BASICS OF ULTRASOUND

Introduction

In this section, a brief history and general overview of ultrasound diagnosis

are described. Also the merits and demerits of medical ultrasound as well
as a comparison with other techniques like CT and MR are outlined.

History
Ultrasound has been used as a navigational and detection aid by the bat for millions of years.
It was not until the second world war, however, that man started extensive use of ultrasound
for the same purpose. With the enormous potential of military research programs, ultrasound
technology rapidly developed.
Although ultrasound had already been used in the therapy and was proposed by S.Y. Sokolov
for diagnostic use in 1937, no successful attempt to apply the ultrasound echo-sounder principle
to medical diagnosis was made until the early 1950s.
Most of the equipment used at that time were industrial-type ultrasound devices for detecting
flows in metal, but soon ultrasonic devices generally known as ultrasonoscopes specifically
intended for medical diagnostics were developed. The major advantages of these devices are
the non-invasive and non-ionizing nature of the examination and their relatively low cost when
compared to X-Ray, Magnetic Resonance (MR), CT and Isotopic Scanning techniques.
Over the last decade, the diagnostic usefulness of the equipment has been vastly improved,
as better instruments were developed and more clinical experience gained, and in several
diagnostic fields, ultrasound technique has shown to be superior to other methods.

General Overview
In Medical Ultrasound, images representing human organs are formed by transmitting sound
waves into the body and receiving back and processing the resultant echoes from the tissues.
To accomplish this, medical ultrasound uses a process very similar to an ocean-going vessels
depth sounding equipment or oceanic survey equipment. All of these systems make use of
sound waves and their reflections.

Sea

Merits and Limitations

By comparison with CT, MR, X-Ray and other diagnostic methods, Ultrasound
Diagnosis, especially for soft tissues and moving organ like heart and blood
flow, has shown great advantages as following:
*
*
*
*
*
*
*
*

Real Time Imaging (Except MR)

Non-invasive (Except MR)
Non-ionizing Radiation (Except MR)
Relatively Low Cost
Wide Applications
Mobility
Flexible Imaging
Biopsy

For the reason of physical and technological limitations, ultrasound method also
suffers from restrictions in imaging and applications as does other technique.
Apart from the geometric distortion of the image display, another important limitation
is the Resolution. Higher frequency ultrasound gives better resolution, but attenuation
in the tissue also increases with increased frequency. Therefore, a compromise has
to be made between resolution and penetration depth.

Frequency

Low

Resolution
Penetration Better

High
Better

Due to the nature of ultrasound propagation, strong reflection of ultrasound beam from
boundaries between tissue and air or boundaries between tissue and bone prohibit
normal scanning of the lungs and the intracranial soft structure in adults as well as to
some extent the intestines.
Generally, ultrasound diagnosis, being one of the diagnostic imaging, is playing a
more and more important role in Medicine as technology is rapidly developing, and
is selected for a screening diagnosis as a first and a finished Diagnostic Imaging
in the world.

Physics and Principles

In this section, some basic concepts are defined and explained as foundational
knowledge to introduce and understand ultrasound system.

* Properties of Propagation
- Velocity and Frequency
- Reflection
- Refraction
- Diffraction
- Scattering
- Attenuation etc..
* Transducer and Impedance Matching
* Doppler Effect
* Pulse Ultrasound

The Nature of Ultrasound

- Mechanical vibration or wave
- With frequencies above the range of human
ear which is greater than 20 kHz. For medical
diagnosis, typically ranging from 1 to 30 MHz.
- Obeys the same physical laws as wave

Compressive Wave

Sound Spectra
0
Infrared
Sound

20 Hz

20 kHz
Audible
Sound

1 MHz

NDT
Cleaning

30 MHz

Diagnostic
Imaging

Velocity
- Dependent on the medium and temperature
- Roughly be considered as a constant 1540 m/s in human body.
- The relation between velocity and frequency is following the equation
below:
Velocity = Frequency * Wavelength ( )

Table 1. Approximate velocities of sound in human medium

Medium

Velocity (m/s)

Blood

1570

Brain

1540

Fat

1450

Kidney

1560

Muscle

1590

Distilled Water

1540

Specific Acoustic Impedance

- The specific acoustic impedance Z is defined as the product
of the density of a medium and the velocity of the sound in
that medium (c).
- Basic concept to understand ultrasound wave reflection.

