Chapter 1.

1.1

April 30, 2000

1 Principles of medical ultrasound imaging and measurements

1.1 1.2 Introduction.................................................................................................................... 3 Ultrasound waves and transducers A. Ultrasound compression waves in biological tissue.............................................. 3 B. Spatial resolution and frequency........................................................................... 6 C. Ultrasound transducers and beams........................................................................ 7 D. Focusing and apodization.................................................................................. 13

1.3 Pulse echo amplitude imaging A. Reflection, refraction and scattering of ultrasound...............................................17 B. A-mode and M-mode imaging- Power absorption and TGC........................... 21 C. Two dimensional (2D) amplitude imaging...........................................................26 D. Resolution, speckle and frequency in ultrasound imaging................................... 28 E. Signal compression and processing.....................................................................31 F. Three-dimenaional (3D) imaging.........................................................................31 1.4 Beam forming with electronic arrays A. Phased linear arrays.............................................................................................35 B. Switched linear arrays..........................................................................................36 C. Curvilinear arrays................................................................................................ 37 D. Annular arrays.....................................................................................................40 E. Dynamic focus and aperture................................................................................ 40 Factors affecting image quality A. What is image quality?.........................................................................................44 B. Effect of side lobes on image quality................................................................... 45 C. Artifacts from inhomogeneities in the tissue........................................................46 D. Reducing the effect of reverberations and wave front aberrations....................... 51 Blood velocity measurements using the Doppler effect of back-scattered ultrasound A. Basic principle..................................................................................................... 52 B. PW and CW Doppler measurements................................................................... 53 C. Spectral analysis.................................................................................................. 55 D. Range ambiguity, frequency aliasing, and LPRF/HPRF PW Doppler.................57 E. Analysis of range ambiguity and velocity range with LPRF and HPRF PW Doppler............................................................................59 Multi range gated (MRG) Doppler and Color Flow Mapping (CFM) A. Measurement of velocity profile with MRG Doppler .........................................64 B. 2D color flow mapping of blood velocities..........................................................66 C. Methods of insonifying the image field ............................................................. 68 D. Comparison between tissue and flow imaging.....................................................69

1.5

1.6

1.7

Chapter 1.1 1.8

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April 30, 2000

Combination of ultrasonic Doppler and amplitude imaging systems A. Need and problems with the combination...........................................................71 B. Instrument optimization....................................................................................... 74 C. The Missing Signal Estimator (MSE) method of simultaneous tissue imaging and Doppler measurements.................................................................................75

1.9 Ultrasound instrumentation A. Introduction ........................................................................................................ 77 B. Instrument block diagram and display interface ..................................................77 C. Interfacing to a computer..................................................................................... 80 D. Ultrasound scanline processing for tissue imaging..............................................81 E. Dynamic range and digital representation of signals............................................83 F. Ultrasound scanline processing for PW/CW Doppler ........................................ 84 G. Ultrasound scanline processing for color flow imaging ..................................... 86 1.10 Quick reference of important concepts Section 1.2.....................................................................................................................88 Section 1.3.....................................................................................................................90 Section 1.4.....................................................................................................................91 Section 1.5.....................................................................................................................92 Section 1.6.....................................................................................................................92 Section 1.7.....................................................................................................................94 Section 1.8.....................................................................................................................95 Section 1.9.....................................................................................................................95 1.11 Further reading on basic principles and clinical applications.......................................... 99

