250

solid materials. A typical value for body tissue is

1500 m s
1
. Using the wave equation v = f , we can
calculate the wavelength of 2.0 MHz ultrasound
waves in tissue:
=

f
=
1500
2.0 10
6
= 7.5 10
4
m 1 mm
This means that 2.0 MHz ultrasound waves will
be able to distinguish detailed features whose
dimensions are of the order of 1 mm. Higher-
frequency waves have shorter wavelengths and these
are used to detect smaller features inside the body.
Using ultrasound in medicine
Chapter 17
Working with ultrasound
Ultrasound is any sound wave that has a frequency
above the upper limit of human hearing. This is
usually taken to imply frequencies above 20 kHz
(20 000 Hz), although the limit of hearing decreases
with age to well below this fgure. In medical
applications, the typical frequencies used are in the
megahertz range.
Sound waves are longitudinal waves. They can
only pass through a material medium; they cannot
pass through a vacuum. The speed of sound (and
hence of ultrasound) depends on the material. In
air, it is approximately 330 m s
1
; it is higher in
Ultrasound scanning is routinely used to check the
condition of a baby in the womb (Figure 17.1).
There do not seem to be any harmful side-effects
associated with this procedure, and it can provide
useful information on the babys development.
Indeed, for many children, their frst appearance in
the family photo album is in the form of an ante-
natal (before birth) scan!
This technique has many other uses in medicine.
It can be used to detect gallstones or kidney stones
(two very painful complaints), so men as well as
women may experience this type of scan.
The technique of ultrasound scanning is
rather similar to the way in which sailors use
echosounding and echolocation to detect the seabed
and shoals of fsh. Ultrasound waves are directed
into the patients body. These waves are partially
refected at the boundaries between different tissues
and the refected waves are detected and used to
construct the image.
In this chapter, we will look at the principles
of ultrasound scanning and we will also look at
another technique in which ultrasound is used to
measure the rate of blood fow in the body.
Family photos
Figure 17.1 An expectant mother undergoes an
ultrasound scan. The image of her baby is built up
by computer and appears on the monitor.
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Objectives
Chapter 17: Using ultrasound in medicine
251
piezoelectric substances, the maximum value of strain
is about 0.1%; in other words, the crystals width
changes by about 0.1%.
In a piezoelectric transducer, an alternating voltage
is applied across the crystal, which then acts as the
vibrating source of ultrasound waves. A brief pulse
of ultrasound waves is sent into the patients body;
the transducer then receives an extended pulse of
refected ultrasound waves.
Detecting ultrasound
The transducer also acts as the detector of refected
ultrasound waves. It can do this because the
piezoelectric effect works in reverse: a varying stress
applied to the crystal produces a varying e.m.f. across
the crystal see Figure 17.2b. To maximise the effect,
the frequency of the waves must match the resonant
frequency of the crystal. The optimum size of
the crystal is half the wavelength (

2
) of the
ultrasound waves.
Figure 17.3 shows the construction of a
piezoelectric ultrasound transducer. Note the
following features:
The crystal is now usually made of polyvinylidene

difuoride. Previously, quartz and lead zirconate
titanate were used.
The outer case supports and protects the crystal.

Producing ultrasound
Like audible sound, ultrasound is produced by a
vibrating source. The frequency of the source is the
same as the frequency of the waves it produces. In
ultrasound scanning, ultrasonic waves are produced
by a device in which a varying electrical voltage is
used to generate ultrasound. The same device also acts
as a detector. This device is known as a transducer;
this is a general term used to describe any device that
changes one form of energy into another.
At the heart of the transducer is a piezoelectric
crystal. This is a crystal that has a useful property:
when a voltage is applied across it in one direction, it
shrinks slightly see Figure 17.2a. When the voltage
is reversed, it expands slightly. So an alternating
voltage with frequency f causes the crystal to contract
and expand at the same frequency f. We say that the
voltage induces a strain in the crystal. In the best
applied stress induced e.m.f.
applied voltage induced strain
a
b
+
+
+
+
+
+

