the Curie temperature, the dipoles - +
will lose their alignment and the
- - + + ++ -
The element can therefore be -
Transducer element will never work again. Therefore - + + ++ - -
made to expand and contract -
NEVER autoclave a transducer because the Curie - + - +
+ --
by the application of a voltage
temperature is likely to be exceeded and this would - + + --
on the surfaces.
destroy the transducer. 1 2
Piezoelectric crystal Piezoelectric element

- + 1
This expansion and contraction + + - 2
+
- The critical dimension of a piezoelectric
could be made to occur by the - + ++ -
application of an AC voltage, + - + element is its thickness.
- - + + - + -
however with imaging + +
- - + + - - + -
The thickness of the element is
ultrasound, very short pulses -
are required therefore a single, - +
- + ++ - +
½ wavelength of its resonant frequency.
- + -
strong, short electric pulse is - + + ++ - + -
- -
applied to the element. - + ++ - + - Question 23:
+
The element expands (or (a) For an element to resonate at 5 MHz, the
- + -
- + + - - -
contracts) and then ‘rings’ or -
+
- + thickness needs to be ? mm
+ + - -
resonates (like a bell) for a short +
period of time.
- - + + - (b) Thicker elements resonate at
-
? frequencies
The frequency with which it resonates is called its
resonant frequency.
Piezoelectric element Simple transducer

+
+ - 1. Converts electrical energy into For diagnostic ultrasound,
+ -
mechanical energy. very short pulses are
+ -
transmits pulses required for high resolution. If
+ - the element was allowed to
+ -
2.Converts mechanical energy into ring down unhindered, a
+ -
+ electrical energy. relatively long ultrasound pulse would result.
-
- receives echoes Also, if the case was hollow, sound waves would travel
back into the casing and reflect back onto the piezoelectric
Electrical connections are required to energise the
element causing it to vibrate and be disrupting to the pulse.
element and to receive the electrical signals from the
element. Immediately behind the element is damping material.
ELECTRODES
The primary purpose of the
May be a thin plating of
damping material is to stop the
gold or silver.
resonance of the element and
thus produce a very short pulse.

Simple transducer Simple transducer

The damping material also stops sound waves The acoustic impedance of PZT material is very
passing back into transducer and then bouncing different to that of the skin, therefore a large
back onto the piezoelectric element. percentage of the sound intensity would be reflected
at this interface instead of being transmitted.
MATCHING
LAYER
Unfortunately the damping material makes the A matching layer is placed immediately in front of the
transducer less efficient in transmitting and less piezoelectric element to match the acoustic impedances of
sensitive to the received echoes, however it is the element (Z = 30 x 106 Rayls) and soft tissue
essential to use for pulsed ultrasound. (Z = 1.6 x 106 Rayls).

The thickness of the matching layer is made ¼ of Matching layer
The acoustic impedance of the matching layer is
the wavelength of the resonant frequency of the PZT ML ST
designed to be the geometric mean of the
piezoelectric element.
materials it is matching.
¼ Question 24: Z ML = Z PZT x Z ST
Calculate the ideal acoustic impedance of a matching layer
for a transducer if the piezoelectric element has an acoustic
impedance of 30 x 106 Rayls.
This thickness allows maximum (Acoustic impedance of soft tissue = 1.6 x 106 Rayls)
reinforcement of the transmitted
wave. Question 25:
Calculate the percentage transmission of the intensity of a
(Sometimes this layer is referred to as beam from the element into soft tissue with and without a
the ¼ wave layer or the ¼ wave matching layer.
matching layer).
(Note: You will require a calculator for questions 24 and 25).

Most transducers also have a lens designed to focus
Matching layer the beam. Even with modern transducers, a lens is
usually used to focus the beam in the orthogonal
(slice thickness) plane.
PZT ML’s
ST
Lens
Modern Impedance Matched transducers have:

- multiple matching layers
- the transducer element is designed with a lower
acoustic impedance (closer to that of soft tissue). Beam focussing will be discussed in Module 4.

Multi-element Transducer Multi-element Transducer

Each element produces a small wavefront.
Individual small elements must be acoustically and
Most modern transducers use many small elements
electrically isolated from each other.
for the formation of each U/S pulse.
multiple elements
These form an array of

elements, and the
transducer is known as an
array transducer. The wavefronts from each of the elements combine to
form a single wavefront.
The required electronics are much more complex This technique allows great flexibility in beam
with a separate electronic channel required for each formation.
element. Types of transducers using this principle:
Linear array, convex array, phased array.
Wave interference Wave interference - Examples:

When two (or more) sound waves combine, the final wave is If the waves are the same frequency and in phase, they will
a summation of the individual waves. produce a wave with a combined (higher) amplitude at the same
frequency.
+ +
Constructive interference
If the waves are the same frequency and 180o out of phase
(opposite phase), they will produce a wave with a lower amplitude
If the waves are both If one wave is positive and at the same frequency.
At any positive, they will add the other is negative their
given together to be a greater addition will be less than
instant: amplitude. This is
constructive interference.
either original wave. This is
destructive interference.
+
Destructive interference
Wave interference - Examples:

There are two types of U.S beams:
o
If the waves are the same frequency and 180 out of phase
(opposite phase), and the same amplitude, they will cancel - continuous
each out completely.
- pulsed
Ultrasound used in diagnostic imaging is pulsed.

+ Once a pulse has been sent into tissue, pulse
Total destructive interference
the transducer is set to receive mode.
If the waves are of different frequencies and/or out of phase
with each other they will produce a complex wave. The returned echo is converted into an
electrical voltage.
echo
The time from pulse transmission to
+ echo receive can be accurately
measured, and this is used to calculate
the interface depth.
Complex interference

Pulse echo imaging Pulse echo imaging

The depth calculation is performed by the The rate at which the pulses are emitted from the transducer
ultrasound machine using the formula: d = vt is called the pulse repetition frequency (PRF)
2 Units: hertz (pulses per second)
d = depth of reflector (in metres)
where: v = velocity of sound (1540 m.s -1) The PRF will depend on the maximum depth that is imaged.
t = roundtrip time of the pulse / echo pulses sent
superficial
The machine must wait until all echoes have been 3 cm
NOTE: received from the viewed depth before the next
pulse is sent.
echoes received
Question 26: Calculate the depth of an interface in a patient
if an echo is received from this interface 0.22 deep 10 cm
ms following emission of the pulse.
Note: You will require a calculator for an accurate answer The deeper the tissues are imaged, the longer the
to this question. However the answer slides will show you transducer must wait for all the echoes to return, therefore
how to approximate if this was a multiple choice question. the PRF must decrease.

Pulse repetition period is the time from the start of one • Pulse duration is the time taken for one pulse. (Units: seconds)
pulse to the start of the next. PD
PRP
P.R.P.
The pulse duration can be calculated by multiplying the number of
This time must be long enough to allow all required cycles in the pulse by the time for one cycle (the period of the
echoes to be received by the transducer. wave). i.e. PD = n x T
A pulse cannot be sent until all echoes from the preceding PD
• The Duty Factor is the fraction of time ie. DF =
pulse have returned from the required depth. PRP
that the unit is transmitting.
1
The PRP and the PRF are related by the formula: f =
T Typical duty factors in diagnostic ultrasound are 0.1% to 1%
(revise module 1)
1 (or 0.01 to 0.001 or 1/100 to 1/1000)
Therefore PRF = PRP and PRP = 1
PRF
If either the PRP or the PRF are known, then the (i.e., the PRP is about 100 to 1000 times longer than the PD)
other can be calculated.

Duty Factor will increase with:
PD Spatial pulse length (SPL) is the actual length of 1
Increased pulse pulse. (Units: metres – although usually expressed in mm.)
duration. PD
(longer pulses)
Decreased PRP. PRP

(increased PRF) It is this length that is most important in U/S.
PRP
The SPL is determined by the length of one cycle, i.e.
Continuous wave
the wavelength (which is determined by the frequency),
ultrasound has a duty
factor of 100% because it and the number of cycles in the pulse.
doesn’t have any ‘off’ time.
SPL = xn

Beam characteristics Beam characteristics

Frequency content of beam Frequency content of beam
A pulsed ultrasound beam consists of sound waves
of more than one frequency.
The range of frequencies I I I
present within a pulse is
I termed the bandwidth.
f f f
short pulse long pulse continuous
Maximum intensity occurs at (wide bandwidth) (narrower bandwidth) (zero bandwidth)
f the resonant frequency of the
transducer.
The shorter the pulse, the greater the range of
The bandwidth is inversely proportional to the frequencies present. increased bandwidth.
pulse duration. 1 1 Continuous wave ultrasound transmits with only
BW =
PD one frequency.
Beam characteristics Beam characteristics

Broad bandwidth pulses have an inherent advantage: Frequency content of beam
5 MHZ
Normally
The sonographer can choose Centre frequency = maximum intensity (or amplitude)
which part of the frequency = resonant frequency of the transducer element.
original
spectrum to use. For example, if I transmitted pulse
the centre frequency is 5 MHz, 4½ As the pulse/echo passes
MHz can be chosen for improved through tissue, the higher after
4 5 6
penetration or 5½ MHz can be f MHz frequency components are attenuation
chosen for improved resolution. attenuated to a greater
4½ MHz 5½ MHz
degree than the lower
penetration resolution frequency components. I
In other words, multiple frequencies can be chosen f
from a single probe. (The dependence of attenuation on frequency was
discussed in Module 2).
Beam characteristics Intensity Variation

The beam emitted from a typical diagnostic ultrasound
transducer is not uniform - it varies over space and time.
Therefore as the pulse/echo passes through tissue:
Spatial variation
This is the variation of the intensity of an ultrasound
- The centre frequency original beam over distance.
decreases. transmitted pulse
- The overall intensity after

decreases. attenuation It varies with:
Distance from the transducer Cross sectional
- The higher frequency area of the beam
I
component of the pulse is
significantly attenuated. I
I
f
Distance from transducer Beam width

Intensity Variation Intensity Variation

Spatial peak Spatial average
The spatial average (SA) is the average intensity across
the beam.
Theoretically the spatial peak (SP) of a beam

occurs along the central axis of the beam at the
ISA = power of the beam
area of the beam
focal point.
However because of beam attenuation, The initial spatial average
the actual spatial peak will occur (at the transducer face)
slightly closer to the transducer. can be calculated: = output power of the transducer
active area of the transducer
I (Although not a particularly useful value, it is the easiest

to measure and is often quoted).
Distance from transducer

Temporal variation
A term that is sometimes used with spatial variation is
the Beam Uniformity Ratio (BUR). The variation of the intensity of an ultrasound beam
with time.
A pulsed ultrasound beam is not a smooth
homogeneous beam of sound.
The BUR is the ratio of the spatial
peak to the spatial average.
ISP
BUR = ISA
The spatial peak can range from 5 to 50 times the Pulse echo ultrasound uses short pulses of
spatial average depending on the degree of focussing1. sound separated with long periods of rest.
(i.e. the BUR can range from 5 to 50).
During the time between pulses, the intensity falls
Increased focussing increases the BUR. to zero.

Temporal variation Temporal variation
The temporal peak (TP) The pulse average (PA)
This temporal variation even occurs during a pulse.
is the intensity at the is the average intensity
These are the slight variations during the individual peak (maximum) over the duration of a
cycles of a pulse. amplitude of the pulse. single pulse.
1000
I
I
Because of these variations, the beam’s measured
intensity will depend on when it is measured. 0
≈ 1 us time ≈ 1 ms
Three different time related intensity measurements The temporal peak intensity is typically 2 to 10
have been defined. times that of the pulse average intensity1.


Temporal variation Temporal variation
1000
The temporal average intensity may be 500 to

1000 times less than the pulse average intensity
1000
because of the very long ‘off’ (or zero intensity)
I time between pulses.
Which means it can be 1000 to 10000
times less than the temporal peak
0 I
≈ 1 us time ≈ 1 ms intensity.
The temporal average (TA) is the average intensity
taken over one on-off beam cycle 0
time
Pulse duration
TA intensity = PA intensity x The temporal average intensity is used when heat
Pulse repetition period
transfer into tissue is being considered.
(Duty factor)

There are six possible intensity measurements that For a given pulsed ultrasound beam:
result from different combinations of the spatial and SPTP >> SPTA >> SATA
temporal variations in a pulsed ultrasound beam: Ranges of intensity in diagnostic ultrasound:1
• SPTP spatial peak, temporal peak
• SPTP: 0.4 to 700 W.cm-2 (B-mode and M-mode)
• SPPA spatial peak, pulse average 3 to 1400 W.cm-2 (Doppler)
• SPTA spatial peak, temporal average
• SPTA: 0.6 to 200 mW.cm-2 (B-mode and M-mode)
• SATP spatial average, temporal peak 0.6 to 2500 mW.cm-2 (Doppler)
• SAPA spatial average, pulse average
• SATA 0.01 to 60 mW.cm-2 (B-mode and M-mode)
• SATA spatial average, temporal average 0.26 to 840 mW.cm-2 (Doppler)
SPTP and SPTA are the ones most commonly used in
clinical ultrasound (although SATA may occasionally Note that SPTP is in Watts cm-2. In other words the
instantaneous intensity of a pulse is very high.
be quoted - because it is the smallest intensity
measurement.

Attempt these questions without referring to your notes. 3. The equation for Snell’s law is:
1. As a general observation, materials with higher _________ (a) v =f
demonstrate faster propagation of ultrasound waves.
(b) sin 01 = v 1
(a) Compressibility sin 0 2 v2
(b) Cross-sectional area (c) sin 0 = 1.22
d
( )
(c) Density 2
(d) Attenuation coefficient Z 2 - Z1

(d) R =
Z2 + Z1
2. The frequency of an ultrasound wave which has a wavelength
of 0.5 mm in soft tissue is: 4. What component of a transducer is designed to control
(a) 3 MHz piezoelectric element resonance?
(a) Damping material
(b) 5 MHz
(b) Electrical insulator
(c) 8 MHz
(c) Matching layer
(d) 10 MHz
(d) Piezoelectric dipoles

Multiple choice questions

5. Coupling gel is applied between the transducer and the References
patient’s skin during scanning to:
1. Gill, R: The Physics and Technology of Diagnostic Ultrasound: A
(a) Soften the skin Practitioner’s Guide. High Frequency Publishing, Sydney, Australia 2012
(b) Activate the piezoelectric element
(c) Reduce friction in moving across the skin
(d) Increase the percentage of sound transmission
from the transducer element into the soft tissue
6. What is the numerical value of the science / engineering prefix

“Micro”?
(a) 106
(b) 103
(c) 10-3
(d) 10-6

Physical Principles of Ultrasound Beam profile

Brian Starkoff The ultrasound beam emitted from a transducer consists
of 2 distinct regions
Module 4
d
Topics: • Beam profile
• Side lobes
• Focussing 1. A near field characterised by a non-diverging beam.
• Multiple beamformers (sometimes called the Fresnel Zone)
This length (in a non-focussed transducer) may be

Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound calculated by the formula:
d
2
are licensed to use this program and files for personal study purposes only.
Copying (in whole or in part), use for any other purpose, or use by any other =
person is prohibited without the prior, express permission of the author. 4
6.0
Beam profile Beam profile

2. A far field characterised by a diverging beam.
(sometimes called the Fraunhofer Zone)
The angle of divergence (in a non-focussed
transducer) is calculated by the formula: Sin θ = 1.22 In practice, the beam will converge somewhat even in a
d non focussed transducer. In fact the beam width at the
0 transition point of a non focussed transducer will be
approximately ½ the diameter of the transducer aperture1.
d
Question 27
(a) Calculate the length of the near field and the angle
of beam divergence in soft tissue of an unfocussed
The point where the beam starts to diverge is known as the 3 MHz, 1.5 cm diameter single element transducer.
‘transition point’, and the distance from the transducer where (b) What is the thickness of the transducer element?
this occurs is the ‘transition distance’.
Note: You will require a calculator to work out question 27(a).
Beam profile Question 28

(the same, longer or reduced?)
Transducers are designed so that pulse echo imaging
occurs in the near field. Increased element dia. = ? near field length
= ? far field divergence
The length of the near field and the angle of
divergence depends on:
Increased transducer frequency = ? near field length
- element diameter (transducer aperture)
= ? far field divergence
- frequency
NOTE: The near field length is proportional to the square
of the element diameter (or aperture) therefore It will be seen by the answers that the better beam
this measurement has the greatest effect on this profile (i.e. the longest near field and least divergence)
aspect of the beam profile. is produced by transducers with a higher frequency and
2 a larger aperture (with aperture having the greatest
d For example, doubling the aperture will
= effect).
4 give 4 times the length of the near field.

With transducers used for clinical ultrasound, the beam profile Beam profile
is also altered in the form of focussing. This is designed to
make the beam much thinner for better lateral resolution. One important aspect of a beam to always
keep in mind is the fact that an ultrasound
beam is 3 dimensional in nature.
without focussing
Remember, any part of the beam intercepting an
interface will return echoes.
with focussing
Note that the principles of near field length and far field
divergence are inherent even in focussed transducers and
therefore these principles still need to be understood.
Beamwidth Beamwidth
An ultrasound beam does not have a clearly Two common definitions are: (for intensity)
defined edge. 1. the 3 dB edge:
(the edge is taken as the point that the intensity of the
– the intensity decreases from the centre of the beam has fallen to ½ its maximum value – i.e. its
beam outwards intensity has fallen by 3 dB)
This is a The edge of the However, as machines became -3dB

graph of the beam is therefore more sensitive, it was found that (½ max I)
intensity I an arbitrary margin the beam could be detected I
across a which must be beyond this boundary. Therefore it
beam. defined. became necessary to widen the
beamwidth definition.
Beam width Beam width
Beamwidth Side lobes

Two common definitions are: (for intensity) The output of an ultrasound transducer is not
2. the 10 dB edge: confined to a single beam.
(where the intensity has fallen by 10dB from its maximum
Some lower intensity beams (called SIDE LOBES) are
value). emitted at various angles from the transducer face.
This is due to complex interference of the wavelets
being emitted from a transducer.
– this is the more commonly

used definition.
-10dB
Question 29 I
A 10 dB beamwidth is ?? than ( 101 max I) Note:

a 3 dB beamwidth for a given this occurs even with a single
beam? Beam width element transducer.

Side lobes Side lobes

Actual beamwidth profiles at various distances from the Side lobes occur in all planes of the transducer.
transducer would look more like these:
side
lobes
I I I I I
1 2 3
Beam width Beam width

(in scan plane) Slice thickness
Side lobes
cross-section
1 2 3
of beam

With array transducers, the regular spacing of the
transducer elements cause a special type of side
lobe known as Grating Lobes. Note that with Matrix transducers (discussed in
module 7), the grating lobes will occur in both
Grating lobes occur only in the scan plane and planes because there are multiple elements in
tend to be more severe (higher intensity) than the both planes of the transducer.
conventional side lobes.
cross-section cross-section
of beam of beam

• Apodisation
Although side lobes and
This involves decreasing
grating lobes are relatively reduced voltage
the voltage of the pulse to
weak, they can create
artifacts if they strike a very the outer elements of
strong reflector. firing group which means
(Described further in module 10). that the wavelets from the
outer elements have
This is a side lobe artifact slightly less intensity.
reduced voltage
Because grating lobes in particular have been the cause of
image degradation due to artifacts, manufacturers have (This also works on receive by decreasing the
made design changes to decrease their production. sensitivity of the outer elements).
Grating lobes may be reduced by:
• Apodisation
• Decreasing the transducer element spacing


• Apodisation • Decreasing the element spacing
Although apodisation reduces grating lobes, it does
increase the width of the main beam slightly.
(Which means that lateral resolutions is slightly
degraded).
0
The angles at which the
I I grating lobes are emitted are
specified by physical laws,
and can be calculated. They
Beam width Beam width are inversely proportional to
the element spacing.
Without apodisation With apodisation 1
sin 0 x

• Decreasing the element spacing Magnified view of two elements in an array
1
x sin 0 x Normal elements
element
0 spacing
Therefore if the spacing can be decreased enough, 0 Subdiced elements

can be increased to the point that most of the grating effective Each segment of a subdiced
lobes will not transmit into the patient. element element will transmit its own
spacing
Unfortunately, there is a limit to how small the elements wavelet, and in this respect will
can be manufactured. The elements are therefore act like an individual transducer
subdiced into smaller segments. element.
Beam focussing Beam focussing

Because the size (diameter) of an ultrasound beam is
directly related to resolution, the beam is focussed to
narrow it in the area of interest. 2. acoustic lens
adding a lens
This is common, and is still done today in many transducers.
with focussing
Uses the principle of

refraction.
Methods of focussing: Refraction was
1. curved element described in module 2.
Concave lens Convex lens
Shaping the transducer element is technically Speed of sound in Speed of sound in
difficult, and is generally not practical to lens is higher than lens is lower than
accomplish with modern transducers. tissue. tissue.


With focussing, decreasing the radius of curvature will:
3. focussed mirror - decrease the focal depth
- decrease the beam width at the focal point
Although an old technique, it it is now d
used in some intravascular transducers.
d
4. electronic
(with an array transducer) d
The most common technique in modern transducers
and will be described in more detail shortly.

The width of the beam at the focal point (and
therefore the lateral resolution) can be calculated.
The focal zone is the depth range of the beam Beamwidth calculation:
that is less than twice its minimum width. 2.4 A
Beamwidth at focus =
D
where = wavelength
A = radius of curvature (= focal depth)
2 xBW 2 xBW
BW D = diameter of element (or transducer aperture)
A
Focal zone NOTE: The beamwidth formula also applies to the
slice thickness plane.
Beam focussing Electronic focussing

Beam intensity increases in the focal zone (because
(array focussing)
of the decreased area of the beam).
(You may wish to revise power, intensity and This is by far the most common type of
area relationship in module 2) focussing used today.
By slightly delaying the firing time of the inner

May lead to a band of increased brightness elements of an array, the combined individual
on the image at the depth of the focus. wavelets form a beamfront which is focussed.
It is usually corrected automatically by the

electronics in the ultrasound machine. (However,
occasionally it may be apparent on the image and
require some TGC correction).

Without Focussing input signal Without Focussing

A multi-element transducer Each element will produce
is shown. Electrical signals its own wavelet, and all
(voltage spikes) are sent wavelets will be emitted
down the cables to the together.
electrodes on each
transducer element.
separate signals
going to individual
If no focussing is applied, elements The wavelets would unite
all the signals reach their (by wave interference),
appropriate element into a single non-focussed
simultaneously. wavefront resulting in a
non-focussed beam.
With Focussing With Focussing

DELAYS
The outer elements will emit
With a focussed their wavelets first .
transducer, a delay
circuit is added. This
DELAYS The wavelets emerge very close
circuit applies variable together, and will join. An
time delays to each ultrasound beam will always travel
wire leading to the at 90o to the plane of the final DELAYS
transducer elements. wavefront (in the direction of the

arrows). This directs the beam
towards the centre.
The signals to the inner
elements are held up The beam shape is therefore
slightly as shown. altered. The joined wavelets have
formed a focussed beam.
Electronic Multiple focal zones

Most U/S machines now allow the use of several different
Focussing focal zones in each beam path.
A separate pulse must be transmitted along the same
The position of the
increased decreased beam path for each zone.
focal point is
delays delays
adjustable, and is After the first pulse is
operator selectable sent out, (focussed
close to the
transducer) the
machine is set to
Increasing the delays, decreases the effective receive echoes from Receives to
radius of curvature, and this results in: this depth only
a set depth. After
• the focal point moves closer to the transducer This segment of echoes is
this, it stops then placed in the
• increased focussing = narrower beam (in focal zone) receiving and sends computer’s image memory.
• a shorter focal zone out the next pulse. 1st pulse

Multiple focal zones Multiple focal zones
The third pulse is

Receives Similarly this next
After the second echoes sent out (focussed to
segment of echoes is
pulse is sent out between these the next deeper area) placed in the computer’s
two depths and again the image memory and
(focussed to a
machine is set to matched to the previous
deeper area), the segments.
machine is set to receive echoes from
receive echoes from this deeper section of
This next segment of echoes
this deeper section is placed in the computer’s the field of view.
of the field of view. image memory and matched
2nd pulse to the first segment. 3rd pulse
This results in a narrow beam over the entire depth, but at a

reduced frame rate because of the extra time taken to
produce each line of echoes.
Variable aperture Dynamic receive focussing

To further reduce beam width close to the transducer, fewer
transducer elements may be used for the pulses focussed close to
the transducer. By selectively delaying signal
This effectively creates a smaller transducer aperture. processing between individual
elements of the transducer
during reception, the transducer
For each The increased may be effectively “focussed” to
successive number of different points in the patient
(deeper) focal transducer during the echo receive phase.
zone, more elements
transducer improves the
elements are deeper field
used. focussing
characteristics
1st focal zone 2nd focal zone 3rd focal zone

transmit and receive transmit and receive transmit and receive
IDEAL ACTUAL
final signal output
However in reality, the wavefronts are curved
individual (radiating out from the point of echo origin). The
signals are
+ wavefront strikes the inner elements first, then the
added
outer ones progressively later.
signal lower voltage output
voltages
produced by + In the addition circuit, the
transducer signal voltages would be
elements. combined over a short but
WAVEFRONT significant period of time and
result in a lower amplitude
In an ideal situation, the wavefront of an echo would be voltage output.
WAVEFRONT
flat, and strike all transducer elements at the same time.

