ULTRASOUND

IMAGING
Everyone thinks of changing the world but no
one thinks of changing himself.

Al John Bobis

Introduction

The application of ultrasound in medical field is based on the sonar

principle as used by bats, ships at sea and anglers with fish
detectors. It is totally non invasive procedure. Acoustic waves are
easily transmitted in water but they are reflected from an interface
according to the change in the acoustics impedance. Leaving bones
and lungs, all tissues of our body are composed of water which can
transmit acoustic waves easily. Ultrasound can be used for
obtaining images of internal organs by sending high frequency
sound waves into the body. The reflected sound waves (returning
echoes) are recorded and processed to reconstruct real time visual
images by the computer. The returning sound waves (echoes)
reflect the size and shape of the organ and also indicate whether
the organ is solid, fluid or something in between. Unlike x-rays,
ultrasound requires no exposure to ionization radiation. It is also a
real time technique that can produce a picture of blood flow as it is
at the very moment of imaging.

Scanning

General rules of scanning are :

(1) ultrasound beam should be directed perpendicular to the object
of interest for optimal visualization
(2) the transducer must be selected which has the highest
frequency allowable for the penetration required
(3) a full bladder is required for optimal visualization of the uterus
and ovaries (GYN) and
(4) scanning of all organs of interest is to be done in two planes
which are perpendicular to each other.

The
scanning
modes
are
:
(1)
Bistable
scanning
Bistable
scanning
displays
images in black and

white.

(2) Grey scale imaging Grey scale imaging is commonly used in which an
analog to digital scan converter transfers information from the receiver to
the computer.

(3) A mode - A-mode (amplitude mode) displays the amplitude of

individual echoes as a function of distance or time on cathode ray tube.
The display is shown alongside the image which is helpful in determining
the type of tissue i.e., cystic or solid.

(4) B-mode - B mode (Brightness mode) displays echoes as individual

spots on the screen corresponding to the points of origin in the tissue.
Differences in amplitudes of returning echoes manifest as different
brightness of the dots. Using many pixels (picture elements), these
numerous dots can be arranged in such a way as to appear in different
shades of grey for good visualization.

The scanning modes are :

(5) M-mode - M-mode (motion mode) is nothing but the application
of B-mode to a moving structure varying with time.

(6) real time. Real time imaging allows the processing of the grey

scale characteristics and the motion of interfaces. The brightness

dots move on the monitor screen as the actual interfaces
Echocardiogram gives the movement of valves and other structures
of the heart which are displayed as a function of time.

THE ULTRASOUND TRANSDUCER

The transducer is a device

capable of changing one form of

energy into another. In
ultrasound, the transducer is
both sender and receiver of
ultrasound pulses and echoes.
The transducer converts
electrical impulses into
ultrasound waves and vice versa.

Parts of Ultrasound Transducer

IMAGE RESOLUTION
Resolution is the ability of the system to separate and define

small and closely separated structure. The resolution can be:

(1) lateral and
(2) axial.

IMAGE RESOLUTION
Lateral resolution is the ability of the system to separate and define small

structures in the plane perpendicular to the beam axis. Lateral resolution can
be optimized by focussing the beam at the area of interest and then slowly
increasing the frequency. If the beam width is greater than the separation
between two objects then these objects can not be resolved.

Axial resolution is the measure of the system to separate and define

structures along the axis of the beam. It depends upon the pulse duration. Two
neighbouring structures can be resolved by beam if the wavelength of the
beam is less than their axial distance between them.

However the average ultrasound pulse contains two wave lengths. Therefore

higher frequency transducer has to be used to improve the axial resolution.

The frequency can not be made much higher to have better resolution as then
the penetration of wave falls with increased frequency.

WORKING OF ULTRASOUND

The ultrasound image is formed from the useful information contained by

the echoes of the ultrasound which are reflected back while traversing
and interacting with the tissues of the body. These interaction contributes
to image formation and images vary as the tissues vary themselves.

The acoustic impedance of some materials are :

(a) Blood 1.6 105 gm /cm2
(b) Bone 7.8 105 gm /cm2
(c) Fat 1.4 105 gm /cm2
(d) Soft tissue 1.6 105 gm /cm2
(e) Air 0.004 105 gm /cm2
(f) Water 1.5 105 gm /cm2

ULTRASOUND MACHINE

Ultrasound machine is about the

size of a small cupboard. It
consists of a computer with a
display unit, circuitory and a
hand held transducer. The
transducer has the shape of a
microphone. It is meant to send
out the ultrasound beam and to
receive the reflected sound
waves. The reflected sound
waves are fed to a computer
which with the help of
algorithms, process them to
create the images.

DOPPLER ULTRASOUND

Doppler ultrasound is based on the principle that sound

reflected by a moving target like blood has a different

frequency from the incident sound wave. The difference in
frequencies is known as Doppler shift which is proportional to
the velocity of the target.
Doppler shift is the useful information with the echoes which
helps in the detection of flowing blood. It also enables to
quantify the velocity of the blood.

Advantages of Ultrasound
Ultrasound is relatively inexpensive and non invasive. It does

not expose patients to ionizing radiation and hence it is safe.

It is preferred for children and pregnant women. The machine
is also comparatively inexpensive.

Disadvantages of Ultrasound
Ultrasound imaging system is highly operator dependent. It

cannot be used for full body survey. It can not image air
containing organs or bones. The resolution of the ultrasound
image is inversely related to the depth of penetration. The
quality of image decreases in the case of obese patients.