+
connector
outer case
acoustic window
crystal
damping
material
Figure 17.2 The piezoelectric effect. a An applied
voltage causes a piezoelectric crystal to contract or
expand. b An applied stress causes an induced e.m.f.
across the crystal.
Figure 17.3 A section through an ultrasound
transducer.
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Chapter 17: Using ultrasound in medicine
252
boundary where the wave speed changes. The
refected waves are then detected and used to
construct an internal image of the body.
Figure 17.4 shows what happens when a beam of
ultrasound reaches a boundary between two different
media. The beam is partially refracted (so that the
transmitted beam has changed direction) and partially
refected. This diagram should remind you of the way
in which a ray of light is refracted and refected
when it strikes the boundary between two media. It
is the change in speed which causes the refraction of
a wave.
For ultrasound, we are interested in the fraction of
the incident intensity of ultrasound that is refected
at the boundary. This depends on the acoustic
impedance Z of each material. This quantity depends
on the density and the speed of sound c in the
material. Acoustic impedance is defned as follows:
acoustic impedance = density speed of sound
Z = c
The unit of acoustic impedance Z is kg m
2
s
1
.
At the base is the acoustic window made from a

material that is a good transmitter of ultrasound.
Behind the crystal is a large block of damping

material (usually epoxy resin). This helps to stop
the crystal vibrating when a pulse of ultrasound
has been generated. This is necessary so that
the crystal is not vibrating when the incoming,
refected ultrasound waves reach the transducer.
SAQ
1 Quartz is an example of a piezoelectric material.
The speed of sound in quartz is 5700 m s
1
.
a Calculate the wavelength of
ultrasound waves of frequency
2.1 MHz in a quartz crystal.
b If the crystal is to be used in an ultrasound
transducer, its thickness must be half a
wavelength. Calculate the
thickness of the transducer.
2 Piezoelectric crystals have many applications
other than in ultrasound scanning. For example,
they are used:
a in gas lighters (to produce a spark)
b in inkjet printers (to break up the stream of ink
into droplets)
c in guitar pickups (to connect the guitar to an
amplifer)
d in the auto-focus mechanism of some cameras
(to move the lens back and forth).
For each of these examples, state whether the
piezoelectric effect is being used to convert
mechanical energy to electrical
energy or the other way round.
Echosounding
The principle of an ultrasound scan is to direct
ultrasound waves into the body. These pass through
various tissues and are partially refected at each
Z
incident
wave
angle of
incidence
reflected
wave
angle of
refraction
refracted wave
(transmitted)
1
Z
2
Figure 17.4 An ultrasound wave is both refracted
and refected when it strikes the boundary between
two different materials.
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Chapter 17: Using ultrasound in medicine
253
Table 17.1 shows values of , c and Z for
some materials that are important in medical
ultrasonography.
Calculating refected intensities
When an ultrasound beam reaches the boundary
between two materials, the greater the difference
in acoustic impedances, the greater the fraction of
the ultrasound waves that is refected. For normal
incidence (i.e. angle of incidence = 0) the ratio of
the refected intensity I
r
to the incident intensity I
0
is
given by:
I
r
I
0
=
(Z
2
Z
1
)
2
(Z
2
+ Z
1
)
2

or
I
r
I
0
=
Z
2
Z
1
Z
2
+ Z
1

2
where Z
1
and Z
2
are the acoustic impedances
of the two materials (see Figure 17.4). The ratio
I
r
I
0
indicates the fraction of the intensity of the
beam that is refected.
Now look at Worked example 1.
Material Density /kg m
3
Speed of sound c/m s
1
Acoustic impedance
Z/10
6
kg m
2
s
1
air 1.3 330 0.0004
water 1000 1500 1.50
Biological
blood
fat
soft tissue (average)
muscle
bone (average; adult)
1060
925
1060
1075
1600
1570
1450
1540
1590
4000
1.66
1.34
1.63
1.71
6.40
Transducers
barium titanate
lead zirconate titanate
quartz
polyvinylidene difuoride
5600
7650
2650
1780
5500
3790
5700
2360
30.8
29.0
15.1
4.20
Table 17.1 Ultrasound properties of some
materials important in medical scanning.
A beam of ultrasound is normally incident on the
boundary between muscle and bone. Use Table 17.1
to determine the fraction of its intensity refected.
Step 1 Write down the values of Z
1
(for muscle)
and Z
2
(for bone).
Z
1
= 1.71 10
6
kg m
2
s
1

