Breast ultrasound

basic physics and instrumentation

Dr. Dominique Amy

Centrul de Diagnostic in Imagistica Medicala – Aix en Provence,
Franta

Dr. Viorela Enachescu

Clinica Medicala III, UMF Craiova

EcoMamoDuct – Workshop – Breast ultrasound

Craiova – 30 nov.- 01 dec. 2007
 Introduction
• Because of its accessibility and low cost ultrasound
is considered to be an easy and simple technique.
• However, optimization and interpretation of an
sonographic image demands large knowledge,
adequate training and experience.
• A lot depends on the quality of the machine.
A(t )  A0 sin(t   )

Frequency and wavelength

• The ideas of frequency, phase and wavelength can be

applied to any kind of waves, independently of their
physical properties.
• The ultrasound wave may be modeled as:
• A(t) = Aosin (t - )
• where:
• A0 – amplitude of the wave
• t - time
  - frequency
  - phase
 Ultrasonic wave
• Wavelength is the length of space over which one complete
cycle occurs (in a simple harmonic wave it may be e.g. the
distance between two subsequent maxima or minima of the
wave).
• With constant frequency the wavelength becomes longer
when the velocity is higher.
• With constant velocity it becomes shorter with growing
frequency.
• Wavelengths of the ultrasound in tissues with usually
applied frequencies are in the range of fractions of
millimeters.
 Propagation of
ultrasound in tissues
• Propagation speed - about 1540 m/s. The US speed in
bones and metals is much higher, whereas the propagation
speed in the air is lower than in the soft tissues.
• Acoustic impedance (Z) - D x V
• Reflection of an US wave on a surface between two media
(or tissues ) depends on the velocity and their density.
• The acoustic impedance of all soft tissues is similar
(highest in muscles, lowest in fat).
• The air - very low acoustic impedance (low V and low D),
• The breast - no interfaces (air/bones) exist is well-suited
to ultrasound inspection.
 Propagation of
ultrasound in tissues
• Echogenicity - the relative intensity of echoes in the region
of interest - compared to the tissue of reference - breast -
normal fatty tissue.
• If the echoes in the breast lesion are stronger - hyperechoic,
if the echoes are weaker - hypoechoic, and if the intensity
is similar - isoechoic. If no echoes - anechoic – ex. cysts
• Acoustic shadowing behind a structure - result of
absorption and/or reflection.
• Acoustic "enhancement" seen behind low-attenuation
structures, as fluid filled areas (e.g. cysts). In fact this is not
a real enhancement, but rather less attenuation than behind
the adjacent higher attenuation tissues.
Ultrasound attenuation
• Breast cyst.
Anechoic structure,
the ultrasound beam
crossing the cyst is
less attenuated than
the beam crossing
adjacent solid tissue –
acoustic
"enhancement".
Ultrasound attenuation
• Breast carcinoma.
Low reflection –
hypoechoic lesion
• High attenuation –
acoustic shadow
• “Paradoxal effect”
Ultrasound attenuation
• Calcification. High
reflection. Acoustic
shadowing.
Ultrasound transducers
• Basic scanhead designs include convex
(curvilinear) and linear array probes.
• In sonographic examination of the breast - a
superficial organ - linear (linear array)
transducers are used. In the linear (linear array)
transducers the piezoelectric crystals are mounted
on a flat rectangular surface, the field of view is
rectangular (in newer transducers it may be
trapezoid, too).
 Transducer and image
parameters
• Spatial resolution - the ability of separation of distinct
objects on the display. In ultrasound the spatial resolution
is different along the direction of the sound beam, and
perpendicular to the beam direction:
• axial resolution ,
• transverse resolution,
• elevational resolution.
• Axial resolution depends mainly on the transducer
frequency (the higher the frequency the better the
resolution), however, the lateral and elevational
frequency depend on the focusing of the ultrasound
beam.
 Transducer and image
parameters
• Choosing the transducer frequency
• The highest possible frequency which enabling
visualization of the area of interest should be used.
The range of the ultrasound wave is shorter with
higher frequencies, therefore it is of utmost
importance that the transducer should be placed
as close to the examined organ as possible.
• In breast US minimal frequency used should be
not less than 7.5 MHz, preferably higher.
 Transducer and image
•
parameters
Focusing
• The lateral resolution depends on the width of the
ultrasound beam. An ultrasound beam emitted by
a crystal is wide, and beam focusing like in a
camera is necessary.
• The focus should always be located at the level
of the examined structure. Only in this way the
optimal quality and resolution may be obtained.
Modern machines usually allow for focusing of
the beam at several levels.