Chapter 1.1

1.3

April 30, 2000

1 Principles of medical ultrasound imaging and measurements

1.1 Introduction
This chapter gives an overview of the basic principles of medical ultrasound imaging, as an introduction to the more elaborate mathematical treatment of wave propagation, scattering, and signal processing presented in the following chapters. Further in depth presentations are also found in the reference list at the end of this Chapter. The amplitude of the back-scattered ultrasound from a transmitted pulse was first used to identify organ structures along a fixed beam direction using the A-mode display described in Section 1.3B. The development continued by scanning the beam in a plane to obtain two dimensional (2D) images of tissue structures. This was first done by manual scanning of the non-moving organs. With the moving structures of the heart, the manual scanning was to slow, and the M-mode display described in Section 1.3B was invented. This allowed for detailed examination of the fast movement of the cardiac valves and the cardiac wall. The need for real time imaging of the heart spurred the development of real time ultrasound beam scanning, first by fast mechanical rotation of the transducer, and later by beam steering with electronic arrays. Over the years, the real time scanning has proven to have so many practical advantages that it has also taken over from the manual scanning of non-moving structures. Ideas of three-dimensional (3D) imaging of organs by beam scanning in 3D directions, was first introduced in the 50'ies, but severe practical problems arouse from the lack of adequate 3D display technology. The power of todays computers and displays now has spurred new life into 3D imaging, but many practical problems is still left due to the high noise level in clinical clinical ultrasound images. Real time 3D imaging is also a problem due to the low speed of sound in tissue and the large number of beam directions that must be used. Processing to visualize volumetric data is also time consuming. When the scatterer is moving, the back-scattered signal will also have a change in frequency in accordance with the Doppler effect. This can be used for the measurement of the velocity of moving targets, for example the blood. By pulsing the beam, blood velocities in a specific area can be measured. However, there is a problem with the pulsed beam since the Doppler signal is sampled for each pulse only, which limits the maximum Doppler frequency that can be analyzed by the sampling theorem. This limits the maximum velocity that can be measured with pulsed wave (PW) Doppler. To avoid this limitation a continuously transmitted wave (CW) must be used. Then the range resolution in the measurement is lost. With scanning of the ultrasound beam, the Doppler effect can be used to image the spatial variation of the blood velocities. In the display, the blood velocities are usually shown in a color scale, which has given the name color flow mapping (CFM) to the technique.

1.2 Ultrasound waves and transducers

A. Ultrasound compression waves in biological tissue
Ultrasound is a term used to describe sound waves that have frequencies above the audible range, that means any sound wave with a frequency in excess of 15-20 kHz. Medical diagnostic ultrasound usually operates in the range 2-10 MHz for transcutaneous measurements, but frequencies up to 40 MHz have been used intraoperatively and with intraarterial imaging with ultrasound catheters.

Chapter 1.2

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April 30, 2000

distance

compression

decompression

pressure

distance

Moves with wave velocity, c

Figure 1-1. Schematic illustration of a longitudinal compression wave. The oscillatory particle movement is along the propagation direction of the wave.
Figure 1-1 illustrates a plane, compression type acoustic wave. The medium is compressed and decompressed with a defined spatial period along the propagation direction, produced by an increase and a decrease in the pressure, respectively. The compression/decompression pattern moves with the wave velocity along the propagation direction. For a frozen instant in time, the spatial period (e.g. the distance between neighboring pressure maxima) of the wave is called the wavelength, . At any fixed point along the wave, the spatial variations in the pressure will pass by with the wave propagation velocity, c, and an oscillation in the pressure with frequency f can be observed. The relationship between the wavelength and the frequency is = c/f (1.1)

At each spatial position, the material points are oscillating around their equilibrium position, producing deformation of the material. Acoustic waves can be of the compression type or of the shear type. For the compression type, termed compression or longitudinal waves, the particle movement is along the direction of wave propagation. For the shear type, the particle movement is transverse to the wave propagation, termed shear or transverse waves. In soft tissue, the shear waves have low propagation velocity (100m/s) and are heavily attenuated (f>1MHz) and can therefore be neglected. However, at interfaces conversion of longitudinal to shear waves introduces extra energy losses. Soft tissue is mainly water with some solids added. Therefore, the wave propagation velocity varies little between different types of soft tissue, and is only slightly above that of water, except for bone where the solid structure is predominant. Table 1-1 shows the sound velocity, mass density, compressibility, and acoustic impedance of some biological and nonbiological materials.

