Physics of Echocardiography: Department of Anaesthesiology, Narayana Hrudayalaya

Physics of
Echocardiography
Dr. Anil Kumar H.R

Junior Consultant
Department of Anaesthesiology
Narayana Hrudayalaya
Department of Anaesthesiology, Narayana Hrudayalaya

History of Ultrasound Imaging
▫ 1760 - Abbe Lazzaro Spallanzani – Father of ultrasound
▫ 1912 - First practical application for rather unsuccessful
search for Titanic
▫ 1942 - First used as diagnostic tool for localizing brain
tumors by Karl Dussik
▫ 1953 - First reflected Ultrasound to examine the heart, the
beginning of clinical echocardiography – Dr.Helmut Hertz , a
Swedish Engineer and Dr. Inge Edler a cardiologist
▫ 1970s - Origin of TEE ,Lee Frazin, a cardiologist from
Chicago mounts M-mode probe on a Transoesophageal
probe.
•

I will be discussing about..
Ultrasound and its properties

Interactions of ultrasound with tissues
Instrumentation and Image formation by
ultrasound
Doppler effect and its applications

Sound
Mechanical vibration transmitted through an elastic
medium
Pressure waves when propagate thro’ air at
appropriate frequency produce sensation of hearing
Vibration Propagation Perception
Surface Vibration Pressure Wave Ear

As sound propagates through a medium the
particles of the medium vibrate
Air at equilibrium, in
the absence of a
sound wave
Compressions and
rarefactions that
constitute a sound
wave

Compressions and rarefactions which constitute the
sound wave can be represented as “Sine wave”
Amplitude - maximal
Wavelength - distance
compression of
between the two nearest points
particles above the
of equal pressure and density
baseline
Frequency – No. of wavelenghths per unit time
1 cycle/ sec = 1 Hz
So, Frequency is inversely related to wavelength
Velocity – Speed at which waves propagate
through a medium
Dependent on physical properties of the medium
through which it travels
Directly proportional to stiffness of the material
Inversely proportional to density till a physiological limit
Velocity = frequency * Wavelength

Sound velocity in different materials
Material Velocity ( m/s)
Air 330
Water 1497
Metal 3000 - 6000
Fat 1440
Blood 1570
Soft tissue 1540

ULTRASOUND
Ultrasound is sound with a frequency over
20,000 Hz, which is the upper limit of human
hearing.
The basic principles and properties are same as
that of audible sound

Frequencies used for diagnostic ultrasound are
between 1 to 20 MHz

Interaction of ultrasound wave with
tissues
1. Attenuation
2. Reflection
3. Scattering
4. Absorption

Attenuation
 Loss of intensity and amplitude of ultrasound wave as
it travels through the tissues
 Due to reflection, scattering and absorption
 Proportional to Frequency and the distance the wave
front travels –
 Higher frequency , more attenuation
 Longer the distance (Depth), more the attenuation
 And also on the type of tissue through which the beam
has to pass
 Expressed as “Half – power distance”
 For most of soft tissues it is 0.5 – 1.0 dB/cm/MHz

Reflection
Basis of all ultrasound imaging
From relatively large, regularly shaped objects with
smooth surfaces and lateral dimensions greater than one
wavelength – Specular Echoes
These echoes are relatively intense and angle
dependent.
From endocardial and epicardial surfaces, valves and
pericardium
Amount of ultrasound beam that is reflected depends on
the difference in Acoustic impedance between the
mediums

Acoustic Impedance
The resistance that a material offers to
the passage of sound wave
Velocity of propagation “v” varies between
different tissues
Tissues also have differing densities “ρ”
Acoustic impedance
“Z = ρv”
Soft tissue / bone and soft tissue / air
interfaces have large “Acoustic Impedance
mismatch”

Scattering
Type of reflection that occurs when
ultrasound wave strikes smaller(less than
one wavelength) , irregularly shaped objects
- Rayleigh Scatterers ( e.g.. RBCs)
Are less angle dependant and less intense.
Weaker than Specular echoes
Result in “Speckle” that produces the texture
within the tissues