Z
2
= 6.40 10
6
kg m
2
s
1
Step 2 Substitute these values in the equation for
I
r
I
0
; note that we can use this equation because we
know that the angle of incidence = 0.
I
r
I
0
=
(Z
2
Z
1
)
2
(Z
2
+ Z
1
)
2
=
(6.40 1.71)
2
(6.40 + 1.71)
2
= 0.33
Note also that we can ignore the factor of 10
6
in
the Z values because this is a factor common to
all the values, so they cancel out.
So 33% of the intensity of ultrasound will be
refected at the musclebone boundary.
Worked example 1
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Chapter 17: Using ultrasound in medicine
254
The poor match of impedance between air and
tissue means that ultrasound cannot penetrate the
lungs. The operator must take care to avoid any
bubbles of gas in the intestines. Bones are also
diffcult to see through. For an ultrasound scan of
the heart, the probe must be directed through the gap
between two ribs.
SAQ
3 Calculate the acoustic impedance of brain
tissue. (Density = 1025 kg m
3
,
speed of sound = 1540 m s
1
.)
4 Determine the fraction of the intensity of an
ultrasound beam that is refected when a beam is
incident normally on a boundary between water
and fat. (Use values from
Table 17.1.)
5 The ultrasound image shown in Figure 17.5
clearly shows the babys skin and some bones.
Explain why these show up clearly while
softer organs inside its body
do not.
6 Explain why ultrasound cannot readily be used to
examine the brain. Suggest an alternative scanning
technique(s) that can be used
for this.
Ultrasound scanning
There are several different types of ultrasound scan
which are used in practice. To illustrate the basic
principles, we will concentrate on the A-scan and
the B-scan.
A-scan
This is the simplest type of scan. A pulse of
ultrasound is sent into the body and the refected
echoes are detected and displayed on an
oscilloscope or computer screen as a voltage
against time graph.
Comparing acoustic impedances
A big change in acoustic impedance gives a large
fraction of refected intensity. Inspection of Table
17.1 shows that:
a very large fraction (

I
r
I
0
99.95%) of the
incident ultrasound will be refected at an
airtissue boundary
a large fraction will be refected at a tissuebone

boundary (as shown in Worked example 1)
very little will be refected at a boundary between

