Ultrasound

Ultrasound Chapter 16
April 2 April 16, 2009
Objectives
Kalpana Kanal, Ph.D., DABR

Assistant Professor, Diagnostic Physics
Director, Radiology Resident Physics
Dept. of Radiology
UW Medicine
To understand:
The basic mechanism underlying the formation of ultrasonic images

images
The various characteristics of ultrasonic waves
The various types of interactions of ultrasonic waves with matter

matter
a copy of this lecture may be found at:

http://courses.washington.edu/radxphys/PhysicsCourse.html
Kalpana M. Kanal, Ph.D., DABR
16.0 Introduction (1)
Ultrasound imaging is a nonnon-ionizing method using sound waves of

frequencies (2 - 10 MHz) exceeding the range of human hearing
Medical diagnostic ultrasound uses ultrasonic waves and the
acoustic properties of the body to produce images from stationary
stationary
and moving tissues
c.f. Dowsett, et al. The Physics of

Diagnostic Imaging, 2nd ed., p. 511.
Kalpana Kanal, PhD
Medical diagnostic ultrasound is used in a call and response

response pulsepulseecho format, wherein short duration ultra sonic pulses travel through
through
intervening tissues and are reflected at tissue boundaries back to
the source
Returning echoes carry the ultrasonic information used to create the
sonogram or measure blood velocities with Doppler frequency
techniques

16.1 Characteristics of Sound:

Propagation (1)
Along a given beam path the depth of an echoecho-producing structure is

determined from the time interval between pulsepulse-emission and echo
return; the relative amplitude of the echo is encoded as a digital
digital
display value
In addition to 2D imaging, medical diagnostic ultrasound provides
provides
anatomic distance, volume and fluid velocity measurements, as well
well
as motion studies and 3D imaging

c.f. Bushberg, et al. The Essential Physics

of Medical Imaging, 2nd ed., p. 471.

Propagation (2)
Kalpana Kanal, PhD

Wavelength
Sonic energy travels as

longitudinal waves parallel to
the direction of the transducer
Sonic energy can also be
produced in short bursts, such
that a small pulse travels by
itself through the medium
Echoes, reflections of the
incident energy pulse occur
due to differences in the elastic
properties of the medium

A sonic wave is a form of

mechanical energy that
propagates through a medium
by compression and
rarefaction of particles that
compose it
Corresponding variations in
positive and negative pressure
amplitude, the magnitude of
which is proportional to the
compressibility of the medium
Wavelength (
() is the distance between two adjacent bands of
compression or rarefaction [meters, m]
adapted from: Bushberg, et al. The Essential

Physics of Medical Imaging, 2nd ed., p. 18.


Frequency

Speed (1)
Frequency (f)
(f) is the number of times the wave oscillates
through a cycle each second [Hertz: (Hz) or cycles/sec or sec-1]
Infra sound < 15 Hz
Audible sound ~ 15 Hz - 20 kHz
Ultrasound > 20 kHz; for medical usage typically 22-10 MHz with
specialized ultrasound applications up to 50 MHz
period (
() - the time duration of one wave cycle: = 1/f

Speed (2)
10

Wavelength, Frequency and Speed (1)
speed of sound is the distance traveled by the wave per unit time
time =
c [m/sec] = [m] f [sec-1]
c = [m] / [sec]; soft tissue = 1540 m/sec
@ 5MHz in soft tissue, =0.3 mm
Dependent on the propagation medium and varies widely in different
different
materials
In a highly compressible medium such as air, sound waves travel at
low speed
In a less compressible medium such as bone, sound waves travel at
at
higher speed
Ultrasonic frequency is unaffected

by changes in speed as the
acoustic wave propagates through
various media
Wavelength is dependent on
the medium (c
(c = f )
The change in speed at an
interface between two media
causes a change in
Remember: wave with higher f
shorter in a specified media
The difference in the speed of sound at tissue boundaries is a

fundamental cause of contrast in an ultrasound image

Kalpana Kanal, PhD
11

12


Ultrasound wavelength
determines the spatial resolution
achievable along the direction of
the beam
A highhigh-frequency ultrasound beam
(small wavelength) provides
superior resolution and image
detail than a lowlow-frequency beam
However, the depth of beam
penetration is reduced at high
frequency and increased at low
frequencies

13

D63. The wavelength of a 2 MHz ultrasound beam is ________ mm.
A. 0.02
B. 0.55
C. 0.77
D. 2.0
E. 5.0
Remember: = c / f
Average c in tissue = 1540 m/sec and f = 2 x 106 sec-1
= 1540 m/sec / 2 x 106 sec-1 = 770 x 10-6 m = 0.77 mm
Kalpana Kanal, PhD
14

Pressure, Intensity and the dB Scale (1)
Raphex 2003 Diagnostic Question
For thick body parts

