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Ultrasound Physics

Definition of Ultrasound
ultrasound is sound with frequency greater than 20,000 cycles per second or 20kHz.
Audible sound sensed by the human ear are in the range of 20Hz to 20kHz.

Advantages
Ultrasound can be directed as a beam.
Ultrasound obeys the laws of reflection and refraction.
Ultrasound is reflected by objects of small size.

Disadvantages
Ultrasound propagates poorly through a gaseous medium.
The amount of ultrasound reflected depends on the acoustic mismatch.

Creating an ultrasound image is done in three steps - producing a sound wave,


receiving echoes, and interpreting those echoes.

Producing a sound wave


• Ultrasound waves are produced by a transducer. A transducer is a device that
takes power from one source and converts the energy into another form eg electricity into
sound waves. The sound waves begin with the mechanical movement (oscillations) of a
crystal that has been excited by electrical pulses, this is called the piezoelectric effect.

• The sound waves are emitted from the crystal similar to sound waves being
emitted from a loud speaker. The frequencies emitted are in the range of (2- 15MHz) and
are unable to be heard by the human ear. Several crystals are arranged together to form a
transducer. It is from the transducer that sound waves propagate through tissue to be
reflected and returned as echoes back to the transducer.
• Sound is produced using Piezoelectricity which is the ability of some materials
(notably crystals and certain ceramics) to generate an electric charge in response to
applied mechanical stress, the reverse applies when
• The word is derived from the piezoelectric effect is reversible in that materials
exhibiting the direct piezoelectric effectconverse piezoelectric effect (the production of
stress and/or crystals will exhibit a maximum shape change of about 0.1% of the original
dimension.
• Precise electrical pulses from the ultrasound machine make the transducer create
sound waves at the desired frequency. The sound is focused either by the shape of the
transducer (Curved, Linear, Sector) or a set of control pulses from the ultrasound
machine. This focusing produces the desired shaped sound wave from the face of the
transducer. The wave travels into the body and comes into focus at a desired depth.

• On the face of the transducer a rubber material enables the sound to be


transmitted efficiently into the body. This rubber coating is required for
impedance matching and allows good energy transfer from transducer to patient
a vice versa. To help with the transmission of sound waves a water based gel is
placed between the patient's skin and the probe.The gel establishes good
acoustic contact with the body, since air is a very good acoustic reflector.

Receiving the echoes


• The image is formed by the reverse of the process used to create the
sound waves. The returning echoes to the transducer are converted by the
crystals into electrical signals and are then processed to form the image.

Forming the image


• To form the image ultrasound machine needs to determine the direction of
the echo, how strong the echo was and how long it took the echo to be received
from when the sound was transmitted. Once the ultrasound scanner determines
these three things, it can locate which pixel in the image to light up and to what
intensity.
Sound in the body
• When a sound wave encounters a material with a different density
(acoustic impedance), part of the sound wave is reflected back to the transducer
and is detected as an echo. The time it takes for the echo to travel back to the
transducer is measured and used to calculate the depth of the tissue interface
causing the echo. The greater the difference between acoustic impedances, the
larger the echo is.

• Highly reflective interfaces give rise to a strong echo which is represented


on the screen as a bright spot, whilst the opposite is true of weak reflective
interfaces. Areas without acoustic interfaces such as the lumen of vessels and
other cavities containing liquid (blood, bile, ascites or urine) give no reflection and
no spot on the screen ie a black space on the monitor. If the waves hits gases or
solids the density difference is so great that most of the acoustic energy is
reflected and it becomes impossible to see deeper.

• The speed of sound is different in different materials, and is dependent on


the acoustical impedance of the material. However, the ultrasound scanner
assumes that the acoustic velocity is constant at 1540 m/s. An effect of this
assumption is that in a real body with non-uniform tissues, the beam becomes
de-focused and image resolution is reduced.