Chapter 1.2

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April 30, 2000

Table 1-1. Acoustic parameters for typical isotropic, homogeneous, elastic materials [6]. Material Mass density kg/m3 Compressibility 10-12 m2 /Nt
508 410 396 396 375-394 380-389 353-393 25-100 810-6 438 452 416 117 143 175 160 793 11.4 13 5.65 7.2 4.93 9 5.94

Sound velocity Acoustic impedance m/s 106 kg/(m2 s)

1 440 1 540 1 570 1 557 1 547-1 585 1 556-1 575 1 542-1 626 2 700-4 100 330 1550 1 497 1 531 2 670 2 500 2 060 2 300 1 000 5 750 5 900 4 350 3 650 3 240 6 260 4 430 1.37 1.59 1.61 1.62 1.64-1.68 1.65-1.67 1.65-1.74 3.75-7.4 0.0004 1.472 1.48 1.569 3.2 2.8 2.78 2.8 1.26 15.2 13 33.71 38 62.5 18 38

Biological material: Fat 950 Neurons 1 030 Blood 1 025 Kidney 1 040 Liver 1 060 Spleen 1 060 Muscles 1 070 Bone 1 380-1 810 Non biological material: Air (0 C) 1.2 Rubber 950 Fresh Water (25 C) 988 Salt Water 1 025 Lucite 1 198 Polystyrene 1 120 Hard PVC 1 350 Typ. Araldit 1 200 Silicon, RTV-11 1 260 Quartz 2 650 Fused quartz 2 200 PZT-5A 7 750 Silver 10 410 Gold 19 290 Aluminium 2 875 Brass 8 578

The sound velocity is related to the mass density and the volume compressibility (defined i Section 2.2A) of the material as

c =1

rk

(1.2)

A typical biological material is inhomogeneous , i.e. composed of different types of soft tissues in defined small regions. However, by excluding fat, the variation of the sound velocity is only .2 -.3% so that the wave propagates approximately like in a homogeneous and isotropic elastic material. By homogeneous we mean that the acoustic parameters are independent of the location and by isotropic we mean that they are independent of the direction in the material. However the material is inhomogeneous enough to scatter the ultrasound from the bulk of all biological materials, as is further discussed in Chapter 7. Although the wave velocity is isotropic, one have found absorption to depend on direction in fibrous and muscular tissue, as discussed in Section 1.3B. The acoustic or characteristic impedance is Z = c (1.3)

Variations in acoustic impedance between two materials causes a reflection of the ultrasound as discussed in Section 1.3A. The wave velocity and impedance of fat is so much lower than for muscular tissue, 9% for the velocity and 19% for the impedance, that it causes a strong scattering of the ultrasound together with a refraction (bending) of the beam. This causes strong artifacts in the image and is discussed in Section 1.5. Figure 1-2 shows the compressibility of the soft tissues as a function of the mass density. The Figure demonstrates the compressibility is reduced as the materials get denser.

Chapter 1.2
600

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April 30, 2000

500

Compressibility 10-12 m2 /Nt

400

300

200

100

0 940

960

980

1000

1020

1040

1060

1080

Mass density kg/m3

Figure 1-2. Compressibility of soft tissues as a function of their mass density.

The variability of the data in Table 1-1 is demonstrated together with the line showing the linear least square approximation. This line gives an approximate linear relationship between the compressibility and the mass density d 0 + {1545 - 1.1 }10-12 m2 /Nt d d 0 + 1405 - 0.9101 2 kg/m3 d This relationship between compressibility and mass density has implications for the angular variation of the scattered intensity from tissue, as further analysed in Chapter 7. Typical frequencies used in ultrasound imaging together with the wavelengths for a wave velocity c = 1580 m/s are shown in the Table 1-2.

(1.4)

B. Spatial resolution and frequency

The resolution in an ultrasound image is proportional to the wavelength, i.e. inversely proportional to the frequency. Therefore to get good resolution, one should use as high a frequency as possible. Unfortunately the attenuation of the ultrasound also increases with frequency as discussed in Section 1.3B. To get adequate penetration, it is necessary to lower the frequency and therefore frequencies in the range 2.5 - 5 MHz are used in adult cardiology and imaging of deep organs. For pediatric cardiology, frequencies up to 7.5 MHz are used and for imaging of peripheral vessels and during surgery, frequencies up to 10 - 15 MHz have been used. For intravascular imaging of atherosclerosis, frequencies up to 40 MHz ( = 39 m) have been used producing a spatial resolution around 100 m.

