ULTRASOUND

Contents
Advantages vs Disadvantages...........................................................................................2
Advantages....................................................................................................................2
Disadvantages................................................................................................................2
Definition. Newton-Laplace Equation. Principles.............................................................3
Newton-Laplace Equation.............................................................................................3
Principles.......................................................................................................................3
Intensity Beam...................................................................................................................3
Interactions with Tissue.....................................................................................................3
Snell's Law....................................................................................................................3
Reflection......................................................................................................................3
Refraction......................................................................................................................3
Diffraction.....................................................................................................................3
Attenuation........................................................................................................................3
Piezoelectric Effect............................................................................................................3
Types of Transmission.......................................................................................................4
Pulsed Wave..................................................................................................................4
Continuous Wave...........................................................................................................4
Transducer.........................................................................................................................4
Construction..................................................................................................................4
Quality Factor (Q).........................................................................................................4
Fields.................................................................................................................................5
Near Field......................................................................................................................5
Far Field.........................................................................................................................5
Imaging Modes..................................................................................................................5
A-Mode (Amplitude Mode)..........................................................................................5
B-Mode (Brightness Mode)...........................................................................................5
M-Mode (Movement Mode)..........................................................................................5
Artefacts............................................................................................................................6
Doppler..............................................................................................................................6
Principles.......................................................................................................................6
Spectrum........................................................................................................................6
Pulsed Wave..................................................................................................................6
 Pulsed............................................................................................................................7
Colour Flow...................................................................................................................7
Visualization..............................................................................................................7
Aliasing..........................................................................................................................7
Quality...........................................................................................................................7
Test Objects...............................................................................................................7
Testing Levels............................................................................................................7
Elastography....................................................................................................................8
Contrast Agents.................................................................................................................8
Harmonic Imaging.............................................................................................................9
Principles.......................................................................................................................9
Beam Generation...........................................................................................................9
3D Ultrasound...................................................................................................................9

Advantages vs Disadvantages
Advantages
 Non-ionizing: No exposure to ionizing radiation, making it safer for patients.
 Comparatively Inexpensive: Cost-effective compared to other imaging
modalities like MRI and CT.
 Real-Time Imaging: Allows for dynamic assessment of organs and blood flow.
 Good Resolution: Achieves millimeter/sub-millimeter resolution at higher
frequencies.
 Information about Blood Flow: Can assess blood flow and detect
abnormalities.
 Compact and Portable: Devices are often small and can be brought to the
patient.

Disadvantages
 Limited Imaging of Certain Organs: Organs containing gas (lungs) or bony
structures cannot be effectively imaged.
 Limited Imaging Windows: Some organs, like the heart and brain, can only be
imaged through specific windows.
 Operator Dependency: Highly dependent on the skill and experience of the
operator.
  Patient Variability: Difficult to obtain good images in certain patients (e.g.,
large patients or those with calcifications).

Definition. Newton-Laplace Equation.

Principles
Definition
 Ultrasound: High-frequency sound waves (>20 kHz) used in medical imaging,
typically in the range of 1-20 MHz for diagnostic purposes.

Newton-Laplace Equation
 Speed of Sound (c): Determined by the elastic properties and density of the
medium.
 Equation: v and mu elastic constants of material.

Principles
 Propagation: Ultrasound waves travel as longitudinal compression waves.
 Amplitude: Related to the pressure and displacement of the waves.
 Frequency and Wavelength: Spatial resolution depends on the frequency, with
higher frequencies providing better resolution but less penetration.

Intensity Beam
 Definitions:
 ISP (Spatial Peak Intensity): Peak intensity in the ultrasound beam.
 ISA (Spatially Averaged Intensity): Average intensity over the beam
area.
 ITP (Temporal Peak Intensity): Peak intensity during a pulse.
 ITA (Temporal Average Intensity): Average intensity over time.
 Importance: Temporal peak intensity can be very high, even if the time-
averaged intensity is low, impacting biological effects.
Interactions with Tissue
Snell's Law
 Law: Describes the refraction of ultrasound waves at an interface between two
media with different sound velocities.
 Equation: sin⁡𝜃𝑖sin⁡𝜃𝑡=𝑐1𝑐2sinθtsinθi=c2c1
 𝜃𝑖θi: Incident angle.
 𝜃𝑡θt: Transmitted angle.
 𝑐1,𝑐2c1,c2: Sound velocities in media 1 and 2, respectively.