• The formula for the velocity of sound is (velocity = frequency x


wavelength). The frequencies used for medical imaging are generally in the
range of 2 to 15 MHz. Higher frequencies have a smaller wavelength (as can be
seen from the formula for velocity of sound), and can be used to make images
with smaller details. However, the attenuation of the sound wave is increased at
higher frequencies, so in order to have better penetration of deeper tissues, a
lower frequency 3-5 MHz is used. Seeing deep structures in the body with
ultrasound is very difficult as some acoustic energy is lost every time an echo is
formed, but most of it is lost from acoustic absorption.

Apparatus

Scanner types

For abdominal ultrasound curved type scanners are used as the best
compromise of two other standard type probes the linear and
the sector scanner.

Linear - the linear array scanners produce sound waves parrallel to each other
and produces a rectangular image. The width of the image and number of scan
lines are the same at all tissue levels. This has the advantage of good near field
resolution. Often used with high frequencies ie 7MHz. Can be used for viewing
surface texture of the liver. There disadvantage is artifacts when applied to a
curved part of the body creating air gaps between skin and transducer.

Sector/Vector - Produces a fan like image that is narrow near the transducer
and increase in width with deeper penetration. It is useful when scanning
between the ribs as it fits in the intercostal space. The disadvantge is poor near
field resolution.
Curved - Often with frequencies of 2 - 5 MHz (to allow for a range of patients
from obese to slender). It is a compromise of the Linear and Sector scanners.
The density of the scan lines decreases with increasing distance from the
transducer. Can be difficult to use in curved regions of the body eg. the spleen
behind the left costal margin.

3D Transducers
Matrix Transducer

• 3 to 1 MHz extended operating frequency range


• 2D Matrix phased array with 2,400 elements
• 2D, biplane (Live xPlane), triggered full volume, Live 3D Echo, Color Doppler
with 2D, biplane and 3D,Harmonic Imaging
Mechanical 3D Tranducer

• 6 to 2 MHz extended operating frequency range


• Supports high resolution 2D imaging
• high resolution, quantitative, single sweep 3D volume aquisition
• 4D imaging up to 36 volumes per second
• Color Doppler
• Field of view: 66 degrees
• General purpose abdominal, obstetricaland gynecological applications

Controls

Ultrasound machines have a large array of options and features. The basic
controls that you need to familiarize yourself in the early stages of learning are

Trackball - used for moving objects on the monitor (similar to using a mouse on
the PC), it is used in conjunction with measuring, annotating, moving Res/Dopler
boxes to the desired location. It has kidney buttons either side which are used to
select functions (the same as clicking buttons on a mouse for the PC).
Freeze - This allows the image to be held (frozen) on the screen. While the
image is frozen measurements can then be taken and organ annotations can be
applied to the image before saving it.

Res or Zoom - This will allow magnification of areas of the ultrasound picture.
Looking at Res/Zoomed areas of interest has the advantage of a more detailed
view with the drawback of less anatomy visible to guide your movements.

Caliper - This is used to measure a distance (eg kidney length). It is used by


selecting a starting spot by pressing a kidney key and using the trackball to
measure to a second mark. The distance between the two marks will then be
displayed on screen measured in cm. This can be used with other functions such
as Res/Freeze.

Gain - This function is very similar to a brightness control. The echo signal
returning to the body is converted into an electronic signal by the transducer.
This electronic signal has to be amplified to produce images on the monitor. This
signal amplification is called Gain and will regulate the strength of the echo’s
being received.

Time Gain - Is an adjustment for the sensitivity at each depth to allow


compensation for signal loss from deeper in the tissue. This can be set so that
organs such as the liver will have uniform brightness at all depths. It is a series of
multiple sliders so you can set the time gain differently for each depth.

BMode imaging Controls

Depth/F.O.V. Control- Varying the depth of the F.O.V. varies the write zoom and
therefore the number of pixels per cm and spatial resolution potential of the system.
It is important not to use excessively large F.O.V’s that reduce spatial resolution
achievable but also not to ‘clip’ the F.O.V. too tightly around the region of interest
such that relationships with other structures are not shown.