Chapter 1.2

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April 30, 2000

Table 1-2. Typical wavelengths with diagnostic ultrasound [6,11,16,21]. Frequency, MHz 2 Wavelength, m 790
2.5 632 3 527 3.5 451 5 316 7.5 211 10 158 20 79 40 39

Tissue image: Deep organs, Adult heart Pediatric heart Periph. vessels Intravascular Doppler: Deep vess., Ad. heart Ped.heart Periph. vessels Intravasc. At audible frequencies, we are used to sound waves bending around corners. We can hear the train before it comes around the bend. However, as the frequency increases and the wavelength reduces, the sound tends to move along straight lines. With loud-speakers we find that the treble sound is more directive than the base. How well the treble sound is heard often depends upon where in the room one is standing, while the base bends around all corners. The bending of waves around corners is called diffraction . The critical factor for how much the wave bends, is the size of the transducer face in number of wavelengths. If this number is large, the sound tends to move in straight lines. Typical non invasive diagnostic transducers are 15-25 mm in diameter, and from Table 1-2, we see that these transducers are many wavelengths wide. For example, a circular transducer of 15 mm diameter will be approximately 20 at 2 MHz and 48 at 5 MHz. This makes it possible to generate beams of ultrasound. The size of the transducer is called its aperture.

C. Ultrasound transducers and beams

An ultrasonic transducer can be made of a plate of piezoelectric material with thin metal electrodes on each face as illustrated in Figure 1-3. The transducer is thus an electrical capacitor. When a voltage source is coupled to the electrodes, the plate either increases or decreases its thickness depending on the polarity of the voltage, as illustrated in Figure 1-3b and c. The transducer can also be used to transfer energy from acoustic vibrations into an electric voltage and in this mode, can be used to receive ultrasonic waves. When an incoming wave hits the transducer surface, it causes the plate to vibrate and the piezoelectric effect produces a voltage between the metal electrodes. If we connect an oscillating voltage source to the electrodes, the plate thickness will vibrate. When the plate thickness is one half wavelength, we get a resonance in the thickness vibration with increased vibration amplitude. The middle of the plate is then a vibration node, i.e. not moving, while the surfaces of the plate are vibration antinodes moving to and from each other with large amplitude. The pressure in the plate is zero on the surfaces when the plate is vibrating freely in air, and maximum in the center of the plate as illustrated in Figure 1-3d. Thus the pressure has antinodes where the material vibration has nodes, and nodes where the vibration has antinodes.

Chapter 1.2

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April 30, 2000

piezo-electric material

metal electrodes a)

+ +

+ +

b)

+ +

+
c)

+ +

velocity ampl.

pressure ampl.

d)

Figure 1-3. a) Cross-section of schematic piezoelectric transducer plate with thin metal electrodes. b) Expansion of the plate thickness by applying a voltage across the plate, and c) compression of the plate thickness by applying a voltage of opposite polarity to the plate. The lowest panel, d), shows the amplitude of the particle velocity and the pressure in the plate for a free vibrating plate in air.

Chapter 1.2 Pressure

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April 30, 2000

time Bw Tp Pressure frequency a) 1 Tp ~ Bw time Tp b) frequency

Bw

Figure 1-4. a) Examples of shortest possible pulses obtained from a transducer with air backing and no quarter wave matching, and b) a transducer with air backing and quarter wave matching. The panels to the right show the Fourier transform of the pulses, which gives the distribution of frequencies in the pulses. The width of these distributions is the bandwidth of the transducer.
Connecting a vibrating transducer surface to the tissue, will cause the tissue surface to vibrate and thus radiate an ultrasound beam into the bulk tissue. The vibration of the surface will be somewhat reduced by the contact loading of the tissue, and a pressure will develop on the surface. However, the plate is much stiffer than the tissue so that the reduction in the vibration at the surface of the transducer due to the load of the tissue is very low. Since the transducer is at resonance, it will ring for quite a few oscillations after we have removed the voltage source. This is called the ring-down . Figure 1-4a shows the velocity on i the transducer surface when the transducer is driven with a very short electric pulse (impulse response), and illustrates the minimum length of the ultrasound pulse which can typically be transmitted with this design. This is undesirably long for pulse echo applications where we want a short pulse for high range resolution. There are two ways to reduce the ringing: i) By mounting the transducer plate on a heavy, stiff and absorbing backing , the ringing is dampened because energy is transmitted into the backing. The disadvantage of this method is that it introduces acoustic power losses into the backing, and reduces the amplitude of the pulse transmitted into the tissue as well as the sensitivity of the transducer as a receiver.

ii) By using a thin plate between the transducer and the tissue which has a stiffness and mass density between that of the transducer and that of the tissue, the energy coupling between the transducer and the tissue will be stronger, and the ringing will die out more quickly. The plate should have a thickness of /4, where is the wavelength in the plate. Such a plate transforms the mechanical impedance of the tissue and is often referred to as a quarter wave impedance transformer . The effect on the ring-down by such a quarter wave impedance matching is illustrated in Figure 1-4b.