ACTUAL
+ +
This problem is
overcome by using the + DELAYS DELAYS
+
delay circuit to hold up
the inner element signals
by a predetermined DELAYS
amount. This allows the
outer element signals to
‘catch up’ and enables
the addition circuit to
produce a short high
amplitude output. The beamformer circuit adjusts the delays to suit required
distance that the echoes are coming from. This is done
WAVEFRONT automatically and continuously during receive.
(The machine knows the depth of the echoes from the
time delay after transmission).
Dynamic aperture Any off axis echoes will

provide only a minimal
signal because the delays +
have been set for axial
echoes. DELAYS
Therefore the best echo

strength will occur along the
axis of the beam path.
To further improve dynamic receive focussing, modern

machines often incorporate dynamic aperture in which the ie. the transducer is
transducer uses fewer elements for the initial echoes and ‘focussed’ to the required Off axis echo
automatically increases the number of active elements as depth along the required produces
it receives deeper echoes. This acts in a similar way to the path. poor signal
variable aperture during transmit described earlier.
It is possible to use multiple beamformers to obtain It is also possible to use multiple beamformers to transmit and
echoes from several different paths simultaneously. receive echoes from several different paths simultaneously in a
linear or curved array.
Beamformer 1
Beamformer 2
+ + Beamformer 3
DELAYS DELAYS
In this case, 3 sets of

Delays are set for Delays are set for lines are created
wavefronts of wavefronts of simultaneously with
echoes from beam echoes from beam the smaller fields of
path 1 therefore 1 2 path 2 therefore view added to make
producing beam producing beam the whole frame.
path 1 on the image. path 2 on the image.
FOV 1 FOV 2 FOV 3
References
Although expensive, it allows several beam paths to be
1. Gill, R: The Physics and Technology of Diagnostic Ultrasound: A
recorded at the same time from a single transmitted pulse. Practitioner’s Guide. High Frequency Publishing, Sydney, Australia 2012

Remember the principles of pulse-echo

Physical Principles of Ultrasound imaging (from Module 3): pulse
echo
Brian Starkoff - A pulse of sound is sent into
the patient and then the
Module 5 transducer waits for echoes
to be received.
Topics: • A-mode
• B-mode Initially, the returned echo was displayed as an
• M-mode amplitude variation on a C.R.O. (cathode ray
• Line density oscilloscope).
• Frame rate
- The amplitude of the trace represents the echo strength.
Copying (in whole or in part), use for any other purpose, or use by any other This early type of ultrasound was known as
person is prohibited without the prior, express permission of the author. A-mode ultrasound.
6.2
A-mode ultrasound
Although A-mode ultrasound is rarely used today, its A-mode ultrasound
principles of operation are the basis of diagnostic
ultrasound, and therefore should be understood.
The pulse strikes an interface in
transducer the patient and returns an echo.
C.R.O. screen
structure in
the patient Because the echo has not
yet reached the transducer
to be detected, no signal is
This signal is registered registered on the C.R.O. as
on the C.R.O. screen as a the trace continues to move
A pulse of sound is emitted deviation in the trace line. across the screen.
from the transducer.
A-mode ultrasound A-mode ultrasound

At this point, the echo from the first interface The second echo moves
reaches the transducer and generates a towards the transducer
small piezoelectric signal. Note that the (but is not yet detected by
pulse has crossed a second interface. the transducer).
The signal from the

transducer is shown on the The pulse continues deeper into
C.R.O. screen as a small the patient.
voltage ‘spike’.

A-mode ultrasound
A-mode ultrasound
The second echo reaches the transducer and the
signal generated is shown on the C.R.O. screen. This is what a trace would look like on an oscilloscope.
The two echoes have been
demonstrated on the C.R.O. screen.
The time between these signals can

be measured (because the speed of Signal strength
the trace is known) and therefore the The trace shows the strength of the
distance between the interfaces in signal on the y-axis and time on the
the patient can be calculated. x-axis (from which the depth of
vt time
(d = 2 ) echoes can be calculated).
• A-mode ultrasound is not able to produce images B-Mode ultrasound

of anatomy.
transducer
• It is still used in ophthalmology because the viewing monitor
A-mode signals can be detected with extreme
accuracy thus enabling very accurate distance interface 1
measurements of critical aspects of the eye.
The measurements are carried out
interface 2
automatically by the machine.
pulse/echo
beam path
The next development was B -mode ultrasound.
Small dots of light resulting from the voltages
Instead of the voltage signal being displayed as generated by the echoes striking the transducer.
an amplitude on the CRT, it was displayed as a
dot of light on the screen.
B-Mode ultrasound B-Mode ultrasound
With B-mode ultrasound, the direction of the path of the As the beam path is altered at the transducer, the image
beam is known. This directional information is passed to the memory trace path is altered so that successive sets of
image memory and the echoes are displayed along this echoes can be displayed in their correct relative positions.
known path.
The brightness of each dot is relative to the strength of the If the echoes from each beam path are retained on the
echo. screen, an image is built up by the multiple beam paths.

B-Mode ultrasound B-Mode ultrasound
With an actual ultrasound image, hundreds of beam

paths are created for each image such that the individual Each echo is placed on the screen in an X-Y co-ordinate
lines are not discernable. Also, many levels of brightness position determined by the received directional and depth
(shades of grey) are presented by the different echo information.
strengths.
Line density Line density

A term used to describe how close together the The term ‘line density’ does
beam lines are. not mean the number of lines
in the image. The center and
right hand diagrams have the
same line density, but
different number of scan lines.
Increased line density increased lateral resolution. With a sector or convex

(However keep in mind that lateral resolution transducer, the line density
cannot be increased beyond the limitations varies with depth. Even with a
imposed by beam width. large number of lines, the line
density can become quite poor in
Lateral resolution is discussed in module 6. the far field.
Spatial compound imaging Spatial compound imaging

Most B-mode images are constructed from a single Spatial compound imaging uses electronic steering
set of beam paths. This can produce problems with to create consecutive frames using beams with
imaging some interfaces accurately – particularly varying angles.
axial interfaces (interfaces lying along the beam
path axis).
+ +
frame 1 frame 2 frame 3
The frames are then added together in the image

memory.


In this example, only three beam paths are shown One disadvantage with spatial compound imaging is
from each point of origin. However up to nine beam that it may reduce shadowing and enhancement
paths can be selected on some machines. because the multiple beam paths tend to ‘write in’
the area behind structures.
(Shadowing and
enhancement are
discussed in module 10) simple
If subtle shadowing
or enhancement is
Because it takes significantly longer to produce a suspected or being
single frame, more complex electronics are required searched for, compound
to maintain an adequate frame rate (e.g. multiple compound imaging

beamfomers which can receive several returning should be turned off.
sets of echoes simultaneously).

Another disadvantage is that frame rate can
suffer because of the increased number of Some alternate trade names:
lines required to form the image. It should SonoCT, Compounding, Compound imaging.
not be used when high temporal resolution
is required (such as looking a fetal hearts). Spatial compound imaging was a common
technique employed with the old static contact B-
Advantages: mode scanners with articulated arms, (in the 1970’s
• Improved signal to noise ratio
and 1980’s) but because of the limitations of
• Improved contrast resolution
technology it was not continued when real-time was
• Improved visualisation of interfaces in
the axial plane
introduced.
With the more powerful and cost effective computer

Another result of compound imaging
is that sometimes it can result in systems now available, real-time spatial compound
3 shadows from a biopsy
multiple linear artifacts caused by needle from three beam
scanning is becoming commonplace.
the several discrete beam paths. paths.
M-mode ultrasound M-mode ultrasound

Using the B-mode image as a reference, a single
M-mode ultrasound is used to demonstrate movement beam path is selected at the transducer, and sound
of organs or structures in a graphic format. pulses are sent along this one path only.
It uses many of the principles of B-mode

ultrasound, but does not build up an image with
multiple beam paths.
The echoes from this single beam path are displayed

on the monitor.


Any movement of the interfaces towards or away from
the transducer will cause the echoes on the monitor to
move to different positions vertically.
depth
time
On the monitor, the echoes from this beam path are
moved across the screen causing the echoes to trace Now when the echoes are moved across the screen, the
out a series of lines. moving echoes trace out wavy lines.
If there is no movement of the interfaces, these lines The display indicates depth on the y-axis, and time on
would be straight. the x-axis. Both these can be measured very accurately.

This is an actual image of an M-mode trace.
depth For example, on this
Uses of M-mode include:
image which is a
• Enables fetal heart movement to tracing of a heart
be recorded. (this shows a fetus valve cusp, ‘d’ would
is alive even without a video
d
be the distance the
recording of the heart valve cusp moves
movement). when it opens, and ‘t’
time would measure the
• Allows accurate measurements
time it takes the cusp
of heart valve opening times and
to open.
valve cusp displacement in
echocardiography. t
M-mode is used mostly in obstetric and It is also used to calculate heart rate by measuring the
cardio-vascular applications. time between heart beats.
Real-time imaging Real-time imaging

Question 30: NOTE: You will need a calculator for this question.
Real-time imaging is the production of rapid,
sequential frames of images. (a) How long does it take to produce a single scan line to a
depth of 10 cm in a patient?
The rate at which B-mode frames are (b) What is the maximum possible PRF?
produced is called the Frame Rate.
(c) How long will it take to produce a single frame of 200 lines in
- It is measured in frames per second (f.p.s.) or Hz. this patient?
High frame rates are important for imaging rapidly (d) What is the maximum possible frame rate?
moving structures. Frame rate can also be calculated directly using the formula:
770
Frame rate depends on: Frame rate = N x D Where: N = number of lines
D = depth of view (in metres)
- the number of scan lines in each frame
Another useful formula relates frame rate to PRF:
- the time required for each scan line PRF = frame rate x number of lines

Now you can do this problem using the frame rate formula: Frame rate is also affected by:
Multiple focal zones

Question 31:
Each additional focal zone will slow the frame rate.
Calculate the maximum frame rate achievable with a 3.5
MHz transducer that is set to image a depth of 12 cm Multiple beamformers + +
DELAYS DELAYS
into the patient, if there are 450 lines in each frame.

If the machine has multiple
beamformers, frame rate will be higher
because several beam paths will be
produced simultaneously.
High frame rates are important for
viewing rapidly moving structures. (Multiple beamformers were discussed in module 4).
Frame rate can be increased by: Frame rate can be increased by:
• Decreasing the number of scan lines.
• Decreasing the scanning depth. With fewer scan lines, less time is taken to produce the
entire frame.
With reduced depth, the ‘wait’ time between This can be accomplished by:
pulses does not have to be as long, therefore (a) Decreasing the width of the F.O.V. (field of view)
it takes less time to record each line.
(b) Decreasing the line density
(Revise pulse echo imaging and P.R.F. in module 3).
Real-time imaging
Frame rate can be increased by:
• Decreasing the number of scan lines. If the maximum depth of the image is increased:
With fewer scan lines, less time is taken to produce the • The image will extend over a greater depth.
entire frame. • The line density will remain the same.
This can be accomplished by: (However with a sector or convex transducer, the line
density in the far field decreases with increasing depth).
(c) Decreasing the number of focal • The P.R.F. will be reduced.
zones (if using multiple focal zones).
• The frame rate will be reduced.
(Each focal zone is equivalent to another scan line).
(d) Using the write zoom feature (described in module 9). More anatomy will
This reduces the scanning depth and the field of be seen, but the
view width. frame rate is
compromised.

Real-time imaging Real-time imaging

If the sector angle or field of view width is decreased: If the sector angle or field of view width is decreased:
Either Or
• The line density will remain the same • The line density will increase
– spatial image quality will remain the same – spatial image quality will increase
and and
• The frame rate will increase • The frame rate will remain the same
– the temporal resolution will improve which will be
Which of these two options will occur will depend on the
good for rapidly moving structures.
brand / model of the machine itself.
(The most common method used is to increase the frame rate).
Real-time imaging Multiple choice questions

Attempt these questions without referring to your notes.
If using High Resolution mode (if available)
• Line density will increase 1. If the field of view is expanded while maintaining the same
scanning depth, what must accompany this change so the
This will improve image quality (for stationary or frame rate is not degraded?
slow moving anatomy) (a) The pulse repetition frequency must increase
The machine will achieve this by: (b) The line density must decrease
(c) The number of pixels in the image matrix must decrease
either (d) The depth of focus must be decrease
– decreasing the width of the field of view (eg. sector angle) 2. If each frame is composed of 200 beam paths and the
(but keeping the same number of lines) scanning depth is 8 cm, what is the maximum frame rate in
frames per second?
or
(a) 10
– increasing the number of lines (b) 24
(however the frame rate will decrease) (c) 48
(d) 75

3. M-mode scanning is characterised by:
5. The temporal average intensity is equal to the product of the
(a) Presentation of multiple beam paths simultaneously
pulse average intensity and the:
(b) Two dimensional grey scale imaging
(c) Movement of a single structure along each beam path (a) Duty factor
(d) Depth of moving reflectors along a single beam path (b) Diameter of the transducer aperture
(c) Pulse repetition period
(d) Pulse duration
4. The binary number 01101 has the decimal value of:
(a) 11 6. Which science / engineering prefix equals 10-3
(b) 12
(c) 13 (a) Centi
(d) 15 (b) Micro
(e) 26 (c) Milli
(d) Mega

Physical Principles of Ultrasound Resolution

Brian Starkoff A term used to describe the degree of detail of
structures that can be seen on images.
Module 6
There are several different types of resolution in
Topics: • Resolution clinical ultrasound.
• spatial resolution • contrast resolution
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound • greyscale resolution • temporal resolution
person is prohibited without the prior, express permission of the author. • colour resolution
5.9
Spatial resolution Axial resolution

This is generally the most common concept of the term The closest distance two structures can be along the
‘resolution’ and will be described in detail. axis of the beam and which can still be seen as separate
entities.
However the other types are also important and will also
be mentioned later in this module.
Spatial resolution is the ability to differentiate small
structures on an image.
• beam characteristics
• line density (which affects lateral
Spatial resolution
resolution)
is affected by:
• storage device (scan converter)
• resolution of the viewing monitor These two These two These two
structures are structures are just structures are
There are 2 types: Axial and Lateral clearly resolved resolved not resolved
As the pulse touches The pulse continues to

pulse
In this first example, the interface, an echo pass through the interface
d the separation of the begins to be returned and an echo will continue
interfaces is the same to the transducer. to be reflected.
as the spatial pulse
length (d).
interface 1 echo
d
interface 2
For example, a 5 MHz pulse with 3 cycles would

be 0.924 mm long.

The pulse has now

passed through the first First echo returning The two echoes are
interface and is now to the transducer clearly separate,
coming into contact with and will be detected
the second interface. by the transducer as
separate signals.
These will be
displayed on the
screen as two
clearly separate
echoes.
Pulse continuing
Second echo to deeper tissues.
being reflected
The pulse has now completely The echoes from the two
In this second
passed through the first interfaces are now
example, the interfaces
interface and the echo from returning to the
are now separated by
this interface is traveling back transducer, however
one half the spatial
to the transducer. However the there is now no clear
pulse length start of the echo from the separation between
second interface is at the same them.
point as the end of the first
d echo.
d/2
At this point the pulse is just
making contact with the
second interface, but is only
½d half way through the first
interface.
When these two echoes arrive at Axial resolution

the transducer, only one (longer)
Axial resolution of the beam is directly related to the
echo will be detected. The
spatial pulse length. A.R. = ½ SPL
detection circuits will be unable
to recognise these as separate Remember: SPL = number of cycles x λ
echoes and will display them as
a single echo on the screen.
The spatial pulse length is affected by:

primarily:
In other words, the distance - frequency
these two structures are (higher frequency = shorter wavelength = shorter SPL
apart is the limit of the axial
resolution of the ultrasound - transducer design
beam. (better damping = fewer cycles = shorter SPL)

Axial resolution Axial resolution

display screen
also affected by: - output power and gain Can also be affected by:
- beamwidth
(only in the case of a
Increased power means that the effective pulse
beam passing through
length (and therefore the effective length of the
obliquely lying interfaces)
echo) will increase because the very low
amplitude ends of the pulse / echo will be larger (however this situation
and therefore detectable. can be thought of as
having both axial and
In a similar way, increased gain will cause the
detectable length of the echo to increase.
lateral considerations) { }
An echo will be returned
while any part of the
{ }
beam is passing through

wide beam narrow beam
the interface.
Narrow beams will give better resolution in this situation.

Axial resolution is also affected by:
- pixel resolution 256
An ultrasound image is made A 5 MHz transducer with 3

up of a finite number of small cycles in a pulse would be
capable of 0.46 mm axial
256
squares (pixels). The number 20cm
depends on the scan resolution.
converter’s memory size.
However in the case of a 256
square matrix with the depth of
field set at 20cm, each pixel
(Scan converters will be discussed would represent 0.78mm.
in more detail in module 8).
In this case, the number of available pixels restricts
the axial resolution to 0.78mm.

Axial resolution is also affected by:
256 - use of the write zoom feature
512
256
20cm
512
The greater the number of pixels, the better the Using write zoom to expand a smaller area of
potential resolution (although it can never be better anatomy over the full storage matrix.
than the spatial pulse length restriction).
(Write zoom will be discussed in module 9).


Axial resolution is also affected by: Axial resolution is also affected by:
depth of the field of view - television monitor resolution
0 0
Generally, the monitor resolution is greater than the
2
other aspects of the resolution chain, however a low
quality or poorly serviced monitor has the potential to
5 limit the overall image resolution.
4
It is unaffected by distance from the transducer
(except in the special case of the beam passing
6
through obliquely lying interfaces where beam width
10 7
cm cm is a contributing factor).
In a similar way to the use of the write zoom It is optimised by:
feature, reducing the depth will use the whole scan - using highest frequency possible.
converter matrix for a smaller anatomical area. - using low power / gain settings.
- setting scanning depth to minimum required.
- Which will improve the potential resolution.
- using the write zoom function.
Lateral resolution Lateral resolution

0
This is the closest distance two structures can be at 90
across the axis of the beam at the same depth, and In the formation of an
which can still be seen as separate entities. image, the
ultrasound beam is
stepped across the
field of view.
As soon as an edge of
the beam intercepts a
reflector, it will
commence returning
an echo back to the
These two These two transducer.
structures are structures are not
clearly resolved resolved
The reflector (or The beam has now

interface) will continue intercepted the
to return an echo the second reflector and
entire time the beam begins returning an
intercepts it. echo from it.
The beam is now in The two reflectors

between the two have been displayed
points and is not on the screen as
returning any separate echoes.
echoes.
* Note that a point reflector will appear as a short line on
the screen (the length being equal to the beam width).

In this second example, the two reflectors are closer The beam is now just intercepting both reflectors.
together (same distance as the beamwidth). Again, an Therefore an echo will continue to be received by the
echo will be returned from each interface while being transducer during the beam’s passage across both
intercepted by some part of the beam. reflectors.

Lateral resolution is related
to, and is approximately
equal to the beam width. poor lateral
resolution
Beam focussing reduces
beam width, and therefore
good lateral
improves lateral resolution.
resolution
Increased frequency also
decreases beam width:
Because the beam has never stopped receiving echoes
from the reflectors, the two reflectors are presented on the
screen as one continuous echo, and there is no way of
Beamwidth at focus = 2.4 A
D
determining that there are two separate reflectors. These
interfaces are not resolved.

lateral resolution is also affected by: lateral resolution is also affected by:
- output power and gain - pixel resolution
Limit of Limit of detectable
detectable echoes now further from
In the same way as axial resolution, the number of
echoes centre of beam available pixels may be the restricting factor.
If the echoes are of 512 256
increased intensity
(because of either
higher initial power
beam width Increased beam width
output or by
256
512
increased gain), the 20cm

beam edges are -10dB -10dB
slightly further from I I

the centre. ( 101 max I) ( 101 max I)
Beam width Beam width 20cm 20cm
each pixel = 0.39mm each pixel = 0.78mm


lateral resolution is also affected by: lateral resolution is also affected by:
- use of the write zoom feature or decreasing depth - line density
As with axial resolution, using write zoom or
decreasing the image depth to expand a smaller area The closer together the beam paths are, the better
of anatomy over the full storage matrix improves the the potential resolution (however this cannot be
potential lateral resolution. improved beyond the beam width limitation).
0 0
5 or 4
better potential
lateral resolution
6
10 7
cm cm

lateral resolution is also affected by:
As previously mentioned,
-television monitor resolution
because of beam width, a point
As with axial resolution, a low quality or poorly serviced source echo will appear as a
monitor has the potential to limit the lateral resolution. line in the image.
Lateral resolution is always worse than axial resolution. (The length of the line equals
the width of the beam).
Question 31:
Question 33:
Write down at least five
factors that determine Calculate the best theoretical axial and lateral resolution
lateral resolution: in soft tissue of a 3.5 MHz transducer with a 2 cm
diameter active face which has 4 cycles in each pulse
Hint: and has an 8 cm focal depth.
You may need to revise the section on beam profile / beam (Note: You will require a calculator for this question).
width in module 4.
Contrast resolution Contrast resolution

Contrast resolution is the ability to differentiate Depends on:
tissues of different echogenicity. • The amount of background noise and
Sometimes a structure can be quite large, but because it is backscatter interference in the image.
almost identical in echogenicity and echotexture to the
Echoes returning to the transducer .
surrounding tissue, it is very difficult to differentiate it as
will interact with each other (by
..
separate.
wave interference) and with .
adjacent reflectors. This causes
..
complex low intensity interference
.
patterns resulting in an overall
..
‘haze’ over the image.
This is also known as ‘speckle’.
The ‘lesions’ in these three examples are quite large, how-
ever in the centre and right hand images the lesions might be The use of harmonics (described in module 13) reduces
overlooked because of the poor contrast differentiation. this speckle and therefore improves contrast resolution.

Contrast resolution Contrast Resolution

Depends on:
• Pre and post processing settings (e.g. dynamic range)
A reduced dynamic range will mean fewer signal
+ = intensities will fall into each grey level. This increases the
contrast of the image (= improved contrast resolution).
Speckle Image with little The lesions in the

(without an to no apparent liver are more
underlying speckle. poorly seen in this
image). image with a lot of
speckle.
Wide dynamic range Narrow dynamic range

Reduced
Speckle artifact will also be described in contrast Dynamic range and other pre and post processing
module 10. resolution. controls will be described in more detail in module 9.
Contrast Resolution Contrast Resolution

Depends on:
• Slice thickness Also depends on:
If a beam passes through tissue in front of, or behind, a lesion, • Inherent characteristics of the electronics of the
echoes will be returned from the surrounding tissue and
machine and transducer construction.
overwrite the lesion, thus reducing the contrast separation
between the two.
The thick slice detects echoes from
Contrast resolution can be improved by:
soft tissue in front of and/or behind
this cyst creating low level echoes • Appropriate power, gain and TGC settings.
within the cyst. • Reduced dynamic range
Focussing in the orthogonal plane has • Use of harmonics (described in module 13)
produced a thinner slice which does • Use of matrix transducers which improve
not create echoes in the same cyst.
focussing in the slice thickness plane
Thin slices improve contrast resolution
(Matrix transducers are explained in module 7).
(‘Slice thickness’ will be described in more detail in module 10)
Greyscale Resolution Temporal Resolution

This term is not used much but may be encountered in some
texts.
• Temporal resolution
It describes how well the echo signal levels are separated on
the image. The smaller the separation, the better the – ability to resolve rapidly moving structures
greyscale resolution. (this is dependent on the frame rate).
It depends on the number of available grey levels (which
depends on the scan converter’s image memory bit depth). High frame rates are required to provide increased
(Scan converters and image memory temporal resolution.
will be discussed in module 8).
0.63 dB 0.16 dB (Methods to increase frame rates were discussed
In this example where 40 dB of signal
levels are spread over the available
in module 5).
40dB
greyscale, the increased number of grey For example, when imaging a fetal heart, very good
levels has far fewer signals in each level temporal resolution is required, so the machine’s
which significantly improves their
settings are optimised for high frame rates (sometimes
separation. 64 256
= improved greyscale resolution. at the expense of other aspects of the image).
levels levels

Temporal Resolution Temporal Resolution

Spectral B-mode
M-mode
Doppler B-Mode temporal resolution can be improved by:
• Reducing the image depth and width of field of

view to the minimum necessary.
Because M-mode and spectral Doppler use only one beam • Switching out of high resolution mode.
path in the patient, their information is refreshed much
• Reduce number of focal zones.
faster than it takes B-mode to form a frame of several
hundred beam paths. • Turn off compound imaging.
Therefore the temporal resolution of M-mode and spectral • Use write zoom function (described in module 9).
Doppler is much better than B-mode. • Turn off frame averaging (described in module 9).
For example, an M-mode and Doppler beam path is
refreshed at approx. 500 to 1000 Hz (the Pulse Repetition
Frequency), however a B-mode frame is refreshed at
approximately 20 to 50 Hz (the frame rate).

