BY: LOIDA R.

AVESTRUZ-HORA ,MD

OBJECTIVE
To provide an overview of the fundamentals of

acoustics, the physics of ultrasound imaging and ultrasound instrumentation with emphasis on points most relevant to clinical practice.

DEFINITION OF TERMS
COMPRESSION-a mechanical deformation induced by an external force ,with resultant increase in the pressure of the medium. 2. RAREFACTION: occurs after compression event ,as backward motion reverses the force. 3. Wavelength-distance between COMPRESSIONS or RAREFACTIONS, or between any two points that repeat on the sinusoidal wave of pressure amplitude.( )
1.

DEFINITION OF TERMS
4.
5.

6.

Period-time duration to complete a single wave cycle .( cycles/sec.) Frequency- number of times the wave oscillates through a cycle each second. Sound-is transmitted as series of alternating pressure waves producing compression and rarefaction of the conducting medium

DEFINITION OF TERMS
7. Hertz(Hz)-the unit of acoustic frequency where 1 Hz

= 1 cycle per second. 8. Piezoelectric effect-the conversion of electrical energy into mechanical (sound) energy by physical deformation of the crystaline structure. * A Piezoelectric material (often a crystal or ceramic) is the functional component of the transducer.

INTRODUCTION
Infrasound less than 15 cycles/sec(Hz) Normal range of hearing 15 Hz and 20 kHz (audible acoustic spectrum). Ultrasound high frequency range above 20 kHz. Medical diagnostic or therapeutic ultrasound uses frequency range of 2 - 10MHz.* with

specialized applications up to 50 MHz.

BASIC ACOUSTIC PRINCIPLES

1.

PROPAGATION OF SOUND - brief energy pulses applied continued back and forth motion series of compressions/rarefactions propagated through the medium/tissue medium is necessary for mechanical energy transfer (sound propagation). - for energy propagation to occur , as a wave front in the direction of energy travel as Longitudinal wave.

- eventually ,an acoustic image is formed from numerous pulses of ultrasound reflected from tissues interfaces back to the receiver. * The resolution of the ultrasound image and the attenuation of the ultrasound beam energy depend on the Wavelength and Frequency.

BASIC ACOUSTIC PRINCIPLES

2. ACOUSTIC IMPEDANCE ( Z=pc ) - p- density and c-speed of sound - gives rise to differences in transmission and reflection of ultrasound energy ,which is the basis for pulse echo imaging -acoustic interfaces-junction of tissues: Large acoustic impedance differences (tissue & air/bone interface)reflects. Smaller differences (muscle & fat interface)reflects only part.

BASIC ACOUSTIC PRINCIPLES

3. REFLECTION -determined by size and surface feature of the interface. -ultrasound energy at a boundary between two tissues occurs ,because of the differences in the acoustic impedances of the two tissues. -Perpendicular sound beam sound bounce back to the transducer Non-perpendicular - ultrasound energy is reflected at an angle equal to the incident angle.

BASIC ACOUSTIC PRINCIPLES

4. REFRACTION - in direction of propagation/ transmitted ultrasound energy at a tissue boundary when the beam is not perpendicular to the boundary. -Ultrasound frequency does not change when propagating into the next tissue ,but a in the speed of sound wave. misregistration of a structure. -increasing scan angle perpendicular to the interfaceminimize the artifact.

BASIC ACOUSTIC PRINCIPLES

5. SCATTERING Most organs have tissue characteristic structure that gives rise to a defined scatter signature to provide diagnostic information Hyperechoic (higher scatter amplitude) Hypoechoic (lower scatter amplitude) * both denote #of scatterers ,acoustic impedance and size of scatterers.

BASIC ACOUSTIC PRINCIPLES

Cont..Scattering a. Specular reflector- smooth boundary between two media ,where the dimension are much larger than the wavelenght of the ultrasound energy return echoes Td >W (-) frequency b. Diffuse reflectors-smaller Td interface(within solid organsechoes are scattered in all direction. Td<W (+) frequnecy

BASIC ACOUSTIC PRINCIPLES

6. ATTENUATION -sound passes through tissueloses energy by absorption(heating), reflection and scattering. -determines efficiency of ultrasound to penetrate specific tissue. -higher frequency attenuated more rapidly than lower frequency.

INSTRUMENTATIONS
BASIC COMPONENTS OF ULTRASOUND SCANNERS:

TRANSMITTER OR PULSER -energizes the transducer

1.
-pulsed ultrasound-commonly used -control output voltagecontrols rate of pulses emitted consistent with diagnostic problem. -spaced ultrasound pulses.