Chapter 1.2

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April 30, 2000

The right panel in Figure 1-4 shows the Fourier transform of the pulses which shows the distribution of frequencies in each pulse. The width of these distributions is called the bandwidth of the transducer, and we see that the bandwidth is inversely proportional to the pulse length, i.e. the wider the bandwidth, the shorter the pulse. Since the backing introduces a reduction in receiver sensitivity, it is avoided if possible. In some cases the backing is required for mechanical support, for example with linear phased arrays, and cannot be avoided. This accounts for a less than optimal sensitivity noted with the linear phased array compared to some other types of transducers. With the second method, the ring-down is reduced through a better coupling of the energy into the tissue. The best transducer is then obtained with air backing and quarter wave matching of the transducer to the tissue load. Two or more /4 layers are also used to improve the bandwidth at the cost of more difficult machining. To analyze the radiated beam from such a transducer plate, we can use Huygens' principle where each point on the surface acts as a source of a spherical wave. According to Huygens' principle, these partial waves will interfere and generate the resulting beam as illustrated in Figure 1-5. The beam is composed of three regions: The farfield region where, due to diffraction the beam expands with a fixed opening angle. In the farfield, the beam is composed of a central main lobe with side lobes as skirts around. The beam amplitude falls gradually off from the axis, and we can define the width of the main lobe as where the amplitude has fallen X dB off from the axial value.

D /2 D2/4 0.8 D /4
2

Side lobe

D=2a

Main lobe

Q12dB

Side lobe Extreme near field Transition region Near field Far field

Figure 1-5. Schematic illustration of the formation of an ultrasonic beam from a circular vibrating plate. According to Huygens' principle, the beam is formed by the interference between spherical waves from each point on the transducer surface. The resulting beam has a characteristic farfield region where it expands with a defined opening angle. In the farfield, the beam is composed of a typical main lobe with surrounding side lobes. Between the transducer and the farfield, is the nearfield region. This is composed of the extreme nearfield where the beam is a cylindrical extension of the transducer, and a transition zone between the extreme nearfield and the farfield.

Chapter 1.2

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April 30, 2000

Table 1-3. Values of kX for various definitions of the beam width. X = is obtained at the zero between the main lobe and the first side lobe.
X dB kX 3 1 10 1.8 12 2 2.44

The dual sided opening angle of the main lobe for a plane circular transducer is then XdB = kX /D (1.5)

where D = 2a is the diameter of the transducer. Values of kX for different reductions X in beam amplitude are shown in Table 1-3. Typical values of 12dB opening angles are shown in Table 1-4. The distance x3 along the transducer axis to the start of the farfield region is for a plane, circular transducer x3 = 2a2 / = D2 /2 (1.6)

This can be defined geometrically as the intersection between the cylindrical extension of the transducer and the 12dB opening angle of the beam, as illustrated in Figure 1-5. This is discussed at length in Sections 5.4-6. Between the transducer and this limit is the nearfield region which is composed of the extreme nearfield for x3 < 0.8 a2 / = 0.2 D2 / (1.7)

where the beam is approximately the cylindrical extension of the transducer. The region between the extreme nearfield and the farfield is called the transition region . In this region the beam contracts before it starts to expand in the farfield, causing an apparent focusing that is referred to as diffraction focusing. The transition between the near field and the far field is not sharp, and the whole concept of dividing the beam into a near field and a far field region is a simplified means of enhancing some aspects of the character of the beam rather than describing well defined regions. Also, the shape of the far field side lobes depends upon the length of the transmitted pulse. For continuous wave (CW) excitation, we have directions of zero field between each lobe with an amplitude variation as illustrated in Figure 1-6a, while with a short p u l s e d w a v e (PW) excitation the zeros disappear and we get an angular variation of the field amplitude as illustrated in Figure 1-6b. This is further analyzed in Section 5.7.