Colour Resolution
• Colour resolution 1. Axial resolution in a real-time image is improved by:
– a term used to describe the ability of the
colour Doppler image to define moving (a) Increasing the transducer frequency
substances (usually blood) in both spatial (b) Having a thinner transducer piezoelectric element
(c) Shortening the pulse length
and temporal aspects. (d) All of the above
2. If the number of scan lines in a real time frame are doubled,

This is always much worse than B-mode resolution. then the ___________ is improved:
Colour Doppler will be dealt with in more detail in (a) Axial resolution
modules 11 and 12 when the principles of Doppler (b) Lateral resolution
are discussed. (c) Sensitivity
(d) Temporal resolution

3. Varying the excitation voltage to each transducer element in an
array transducer is called: 5. Autoclaving transducers is recommended:
(a) Subdicing (a) Whenever sterilisation is required

(b) Interelement isolation (b) To remove old coupling gel
(c) Apodisation (c) On a daily basis
(d) Integration (d) Never
4. Which operator control affects frame rate? 6. If the number of cycles in the transmitted pulse is increased:
(a) Receiver gain
(b) Transmit power (a) Axial resolution is degraded
(c) Scan depth (b) Lateral resolution is improved
(d) Time gain compensation (c) Spatial pulse length is reduced
(d) Rate of attenuation is increased

Physical Principles of Ultrasound Acoustic windows
Brian Starkoff A term referring to a structure or anatomical

configuration that allows deeper anatomy to be
visualised by ultrasound.
Module 7
Topics: • Acoustic windows
• Real-time transducers
• B-mode steering Suitable windows are used to
view the anatomy from as many
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound angles as possible.
5.8
Acoustic windows Acoustic windows

Examples: transverse Examples:
• Full urinary bladder • Liquid filled stomach - pancreas
–females: uterus & ovaries
males: prostate gland
Transducer is angled to utilise the acoustic window to

view as much of the underlying anatomy as possible. Tail of pancreas
bladder bladder
uterus uterus
Water in the stomach displaces the stomach gas
and adjacent bowel to allow visualisation of the
ovaries ovaries
pancreatic tail.
Acoustic windows Liver Acoustic windows

Examples: Examples:
• Liver and spleen • Anatomical configurations: intercostal spaces,
- to view the kidneys
and adrenals
sternal notch
Here, a space between
Rt kidney
the ribs allows the beam
access to the heart.
ribs
heart heart
• Aqueous and
vitreous humour
- eye structures
(e.g. retina)
• Amniotic fluid
– for the developing foetus

Acoustic windows Real-time transducers

Examples: Real-time transducers automatically perform the
• Anatomical configurations: repeated sweeping of the U/S beam across the
fontanelles of neonatal heads anatomy.
The bone free anterior fontenelle allows the sound to
pass down into the brain structures. Although there is a
very large number
of transducers
outline of
available for each
skull machine, real-time
transducers fall into
a very limited
number of basic
types.
Real-time transducers The following slides provide a description of the

There are four principle transducer types: different transducer types.
1. Sector 2. Linear
However please note:
The mechanism by
which the beam is Although not specifically mentioned here, it should be
steered or directed remembered that these transducers inherently still
to the different have the various components of a basic transducer
beam paths can be (described in module 3) such as a sealed case,
3. Convex 4. Radial damping material, electrodes, matching layer/s.
either:
- mechanical If you are asked to describe one of these

- electronic transducers, the basic components should be
mentioned as well.
Sector transducer Sector transducer

These transducers are also called electronic sectors
or phased arrays.
The transducer is composed of a The beam from an array transducer can
number of narrow rectangular be made to emit at an angle by altering
transducer elements (typically 128)1. the firing sequence of the elements.
Each element requires a separate

electronic circuit (or ‘channel’) for By altering the time delays, the beam
operation. may be directed at varying angles from
the transducer.
(Array transducers have - this is called electronic ‘steering’
previously been mentioned
in modules 3 and 4).
transducer transducer
face face

Electronic steering Electronic steering
When electronic
electrical pulses
steering is used,
If all the electrical the elements are
pulses are sent energised from one
to the transducer side of the group to
elements at the the other in In this case the right
same time, all sequence. hand element will be
the elements’ (Only very short energised first,
wavelets would delays are used – followed by the one to
emerge the time separation its left, and so on.
simultaneously being in the
and form into a nanosecond
beam as shown. range).
The wavelets will

emerge in
sequence.
However they
will be close
A sound beam will
enough to join up
always travel at 90o
to form a single
to its wavefront.
wavefront.
The wavefront will therefore be angled In this case the beam
from the transducer face, the specific will travel towards the
angle being dependent on the original left of the screen.
time delays of the electrical signals.
For each different

beam path, the
signal delays are
adjusted.
By further altering the time delays, the beam can

also be focussed. (Electronic focussing was
discussed in module 4).

Electronic steering Sector transducer

A disadvantage of
electronic steering Lateral resolution will
is that the effective be poorer towards the
aperture of the extremes of the field of
transducer becomes view with this type of
smaller. The further transducer because of
it is steered, the
more pronounced
the narrower effective
the effect becomes. aperture causing
increased beam width
A small aperture will result in a reduced near field and
increased divergence in the far field which is detrimental to the particularly beyond the
image. Beamwidth at the focal point will also increase. focal point.
(Near field, far field and beam focussing were discussed in module 4
Grating lobes are also more pronounced with
Also, when steered, the transducer is less sensitive when electronic steering.
receiving echoes because of the reduced effective aperture.

Focussing in the orthogonal plane
(across the scan plane) usually is
still performed by a fixed acoustic
lens in most transducers. This is
because without multiple segments
in this plane, electronic focussing is Some modern transducers
not possible. electronically focus in this third
plane by having multiple elements
This focussing is usually “weak” across the transducer face.
focussing. It produces a moderately
thick slice thickness.
These transducers are sometimes
known as non matrix (or
‘1 dimensional’ (1-D)) phased arrays.

These transducers are commonly Advantages of electronic sectors:
called matrix transducers. They may Very small probe footprint
also be called 1½D or 2D transducers. - manoeuvrable
They are much more expensive to - small acoustic windows can be used.
manufacture and require more complex Capable of high frame rates.
electronics to send the pulses and The diverging beam paths provide a very
receive the echoes. good far F.O.V. (field of view).
However they can produce very thin
slice thicknesses.
(A 2D transducer has a much larger

These transducers are ideal for cardiac
number of elements in the slice applications.
thickness plane than a 1½ D
transducer
transducer).
face

Disadvantages: With sector transducers, the very narrow near field

x The electronic steering makes them much of view is a significant disadvantage if superficial
more susceptible to grating lobe artifacts. structures are of interest (such as with small parts
x Orthogonal plane focus is fixed. scanning and breast ultrasound).
requires a lens in this plane
(unless it is a matrix transducer)
x Lateral resolution degrades towards the
edges of the field of view.
x They have a poor near F.O.V.
x Reduced line density in the far field.
- Interpolation can help if line density
becomes too poor. (discussed later)
transducer
face
Sector transducer Linear Array

To help overcome this poor near field of view, a ‘standoff’
A linear array transducer has a wider face (larger
can be used.
‘footprint’) and produces a rectangular field of view.
This is a sound transmitting pad or standoff

device fitted between the
transducer and the skin. It allows
the sector F.O.V. to widen before
reaching the skin surface.
Although the standoff helps, sector transducers, in general,

are not the preferred type for superficial structures.
Linear Array Linear Array

electrical
connections
PZT
0.1 – 0.3 mm 5 – 10 mm elements
0.1 – 0.3 mm 5 – 10 mm
PZT
elements • Each element is individually wired and is
electrically and acoustically insulated from its
adjacent elements (as with all array transducers).
• The transducer is composed of a large number (64
to 256) of small piezoelectric elements arranged
beside each other in a linear format.
• Each element may measure 0.1 to 0.3 mm wide by
5 - 10 mm long

Groups of elements are fired for each beam path

to improve focussing capabilities and beam profile. When a group of elements is pulsed,
the transducer aperture is much larger
which produces a much better beam
profile.
If a single element only was pulsed, the near In this example, only 5 elements are
field would be very short and the angle of shown producing each beam for clarity,
divergence in the far field would be large. This however up to 128 elements could be
type of beam profile would not be practical. used for each pulse2.
You may like to revise the beam profile section of your
notes (in module 4).

To produce the multiple beam paths, groups of
elements are stepped with one element spacing
across the transducer face.
Also, because the elements are individually

energised, electronic focussing can be
employed. This can be used on transmit and
receive.
Variable aperture on transmit and dynamic

aperture on receive can also be used.
(Variable and dynamic aperture and electronic

focussing were discussed in module 4). Complete frame
Focussing in the orthogonal plane

It is possible to double the line density by (across the scan plane) is still
moving the group effectively one half performed by a fixed acoustic lens in
element spacing. This is accomplished most transducers. This is because
by adding one element to the next group without the multiple segments,
electronic focussing is not possible.
(increasing the group number by one)
thereby moving the centre of the group
This focussing is usually “weak” focussing. It
by half a crystal. For the next line the
produces moderately thick slice thickness.
trailing element is omitted.
These transducers are sometimes known as non
matrix (or ‘1 dimensional linear (1D)) arrays’.


These transducers are commonly called matrix
transducers. They may also be called 1½D or 2D
transducers. They are much more expensive to
manufacture and require more complex electronics to
As with the sector transducers send the pulses and receive the echoes.
already discussed, some modern
However they can produce very thin slice thicknesses.
transducers electronically focus in
this third plane by having multiple (A 2D transducer has a much larger number of
elements across the transducer elements in the slice thickness plane than a 1½ D
face. transducer).

Advantages: To overcome the disadvantage of the narrow far field of view,
Wide near field of view some machines are able to steer the beam paths laterally to
They do not use beam steering (which degrades the form a trapezoidal or ‘virtual convex’ shape field of view.
beam profile) Each beam path is electronically
steered to the appropriate degree.
Disadvantages:
(Problems with Other than the beam steering,
X Large probe “footprint” - small acoustic windows)
the same principles of operation
X Relatively narrow far field of view of a linear array are followed –
X Orthogonal plane (slice thickness) focussing is fixed (each active group is stepped
for the non matrix transducer type across the transducer face).
Linear array transducers are ideal for superficial and

musculo-skeletal applications. This feature can usually be switched on or off depending on
the clinical situation.
Convex array Convex array

• These transducers are similar in construction and
operation to a linear array, but the face is curved in an • Curved transducer face
arc thus increasing the far field of view (a disadvantage • Wide far F.O.V.
of linear arrays). • Relatively wide near F.O.V.
• Does not use electronic steering
which improves the beam profile
X The footprint is still too large for small

acoustic windows.
X Orthogonal plane focussing is fixed
(unless it is a matrix type).
These transducers are very good for general sonography.

Convex array Radial transducers

Some curved arrays have
been constructed with a very
small radius of curvature (a
tightly curved array). These
transducers are excellent for
small acoustic windows or
intra-cavity applications. Image from a radial transducer
However these transducers cannot use as large an aperture

(number of elements) to form each pulse and the beam Principle used in intravascular catheters.
diverges much more in the far field. Therefore they are
designed to be used for relatively shallow depths of
Beam source is made to rotate through 360O
penetration. The image degrades (especially lateral resolution)
at deeper depths. emitting radial beams.
Radial transducers Radial transducers

Two types - 1. Mechanical rotating element Two types - 2. Phased array
rotating mirror
fixed transducer Multiple transducer elements (eg 64) are

element mounted in a radial pattern around the
(a) transducer element is rotated. transducer.
(b) element is fixed and beam is reflected off a
rotating mirror. This design allows for a free internal
Rotation is usually by externally driven shaft, lumen for a guide wire, etc.
but may be by a tiny internal motor.
Specialised transducers Specialised transducers

The following real-time transducers have been developed.
Intracavity transducers: Intraoperative transducers:
- transvaginal, transrectal, transoesophageal
These high frequency transducers have a very
compact scan head for use during surgery.
These transducers are either sector or tightly curved arrays.

Because of their internal approach:
- they avoid beam artifacts from the abdominal or chest wall.
- higher frequencies can be used to provide better resolution.
However their very divergent beam paths limit them to
fairly shallow depths of view.

Forms of B-mode steering Forms of B-mode steering

With B-mode ultrasound, there are several types of 2. Sector steering
‘steering’ that may be encountered with machines. With this steering (in a sector or convex transducer), if
the entire F.O.V. is not used (e.g. if it has been
1. Beam Steering
narrowed to improve frame rate or line density), the
narrower sector segment may be steered across the
This steering forms the field
available sector area.
of view, and has already
been covered in detail. This enables the reduced sector F.O.V. to be adjusted
without moving the probe (e.g. with a trans-vaginal
examination).
Forms of B-mode steering

References:
3. Linear array steering
The entire F.O.V. with a linear array can be 1. Martin, K. Thrush, A: Diagnostic Ultrasound: Physics
angled (by electronically steering all beams by and Equipment. Cambridge University Press, New
York, 2010.
the same amount.
2. Gill, R: The Physics and Technology of Diagnostic Ultrasound:
A Practitioner’s Guide. High Frequency Publishing, Sydney,
Australia 2012
This useful feature allows the beams to be directed at

90o to an angled specular reflector for better
visualisation (e.g. a biopsy needle).

Signal pathways and display

After the echoes are received at the transducer, they
Brian Starkoff must be:
- processed
- stored
Module 8 - displayed
Topics: • Signal pathways There are two categories of processing:

• Analog-digital conversion - pre-processing
• Scan converters and image memory (this occurs prior to final storage)
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound - post-processing
are licensed to use this program and files for personal study purposes only. (occurs after storage)
6.1
This is a basic block circuit diagram of a diagnostic Start with the transducer that you hold in your hand, and
ultrasound unit. Although it appears complex, the following the image that you see with your eyes.
slides will take you through each main component.
scan
demodulation converter
image
memory display
amp. pulse
generator
display transducer A pulse generator initiates the signal that is sent
amp. pulse to the transducer to excite the PZT element.
generator The pulse generator is simply an electronic circuit that produces
recorder
beam small electrical voltages at regular intervals. The rate that the
tracking pulses are produced (the PRF) will be determined by the depth
transducer of the field of view.
(Revise pulse-echo imaging principles in module 5)
The pulse generator also links with the The pulse sent by the pulse generator is quite
scan converter (the main image data small (too small to energise the PZT element),
storage device). The scan converter needs therefore it is amplified significantly before being
to know when the pulse is being sent so sent to the transducer. scan
that it can place each echo at the correct scan converter
converter (amplifiers are used throughout image
depth location in the image image the overall circuit) memory
memory. memory
display
display
amp. pulse
pulse
generator
generator
When the transducer receives

transducer the voltage pulse, the transducer
transducer element is energised and the
sound pulse is emitted.
Module 8 Page 62
Brian Starkoff
When an echo is received by the transducer, a small The signal then goes through a demodulation process
electrical signal is produced by the PZT element. (described in the next module’s notes) in which the signal
is changed into a single voltage spike which is then
Because the signal generated by the transducer is
passed to the scan converter image memory.
very weak, it is amplified (by a large amount).
scan
converter scan
image demodulation converter
memory image
amp. memory
amp.
display
display
amp. pulse
generator amp. pulse
generator
Note that at this stage the signal consists of
a small number of high frequency cycles.
(You may wish to revise basic transducer
transducer operation in module 3). transducer
A beam tracking circuit determines the beam path An output is available for the final image to be
direction along which the pulse is transmitted (and directed to the display and a recording device (e.g.
received). laser camera, video recorder, etc.).
scan scan
demodulation converter demodulation converter
image image
memory memory
amp. amp.
display display
amp. pulse amp. pulse
generator This information is generator
recorder
beam passed to the scan beam
tracking converter so that the tracking
echoes are stored in
transducer the image memory in transducer
the correct position.
The main control inputs are indicated as follows: Overall gain is an adjustment of the receive amplifier.
Power is an adjustment of the transmit amplifier. It It controls how much the echo signal is amplified.
controls the signal voltage received by the transducer Note: it has no effect on the transmit pulse intensity.
element and therefore the pulse intensity.
scan scan
demodulation converter gain demodulation converter
image image
memory memory
amp. amp.
power power
display display
amp. pulse amp. pulse
generator generator
recorder recorder
beam beam
tracking tracking
Increased power causes
transducer increased dose to the patient. transducer
Module 8 Page 63
Brian Starkoff
Relationship between Power and Gain Time gain Compensation adjustment is made in the
receive amplifiers. It has an input from the pulse
Both power and gain will affect the amplitude of the generator because the automatic increasing of the gain
signal of the echo stored in the image memory (and must be started at the time of pulse transmission.
therefore how bright the echo is shown on the image.
Power will alter pulse intensity and echo intensity. gain demodulation scan
converter
Increased power will increase penetration to deeper
tissues but it will increase the dose to the patient. amp. TGC
Gain will affect the signal of the echo only. Increased power
gain will not affect the dose to the patient. display
amp. pulse
If power is reduced, the pulses are less intense which generator
results in less intense echoes. This can be compensated recorder
beam
for by increasing overall gain but the signal to noise ratio tracking
is reduced (causing more noise on the image). This can (Revise TGC principles in
module 2).
lead to reduced image quality. transducer
Pre-processing of the signals Post-processing is Analog - Digital conversion

is performed prior to final performed after storage.
storage in the image memory. With digital systems the continuously varying
pre post
process
voltages generated by the PZT element in the
process
transducer (analog values) must be converted into
numbers (digital values) that the digital circuits in a
gain demodulation scan
converter
computer can process.
amp. TGC Special circuits

power (A-D converters) 11
display accomplish this.

pulse 10 analog signal
amp.
generator
recorder
beam 01
tracking peak digital value = ’10’
(Pre and post processing
are described in Module 9). 00
transducer
Analog - Digital conversion Analog - Digital conversion

A-D conversion converts the continuously variable analog
However a 3 bit system would produce different digital
signal voltages into discrete steps necessary for input into
values (‘100’ and ‘101’) and the shape of the waveform is
a computer.
improved.
In this example, the 2 bit system would produce the same
digital value (‘10’) for both the left and right signals. Also, 2 bits 3 bits
the waveform shape would not be representative of the
analog wave. 111
11 110
11
101
10 100
10
011
01 010
01
001
00 000
00
Module 8 Page 64
Brian Starkoff
Analog - Digital conversion Analog - Digital conversion

A 4 bit system would produce an even better
This example shows how a greyscale with more (digital)
conversion accuracy. steps more closely approaches the continuous (analog)
The greater number of digital bits in each conversion, greyscale.
(more individual values available), the more accurate
is the conversion. 4 bits
1111
1110
1101
1100
1011
1010
1001
1000
0111
0110
64 bit converters 0101
are now common.

0100
0011
continuous 6 values 22 values
0010 (analog)
0001
0000
Analog - Digital conversion Scan converter

The scan converter is an integral part of all modern
Although A-D conversion can occur anywhere ultrasound machines. Its invention revolutionised
prior to storage, modern machines undertake this diagnostic ultrasound.
step very early in the circuit, sometimes
The scan converter incorporates the image memory in the
immediately after receiving the signal from the
ultrasound machine which has now evolved into a large and
transducer elements.
very important component of an ultrasound system.
NOTE: If an analog monitor is used for display, • The scan converter changes the co-ordinate system image
(i.e. using X-Y co-ordinates) into a television type signal.
digital to analog conversion (which converts
digital signals back to analog signals) must take • It does this by storing the image data in the image memory
place before the video signal is passed to the in the X-Y format of acquisition, and then reading or
monitor. scanning this image data in a raster format used by a
television system.
(Most modern machines now have digital monitors).
see next slides
Television display principles Television display principles

Television systems use a ‘raster’ There are two types of raster systems used in television
monitors: - interlaced (or non sequential)
format for producing the image
- non interlaced (or sequential)
on the screen. With this system, line line
1
the signal is written horizontally, 3
2
4
left to right, along sequential 5 6
lines. At the end of each line, the 7 8
9 10
trace or signal then starts at the
beginning of the next line. When the last line at the
With the interlaced system, alternate lines are written on the first
bottom of the screen is completed, the signal starts
screen pass, then the interposed lines are written on the next
over at the top again. pass. This means that it takes only ½ the time to write a frame
(= double the frame rate) resulting in less image flicker.
There are 625 lines in a PAL (European, Malaysian &
An interlaced system achieves 50 f.p.s. in the PAL system.
Australian) system and 525 in the NTSC (American) However image quality can potentially suffer because of alignment
system – therefore these two systems are not problems of the two images.
compatible with each other. Home television uses this method.
Module 8 Page 65
Brian Starkoff
Television display principles Image memory

With the non interlaced (sequential) system, the lines The image memory of a scan converter consists of a very
are written sequentially from top to bottom down the large bank of computer memory in which individual frames of
line images can be stored.
screen. 12
34 There is a large section of temporary storage (sometimes
56
78 called a ‘buffer’) where frames are held to undertake pre-
9 10 processing steps.
The final (processed) data are then sent to the final storage
This system produces frames with improved resolution, area ready to be sent to the display and recording device.
but ½ the frame rate of the interlaced system (25 f.p.s. in Image memory
the PAL system) which can result in more eye strain
Display and
because of increased image flicker. recording
Computer monitors and ultrasound monitors normally use
this system (because of the improved image quality). Temporary storage Final storage
Image memory Image memory

Each frame of an image memory consists of a very large
The digital echo signals (binary numbers) are stored in the
bank of computer memory cells. Each cell is assigned an
computer memory matrix at their appropriate X-Y co-ordinates.
X-Y location, and the entire image group can store the data
for a complete frame of an ultrasound image. The number of individual memory locations (= no. of pixels)
The number of cells (called pixels) determines determines the matrix resolution. (commonly 512 x 512 matrix).
the potential spatial resolution of the stored More pixels provide better ‘pixel resolution’.
image, with 512 x 512 being the most common.
A 256 x 256 matrix will have lower spatial

resolution because each pixel will
represent a larger block of anatomy.
Larger matrix sizes are possible (e.g. 1024 x 1024),
however resolution is then limited by beam geometry and
other factors. Therefore there is little practical gain for the
added expense for this size matrix.

For example, the centre pixel has a ‘1’ stored in it in the top
The range of values that may be stored at each location
layer.
depends on the bit depth of the memory.
1
This is a three dimensional representation of an image In the other layers, this pixel
matrix. has other values which may
be stored there. In this
1 0
example, the central pixel has
Each of these layers represents 0 the binary number 1010
1
one level of the matrix depth, 0 stored in it.
with each cell able to store a 1
maximum of two values (0 and 1) Question 34:

What decimal value is stored 0
Because it is necessary to store many values in each image in this pixel location?
pixel (= many shades of grey), then layers of cells are
banked together. The number of layers is the bit depth. (You may want to revise binary numbers in module 1).
Module 8 Page 66
Brian Starkoff

read
The number of different values that can be
stored in each location equals the number of
different shades of grey that can potentially be
produced on the final image.
Question 35:
What is the maximum number of
1
pixel values (shades of grey) that: 0
1
0
(a) a 4 bit system can store?
(b) an 8 bit system can store? 1
to TV system
0
1
0 • After storage, the memory contents are
output in sequential fashion to a TV system.
This is the scan conversion process.
Image memory Multiple choice questions

Digital image storage systems have a number of Attempt these questions without referring to your notes.
advantages: 1. The advantage of a 512 x 512 image matrix compared with a
– Many images can be stored 256 x 256 matrix is:
(by simply increasing the amount of memory). (a) The number of shades of grey is increased
– The stored data may be manipulated (b) Greater spatial resolution is possible
(c) Contrast sensitivity is increased
(post processing).
(d) Higher frame rates are possible
– While one image is being stored, a previously
stored image can be read at the same time which
2. A binary digit is called a:
makes it suitable for real-time ultrasound.
(a) Bit
By storing a large number of final images, the sonographer (b) Byte
can view any of the stored (previous) images after freezing (c) Word
the scan. (d) Pixel
- This is called a ‘cineloop’ function.
3. Dynamic receive focussing uses: 5. The ability of an ultrasound machine to demonstrate rapidly
(a) Mechanical means to focus the beam moving anatomy is associated with:
(b) Time delays to excite the transducer elements (a) Pulse duration
(c) Delay lines after the echoes are detected in the transducer (b) Transducer frequency
elements (c) Output power
(d) Variable number of elements to form the pulsed beam (d) Frame rate
4. Television frames are displayed at a rate of frames 6. Which control allows variable amplification of echo signals
based on reflector depth?
per second in a PAL non-interlaced monitor:
(a) 25 (a) Overall gain
(b) 50 (b) Scanning depth
(c) 100 (c) Time Gain Compensation
(d) 625 (d) Dynamic range
Module 8 Page 67
Brian Starkoff
Pre processing
Physical Principles of Ultrasound There are a number of steps that the signal from the
Brian Starkoff transducer must go through before it is able to be
passed on to the scan converter memory:
Module 9 • Amplification • Edge enhancement
– overall gain and TGC • Frame averaging
Topics: • Signal processing • Compression • Smoothing
- pre processing • Demodulation • Reject
- post processing • Analog-digital conversion • Write zoom
• Measurements • Interpolation
• Quality Control
Once these pre processing steps have been carried out
are licensed to use this program and files for personal study purposes only. and the image data have been stored in the image
Copying (in whole or in part), use for any other purpose, or use by any other memory, the processing cannot be undone. The patient
6.4
would need to be rescanned to make any changes.
Amplification Amplification
There are a number of separate
amplifiers which act on the signal. Note: Thanks to the improved electronics and
computing power, some machines have overall
The initial amplifiers are radio frequency amplifiers, i.e.
gain and TGC as post processing controls.
they act on the very high (MHz range) frequencies.
These include: - This means that these adjustments can be
scan
demodulation converter
image
made after the image has been frozen.
- Pre-amplification – TGC
memory
amp.
usually immediately at the
transducer connection or in pulse
display
amp.
the transducer itself. generator
recorder
beam
- T.G.C. transducer
tracking
- Overall gain
Signal compression Signal compression

(This step is often combined with an amplifier) Dynamic range Note: Revise decibels and the introduction
A very wide range of signal to dynamic range in module 2.
voltage values (e.g. 1 - 10,000) 255 255
This is the range of
which vary logarithmically, must signal amplitudes that
be compressed into a narrow the system will use for
linear range (e.g. 256) suitable grey scale assignment.
128 128
for storage and display. It is expressed in dB.
This logarithmic variation was In the example here,
mentioned in module 2 when the range is from 1 to
the decibel was discussed. 0 10,000 mV. 0
Compressed 1 10 100 1000 10000 Compressed 1 10 100 1000 10000
(stored) value Signal level (mV) (stored) value Signal level (mV)
Logarithmic
compression is The dynamic range control is a pre-processing control
used that enables the sonographer to alter this range.