(abdomen), a lower frequency
ultrasound wave is used (3.5 to
5 MHz) to image structures at
significant depth
For small body parts or organs
(thyroid, breast), a higher
frequency is employed (7.5 to
10 MHz)
15
The pressure amplitude = peak maximum

or peak minumum from average pressure
Ultrasound intensity
the amount of power (energy per unit time) per unit area
proportional to the square of the pressure amplitude, I P2
units of milliwatts/cm2 or mW/cm2
measured in decibels (dB) as a relative intensity
dB = 10 log10 (I2/I1) or dB = 20 log10 (P2/P1) since I P2
I1 and I2 are intensity values
P1 and P2 are pressure or amplitude variations
1 B = 10 dB where B is measured in bels
bels
16
16.1 Characteristics of Sound

16.1 Characteristics of Sound

Example: Calculate the remaining intensity of a 100100-mW ultrasound

pulse that loses 30 dB while traveling through tissue.
Relative Intensity (dB)
= 10log
+ ve
I2
I1
30 dB = 10log
- ve
I2
100 mW
I2
3
10 =
100 mW
I 2 = 0.001 100 mW = 0.1mW
3 = log
Intensity reduced to 50% -3dB, 10% -10 dB; to 1% -20 dB

The tissue thickness that reduces the US intensity by 3 dB is considered
half-value thickness

17
16.1 Characteristics of Sound Key Points
18
16.2 Interactions of Ultrasound with Matter
Ultrasound frequency is independent of the medium

Speed of sound (c) is dependent on the medium
Wavelength changes in traversing mediums with differing values
of c
c [m/sec] = [m] f [1/sec]
For most calculations, the average speed of sound in soft tissue,
tissue,
1540 m/sec,
m/sec, should be assumed
Others: cair = 330 m/sec and cfatty tissue = 1450 m/sec
dB = 10 log10 (I2/I1)
Kalpana Kanal, PhD
I2
100 mW
19
Ultrasound interactions are determined by the acoustic properties

properties of
matter
As ultrasonic waves propagate through a medium, some effects that
that
are observed include
Reflection:
Reflection: occurs at tissue boundaries when differences in
acoustic impedance exist
Refraction:
Refraction: describes change in direction of ultrasound energy
with nonnon-perpendicular incidence
Scatter:
Scatter: occurs by reflection or refraction
Attenuation:
Attenuation: loss of ultrasound energy due to absorption and
scatter in medium
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16.2 Interactions of Ultrasound with Matter:

Acoustic Impedance (1)

Acoustic Impedance (2)
Acoustic impedance: Z = c, units are rayl [kg/m2-sec]

= density (kg/m3) and c = speed of sound (m/sec)
Looking at compressibility of a medium
Z gives rise to differences in transmission and reflection of
ultrasound energy which is the basis for pulse echo imaging
Lung
600
300
0.18
21


Reflection (1)
Kalpana Kanal, PhD
22

Reflection (2)
A portion of the ultrasound beam is

reflected at tissue interface due to
differences in Z.
The sound reflected back toward the
source is called an echo and is used
to generate the ultrasound image
The percentage of ultrasound intensity
reflected depends in part on the angle
of incidence of the beam
As the angle of incidence increases,
reflected sound is less likely to reach
the transducer

Air and lung media have low values of Z, whereas bone and metal have
high values
Large differences in Z (air(air-filled lung and soft tissue) cause reflection, small
differences allow transmission of sound energy
The differences between acoustic impedance values at an interface
interface
determines the amount of the wave reflected at the interface
23
Sound reflection occurs at tissue boundaries with differences in acoustic

impedance
2
2
The intensity reflection coefficient, RI = Ir/Ii = (Z2 Z1) (Z2 + Z1)
The subscripts 1 and 2 represent tissues proximal and distal to the
boundary and the equation only applies to normal incidence
The transmission coefficient = TI = 1 RI = (4Z1Z2)/(Z1+Z2)2

24

Tissue Reflections
Air/tissue interfaces reflect virtually all incident ultrasound beam

Gel applied to displace the air and minimize large reflections
Bone/tissue interfaces also reflect substantial fractions of beam
beam
Imaging through air or bone is generally not possible
The lack of transmissions beyond these interfaces results in an area
void of echoes called shadowing
The strongest echoes in abdomen are likely to arise from gas
Organs such as kidney, pancreas, spleen and liver are comprised of
subregions that contain many scattering sites, resulting in a speckled
speckled
texture on images
Organs with fluids such as bladder, cysts, and blood vessels show
show almost
no echo (appear dark)
D54. Approximately what fraction of an ultrasound beam is reflected

reflected from an
interface between two media with Z values of 1.65 and 1.55?
A. 1/2
B. 1/10
C. 1/100
D. 1/500
E. 1/1000
25
D58. Ultrasound moves with the highest velocity in:
A.
B.
C.
D.
medium
Fat
Blood
Muscle
Bone
Kalpana Kanal, PhD
Z
1.38
1.61
1:70
7.80
26