Table 1-4. Dual sided 12 dB opening angle in degrees for practical circular transducers in the range 2-50 MHz.
D=2a mm =0.75 (2MHz) =0.5 (3MHz) =0.3 (5MHz) =0.2 (7.5MHz) =0.15 (10MHz) = 75 (20MHz) = 50 (30MHz) = 37 (40MHz) = 30 (50MHz) 1 1.5 2 3 4 5 6 8 10 12 15 17 5.9 4.8 3.8 3.4 3.4 2.9 2.3 2.0 2.3 1.9 1.5 1.3 1.7 1.4 1.2 1.0 0.9 0.7 0.6 0.6 20 4.3 2.9 1.7 1.1 0.9 24 28 3.6 3.1 2.4 2.0 1.4 1.2 0.95 33 2.6 1.7 1.0

4.3 5.7 3.8 2.9 4.3 2.9 2.1 3.4 2.3 1.7

2.9 1.9 1.4 1.1

1.2 2.1 1.4 1.1 0.9

4.6 3.4 1.7 1.1 0.9 0.7

3.8 2.9 1.4 0.9 0.7 0.6

4.3 2.9 2.1 1.1 0.7 0.5

Chapter 1.2 dB

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-10

-20

-30 -10 0 dB

0 a)

10 degrees

-10

-20

-30 -10

0 b)

10 degrees

Figure 1-6. Far field angular variation of the amplitude of the transmitted wave for a plane, circular 3MHz transducer with 15 mm diameter. CW excitation of the transducer is shown in a), and PW excitation in b).
F side lobe D=2a main lobe DF x3 QF =Q12dB Qg

LF (1dB)

Figure 1-7. Focusing of an ultrasound beam by shaping the transducer disc as a spherical shell.

Chapter 1.2
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0.5

0.5

0 20

0 10 0 a) 10 20 mm 20 10 0 b) 10 20 mm

1.0

1.0

0.5

0.5

transducer diameter c)

0 20

10

0 d)

10

20 mm

Figure 1-8. Focal field distribution from a 3 MHz spherical shell with diameter 15 mm and focal radius 75 mm. CW excitation with uniform vibration amplitude over the disc is shown in a), and PW excitation with uniform vibration amplitude over the disc is shown in b). With an apodization of the vibration amplitude over the disc as in c), the PW excitation produces the field shown in d). D. Focusing and apodization
The beam can be focused in a simple way by forming the transducer as part of a spherical shell as illustrated in Figure 1-7. The geometrical focus will be in the center of curvature of the shell. However, because the transducer disc is a limited number of wavelengths in diameter, we get diffraction of the sound and the focus will not be as sharp as the focus obtained with geometrical beams. The field distribution will be as shown in Figure 1-7, with some variations depending on how the transducer is excited. Figure 1-8a shows the cross sectional distribution of the amplitude at the focal point for CW excitation of the beam with equal vibration amplitude over the disc. The field is composed of a main lobe and side lobes with clear zeros in between. Figure 1-8b shows the amplitude variation with PW excitation of the disc producing a transmitted pulse as in Figure 1-4b with uniform vibration amplitude over the whole disc. The zeros between the sidelobes with CW excitation have disappeared. It can be advantageous to let the amplitude of the plate vibration degrade from the center to the edges. This is called apodization . With a variation of the vibration amplitude as shown in Figure 1-8c, we get a variation of the field in the focus with PW as shown in Figure 1-8d. When apodization of the excitation amplitude over the transducer surface is done, the width of the main lobe increases, but the amplitude of the sidelobes decreases. One reason to do this is that the sidelobes generate acoustic noise since they detect targets that are not along the beam direction. This reduces the contrast resolution of the instrument, which is the ability to discriminate a weak target that is close to a strong one. The effect of the sidelobes is further discussed in Section 1.5. Although the amplitude of the sidelobes is much lower than for the main lobe, the sidelobes contain a fair amount of energy because they form a skirt around the main lobe.