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ULTRASOUND

Sound waves are produced by vibrating sources. The vibrating sources cause the adjacent
molecules in the air to be compressed and expanded depending on the movement of the source
and oscillated with the frequency of the source. Sound wave can be transmitted through many
materials, such as air, water, wood and biological tissue but the sound cannot travel in a vacuum.
The resultant air compressions are accompanied by increases in the pressure. Here zero pressures
refer to equilibrium, usually the atmospheric pressure, if we are considering a sound wave in air.
Places where particles are squeezed together are referred to as regions of compression and the
pressure here is greater than zero. Places where particles are expanded are referred to as regions
of rarefaction (expansion) and the pressure here is less than zero.

Sound waves are generally classified based on the frequency of the waves. Infrasound
waves are less than 20 Hz and cannot be heard by humans. Audible sound falls in the range
between 20 Hz and 20,000 Hz. Any sound wave frequency above the limit of human hearing is
technically considered ultrasound. However, in diagnostic ultrasound generally the most used
frequencies are ranging from 1 MHz up to 20 MHz.
Why high frequency?
It gives the ability to determine small objects.
It gives the penetrability of the beam.
The beam become more collimated and directional
ULTRASOUND IMAGING ADVANTAGES:

The transducer has two functions, it is used to send and receive the reflected signal from
the tissue of interest. One of the advantages of ultrasound imaging is that it produces high-
resolution images that rival (competitor) another relatively common imaging modality: x-ray
imaging, plus it can produce real-time images. Ultrasound is a very valuable diagnostic tool in
medical disciplines such as cardiology, obstetrics, gynecology, surgery, pediatrics, radiology,
and neurology.
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ACOUSTIC IMPEDANCE:

The acoustic impedance is resulted from the production of the material density and the speed of
the sound in the material. The significance of this quantity is its role in determining the
amplitude of reflected and transmitted waves at an interface.

Z = P*V. kg/ m2s (10-6) )

ATTENUATION:

As waves travel through a medium that contains molecules packed in various densities,
the molecules will be brought into oscillation and, hence, energy is depleted from the wave
propagation, Attenuation of waves in biological tissues can occur by absorption, refraction,
diffraction, scattering, or reflection.
Since the ultrasound transducer can only detect sound waves that are returned to the
crystal, the absorption of sound in the body tissue decreases the intensity of sound waves that can
be detected. Since most soft tissues transmit ultrasound at nearly the same velocities, refraction
of ultrasound is usually a minor problem, although sometimes organs can appear to be displaced
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or have an incorrect shape due to the refraction of the ultrasound waves coming from or going to
the transducer.
Attenuation in soft tissue is highly dependent on the ultrasonic frequency. In most cases
attenuation is nearly proportional to the frequency.

REFLECTION:
Whenever an ultrasound beam is incident on an interface formed by two materials having
different acoustic impedance, in general, some of the energy in the beam will be reflected and the
reminder transmitted (Figure 1). The amplitude of the reflected wave depends on the difference
between the acoustic impedance of the two materials forming the interface.

Figure 1
In fact at most soft tissue-soft tissue interface in the body the reflection coefficient is
fairly small and most of the sound is transmitted through the interface. In case, that the beam is
almost completely reflected. This illustrates the difficulty in transmitting ultrasound beyond any
tissue to air interface. Nearly total reflection results in virtually no sound beyond the interface.

The complete reflections at air interfaces also explain the need for a coupling medium,
such as gel, between the ultrasound transducer and the tissue of the patient during ultrasound
examinations. Soft tissue-to-bone is also strong reflector. Reflection of sound beam occurs
whenever the beam is incident on an interface formed by two tissues having different acoustic
impedance. The acoustic impedance could be cause by a change in speed of sound, a change in
densities or both.
SCATTERING:
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If an ultrasound beam is incident on a highly irregular or rough surface such as kidney

(Figure 2A) or on particles with small size comparable or small compared with wave length , the
incident beam is scattered in all direction example of small scatters include red blood cells and
small structures distributed throughout the Parenchyma of most organs (Heterogeneous tissue
such as liver) (Figure 2B).

(Figure 2)
ULTRASOUND WAVES PROPERTIES:

As mentioned before, ultrasound imaging has reasonable similarities to x-ray imaging.

On the other hand, there are considerable differences between ultrasound imaging and with x-ray
imaging. Ultrasound has no reported side effects for biological imaging applications, whereas x-
ray ionizes molecules and atoms since its energy approaches the atomic binding energies. The
speed of an ultrasound wave is different in different tissues, whereas electromagnetic waves only
have a relatively slight difference in speed of propagation between most biological tissues.
Informally speaking, the wave spends more time passing through one type of tissue than
another one. For instance, the speed of ultrasonic waves in soft tissue is much less than the speed
of electromagnetic waves (including x-ray and light): for example, V sound = 1540 m/s versus
Velectromagnetic = 2.9979 × 108 m/s; however, a small but detectable variation in the speed of sound is
capable of providing detailed structural information. The reason why the changes in speed of
sound propagation are detected is the reflection from boundaries with different densities on
either side.

