Basic Ultrasound

in Neurosonology
 What is Ultrasound ?
·  Ultrasound or ultrasonography is a medical
imaging technique that uses high frequency
sound waves and their echoes
·  Known as a ‘pulse echo technique’
·  The technique is similar to the echolocation
used by bats, whales and dolphins, as well
as
SONAR used by submarines etc
 What is Neurosonology ?
·  Sonography of the brain, cerebral circulation,
the spine, and all peripheral nerves and
muscles.
·  Applied to pathology at all life stages, from
prenatal care to children and adults.

American Institute of Ultrasound in Medicine,

2015
 Lecture ObjecCves
·  Review basic physics vocabulary
·  Explain the principles of sound waves
·  Use ultrasound physics to explain how
images are produced
·  Teach how to use these principles to help
your diagnostic abilities
·  Ultrasound knobology
 Basics Ultrasound

20 Hz
20 kHz

Infrasound Sound Ultrasound

·  Nondiagnosticc medical applications <1MHz

·  Medical diagnostic ultrasound >1MHz
 Basics Ultrasound
·  Sound is mechanical (not electromagnetic)
energy traveling though maTer as a wave
·  Depending on the matter -­‐ the wave will
travel at different velocities or directions
·  U/S probes emit and receive high-­‐
frequency (2-­15
‐ MHz) sound energy as
waves to form pictures
Physical Principles
 Sound Wave
·  A series of repeaCng mechanical pressure waves tha
propagate through a medium
·  1 Cycle = 1 repetitive periodic oscillation

Cycle
 Waveleng
th
Distance of one complete cycle

Wavelength
 Frequency
·  Number of cycles per second
·  Measured in Hertz (Hz)
-­‐ Human Hearing 20 -­‐ 20,000 Hz
-­‐ Ultrasound > 20,000 Hz
-­‐ Diagnostic Ultrasound 2 to 15
MHz
(this is what usually used)
 Frequen
cy
1 cycle in 1 second = 1 Hz

1 second = 1 Hertz
 High
Frequency
·  High frequency (5-­15
‐ MHz)
greater resolution
less penetration
·  Shallow structures
vascular, abscess, gyn,
testicular
 Low
Frequency
·  Low frequency (2-­3.5
‐ MHz)
greater penetraCon
less resolution
·  Deep structures
Aorta, cardiac, cerebral
circulation
 Amplitude
The degree of variance from the norm

Amplitude
Production of an Image
·  Probe emits a sound wave pulse – measures the Cme
from emission to return of the echo
·  Wave travels by displacing maTer, expanding and
compressing adjacent tissues
·  It generates an ultrasonic wave that is propagated,
impeded, reflected, refracted, or aTenuated by the
tissues it encounters
 Producing an image

·  Important concepts in production of an U/S

image :
· Propagation velocity
· Acoustic impedance
· Reflection
· Refraction
· Attenuation
 Propagation Velocity
·  Sound is energy transmiTed through a medium -­‐
each medium has a constant
velocity of sound (c)
·  Tissue’s resistance to compression
–  density or stiffness
·  Product of frequency (f) and wavelength (λ)
c=fλ
·  Frequency and Wavelength therefore are directly
proportional -­‐ if the frequency increases, the
wavelength must decrease
 PropagaCon
Velocity
·  Propagation velocity
-­‐ Increased by increasing
sCffnes
-­‐ Reduced by increasing density
·  Bone: 4,080 m/sec
·  Air: 330 m/sec
·  Sof Tissue Average : 1,540 m/sec
 Impedance
Acoustic impedance (z) of a material is the
product of its density and propagation
velocity
Z= pc

Differences in acoustic impedance create

reflective interfaces that echo the u/s waves
back at the probe

Impedance mismatch = ΔZ
 Acoustic Impedance
·  Homogeneous mediums reflect no sound
·  Acoustic interfaces create visual boundaries
between different tissues.
·  Bone/tissue or air/tissue interfaces with large
Δz values reflect almost all the sound
·  Muscle/fat interfaces with smaller Δz values
reflect only part of the energy
 Refraction
·  A change in direction of the sound wave as it
passes from one tissue to a tissue of higher
or lower sound velocity
·  U/S scanners assume that an echo returns
along a straight path
·  Distorts depth reading by the probe
·  Minimize refraction by scanning
perpendicular to the interface that is causing
the refraction
 Reflection
·  The production of echoes at reflecting
interfaces between tissues of differing
physical properties