How is ultrasound imaging done?
“From sound to image”

PIEZOELECTRIC
EFFECT
Pierre Curie Jacques Curie

(1859-1906), (1856-1941)
Nobel Prize in
Physics, 1903

Crystals of tourmaline, quartz, topaz, cane sugar, and
Rochelle salt have the ability to generate an electric
charge in response to applied mechanical stress
“Piezoelectricity" after the Greek word Piezein, which

means to squeeze or press.
“Converse” of this effect is also true

Construction of a Transducer
Backing
Material
Electrodes
Piezoelectric
crystal

Phased Array Transducers
Electronic Phased Array

which uses the principle
of Electronic Delay

Electronic Focusing
Electronic beam
steering

Characteristics of ULTRASOUND BEAM

Length of near field = ( radius)2 / wavelength of
emitted ultrasound

1. Piezoelectric crystal
2. High frequency electrical signal with continuously
changing polarity
3. Crystal resonates with high frequency
4. Producing ULTRASOUND
5. Directed towards the area to be imaged
6. Crystal “listens” for the returning echoes for a
given period of time
7. Reflected waves converted to electric signals by
the crystal
8. processed and displayed

Schematic representation of the recording and
display of the 2-D image

Our TEE Work Station..

Resolution
Ability to distinguish two points in space
Two components –
Spatial – Smallest distance that two targets
can be seperated for the system to
distinguish between them.
Two components – Axial and Lateral
Temporal

• Axial Resolution
▫ The minimum separation
between structures the
ultrasound beam can
distinguish parallel to its
path.
▫ Determinants:
▫ Wavelength – smaller the
better
▫ Pulse length – shorter the
train of cycles greater the
resolution

• Lateral Resolution
▫ Minimum separation between
structures the ultrasound
beam can distinguish in a
plane perpendicular to its
path.
▫ Determinants:
▫ Depends on beam width –
smaller the better
▫ Depth
▫ Gain

Temporal resolution
Ability of system to accurately track moving
targets over time
Anything that requires more time will
decrease temporal resolution
Determinants:
Depth
Sweep angle
Line density
PRF

The Trade off ..

So..
To visualise smaller objects shorter wavelengths
should be used which can be obtained by
increasing frequency of U/S wave.
Drawbacks of high frequency –
More scatter by insignificant inhomogeneity
More attenuation
Limited depth of penetration
For visualising deeper objects lower frequency is
useful, but will be at the cost of poor resolution

The reflected signal can be displayed
in four modes..
A- mode
B- mode
M- mode
2-Dimensional

M- Motion mode
the reflector is
moving so if the
depth is shown in a
A –mode B- Brightness
A time plot, the
shows the mode shows motion will be seen
Amplitude of the energy as as a curve
reflected the brightness
energy at of the point
B
certain depth

M- mode
• Timed Motion display ; B – Mode with time
reference
• A diagram that shows how the positions of the
structures along the path of the beam change
during the course of the cardiac cycle
• Strength of the returning echoes vertically and
temporal variation horizontally

M – Mode uses..
Great temporal resolution- Updated

1000/sec. Useful for precise timing of
events with in a cardiac cycle
Along with color flow Doppler – for the
timing of abnormal flows
Quantitative measurements of size ,
distance & velocity possible with out
sophisticated analyzing stations

M-Mode
Imaging
M-mode beam through Mitral Valve

2 – D MODE
Provides more structural and functional
information
Rapid repetitive scanning along many different
radii with in an area in the shape of a fan
2-D image is built up by firing a beam , waiting
for the return echoes, maintaining the
information and then firing a new line from a
neighboring transducer along a neighboring line
in a sequence of B-mode lines.

