Sub.

: Medical physics Sound in Medicine ‫مدرس المادة‬

Lec.1 27/11/2014 ‫ناهدة حمود الجراح‬

Infrasound
< 20 Hz
Earthquake, atmospheric pressure changes, blower in ventilator
Not audible
Headaches and physiological disturbances
Sound
20 ~ 20,000 Hz
Audible
Ultrasound
> 20 kHz
Not audible
Medical imaging, blood flow measurements, etc.
General Properties of Sound
Sound:
1-Mechanical disturbance or vibration in a gas, liquid, or solid.
2-Travels from a source with some definite velocity.
 3-Vibration local increase (compression) or decrease (rarefaction)
of pressure relative to atmospheric pressure.
4- Longitudinal wave: pressure changes in the same direction as
wave.
5- Compression and rarefaction: density changes by displacements of
atoms and Molecules.

*The relationship between the frequency of vibration  of the sound

wave, the wavelength  , and the velocity  of the sound wave is

 = 

*The intensity  of a sound wave is the energy passing through 1 m2/sec,

For a plane wave Is given by

=1/2 A2(2)2=1/2(A)2

Where  is the density of the medium ,  is the velocity of sound ,  is

the frequency,  is the angular frequency, which equals (2), A is the
maximum displacement amplitude of the atoms or molecules from the
equilibrium position ,and  is the specific acoustic impedance .

*The intensity can also be expressed as:

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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
Lec.1 27/11/2014 ‫ناهدة حمود الجراح‬
=0 /2  0=√2   0=The maximum change in pressure.
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H.W: The maximum sound intensity that the ear can tolerate at
1000Hz is approximately (1w/m2). a) What is the maximum
displacement in air corresponding to this intensity?

b) The faintest sound intensity the ear can hear at 1000 Hz is

approximately 10-12 W/m2. What is A under these conditions?

We can use ratios between cases a and this case.

This displacement is smaller than the diameter of the hydrogen atom,

C) Calculate the sound pressures for cases a and b?

Sound intensity
Reference sound intensity and pressure
I0 = 10-16 W/cm2, P0 = 210-4 dyne/cm2
Barely audible at 1000 Hz by a person with good hearing
Maximally intense sound without pain = 120 dB

R/A0 = 2 -1/1 + 2

For sound wave in air hitting the body, 1 is the acoustic impedance of
air and 2 is the acoustic impedance of tissue.

If 1 = 2  no reflection and transmission to sound, medium is

complete.

If 2  1  sound wave passes through tissue. There is some loss of

energy due to frictional effects.


Absorption of sound energy
Amplitude at depth of x = A(x) A0ea x
a = absorption coefficient in cm-1 at a particular frequency
Intensity, I A2
I (x) I0 eax
The HVT (half-value thickness) is the tissue thickness needed to
decrease I0 to I0/2
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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
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-High absorption in the human skull.
- Absorption increases, as sound frequency increases there is maximal
Frequency that can be used in the human body
Divergence (spreading out) of sound
Decreases intensity
If point source, intensity decreases by the inverse square law (I 1/x2)
Where x is the distance from the source to the measuring point.
The Stethoscope
Hearing aid for sounds from the heart and lungs (Fig.1)

Mediate auscultation: The act of listening to the sound of the heart and
lungs using a stethoscope.
Modern stethoscope: bell, tube, ear pieces (Fig.2).

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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
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Open bell: small air volume is desirable

The open bell is an impedance matcher between the skin and the air
and accumulated sounds from the contacted area. The skin under the open
bell behaves like a diaphragm. The skin diaphragm has a natural resonant
frequency at which it most effectively transmits sounds; the factors
controlling the resonant frequency are similar to those controlling the
frequency of a stretched vibrating wire. The tighter the skin is pulled, the
higher its resonant frequency. The larger the bell diameter, the lower the
skin's resonant frequency.
 Closed bell with diaphragm: better for lung sounds, which are of
higher frequency than heart sounds, small air volume is
desirable.
Tube: 20 cm long, 0.3 cm diameter
The volume of the tubes should also be small, and there should be
little frictional loss of sound to the walls of the tubes. The small volume
restriction suggests short, small diameter tubes, while the low friction
restriction suggests large diameter tubes. If the diameter of the tube is too
small, frictional losses occur, and if it is too large, the moving air volume
is too great; in both cases the efficiency is reduced.
Ear pieces: must fit snugly in the ear to minimize air leakage.