Dynamic range Dynamic range assigned to assigned to
255 0 (black) 255 (white)
In this example, the With a narrow 255
dynamic range has dynamic range,

been reduced many signals will fall
(narrowed). It now beyond the grey
128
assigns signal levels scale assignment
128
from 10 mV to 1000 mV range, and not be
to the grey scale. considered.
0 The image appears

Compressed
Question 36: (stored) value
1 10 100 1000 10000 with higher 0
Signal level (mV) Compressed
contrast. (stored) value
1 10 100 1000 10000
What is the dynamic range in this example? Signal level (mV)

Dynamic range 255 Dynamic range
When the dynamic range is reduced (narrowed):
Here, the dynamic  Many low level signals are excluded (assigned
range is set at ‘0’. black on the screen).
(This setting is not 128  More high level signals are assigned white on the
possible on modern screen.
ultrasound  The displayed image appears with higher contrast.
machines).  Contrast resolution is increased.
Compressed
0 When the dynamic range is increased (widened):
1 10 100 1000 10000
(stored) value
Question 37: Signal level  More low level signals are visible on the screen.
 The displayed image appears with lower contrast.
What would an image look like if this setting was  Contrast resolution is reduced.
possible?
Demodulation
The signal then goes through a step (circuit) to
change each echo (which contains several cycles (a) Rectification: - the negative
at a high frequency) into a single voltage spike parts of the signal are
which is the type of signal suitable for storage. removed.
This step is called demodulation.
(b) Enveloping: - the high frequency components are
demodulation scan removed.
converter
image
memory
amp.
clock
display
pulse
The echo signal has now been
amp.
generator
recorder converted from several high
beam
tracking frequency cycles to a single
voltage ‘spike’.
transducer

Analog – digital conversion • Interpolation

This must be performed at some point between transducer Often, the u/s lines of sight do not cover all pixels in
and storage and has been described in Module 8. the memory matrix.
- this would cause a checkerboard pattern
The further pre-processing that will be considered in of blank pixels
this module are: (This is particularly
pre
process relevant to the far field of
• Interpolation demodulation scan
converter view sector transducers).
image
• Edge enhancement memory
• Frame averaging amp. The blank pixels are filled

• Smoothing in by the computer with
display
• Reject amp. pulse

average values based on
generator
• Write zoom recorder the values of the adjacent

beam
tracking pixels.
Note: this is an automatic function – it is not controllable.
• Edge enhancement
• Edge enhancement
The sequence of slides in the computer files demonstrates
Designed to emphasise the change in signal
how the process may take place.
levels across an interface.
Although you are not required to remember the level of
detail that is contained in the sequence, it is recommended
that you look at the slides to give you an idea of how the
original edge enhanced machine is able to manipulate the images.
The process uses a kernel (a mathematical You need only know that edge enhancement exaggerates
process) on each pixel value. the brightness change across boundaries and that the
It makes the edges of structures look ‘sharper’ on computer accomplishes this by applying a mathematical
formula to the pixels along each beam path in a frame.
the image.
Frame averaging
• Image updating
As each new frame is acquired, the values of frame
each pixel in the image memory are replaced by 1 With frame averaging,
new values: each pixel is looked at
BUFFER 80 in turn, but with this
process it is compared
either:
with the same pixel
as an absolute new value location from a
as an average of the new value and that previous frame (or
or frames).
of the same pixel in a previous frame (or
number of frames). Of course this means that the image memory storage must
be very large – multiple frames must be held in a temporary
- called frame averaging storage area (called a ‘buffer’).
(sometimes called persistence)
In the example here, a value 80 is stored in a particular pixel.

Frame averaging Frame averaging

frame frame frame
1 2 3
frame frame
1 2 BUFFER 80 88 81
In the following
frame, the same pixel
BUFFER 80 88 now is assigned a Here,the pixel value has been averaged
value of 88. (If this over three frames rather than two. 83
was presented FINAL IMAGE
directly to the screen, Frame averaging is designed to reduce speckle, however
84
the pixel might be the image may appear to ‘smear’ on the screen because
FINAL IMAGE very slightly brighter). some previous frame data are still being presented.
The computer has now averaged the two values of this
Note: Although it gives the appearance that the frame rate
pixel and calculated a final value of 84. This value is has dropped, the actual frame rate does not change.
the one that will get used for the final image. However there is a loss of temporal resolution.
• Smoothing
Each pixel value is averaged to some degree with the • Reject (also called ‘threshold’ or ‘suppression’)
surrounding pixel values (using a mathematical process
similar to that demonstrated in edge enhancement). – Signals below (or above) a certain level are
discarded.
50 40 30 20 10 50 40 30 20 10
40 50 40 30 20 40 47 40 30 20 Signal
Final
image level
30 40 50 40 30 30 40 50 40 30
20 30 40 50 40 20 30 40 50 40
Reject level Time / depth
10 20 30 40 50 10 20 30 40 50
The process produces a smoother image with less speckle

but the image loses some contrast resolution.
Time / depth
When you get the opportunity, adjust these • Write zoom

controls on the ultrasound machine and see 5.6 cm
2 cm
what difference each one makes to the image.
Assume we have a 14 x 14
square matrix, and this
Remember that these adjustments must be represents a 5.6 cm x 5.6
made in real-time (while you are scanning). cm field of view in the
patient.
• Write zoom (or pre-processing zoom)
In this case each pixel will
Also known as Hi-Res (HR) zoom. represent 4.0 mm sq. of
anatomy.
– An image magnification technique applied during PIXEL SIZE = 4.0 mm
acquisition.
With write zoom, a smaller field of view is selected (in this
case a 2 cm sq. area). The echo data are then placed in the
entire scan converter area.

• Write zoom 2 cm
2 cm • Write zoom - overview
– Image magnification technique applied during
acquisition.
– Only a specified area of the available image

is stored in the scan converter.
* The rest of the image data are discarded.
– After the image is frozen, the zoom cannot be

PIXEL SIZE = 4.0 mm PIXEL SIZE = 1.4 mm
undone. The patient must be re-scanned to
The entire matrix now represents 2 cm sq. of anatomy. make changes.
Each pixel, therefore, now represents 1.4 mm sq. of anatomy
which is a significant improvement in the potential spatial
resolution.
Post-processing
• Write zoom - overview This processing occurs after the data have been
– The entire storage matrix is used for a stored in memory.
reduced anatomical area.
* therefore pixel resolution improves. The stored data remain intact and can be re-
accessed at any time.
Note that spatial resolution cannot be improved
beyond that inherently available from the beam Common post processing functions are:
geometry and spatial pulse length. • Read zoom (or Post-processing zoom)
• Post processing curves (grey scale mapping)
– Frame rate will improve because of the
reduced depth and width of the field of view
(i.e. temporal resolution will improve).
Note: Thanks to the improved electronics and
computing power, some machines have overall
gain and TGC as post processing controls.
READ ZOOM or post processing zoom READ ZOOM

5.6 cm
Sometimes called ‘Magnification’ or ‘Mag.’ 2 cm As with write zoom, a
• An image magnification technique applied after smaller area of the image is
storage. selected for enlargement.
• A defined area only of the image storage
matrix is scanned and displayed.
5.6 cm
Again, let us take our

14 x 14 matrix with
some data from
several beam paths. PIXEL SIZE = 4.0 mm
With read zoom, the computer ‘scans’ or reads the data in
the selected area only, and outputs it directly to the display
PIXEL SIZE = 4.0 mm
system.

READ ZOOM WRITE ZOOM READ ZOOM

2 cm 2 cm 2 cm 2 cm
PIXEL SIZE = 4.0 mm PIXEL SIZE = 4.0 mm PIXEL SIZE = 1.4 mm PIXEL SIZE = 4.0 mm
Each pixel now appears larger on the screen, however
the (anatomical) resolution of each pixel is unchanged. The comparison between read and write zoom is shown.
Grey scale mapping

Read zoom - overview (Post processing curves)
• Image magnification technique applied after storage. • A specific value is stored in each pixel location in
• A defined area only of the image is output to the the scan converter image memory.
monitor and displayed.
• Each monitor pixel is assigned a brightness level,
• All image data remain in memory and can be recalled.
(greyscale), based on the value stored in memory.
• Pixel resolution does not alter.
0 70 90 70 0
The advantage of read zoom is that it is very user friendly –
90 150 0 150 25
you can freeze the image, then magnify and compose it,
and record it. You can also change it if it does not suit, or 90 30 0 70 0
even revert back to the original image.
0 150 70 150 10
Note: Some machines combine the two zooms. In real 10 10 200 10 0
time, a write zoom operates. When frozen, a
read zoom is available. Commonly, 256 separate grey levels are available.
Grey scale mapping Grey scale mapping

(Post processing curves) (Post processing curves)
The transfer from pixel value to brightness is done by a • A curved map may be used to spread the low level
transfer (or greyscale) curve. echoes over a greater range of grey levels.
white
In this case, the values white white
around 128 are assigned

brightness
brightness
mid level greys.

grey grey grey
Low numbers in the pixel

locations are assigned
black black
0 128 256
darker level greys. black
0 128 256 0 128 256
Pixel value Pixel value Pixel value
• A linear map is one in which the levels of grey are • This allows slightly different echo levels to be
spread equally over values. displayed separately in this low level range (at the
expense of the high level range).

Grey scale mapping Colour B-mode

(Post processing curves) Also known a B-colour
The B-mode image can be changed from varying shades
white white
of grey to varying shades of a selected colour. This
technique is based on the notion that the human eye is
brightness
more sensitive to subtle variations of brightness of certain

grey grey colours than that of grey shades.
black
black
0 128 256 0 128 256
Pixel value Pixel value
• A number of different curves are available on most
units.
With this feature, a selection of colours is available to
The sonographer must choose the curve that best
choose from.
suits the clinical situation.
Measurements
Measurement calculation
As with the pre-processing controls, when you • As each pixel represents a set spatial size,
get the opportunity, experiment with different distances can be accurately measured by
grey scale maps and B-colour settings on the counting the number of pixels between points
ultrasound machine and see what difference and multiplying them by the size each pixel
each setting makes to the image. represents.
Because these are a post-processing controls, • Area is obtained by

you can make the adjustments on a frozen counting the number of
image. If you don’t like the result of the new pixels in a specified area,
setting, simply select the original one again. and multiplying by the area
of one pixel.
Presets Quality control

In any medical imaging department programs should
When you select a preset on the machine, the
be in place to check equipment performance.
software will set numerous parameters, including the
pre and post processing settings, to suit an average Tests may be performed to:
patient for the examination selected. However these
settings can be changed if necessary to suit your 1. Compare different transducers.
specific examination.
2. Monitor same transducer or machine
performance over a period of time.
Consider setting aside some time to practice on the
machine or machines that you use. Check what 3. Compare different machine settings.
controls are available and what changes they make
to the image. To monitor ultrasound machine performance, test
objects and phantoms are used.

Quality control Quality control

Phantoms are tissue mimicking devices used to
A Test object is a fluid filled device with a series evaluate the performance of the unit under near clinical
situations.
of wires (metal or nylon) in a variety of spacings
There are a variety of phantoms available for
and orientations.
ultrasound tests.
(a) general type (e.g. RMI tissue phantom)
The device is scanned, and • This type has a gel filling with:
images are obtained from the – Attenuation properties similar to soft tissue.
internal wires. – Scattering (internal echo) properties similar to soft tissue.
– Speed of sound same as soft tissue (1540 m.s-1).
Note:
Velocity of sound in • It has wires similar to a test object.
the object must be the
• It also contains simulated ‘cysts’ and ‘lesions’ of various
same as soft tissue
(1540 m.s-1). sizes.
example: AIUM test object
• contrast resolution
(b) dedicated phantoms
• slice thickness
Quality control - Aspects to test. Quality control - Aspects to test.

• Registration
(correct placement of echoes) • Dead zone
Use deep row of horizontal wires. (unusable scanning depth because
Confirm interspacing and straightness of ‘main bang’ or ‘near field’ artifact)
of line.
use top row of wires
X
Test object or phantom Image
In this case poor registration is demonstrated. Test object or phantom Image
Observe that the point reflectors are imaged as short lines Check depth of shallowest wire clearly visible
(equal to the beam width) at 90o to the beam path.

• Axial resolution • Lateral resolution
Use unevenly spaced wires in Use unevenly spaced wires in horizontal
offset vertical alignment. alignment.
Determine which wires can just be Determine which wires can just be
separated and look up their separation on
separated and look up their separation on
the phantom literature.
the phantom literature.

Note that the wires are offset vertically to prevent the more
superficial wires from shadowing the deeper ones. Perform the test at different depths if the phantom allows it.


• Calliper calibration - axial • Calliper calibration - lateral
In the case of a horizontal test, use a row
Use a column of evenly spaced wires.
of evenly spaced wires and measure
centre to centre of the echoes (and use
Set callipers to measure distance from maximum number of wires for accuracy).
leading edges of top and bottom wires.
Using the maximum number of wires
minimises the error in placing the cursors.

To calculate the error:
the % error: = actual distance – measured distance X 100
actual distance
Test object or phantom Image a 2% error is acceptable
• Beam profile / beam width • Sensitivity

(ability to detect weak echoes)
Use column of evenly spaced wires.
Must use a tissue equivalent phantom.
The width of the echoes will give
• Requires a deep object
an estimate of the beam width at
(preferably a simulated lesion)
various depths.
to be just imaged with known
power/gain TGC settings.
• Compare this with another
transducer or the same
transducer at another time
with the same machine
Test object or phantom Image settings. Image

• Uniformity • Uniformity
(The even spread of echoes across the
field of view of a homogeneous material).
Must use a tissue equivalent phantom. Dead elements shown as loss
of individual scan lines.
After correct adjustment of TGC,
the image should appear with even
echogenicity and echotexture.
(Determination if it is really a
dead element problem or
Image
poor contact is discussed in
Module 10 under ‘equipment
Phantom Image related artifacts’).


• Contrast resolution • Slice thickness
Requires a specialised phantom.
Contains tissue mimicking material
with sets of ‘lesions’ of same size but Recall that the ultrasound beam is 3
varying degrees of echogenicity. dimensional – it has thickness as well as width.
The cone shapes in this model allow varying size targets to Structures anywhere
be scanned – depending on the exact scan plane. within the beam
Phantom volume will return
echoes.
Image
Echoes received from regions other than the two
dimensional scan plane will reduce the contrast
Resolution is determined by the resolution of the image. The slice thickness,
smallest difference in echogenicity therefore, should be as thin as possible.
visible.

• Slice thickness • Slice thickness
Requires a specialised test object
or phantom.
This is the superficial edge of the beam.
Contains a reflecting surface
angled across orthogonal plane.
Test
Test object
object
Image
Image
This is the deep
slice thickness plane edge of the beam. This is the type of image you
would see.
Note:
You may wish to revise your module 7 notes on how
transducers are focussed in this plane. Slice thickness is estimated by the thickness of the echo band.
Quality control - Aspects to test. Quality control

With quality control, also remember other
• Slice thickness equipment which will effect the final image.
e.g. • camera
• processing
If the image appears correct on the
Test monitor, but the printed copy shows too
object much contrast, is too bright or too dark,
a then the camera settings or processing
Image steps would most likely be at fault.
a
0 Looking at the grey scale bar is a good
way to assess this. monitor print
A dated copy of a test phantom image and the conditions

The actual thickness can be
under which it was obtained (such as machine settings,
calculated if the geometry is known. etc.) should be retained for time related comparison.


1. Dynamic range refers to: 3. The processing technique used to emphasise a change in
(a) Range of high and low signal levels that can be detected, signal level across an interface is called:
recorded and / or displayed (a) Edge enhancement
(b) Transducer frequency range that can be transmitted and (b) Selective enhancement
received by the scanner (c) Contrast enhancement
(c) Range of time between successive echoes required for (d) Frame averaging
signal processing
(d) Enveloping window in signal processing
4. Which control affects the frame rate
2. The signal processing technique to remove signals below a (a) Dynamic range
certain magnitude is: (b) Frame averaging
(a) Rectification (c) Scan depth
(b) Enveloping (d) Read zoom
(c) Integration
(d) Reject
5. The computer parameter that limits the number of brightness

levels available for display of the image matrix is the:
(a) Memory capacity in megabytes
(b) Clock speed
(c) Number of pixels
(d) Bit depth
6. The post processing technique of smoothing when applied to

image data:
(a) Enhances spatial resolution
(b) Enhances structural boundaries
(c) Reduces speckle
(d) None of the above

Physical Principles of Ultrasound Artifacts

Artifacts in B-mode imaging can be:
Brian Starkoff • Echoes which do not represent structures at that location.
• No echoes produced in a position where a structure exists.
Module 10 • Distortion of echo characteristics
This can lead to false or misleading information
Topics: • Imaging artifacts
sound interaction
May be related to technique
equipment
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound Artifacts may:
are licensed to use this program and files for personal study purposes only. • detract from the image
person is prohibited without the prior, express permission of the author. • provide useful information
6.5
Artifacts Artifacts
Assumptions of ultrasound:
• The pulse-echo beam travels in a straight line. Sound interaction related artifacts
-1
• The speed of ultrasound is constant at 1540 m.s . This is the most common group and will be
• The rate of attenuation through tissue is constant. described in detail in this module.
or: The strength of the echo is directly related to the
reflectivity of the reflector. • Enhancement • Refraction
• All echoes originate from the centre of the beam path. • Shadowing • Speed of sound
• Sound beams travel directly to a reflector and back to the • Anisotropy • Mirror
source. • Repeat echo • Speckle
• All echoes originate from the most recently transmitted • Side lobe • Range ambiguity
pulse.
• Beam width • Near field artifact
There are many instances in ultrasound where these
• Slice thickness
assumptions are incorrect – and this causes artifacts.
Artifacts - Enhancement
Enhancement is most commonly seen behind fluid filled
This is an area of increased echo brightness distal structures such as cysts or a full bladder.
to structures that attenuate the sound beam less It occurs because the beams of sound which pass
than the surrounding anatomy. through the fluid are not attenuated as much when
less sound they are actually in the fluid. (fluid has a lower
Increased
attenuation attenuation coefficient than average soft tissue).
brightness
less sound
attenuation
You might want to revise
Increased your notes on
brightness attenuation coefficients
in module 2 and note the
attenuation coefficient for
Area of enhancement water compared to soft
behind a cyst tissue.
Module 10 Page 79
Brian Starkoff
Enhancement can be very useful because it indicates
The pulses of sound emerging from the back of the properties about the type of material in the structure.
fluid (circled) are slightly more intense than those
- it suggests that the
passing through soft tissue only in the adjacent beam
material is fluid.
paths.
Enhancement is used as a
Therefore the echoes diagnostic criterion for cysts.
less sound
attenuation produced by these
Increased
pulses will also be Some solid lesions will also
brightness
slightly more intense produce enhancement if they
contain low attenuating tissue
which means that
(e.g. fat).
they will be brighter
on the screen.
X However useful information (such as a small lesion) may
be obliterated because of the overbright echoes deep to
the structure.
Artifacts - Shadowing Artifacts - Shadowing

Occurs when a proximal target is more attenuating
(absorbing or reflective) than the tissue beside it, This is an example of ‘hard’
causing reduced sound transmission behind the shadowing caused by a highly
structure. reflective structure (such as
Absorbing or reflective structure calcification).
Because the pulses behind
the structure are less
intense than those in the
the adjacent tissue, the This is an example of ‘soft’
echoes received from this shadowing from a structure with
area are also less intense increased absorption. In this case
and therefore are more it is a breast carcinoma.
hypoechoic (or even
Reduced brightness anechoic) on the image.
Artifacts - Shadowing Artifacts - Edge artifact (Edge shadowing)

• bone
Occurs quite severely behind: • calcification
• air / gas
X It is detrimental if wanting to image

anatomy behind such structures
(that lie in the shadow).
Caused by:
However it can be useful. Shadowing is used as a divergence of beam after
diagnostic criterion for calculi, or calcification. reflection from or refraction
through the outer edge of
The fact that the structure causes a shadow tells the a curved interface.
sonographer or doctor important information about its
nature. the beam loses intensity after divergence (because
of the increased beam area).
Module 10 Page 80
Brian Starkoff
Artifacts - Edge artifact (Edge shadowing) Artifacts - Anisotropy
A condition in which similar tissue displays varying echogenicity

because of different angles of insonation.
It occurs with specular reflectors (such as tendons) which lie at
varying angles to the axis of the beam.
any (weak) echoes

also undergo
divergence and
become even weaker. This area will have low
This part of the tissue will
the weak (or non existent) echoes are placed along echogenicity (or may not
have high echogenicity.
show at all.
the assumed beam path.
Artifacts - Repeat echo Artifacts Repeat echo - Reverberation

The following are repeat echo artifacts.
A pulse is sent into the patient. When it strikes an
interface (dotted arrow), an echo is reflected back to the
transducer. (the remaining sound continues into the
Reverberation Comet tail Ring-down
patient).
The echo will produce an image of the interface on the
Reverberation screen.
echo returning to the transducer
This is a major means by which false echoes are
created.
It occurs when a strong echo from a deep interface is

reflected back into the patient from a strong proximal
reflector (eg some skin interfaces or even the
transducer itself). display
Artifacts Repeat echo - Reverberation Artifacts Repeat echo - Reverberation
If the returning echo is strong, and it strikes another If this happens, then the reflected echo is like another
good reflector on the way back (in this example it is the pulse. When it strikes the interface again, it will send
transducer-skin interface) then a reasonable amount of another echo back to the transducer.
this echo will then reflect back down into the patient. Although this echo will be weaker than the first one, it
may still be quite detectable.
echo reflecting back down 2nd echo from the same interface
display display
Module 10 Page 81
Brian Starkoff
When the second echo is detected by the transducer, This process can sometimes repeat itself several
the electronics interpret this as an echo coming from a times before the strength of the echo falls to a level
deeper interface (because it arrived at a later time). This which cannot be detected.
echo therefore shows on the screen as a deeper
These echo paths are shown side by
interface (because it was detected at a later time). side for clarity. Keep in mind that they
2nd echo from the same interface are actually in the same beam path and
therefore one on top of the other.
display
display
• Reverberation can be ‘discrete’ The effect is most commonly seen in anechoic

(shows multiple discrete linear
(black) structures because any echoes are more
echoes) if caused by large
easily seen here.
specular reflectors - most
likely the anterior bladder wall
and skin surface in this case.
Also note the extreme enhancement X Reverberation is
behind the bladder detrimental to an
image.
• Or it can be ‘diffuse’ (shows a
more even pattern of echoes) if
caused by smaller interfaces.
To reduce superficial reverberation: To reduce superficial reverberation:

• Avoid 90o incidence on the • Reduce probe pressure which
reflecting surfaces by angling the will position the reverberations
probe and approaching from a more superficially.
different direction.
bladder bladder bladder
Module 10 Page 82
Brian Starkoff
To reduce superficial reverberation: To reduce superficial

reverberation:
• Use a standoff to move the
transducer face (which can • Use harmonic imaging.
(Harmonic imaging is described
sometimes be a major in module 13).
contributing factor) away from
the skin surface.
Adjusting TGC, gain and dynamic range will also

bladder bladder
reduce the reverberation on the image, but caution -
these techniques will also reduce the echoes of real
structures as well.
Artifacts Repeat echo – Comet tail Artifacts Repeat echo – Comet tail
Commonly occurs behind metal or crystals. It is caused

by the sound internally reflecting within the structure.
Comet tail artifact is a short range reverberation
With each reflection, a small amount of sound passes
artifact and follows the same principles of the
back to the transducer and is detected.
reverberation artifact that has just been described.
Because each echo is received a little later than the
previous one, it is placed on the screen a bit deeper.
Artifacts Repeat echo – Comet tail Artifacts Repeat echo – Ring-down

There is some difference of opinion in the literature on
The artifactual reflections often trail away in a comet the exact cause of this artifact, but it is agreed that it
tail appearance because each successive reflection occurs behind a group (or groups) of small gas bubbles.
is significantly weaker than the previous one.
This artifact can be useful because it suggests that
the structure causing it is metal or crystal.
It results in multiple strong echoes being displayed on the

image in a band deep to the gas bubbles. Because of the
These are images of cholesterol crystals in strength of the echoes, they are very echogenic and do not
Rokitansky-Aschoff sinuses in a gallbladder with fade away with time over the depth of the image (like a
adenomyomotosis. comet tail artifact).
Module 10 Page 83
Brian Starkoff
Artifacts Repeat echo – Ring-down Artifacts Repeat echo – Ring-down
Theory 1 Theory 2
When the sound pulse hits the
Under the influence of the
gas bubbles, it causes them to
sound pulses, a pocket of fluid
resonate1 (strongly vibrate at a
trapped between a group of
specific frequency). These
closely located bubbles
vibrations send compression
vibrates2,3, and in a similar
waves back to the transducer
manner to the bubble
which are interpreted as
resonance theory, the
repeated echoes.
vibrations send compression
This artifact is, therefore, waves back to the transducer
sometimes known as and are interpreted as echoes.
“Resonance”.
Artifacts Repeat echo – Ring-down Artifacts Repeat echo – Ring-down
Theory 3 It is possible that more than one of these

mechanisms, sometimes simultaneously, are
The bubbles reflect the sound
involved to produce the multiple strong echoes from
very strongly (as expected) and
the gas bubbles.
these reflections are
continually bounced internally
between the bubbles, with
some of the reflections
continually returning to the
transducer as strong echoes4.
Gas in a liver abscess has
caused this ring-down artifact.
This artifact can be useful because it indicates that
the structure causing it is gas.
Artifacts Artifacts - Beam width
The following three artifacts are related to the beam

profile.
Beam width Side Lobe Slice thickness
Keep in mind that when any part of the sound Any reflector within the beam can cause an echo to be
beam strikes an interface it can return a placed on the image along the beam path. So if the edge
detectable echo. of the beam intersects a strong reflector, an echo will be
returned – and, if strong enough to be detected, it will be
placed along the central axis of the beam.
Module 10 Page 84
Brian Starkoff
Artifacts - Side lobe Artifacts - Side lobe
As mentioned in module 4, the beam has off axis Any echo received by the
sound. However these side lobes are much transducer is placed
weaker (less intense) than the main beam and along the central axis of
usually do not create significant echoes. the beam (where it
assumed the echo came
However if one of from).
these weak off axis
beams strikes a
strong reflector, it Here, the posterior wall
could return an echo
of the bladder is
strong enough to be
reproduced in the
detected.
bladder lumen.
Artifacts - Slice thickness Artifacts - Slice thickness
It is important to remember that an ultrasound beam The result is that when the beam is through the
is three dimensional (i.e. it has thickness). structure (say a small cyst), there might also be
echoes of the soft tissue present on the image
Also remember that any structure within any part of
causing the cyst to contain echoes.
the beam can return a detectable echo.
As the beams move across
a structure building up a
frame, any part of a beam
outside the structure may
still return echoes which
can be detected.
The echoes could well come
from the adjacent soft tissue.
Artifacts - Slice thickness Artifacts - Slice thickness

This image demonstrates a slice thickness artifact
Another effect of slice thickness is that the lumen of caused by adjacent tissue either immediately in front
small tubular structures (such as small veins) lying in the or behind the bladder.
scan plane, may fill in with echoes if the slice thickness
is too large.
These internal echoes are There is another example (of a breast cyst) in the
caused by tissue beside the vein. computer file.
Module 10 Page 85
Brian Starkoff
Artifacts - Slice thickness Artifacts - Refraction

The beamwidth formula (Module 4) applies to the slice (Also called lens effect artifact or lens artifact).
thickness as well as the beam width therefore if the If, during the production of the scan lines for an
transducer element length (which is the aperture), image, the beam is refracted (see module 2), the
frequency and depth of focus are known, the slice thickness machine assumes that the echoes came from a
can be calculated. straight line and are placed in the wrong part of the
2.4 A image.
Beamwidth at focus = D This can happen when
D
scanning through
With most transducers, this focussing is A certain structures such
accomplished with an acoustic lens (and as the rectus abdominis
is therefore fixed). However with matrix muscles of the anterior
transducers (Module 7), the focussing is abdominal wall.
electronic and varies with the
conventional beam width focussing.
Artifacts - Refraction Artifacts - Refraction

Refraction can also cause an apparent break in a linear interface.
In this case the spherical structure being imaged is
placed incorrectly to the left (and/or the right) of its
correct position.
This has resulted in a phantom
duplicated gestational sac in this
patient.
In another example, a ‘duplicated’

aorta has resulted while scanning This can happen if a beam is refracted by a lesion or a
the pancreas. muscle/muscle interface. The machine assumes that the echoes
from this path have come from the original beam path direction.
If the transducer is moved laterally, The echoes from this (and other adjacent beam paths) are
the artifact would disappear. displace sideways and are placed slightly deeper because of the
longer refracted beam path.
Artifacts - Speed of sound Artifacts - Speed of sound
The assumption that the speed of sound is If the speed of sound through the lesion here is
constant at 1540 m.s-1 is sometimes incorrect. slower than 1540 m.s-1, the echoes from behind the
lesion will take longer to return.
The image of the
If the sound along the tissues behind the
beam path varies, lesion will therefore
distances will be be placed on the
miscalculated and the screen too deep.
echoes placed in the
wrong position.
Module 10 Page 86
Brian Starkoff
Artifacts - Mirror Artifacts - Mirror

Echoes can (and will) then return
A specular reflector acts as a
along the same beam path.
mirror.
Echoes would then be placed
along the incorrect path and
at a deeper point because of
When a sound beam the longer distance travelled
strikes such an interface, (= longer time before they
it can be reflected back at were received).
an angle as shown here.
Scan plane
Scan plane of mirrored lesion

Scan plane of actual lesion
If the reflector is curved (as in If the reflecting surface is
the diaphragm), the mirror angled in the orthogonal (slice
thickness) plane, it is possible
image can be distorted and
that the actual lesion might
lose its resemblance to the
not be visible in the same
real structure. plane as the mirror image.
orthogonal (90o)
plane
10

Ways to help determine if the echoes above
the diaphragm are real echoes:
• A mirror image cannot be in front of
the reflecting surface.
• The diaphragm will not be as echogenic
(much of the sound is passing through it
rather than reflecting from it.
• If actual anatomical structures (eg.

aorta or ribs) can be seen deep to
This artifact commonly causes
the echoes.
liver tissue to be displayed too
deep (above the diaphragm).
Module 10 Index
Module 10 Page 87
Brian Starkoff
Artifacts - Speckle Artifacts - Speckle

However it can obscure anatomical detail and leads to
As mentioned in module 2 and reduced contrast resolution.
module 6, during a pulse-echo
sequence, scattered echoes from .
multiple tiny reflectors within the
.
beam will interact with each other
to form complex interference . . + =
patterns of echoes returning to the .
. . Speckle Image with little The lesions in the
transducer. These patterns cause a
speckled appearance over the (without an to no apparent liver are more
underlying speckle. poorly seen in this
ultrasound image which contributes image). image with a lot of
to the ‘texture’ we see in an image. speckle.
Artifacts - Range ambiguity

Artifacts - Speckle
Methods to reduce speckle: • Occurs if a second pulse is emitted, but the machine is still
receiving echoes from the previous pulse.
Use of:
• Harmonics
• Compound imaging imaging
depth
• Frame averaging
• Smoothing
Speckle
echo from deep
pulse 1 next pulse object is displayed
deep object is also echo from deep on the screen (at
returning an echo object now reaches the wrong depth)
transducer
Artifacts - Range ambiguity Artifacts - Range ambiguity

• This can also happen if multiple focal zones are used:
(You may like to revise the principles of
The machine has assumed that the echo (from the deep multiple focal zones in Module 4)
object) has originated from the most recent pulse.
The first focal zone pulse is emitted.
The machine stops ‘listening’ for
echoes at the depth dictated by this
zone.
imaging
depth The transducer now transmits the
second focal zone pulse.
(The machine will be set to receive
echoes from the deeper depth).
If the beam is passing through a low
pulse 1 next pulse attenuating medium (such as a full
This could occur at higher PRF’s (due to a shallow depth of bladder), the first pulse will continue
field) and if there is a strong deep reflector. with little loss of intensity.
Module 10 Page 88
Brian Starkoff
Artifacts - Range ambiguity Artifacts - Range ambiguity

The echo from the first focal zone
pulse has now reached the
transducer.
Echo from the second pulse (which provides
the correct depth of the interface) has not
yet reached the transducer.
If there is a deep strong

reflector (such as a bone The second pulse has now
surface or a bladder wall), reached the deep interface The machine assumes that this echo (from the
the first pulse (which is still and returns an echo. first pulse) has come from the second pulse
quite intense) will strike it and places it at a shallow depth because of
and return an echo the shorter time delay to receive it.
Artifacts - Range ambiguity Artifacts - Near field artifact

near field clutter
Also known as
main bang artifact)
• Region of high intensity
When the echo from the second pulse echoes in the tissue
is received, the image of the interface
immediately under the
is placed at the correct level.
transducer.
• Caused by the high
amplitude vibrations of the
transducer transducer
element.
If the range ambiguity artifact has been
caused by this process, switching to a • Causes a region (called the ‘dead zone’) in which
single focal zone will remove it. structures may be very difficult to distinguish.
Artifacts - Technique related Artifacts - Equipment related

The settings used by a sonographer can cause a
misrepresentation of a structures echo pattern. Artifacts can also be caused by the equipment itself
• TGC such as:
If the TGC is set incorrectly • Electronic noise
as in this example, tissues (for example from
are represented with too a diathermy
much or too little machine in an
echogenicity.
adjacent room or
• Power and gain an electronically
Incorrect power or gain settings can introduce false echoes noisy CT scanner)
or exclude real echoes.
• Pre / post processing • Element dropout

Incorrect settings with these controls can misrepresent
echoes. (for example from a cracked transducer element).
Module 10 Page 89
Brian Starkoff
To determine if the shadow is due to a faulty Artifacts

transducer element, look at the surface echoes.
Question 38:
With element If it is a loss of
dropout, the shadow transducer contact
Name the assumption of ultrasound that is incorrect
will extend to the with the skin, there in each of the following artifacts:
transducer without a will be reverberation
bright surface echo. artifact or bright 1. Side lobe artifact
echoes at the
transducer surface. 2. Enhancement
3. Slice thickness artifact
4. Refraction artifact
5. Range ambiguity artifact

3. Enhancement, an artifact in b-mode imaging is:
1. Distance error along the direction of propagation is
(a) Caused by incorrect TGC adjustment
caused by ___________
(b) Caused by differences in attenuation along the beam path
(a) An incorrect setting for velocity in tissue (c) Enhanced by the use of compound imaging
(b) Acoustic noise (d) Seen behind highly reflective structures
(c) A cracked transducer element
(d) Too few beam paths in the image
4. In a quality control phantom, lateral resolution is tested by the
2. Ring-down artifact in real-time imaging ___________
set of:
(a) Is induced by refraction of overlying tissues (a) Vertically aligned evenly spaced wires
(b) Occurs for structures located in front of strongly a (b) Vertically aligned unevenly spaced wires
reflective interface (c) Horizontally aligned evenly spaced wires
(c) Is generated by resonance of air filled cavity (d) Horizontally aligned unevenly spaced wires
(d) Is caused by propagation speed errors

5. All the following quality control tests require a tissue mimicking References:
phantom EXCEPT:
(a) Sensitivity 1. Hedrick R, Hykes D. Starchman D: Ultrasound Physics and
(b) Contrast resolution Instrumentation 3rd ed. Mosby 1995
(c) Uniformity
2. Myra K. Feldman, Sanjeev Katyal, Margaret S Blackwood:
(d) Slice thickness July 2009 RadioGraphics, 29, 1179-1189
(e) None of the above – they all require a tissue
mimicking phantom 3. Tasneem Lalani MD
http://courses.washington.edu/radxphys/Lectures0809/L
6. Mirror image artifact in real-time imaging alani_US%20physics%20lecture%20042009.pdf
(a) Is induced by refraction of overlying tissues
(b) Occurs for structures located in front of strongly a reflective 4. Gill, R: The Physics and Technology of Diagnostic
interface Ultrasound: A Practitioner’s Guide. High Frequency
(c) Is generated by resonance of air filled cavity Publishing, Sydney, Australia 2012
(d) Is caused by propagation speed errors
Module 10 Page 90
Brian Starkoff
Doppler ultrasound
Physical Principles of Ultrasound Doppler effect
Brian Starkoff • The Doppler effect was first discovered
Module 11 by Christian Doppler in 1842.
• It is an apparent change in frequency of

Topics: Doppler ultrasound
a wave when there is relative motion
• Basic principles
between the source and the observer.
• Continuous wave
• Pulsed wave • Doppler discovered it when a train
• Spectral analysis passed him while the whistle was being
• Colour and power Doppler blown. He noticed the shift in the
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound frequency of the whistle as it passed him.
person is prohibited without the prior, express permission of the author. • This is the same effect as you would hear at
6.1
a car racing track as the cars zoom past.
Doppler ultrasound Doppler ultrasound

Doppler effect Doppler effect
The effect occurs because if the train is coming towards
you, the individual cycles of the sound are very slightly The effect also occurs with ultrasound.
closer together when they strike your (stationary) ears - If a transmitted beam strikes an interface moving
i.e. their wavelength is slightly shorter which means they towards it, the echo that returns from that interface
have a slightly higher frequency. will be a slightly higher frequency.
transmit
Of course, if you were on the train, there would be no
change in frequency because your ears would be
This will occur if receive
travelling at the same speed as the whistle.
the beam
• When the source is moving towards the observer, passes through
there is an apparent increase in frequency. (moving) blood.
• When the source is moving away from the observer,

there is a decrease in the frequency.

Doppler effect fT The Doppler equation can also be
transmit 2vf
expressed in terms of velocity: fD = c
fR
receive Where: fD = Doppler shift frequency
difference f D v = the velocity of the reflector
The Doppler shift frequency is the difference between c = velocity of U/S in the medium
the transmitted frequency and the frequency of the
f = frequency of the transducer
echoes received from the moving interfaces.
fD = fT - fR (The ‘2’ is necessary because there is a double Doppler shift
- the first when the pulse strikes the moving reflector and
The ultrasound system uses a process called ‘Fourier
the second because the echo comes from a moving
Analysis’ to calculate the Doppler frequency shift. source).
Question 39: In the clinical situation, this equation is much more useful
What is the Doppler shift if the transmitted frequency because it allows the velocity of the blood flow to be
is 5 MHz, and the received echoes are 5.01 MHz? considered.


Question 40:
However for this formula to hold true, the motion of
If a 2 MHz transducer scans a soft tissue interface that has the interface must be directly towards or away from
a velocity of 40 cm/s towards the transducer, what is the the transducer.
Doppler shift frequency?
Note: You will require a calculator for an accurate answer If this is not the case, the angle of the movement to
to this question. However the answer slides will show you the U/S beam must be taken into account.
how to approximate if this was a multiple choice question.
From the equation, it follows that:
0
If the Doppler shift frequency is known, then the velocity
and direction of the reflector can be calculated.
Question 41: The Doppler angle ( 0 ) is the angle that the
Find the velocity and direction of the blood flow if the ultrasound beam makes with the direction of flow.
received frequency of the echoes is 3000 Hz higher than the
transducer frequency of 5 MHz.

The Doppler equation then becomes: 2vf cos 0
f =
D c
For a given velocity of blood:
2 v f cos 0
f D = c 0 The maximum Doppler shift will occur when cos 0 = 1
(ie when 0 = 0o )
This is the formula we will normally use, because skin

in a clinical situation, it is usual to have the
ultrasound beam passing through a blood vessel 0
o
at an angle.
(You should remember this formula)
The other individual components of the equation
have already been described.
Doppler ultrasound Cos 0 Variation in Doppler

2vf cos 0 Doppler angle (degrees) Cos 0
f =
D c
For a given velocity of blood: 0 1.000
15 0.996
No Doppler shift will occur when cos 0 = 0 30 0.866
(ie when 0 = 90o) 45 0.707
skin
60 0.500
Therefore the Doppler 75 0.259
shift = 0 when the flow 90
0
90 0.000
is at 90o to the 0
Note that beyond 60 , Cos 0 approaches 0 very rapidly.
transducer.
Therefore in ultrasound the angle of the Doppler
This is logical because in this situation, blood is not beam to the flow direction should be kept to 60o or
travelling towards or away from the transducer. less for accurate measurements.

Cos 0 Variation in Doppler Doppler ultrasound

1
0.9 Question 42:
0.8
A 2 MHz transducer receives a 2.001 MHz echo from a
0.7
0.6
blood vessel which makes an angle of 60o with the U/S
0.5 beam.
cos 0 0.4 What is the velocity and direction of flow within this vessel?
0.3
0.2
0.1 Theoretically, no Doppler shift

0
occurs when the transducer is
0 15 30 45 60 75 90
Doppler angle in degrees (0) at 90o to the blood vessel.
The degree of error increases rapidly after 600
In reality, however, some Doppler shift is always present
At 400, a 50 error causes an 8% velocity calculation deviation. (and usually detected) in this situation.
At 700, a 50 error causes a 25% velocity calculation deviation.

The reason is that the beam originates from an area on
the face of the transducer (the aperture), not just from There are several types of Doppler used in clinical
the centre point. ultrasound:
This effectively creates
multiple Doppler beam paths • Continuous wave
for each reflector each at a
slightly different angle. • Pulsed wave • Spectral
• Colour
• Power
Therefore each blood cell is travelling slightly to and from
the different points of the transducer face. Each will now be described in more detail.
Continuous wave Doppler Continuous wave Doppler

• A continuous beam of ultrasound is sent into the
• A continuous beam of ultrasound is sent into the tissue and the echoes are continuously received.
tissue and the echoes are continuously received. In a simple machine
transmit
receive without B-mode
capability the beam is
directed manually by
manipulating the
transducer.
• Two transducer elements are required:
- one to transmit and one to receive.
In a simple machine without B-mode These are mounted side

capability the beam is directed manually by side in the same
by manipulating the transducer transducer head.

Continuous wave Doppler Continuous wave Doppler

Advantages
Because the transmit and receive beam paths
are very slightly different, Doppler signals will • Transducers and associated electronics are
only be received from the region where the two very simple and inexpensive.
beam paths overlap. • Does not suffer from aliasing.
(Aliasing is a Doppler artifact described in module 12).
receive Fortunately, this “sample Disadvantages

volume” is very large and
transmit • All flow along the beam path will be intercepted
does not cause any
and detected giving confusing signals when
problems in most
multiple vessels are crossed.
situations.
beam crossing
3 vessels
Pulsed Doppler Pulsed Doppler

To overcome the problem of detecting blood flow in all • When an echo is received, the electronics compares
vessels along the beam path, pulsed Doppler was the frequency of the echoes with that of the original
developed. transmitted pulse. If there is a difference, then it is
This technique allow detection of Doppler signals from determined the echoes originated from a moving
a specified depth. target, and this is registered as such.
Note: It takes many pulse-echo
• With pulsed Doppler, a
sequences to gather enough
single, relatively long pulse
information for the machine to
of sound is transmitted,
calculate the subtle frequency
and the same group of
differences (over 100 are used
transducer elements is
in pulsed Doppler for the
used to receive echoes (as
Doppler shift determination).
in B-mode U/S).

• By only listening for echoes for a limited time after • When a pulse is transmitted into the patient the
transmission (= limited depth), Doppler shifts from transducer would normally go immediately to ‘receive’
only a very narrow range of depths are received. mode and start listening for returning echoes.
However with pulsed Doppler, the transducer
effectively switches off and does not go into receiving
mode. It does not start to detect echoes yet.
In other words, the sonographer can
set the machine to detect echoes
from a specific depth.


• As the pulse moves down through the patient, it When the echo from the blood vessel reaches the
continuously returns echoes, but the transducer is transducer, the electronics have been set to turn the
not switched to receive mode and does not register transducer to ‘receive’ mode.
them. -- a ‘gate’ opens
(the sonographer has chosen to
receive echoes only from the depth
where the blood vessel is).
After a short period of time (adjustable -- a ‘gate’ closes

by the sonographer), the transducer is
again switched ‘off ’ and detects no
An echo is now being returned from the blood vessel.
further echoes during the pulse-echo sequence.
This process is known as “range gating” Pulsed Doppler
The sonographer can adjust the size of • When combined with a B-mode image,
the “gate” and its depth in the tissue. (as is normally the case) this range gate
can be set within the desired vessel.
Direction of Doppler beam and the
position of the sample volume.
Sample volume: Size and depth

open ‘gate’ set by the sonographer.
close
‘gate’
Doppler angle: Set by the sonographer to the direction of
The area interrogated is known flow so that the machine can calculate the velocity from the
as the “sample volume”. Doppler shift.
(It is a volume because it has a dimension in
the slice thickness direction as well).

Doppler pulses are of a much higher intensity and are
Ultrasound units which allow combined B-mode and longer (contain more cycles) than B-mode pulses.
Doppler are known as Duplex units. B-mode pulse e.g. 1½ to 3 cycles
Note that the angled Doppler beam
from a linear array is produced by Doppler pulse e.g. 4 to 6 cycles
electronically steering the beam (as
in a phased sector array) from a Doppler a) Because the echoes from the blood cells are very
group of the transducer’s elements. pulse weak, a much higher intensity is needed to provide
Imaging
pulse better signal to noise ratio.
A Doppler pulse is created by a smaller
b) More cycles allow the electronics to better detect the
number of transducer elements (which means
a smaller aperture) than a B-mode pulse. This subtle frequency changes in the echoes and also
creates a less focussed pulse which results in produce a narrower bandwidth which also helps
a larger sample volume thickness. detection of the subtle frequency changes.
(You may wish to revise ‘bandwidth’ in Module 3 )


• The Doppler signals can be interpreted audibly over • The brightness of the trace represents the strength
a loudspeaker, or presented as a graph known as a of the signal at the particular velocity.
spectral Doppler waveform.
• The x-axis shows time this depends on:
• the number of reflectors
• The y-axis (vertical) shows the frequency shift in the sample – i.e. the
(or velocity if the Doppler angle is known). number of blood cells).
• the power and gain

settings.
• the amount of
attenuation the beam
has suffered.
Pulsed Doppler Spectral analysis

Basic waveform analysis
The spectral analyser is the device in the ultrasound Usually flow towards the transducer is shown above the baseline
machine which separates the echoes into the various and flow away is shown below. However this can be reversed by
frequency components to produce the graph. It uses a the sonographer.
A line drawn over the
method called Fourier Analysis. systolic peak upper margin of the trace
produces what is termed
the ‘Spectral Envelope’.
The thickness of the

The process of obtaining trace vertically is
and interpreting this sometimes called the
waveform is known as ‘Spectral Bandwidth’ of
diastole baseline (0 velocity)
Spectral analysis. the trace. This shows
Area between the spectral trace and the range of frequencies
the baseline in which no signal appears (velocities) in the flow at
(i.e. no velocities have been detected) any instant.
is known as the ‘Spectral Window’.
Spectral analysis Spectral analysis

If the trace is thicker than normal, resulting in the spectral Some intrinsic spectral broadening will always be present in the
window filling in with signal, it is called spectral broadening. waveform even if all the blood was travelling with the same
velocity.
It indicates that there is a The effect is caused by the beam

simultaneous increased originating from an area on the face
range of blood cell velocities of the transducer (the aperture), not
in the sample volume (i.e. just from the centre point.
the blood is more turbulent).
This effectively creates multiple Doppler beam paths for

A common reason for this is each reflector each at a slightly different angle. Therefore
the disruption to flow through varying Doppler shifts will be detected within the sample
an arterial stenosis. volume.


This result is a slight spread of Spectral broadening will increase with a larger sample volume.
frequencies on the display which This is because blood flow near the vessel walls is slightly
causes an apparent increased slower than the flow in the mid vessel.
range of velocities.
Note that a smaller aperture will decrease the degree of intrinsic

spectral broadening that occurs.
The larger range gate will

include a wider variation in
blood cell velocities.
Intrinsic spectral broadening is an artifact of Doppler ultrasound.