2-D imaging by steering the transducer over an area
that needs to be imaged

Mechanical Steering of the Transducer

Electronic Phased Array Transducers for 2-D
imaging
Linear Array Curvilinear Array

A single ‘FRAME’ being formed A ‘CINE LOOP’ from multiple FRAMES
from one full sweep of beams

Resembles an anatomic section – easy
to interpret
2-D imaging provides information about
the spatial relationships of different
parts of the heart to each other.
Updated 30- 60 times/sec ; lesser
temporal resolution compared to M-
mode

Doppler Study
Study of blood flow dynamics
Detects the direction and velocity

of moving blood within the heart.

Comparison between 2-D and Doppler
2-D Doppler
Ultrasound Tissue Blood

target
Goal of Anatomy Physiology
diagnosis
Type of Structural Functional
information
So, both are complementary to each other

DOPPLER
EFFECT
Christian Andreas Doppler

(1803 – 1853)
DOPPLER EFFECT-
Certain properties of light emitted from stars depend upon
the relative motion of the observer and the wave source.
Colored appearance of some stars as due to their motion

relative to the earth, the blue ones moving toward earth and
the red ones moving away.

OBSERVER 1 OBSERVER 2
Small wavelength Long wavelength
High frequency Low frequency

Doppler principle as applied in Echo..
Doppler Frequency Shift - Higher returned frequency if
RBCs are moving towards the and lower if the cells are
moving away

The Doppler equation
Velocity is given by Doppler equation..

V = c fd / 2 fo cos 
V – target velocity
C – speed of sound in tissue
fd –frequency shift
fo –frequency of emitted U/S
 - angle between U/S beam & direction of
target velocity( received beam , not the emitted)

Doppler Equation

Doppler blood flow velocities are
displayed as waveforms

Important consideration !
When flow is perpendicular to U/S beam angle of
incidence will be 900/2700 ;
cosine of which is 0 – no blood flow detected
Flow velocity measured most accurately when

beam is either parallel or anti parallel to blood
flow.
Diversion up to 200 can be tolerated( error of < or
= to 6%)

“Twin Paradoxes of Doppler”
Best Doppler measurements are made when

the Doppler probe is aligned parallel to the
blood flow
High quality Doppler signals require low

Doppler frequencies( < 2MHz)

Importance of being parallel to flow when
detecting flow through the aortic valve

V =VcV
fd
/fd 2/fdfocos
cos 
Velocity is directly proportional to

frequency shift and for clinical use it is
usual to discuss velocity rather than
frequency shift ( although either is
correct)

Applications of Doppler - Different modes
to measure blood velocities
Continuous wave
Pulsed wave
Colour Flow Mapping

Modern echo scanners combine Doppler capabilites
with 2D imaging capabilities
Imaging mode is switced off (sometimes with the

image held in memory) while the Doppler modes are in
operation

CONTINUOUS WAVE DOPPLER
Continuous generation of ultrasound waves coupled with
continuous ultrasound reception using a two crystal
transducer

CWD at LVOT in Deep TG Aortic
Long axis view

Can measure high velocity flows ( in
excess of 7m/sec)
Lack of selectivity or depth discrimination
-Region where flow dynamics are being
measured cannot be precisely localized
Most common use – Quantification of
pressure drop across a stenosis by applying
Bernoulli equation

Bernoulli Equation
Balancing Kinetic and Potential energy
As this goes up.. This goes down..
1/2 PV2 Pressure

P = 4V2
Kinetic Potential
Energy Energy

PULSED WAVE DOPPLER
Doppler interrogation at a particular depth rather
than across entire line of U/S beam.
Ultrasound pulses at specific frequency - Pulse
Repetition Frequency (PRF) or Sampling rate
RANGE GATED - The instrument only listens for
a very brief and fixed time after the transmission
of ultrasound pulse
Depth of sampling by varied by varying the time
delay for sampling

Transducer alternately transmits and receives the
ultrasound data to a sample volume. Also known
as Range-gated Doppler.