Gain- Refers to the degree of amplification applied to all returning signals. If set too
low there will be underwriting of the image and real echo will be lost from the display.
If set too high there will be overwriting of the display with artefactual noise introduced
and also a reduction in contrast resolution as all echoes get progressively brighter.

T.G.C.- The T.G.C. control compensates for the effects of attenuation by


progressively increasing the amount of amplification applied to signals with depth
(time). The sonographer aims to produce an image of uniform brightness from top to
bottom and this requires regular adjustment of this control during scanning.

Power or Output Control- This controls the strength of the voltage spike applied to
the crystal at pulse emission. Increasing power output increases the intensity of the
beam and therefore the strength of echo return to the transducer. i.e. increases
signal to noise ration (SNR). However it also increases the patients ultrasound dose.
It is best practice to operate on minimum power and maximum gain, remembering
though that no amount of gain can compensate for insufficient power. The obvious
alternative to increasing power output if ‘dropout’ artefact is encountered at depth is
to use a lower frequency transducer.

Dynamic Range- Refers to the range of echoes processed and displayed by the
system, from strongest to weakest. The strongest echoes received are those from
the ‘main bang’ and transducer-skin interface and they will always be of similar
strength. As DR is reduced therefore it is the echoes at the weaker end of the
spectrum that will be lost. DR can be considered as a variable threshold of writing for
weaker signals. For general imaging the DR should be kept at its maximum level to
maximise contrast resolution potential. However in situations where low-level noise
or artefacts degrade image quality the DR can be reduced to partially eliminate these
appearances.

Focal Zones- Throughout the scan the sonographer should constantly check the
position of the focal zone(s) and ensure they are at the depth of interest. Multiple
focal zones can be used to maximise lateral resolution over depth if motion is not
encountered, but it is important to minimise the focal zones used when assessing
moving structures i.e. a fetal heart.

Artefacts

Reverberation is the persistence of sound in a particular space after the original


sound is removed

How to Select the best transducer

Transducer selection is based on all the six F’s

-Frequency
-Format/F.O.V
-Footprint
-Frame Rate
-Focal Characteristic
-Functional Aspects

Frequency- It is best to use the maximum frequency possible to image the region of
interest, allowing for adequate penetration to this depth and thus avoiding ‘dropout’
artefact. There are several reasons for this, increasing frequency will; improve axial
resolution, produce a better beam shape (longer near field) and increase the return
from non-specular interfaces. Transducer frequencies common today are 5-15MHz
for superficial work and 2-7MHz for deeper areas.
Format- The depth of interest also influences the decision on transducer format
used. Linear arrays with their rectangular field of view ( F.O.V.) provide the widest
superficial F.O.V and best spatial resolution in the superficial zone. However when
imaging to depth a transducer with a radiating scan format is needed to give a useful
width to the F.O.V with depth. i.e. Convex, Phased and Annular arrays all have this
radiating scan format. Convex arrays are the most common today.

Footprint- This refers to the area of the transducer face that contacts the patient.
Footprint becomes significant when access is limited (i.e. between ribs or through
cranial fontanelle). In these situations phased and annular arrays provide the
smallest footprint. In contrast the wide footprint linear and convex arrays provide
superior superficial imaging but can be more difficult to keep in complete contact
with the skin.

Frame Rate- This refers to how many times a second the image is updated. The
frame rate determines the temporal resolution potential of the system and therefore
is important when assessing moving interfaces. Cardiac ultrasound is a classic
example of a situation where frame rate is very important. Mechanical transducers
are generally unsuitable for this work because their frame rates are too slow.
Multiple focal zones are unheard of and the line densities used are much lower that
for general imaging.

Focal Characteristics- Most systems now allow a variable depth of focus by varying
the firing delays of the crystal elements across the array. It is important to keep the
focal zone(s) to the depth of interest.

Functional Aspects- Will you need to perform colour or PW doppler during the
examination and does the transducer have this capability. Not all transducers allow
biopsy guides to be attached and specialised transducers need to the used for
intracavity exams.