Refraction
RI = (Z2 Z1)2(Z2 + Z1)2 = (1.65 - 1.55)2 / (1.65 + 1.55)2

= 0.01/10.24 1/1000 = 0.1%
27
The change in direction of an ultrasound beam at a tissue boundary

boundary when
the beam is not perpendicular to the boundary
Wavelength change causes change in propagation direction (c = f)
sin(
sin(t) = sin(
sin(i) (c2/c1), Snell
Snells law;
law; for small 15o: t = i * (c2/c1)
When c2 > c1, t > i , When c1 > c2, t < i
Ultrasound machines assume straight line propagation; refraction effects
give rise to artifacts

28

Scatter

Attenuation (1)
Acoustic scatter arises from objects within a tissue with dimension

dimension or <
represent a rough or nonspecular reflector surface
As , the nonnon-specular (diffuse scatter) interactions increase, resulting in
an increased attenuation and loss of echo intensity
Scatter gives rise to the characteristic speckle patterns of various
various organs
and is important in contributing to the image grayscale range

29
Attenuation, the loss of intensity with distance, is caused chiefly

chiefly through
scattering and tissue absorption (energy absorbed)
Attenuation coefficient (
(): intensity loss per unit distance (dB/cm)
Medium and frequency dependent: (f) f
Rule of thumb: /f for soft tissue is approximately 1 dB/cm/MHz!


Attenuation (2)
Acoustic Impedance (Z)

equal to density of the material times speed of sound in the
material in which ultrasound travels, Z = c
= density (kg/m3) and c = speed of sound (m/sec)
As ultrasonic waves propagate through a medium, some effects
that are observed include
Kalpana Kanal, PhD

30

Key Points
31
2
2
Reflection (R
(RI = Ir/Ii = (Z2 Z1) (Z2 + Z1) and TI = 1 RI)
Refraction (c
(c2 > c1, t > i , When c1 > c2, t < i)
Scatter (from objects w/ dimension or < ; as f )
Attenuation (
(/f for soft tissue 1.0 dB/cm/MHz)
dB/cm/MHz)
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16.3 Ultrasonic Transducers (1)
Ultrasound is produced and

detected with a transducer,
composed of one or more ceramic
elements with electromechanical
(piezoelectric) properties
The ceramic piezoelectric element
converts electrical energy into
mechanical energy to produce
ultrasonic waves and mechanical
energy into electrical energy for
ultrasonic wave detection

33

Kalpana Kanal, PhD
34
Conversely, a PC converts
electrical energy into
mechanical (vibrational)
energy through physical
deformation of the crystal
structure
PC used both as a
transmitter and receiver of
ultrasonic waves

Piezoelectric crystals (PC)

have a well defined molecular
arrangement of electrical
dipoles
Ultrasound transducers
employ a synthetic
piezoelectric ceramic, leadleadzirconatezirconate-titanate (PZT)
Mechanical pressure applied
to the PC surface creates an
electric potential difference
across crystal faces
35
Natural resonant freq. (f0) of the

PC is determined by thickness (t)
f0 determined by equating t =
(or = 2t)
2t) in the PC compound
(e.g. PZT)
Thus f0 = c/2t (remember f = c/
c/);
e.g., @ 5MHz, t = 0.4mm
Higher frequencies are achieved
with thinner elements and lower
frequencies with thick elements
Resonance transducers transmit
and receive preferentially at a
single center frequency
frequency

36
A matching layer provides the

interface between the PC material
and tissue (patient) and minimizes
acoustic impedance mismatches
The material has acoustic
properties intermediate to soft
tissue and the PC material
The matching layer thickness =
in the matching layer
A coupling gel is used to eliminate
air bubbles which would cause
signal loss

37

38

BroadBroad-bandwidth Multifrequency
Multifrequency Transducers
One characteristic of a transducer is the frequency purity

purity and the length of
time the resonance persists, or ring down time
time
This characteristic is named the Q factor: Q = operating frequency
(MHz)/bandwidth = f0/BW
A block of damping material is placed behind the PC in the transducer
transducer to
reduce the ring down time and produces a short spatial pulse length
length (SPL) to
preserve detail along the beam axis (axial resolution)
High Q transducer long wave train with a narrow frequency range

Low Q transducer short wave packet with a wide frequency range
Imaging applications require broad bandwidth transducer to preserve
preserve detail
along beam
Blood velocity measurements require narrow bandwidth to preserve
velocity information

Kalpana Kanal, PhD
39

40
10

Linear or Curvilinear Array Transducers

Phased Array Transducers
Transducers come with many individual piezoelectric elements arranged

arranged in
linear or curvilinear arrays
256 to 512 elements
Simultaneous firing of a small group of approx. 20 elements produces
produces the
ultrasound beam
Rectangular field of view produced for linear and trapezoidal for
for curvilinear
array transducers

c.f. Hangiandreou, Radiographics 2003; 23:101923:1019-1033

41

Ultrasound is produced and detected with a transducer

Natural resonant freq. (f0) of the PC is determined by thickness
(t) of transducer, f0 = c/2t
The matching layer thickness = in the matching layer
Acoustic coupling gel is used to eliminate air pockets that could
could
attenuate and reflect the ultrasound beam
High Q transducer long wave train with a narrow frequency
range
Low Q transducer short wave packet with a wide frequency
range
Linear and phased array transducers
Kalpana Kanal, PhD
42
16.4 Ultrasound Beam Properties

Near Field and Far Field(1)
16.3. Transducers Key Points
64 to 128 elements
All active during imaging
Using time delays can steer and focus beam electronically
Near (parallel) Field Fresnel

zone
zone
Is adjacent to the transducer
face and has a converging
beam profile
The far field or Fraunhofer zone is
where the beam diverges
c.f. Bushberg, et al.