Some typical waveform types Some typical waveform types
Arterial: Venous:
low resistance high resistance
pulsatile flow, continuous pulsatile flow which falls to continuous flow, although it may be
flow throughout systole zero or even reverses phasic (varies with respiration)
and diastole during diastole

Common measurements: Other measurements sometimes used:
• Peak Systolic Velocity • Diastolic systolic ratio
• End Diastolic Velocity = EDV
PSV
• Systolic diastolic ratio
= PSV
• Pulsatility index (PI)
EDV = PSV - EDV
• Resistive index (RI) Mean
(Mean = mean velocity
= PSV - EDV
PSV throughout one cycle)
The results of these ratio formulae also provide an indication of
the degree of resistance of blood flow in the receiving organ or
The results of the ratio formulae provide an indication of the area and are alternatives to the previously mentioned ratios.
degree of resistance of blood flow in the receiving organ / area.
The measurement packages in the machine usually perform the
calculations automatically from the measured PSV and the EDV.

Spectral analysis Colour Doppler

• Colour Doppler uses a similar system to spectral
Other measurements sometimes used:
Doppler. Pulses are sent out and a range gating system
• Acceleration time is used to sample echoes from set depths.
• The pulse lengths in colour Doppler are shorter than
V those in spectral Doppler (due to time constraints) but
still longer than those in B-mode imaging (to improve
frequency shift detection).
T B-mode pulse e.g. 1½ to 3 cycles
(the time taken for the

blood to go from end Doppler pulse e.g. 4 to 6 cycles
diastole to peak systole)
Colour pulse e.g. 2 to 4 cycles
Colour Doppler Colour Doppler

• Each beam path needs several pulse-echo
• Colour systems use multiple range gates along each
sequences to gather enough information to
beam path thus building up a large area of coverage.
determine the average Doppler shift. At least 4 and
• The average velocity in each range gate is assigned a up to 251 pulses per line are used.
colour, and this is overlaid on the B-mode image. • This is significantly fewer than spectral Doppler
Each of these boxes is a (which uses typically over 100 pulses) because it
small sample volume would take too long to build up a colour image
using that many pulses. The trade-off is that there
is not the same level of information in each of the
colour sample volumes.
• Each sample volume contains three
pieces of Doppler information:
(a) Mean (average) of the Doppler shifts
• Colour will only be overlaid where a Doppler shift (b) Range of shifts (variance)
(movement) is detected. (c) Average power of the Doppler shifts
Colour Doppler Colour Doppler

Colours are assigned depending on the direction of As well as calculating the average velocities within
flow and the average velocity in each sample volume. each sample volume, the system is also capable of
detecting the range of velocities within the samples.
• Flow towards the transducer is traditionally shown
as red, and flow away as blue (however the This is known as the Variance. It can be switched
sonographer can reverse this). on if required and is traditionally presented in
shades of green and yellow.
• The velocity of the blood is represented by the
hues within the colour – lighter hues indicating
higher velocities. The presence of increased
variance indicates significant
• A variety of colour ‘maps’ are available on most turbulence in the flow and is
machines which provide different colour often used in cardiac work to
demonstrate stenotic jets.
representations of the flow.

Power Doppler Power Doppler

• With Power Doppler, there is less emphasis on requiring a
• Power Doppler systems work in a similar way to
good Doppler angle (as long as any Doppler shift can be
colour Doppler systems with multiple range gates
detected then that is satisfactory).
along each beam path. However when a Doppler
• This system is much more sensitive to slow flow situations
shift is detected, the frequency information is where the actual frequency shift is low.
ignored and the strength (or power) of the Doppler
• The wall filter is set to very low (or completely off) so that
shift is determined. A colour is placed in the even the very low Doppler shifts are detected.
overlaid sample volume with the intensity of the
colour proportional to the signal strength.
Power Doppler can utilise the inherent, but low, Doppler

shifts when the beams are at 90o to the vessel.
Directional Power Doppler Tissue Doppler Imaging (TDI)

• Some machines can also determine if the received echoes Also known as Doppler Tissue Imaging (DTI)
are of a higher or lower frequency than the transmitted
pulses and therefore can assign a directional colour. • Doppler ultrasound will detect any moving interface including
solid tissue. It has been adapted to preferentially detect the
• There is no velocity information in the colour assignment. high amplitude low frequency Doppler shifts from tissue
As with simple Power Doppler, only the strength (or power) rather than the low amplitude high frequency shifts from blood
of the Doppler shift determines the hue of the colour. cells.
• Directional Power Doppler maintains the sensitivity to • This technique is used to assess
slow flow but gives the added information of direction of the velocity that specific tissue is
flow. moving at. It is used in both
spectral and colour Doppler.
• TDI is commonly used in cardiac

ultrasound for assessment of the
velocity of myocardial motion.
There is an example image of directional power Doppler
in the computer slides.
Colour and Power Doppler Colour and Power Doppler

The machine needs to perform a very large number of
pulse-echo sequences to build up a colour image (as well • Colour or Power Doppler is used as a guide to flow
as producing a real-time B-Mode image at the same patterns. It is not a quantitative technique (i.e. it
time). does not measure velocities). Spectral Doppler is
Therefore it takes a relatively long time to build up each still required to enable velocity measurements).
frame so the frame rate is usually quite low.
References
1. Satish K Bhargava: Textbook of Colour Doppler Imaging

Jaypee Brothers Medical Publishers, New Delhi, 2003
Steps that can be taken to improve frame rate when using

colour and power Doppler will be discussed in Module 12.

Doppler Controls
The following Doppler controls will be discussed
Brian Starkoff
• Gain
Module 12 • Focus
Spectral
Topics: Doppler ultrasound • PRF
• Wall filter
• Doppler controls
• Doppler artifacts Colour • Motion differentiation
• Doppler quality control • Sensitivity
• Colour box size
• Colour-echo write priority
• Colour persistence and colour capture
6.1
Gain Focus
Excess gain will cause: Remember from module 2 that intensity = Power
area
therefore: beam area = intensity = echo strength
Spectral: - over measurement of velocities
- increased representation of spectral
broadening
Colour: - extension (bleeding) of colour into

adjacent soft tissue
- colour noise displayed in the image,
especially in anechoic regions
and: beam area = intensity = echo strength
* Because the echoes from blood are very weak, always
ensure that the focus is at the point of interest for
maximum signal (echo) strength.
Wall Filter Wall Filter

Movement from walls and adjacent tissue
produce low frequency shifts.
For example:
Let us assume that the
machine has detected
frequency shifts of 150
Hz in the vessel, 80
Hz at the vessel walls
and 50 Hz in the
adjacent soft tissue. 150 Hz
CAUTION
80 Hz
A setting too high
A wall filter removes these will also remove 50 Hz
low frequency signals. wanted shifts.
A wall filter of 100Hz A wall filter of 200Hz will
In slow flow vessels it is possible that ALL signals will remove shifts remove all shifts in this
may be removed with a too high setting below this level. example.

Wall Filter Wall Filter

• In slow flow areas (e.g. veins) use a low wall
This filter is also available in spectral Doppler to
filter setting.
reduce unwanted low velocity signals.
• In fast flow areas (e.g. arteries) use a higher
setting to prevent unwanted colour over solid
tissue.
Unwanted colour over moving tissue is known
as ‘flash artifact’ or ‘wall thump artifact’.
On most machines, the colour

filter setting is visually shown
in the colour bar by a black The wall filter has been
band at base line. increased in this image.
PRF PRF
(pulse repetition frequency) (pulse repetition frequency)
also called ‘Velocity’ Range’ or ‘Scale’
• High PRF is required to accurately show fast
low prf high prf velocities without aliasing (an artifact which will
be described later)
but
high PRF will limit low velocity representation.
low prf high prf

It is the rate at which pulses are sent out low prf high prf
The machine must sample (send out pulses) at least at
twice the rate as the highest Doppler shift frequency
that it needs to detect. If it does not then it cannot
accurately determine the Doppler frequency.
PRF Sensitivity
(pulse repetition frequency) 4 (also known as ‘packet size’ or ‘ensemble length’)
• Low PRF will show slow velocities better

but
low PRF will cause aliasing of fast velocity
flow. 4
low prf high prf

low prf high prf 1
Several pulses (at least 4 and up to 25 ) are required
for each beam path so that the machine can gather
enough data to calculate the average Doppler shift in
each sample volume.

Sensitivity Sensitivity
The machine stores the signals from When the sensitivity is increased = more pulses are
1 each sample volume for each successive sent out for each line.
pulses 2 pulses
3 pulse in a set.
echoes
1
2
echoes 3 echoes
The set of echoes from each sample volume is used With more samples in each set, the machine is able to
to determine the average velocity in that volume. calculate smaller Doppler shifts (smaller velocities).
Sensitivity Review - Wall filter, Sensitivity, PRF

Increased sensitivity = more pulses per line
• For slow flow
• Use lower sensitivity if looking at arteries – low wall filter
– increased frame rate – high sensitivity
– low PRF
– less “bleeding” of colour into tissue
• For fast flow
• Use higher sensitivity if looking at slow flow
– higher wall filter (if necessary)
vessels (e.g. veins)
– lower sensitivity (if necessary)
– but frame rate is compromised
– higher PRF
Note: It is not uncommon for machines to link the wall filter

and PRF so that the wall filter increases when the
PRF is increased to image higher velocity flow
(and vice versa).
Colour box size Colour-echo write priority

(Also known as ‘Grey scale priority’ or ‘Priority’)
Reduced width of box
= fewer pulses / frame For every pixel in an ultrasound image, an ultrasound
machine can only write either a colour signal or a B-mode
= higher frame rate
signal – not both.
Therefore if a Doppler signal is detected in a pixel where
Reduced depth or height of box: there is also a B-mode echo, a decision must be made as
Because the PRF is set to which one takes priority.
independently (unlike A B-mode echo that is more
This control-echo intense (more echogenic)
B-mode), adjusting the control sets the
colour box will not affect the than the indicator, will take
level at which a priority.
PRF and the Doppler lines colour signal will
will take the same amount be written over a If the B-mode echo is less
of time to be produced. B-mode echo. intense (more hypoechoic)
The frame rate will remain the same. than the indicator, colour
will take priority.

Colour-echo write priority Colour persistence

Raising the threshold will Averages colour sample volumes over a number
allow colour to overwrite B- of frames. This produces a more even colour fill.
mode noise. previous previous current displayed
frame frame frame frame
Lowering the threshold will

prevent colour from
overwriting real B-mode
echoes.
+ + +
The individual clinical situation will determine which
setting is most appropriate. _.
. 3
Some manufacturers may call this control another name:
e.g. threshold, colour threshold or priority. Operates like the B-mode frame averaging described
in module 9.
Colour persistence Colour capture

This produces a smoother colour image. It will fill in
Uses highest value for each location over a
momentary loss of colour signals from frame to frame.
specified number of frames.
However it can cause ‘smearing’ of the colour if there is
significant movement between frames frame 1 frame 2 frame 3 displayed
previous frame
previous current displayed
frame frame frame frame
+ + +
chooses highest
_.
. 3
Persistence is often increased with Power Doppler to This control can be useful for producing a very well
improve colour filling of the vessel. colour filled image for recording purposes.
Colour and Power Doppler Doppler artifacts

When using colour, frame rate can be optimised (increased) As with B-mode, Doppler suffers from artifacts
by: specific to this mode of ultrasound.
• Decreasing the width of the colour box. The Doppler artifacts discussed in this section are:
• Decreasing the overall B-mode field of view to the • Aliasing
minimum required. • Mirror image - spectral and pulse echo
• Decreasing the colour line density (if this control is • Anechoic space
available). • Temporal resolution artifact
• Decreasing the number of focal zones. • Twinkle artifact
— (although most machines will do this automatically)
Doppler artifacts related to the following have been
• Decreasing the number of pulses that are sent along each discussed previously:
beam path.
• Inappropriate gain settings (module 11)
— by reducing the ‘sensitivity’ • Intrinsic spectral broadening (module 11)
• Wall filter settings (this module)

Aliasing Aliasing
(Also known as frequency aliasing)
Pulsed Doppler suffers from an inherent limitation Because of the pulsed nature of the beam, the
in the accurate detection of Doppler shifts (and machine can only obtain samples of the blood cell
therefore velocity calculations). movement.
If this sampling rate (i.e. the PRF) falls below a

We have seen how the transducer transmits a certain limit, or the blood velocity gets too high,
pulse, then waits for the echoes to return from the an artifact called aliasing occurs.
specified depth before it transmits the next pulse.
The rate at which it sends out the pulses is the

Pulse Repetition Frequency (PRF). (this is similar
to what happens with B-mode ultrasound –
module 3).
Aliasing Aliasing
transmit transmit
receive These are the receive

points of data with
which the machine
Doppler shift has work out the
Doppler shift.
Remember that the machine compares the sampling

times
frequency of the transmitted beam and received
echoes to calculate the Doppler shift. With pulsed Doppler, the machine ‘sees’ only very
short samples of received echoes.
Aliasing Aliasing
transmit ½ the transmit

sampling rate
(PRF)
These are the receive
points of data with receive
which the machine
has to work out
the Doppler shift.
However if the sampling rate is too low for the frequency that
it is trying to measure, it does not have enough data to
Providing the points are close enough together, the correctly work out the frequency difference.
machine can construct the correct Doppler shift. Aliasing is now occurring

Aliasing Aliasing
Sampling rate
(PRF)
Doppler
shift
frequency This is what aliasing
appears like in a spectral
The sampling rate (the PRF) must be at least twice that Doppler waveform.
of the frequency it is trying to measure.
The Nyquist limit is the limit of the frequency that the
machine is able to correctly measure.
(It is ½ of the PRF). +PRF/2
e.g. if the PRF was 4000 Hz
then the machine could only In this case, the received Doppler shift is too high for the
0 Hz PRF and the trace extends beyond the top of the scale
represent 2000 Hz Doppler
shifts accurately (in both and is incorrectly produced at the bottom of the graph.
directions). -PRF/2
Aliasing Aliasing
Options to avoid or reduce aliasing: Options to avoid or reduce aliasing:
1. Move the baseline (This allows the machine to measure If the baseline is moved to the bottom (or top) of its limits, it
higher Doppler shifts (velocities) in one direction – but at is possible to measure frequency shifts up to the PRF (but
the expense of the reversed direction). only in one direction).
+1500 +2500
+1500 +3000
0 Hz Hz
0 0 Hz Hz
-1500 -500
Aliasing No aliasing
-1500 0
For example in this case, if the PRF was 3000 Hz and Aliasing No aliasing
aliasing was occurring, then moving the baseline lower
would allow higher Doppler shifts to be measured (in the
+ve direction).
Aliasing Aliasing
Options to avoid or reduce aliasing:
However there is a limit to increasing the PRF
2. Increase the PRF (on some machines this is shown as - The transducer must wait until echoes are back
‘velocity scale’ or ‘scale’) from the required depth before next pulse is sent.
Aliasing No aliasing
UNLESS
3. High PRF mode is used (if available)
PRF = 3407 Hz PRF = 5357 Hz

High PRF mode High PRF mode

Some machines do not have this feature. If it is available, it 1st pulse’s However, when the sample volume gate
may be user selectable or it may be automatic. echo opens for the echoes from the original
With this technique, a second pulse is sent out before pulse, the transducer receives echoes from
the echoes are received from the chosen depth. both pulses. Effectively, a second gate is
opened closer to the transducer.
2nd pulse’s
echo
2nd pulse echo
If the second gate is not in a

vessel then no Doppler shift is
1st pulse detected and there are no problems.
However it can lead to conflicting
This means that the PRF is much higher (twice or even signals if the second gate is in a vessel. This
three times) which means that much higher velocities can would lead to a type of range ambiguity artifact.
be measured without aliasing.
12
High PRF mode Aliasing
Most machines will show the extra sample volume/s on the Other ways to avoid or reduce aliasing:
screen. In this case two sample volumes are shown meaning
that there are two pulses transmitting in the beam path. Reduce the Doppler shift frequency by:
4. Using a lower frequency 2 v f cosƟ

transducer f D =
c
(If ‘f’ is lower then fD will be lower).
5. Using an increased Doppler
angle (angle on incidence 2 v f cosƟ
to the vessel) - but not
f D =
c
more than 60o.
(If ‘Ɵ’ is higher then cos Ɵ will be less therefore fD will be

lower).
Aliasing Aliasing
Other ways to avoid or reduce aliasing:
NOTE:
6. Reduce the imaging depth.
Aliasing does not occur with continuous wave
Less time would be required to wait for all echoes to (CW) Doppler because there is no sampling (the
be received from the set depth so the next pulse could
machine gets continuous feedback).
be sent out sooner. (i.e. the PRF could be increased).
That is why, despite the disadvantages of CW
Note that reducing the overall depth of the imaging field
Doppler, it is still an invaluable part of Doppler
of view will not automatically increase the Doppler PRF
(as would occur with the imaging PRF in B-mode ultrasound – particularly in cardiac applications
ultrasound), because the Doppler PRF is a separate where very high velocities may be encountered.
manual control.
CW Doppler is capable of correctly measuring
However reducing the depth would allow manual very high Doppler shifts (= high velocities).
adjustment to a slightly higher Doppler PRF if required.

Aliasing in colour Doppler Aliasing - Colour Doppler

Colour Doppler is a form of pulsed Doppler, therefore Very high velocities
aliasing will also occur with this mode of ultrasound. cause multiple aliasing
thus producing a mosaic
It presents with colours not correctly representing the effect.
detected flow (apparent flow reversal).
The mosaic effect here
Because colour Doppler is used indicates very high
as a guide, aliasing is not as velocities through a
important to prevent. Many severe carotid stenosis.
sonographers deliberately set the
PRF (velocity scale) at a level to
produce some aliasing because (All these colour images are
the colour changes act as a better seen on the computer
beacon to potential pathology. slides).
Aliasing - Colour Doppler Aliasing - Colour Doppler

To determine if the colour change is true flow
If the colour change goes from the
reversal or if it is aliasing, look for the colour change
lowest shade of red, through
from red to blue:
black, to the lowest shade of blue
then it is most likely flow reversal.
If the colour change goes However, it is possible for

from the highest shade of aliasing to go through black
red to the highest shade of when it is severe with multiple
blue then it is aliasing. changes in the colour. (Note
the many small changes
through black on this aliasing
image).
Spectral mirror artifact Spectral mirror artifact

• Caused by the beam originating from an area on the face of
the transducer (the aperture), not just from the centre point.
Bi-directional flow depicted when beam is at 90o to This effectively creates multiple Doppler beam paths for
the vessel. each reflector, the same as the cause of intrinsic spectral
broadening. (Revise intrinsic spectral broadening in Module 11).
• Therefore Doppler shifts will be detected symmetrically in
both directions.

Pulse-echo mirror artifact Pulse-echo mirror artifact

(Colour mirror artifact) (Colour mirror artifact)
A phantom vessel / flow appears deep to the real vessel.
When a pulse strikes a blood cell, Rayleigh scattering
occurs (module 2). Echoes radiate out in all directions.
Vessel Some echoes will go straight back to the

transducer to produce the correct image.
If some of the radiating

echoes strike a strong
Mirror image reflector, they can be
This can occur because of a similar set of circumstances reflected back to the
which produce a B-mode mirror artifact (described in strong reflector transducer.
module 10).
Pulse-echo mirror artifact Pulse-echo mirror artifact

(Colour mirror artifact) (Colour mirror artifact)
Because the beam is The result is the production of a second

Orthogonal Doppler image deep to the correct one. Orthogonal
three dimensional, the plane plane
echo might also reflect
off a structure which is
behind or in front of the
scan plane.
strong strong
echo placed echo placed
strong reflector reflector strong reflector reflector
here here
Pulse-echo mirror artifact Anechoic space artifact

(Colour mirror artifact)
Colour signal is represented in anechoic
Because these are echoes of actual Doppler areas that do not have flow.
shifts, spectral Doppler signals will also be
obtained from both ‘vessels’.
• Caused by the colour-
write priority feature
and high colour gain.
• Generally, B-mode
(grey-scale) signal is
given priority on screen.
• If there are no B-mode echoes present, low level

colour noise may be written in.

Anechoic space artifact Temporal resolution artifact

• Spectral Doppler will not indicate directional flow.
Apparent velocity difference in
different parts of a vessel.
• Caused by low frame rate
- different parts of the frame are produced by
different segments of the cardiac cycle
diastole systole
However it is worth noting that the colour frequency

shifts that can be seen on the colour image are depicted
on the spectral Doppler image as random low level
signals on the screen.
Twinkle artifact Quality control in Doppler systems

This is a linear multi-coloured colour Doppler artifact • String phantom This device can be used to check
which occurs behind small highly reflective structures. the accuracy and characteristics
Its cause is not well of a spectral Doppler signal.
understood, but the Doppler A monofilament (e.g. string) is driven in a liquid bath
detection circuits detect phase at a known rate around two pulleys. The speed of the
shifts from the complex string is adjustable.
reflections from the structures,
interpret these as movement
Sample volume
and present them as colour placed on
signals. The speed of sound in moving string
the liquid must be the
It has been determined that it occurs with most same as soft tissue
intensity behind structures with a rough surface (such (1540 m.s-1).
as small renal or biliary calculi)2.
Quality control in Doppler systems

• Flow phantom
This device pumps a liquid through a tube which
passes through a tank of liquid or a block of tissue
mimicking material. The pumped liquid contains
scatterers which simulate blood.
The speed of sound

PUMP
in the liquid or
tissue mimicking
material must be
the same as soft
tissue (1540 m.s-1).


3. Aliasing is a potential problem in PW Doppler because of:
1. What is the maximum velocity limit for a CW Doppler unit (a) High frequency transducers
operating at 5 MHz? (b) Intermittent sampling
(c) Dynamic focussing
(a) 200 m.s-1
(d) Motion of the interface perpendicular to the ultrasound
(b) 200 cm.s-1
wave direction
(c) 100cm.s-1
(d) None of the above
4. What parameter relates to the number of pulses that are used
2. Lateral resolution of a B-mode image is influenced by: along each colour beam path to determine the Doppler shift in
(a) Matrix size each range gate?
(b) Line density (a) Sensitivity
(c) Beam width (b) Pulse repetition frequency
(d) All of the above (c) Pulse duration
(d) Colour gate

5. A method to eliminate aliasing in a spectral Doppler image is to: References
(a) Decrease the amplifier gain
(b) Decrease the size of the range gate 1. Satish K Bhargava: Textbook of Colour Doppler Imaging
(c) Increase the pulse repetition frequency Jaypee Brothers Medical Publishers, New Delhi, 2003
(d) Increase the transmit power
2. Kamaya A, Tuthill, T, Rubin, JM: Twinkling Artifact on Color Doppler
Sonography: Dependence on Machine Parameters and Underlying
6. Calculate the minimum pulse repetition frequency necessary to Causes, AJR December 2011, 197 (6)
prevent aliasing if the velocity of blood is 10 cm.s-1, the Doppler
angle is 60o s and the transducer frequency is 3 MHz.
(a) 200 Hz
(b) 400 Hz
(c) 550 Hz
(d) 1100 Hz

Physical Principles of Ultrasound Intravascular contrast agents

Ultrasound contrast agents are designed to be
Brian Starkoff injected into a blood vessel to enhance the reflection /
scattering properties of blood.
Module 13 • To better show the flow within a blood vessel.
Topics: • Contrast agents • To better demonstrate the vascularity of a structure,
organ or lesion.
• Harmonics
• Biological effects
These consist of tiny
• Recording methods outer shell
microbubbles (1 to 4 microns
• New / future developments
in diameter). They have an
outer shell composed of a
Copyright © 2018, Brian Starkoff. Students and other persons studying ultrasound variety of materials (e.g. central gas
Copying (in whole or in part), use for any other purpose, or use by any other albumin or polymers) to
person is prohibited without the prior, express permission of the author. enclose a central gas such as 1 to 4 x 10-6 mm
6.2
air or nitrogen.
Intravascular contrast agents Intravascular contrast agents

Uses:
The microbubbles of gas are excellent scatterers of 1. Doppler imaging
sound (much better than blood cells).
The acoustic impedance mismatch of the
Also, when an ultrasound pulse bubbles, and also their resonance, greatly
strikes the microbubbles, they increase the intensity of the scattered echoes
resonate (vibrate at a particular from the blood thus enhancing the image,
frequency specific to the particularly for colour Doppler applications.
microbubble). These vibrations
cause relatively intense sound - useful when echo return is poor:
• trickle flow through a very tight stenosis
waves to travel in all directions e.g.
• small deep arteries (e.g. renal arteries)
– including back to the
transducer.
2. Contrast harmonic imaging
(see following section on harmonic imaging)
Intravascular contrast agents Harmonics

Harmonics are frequencies in a sound wave at
When using contrast agents, a lower power multiples of the fundamental frequency of the
setting is required because if the pulses are too wave.
intense, the contrast agent microbubbles might
collapse under the compression waves which
would destroy the contrast agent. e.g. An echo of a wave that was transmitted at 3 MHz
(the fundamental frequency or 1st harmonic) may
This lower power setting would show as a low include frequencies at 6 MHz (the 2nd harmonic)
Mechanical Index (MI) readout on the screen. as well as at 3 MHz.
(Mechanical Index is discussed later in this module).
Echoes at other multiples of the 1st harmonic
(9 MHz, 12 MHz, etc) are also present but are
generally not used in diagnostic ultrasound.