Reflection
 Reflection: Occurs when the ultrasound wave encounters a boundary between
two different tissues.
 Acoustic Impedance (Z): Determines the fraction of the wave that is
reflected.
 Equation: 𝑍=𝜌𝑐Z=ρc
 𝜌ρ: Density.
 𝑐c: Speed of sound.
 Reflection Coefficient (R): 𝑅=(𝑍2−𝑍1𝑍2+𝑍1)2R=(Z2+Z1Z2
−Z1)2

Refraction
 Refraction: Bending of the ultrasound wave as it passes from one medium to
another with different sound speeds.
 Equation: Derived from Snell's Law.

Diffraction
 Diffraction: Bending and spreading of ultrasound waves around obstacles and
openings.
 Interference Patterns:
 Constructive Interference: Peaks coincide.
 Destructive Interference: Peaks coincide with troughs.

Attenuation
 Attenuation: Reduction in the amplitude and intensity of the ultrasound wave as
it travels through tissue.
  Mechanisms:
 Absorption: Conversion of sound energy into heat.
 Scattering: Redirection of sound waves in multiple directions.
 Attenuation Coefficient: Varies with frequency and type of tissue.
 Higher Frequencies: Greater attenuation.

Piezoelectric Effect
 Definition: The ability of certain materials to generate an electric charge in
response to mechanical stress.
 Mechanism:
 Polarized Crystal: Crystals like PZT (lead zirconate titanate) and PVDF
(polyvinylidene difluoride) are used.
 Compression and Expansion: When compressed, the crystal generates a
voltage; when expanded, it generates an opposite voltage.
 Applications:
 Transmitter: Applying a varying voltage causes the crystal to vibrate,
emitting ultrasound waves.
 Receiver: Vibration of the crystal due to incoming ultrasound waves
generates a varying voltage.

Types of Transmission
Pulsed Wave
 Definition: Sends out short pulses of ultrasound and listens for echoes.
 Depth Information: Timing of echo return provides depth information.
 Advantages: Allows depth resolution and axial resolution due to pulse length.

Continuous Wave
 Definition: Continuously transmits and receives ultrasound waves.
 Applications: Used for continuous monitoring of blood flow.
 Limitations: Does not provide depth information.
Transducer
Construction
 Crystal Thickness: Half-wavelength thickness for constructive
interference and optimal resonance.
 Housing: Provides electrical and acoustic insulation.
 Backing Block: Absorbs excess vibrations to improve resolution.
 Matching Layers: Reduces reflections and improves transmission
efficiency.

Quality Factor (Q)

𝑄=Resonant frequencyBandwidthQ=BandwidthResonant frequency

 Formula:

 High Bandwidth: Can detect harmonic frequencies and provide better

resolution.
 Low Q: Produces shorter pulses, improving resolution.

Fields
Near Field
 Definition: Region close to the transducer where constructive and destructive
interference patterns create peaks and troughs.
 Characteristics: Complex interference patterns, providing higher resolution.

Far Field
 Definition: Region beyond the near field where the ultrasound beam becomes
more uniform and diverges.
 Characteristics: Smoother field, lower resolution compared to the near field.

Imaging Modes
A-Mode (Amplitude Mode)
 Function: Measures the amplitude of echoes returning from different depths.
 Output: Provides a one-dimensional trace of echo amplitude along the path of
the transducer.
  Usage: Historically used, now largely obsolete.

B-Mode (Brightness Mode)

 Function: Creates a 2D image by sending out pulses and recording the strength
of returning echoes.
 Process:
 Pulse Transmission: A pulse is sent, and echoes are collected.
 Depth Measurement: Time of return determines the depth.
 Image Formation: Multiple lines are scanned to form a 2D image.
 Advancements: Modern systems use multiple elements and electronic switching
for faster and more accurate imaging.

M-Mode (Movement Mode)

 Function: Records the motion of structures over time.
 Process:
 Repeated Line Acquisition: A stationary image line is repeatedly
acquired.
 Temporal Sweep: The image line is swept horizontally to display
changes over time.
 Applications: Commonly used in cardiac imaging to assess heart motion.

Artefacts
 Multiple Reflection (Reverberation):
 Cause: Echoes bounce back and forth between structures, creating
delayed return signals.
 Effect: Produces artefacts beyond the true structures.
 Double Reflection:
 Cause: Echoes reflect off structures multiple times before returning.
 Effect: Creates mirror image artefacts, such as ghost images.
 Shadowing and Enhancement:
 Cause: Structures with high or low attenuation affect the ultrasound
beam.
 Effect: Highly attenuating structures create shadows, while low
attenuating structures create brighter areas beyond them.
Doppler
Principles
 Doppler Effect: The change in frequency or wavelength of a wave in relation to
an observer moving relative to the wave source.
 Medical Application: Used to measure blood flow by detecting frequency shifts
in the returning echoes from moving red blood cells.