 Display modes
• The echoes in the ultrasound are collected line after
line. The information received in form of echoes
reflected from interfaces met along the ultrasound
beam may be presented in different formats.
• There are 3 basic presentation modes used in the
clinical ultrasound: amplitude (A), brightness (B),
and motion (M) mode. In breast ultrasound the B-
mode is used.
• B (brightness) mode
• In the B-mode the amplitudes of reflections are
coded in the gray-scale. The two-dimensional B-
mode is the fundamental presentation used in the
clinical ultrasound.
 Volume measurements
• There are several formulas for calculation of
volume based on measurements of three
orthogonal dimensions of the displayed organ
or lesion. One of the most popular is the
following ellipsoid formula.
• D1, D2, D3 - diameters of examined structure
measured in three orthogonal (perpendicular to
each other) planes.
• This method of calculation of volume may
give inaccurate results, the error can be large
in structures differing from an ellipsoid.
Artifacts
• Reverberations
• Reverberations are artifacts
originating from multiple
reflections of the
ultrasound wave on
parallel reflective layers of
a tissue.
• The reverberation artifact
is common in larger
breast cysts.
Artifacts
• Lateral shadows (edge
shadows)
• Shadows may occur behind
the edges of objects, which
are not strong attenuators.
This may be due to
defocusing action of a
refracting surface, or
destructive interference of
portions of the ultrasound
pulse. Edge shadowing can
be seen in breast cysts.
 New ultrasound
techniques
• Harmonic imaging (tissue harmonic imaging, THI)
• If ultrasound wave propagating in a tissue has energy high
enough, it causes vibration not only of frequency
emitted by the transducer but also higher frequencies,
especially waves with frequency twice as high as the
emitted frequency. Because those vibrations originate in
the tissues the intensity of reverberations is diminished,
there are virtually no side-lobe artifacts, however, the
acoustic shadows are stronger.
• Harmonic imaging improves the quality of the image,
enhances the contrast between tissue, and is especially
useful in differential diagnosis of breast cysts.
 New ultrasound
•
techniques
Compound imaging (Sono-CT)
• This technique makes possible averaging of several images
obtained with different angles of incidence of emitted
ultrasound beam.
• The images are then combined by the computer into one
image. In the resulting image the patterns of real
structures are reinforced while artifacts such as speckle
and noise are averaged out.
• Suppresses a large portion of acoustic shadows which in
breast ultrasound are an important sign of malignancy. In
routine examinations of the breast compound imaging
should be used with caution as it may decrease the
sensitivity of the examination.
 New ultrasound
techniques
• Panoramic imaging (extended field of view)
• Panoramic imaging is a technique in which
subsequent images obtained during a longitudinal
uniform sweeping are pasted together.
• Cross sections of the entire breast on a single
image may be obtained using this technique.
• Sie-scape techmique
 New ultrasound
techniques
• 3D-imaging - two stages:
• 1. the acquisition of data, in which a set of contiguous slices of the
examined region are obtained.
• 2. obtained data is computed using one of the typical algorithms:
• multiplanar reformation (MPR),
• maximum intensity projection (MIP),
• minimal intensity projection (mIP),
• shaded surface display (SSD),
• volume rendering (VR).
• Allow obtaining of images in the plane parallel to the surface of the
transducer (the C-plane, or "bird's eye view")may supply additional
information useful in differential diagnosis of breast masses.
• Allow precise and repetitive calculation of volumes and precise planning
of biopsies.
 New ultrasound
techniques
• Elastography\
• Elastography compares ultrasonic images of an object
before and after application of a slight compression
differentiating soft and firm portions of imaged area.
• Alternatively a low-frequency vibration may be applied
differentiating moving and immobile
• Breast is well suited for elastographic imaging, since the
normal breast tissue is relatively soft, and breast cancers
are usually stone-hard.
• Value of elastography in breast imaging is under clinical
evaluation.
 References
• Goldberg BB (red.) Textbook of abdominal
ultrasound. Williams and Wilkins, Baltimore 1993
• Kremkau FW. Diagnostic ultrasound. Principles and
instruments. WB Saunders Company, Philadelphia,
2002
• Barr RG. Breast ultrasound: a bright future. Medica
Mundi 2001; 45(2): 8-13
• Hiltawsky KM, Krüger M, Starke C, Heuser L, Ermert
H, Jensen A. Freehand ultrasound elastography of
breast lesions: clinical results. Ultrasound Med Biol
2001; 27(11): 1461-1469