Reflection
Incident wave

Transmitted wave

Reflected wave
Medium 1

Medium 2

Reflection
- One of the basic principles of medical ultrasound diagnosis.
- Occurs at areas of acoustic impedance mismatch.
- Divided into several different types including:
Specular Reflections, which occur at large change
in impedance producing a large reflection, and also
reducing the continuing wave amplitude.
Medium Reflections, which occur with dense tissues
such as muscle.
Diffuse Reflections, which occur with soft tissues such
as liver.

Refraction
When a propagating ultrasound wave
encounters a Specular interface at an
oblique angle, it is Refracted in the
same way that light is refracted through
a lens. The portion of the wave that is not
reflected continues into the second medium.
It is dependent on the velocities of the
two medium. If the velocities are equal,
There would be no refraction occurred
and the beam goes straight into the
second medium. For the velocities of
the different tissues in the human body
are quite close, refraction's can be ignored.

incident wave

Reflected wave

Medium 1

Medium 2

Transmitted wave

Diffraction
If an ultrasound beam passes an
obstacle within a distance of 1 or 2
wavelengths, its direction of
propagation is deflected by diffraction
as shown in the figure. The closer the
beam is to the diffracting object, the
greater the deflection is.

Deflecting beam

Diffracting
Object

1 or 2 wavelengths

Scattering
- Occurs when small particles absorb part
of the ultrasound energy and re-radiate it
in all directions as a spherical field. This
means that the transducer can be positioned
at any angle to the ultrasound beam and
still receive echoes back. Scattering allows
reflections from objects even smaller than
the wavelength. Many biological interfaces
have irregular surfaces, tending to give
scatter-like reflection, which is quite useful,
as it will give at least some echoes even
though the beam is not directly perpendicular
to the reflecting interface.

Spherical Scatter-wave

Backscatter
Backscatter or Rayleigh scattering occurs
with structures smaller than the transmitted
wavelength. Reflected energy is very low,
but contributes to the texture of the image.

Attenuation
Attenuation of ultrasound wave occurs when it is propagating
through the medium. Loss of propagating energy will be in the
form of heat absorbed by the tissue, approximately 1 dB/cm/MHz,
or caused by wavefront dispersion or wave scattering.

Transducer
The transducer is the component which, when connected to
the ultrasound equipment, transmits the ultrasound and
receives its reflections or echoes from tissues.
Transducer is one of the most important component of the
ultrasound system. For more detail information, please refer
to System Components.

Impedance Matching
-To transmit as much power as possible from transducer to the tissue.
Transducer
Case

Tissue

Transducer
Crystal

Matching Layer

Doppler Effect
In ultrasound Imaging, echoes received from most tissues will be at the same
frequency as the transmitted beam. However, if echoes received are from
tissues or blood cells that are moving, the transmitted and received frequencies
will not be the same. This shifted frequency can be used to determine the
relative velocity and the direction of this moving tissues. This effect is known as
the Doppler Principle. Essentially, the greater the frequency shift, the higher
the velocity of the moving object. Additionally, movement toward the transducer
results in a higher received frequency, and movement away in a lower received
frequency.

Doppler Effect
TXM

TXM

RCV

RCV

If the reflector is moving toward the

transmitter, the received frequency
will be higher than the transmit
frequency.

If the reflector is traveling away

from the transmitter, the received
frequency will be lower than the
transmit frequency.

Pulse Ultrasound
For practical use, most modern ultrasound systems are designed based on the
principle of pulse-echo technique, which means that transducer emits only a
few cycles of pulses at a time into the human body. When encountering tissues
interfaces, reflection and scattering will occur and produce pulse echoes, By
detecting these echoes, tissue positioning and identification as well as diagnosis
can be made.

Spectral Doppler
Spectral Doppler, of high value in ultrasound diagnosis, can be used for
evaluation of blood flow, includes three kinds:
- Pulse Doppler(PW)
- High Pulse Repetition Frequency
Pulse Doppler (HPRF)
- Continuous Wave Doppler (CW).