INSTRUMENTATIONS
2. TRANSDUCER - ceramic elements with electromechanical properties electric energy to mechanical energy and vice versa using Piezoelectric materials. -Two functions: 1. Converts electric energy to acousticpulses. 2. Receives reflected echoes converting weak pressure changes into electric signal.

INSTRUMENTATIONS
-Elements: 1. Piezoelectric crystals-natural and synthetic natural= quartz crystal synthetic = lead-zirconate-titanate(PZT). 2. Damping Block /Backing materials-soften sound -reduce pulse length (2-3cycles)better axial resolution. 3. Specialized transducer coatings and coupling gelsefficient energy transfer(transducer to body).

INSTRUMENTATIONS
4. Matching Layer

provides interface between the transducer element and the tissue> minimizes the acoustic impedance differences between the transducer and the patient.

INSTRUMENTATIONS
3. RECEIVER AND PROCESSOR -detect and amplify the back scattered energy and manipulate the reflected signals for display. -provides means for compensatory differences in echostrength due to attenuation. -compression and maping of data.

INSTRUMENTATIONS
4. IMAGE DISPLAY( echo display modes) A) A-mode AMPLITUDE)- display of the processed information from the receiver versus time. B) M-mode (MOTION)-uses B-mode info/ display echoes from moving organs/ organ tissue. C) B-mode ( BRIGHTNESS) electronic conversion of the A-mode and A-line into brightness-modulated dots on a display screen.

INSTRUMENTATIONS
D. Real time, gray scale B-mode display generate 2D image -greatest intensitywhite -absence of signalblack -intermediate intensityshadows of gray -real time -2D images at rate of 15-60 frames /sec. Assesses anatomy and motion. Effect is dynamic.

INSTRUMENTATIONS
TRANSDUCERS USED: 1) Linear Array Transducer -rectangular image -OB, small parts and peripheral vascular examination. -larger filled of view(FOV) -large surface area

INSTRUMENTATIONS
2) Sector scanners - either mechanical or electronic steering - small surface area - examination where access is limited - superimposes multiple views of the anatomy in a single plane.

INSTRUMENTATIONS
-transducer frequency selection: 1) Superficial vessels and organs (thyroid, breast, testicles & intraoperative application): 1-3 cm. from the surface - 7.5 to 10 MHz 2) Deeper structures (abdomen or pelvis): more than 12 to 15 cm. from the surface - 2.25 to 3.5 MHz

INSTRUMENTATONS
4. IMAGE DATA ACQUISIION Image formation requires knowledge of ultrasound production ,propagation and interactions Images are created using pulse echo method Pulse transmit into the patient> partial reflections from tissue interfaces > create echoes> return to tranducer Image formation> hardware components>data

INSTRUMENTATIONS
5. IMAGE STORAGE -video display are standardized and match to hard copy device. -image display determined by brightness and contrast settings (system gain settings and TGC adjustment). -permanent storage-transparencies printed or film by optical or laser cameras and printers, as well as on videotape. Digital storage.

IMAGE QUALITY

The key determinants of the quality of an ultrasound image include its spatial, contrast and temporal resolution, and freedom from certain artifacts Spatial resolution-ability to differentiate 2 closely situated object as distinct structures.

1)

IMAGE QUALITY
a. axial resolution-refers to the ability to discern two closely spaced objects in the direction of the beam. b. lateral resolution-plane perpendicular to the beam and parallel to the transducer. Determined by the width of the ultrasound beam. c. elevation/azimuth resolution-slice thickness is perpendicular to the plane of the image and to the transducer.

IMAGE QUALITY
2. CONTRAST RESOLUTION

- reflections that delineate tissue boundaries and internal architectures - density and size of scatterers>specific texture 3. ARTIFACTS - arise from incorrect display of anatomy or noise during imaging - machine and operator related

IMAGING PITFALLS
1)

Artifacts-structures not actually present a. reverberation b. refraction c. side lobes d. shadowing e. multipath artifact

IMAGING PITFALLS
2) Improper adjustment of system gain and time gain

compensation settings(strength of sound) 3) Inadequate penetration 4) Poor resolution 5) Careless selection of transducer frequency and lack of attention to the focal characteristics of the beam

BIOLOGIC EFFECTS/MECHANISM OF ACTION

1.
2. 3.

THERMAL EFFECTS-molecular agitation and relaxation stresses. CAVITATION-tiny bubbles of gas or cavities will form. VISCOUS STRESSES-tissue interface(different tissue viscosities)viscous stress(boundary)microstreamingdisrupts membrane and cells(interface).

BIOLOGIC EFFECTS
The biologic effects is not the real issue, the

knowledge and skill of the users are major determinants of the risk-to-benefit implication of the use of ultrasound in a specific clinical situation.