·  Specular -­‐ large smooth surfaces

·  Diffuse – small interfaces or nooks
and
crannies
 Specular Reflection
·  Large smooth interfaces (e.g. diaphragm,
bladder wall) reflect sound like a mirror
·  Only the echoes returning to the machine are
displayed
·  Specular reflectors will return echoes to the
machine only if the sound beam is
perpendicular to the interface
 Diffuse Reflector
·  Most echoes that are imaged arise from
small interfaces within solid organs
·  These interfaces may be smaller than the
wavelength of the sound
·  The echoes produced scatter in all directions
·  These echoes form the characteristic pattern
of solid organs and other Cssues
 Reflectors
Specular Diffuse
 Attenua
tion
diminish as they travel

·  In · ideal
The systems
intensity sound
of sound waves
pressure (amplitude)
through a medium is only
waves
reduced by
are scaTered andthe spreading
others are of
·  In real systems some waves
of amplitude) is called
absorbed, or reflected
·  This decrease in intensity (loss
atienuation.
 ULTRASOUND PULSES
MAKING THE IMAGE
Acoustic impedance determines the amount of
sound waves transmiTed and reflected by tissues

Reflection occurs when the ultrasound beam hits

two tissues (areas) having very different acoustic
Impedance

A stream of echoes from return to transducer

Deeper echoes from deeper tissues arrive later
Stronger echoes arrive from stronger reflectors
 MATERIAL IMPEDANCE (Z)
Air 400
Fat 1,380,000
Water 1,430,000
Tissue 1,630,000
Muscle 1,700,000
Bone 7,800,000

Typical AcousCc Impedance Value

INTERFACE PERCENT
REFLECTION
Fat – Muscle 1%
Fat – Bone 50%
Tisue – Air 100%
 ULTRASOUND PULSES
MAKING THE IMAGE

·  The image is a 2D map of reflections

displayed as a grey scale
·  B mode = brightness modulation
·  “Real time” is lots of B mode images run
together
The Machine
The Two Main Components of an
Ultrasound Unit
 Transducer (AKA :
Probe)
·  Piezoelectric crystal
·  Continuous mode
–  continuous alternating current
–  doppler or theraputic u/s
–  2 crystals –1 talks, 1 listens
·  Pulsed mode
–  Diagnostic u/s
–  Crystal talks and then listens

·  Emit sound afer electric charge applied

·  Sound reflected from patient
·  Returning echo is converted to electric signal
>> grayscale image on monitor
·  Echo may be reflected, transmiTed or
refracted
 Frequency and
Resolution
resolution improves
·  As frequency increases,

·  As frequency increases,
decreases
depth of penetration

Penetration

transducers to image
more superficial
structures
·  Ex: Equine Tendons
 Transducers

·  The higher the frequency, the beTer the

resolution
·  The beTer the resolution, the better you can
distinguish objects from each other
 T
ransducers
·  Lower frequency
 T
ransducers
·  Higher frequency
 Transducers
·  Linear
– Gives rectangular image
– Generally has higher frequency (5-­12
‐ MHz)
– Good for looking at a smaller area and for
gauging
depth
– Gives more of a one dimensional view
– Sometimes referred to as the vascular probe
 Transducers
·  Linear
 Transducers
·  Curvilinear
– Uses same linear orientation but arranged
on a
curved surface
– Generally lower frequency (2-­5
‐ MHz)
– Gives a wider angle of view
 Transducers
·  Curvilinear
 Transducers
·  Sector
– Produce a fan-­like
‐ image that is narrow as
it
leaves the transducer and increases with
depth
– Ideal for imaging through small
“windows” (cranial window in the temple,
or
between the ribs)
– Commonly used for transcranial and
cardiac
imaging
 Transducers
·  Curvilinear
 Monitor Display and
Storage

·  Converts signal to an image/ archive

·  Tools for image manipulation
–  Gain – amplification of returning echoes
·  Overall brightness
–  Time gain compensation (curve)
·  Adjust brightness at different depths
–  Freeze
–  Depth
·  Zoom in for superficial view
·  Zoom out for wide view
·  Depth limited by frequency
–  Focal zone
·  OpCmal resoluCon wherever focal zone is
 Modes of
Display

·  A Mode (Amplitude)
·  B mode (brightness) – used most ofen
–  Real Cme, gray scale
–  2 D reconstrucCon of the image slice
–  Flip book-­‐ 15-­60
‐ images per second
·  M mode – moCon mode
–  Echo amplitude and position of moving
targets
–  Valves, vessels, chambers
–  Cardiovascular applicaCon
·  Doppler
–  Color Doppler
 A -­‐ Mode