Pulse Doppler
In Pulse Doppler, a single ultrasound line
is repeatedly fired. Echoes reflected from
moving structure, including blood cells,
experience a Doppler shift in frequency.
Using the Doppler equation, the echo
information obtained within the Sample
Volume is analyzed for shifted frequency
content and amplitude, rather than transmit
frequency amplitude. From this, the blood
velocity can be determined.

Transducer
Sample
Volume

Pulsed Doppler Line

Pulse Doppler
In order to obtain enough data to
calculate the frequency components
of the sampled volume, many
ultrasound lines must be fired.
The frequency data is converted to
velocity, and displayed in a scrolling
strip format on the monitor.

Time

The highest detectable velocity is

limited by one half of the rate at
which the ultrasound lines are fired,
known as *Nyquist Limit .
Velocity

Pulse Repetition Frequency

T

Pulse Repetition
Period
* Pulse Repetition Frequency (PRF) is the number of times per second that
transducer transmits a pulse.
* Pulse Repetition Frequency is dependent on transmit depth and
propagation velocity. ( 1540 m/s )

Nyquist Limit
The maximum Doppler shift velocity measurable in Pulse Doppler is limited to one
half the sampling rate defined by the PRF, which is mainly determined by the sampling
depth. For a given transducer and depth, this maximum measurable velocity, which is
known as the Nyquist Limit, can be calculated using the following equation:
PRF
Nyquist Limit =
2

Aliasing
If the maximum velocity for that transducer and depth exceeds the Nyquist limit, a
phenomenon known as Aliasing occurs. Aliasing results in the display of erroneous
velocity information.(Showing a wraparound effect.)

2
Velocity 0
-2
Spectral Display Showing Aliasing

HPRF Doppler
Transducer

The Nyquist limit will decrease with

depth of the sample volume. As this
limit reaches 1/2 PRF, the system
automatically increases the sample
rate by increasing the PRF and the
number of samples. This results in
more than one wavefront propagating
through the body simultaneously.
Therefore, information obtained may
be from more than one location.

Angle of Incidence
When the motion of the object and the transmitted
beam are not parallel, it is necessary to correct for
the angular difference. Motion that occurs at an
angle to the beam axis will result in a decrease
in the magnitude of the frequency shift and a lower
calculated velocity. Therefore, the transmitted beam
needs to be parallel to the flow for the most accurate
velocity. An equation is used to correct for the angle
offset. The transducer receives only the component
parallel to the beam Vcos .

Ultrasound Beam

Blood Flow
V

Continuous Wave Doppler

Continuous Wave Doppler, or CW Doppler, is a similar modality to Pulse Doppler in that frequency
data is gathered to determine blood velocity along the ultrasound line. With CW Doppler, the transmit
and receive functions happen simultaneously. This overcomes the maximum velocity limit, but the
exact point along the ultrasound line from which the velocity data originated can not be determined.
(No range resolution).
CW Doppler is used primarily in diagnosing abnormalities in which range resolution is not important
or when the sonographer is interested in the quantification of high velocity jets.

CW

PW

Range Resolution

None

Determined by
Sample Volume

Maximum Velocity

Virtually Unlimited

Limited by 1/2 PRF

Continuous Wave Doppler

Monitor
Transducer

Velocity

Time

Color Flow Mapping

Color Flow Mapping (CFM) combines B-mode image format and Pulsed Doppler to
provide a two dimensional representation of blood flow in Real Time.
The Doppler ultrasound lines, like B-mode lines, are sequentially scanned through the
frame. Multiple range gates are taken along the Doppler lines. The calculated velocity
data is assigned a color to represent a certain velocity and direction, and then displayed
combining with the B-mode image at the original location.

Blood
Flow

2-D

CFM

MTI (Moving Target Indicator)

First
Blood Cell

Ultrasound Line

Second
Blood Cell

Subduction

Blood Cell Signal

Ultrasound Line

CFM Display

Monitor

Transducer

Color Box

Doppler Ultrasound Line

Limitations of CFM
- Only give the average of the velocity across the beam,
can not get the maximum velocity.
- Sensitivity, a compromise to be made among the depth,
velocity range, and PRF
- Frame Rate, influenced by FOV , scan angle and control
system of transmit and receive.