The Essential Physics
of Medical Imaging, 2nd
ed., p. 491.
43
44
11

Near Field and Far Field (2)
Near Zone length = d2/4
/4 = r2/
d=transducer diameter, r=radius

Side and Grating Lobes
Unfocused
transducer
c.f. Bushberg, et
al. The
Essential
Physics of
Medical
Imaging, 2nd
ed., p. 496.
A focused single element transducer

uses either a curved element or an
acoustic lens:
Reduce beam width
All diagnostic transducers are
focused
Focal zone is the region over
which the beam is focused
A focal zone describes the region
of best lateral resolution
Focused
transducer
c.f. Bushberg, et al.

The Essential Physics
of Medical Imaging, 2nd
ed., p. 492.
45
46
16.4 Spatial Resolution - Axial
16.4 Spatial Resolution
Side and grating lobes are offoff-axis energy emissions of ultrasound beam produced
by linear and phased array transducers
Caused by the radial expansion and contraction of the transducer element during
thickness contraction and expansion
Echoes received from side lobes are mapped into the main beam, causing
causing artifacts
Side lobes are forward directed, grating lobes emitted at very large
large angles
Spatial resolution has 3 distinct measures: axial, lateral and slice

slice thickness
(elevational)
c.f. Bushberg, et
al. The
Essential
Physics of
Medical
Imaging, 2nd
ed., p. 497.
Axial resolution (linear, range,

longitudinal or depth resolution) is
the ability to separate two objects
lying along the axis of the beam
The minimal required separation
distance between two boundaries
is SPL (about ) to avoid
overlap of returning echoes
Higher frequencies reduce SPL,
improving axial resolution
however, increases attenuation
Axial resolution remains constant
with depth
Kalpana Kanal, PhD
47
48
12
16.4 Spatial Resolution - Slice thickness (Elevational)
16.4 Spatial Resolution - Lateral
Lateral resolution - the ability

to resolve adjacent objects
perpendicular to the beam
direction and is determined by
the beam width and line
density
Typical lateral resolution
(unfocused) is 2 - 5 mm, and is
depth dependent
Single focused transducers
restrain the beam to within
narrow lateral dimensions at a
specified depth using lenses at
the transducer face
Elevational resolution is dependent on the transducer element

height
Perpendicular to the image plane
Use of a fixed focal length lens across the entire surface of the
the array
provides improved elevational resolution at the focal distance,
however partial volume effects before and after focal zone
c.f. Bushberg, et
al. The
Essential
Physics of
Medical
Imaging, 2nd
ed., p. 497.
c.f. Bushberg, et al. The Essential Physics of
Medical Imaging, 2nd ed., p. 499.
49
50
16.5. Image Data Acquisition
16.4. Ultrasound Beam Properties Key Points
The ultrasound beam consists of near and far field, Near field length
= d2/4
d2/4 = r2/
r2/
Less beam divergence in the far field occurs with highhigh-frequency,
largelarge-diameter transducers, sin(
sin() = 1.22
1.22/d
All diagnostic transducers are focused. The focal zone describes the
region of best lateral resolution
Echoes received from side lobes are mapped into the main beam,
causing artifacts
Minimal required separation distance between two boundaries is
SPL,
SPL, Axial resolution remains constant with depth
Typical lateral resolution (unfocused) is 2 - 5 mm, and is depth
dependent
Kalpana Kanal, PhD

51
52
13

Pulse Echo Operation

Medical Imaging, 2nd ed., p. 505505-507.
Kalpana Kanal, PhD
54

Pulse Repetition Frequency (PRF)
Maximum imaging depth is dependent on attenuation and the pulse repetition

frequency (PRF
(PRF = the number of times the transducer is pulsed/sec)
Increase in PRF causes a decrease in maximum imaging depth
Increase in transducer frequency causes a decrease in imaging depth
depth due
to signal attenuation of the ultrasound pulse
The time delay between the transmission pulse and the detection of
the echo is directly related to the depth of the interface as:
c = 2D / time, Time = 2D / c
For soft tissue (c
(c = 1540 m/s or 0.154 cm/ sec),
sec), a return time of
13 s corresponds to a depth of 1 cm (round trip = 2 cm)
Time (
(sec) = 13 sec x D (cm)
Distance (cm) = 0.077 x Time (
(sec)
53