Spectrum
 Blood Flow Velocities: Blood flow within a vessel varies, leading to a spectrum
of frequencies in the returning echoes.
 Doppler Spectral Analysis: Uses Fourier analysis to separate echoes based on
their frequency shifts, reflecting the velocities of red blood cells.
 Sonogram: A visual representation showing the flow velocities over time.

Pulsed Wave
 Definition: Sends out pulses of ultrasound and measures the frequency shifts in
the returning echoes.
 Depth Selection: Allows selection of a specific depth range (gate) for Doppler
measurements.
 Pulse Repetition Frequency (PRF): The frequency at which pulses are sent
out; must be high enough to avoid aliasing.

Pulsed
 Multiple Pulses: Typically, around 40 pulses are sent out to gather Doppler data.
 Sampling: Samples are spaced according to the PRF; must sample at more than
twice the maximum frequency to avoid aliasing.

Colour Flow
 Principle: Encodes the mean frequency shift into colors to represent the
direction and magnitude of blood flow.

Visualization
 Flow Towards Transducer: reds and oranges.
 Flow Away from Transducer: blues.
 Velocity Variations: Darker colors near vessel walls indicate slower
flow, while lighter colors in the center indicate faster flow.
 Speed: Requires fast processing for good frame rates, which can be challenging
for large regions of interest (ROI).
Aliasing
 Definition: An artifact that occurs when the PRF is not high enough to
accurately sample the Doppler shifts.
 Appearance: High flow velocities, such as at a stenosis, can cause aliasing,
appearing as color wrap-around on the Doppler image.

Quality
 Quality Assurance (QA): Ensuring the reliability and accuracy of ultrasound
equipment through regular testing and maintenance.

Test Objects
 Tissue Equivalent Phantoms: Water-based gel with graphite particles to
simulate tissue attenuation and velocity.
 Embedded Wires: Thin metal or nylon wires to check the accuracy of
distance measurements.
 Echogenicity Variations: Areas that mimic cysts or other structures with
varying echogenicity.

Testing Levels
 User Tests: Conducted monthly, usually without special equipment.
 Detailed Tests: Conducted yearly, using phantoms to simulate various
conditions.
 Importance: Regular testing helps detect gradual deterioration of equipment,
which may not be immediately noticeable to users.

Elastography
 Definition: An imaging modality that maps the elastic properties of soft tissue.
 Principle: Measures tissue stiffness by comparing ultrasound images taken
before and after applying a mechanical force.
 Technique:
 Speckle Tracking: Ultrasound speckle patterns are compared to
determine tissue displacement and strain.
 Color Coding: Hardness of tissue is color-coded to generate an image
representing mechanical properties.
 Applications: Commonly used to characterize tumors, as malignant tissues are
usually stiffer than benign tissues.
Contrast Agents
 Definition: Substances used to enhance ultrasound imaging.
 Types: Encapsulated gas bubbles or microspheres.
 Properties:
 Circulation: Last up to a few minutes in circulation and can pass
through pulmonary capillaries.
 Enhancement: Enhances Doppler signals by providing strong reflectors.
 Nonlinear Vibration: Large pulses can break up the bubbles, resulting in
stimulated acoustic emission.
 Techniques:
 Initial Large Signal Imaging: Imaging the initial signal from the intact
bubbles.
 Reperfusion Imaging: Imaging the reappearance of contrast as new
bubbles enter the imaging field.

Harmonic Imaging
Principles
 Definition: An advanced ultrasound technique that utilizes harmonic frequencies
generated by tissue or contrast agents.
 Mechanism:
 Nonlinear Vibration: Tissue and contrast agents generate harmonics at
multiples of the transmitted frequency.
 Harmonics Detection: Ultrasound machines are designed to detect these
weaker harmonic signals.
 Improved Imaging: Harmonic imaging reduces artifacts and improves
image resolution and contrast.

Beam Generation
 Generation:
 Within Tissue: Harmonic beams are generated within the tissue,
reducing multiple reflection artifacts.
 Better Resolution: Harmonic beams produce narrower beams with
better resolution and contrast.
 Lower Amplitude Echoes: Weaker fundamental echoes are reduced,
enhancing the clarity of the image.
3D Ultrasound
 Definition: An extension of traditional 2D ultrasound that creates three-
dimensional images.
 Techniques:
 Stack of 2D Images: A series of 2D images are captured by moving the
transducer perpendicular to the image plane, either manually or by
electronic beam steering.
 3D Image Formation: The stack of 2D images is combined to form a
3D image.
 Applications:
 Fetal Imaging: Commonly used for diagnosing fetal abnormalities
through surface-shaded 3D images.
 Cardiac Imaging: Used for detailed visualization of cardiac structures,
aiding in surgery and interventions.
 Advantages: Provides comprehensive spatial information, improving diagnostic
accuracy and planning.