Harmonics Harmonic Imaging

transmitted
echo at fundamental frequency beam echo at fundamental frequency
echo at 2nd harmonic echo at 2nd harmonic

The two (or more) frequencies are
combined in the reflected wave
making a complex wave. They are I
able to be separated by the signal
processing electronics.
f
(eg. 3 MHz 6 MHz )
transmitted beam The component frequencies have a bandwidth
(fundamental frequency or 1st harmonic) determined by the length of the pulse.
(revise bandwidth in module 3)
Harmonic Imaging
Contrast Harmonic Imaging
Harmonic imaging techniques can be used under two Harmonic imaging was developed for use with
different conditions: ultrasound contrast agents used in vascular studies in
which the microbubbles’ scattering and resonance
contained very high amplitude 2nd harmonic
- with the use of contrast agents frequencies (even higher than the fundamental
(contrast harmonic imaging) frequency).
- without the use of contrast agents

(native tissue harmonic imaging or THI) If the receiving circuits are
tuned for the 2nd harmonic
frequency, the machine will
detect the microbubble
‘reflections’ (i.e. the blood)
extremely well.
Tissue Harmonic Imaging

Contrast Harmonic Imaging
Operation: It was discovered that harmonics were also
The transducer transmits at the fundamental generated (to a lesser degree) in real-time soft
frequency (for example 3 MHz). received echoes tissue imaging. As equipment became more
sensitive to weak echoes, the harmonic frequencies
The received echoes could be detected.
contain both I
fundamental and 2nd 2nd harmonics generated in soft tissue are of much
harmonic frequencies. lower intensity than the fundamental frequency (at
least - 30dB).
f
(eg. 3 MHz 6 MHz )
(You might like to revise the section on decibels in Module 2
A frequency filter is used to detect only the 2nd and work out how much weaker an echo would be at -30 dB).
harmonic frequency and excludes the fundamental
frequency.

Tissue Harmonic Imaging Tissue Harmonic Imaging

Harmonics are generated as the sound wave is
distorted due to speed changes at the wavelength The distortion requires high intensities and also for
level as it passes through tissue. the sound wave to have travelled some distance.
Because the tissue is
compressed during this part Note:
of the wave, the wave travels
Higher frequency harmonics are also
very slightly faster.
generated (3rd and 4th harmonics), but these
frequencies are attenuated too much by the
tissue, and are not used.
Conversely, because of rarefaction, the wave
travels very slightly slower in this region.
This distortion is also known as ‘non-linear propagation’.

(Speed of sound variation was explained in module 1)

Tissue harmonic imaging also uses the filter A problem with this detection
system to detect the harmonic frequencies (as with technique is the fact that with
contrast harmonic imaging). the very short pulse lengths
received echoes used in today’s equipment, I
the bandwidth of the echoes
is very wide.
f
I
(eg. 3 MHz 6 MHz )
f
(eg. 3 MHz 6 MHz ) (Another reminder to revise your notes on bandwidth in module 3).
Only the 2nd harmonic

frequency is used.

To improve frequency separation, the pulse lengths are
The filtering necessary to exclude the fundamental increased (which narrows the bandwidth), but this causes a
reduction in the axial resolution1,2.
frequency will also remove a large portion of the 2nd
harmonic. received echoes received echoes
I I
I I
f f f f
(eg. 3 MHz 6 MHz ) (eg. 3 MHz 6 MHz )
Question 42: Why are such short pulse lengths used in short pulse longer pulse
B-mode ultrasound?

Tissue Harmonic Imaging Pulse Inversion Harmonics

To overcome the frequency separation problem when
using short pulse lengths, Pulse Inversion Harmonics First, let us consider the echoes if they returned at
was developed. the fundamental frequency:
With this technique, two pulses are sent along each beam echoes
path (similar to the technique used for multiple transmit from 1st
focal zones). In this case, however, the two pulses are pulse
180o out of phase with each other (i.e. the second pulse is
echoes
+ =
phase inverted). from 2nd
The two echo sets pulse
first pulse
(one from each pulse)
are added together to
provide the final set of
second pulse When these are added together, they undergo
echoes which proceed
destructive interference , and cancel each other out.
for further processing.
Pulse Inversion Harmonics Pulse Inversion Harmonics

However as we have seen, the wave distorts as it Separation occurs echoes
passes through the tissue: from 1st
echoes
because the fundamental + pulse
frequency component of
1st from 1st
pulse
the now more complex echoes
pulse
wave is cancelled at from 2nd
echoes addition, but the 2nd pulse
2nd
from 2nd harmonic (distorted)
pulse
original pulse shape eventual pulse shape pulse
component is not.
(and therefore echo
shape) Keep in mind that this is a very simplistic
When the two harmonic affected echoes are added explanation of the process, and that the
together, they do not exactly cancel. The final mathematics behind the addition of the distorted
wave, after addition, is the harmonic frequency. waves is VERY complex.
Pulse Inversion Harmonics Tissue Harmonic Imaging

Advantages:
• Bandwidth of the pulse / echo is not an issue, so very Harmonics are:
short pulse lengths can be used and there is no loss of
harmonic frequency intensity due to filtering. Less efficient superficially -
There is insufficient time to
• Harmonic frequencies from both pulses are available generate distortions.
which increases the final amplitude.
Best in the midfield in the focal zone -
The beam has relatively high intensity
Disadvantages: and only moderate attenuation.
• Frame rate is compromised (two pulses are required for
echo sets along every beam path) which reduces Less efficient deep -
temporal resolution.
The high frequency harmonics
are attenuated too much.
• The equipment is more expensive.


Effects: Effects: (cont.)
• Reduction in artifacts generated by side lobes. • Reduced generation and detection of echoes
– the weaker side lobe intensities do not caused by scatter because the harmonic generated
generate significant wave distortions beam does not interact with as much tissue.
(= much lower harmonic intensities).
• Reduced beamwidth
– the weaker beam edge intensities do not generate Reduced speckle.
significant distortions (= lower harmonic intensities).
. ..
Side
..
Side
lobes lobes The contrast of the
.
Side lobes Side lobes ..
I image increases. . ..
.. .
..
Beam width Reduced beam width • Reduced near field
Fundamental frequency 2nd harmonic frequency
reverberation artifacts.
Tissue Harmonic Imaging

Biological effects
Advantages:
Diagnostic ultrasound uses very short pulses of
• Reduced speckle leading to improved contrast sound with an average intensity (SPTA) of 1 to 50
resolution. mW cm-2.3
• Reduced near field artifact (clutter).
• Reduced side lobe and beam width artifacts. All ultrasound will always have some biological
• Improved lateral resolution. effect (bioeffect) on tissue. However if the
Disadvantages: ultrasound cause a harmful effect on the tissue,
then this is termed a biohazard.
• Limited use in superficial and deep areas
• Added equipment expense
• Lower frame rates with pulse inversion
techniques
Biological effects - thermal

Biological effects Thermal effects depend on:
(a) Beam characteristics
Ultrasound may have two effects on tissue: • frequency: f = absorption = heat
- thermal • intensity: intensity = heat
- mechanical Increasing the power control setting on the machine will
increase the pulse intensity and increase the thermal
Thermal effects are caused by transfer of energy effect.
from the wave to the tissue causing molecules continuous or pulsed
• mode of ultrasound:
to vibrate. real-time, M-mode or Doppler
i.e. caused by absorption of energy from the M-mode and spectral Doppler use repeated pulsing along a
sound beam. single beam path which will increase local heating along this
path. Also, spectral and colour Doppler use more intense
pulses, with spectral Doppler being the most intense.
(Revise Module 11)

Biological effects - thermal Biological effects - thermal

Thermal effects depend on: Thermal effects depend on:
(a) Beam characteristics (cont.) (b) Tissue characteristics
• absorption characteristics
absorption = heat
Colour and spectral Doppler use
• pulse duration • vascularity
longer pulse durations.
(pulse length) Longer pulse duration = increased blood supply = heat removal
energy in each pulse. = thermal effects
The surface of bone at a bone-soft tissue interface is at
higher risk for temperature rises because of bone’s high
• exposure time attenuation coefficient (= increased absorption) and poor
vascularity. This is particularly relevant in 2nd and 3rd
trimester obstetric examinations.

Temperature rises to local tissue from real-time b-mode
diagnostic ultrasound are well below any level To assist the operator in determining the level of
considered hazardous. possibility that a 1o C temperature rise may occur,
(1.5o C is considered to have no adverse effects) a Thermal Index was developed for display on the
machine.
(Normal daily changes of body temperature may
exceed 1o C). W0
TI =
Where W deg
Harmful thermal effects are not considered possible
with currently available real-time B-mode imaging
W0 = Power setting of the ultrasound unit
equipment.
W deg = Power required to produce a 1o C rise
However: Doppler units produce beams with higher
average intensities, and insonate the same under specific conditions
area for longer periods of time.

A conservative estimate for Wdeg Three different thermal indices have been calculated for
W0
is given by the formula: 3 TI = three common conditions:
W deg
210 TIS = Used when soft tissue only is being
Wdeg = Where f is in MHz.
f (soft tissue) insonated. -1 -1
(usually derated by 0.3 dB.cm .MHz
Therefore it follows that if frequency increases, Wdeg will to allow for attenuation in tissue)
decrease and TI will increase.
(This is logical because f= energy absorption = heat.) TIB = Used when bone lies near the focus.
(bone) (late 1st trimester, 2nd and 3rd trimester obstetrics
TI will also increase with increased output power. when bone is present in the foetus)
TIC = Used when scanning through surface bone or
A thermal index of 1 means that the conditions set on the (cranial bone) when bone is close to the transducer.
machine match those of the Wdeg calculation, and (neonatal head and transcranial applications)
therefore there is an increased potential for thermal
effects to occur.

Biological effects - mechanical Biological effects - mechanical

Two potential mechanical • Cavitation
effects can occur: • Microstreaming
Cavitation Cavitation - (a) stable
• Under the influence of repeated compression /
rarefaction waves, tiny microbubbles can form. • Bubble size grows to a size determined by
wavelength.
– dissolved gas comes out of solution under low
pressure conditions
• Resonance occurs within the bubble, with large
Region of rarefaction vibrational amplitudes.
– may lead to shear of cell membranes and large
molecule disruption
The higher this peak rarefaction factor is, the
more likelihood that cavitation will occur.
Biological effects - mechanical Biological effects - mechanical

Cavitation - (b) inertial (transient) Microstreaming
• At higher intensities, the microbubble may grow
rapidly, then collapse suddenly under a • The force of the ultrasound compression waves
compression wave. can cause movement of liquids (e.g. blood, urine
etc.). However this movement (or microstreaming)
• The collapse causes shock waves and high local is considered harmless at the ultrasound intensities
temperatures which can disrupt cells and used at diagnostic levels4.
macromolecules.
High intensity U/S is needed to produce cavitation.
It is considered possible to produce cavitation with

current diagnostic ultrasound equipment, if there
are pre-existing cavitation nuclei in the tissue.
Biological effects - mechanical Biological effects

A mechanical index (MI) has been developed to
indicate the level of possibility of cavitation occurring. Animal studies:
Pr Biohazards have been shown to occur:
MI =
Where f • fetal growth retardation
Pr = Peak rarefaction factor (in megapascals) • fetal death
• neurologic deficit
f = Transducer frequency in MHz
• spinal cord damage -----> paralysis
Below a MI of 0.7 it is not considered possible to
produce microbubble growth. None of these responses have been shown to
occur with pulsed ultrasound.
MI will increase with increased output power.
MI will decrease with increased frequency.

Biological effects
Human studies: Biological effects
Large numbers of studies have been carried out on the Based on these findings, a curve can be plotted for
potential biological effects of ultrasound. critical values of intensity vs. time of insonation.
No reproducible studies have shown harmful effects by This curve is slightly different if a
diagnostic ultrasound. focussed beam is considered
100
An AIUM released statement5 in 1987 states in part: Possible effect
“In the low megahertz frequency range there have been 10 focussed beam
no independently confirmed significant biological effects in 1
mammalian
-2
tissues exposed to unfocussed ultrasound Intensity
-2
W cm 0.1
with intensities below 100 mW cm. Furthermore, for No effect
ultrasonic exposure times less than 500s and greater than Diagnostic pulse
1s, such effects have not been demonstrated even at .01 echo imaging
higher intensities, when the product of intensity and .001
lies well within
exposure time is less than 50 J cm-2 ” 2 3 4 5
the ‘no effect’
(SPTA intensities, frequency range 0.5 to 10 MHz)
1 10 10 10 10 10
Irradiation time (secs)
field.
Biological effects
Biological effects
But “It has been demonstrated in experiments with
A later statement (1992):
unperfused tissue that some Doppler diagnostic
equipment has the potential to produce biologically
“Known diagnostic ultrasound equipment as used significant temperature rises, specifically at bone/soft
today for simple B-mode imaging operates at tissue interfaces. The effect of elevated temperatures
acoustic outputs that are not capable of producing may be minimised by keeping the time for which the
harmful temperature rises. Its use is therefore not beam passes through any one point in tissue as short
contraindicated on thermal grounds. This includes as possible. Where output power can be controlled, the
endoscopic, transvaginal, and transcutaneous lowest available power level consistent with obtaining
applications.” the desired diagnostic information should be used.”
Biological effects Biological effects

Recommended limits for TI and MI: Recommended limits for TI and MI:
One study states that TI and MI not to exceed 1 for obstetric
This varies depending on the research group. It is complex applications.7
and depends on many issues including the application, Others state that the accepted safe limit for TI is 1.5 and for
exposure time and the presence of contrast agents. MI is 1.9 4
The British Medical Ultrasound Society have much more
detailed recommendations as shown on the next two slides.
The Australasian Society for Ultrasound in Medicine It is recommended that you read this article in full.
(ASUM) also have issued a number of statements (see references at end of this module notes)
relating to ultrasound safety and it is recommended that
these statements be read in full6. ASUM’s recommendation is that a temperature rise of 1.5o is
safe for all examinations (TI = 1.5)6.
However keep in mind that this is 1.5o above normal body
temperature of 37o. If the patient has a raised temperature
then this limit must be lowered.

from The British Medical Ultrasound Society8 from The British Medical Ultrasound Society8
13
Biological effects Recording methods

General rules for safety: Most ultrasound images and video sequences are now
As with any process in which energy is imparted to the body, the recorded digitally:
ALARA principle should be adhered to:
• On a hard drive or solid state memory on the
As Low As Reasonably Achievable
ultrasound machine.
This means that any dose given to the patient should be kept as
low as possible while still achieving an acceptable result. • On centralised hard drives (in a PACS system) for
internal departmental retrieval and archiving.
• Diagnostic U/S should only be used when medically
indicated, or when there is an expected benefit to be ― The images are then commonly recorded onto
gained. laser discs (cd’s or dvd’s) for dispersal to referring
• The examination should be completed in the shortest doctors.
possible time. However hard copies (printed images) are sometimes
• Output power should be kept to a minimum commensurate required to record and dispense the ultrasound images or
with obtaining adequate images. videos.
• Active transducer should not be left resting on the skin The following slides show recording devices which may be
while not scanning. found in ultrasound departments:
13 13
Recording methods Recording methods

1. Dry laser camera 2. Video printer
May be used for images from other imaging modalities A compact unit (about the size of a video recorder) that
(CT, MRI, radiography, etc). uses heat sensitive paper or transfer material to imprint
Advantages: an image onto a paper or plastic film.
• Produces good quality
transmission images in a relatively Advantages:
compact stand alone unit. • colour models available
• Can be designed to use film of a • images viewed with reflected
variety of sizes. light
• Multiple small images can be placed on a larger sheet
making them very economical. Disadvantages:
Disadvantages: • Initial cost - especially colour models
• Uses transmission type film which requires a • cost of individual images (colour models only)
backlit viewing box to view them. • grey scale inferior to multi-image camera
• Moderately expensive

13
Recording methods New / future developments

Video recording
Ultrasound is undergoing continual development.
Ideal for recording dynamic studies, especially cardiac Following are some of the recent developments
examinations. that have taken place:
This may be performed on a simple domestic type VHS • Electronic focussing in the orthogonal (slice
video recorder, but is usually a more expensive thickness) plane
commercial type. It may even be a SVHS type – (Super
VHS). However the frozen image quality is inferior to
camera images. • Harmonic imaging – pulse inversion harmonics
Most departments now use DVD recording technology

• Spatial compound imaging
for high quality video recording. These developments have already been mentioned
in this or previous modules.
New / future developments New / future developments

• Encoded pulses • Encoded pulses
Each pulse is assigned with a unique code which is The improved sensitivity allows blood cells to be
retained within the pulse and its returned echoes. detected on b-mode imaging so that flow can be
seen without the use of Doppler.
Conventional 101101
uncoded pulse Coded pulse
Because echoes are a mirror image of the

transmitted pulse, they also are coded.
The machine can now tell the difference between
true echoes and random noise.
The result is significant improvement in sensitivity normal b-mode B-flow TM
(GE medical Systems)

and signal-to-noise ratio.

• Elastography • Strain elastography
A technique used to assess the compressibility With this technique, slight compressions of the
or ‘stiffness’ of tissues and / or lesions. The tissue are applied during a scan.
information is used to help determine if: (a) Using gentle manual compressions of the skin
(a) tissues are normal or abnormal with the transducer.
(b) a lesion is benign or malignant
compressed
Two techniques can be used:
This lesion
- Strain elastography compresses
(also known as static elastography or more than the
compression elastography) superficial one.
This method has significant interoperator variability

- Shear wave elastography
because the results depend on the amount of
compression used.


• Strain elastography • Shear wave elastography (SWE)
Shear waves are waves created during an ultrasound pulse
(b) Using intense pulses of ultrasound from the that travel at 90o to the direction of travel of the pulse.
transducer itself. (Known as ARFI imaging –
Shear waves travel much slower than
Acoustic Radiation Force Impulse imaging). the ultrasound pulses (1 – 10 m-s). Shear waves
Providing high frame rates are
available, these wave can be tracked
and their speed calculated.
The waves travel faster through less
compressible tissue, so tissue
compressibility (or ‘stiffness’) can be
mapped.
This method has less variability in the results but
requires more complex equipment. The technique uses a strong initial pulse (ARFI) to create the
shear waves.

• Elastography • Panoramic (extended field of view) ultrasound
A colour map is created With this system, the
showing the variability of the machine automatically
compressibility of the tissue stitches (joins) successive
and is overlaid on the B-mode frames to produce a final
image. F.O.V. that is much wider
than that normally
attainable with a transducer.
www.hitachi-medical-systems.eu/fileadmin/hitachi/onPage/hi-rte/eus3.jpg
Research has indicated that benign and malignant As the transducer records successive frames of the area,
tissues have different levels of compressibility. image recognition software matches and joins the frames
into one image.
This technique has shown significant promise in several
The process requires a smooth sweep of the transducer to
clinical areas of ultrasound including breast diagnosis.
produce an acceptable frame sequence.
3D ultrasound 3D ultrasound
A 2D image is made A 3D volume data set is

To attain a 3D image, a up of “pixels” (the made up of “voxels”
volume set of data is smallest information (volume elements).
required. unit in the image).
This volume data

set is made up of
multiple slices in
the orthogonal
plane.
Single slice Volume data set 2D image Volume data set

Once an accurate volume data set is obtained, the With Section Reconstruction, the software can
3D data can be visualised in several different ways: reconstruct the data in any plane as set by the
sonographer.
• Section Reconstruction
• Surface rendering
• Volume Rendering
• Transparent rendering
• Colour Mode Reconstruction
The section reconstructions will still appear as 2D slices.
With Surface Rendering, voxels below a set value within
transverse sagittal a complete data set are removed.
www.firstimpression3d.com www.healthtap.com
Coronal reconstruction
of an IUCD This technique is particularly successful with obstetric
©GE Medical Systems Ultrasound
coronal
scans where the foetus is surrounded by amniotic fluid.
Transvaginal scan of a uterine fibroid
With Transparent Rendering,
the whole data set is used and It is critically important that the data sets are obtained
voxels with a maximum (or as accurately as possible. Each scan plane image in
minimum) value are displayed, the set should be a fixed and a known distance from
and others are excluded. the previous image.
©GE Medical Systems Ultrasound
In this case, maximum values are displayed resulting in an

image of the bony structures of a foetus. Methods used for obtaining the Data Volume Sets:
In Colour Mode Reconstruction, voxels • External tracking

with colour or power Doppler • Freehand acquisition
information in a data set are displayed
and other echoes are excluded. • Automated acquisition
This results in vessels being displayed

without the surrounding tissue.

External tracking: Freehand acquisition:
The transducer is either mechanically attached to an The transducer is swept through an area (either linearly or
articulated arm or tracked by remote magnetic sensors. in an arc). The machine captures successive frames at a
set rate.
This was an early method which has now been superseded.

This method is simple, but requires smooth controlled
movement by the sonographer otherwise good
reconstructions will not be obtained.
Automated acquisition: Automated acquisition: - Mechanical probe
The probe has an inbuilt motor which arcs the curved
The transducer is designed to automatically change the array through the orthogonal plane.
scan plane in an arc. Because the movement is
automated, a very accurate data set can be obtained.
However the transducers are generally bulkier than

standard probes, and no movement of the probe is
critical during acquisition.
Two types of probes have been developed: These probes tend to be

• Mechanical relatively bulky, but produce very
good images.
• Matrix
Automated acquisition: - Matrix probe 4D ultrasound is real time 3D ultrasound.
The probes steer the scan plane electronically. The head
consists of many thousands of individual elements. Conventional 3D ultrasound produces one Volume Data
Set at a time. This is then reconstructed as required.
The rapid acquisition of data sets in the automated probes
mean several data sets per second can be obtained. With
sufficient computer processing power, reconstructions can
be done dynamically so that the 3D images are produced
with acceptable frame rates.
These probes are much more compact the mechanical Frame rates with the matrix transducers are superior to
ones and produce faster data sets. the mechanical ones which make them preferred for
cardiac applications.

Size reduction and portability of machines References:

1. Duck FA.(2002) Nonlinear acoustics in diagnostic US. US Med Biol 28:1-18
Very compact ultrasound units are being developed 2. Lawrence H. Le Radiology and Diagnostic Imaging. University of Alberta &
to enable the units to be used external to imaging Alberta health Services.
http://www.radiologyphysics.bitica.com/files/Ultrasound%20Imaging%2005_H
departments. They have also been developed to use armonic%20Imaging%20(Mar%2018,%202009).pdf
battery power which means they can be used: 3. Hedrick R, Hykes D. Starchman D: Ultrasound Physics and Instrumentation 3rd
ed. Mosby 1995
• At accident sites 4. Gill, R: The Physics and Technology of Diagnostic Ultrasound:
• On sports fields A Practitioner’s Guide. High Frequency Publishing, Sydney,
Australia 2012
• In the field for defence force applications 5. Americian Institute of Ultrasound in Medicine: Bioeffects considerations
for the safety of diagnostic ultrasound, J Ultrasound Med 7:S1, 1988.
6. Australasian Society for Ultrasound in Medicine. http://www.asum.com.au

Many of these models have
full imaging capability 7. FDA Recommendations for the Safe Use of Ultrasound in Obstetrics
Sherri A. Longo, M.D
including intra-cavity http://e-edcredits.com/articles/CNE-Longo-Sono-Safety.doc
scanning and colour Doppler. 8. The British Medical Ultrasound Society

http://www.bmus.org/policies-guides/BMUS-Safety-Guidelines-2009-
revision-DETAILED.pdf

Answers to module questions Answers to module questions

-1
Question 1: Question 3: 7.5 x 10 mm
2 Question 5: Question 6: Question 7:
m 2 Question 4(a):
= (a) 3
6 3 -27
6 x 10 x 4 x 10
12 v=f T= 1
(b) 1m
m
=
4 = 6 x 4 x 10
-15
= v f
1
(c) 3 Hz f 6 s
6 9 = 24 x 10
-15
1540 = 10 x 10
4 6 (d) 5 volts = 5 x 106 m
-14
m = x = 2.4 x 10
9 1 (e) 3 m.s-1 1 x 10-6 s
Question 4(b): = 308 x 10 m
-6
= 10
24
= 6 x 10-27
9 4 x 1012 = 0.308 mm = 0.1 μs
= 2.66
-27 -12
Question 2: = 1.5 x 10 x 10
1.0
2.1 x 1010 km = 1.5 x 10
-39

= v
Question 11: 64
(a) v = f
f -1
1540 m = 4 x 106 x 1 x 10-3 m.s 111111
= 2 x 106 = 4000 m.s
-1
1 0
= -6
770 x 10 m (b) nothing 25 24 23 22 2 2
The velocity in a particular
= 0.77 mm material is constant. (However = 32 + 16 + 8 + 4 + 2 + 1 = 63
the wavelength would change). Therefore the maximum (decimal) value that a six bit
Question 9: number can hold is 63. However the value ‘0’ is also a
15 x 10-4 m (c) 12 MHz relevant value (i.e. 000000), so a total of 64 different values
= 1.5 x 10-3 m can be represented by this binary number.
= 1.5 mm
Question 12:
Question 13:
1011010
(a) Increase the Power output. It is one of the controls
on the ultrasound machine.
26 24 23 21
(b) Decrease the area of the beam by moving the
= 64 + 16 + 8 + 2 = 90 focus to the area of interest. Focus placement is
another one of the controls on the machine.
(As we will see later, decreasing beam area also
(Note that the “0’s” have been omitted for simplicity) improves lateral resolution).