Pulse Repetition Frequency (PRF)
In pulsepulse-echo format the US beam is intermittently transmitted with

most of the time used for listening to the returning echoes
Pulse duration is typically 1 2 sec
One pulse echo sequence produces one line of image data
55
Ultrasound transducer frequency (MHz) should not be confused with

with the pulse
repetition frequency (KHz)
Pulse duration = number of cycles in pulse / transducer frequency
frequency (MHz)
Duty cycle = fraction of on
on time of pulse = pulse duration / PRP = 1
1s/500
s/500s
= 0.2% implying that most time spent in listening for echoes
56
14
16.6. 2D Image Display and Storage

Echo Display Modes
A-mode: amplitude
amplitude mode,
used in ophthalmology or
when accurate distance
measurements are required
B-mode: brightnessbrightness-modulated
dots on a display screen
proportional to the echo signal
amplitude
M-mode or TT-M mode: timetimemotion
motion mode, displays time
evolution vs. depth
M-mode is valuable for
studying rapid movement, such
as mitral valve leaflets
Electronic Scanning and RealReal-Time Display

Sequential linear array: 256 to 512 individual transducer elements
elements
producing a rectangular or convex curvilinear array
Sequential scanning uses transducers pulsed in groups, where each
each
group sends and receives before next group is pulsed
Number of AA-lines is approx. equal to the number of transducer
elements
c.f. Bushberg, et
al. The Essential
Physics of Medical
Imaging, 2nd ed.,
p. 512.

57

Image Frame Rate
Electronic Scanning and RealReal-Time Display

The beam former electronically steers the US beam by
introducing phase delays during the transmit and receive timing
of the phasedphased-array transducer
A sector format composite image is produced
c.f. Bushberg, et al. The

Essential Physics of
Medical Imaging, 2nd ed.,
p. 513.
Kalpana Kanal, PhD
58
A scan converter is used to create 2D images from echo formation

received
A 2D image (a single frame) is created from a number of AA-lines, N
(typically 100 or more), acquired across the FOV
Larger number of lines will produce a higher quality image
The frame rates (1/acquisition time per frame) for real time imaging
imaging
are typically 1515-40 frames/second, which permits motion to be
followed
Maximum frame rate possible is calculated as shown below:
From Time (sec)
sec) = 13 sec x D (cm)
59
60
15

Image Frame Rate
Improve
temporal
resolution
Image quality
depends on
frame rate and
US images typically consist of 640 x 480 or 512 x 512 pixels

Pixel depth is typically 8 bit or 1 byte, providing 256 levels of
of gray
scale
Image storage without compression is approximately 0.25 MB per
image
Color images require 24 bits/pixel for storage
Line density is
the number of
vertical lines
per FOV
61
16.7 Miscellaneous Issues

Clinical Transducers
16.5. and 16.6. Image Data Acquisition, Display and

Storage Key Points
In pulsepulse-echo format the US beam is intermittently transmitted with

most of the time used for listening to the returning echoes
Time (
(sec) = 13 sec x D (cm), Distance (cm) = 0.077 x Time
(sec)
Increase in PRF causes a decrease in maximum imaging depth
Increase in transducer frequency causes a decrease in imaging
depth due to signal attenuation of the ultrasound pulse
Duty cycle = fraction of on
on time pf pulse = pulse duration / PRP
Maximum frame rate possible =
Image storage without compression is approximately 0.25 MB per

image, Color images require 24 bits/pixel for storage
Kalpana Kanal, PhD
62
Low frequency transducers have better tissue penetration

Transducers used for abdominal imaging are generally in the 2.5 to 5
MHz range
Specialized highhigh-resolution and shallowshallow-penetration probes (8 to 20
MHz) have been developed for studying the eye
In infants, 3.5 to 7 MHz transducers are used for echoencephalography
echoencephalography
Endovaginal transducers pelvic region and fetus
Endorectal transducers prostate, Transesophageal transducers
heart, Intravascular transducers blood vessels
c.f. Bushberg, et
al. The Essential
Physics of Medical
Imaging, 2nd ed.,
p. 523.
63
64
16
16.7 Harmonic Imaging

How Are Harmonics Generated?

Overview
c.f. Ultrasound Technology Update, GE

Medical Systems Document, p. 2

65

When the pulse encounters

the bubble, it generates two
kinds of responses
First, echo returns from the
bubble as in conventional
ultrasound and second, the
bubble vibrates in response to
the shock from the pulse (bell)
Vibration generates a
second harmonic at twice
the frequency of the
original ultrasound pulse
This kind of imaging benefits

from the fact that the only the
strong signal returning from the
body at twice the fundamental
frequency will be the signal that
comes back from places where
the bubbles are
By listening only for the ring of
the bell, the harmonic signal, the
ultrasound system can generate
very high contrast ultrasound
images that are relatively free
from the kind of interference
that makes conventional
ultrasound imaging difficult