Ultrasound Pictures of the Body

Bats and porpoises emit ultrasound (30 ~ 100 kHz) and listen to the
echoes to navigate: delay time of echo distance to the object
SONAR (Sound Navigation and Ranging) it was discovered during
World War II, where the sound wave pulse is sent out and reflected from
object.
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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
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From the time required to receive the echo and the known velocity of sound
in water, the distance to the object can be determined.
- To obtain diagnostic information about the depth of structures in the body,
we send pulses of ultrasound into the body and measure the time required to
receive the reflected sound (echoes) from various surfaces in it. This
procedure is called the A scan method of ultrasound diagnosis.

A scan
- Pulse transmission: a few s long pulse with 400 ~ 1000 pulse/s.
 -Two medium with different acoustic impedance reflection.
A scan procedure, echoencephalography has been used in the detection of
brain tumors. Pulses of ultrasound are sent into a thin region of the skull
slightly above the ear and echoes from the different structures within the
head are displayed on oscilloscope, the usual procedure is to compare the
echoes from the left side of the head to those from the right side and to
look for a shift in the midline structure. A tumor on one side of the brain
tends to shift the midline toward the other side, a shift of more than 3mm
for adult or 2mm for child is considered abnormal.
- Application of A scans in ophthalmology can be divided into two
areas:
One is concerned with obtaining information for use in the diagnosis of
eye diseases.
The second involves biometry, or measurements of distances in the eye.
At the low power levels used, there is no danger to the patient's eye.
Ultrasound frequencies of up to 20MHz are used. These high frequencies
can be used in the eye to produce better resolution since there is no bone
to absorb most of the energy and absorption is not significant because the
eye is small.
-Ultrasound diagnostic techniques provide information about the deeper
regions of the eye and are especially useful when the cornea or lens is
opaque. Tumors, foreign bodies, and detachment of the retina (the light-
sensitive part of the eye) are some of the problems that can be diagnosed
with ultrasound. With ultrasound, it is possible to measure distances in
the eye such as lens thickness, depth from cornea to lens, the distance to
the retina, and the thickness of the vitreous humor.

B scan
The B scan method is used to obtain two-dimensional views of parts of
the body .The principles are the same as for the A scan except that the
transducer is moved. As a result, each echo produces a dot on the
oscilloscope at a position corresponding to the location of the reflecting

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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
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surface. A storage oscilloscope is usually used so that a lasting image can
be formed and a photograph can be made.
B scan provide information about the internal structure of the body. They
have been used in diagnostic studies of the eye, liver breast, heart, and
fetus. They can detect pregnancy as early as the fifth week and can
provide information about uterine anomalies.

Ultrasound to Measure Motion:

Two methods are used to obtain information about motion in the body
with ultrasound:
1- M (motion) scan.
Used to study motion of the heart and heart valves.
The M scan combines certain features of the A scan and B scan. The transducer
is held stationary as in the A scan and the echoes appear as dots as in the B
scan of the mitral valve and pericardial effusion can be detected with an M
scan.
2-Doppler technique
-Used to measure blood flow.
-Detect motion of fetal heart, umbilical cord, and placenta in order to
establish fetal life during the 12 to 20 week of gestation.

H.W.: Explain the Doppler Effect?

Physiological Effects of Ultrasound in Therapy

 Low intensity ultrasound levels used for diagnostic work (0.01
W/cm2 average power and 20W/cm2 peak power)no harmful effects
are observed. As the power is increased, ultrasound becomes useful in
therapy. Ultrasound is used as a deep heating agent at continuous
intensity levels of about 1 W/cm2 and as a tissue-destroying agent at
intensity levels of 103 W/cm2.
The primary physical effects produced by ultrasound are temperature
increase and pressure variation. The primary effect used for therapy is the
temperature rise due to the absorption of acoustic energy in the tissue.
Ultrasound diathermy complements deep heating electromagnetic
diathermy.
Ultrasound waves differ completely from electromagnetic waves, they
interact with tissue primarily by microscopic motion of the tissue
particles. As a sound wave moves through tissue, the regions of
compression and rarefaction cause pressure differences in adjacent
regions of tissue. Stretching occurs in these regions, if the stretching
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Sub. : Medical physics Sound in Medicine ‫مدرس المادة‬
Lec.1 27/11/2014 ‫ناهدة حمود الجراح‬
exceeds the elastic limit of the tissue, tearing results. This is why an
eardrum can be ruptured by a very intense sound source. In physical
therapy the typical intensity is about 1 to 10 w/cm2 and the frequency is
about 1 MHz .
-Intense ultrasound waves can changewater into H2 and H2O2 andrupture
DNA molecules.
***Negative pressure in the tissue during rarefaction can cause dissolved
gas to come out of solution and form bubbles. This forming of bubbles
called cavitation, can break molecular bonds between the gas and tissue.
The collapse of the bubbles releases energy that can also break bonds. Free
radicals produced during the breaking of bonds can lead to oxidation
reaction. At power levels of 103 w/cm2 it is possible to selectively destroy
tissue