Intensity
Relative
intensity
remaining in
reflected beam
Intensity
lost from
Use the decibel formula to
work solve this calculation.
dB = 10 log ( II )o
dB original beam
-30 dB 0.1% 99.9% The received beam
-40 dB 0.01% 99.99%
dB = 10 log ( ½1 ) The original
Note that for every 10 dB of attenuation Relative Intensity (transmitted) beam
that occurs, the remaining intensity
decreases by a factor of 10. (This is
intensity
dB
remaining in
reflected beam
= 10 log ( 12 )
(0.5)
because of the nature of logarithms).
Note that a negative
At -50 dB, the remaining intensity would 0 dB 100% = 10 log
be 0.001% decibel change means
-10 dB 10% that there is a loss in
-20 dB 1% = 10 x - 0.301
However the answers can also be intensity (or power or
calculated if desired using the decibel -30 dB 0.1% amplitude).
formula: -40 dB 0.01%
= - 3.01 dB
I
dB = 10 log (I ) o = 3.01 dB loss

Question 16 Question 16 - continued
dB = 10 log ( II ) o
Remember to use I Remember that for every 3 dB loss of intensity, the intensity
the minus sign -6 = 10 log ( 12 ) will fall to half its value. In this case there is a 6 dB loss
because it is a which is two lots of 3 dB. Therefore the intensity has halved
reduction in intensity.
-0.6 = log ( 12I ) in value (3 dB) and then halved again (another 3 dB).
Note that to get rid of the ‘log’, you will need to take the anti-log of the value.
Therefore the intensity has fallen to ¼ (0.25) of its value (½ x ½).
antilog (-0.6) = antilog log ( ( 12I ))
The ‘anti-log’ and
I the ‘log’ cancel Final intensity is 12 x 0.25
0.25 = ( )
12 each other.
= 3 mW.cm-2
I = 3 mW cm-2
Go to the next slide to see how to work this out without a
calculator.

Question 18:
I v1
1 x 4 x 10 = 40 dB
dB = 10 log ( ) sin 01 =
Io v2 ( for soft 5 cm
50
= 10 log ( ) (total distance
0.005 1450 tissue)
pulse-echo has
=
1585 (4 MHz beam) travelled – down
= 10 log 10000 and back in cm.)
= 0.91
= 10 x 4 Note: If unsure of the problem, draw a simple diagram
0 = 66 0 Question 20:
= 40
( ) ( )
2 2
Z2 - Z 1 1.63 - 0.0004
R= = = 0.999
The display has a Z2 + Z1 1.63 + 0.0004
40 dB range T = 1 - 0.999 = 0.001
= 0.1 %


Question 22(a):
Question 21:
total attenuation through the kidney (down and back):
Transmitted beam = 0.001 (of incident beam) = α × cm × MHz = 1 × 8 × 5 = 40 dB
The proportion of the beam that is reflected is now calculated:
dB = 10 log ( II )
( ) ( )
o
Incident (original) Z2 - Z 1
2
1.62 - 1.38
2
R= = 0.0064
= 10 log (0.001
1
) beam
Z2 + Z1
=
1.62 + 1.38
= 10 log 0.001 The decibel loss that occurs at this point of reflection is now
calculated.
= 10 x -3
= -30 Transmitted dB = 10 log ( II ) o
= 10 log 0.0064 = 21.9 dB loss
beam
therefore a 30 dB loss occurs Therefore total loss = 40 + 21.9 dB
= 61.9 dB

Question 23: v = f (Note: You must use
Question 22(b): the speed of sound in a
v
total attenuation = 61.9 dB (from question 22(a)) = PZT element for the
f calculation because at
dB = 10 log ( II ) =
4000 m
5 x 10
6
this stage the sound is
o still totally within the
-61.9 = 10 log
I
( 3500 ) = 0.8 mm element).
element thickness = 0.4 mm
I
-6.19 = log ( 3500 ) Question 24:
I
antilog (-6.19) = antilog (log (3500)) Z ML = 30 x 1.6
I
6.45 x 10 = -7
3500 ( ) = 6.93 x 106 Rayls
(Note: It is not necessary to write the 106 factor in each
-2
I = 0.0023 mW cm element of the calculation as long as you remember that the
final answer will have the factor included).

Question 25:
Don’t forget – it doesn’t matter which material you make Z1 and Question 26: HINT: If this question was in a
multiple choice exam and you
Z2. The result will be the same. For mathematical ease, it is were not allowed a calculator,
suggested that you make Z2 the larger one. you could approximate the 0.11
vt
( )
2
to 0.1 which would make the
d=
( )
Z2 - Z
2
30 - 1.6
without: R=
1
= 0.81 2 0.22 ms calculation very simple. The
= 30 + 1.6 correct MCQ answer would be
Z2 + Z1
T=1-R = 0.19 = 19% 1540 x 0.22 x 10-3 m close to this answer.
=
2
with: -3 = 1540 x 0.1 x 10 m
-3
= 1540 x 0.11 x 10 m
( )=( )
Z2 - Z
2
30 - 6.93 2
R1 =
1
= 0.39 T = 0.61 -3
Z2 + Z1 30 + 6.93 = 169.4 x 10 m
-3 = 154 x 10 m
( )=( )
Z2 - Z 1
2
6.93 - 1.6 2
R =
2 = 0.39 T = 0.61 = 0.1694 m = 0.154 m
Z2 + Z1 6.93 + 1.6
= 16.94 cm = 15.4 cm
Ttotal = 0.61 x 0.61 = 0.37 = 37%
This is a big improvement from not having a matching layer.


Question 27 (a) (i): Question 27 (a) (ii):
First, the wavelength needs to be calculated First, the wavelength needs to be calculated
v 1540 v 1540
v=f = = m = 0.513 mm v=f = = m = 0.513 mm
f 3 x 10 6 f 3 x 10 6
Now the near field length can be calculated Now you can calculate the angle
2 -2 -2 -3
d 1.5 x 10 x 1.5 x 10 1.22 1.22 x 0.513 x 10
= = m Sin 0 = =
4 4 x 0.513 x 10
-3
d 1.5 x 10
-2
-1 -1
1.5 x 1.5 x 10 = 0.4172 x 10
= m
2.052
-1
= 0.04172
= 1.096 x 10 m
o
0 = 2.391
= 10.96 cm

Question 27 (b): Question 28 (first part) :
First, the wavelength needs to be calculated. Increased element dia. = longer near field length
= reduced far field divergence
Remember to use the speed of sound in PZT material!
Reason
v 4000
m = 1.33 mm
2
v=f = = d
f 3 x 10 6 Near field length is calculated by the formula =
4
If d increases, will also increase.
Element thickness = ½ Angle of divergence is calculated by the formula Sin 0 =

1.22
d
= 0.66 mm If d increases, sin 0 must decrease.
If sin 0 decreases, then 0 must decrease

Question 28 (second part) :
Question 29:
Increased transducer frequency
= longer near field length
= reduced far field divergence
Reason
If frequency increases, wavelength ( ) will decrease. The 10 dB beam width

-3dB
d
2 I -10dB
will be wider than the
Near field length is calculated by the formula = ( 1
max I)
4 3 dB beam width. 2
If decreases, must increase.

( 1
10
max I)
1.22
Angle of divergence is calculated by the formula Sin 0 = -3 dB Beam width
d -10 dB Beam width
If decreases, sin 0 must decrease.
If sin 0 decreases, then 0 must decrease


Question 30 (b):
Question 30 (a):
The maximum possible PRF will occur if the machine transmits
This part of the question is a simple depth time calculation the next pulse as soon as all the echoes from the 10 cm depth
so you will need the depth / velocity / time formula (d = vt
2 ). are received. That means the pulses can be transmitted every
You know the depth (10 cm) and you know the velocity of 0.13 ms (the answer to Q 29 (a)). Once you know the time
sound (1540 m.s-1) between pulses, you can calculate the frequency of the pulses
(the PRF) with the frequency / time formula ( f = T1 ).
d= vt t = 2d
2 v 1
f =
T
2
= x 10 x 10 s
-2
1
1540 = -3 Hz
0.13 x 10
-1
10 1 x 10
3
= s Hz
770 =
0.13
3
= 0.13 x 10
-3
s = 7.69 x 10 Hz
= 0.13 ms = 7.69 kHz

Question 30 (d):
Question 30 (c):
From the answer to Q 29 (c), you now know the time it
Now that you know the time it takes to produce 1 line (from takes to create 1 frame (26 ms). To calculate the
Q29 (a)), you simply multiply this by 200 to find the time for frequency of the repeating frames, you simply use the
200 lines. frequency / time formula ( f = T1 ).
f = 1
= number of lines x time for each line T
= 1
26 x 10 -3 Hz
= 200 x 0.13 ms
1 3
= x 10 Hz
= 26 ms 26
3
= 0.03846 x 10 Hz
= 38.46 Hz

770
FR= NxD 1 transducer aperture diameter
770 2 transducer frequency (element thickness)
= -2
Hz
450 x 12 x 10
3 focussing
77000 Hz
= 4 distance from the transducer (depth)
5400
5 output power and gain settings
= 14.26 Hz 6 line density
Note that the frequency of the transducer does not need to 7 scan converter size
be known for this calculation. 8 television monitor
You may be able to think of others.

Question 33: First, calculate the wavelength of the beam.

Question 34:
v 1540
v=f = = -6
m = 0.44 mm
f 3.5 x 10 Binary 1010 = 1 0 1 0
3 2 1 0
Now calculate the resolution 2 2 2 2
Axial resolution Lateral resolution
=8+0+2+0
SPL = n 2.4 A
BW =
d
= 4 x 0.44 mm = 10
2.4 x 0.44 x 80 mm
=
= 1.76 mm 20
= 4.2 mm
A.R. = 0.88 mm
L.R. = 4.2 mm
Question 35(a): 1 1 1 1
Question 36:
2 3 2 2 2 1 20
= 8 + 4 + 2 + 1 = 15 dB = 20 log ( AA )
o
(+ 1 for the case where there is 0 0 0 0)
= 16 different values = 20 log ( 1000
10
)
Question 35(b): 1 1 1 1 1 1 1 1 = 20 x 2
27 26 25 24 23 22 21 20 = 40 dB
= 128+64+32+16+8+4+2+1 = 255
Note that because we are considering voltage changes, the
(+ 1 for the case where there is 0 0 0 0) V I
20 log ( V ) formula is used - not the 10 log ( I ) intensity
= 256 different values o o
change formula.

The image would be described as ‘bistable’. It would 1. Side lobe artifact:
have no shades of grey – it would be black and white. All echoes originate from the centre of the beam path.
All signals below 100 mV would be assigned black (they 2. Enhancement:
would not be seen), and all signals 100 mV and above The rate of attenuation through tissue is constant.
would be assigned maximum white.
3. Slice thickness artifact:
255
All echoes originate from the centre of the beam path.

4. Refraction artifact
128
The pulse-echo beam travels in a straight line.
Compressed
(stored) value
5. Range ambiguity artifact:
0
All echoes originate from the most recently transmitted pulse.
11 10 100 1000 10000
Signal level
Question 39: 0.01 MHz or 10 kHz

The very first ultrasound machines produced
images in this format.


2vf 2vf
Question 40: 40 cm.s-1 2 MHz f =
D
c
Question 40:
-2 6
f =
D
c
2 x 40 x 10 x 2 x 10 Hz
-2
2 x 40 x 10 x 2 x 10 Hz
6 f D = 1540
f = D
1540 -2 6
= 160 x 10 x 10 Hz
= 0.104 x 10
4
Hz 1540
-3 6
= 1600 x 10 x 10 Hz
= 1040 Hz Now 1600 divided 1540
by 1540 is
approximately 1
NOTE: If you were not permitted the use of a calculator and this = approximately 1 x 103 Hz
was in a MCQ exam, you would need to approximate = approximately 1000 Hz (or 1 kHz)
the answer and choose the closest multiple choice
answer. The next slide will show you how.
In a Multiple Choice Exam, choose the answer that is
closest to this.
Question 41: 2vf Question 42: fD = 2.001 MHz – 2 MHz = 1000 Hz

f D = c f c 2 v f cos O
v =
D
fD =
fD c 2 f cos O c
v = 2f 1000 x 1540
= 2 x 2 x 106 x cos 600
m.s-1
3000 x 1540
= 2 x 5 x 106
m.s-1
1000 x 1540
= 2 x 2 x 106 x 0.5
m.s-1
= 300 x 1540 x 10-6 m.s-1
= 500 x 1540 x 10-6 m.s-1
= 0.462 m.s-1 or 46.2 cm.s-1
= 0.77 m.s-1 or 77 cm.s-1
The direction of flow is towards the transducer because the The direction of flow is towards the transducer because
received frequency is higher than that transmitted. the received frequency is higher than that transmitted.
Answers to Multiple Choice Questions

Module 2 Module 3 Module 5 Module 6
1. (a) 1. (c) 1. (b) 1. (d)
2. (b) 2. (a) 2. (c) 2. (b)
3. (c) 3. (b) 3. (d) 3. (c)
4. (b) 4. (a) 4. (c) 4. (c)
5. (a) 5. (d) 5. (a) 5. (d)
6. (d) 6. (d) 6. (c) 6. (a)
Module 8 Module 9 Module 10 Module 12
1. (b) 1. (a) 1. (a) 1. (d)
2. (a) 2. (d) 2. (c) 2. (d)
3. (c) 3. (a) 3. (b) 3. (b)
4. (a) 4. (c) 4. (d) 4. (a)
5. (d) 5. (d) 5. (d) 5. (c)
6. (c) 6. (c) 6. (b) 6. (b)

A Index B
Artifacts (B-mode) Artifacts (Doppler)
Page Page Page Page
15 Absorption 81 Anisotropy 104 26 Bandwidth
Aliasing
84 Beam width 108 Anechoic space
18 Acoustic impedance artifact 74 B-colour
83 Comet tail
33 Acoustic lens 80 Edge artifact 96 Intrinsic spectral 30 Beam profile
broadening
79 Enhancement Beam steering (electronic steering)
58 Acoustic lens 108 Pulse-echo mirror 54
89 Equipment related
- linear array 107 Spectral mirror 31 Beam width
86 Lens (or lens effect)
23 Acoustic lens 109 Temporal resolution
89 Main bang 84 Beam width artifact
- simple transducer 86 Mirror
109 Twinkle artifact
89 Near field 8 Binary numbers
53 Acoustic windows
88 Range ambiguity 79 Assumptions of 115 Biological effects
104 Aliasing 86 Refraction ultrasound
81 Reverberation 115 Biological effects - thermal
38 A-mode ultrasound 15 Attenuation
83 Ring down 117 Biological effects - mechanical
64 Analog-digital conversion 80 Shadowing 45 Axial resolution
84 Side lobe 60 B-mode steering
1 Anechoic 75 Axial resolution
85 Slice thickness 39 B-mode ultrasound
- measurement
108 Anechoic space artifact 87 Speckle
81 Anisotropy 86 Speed of sound
89 Technique related
C D Page
22 Damping material Page
Page Page 89 Dead zone 100 Doppler controls
76 Calliper calibration 93 Continuous wave Doppler 11 Decibels 92 Doppler equation
117 Cavitation 111 Contrast agents
69 Demodulation 97 Doppler measurements
74 Colour B-mode 112 Contrast Harmonic Imaging
67 Cineloop 24 Destructive interference 91 Doppler ultrasound
50 Contrast resolution Duty factor
102 Colour box (Doppler) 16 Diffraction 25
77 Contrast resolution
103 Colour capture (Doppler) 99 Directional Power Doppler 37 Dynamic aperture
- testing
98 Colour Doppler 24 Constructive interference 16 Divergence 13, 68 Dynamic range
103 Doppler artifacts 36 Dynamic receive focus
102 Colour-echo write priority (Doppler) 59 Convex transducer
104 Aliasing
52 Colour resolution 59 Curved array transducer 108 Anechoic space artifact
96 Intrinsic spectral
83 Comet tail artifact broadening
24 Complex interference 108 Pulse-echo mirror
107 Spectral mirror
40 Compound imaging 109 Temporal resolution
99 Doppler Tissue Imaging (DTI)
Page
E 102
1
Echo write priority (Doppler)
Echogenic
F H I
Page Page
1 Echogenicity 109 Flow phantom (Doppler)
Page
66 Image memory
2 Echotexture 111 Harmonics
33 Focussing 26 Intensity variation - spatial
80 Edge artifact 114 Harmonics – Pulse inversion
124 4D ultrasound 27 Intensity variation – temporal
70 Edge enhancement 106 High PRF mode
70 Frame averaging 70
111 Interpolation
1 Hypoechoic
121 Elastography Intravascular contrast agents
42 Frame rate – B-mode
121 Elastography - strain 96 Intrinsic spectral broadening
103 Frame rate – Colour Doppler
121 Elastography – shear wave
104 Frequency aliasing
34 Electronic focussing
L 119
48
Laser camera
Lateral resolution
Electronic sector transducers
G
54
75 Lateral resolution - measurement
54 Electronic steering Page
33 Lens
120 Encoded pulses 32 Grating lobes
58 Lens - linear array
79 Enhancement 73 Grey scale mapping 23 Lens – simple transducer
101 Ensemble length (Doppler) 102 Grey scale priority 86 Lens artifact (or lens effect artifact)
89 Equipment related artifacts 51 Grey scale resolution 40 Line density
122 Extended field of view ultrasound 57 Linear array transducer

M P
Page Page Page Page
89 Main bang artifact 101 Packet size (Doppler) 68 Pre processing
117 Microstreaming 70 Edge enhancement
23 Matching layer 86 Mirror artifact (B-mode) 122 Panoramic ultrasound
70 Frame averaging (Persistence)
66 Matrix resolution 107, 108 Mirror artifacts (Doppler) 70 Persistence (B-mode) 70 Interpolation
59 Matrix transducers (linear) 103 Persistence (Doppler) 70 Persistence (Frame averaging)
41 M-mode
56 Matrix transducers (sector) 54 Phased array transducer 71 Smoothing
119 Multi-imaging camera
71 Reject
74 Measurements 21 Piezoelectric element - construction
37 Multiple beam formers 71 Write zoom
117 Mechanical index 22 Piezoelectric element - operation
24 Multiple element transducers 102 Priority
66 Pixel resolution
118 Mechanical index safety limits 35 Multiple focal zones 5 Propagation of sound
72 Post processing
66 Memory 25 Pulse duration
73 Grey scale mapping
72 Read zoom 25 Pulse-echo imaging
99 Power Doppler 108 Pulse-echo mirror artifact (Doppler)
N 9 Power and Intensity changes

114 Pulse inversion harmonics
25 Pulse repetition frequency (B-mode)
Page 101 Pulse repetition frequency (Doppler)
89 Near field artifact 94 Pulse wave Doppler
Q S
Page
Page
74 Quality control (B-mode)
109 Quality control (Doppler)
75 Axial resolution
109 Flow phantom Page Page Page
76 Calliper calibration 65 Scan converters 2 Sonologist
109 String phantom 96 Spectral waveform
77 Contrast resolution
16 Scattering Sound-tissue interactions 86 Speed of sound
75 Dead zone
101 Sensitivity (Doppler) 15 Absorption artifact
75 Lateral resolution
121 Shear wave elastography 15 Attenuation 109 String phantom
75 Registration
16 Diffraction
77 Slice thickness 80 Shadowing 1 Study program
16 Divergence
Page Page 31 Side lobes
17 Reflection
Radial transducers 18 Reflection coefficient 84 Side lobe artifact
R
60 14 Refraction
88 Range ambiguity artifact 14 Refraction 68 Signal compression 16 Scattering
95 Range gating 86 Refraction artifact 62, 68 Signal processing 26 Spatial Intensity variation
72 Read zoom 71 Reject 85 Slice thickness artifact
45 Resolution 25 Spatial pulse length
54 Real-time transducers 77 Slice thickness
45 Axial 45 Spatial resolution
59 Curved array - measurement
52 Colour 60 Specialised transducers
54 Electronic sector 71 Smoothing
50 Contrast
57 Linear array 87 Speckle artifact
51 Greyscale 2 Sonographer
60 Radial 48 Lateral 96 Spectral analysis
60 Specialised transducers 50 Temporal 96 Spectral bandwidth
119 Recording methods 81 Reverberation artifact 107 Spectral mirror artifact
17 Reflection 83 Ring down artifact
T Page
Page Page U 1 Ultrasound terminology
89 Technique related artifacts 21 Transducer - Basic

65 Television principles Transducers – Real-time 36 Variable aperture on transmit
27 Temporal intensity variation
50 Temporal resolution
59 Curved array
54 Electronic sector V 6 Velocity variation
120 Video printer
57 Linear array
109 Temporal resolution artifact 60 Radial
116 Thermal index 60 Specialised transducers
100 Wall filter (Doppler)
60 Tightly curved array
118 Thermal index safety limits 24 Wave interference
122 3D ultrasound W 4 Wave physics
19 Time Gain Compensation 5 Wave terminology
112 Tissue Harmonic Imaging– Principles 71 Write zoom
114 Tissue Harmonic Imaging– General

Zoom
99 Tissue Doppler Imaging (TDI)
Z 72 Read zoom
71 Write zoom

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Physical Principles of Ultrasound

Ultrasound is performed in Intense echo regions (bright on

Module 1 Page 1 Brian Starkoff

• Examinations are carried out by professionals

Ultrasound advantages Ultrasound disadvantages

• Large areas of the body are unsuitable for imaging:

Module 1 Page 2 Brian Starkoff

• Diagnostic ultrasound uses frequencies in the 1916 Underwater detection attempted

Historical Physics fundamentals

Module 1 Page 3 Brian Starkoff

Physics fundamentals Physics fundamentals

Physics fundamentals BASIC DEFINITIONS

Module 1 Page 4 Brian Starkoff

Wave Physics PROPAGATION OF SOUND

There are two types of mechanical waves:

PROPAGATION OF SOUND WAVE TERMINOLOGY

Immediately behind the Immediately in front of the

Difference between the

WAVELENGTH ( ) - Length of one cycle

WAVE TERMINOLOGY WAVE TERMINOLOGY

Module 1 Page 5 Brian Starkoff

Symbol Measurement units

Velocity v Metres / sec (a) How many wavelengths are shown?

Question 6: Question 10:

Question 8: (b) If the transducer frequency is increased, what

VELOCITY VARIATION VELOCITY VARIATION

Module 1 Page 6 Brian Starkoff

VELOCITY VARIATION VELOCITY VARIATION

VELOCITY VARIATION VELOCITY VARIATION

VELOCITY VARIATION VELOCITY VARIATION

Module 1 Page 7 Brian Starkoff

To convert from binary to decimal: e.g. 10011010

Introduction to the binary number system:

Module 1 Page 8 Brian Starkoff

POWER AND INTENSITY

Module 2 The area of an ultrasound beam is not constant. It changes over

Module 2 Page 9 Brian Starkoff

The relationship between the echo intensity and the pixel

To overcome this non-linear relationship and to directly relate

6 1 The intensity for the first shade of grey

Module 2 Page 10 Brian Starkoff

the non linear variations / dB

0 medium enabling a linear 0.3

relationship between the grey 0

and the settings on the machine.

THE DECIBEL THE DECIBEL

Module 2 Page 11 Brian Starkoff

THE DECIBEL Decibels vs. intensity of reflected wave

2 Let’s look at the intensity remaining in a reflected

Module 2 Page 12 Brian Starkoff

0.001 mW.cm-2 2. The range of signals that the 0.01 mV

Dynamic range Dynamic range

Module 2 Page 13 Brian Starkoff

Sound-tissue interactions Sound-tissue interactions

Sound-tissue interactions Sound-tissue interactions

Sound-tissue interactions Sound-tissue interactions

Module 2 Page 14 Brian Starkoff

transmitted through the - Reduction in intensity of an ultrasound beam as it

- These attenuation processes include:

fat/muscle interface? material involved, the distance travelled and the

Sound-tissue interactions Attenuation coefficients

Absorption Various properties of the material

Module 2 Page 15 Brian Starkoff

Principal elements of attenuation