Kalpana Kanal, PhD
66

The harmonics are not generated

by the ultrasound scanner itself
These signals are generated in
the body as a result of
interactions with the tissue or
contrast agents
Interactions with contrast agents
Patient injected with contrast
agents containing very small
bubbles
A conventional ultrasound
pulse is sent into the body

67
68
17


Interactions with Tissue

When the sound wave passes through the tissue, it compresses and
and expands the tissue
When the tissue is compressed, the speed of sound is higher and
when it is expanded, the speed of sound is lower
c.f. Ultrasound Technology Update, GE Medical

Systems Document, p. 2

69

Because the speed of sound is higher when the pressure is higher,
higher,
the top of the waveform gets pulled forward as the wave passes
through tissue
This distortion of the tissue causes harmonics to be generated
Different tissues distort the wave in different ways (fat distorts
distorts more
then muscle, liver or kidney tissue)
The resultant waveform contains both the fundamental frequency
plus the harmonic frequencies caused by the distortion


70


This ability to create
harmonics in tissue is an
effect that is seen in
varying degrees through
out the ultrasound field of
view
The harmonic imaging
effect without contrast
agents is most pronounced
in the mid field (middle of
the ultrasound image)

Kalpana Kanal, PhD

71
72
18
16.7 Potential Advantages of the Harmonic Signal
Harmonic beams are narrower

than their conventional
counterparts
Side lobes are lower as well
c.f. Bushberg, et al. The

Medical Imaging, 2nd ed.,
p. 519.
73

74
16.7 Potential Advantages of the Harmonic Signal
The result is improved lateral

spatial resolution and better
contrast resolution, removal of
multiple reverberation artifacts
caused by anatomy adjacent to
the transducer
Furthermore, since the harmonics
are generated inside the body,
they only have to pass through the
fat layer once (on receive), not
twice (transmit and receive)
Kalpana Kanal, PhD

75
76
19
16.7 Pulse Inversion Harmonic Imaging

Contrast Agents

Kalpana Kanal, PhD
78
Artifacts arise from the incorrect

display of anatomy or noise during
imaging
Refraction causes misplaced
anatomic position in the image
Shadowing and Enhancement
Shadowing is the reduced
echo intensity behind a highly
attenuating or reflecting
object, such as a stone
creating a shadow
shadow
Enhancement is the increased
echo intensity behind a
minimally attenuating object
such as a fluid filled cyst


77
16.8 Ultrasound Artifacts
Improves sensitivity
to microbubble
contrast agents
Reduces signal
from surrounding
soft tissues
Disadvantage
include motion
artifacts from
moving tissues that
occur between
pulses and frame
rate penalty (at
least 2 times
slower than a
standard scan)
D68. A shadowing artifact in ultrasound may be due to the reduction

of reflected intensity behind all of the following except:
A. A strong attenuator.
B. A highly reflective interface.
C. Gas or air.
D. Water.
79
D
A shadowing artifact is caused by a lack of reflection from an
area. This can be caused by an incident beam being highly
attenuated, or if the beam is strongly reflected from an overlying
overlying
interface, such as between air or gas and tissue. Water has a low
low
absorption coefficient, and acts as a window, generally producing
producing no
shadowing.
80
20
Reverberation artifacts commonly

occurs between two strong reflectors,
such as an air pocket and the
transducer array at the skin surface
The echoes bounce back and forth
between the two boundaries and
produce equally spaced signals of
diminishing amplitude in the image
This is often called a cometcomet-tail
tail
artifact
Speed displacement artifacts are
caused by the variability of the speed of
sound in various tissues
In the case of fatty tissues, the
slower speed of sound in fat (1,450
m/sec) results in a displacement of
the returning echoes from distal
anatomy by about 6% of the distance
traveled through the mass
D64. Reverberation artifacts in ultrasound are caused by:
A. Scattering from small objects

B. Decreased signal intensity in air
C. Multiple reflections from two adjacent interfaces
D. Random signals produced in the electronics of the transducer
E. Patient movement

81
82
Side Lobes and Grating Lobes

Side lobe energy emissions in
transducer arrays can cause
anatomy outside the main
beam to be mapped into the
main beam
For a curved boundary, such
as the gallbladder, side lobe
interactions can be remapped
and produce findings such as
pseudopseudo-sludge
sludge that is not
apparent with other scanning
angles
Grating lobes occur with
multielement array transducers
and result from the division of a
smooth transducer surface
unto a large number of small
elements
Create ghost images of offoffaxis highhigh-contrast objects

Kalpana Kanal, PhD
83
A mirror image artifact arises from

multiple beam reflections between
a mass and a strong reflector,
such as a diaphragm
Multiple echoes result in the
creation of a mirror image
beyond the diaphragm of the
mass
Speckle is a textured appearance

that results from small, closelycloselyspaced structures that are too
small to resolve as seen on
images of solid organs