soft tissues including fat and muscle.
This means that bone shows up well in an ultrasound
scan, but it is diffcult to see different soft tissues
(Figure 17.5). Another problem is that the patients
skin is in contact with air, and 99.95% of the
ultrasound will be refected before it has entered
the body. To overcome this, the transducer must be
coupled to the skin using a gel whose impedance
matches that of the skin. This process of impedance
matching explains why the patients skin is smeared
with gel before a scan.
The acoustic impedance of the gel is
typically 1.65 10
6
kg m
2
s
1
and that of skin is
1.71 10
6
kg m
2
s
1
. With gel between the skin
and the transducer, the percentage of the intensity
refected is 0.03%.
Figure 17.5 Ultrasound scan of a fetus at 20 weeks;
the babys skin is clearly visible, as are its bony skull
and ribs.
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Chapter 17: Using ultrasound in medicine
255
where c is the speed of the ultrasound in the bone (see
Worked example 2).
Because ultrasound waves are gradually attenuated
as they pass through the body (their energy is
absorbed so that their amplitude and intensity
decrease), the echoes from tissues deeper in the body
are weaker and must be amplifed.
A-scans are used for some straightforward
procedures such as measuring the thickness of the
eye lens.
B-scan
In a B-scan, a detailed image of a cross-section
through the patient is built up from many A-scans. The
ultrasound transducer is moved across the patients
body in the area of interest. Its position and orientation
are determined by small sensors attached to it.
Each refected pulse is analysed to determine the
depth of the refecting surface (from the time of echo)
and the nature of the surface (from the amplitude
of the refected wave). A two-dimensional image
is then built up on a screen by positioning dots to
represent the position of the refecting surfaces and
A pulse generator controls the ultrasound
transducer. It is also connected to the time base of
the oscilloscope. Simultaneously, the pulse generator
triggers a pulse of ultrasound which travels into the
patient and starts a trace on the screen. Each partial
refection of the ultrasound is detected and appears as
a spike on the screen (Figure 17.6).
In Figure 17.6, the pulses 1, 2 and 3 are refected at
the various boundaries. Pulse 1 is the refection at the
musclebone boundary at B. Pulse 2 is the refection
at the bonemuscle boundary at C. The time t is
the time taken for the ultrasound to travel twice the
thickness of the bone. Finally, pulse 3 is the refection
at the muscleair boundary at D. The thickness of the
bone can be determined from this A-scan.
time interval between pulses 1 and 2 = t
thickness of bone =
distance travelled by ultrasound
2
thickness of bone =
ct
2
Time
0
A B
1
t
voltage
pulse sent
from
transducer
2
reflected pulses
bone
muscle
ultrasound
transducer
gel
muscle
3
C D
0
V
o
l
t
a
g
e
Figure 17.6 An A-scan. Information about the
depth of refecting tissues can be obtained from
the positions of the spikes along the time axis; their
relative amplitudes can indicate the nature of the
refecting surfaces.
In a particular A-scan, similar to Figure 17.6, the
time interval between pulses 1 and 2 is 12 s. The
speed of ultrasound in bone is about 4000 m s
1
.
Determine the thickness of the bone.
Step 1 Determine the distance travelled by the
ultrasound in the time interval of 12 s.
distance = speed time
distance = 4000 12 10
6
= 4.8 10
2
m
Step 2 Calculate the thickness of the bone.
The ultrasound wave has to travel twice the
thickness of the bone. Hence:
thickness of bone =
4.8 10
2
2
= 2.4 10
2
m (2.4 cm)
Worked example 2
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Chapter 17: Using ultrasound in medicine
256
SAQ
7 Two consecutive peaks in an ultrasound A-scan
are separated by a time interval of 0.034 ms.
Calculate the distance between the two refecting
surfaces. (Assume that the speed of sound in the
tissue between the two surfaces
is 1540 m s
1
.)
8 Explain why an ultrasound B-scan is used to
examine a fetus rather than
X-rays.
Doppler ultrasound
The patient in Figure 17.9 is undergoing a different
medical application of ultrasound scanning. The
doctor is holding an ultrasound probe against her
neck to examine the blood fow in a major artery. This
relies on the Doppler effect.
The Doppler effect occurs when waves are emitted,
refected or detected by a moving object. In this case,
we will consider a moving refector the iron-rich
blood cells moving along an artery. When a pulse of
ultrasound waves is sent along the artery, they are
partially refected back by the cells. The refected
waves have a slightly different wavelength and
frequency, an example of the Doppler effect.
with brightness determined by the intensity of the
refection, brighter dots indicating more refected
ultrasound (see Figure 17.7).
Figure 17.8 shows the result of a typical B-scan.
Because it takes several seconds for the scanner
to move across the body, problems can arise if
the organs of interest are moving this gives
a blurred image.
movement of
ultrasound
transducer
B-scan
display
organ
skin
Figure 17.7 In a B-scan, dots are produced on the
screen rather than the pulses as in the A-scan. By
moving the transducer, a series of dots on the screen
trace out the shape of the organ being examined.
Figure 17.8 An ultrasonic B-scan of an abnormal
thyroid gland.
Figure 17.9 Ultrasound examination of the carotid
artery in the neck, a form of Doppler ultrasonography.
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Chapter 17: Using ultrasound in medicine
257
10 Figure 17.10 shows an ultrasound transducer
pointing towards a blood vessel.
The frequency of the ultrasound waves emitted
by the transducer is f. The detected ultrasound
waves have a higher frequency because of the
Doppler effect. The change in the frequency f of
the waves is given by the equation:
f =
2f cos
c
where v is the speed of the blood, is the angle
between the incident ultrasound and the direction
of the blood fow and c is the speed of the
ultrasound in blood.
A transducer emitting ultrasound at frequency
6.0 MHz detects a change in frequency of 0.85 kHz
when the angle between the emitted waves and
the blood vessel is 58. The speed of ultrasound
in blood is 1500 m s
1
. The diameter of the blood
vessel is 1.2 mm.
Determine the speed v of the blood fow in the
vessel and the rate of fow of blood
(in m
3
s
1
) through the vessel.
Why does this happen? If the refecting surface is
stationary, nothing unusual happens the refected
waves are a mirror image of the incident waves, so
that their wavelength is unaltered. However, if the
refector is moving away from the source, things are
different. Each refected wave is refected from a
slightly different position, slightly further away from
the source. The result is that the string of refected
waves is slightly longer than the incident waves. In
other words, the refected waves are longer they
have an increased wavelength. Because their speed is
unaffected, their frequency must decrease.
The greater the speed of the receding refector, the
greater the decrease in the frequency of the ultrasound
waves. It follows that the speed of the receding
refector can be deduced from the change in frequency
of the waves. (Note that an approaching refector will
increase the frequency of the ultrasound waves.)
Doppler ultrasonography is used to study the
movement of a patients blood along blood vessels
(veins and arteries). It can show up the pulsing
movement of the blood as the heart beats. More
importantly, it can show whether the blood is
moving smoothly (the blood moves at a uniform
speed throughout the blood vessel) or whether there
is turbulence (blood fows at different speeds in
different regions of the vessel). This can be a sign of
blockages developing, or of weakening of the walls
of the vessel.
Kidney transplant patients are monitored using
Doppler ultrasound to determine whether blood
is fowing normally through their new organ. The
technique is also used in the diagnosis of faulty
heart valves.
SAQ
9 Doppler ultrasound can be used to monitor the
action of the heart as it beats. At any instant,
some areas of the heart will be moving towards
the ultrasound probe while others will be moving
away from the probe. How will the wavelength
and frequency of ultrasound waves be affected
when they refect from a surface that is moving
towards the probe? Explain
your answer.
skin

gel
ultrasound transducer
blood vessel
red blood cells
Figure 17.10 For SAQ 10.
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Chapter 17: Using ultrasound in medicine
258
Summary
Ultrasound is a longitudinal mechanical wave with a frequency greater than 20 kHz.