·  The amplitude of
reflected ultrasound,
displayed on an
oscilloscope screen
·  It is just of historical
importance
·  Now used only in
ophtalmology to detect
finding in the opCc
nerve
B-­Mode
‐
M-­Mode
‐
Color Doppler: normal carotid artery
and internal jugular vein
Pulse Wave Doppler
Pulse Wave Doppler
 Power Doppler
Power Doppler
Normal right elbow and lateral epicondylitis of the left elbow
(tennis elbow)

Right Left
 Signal AmplificaCon
TGC (Cme gain Gain
compensaCon)

–  Manual control

or suppression of sectors

suppress
scree
superficial
n

*blinders
*glasses
 Ultrasound Terminology
Never use dense, opaque, lucent
Echogenicity
–  amount of energy reflected back from Cssue interface
–  amplitude / brightness of the image
Hyperechoic : more echogenic than surrounding Cssue
Hypoechoic : less echogenic than surrounding Cssue
Isoechoic : same echogenicity as surrounding Cssue
Anechoic : absence of echoes
 Hype
rechoic

·  Structure reflects most

sound waves
·  Structure appears white
on screen
 Ane
choic

·  Structure allows most

sound waves through
·  Structure appears black
on screen
 Iso/Hypo
echoic

·  Tissues in between
·  Allow some sound
waves through and
reflect others
·  Structures appear in
various shades of
gray depending on
amount of reflecCon
 Ec
hogenicity

· Hyperechoic

· Isoechoic

· Hypoechoic

· Anechoic
 Terminol
ogy
·  Homogeneous
– Structure has uniform
texture
 Terminology
·  Heterogeneous
– Various degrees of echogenicity
present
 Ultrasound ArCfacts
·  ArCfacts lead to the improper display of the
structures to be imaged
– Affect the quality of images
·  Can be falsely interpreted as real pathology
·  Important to understand and appreciate
·  Improper machine sesngs – gain
– Image too bright or too dark
– Can disguise underlying pathology
 Ultrasound
ArCfacts

·  AcousCc enhancement
·  AcousCc shadowing
·  ReverberaCon arCfact
·  Gain arCfact
·  Contact arCfact
 AcousCc enhancement
·  Hyperintense (bright) regions below objects of
low U/S beam aTenuaCon
·  AKA Through transmission
·  BeTer ultrasound transmission allows
enhancement of the ultrasound signal distal
to
that region
·  Examples: cyst or urinary bladder
AcousCc Enhancement
 AcousCc shadowing
·  U/S beam does not pass through a highly
reflecCve object or highly aTenuaCng
surface
·  Black area beyond the surface of the reflector
·  Classic examples : bones
·  Important diagnosCc clue seen in a large
number of medical condiCons
– Biliary stones
– Renal stones
– Tissue calcificaCons
AcousCc Shadowing
 ReverberaCon
·  Time delays due to travel of echoes when there
are 2 or more reflectors in the sound path
·  Mirror image – liver, diaphragm and GB
·  Return of echoes to transducer takes longer because
reflected from diaphragm
·  A second image of the structure is placed deeper
it really is
than

·  Comet tail – gas bubble

ReverberaCon ArCfacts
Mirror Image ArCfact
 Comet tail arCfact

www.upei.ca/~vetrad
Gain ArCfact
 Contac
t arCfact

·  Caused by poor
probe-­paCent
‐
interface
 Knobology
The funcConality of controls on an instrument as
relevant to their applicaCon
 Important Knobology
·  Power
·  Gain
·  Time Gain CompensaCon (TGC)
·  Depth
·  Focus
·  Frequency
 Power
§  Controls the strength or intensity of the
sound wave
§  Use ALARA principle
As low as reasonably acheivable
 Gain
§  Degree of amplificaCon of the returning
sound
§  Increasing the gain, increases the strength
of the returning echoes and results in a
lighter image
§  Decreasing the gain, does the opposite
 Gain Knob
(Controls overall brightness of the image)
 Time Gain Compensation (TGC)
(Allows adjustment of image brightness at selective depth)
 Depth
§  Each frequency has a range of depth of
penetraCon
§  Decrease the depth to visualize superficial
structures
§  May need to increase the depth of
penetraCon to visualize larger organs
 Depth Knob
(Allows adjustment of the depth of field of view)
 Focus Knob
(Allows focus of ultrasound beam to area of interest)
 Frequency Knob
(Adjust Frequency to balance depth and resolution needs)

8.0 MHz 10.0 MHz 13.0 MHz