TRANSDUCER:
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Several component compromise the transducer (Figure 3). The case provides structural
support for the internal filling and mechanical support so the device can be manipulated by hand.
The face of the transducer assembly is a protective acoustic window designed to match the active
crystal and transmit the ultrasound beam through acoustic coupling to the patient. A matching
layer with acoustic impedance is used to improve ultrasound transmission into tissue by
reducing surface reflectivity.

Figure 3
Ultrasound waves can be produced in different modes of operation. The most often used
mechanism is piezoelectrically. In piezoelectric ultrasound generation, a class of molecules with
an unequal distribution of electric charges can be driven to oscillation by applying an external
alternating electric field. As a result, the medium made up of these molecules changes shape in
harmony at the rhythm of the alternating current through the medium. Common transducer
materials are, for instance, barium titanate, and lead zirconate–titanate,. The most commonly
used ceramic material is a lead zirconate–titanate crystal. This crystal is sandwiched between two
electrodes that provide a voltage across the thickness of the crystal. The crystal will hence
change (Figure 4) shape when a voltage is applied to it. Conversely, any ultrasonic transducer
material will also produce a voltage when it changes shape.
The piezoelectric crystals produce sound waves with only milliwatts of power, which is
still appropriate for diagnostic use. Since the emitted and received levels of acoustic power are
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very small, the intensity of the sound waves often provides a better mechanism to describe the
magnitude of the sound.

Figure 4
Consequently, the piezoelectric crystals are backed by material designed to damp the
movement of the crystal so that, when the electric stimulus is removed, the crystal will cease
motion immediately.
The focusing plays an important roll in determining and reaching to the tissue of interest.
Focusing the beam is accomplished by shaping the crystal, the face and using acoustic lens.
OPERATION MODE:

The pressure waves collected by the piezoelectric detector followed by conversion into an
electronic signal can subsequently be recorded on an oscilloscope. The oscilloscope can
represent the received signal in the following modes of operation: A-mode stands for amplitude
mode, and B-mode represents brightness mode. Additional operational modes are M-mode or
TM-mode (Time-mode). These modes can be divided as follow:

(A) - STATIC IMAGING MODES:

1) - A-MODE IMAGING:
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A-mode (Figure 5) is used when distances need to be calculated in relative accuracy.

Examples of A-mode imaging are found in neurology and in ophthalmology. In neurology the
mid-line echo of the separation between the left and the right side of the brain often needs to be
determined. The mid-line echo needs to be measured exactly in between both the sides of the
scull; any deviation is an indication of abnormal case. This method is fast and relatively
inexpensive and accurate enough for a first diagnosis.

Figure 5
In ophthalmology, the measurement of eye dimensions: length of the eye, position of the
lens, and the location of foreign objects, can be measured in A-mode imaging. However, most of
these diagnoses can also be done with greater precision and not much more expensively by laser
interferometry measurement.

2) - B-MODE IMAGING

In B-mode (Figure 6) imaging the amplitude of the collected electronic signal is

represented by a relative brightness of the tracking dot on the screen.
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Figure 6
In A mode display, the height of the blip is proportional to the intensity of the reflected
wave. If that blip is now squeezed down to a dot on CRT (screen) display, its brightness will be
proportional to the intensity of the reflected wave, this type of display is called B-mode
“brightness mode”. This has two dimensional sight.
In the so called B-mode ultrasound scan (brightness mode), the line along which the
ultrasound scan is made is varied in angle and a two dimensional image is created. By scanning
this two dimensional plane continuously; a moving image is created of the fetus and for instance
the heart. The B-mode is used to study the abdominal imaging.

(B) - DYNAMIC IMAGING MODES :

1) - M-Mode or TM-Mode Imaging
If a pulse-echo transducer is positioned over the heart and operated in the A mode, the
image will contain a number of blips, some of them stationery and some vibrating back and
forth. The stationary blips indicate motionless interfaces, and their amplitude is proportional to
the intensity of the echo. The vibrating blips represent interfaces that are in motion relative to the
transducer. The magnitude of the vibration of each blip represents the degree of movements of
the tissue interface.
In M-mode (Figure 7) the display keeps track of each scan by the transducer, while
adding subsequent scans as a function of time to the same display. When an artifact that provides
a reflection remains in one place, the brightness spot does not move in each subsequent scan line;
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however, when there is movement, the data created by the moving reflection will change position
on the screen as well.