PWD at LVOT in Deep TG aortic long
axis view

PRF for a given transducer of a given frequency at
a particular depth is fixed; But to measure higher
velocities higher PRFs are necessary
Drawback – ambiguous information obtained

when flow velocity is high velocities (above 1.5 to
2 m/sec)
This effect is called Aliasing

ALIASING
Aliasing will occur if low pulse repetition
frequencies or velocity scales are used and high
velocities are encountered
Abnormal velocity of sample volume exceeds the

rate at which the pulsed wave system can record it
properly.
Blood velocities appear in the direction opposite to

the conventional one

Full spectral PW display is
display of a high aliased, or cut
velocity profile off, and the top
fully recorded by is placed at the
CW Doppler bottom

Aliasing occurs if the
frequency of the
sample volume is more
than the Nyquist limit
Nyquist limit = PRF/2

To avoid Aliasing - PRF = 2 ( Doppler shift
frequency or Maximum velocity of Sample
volume)
Can be achieved by – Decreasing the

frequency of transducer, decrease the
depth of interrogation by changing the view
( this increases the PRF)

Color Flow Doppler
Displays flow data on 2-D Echocardiographic
image
Imparts more spatial information to Doppler
data
Displays real-time blood flow with in the heart
as colors while showing 2D images in gray
scale
Allows estimation of velocity, direction and
pattern of blood flow

Multigated, PW Doppler in which blood flow velocities
are sampled at many locations along many lines
covering the entire imaging sector

Echo data is processed through two channels that
ultimately combine the image with the color flow data
in the final display.

Color Flow Doppler..
Flow toward transducer – red
Flow away from transducer – blue
Faster the velocity – more intense is the
colour
Flow velocity that changes by more than
a preset value within a brief time
interval (flow variance) – green / flame

CFM v/s Angiography
CFM Angiography
Records velocity not flow; So Records flow
in MR, CFM jet area consists
of both atrial and ventricular
blood – Billiard Ball Effect
Larger regurgitant orifice Larger regurgitant orifice

area there will be smaller jet area there will be larger jet
area area

Instrumentation factors in Color Doppler Imaging
Eccentric jets appear smaller than equivalently sized
central jets – Coanda Effect
High pressure jet will appear larger than a low-pressure
jet for the same amount of flow
As gain increases, jet appears larger
As ultrasound output power increases, jet area
increases
Lowering PRF makes the jet larger
Increasing the transducer frequency makes the jet
appear larger

To Summarise..
Knowledge of physics helps us appreciate
“why we are seeing what we are seeing, And
what we can do to see it better”
Echocardiography is based on the electrical

conversion of reflected ultrasound waves
from structures and blood flow within the
cardiovascular system.

To Summarise..
Good quality image is a compromise
between resolution and depth of
interrogation
Doppler study complements 2-D echo
Aligning Doppler beam parallel to direction of

target velocity is key to obtaining accurate
measurements.


Physics of Echocardiography: Department of Anaesthesiology, Narayana Hrudayalaya

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Physics of

Dr. Anil Kumar H.R

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Ultrasound and its properties

Department of Anaesthesiology, Narayana Hrudayalaya

Vibration Propagation Perception

Surface Vibration Pressure Wave Ear

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Metal 3000 - 6000

Soft tissue 1540

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

“From sound to image”

Department of Anaesthesiology, Narayana Hrudayalaya

Pierre Curie Jacques Curie

Department of Anaesthesiology, Narayana Hrudayalaya

“Piezoelectricity" after the Greek word Piezein, which

“Converse” of this effect is also true

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Electronic Phased Array

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Great temporal resolution- Updated

Department of Anaesthesiology, Narayana Hrudayalaya

M-mode beam through Mitral Valve

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Department of Anaesthesiology, Narayana Hrudayalaya

Study of blood flow dynamics

Detects the direction and velocity

Department of Anaesthesiology, Narayana Hrudayalaya

Ultrasound Tissue Blood

So, both are complementary to each other

Department of Anaesthesiology, Narayana Hrudayalaya

Christian Andreas Doppler

Colored appearance of some stars as due to their motion

Department of Anaesthesiology, Narayana Hrudayalaya