Ultrasound

What is Sound?
• Sound is propagated through a mechanical
movement of a particle through compression
and rarefaction that is propagated through
the neighbor particles depending on the
density and elasticity of the material in the
medium.
• Sound waves propagate mechanical energy
causing periodic vibration of particles in a
continuous, elastic medium.
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• Sound waves consist of mechanical vibrations
containing condensations (compressions) &
rarefactions (decompressions)that are
transmitted through a medium.
 Sound is mechanical energy that needs a
medium to propagate.
 Thus, in contrast to electromagnetic waves, it
cannot travel in vacuum.

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 Ultrasound Physics
• The term ultrasound refers to acoustical waves
above the range of human hearing (frequencies
higher than 20 kHz).
• Humans can hear only a limited range of
frequencies (Audible spectrum).
• The frequency range of audible sound is
approximately 20 Hz to 20 kHz.
• Frequencies lower than 20 Hz are Infrasound and
frequencies higher than 20 kHz are called
Ultrasound
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 Cont..

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 Cont..
• Ultrasound or ultrasonography is a medical
imaging technique that uses high frequency
sound waves and their echoes.
– The technique is similar to the echolocation used by
bats, whales and dolphins, as well as SONAR used by
submarines.
• Diagnostic ultrasound equipment used ultrasound
frequencies in the range of approximately 1 MHz
to 15 MHz/2MHZ-16MHZ/but , 2-10MHZ is most
important
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 In ultrasound the following events happen
1. The ultrasound machine transmits high frequency sound pulse in to
your body using probe
2. The sound wave travel in to your body and hit a boundary b/n
tissue (soft tissue and bone
3. Some of the sound waves get reflected back to the probe ,some
travel further until they reach another
boundary and gat reflected
4. The reflected wave are picked up by the probe and relayed to the
machine
5. The machine calculate the distance from the probe to the
tissue/organ using the speed of sound tissue
(1540m/s) and the time of the echoes return
6. The machine display the distance and intensities of the echoes on
the screen forming 2D image

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 ULTRASOUND – How is it produced?
• Produced by passing an electrical current through a piezoelectric
(material that expands and contracts with current) crystal
• Transducer produces ultrasound pulses
• These elements convert electrical energy into a mechanical
ultrasound wave

• Reflected echoes return to the scan head which converts the

ultrasound wave into an electrical signal

• Transducer are both transmitter and receivers of ultrasound

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 Frequency vs. Resolution
• The frequency also affects the quality of the
ultrasound image
• The higher frequency ,the better resolution
• The lower frequency ,the less resolution
• The higher the applied ultrasound frequency
to any given material the lower the
penetration depth due to the absorption of
sound energy

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 Piezoelectric effect
• If we applied voltage in pulses the transducer
will expand and contract
• By applying this voltage in very quick pulse we
can vibrate the transducer and produce the
ultrasound wave
• If any external force is applied to the
transducer a voltage is generated. This
phenomena is called piezo-electric effect

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 Image Formation
• Electrical signal produces ‘dots’ on the screen
• Brightness of the dots is proportional to the
strength of the returning echoes
• Location of the dots is determined by travel
time. The velocity in tissue is assumed
constant at 1540m/sec
Distance = velocity/ Time

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 Interactions of Ultrasound with Tissue
• Acoustic impedance (AI) is dependent on the
density of the material in which sound is
propagated
Acoustic impedance(Z)=density *velocity
• The greater the impedance the denser the
material.
• Reflections comes from the interface of different
AI’s
• Greater change of the AI = more signal reflected
works both ways (send and receive directions)
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 Cont..
• At the border of d/t structure some of the
transmitted wave are reflected back according
to the Acoustic impedance d/c two structures
• The average impedance is about 1.6
• Greater the AI, greater the returned signal
Largest difference is solid-gas interface
• we don’t like gas or air
• we don’t like bone for the same reason
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 Cont..

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 Cont..
• Sound is attenuated as it goes deeper into the
body
• Reflection
• Refraction
• Transmission
• Attenuation

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 Reflection
• The ultrasound reflects off tissue and returns
to the transducer, the amount of reflection
depends on differences in acoustic impedance
• The ultrasound image is formed from reflected
echoes

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 Reflection
• The reflection coefficient describes:
– the fraction of sound intensity incident on an interface
that is reflected
– The ultrasound reflects off tissue and returns to the
transducer, the amount of reflection depends
on differences in acoustic impedance
The ultrasound image is formed from reflected echoes
– Strong Reflections = White dots
– Weaker Reflections = Grey dots
– No Reflections = Black dots

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 Refraction

• when the beam is not perpendicular to the

boundary:
– the change in direction of the transmitted
ultrasound energy at a tissue boundary
• Ultrasound frequency does not change:
– when propagating into the next tissue
– but a change in the speed of sound occur.