Figure 7
In order to make variations more clear the ultrasonic image along this beam is displayed as a
function of time. Ultrasound M-mode analysis is a technique in which a reflected ultrasound
signal is plotted against time, In this way a two-dimensional image is created, by focusing the
ultrasound transducer array along a line and recording the reflected waves. Hence, this mode is
often used to study moving structures such as the heart. The M-mode principal application is in
dynamic imaging of internal structure.
2 - REAL-TIME SCANNERS:

Real time ultrasound is dynamic imaging. It is to compound B-mode what fluoroscopy to

radiography. There are three types of real-time ultrasound devices mechanical devices, the linear
array and the phased array.

a) - MECHANICAL SCANNER:
These units employ either single or multiple transducers. The transducers
assembly is motorized so that the ultrasound beam is mechanically swept across the
desired field of view in an oscillating fashion (Figure 8). Each sweep results in one image
frame.
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Figure 8

b) - LINEAR ARRAY SCANNING:

1) - SEQUENTIAL LINEAR ARRAY:
In figure (9) a line of transducers is contained in a single case. When individual
transducers are energized sequentially, they must remain active long enough to receive the
reflected ultrasound wave.

Figure 9
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2) - SEGMENTAL LINEAR ARRAY:

In A segmental linear array (Figure 10) four or five contiguous transducers are energized
simultaneously so that each pulse of ultrasound results in four or five scan lines. In typical
system transducers numbers 1 to 5 will be energized for one pulse and produce five scan lines.

Figure 10
The second ultrasound pulse will be emitted by transducer 2 to 6, which again will produce five
scan lines of information. Next transducers 3 to 7 are energized to produce an additional five
scan lines of information. The advantage of the segmental linear array is that it provides for
increased image line density over the sequential array and consequently results in better image
quality.

3 - PHASED ARRAY SCANNER:

It is a very similar to the linear array, but the electronic control of the emission and
reception results in sector scan. The delaying of excitation of each transducer element is known
as phasing and such an assembly as Phased array (Figure 11).
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Figure 11
CURVED ARRAY:
It is a linear array transducer into convex shape, with an image which combines a
relatively large surface field of view with sector display format.
Large versions are serving for general abdominal, obstetric, trans-abdominal and pelvic
scanning. Small versions with high frequency are often used in trans-vaginal and trans-rectal
scanning and for pediatric imaging.

DOPPLER EFFECT:

Doppler ultrasound: C. J. Doppler noted that the wavelength of the light varied according
to the relative motion of the source of light and the observer. This principal can be applied on the
sound in the same manner as light. For any sound beam, whenever there is relative motion
between the source and the listener, the frequency heard by the listener will defer from that
produced by the source. The received frequency will be either greater or less than that
transmitted by the source depending on whether the source and the listener are moving toward or
away from one another. Such a shift in the received frequency relative to the transmitted
frequency is called Doppler shift. A Doppler frequency shift can occur for a moving source and
stationary listener, a moving listener and stationery source, or a moving source and moving
listener.
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The use of Doppler ultrasound is a common means of detecting heart beats in order to
calculate the heart rate “HR”. The transducer is used to send and receive the reflected signal
from the heart. The received signal is demodulated producing an audio frequency signal,
representing the Doppler frequency shifts imposed upon the original ultrasound frequency by
heart movement.

DUPLEX SCANNER:
Currently Phased array real-time ultrasound is the principal ultrasonic imaging technique. A
promising extension of this technique is the Duplex scanner, which incorporate multi-element
transducer with Doppler detection of motion. In addition to detection of motion, such systems are
finding great application in blood flow imaging, blood vessel wall, the direction of the blood
flow it can be detected with color imaging , red color indicate the blood is flowing away and
blue indicate it is flowing toward the transducer. The relative velocity of flow can be indicated
by the color intensity. It is also known as a ‘‘color flow Doppler.’’ Visualization is usually two-
dimensional (2D) but can also be three dimensional (3D). 3D is a image representation of a
volume or 3D object, such as the heart or fetus or four dimensional (4D). (4D) is a 3D image
moving in time.
FETUS:
In general there are many benefits of having the ability to store and manipulate the data,
this should enhance the ability to image the maternal pelvic, the fetus and placenta. In addition to
that it can give the possibility to calculate the expected date of delivery (EDD) by measuring the
diameter of the head of the fetus or by measuring the femur.
KIDNEY:
The ultrasound is used to localize the kidney stone position or by using x-ray, while the
destruction of the stone can be performed by repeated application of acoustic shock-wave
(LITHOTREPSY).

DENTISTRY:
It is used for measuring the thickness of the soft tissue in the oral cavity.
TUMORS:
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Modern ultrasound has different algorithms for different functions, which are used to
calculate the distance, area and volume, thus tumor can be detected and localized by ultrasound.