84
21
16.9 Doppler Ultrasound
The Doppler ultrasound is based

on the shift in frequency in an
ultrasound wave caused by a
moving reflector (siren on a fire
truck)
Objects moving toward the
observer (transducer) appear
to have a higher frequency
and shorter wavelength
Objects moving away from the
observer (transducer) appear
to have a lower frequency and
longer wavelength
If object moving perpendicular
to the observer (transducer),
no change in the observed
frequency or wavelength
16.9 Doppler Frequency Shift
Cos 0 = 1, cos 30 = 0.87, cos 45 =

0.707, cos 60 = 0.5, cos 90 = 0

The Doppler shift is the difference

between the incident frequency and
reflected frequency
fd = Doppler frequency shift
fi = transducer frequency
fr = reflected frequency
v = blood velocity
ct = speed of sound in tissue
As the angle of incidence increases
with respect to the long axis of the
blood vessel, the Doppler shift
decreases according to the
dependence on the cosine of the
angle
f d = fi f r =
v=
2 v cos ( )
fi
ct
f d ct
2 f i cos ( )

85
86
16.9 Doppler Frequency Shift
Frequency shifts are in the audible range

fi = 5 MHz, v = 35 cm/sec, = 45o
fd = 2 (35 cm/sec)(0.707)(5 MHz)/(154,000
cm/sec) = 1.6 kHz
Human audible spectrum: 15 Hz 20 kHz
Preferred Doppler angle is from 3030-60 degrees
At >60 deg, minor errors in angle accuracy can
result in large errors in velocity
At <20 deg, refraction and aliasing problems can
occur
16.9 ContinuousContinuous-Wave Doppler Operation
f d = fi f r =
2 v cos ( )
fi
ct
Kalpana Kanal, PhD

87
Continuous Wave Doppler: one transducer continuously transmits

and one transducer continuously receives
The frequency of the two signals are subtracted to give the Doppler
Doppler
shift
ContinuousContinuous-wave Doppler is inexpensive, does not suffer from
aliasing but lacks depth resolution and provides little spatial
information
Samples everything along the Doppler line
Cannot position the Doppler to listen at a specific area along it
its
path
Good for measuring fast flow and assessing deep lying vessels
88
22
16.9 Pulsed Doppler Operation

Pulsed Wave Doppler: allows both velocity and depth information to be

obtained (pulse(pulse-echo)
Single transducer used
Doppler information is only provided for a selected area (range gate)
specified by the operator
According to sampling theory,

a signal can be reconstructed
as long as the true frequency
(Doppler shift) is less than half
the sampling rate
This the PRF (sampling
frequency) must be at least
twice the maximal Doppler
shift encountered in the
measurement
High blood flow causing the
Doppler shift to exceed PRF
will result in false (aliased)
velocities
89
Thus the maximum velocity

which can be displayed is
limited
A 1.6 kHz Doppler shift
requires a minimum PRF of 2 x
1.6 = 3.2 kHz
The most straightforward
method to reduce or eliminate
aliasing error is for the user to
adjust the velocity scale to a
wider range as most
instruments have the PRF
linked to the scale setting
f max
16.9 Duplex Scanning
PRF 2 f 0 vmax cos ( )

=
=
2
ct
vmax =
ct PRF
4 f 0 cos ( )

Kalpana Kanal, PhD
90
91
Combination of 2D BB-mode
imaging (visual guidance) and
pulsed Doppler data acquisition
The 2D BB-mode creates the realrealtime image to facilitate selecting
the Doppler gate window position,
and then is switched to the
Doppler mode
Sample volume position (range
gate) indicated by a window
position cursor and a line cursor
for the angle
Errors in the flow volume may
occur
vessel axis might not lie totally
within scanned plane
vessel might be curved
Figure courtesy: Brent Stewart, Ph.D.
92
23
16.9 Spectral Waveform

16.9 Laminar Flow
Layers of flow (normal)

Slowest at vessel wall
Fastest within center of vessel
Disease states disrupt laminar flow (turbulent flow)
Doppler produces an audible signal

as well as a graphical representation
of flow = Spectral Waveform
The spectral waveform represents
the audible signal and provides
information about
the direction of the flow
how fast the flow is traveling
(velocity)
the quality of the flow (normal vs.
abnormal)
Plot of Doppler shift frequency
spectrum versus time
Figure courtesy: Bill Warren, M.D.