Ultrasound transducers use the piezoelectric effect to generate and detect ultrasound waves.

The acoustic impedance

Z of a material depends on its density and the speed c of sound:
Z = c.
The fraction of the intensity of an ultrasound wave refected at a boundary is given by

I
r
I
0
=
(Z
2
Z
1
)
2
(Z
2
+ Z
1
)
2
or
I
r
I
0
=
Z
2
Z
1
Z
2
+ Z
1

2
To transfer a high proportion of the intensity of an ultrasound pulse into the patients body, an

impedance-matching gel must be used with acoustic impedance almost the same as that of the skin.
In ultrasound scanning, an A-scan uses a single pulse to determine the depth and nature of refecting

surfaces. A B-scan builds up a two-dimensional image from multiple A-scans.
In the Doppler effect, the wavelength and frequency of a wave are altered on refection by a

moving surface. The frequency of a wave decreases for a receding source and increases for an
approaching source.
The Doppler effect can be used to determine the speed of blood in arteries.

Questions
a 1 Defne acoustic impedance of a material and show it has unit kg m
2
s
1
. [2]
The acoustic impedance of air, gel and skin are 430 kg m b
2
s
1
, 1.6 10
6
kg m
2
s
1
and 1.7 10
6
kg m
2
s
1
respectively.
Calculate the fraction of intensity of the ultrasound that penetrates the i
airskin boundary and the gelskin boundary. [6]
Explain why gel is smeared on the skin and the transducer before an ii
ultrasound scan. [2]
[Total 10]
a 2 Describe the principles of the production of a short pulse of ultrasound using a
piezoelectric transducer. [5]
continued
Glossary
Hint
Answer
Chapter 17: Using ultrasound in medicine
259
20 s
The CRO timebase is set to 20 s cm
1
. The speed of ultrasound in the fetal
head is 1.5 10
3
m s
1
.
Calculate the size of the fetal head. [4] i
State and explain what would be seen on the CRO screen if gel had ii not been
applied between the ultrasound transducer and the skin of the mother. [3]
OCR Physics A2 (2825/02) June 2007 [Total 12]
3 The ratio of refected intensity to incident intensity for ultrasound refected at a boundary
is related to the acoustic impedance Z
1
of the medium on one side of the boundary and
the acoustic impedance Z
2
of the medium on the other side of the boundary by the
following equation:
refected intensity
incident intensity
=
(Z
2
Z
1
)
2
(Z
2
+ Z
1
)
2
State the a two factors that determine the value of the acoustic impedance. [2]
continued
The diagram below shows a trace on a cathode-ray oscilloscope (CRO) of an b
ultrasound refection from the front edge and rear edge of a fetal head.
Hint
Answer
Chapter 17: Using ultrasound in medicine
260
An ultrasound investigation was used to identify a small volume of substance in b
a patient. It is suspected that this substance is either blood or muscle.
During the ultrasound investigation, an ultrasound pulse of frequency 3.5 10
6
Hz
passed through soft tissue and then into the small volume of unidentifed substance.
A pulse of ultrasound refected from the front surface of the volume was detected
26.5 s later. The ratio of the refected intensity to incident intensity for the ultrasound
pulse refected at this boundary was found to be 4.42 10
4
. The table below shows
data for the acoustic impedances of various materials found in a human body.
Medium Acoustic impedance Z/kg m
2
s
1
air 4.29 10
2
blood 1.59 10
6
water 1.50 10
6
brain tissue 1.58 10
6
soft tissue 1.63 10
6
bone 7.78 10
6
muscle 1.70 10
6
Use appropriate data from the table to identify the unknown medium. You i
must show your reasoning. [4]
Calculate the depth at which the ultrasound pulse was refected if the speed ii
of ultrasound in soft tissue is 1.54 km s
1
. [2]
Calculate the wavelength of the ultrasound in the soft tissue. [2] iii
OCR Physics A2 (2825/02) June 2005 [Total 10]
Hint
Answer