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 Refraction

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 Transmission
• Some of the ultrasound waves continue
deeper into the body
• These waves will reflect from deeper tissue
structures

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 Attenuation
• Attenuation refers to:
– the loss of intensity of the ultrasound beam from
absorption and scattering in the medium.
• Defined - the deeper the wave travels in the
body, the weaker it becomes -3 processes:
reflection, absorption,refraction
• Air (lung)> bone > muscle > soft tissue >blood

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Scattering occurs by
– reflection or refraction,
– usually by small particles within the tissue
medium,
– causes the beam to diffuse in many directions
Absorption is the process whereby :
– acoustic energy is converted to heat energy.
– In this situation, sound energy is lost and cannot
be recovered.

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The FREQUENCY of the transducer
• The HIGHER the frequency, the LESS it can
penetrate
• The LOWER the frequency, the DEEPER it can
penetrate
• Wave length=sound velocity(c) /ultrasound
frequency(f)

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• The higher the applied ultrasound frequency
the better detection of small objects
• A 12 MHz transducer has very good
resolution, but cannot penetrate very deep
into the body
• A 3 MHz transducer can penetrate deep into
the body, but the resolution is not as good as
the 12 MHz

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 Ultrasound beam pattern
• If there no acoustic lens on the transducer surface,
the ultrasound beam is transmitted in a straight line
in the near field then begins divert from a certain
point in the far field as shown above. This is called an
unfocused beam
• If there an acoustic lens on the transducer surface
the ultrasound beam will be focused and convert as
a certain point called the focal point
• We can say generally the focused beam can obtain a
clearer image.
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 Resolution
• They are two major parameters, which
influence the diagnostic image quality these
are axial and lateral resolution
• Resolution can be defined as the ability of the
equipment to distinguish two separate objects

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 Axial Resolution
• Axial resolutions describe resolution in the
axial direction Axial resolution is determined
by the US wave length and frequency
• If the US beam use a short wave length we can
distinguish two separate objects which are
based closed together in line in axial direction.
This is because wave length of the US beam is
shorter than the distance

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• If the US beam uses a longer wave length , we
cannot distinguish two separate objects, this is
because the wave length is longer than the
distance between the two objects Because a
higher frequency mean a short wave length,
• We can say generally: that the higher the US
frequency, the higher the axial resolution

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 Lateral Resolution
• Lateral resolution describes resolution in the
lateral direction If the U.S. beam is wide, the
displayed object size may be bigger than the
actual object size so lateral resolution is poor.
• If the US beam is narrow the displayed object
size will be a closer to the actual size so lateral
resolution is better.
• Generally speaking: the narrow the US beam,
the higher the lateral resolution in general, the
higher the US frequency the higher the
resolution and the lower the penetration.
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• The lower the US frequency the lower the
resolution but the higher the penetration.
• To determine a wide range of diagnostic
requirements we need a wide range of US
frequencies that is why there is a wide
selection of probe frequency for studies of
different organs

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• Ultrasound has become a very powerful
imaging modality mainly due to its unique
temporal resolution, low cost, nonionizing
radiation, harmonic imaging, three-
dimensional visualization, transducer micro-
machining and portability.

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 Major Uses of Ultrasound
• Ultrasound has been used in a variety of
clinical settings, including obstetrics and
gynecology, cardiology and cancer detection.
– The main advantage of ultrasound is that certain
structures can be observed without using
radiation.
• Ultrasound can also be done much faster than X-rays or
other radiographic techniques.
• Here is a short list of some uses for
ultrasound:
– Obstetrics and Gynecology
– Cardiology
– Urology
 Obstetrics and Gynecology
– measuring the size of the fetus to determine the
due date
– determining the position of the fetus to see if it is
in the normal head down position or breech
– checking the position of the placenta to see if it is
improperly developing over the opening to the
uterus (cervix)
– seeing the number of fetuses in the uterus
– checking the sex of the baby (if the genital area
can be clearly seen)
 Obstetrics and Gynecology
– checking the fetus's growth rate by making many
measurements over time
– detecting ectopic pregnancy, the life-threatening situation
in which the baby is implanted in the mother's Fallopian
tubes instead of in the uterus
– determining whether there is an appropriate amount of
amniotic fluid cushioning the baby
– monitoring the baby during specialized procedures -
ultrasound has been helpful in seeing and avoiding the
baby during amniocentesis (sampling of the amniotic fluid
with a needle for genetic testing). Years ago, doctors use to
perform this procedure blindly; however, with
accompanying use of ultrasound, the risks of this
procedure have dropped dramatically.
– seeing tumors of the ovary and breast
 Cardiology
– seeing the inside of the heart to identify abnormal
structures or functions
– measuring blood flow through the heart and
major blood vessels
 Urology
– measuring blood flow through the kidney
– seeing kidney stones
– detecting prostate cancer early