93
16.9 Spectral Waveform

94
16.9 Color Flow Imaging
Flow coming TOWARD the transducer

is represented above the baseline
Flow traveling AWAY from the
transducer is represented below the
baseline
The amplitude of the shift frequency is
encoded as graygray-scale variations
Two Doppler spectra are shown at 2
discrete points in time with amplitude
versus frequency
A broad spectrum represents
turbulent flow while
A narrow spectrum represents laminar
flow within the Doppler gate
Color flow imaging provides a 2D

visual display of moving blood in the
vessels, superimposed on the
conventional graygray-scale image
Blue and Red colors are assigned,
depending on motion toward or away
from the transducer
Typically, flow toward the transducer
is assigned red and flow away from
the transducer blue
Kalpana Kanal, PhD

95
96
24
16.9 Color Flow Imaging
Turbulent flow can be displayed as

green or yellow
The color intensity varies with flow
intensity
Color Doppler can detect flow in
vessels too small to be seen by
imaging alone
One limitation of color scanning is
that clutter of slowslow-moving solid
structures and noise can overwhelm
the smaller echoes from moving
blood
Spatial resolution of the color image
is much lower than that of graygray-scale
image
16.9 Power Doppler
Power Doppler permits detection and interpretation of slow blood

flow but sacrifices directional and quantitative flow information
information
Power Doppler uses the return Doppler signal strength alone
It ignores the direction of frequency shift or phase, as in
conventional color flow imaging
Power Doppler uses the same power levels as those of conventional
conventional
color scanning
It is more sensitive than standard color flow imaging
The image signal does not vary with the direction of flow
Aliasing artifacts do not occur in power Doppler
97
98
16.10 System Performance and Quality Assurance

16.11 Bioeffects
Isppa and Ispta are important parameters when considering the

possibility of inducing bioeffects
The intensity at a specific point during a single pulse is the
spatial peak pulse average intensity (Isppa
(Isppa))
The intensity at a specific point averaged over a long period
(many pulses) is the spatial peak temporal average intensity
(Ispta)
Ispta)
At high power levels, ultrasound can cause:
Cavitation - the creation and collapse of microscopic bubbles
SmallSmall-scale fluid motions called microstreaming
Tissue heating occurs as a result of energy absorption and is
the basis of using ultrasound for hyperthermia treatment
No harmful effects have been reported for diagnostic imaging
uses of pulsed ultrasound below 100 mW/cm2 (Ispta)
c.f. Bushberg, et
al. The
Essential
Physics of
Medical
Imaging, 2nd
ed., p. 545.
Precision multimulti-purpose grey

scale phantom (RMI 403GS LE)
Kalpana Kanal, PhD
99
100
25
16.11 Bioeffects
Bushberg, et al., The

Medical Imaging, 2nd
ed., p. 553.
Kalpana Kanal, PhD
101
26

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Ultrasound Chapter 16

April 2 April 16, 2009

Kalpana Kanal, Ph.D., DABR

The basic mechanism underlying the formation of ultrasonic images

The various characteristics of ultrasonic waves

The various types of interactions of ultrasonic waves with matter

a copy of this lecture may be found at:

16.0 Introduction (1)

16.0 Introduction (2)

Ultrasound imaging is a nonnon-ionizing method using sound waves of

c.f. Dowsett, et al. The Physics of

Kalpana Kanal, PhD

Kalpana M. Kanal, Ph.D., DABR

Medical diagnostic ultrasound is used in a call and response

c.f. Dowsett, et al. The Physics of

Kalpana M. Kanal, Ph.D., DABR

April 2 April 16, 2009

16.1 Characteristics of Sound:

16.0 Introduction (3)

Along a given beam path the depth of an echoecho-producing structure is

c.f. Dowsett, et al. The Physics of

Kalpana M. Kanal, Ph.D., DABR

c.f. Bushberg, et al. The Essential Physics

16.1 Characteristics of Sound:

Kalpana Kanal, PhD

Kalpana M. Kanal, Ph.D., DABR

Kalpana M. Kanal, Ph.D., DABR

16.1 Characteristics of Sound:

Sonic energy travels as

c.f. Bushberg, et al. The Essential Physics

A sonic wave is a form of

adapted from: Bushberg, et al. The Essential

Kalpana M. Kanal, Ph.D., DABR

c.f. Dowsett, et al. The Physics of

April 2 April 16, 2009

16.1 Characteristics of Sound:

16.1 Characteristics of Sound:

Kalpana M. Kanal, Ph.D., DABR

Kalpana M. Kanal, Ph.D., DABR

16.1 Characteristics of Sound:

16.1 Characteristics of Sound:

Ultrasonic frequency is unaffected

The difference in the speed of sound at tissue boundaries is a

c.f. Bushberg, et al. The Essential Physics

Kalpana Kanal, PhD

Kalpana M. Kanal, Ph.D., DABR

c.f. Dowsett, et al. The Physics of

Kalpana M. Kanal, Ph.D., DABR

April 2 April 16, 2009

16.1 Characteristics of Sound:

16.1 Characteristics of Sound:

c.f. Bushberg, et al. The Essential Physics

Kalpana M. Kanal, Ph.D., DABR

c.f. Bushberg, et al. The Essential Physics

D63. The wavelength of a 2 MHz ultrasound beam is ________ mm.

Kalpana M. Kanal, Ph.D., DABR

Kalpana Kanal, PhD

Kalpana M. Kanal, Ph.D., DABR

16.1 Characteristics of Sound:

Raphex 2003 Diagnostic Question

For thick body parts

The pressure amplitude = peak maximum

April 2 April 16, 2009

16.1 Characteristics of Sound