System Overview

In General, a ultrasound imaging system consists of several components listed below:

* Transducer - Transmitting and receiving ultrasound
* Beamfomer - Transmit and receive control including phase delay,
focus, aperture, signal conversion, etc..

Transducer

Phased Array
In a phased array system, a series of elements are arranged into a array. The
timing of the transmit drive pulses to each element and are arranged so that the
wavefronts from all the transmitting elements arrive at a selected spatial point
at the same time. This is accomplished by introducing a curve into the timing
delays whose center is the desired focal point. This in effect is the same as
using an acoustic lens, as a lens implements focus by delaying waves to a
specific degree so that the same result is achieved. Using electronic instead of
physical delay allows the transmit focal point to be changed simply by changing
the delay relationships.

Phased Array
Wavefront from Elements

Time Delay

Summation
Wavefront
Focal Point

Linear Array
- Rectangular Scan Format
- Large Aperture
- Wide View at Near Field
- Smaller Effect of Side Lobe

Convex Format
- Wide View at Near and
Far Field

Sector Format
- Radial Pie-shaped
Scan Format
- Narrow Aperture
- Wide View at Far Field

Expand or Vector Format

- Wide View at Near and
Far Field

Beamformer
Conventional Beamformer
Transmit/Receive
Analog
Summation

Pre- Amplifier
Array
Analog
or Digital

Delay
Control

A-D

Digital Beamformer
A-D Converter
Digital
Summation

Array

Pre- Amplifier
Digital
Control

Detector

Digital Beamformer

Digital Transmit
- Dynamic Focus

Digital Tracking Lens

- Dynamic Focus
- Dynamic Aperture

Software Control

Sum

Detector

Memory
Cine

Advantages of the Digital Beamformer

- Optimize Frequency and Band Control
- Multi Focal Zone at Any Depth
- Dynamic Receiving Focusing
- Dynamic Tracking Lens
- Sidelobe Compression
- Dynamic Aperture
- Higher Doppler Sensitivity

Clinical Merits
* Better Image Quality
- Assure Accurate Spatial Resolution
- Improve Contrast Resolution
- High Frame Rate
- Decrease Artifacts

* More Reliable Diagnosis

- More Accurate Detection and Analysis
in CFM and Pulse Doppler
- More Sensitivity

Image Quality

Introduction
In this section, several parameters listed below, which are usually used to judge
the image quality of ultrasound system are introduced and, for general purpose,
some examples about the effects on the image quality are given.

* Resolution
- Spatial Resolution
(Lateral and Axial Resolution)
- Contrast Resolution
* Uniformity
* Effects on Image Quality
* Phantoms

Spatial Resolution
Spatial Resolution is defined as the ability to distinguish small structures with clarity.
Generally speaking, it can be divided into Lateral and Axial Resolution, and it is
dependent on the numbers of the channels of the system and the frequency used.
The more channels , the better lateral resolution is. The higher frequency used, the
better axial resolution is.

Lateral Resolution
Lateral Resolution is the ability of the system
to resolve structures that are very close to one
another at the same depth.
Lateral Resolution is dependent on the beam
width as determined by crystal geometry, depth
and focusing.

Lateral

Lateral Resolution

Beam width is narrow enough to be able to resolve these two structures separately.

Beam width is too wide to be able to resolve these two structures separately.

Axial Resolution
Axial Resolution is the ability of the
system to resolve structure that are
very close to one another at different
depth.
Axial Resolution is dependent on
frequency and transmit pulse width.
3.5 MHz
5.0 MHz
7.5 MHz
10 MHz

0.4 mm
0.3 mm
0.2 mm
0.1 mm

Axial

Axial Resolution
Beam

Good Axial Resolution

Poor Axial Resolution

Contrast Resolution
Contrast Resolution, or gray scale resolution, is the ability to differentiate tissue
types and to see subtle structures in the presence of very bright reflectors. It is
one of the most important parameters to judge ultrasound image quality, and
also this tissue-differentiating capability provides critical diagnostic information.