• In addition to these areas, there is a growing

use for ultrasound as a rapid imaging tool for
diagnosis in emergency rooms.
 Dangers of Ultrasound
• There have been many concerns about the
safety of ultrasound.
– Because ultrasound is energy, the question
becomes "What is this energy doing to my tissues
or my baby?“
• There have been some reports of low birthweight
babies being born to mothers who had frequent
ultrasound examinations during pregnancy.
• The two major possibilities with ultrasound
are as follows:
– development of heat - tissues or water absorb the
ultrasound energy which increases their
temperature locally
– formation of bubbles (cavitation) - when dissolved
gases come out of solution due to local heat
caused by ultrasound
• However, there have been no substantiated ill-
effects of ultrasound documented in studies in
either humans or animals.
– This being said, ultrasound should still be used
only when necessary (i.e. better to be cautious).
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 A basic ultrasound machine has the following
parts:
– transducer probe - probe that sends and receives the
sound waves
– central processing unit (CPU) - computer that does all of
the calculations and contains the electrical power supplies
for itself and the transducer probe
– transducer pulse controls - changes the amplitude,
frequency and duration of the pulses emitted from the
transducer probe
– display - displays the image from the ultrasound data
processed by the CPU
– keyboard/cursor - inputs data and takes measurements
from the display
– disk storage device (hard, floppy, CD) - stores the acquired
images
– printer - prints the image from the displayed data

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 Central Processing Unit (CPU)
• The CPU is the brain of the ultrasound
machine.
– The CPU is basically a computer that contains the
microprocessor, memory, amplifiers and power
supplies for the microprocessor and transducer
probe.
• The CPU sends electrical currents to the
transducer probe to emit sound waves, and
also receives the electrical pulses from the
probes that were created from the returning
echoes.
– The CPU does all of the calculations involved in
processing the data.
• Once the raw data are processed, the CPU
forms the image on the monitor.
– The CPU can also store the processed data and/or
image on disk.
 Transducer Pulse Controls
• The transducer pulse controls allow the
operator, called the ultrasonographer, to set
and change the frequency and duration of the
ultrasound pulses, as well as the scan mode of
the machine.
– The commands from the operator are translated
into changing electric currents that are applied to
the piezoelectric crystals in the transducer probe.
 Display
• The display is a computer monitor that shows
the processed data from the CPU.
– Displays can be black-and-white or color,
depending upon the model of the ultrasound
machine.
 Keyboard/Cursor
• Ultrasound machines have a keyboard and a
cursor, such as a trackball, built in.
– These devices allow the operator to add notes to
and take measurements from the data.
 Disk Storage
• The processed data and/ or images can be
stored on disk.
– The disks can be hard disks, floppy disks, compact
discs (CDs) or digital video discs (DVDs).
• Typically, a patient's ultrasound scans are stored on a
floppy disk and archived with the patient's medical
records.
 Printers
• Many ultrasound machines have thermal
printers that can be used to capture a hard
copy of the image from the display.
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• The cable provides the electrical connection.
• The strain relief supports the very fine coaxial cables
in the cable.
• The case protects the internal crystal connections.
• The damping material isolates the crystal element
from mechanical noise and provides mechanical
support.
• The piezoelectric element converts electrical impulses
to mechanical motion and back.
• The filler or lens provides mechanical isolation for the
crystal element, impedance matching and it’s shape
provides focus
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• Crystalline or semi crystalline polymers are
the poly vinylidene fluoride (PVDF), quartz,
quartz, barium titanate, and lead zirconium
titanate (PZT).
 Dependent upon its thickness (l) and
propagation speed (c), the piezoelectric
material has a resonance frequency given by
f = c/2l
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 Cont..
 The speed in the PZT material is around 4000 ms-1,
so for a 5-MHz transducer, the thickness should be

0.4 mm thick.

 The matching layer is usually coated onto the

piezoelectric crystal in order to minimize the
impedance mismatch between the crystal and the
skin surface

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 Type of probes

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 Damaged Ultrasound probes

Malfunction of signal cable

Malfunction of
matching layer

Strain relief was torn Cover was broken

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 Display mode of ultrasound/scan

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 A-mode (Amplitude scan)
• Gives no photo image
• Pulses of ultrasound sent into the body, reflected
ultrasound is detected and appear as vertical
spikes on a CRO screen.
• Used to measure distance
• The horizontal positions of the ‘spikes’ indicate
the time it took for the wave to be reflected.
• Commonly used to measure size of foetal head.
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 B-mode/Brightness
 An array of transducers is used and the ultrasound
beam is spread out across the body.
 Returning waves are detected and appear as spots of
varying brightness.
 These spots of brightness are used to build up a
picture.
 Strong reflection will show brighter dots
 Week reflection cause of less brighter dots
 Two dimensional display

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 M-mode/motion
• Is the scrolling display allowing the operator to view
and recording organ motion
• This display mode is useful for studying moving
target
• movement of body structure are displayed while
the transducer is keep in fixed position, but B&M
mode is common
• This mode can be useful when imaging heart valves,
because the movement of the valves will make
distinct patterns in the “image”
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• A Mode presents reflected ultrasound energy on a single line display.
The strength of the reflected energy at any particular depth is
visualized as the amplitude of the waveform.
• B Mode converts A Mode information into a two dimensional
grayscale display.
• C Mode is a color representation of blood flow velocity and direction.
• D Mode is a spectral representation of blood flow velocity and
direction.
• P Mode is used to visualize very low blood flows in color. Unlike C
Mode, this mode does not show the operator flow direction.
• Triplex is the simultaneous operation of B Mode, C Mode and D
Mode.
• M Mode is a scrolling display allowing the operator to view and
record organ motion

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 Doppler Ultrasound
• Doppler ultrasound is based upon the Doppler
Effect.
– When the object reflecting the ultrasound waves is
moving, it changes the frequency of the echoes,
creating a higher frequency if it is moving toward the
probe and a lower frequency if it is moving away from
the probe.
• How much the frequency is changed depends
upon how fast the object is moving.
– Doppler ultrasound measures the change in frequency
of the echoes to calculate how fast an object is moving.
• Ultrasound wave reaches the moving red blood cell
and bounces back. However, this time if you
measured the frequency of the returned wave, it
will not be the same as the frequency of the
transmitted wave.
• The wave that bounces off an object moving
towards the probe will have a higher frequency than
the frequency of the wave transmitted from the
probe. This is because the moving object “squashes”
the waves as it moves towards the probe
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• Doppler ultrasound
used to measure blood
flow through the heart.
– The direction of blood
flow is shown in different
colors on the screen.
 Types of US Doppler Technique
• Pulsed-wave Doppler (PW Doppler)
• Continuous-wave Doppler (CW Doppler
• Color Flow Imaging (CIF)

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 Sample key board

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 Common key board buttons

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 Cont..

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 Ultrasound image artifacts
• Image artifacts: Any missing or distorted
image that does not match the real image of
the part being examined
Artifact causes
• Acoustic characteristics of the tissue
• Scanners setting
• Lack of user’s experience
• Defected part within the scanner
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 Common artifacts
• Cyst’s artifact(strong back-wall effect)
• Abdominal wall artifact
• Gas artifact
• Reverberation artifact
• Incomplete image artifact
• Gain artifact
• Shadow artifact

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 Daily checks
• Visually inspects all transducers. Cable, cracked
surface, punctured, discolored casing
• Visually inspect the power cords.
• Verify that the trackball and DGC controls appears
clean and free from gel or other contaminants.
Once the system is powered on:
• Verify that the monitor displays CORRECTLY the
connected transducer’s identification, current
date, time.
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 Daily adjustments
• FOCUS.
• DEPTH GAIN COMPENSATION.
• OVERALL GAIN.
• ZOOM.
• MONITOR (B/C).

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 Cleaning and disinfecting
• Transducers
• Surface of the system
• Track ball
• Filters
• TGC controls slides

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