ECHO

BASICS
PHYSICS AND INSTRUMENTATION

- DR. NAIR ANISHKUMAR P.K.V

Sound
Mechanical vibration transmitted through an elastic
medium.

Spectrum of sound
Advantages for Diagnostic utility

Ultrasound can be directed as a beam and

focused

As ultra sound passes through a medium it

obeys laws of reflection and refraction

Targets of relatively small size reflect ultrasound

thus can be detected and characterised.

Disadvantages

Ultrasound is poorly transmitted through a gaseous

medium

Attenuation occurs rapidly, Especially at higher

frequency.
Mechanics :

Particles of the medium vibrate parallel to the line of

propagation producing longitudinal waves.

Areas of compression alternates with areas of rarefaction.

Amount of reflection , refraction and attenuation

depends on acoustic properties of medium

Denser medium reflect higher percentage of sound

energy
Mechanics :
INTERACTION BETWEEN
ULTRASOUND AND TISSUE

The loss of ultrasound as it propagates through a medium is

referred to as attenuation

It is the rate at which the intensity of the ultrasound beam

diminishes as it penetrates the tissue.

Attenuation has three components: absorption, scattering, and

reflection
Attenuation

Always increases with depth

It is affected by the frequency of the transmitted beam and

the type of tissue through which the ultrasound passes

The higher the frequency is, the more rapidly it will

attenuate

Attenuation increases with increase in density of medium.

Attenuation

Expressed as the half-power distance,which is a measure of

the distance that ultrasound travels before its amplitude is
attenuated to one half its original value.

As a rule of thumb, the attenuation of ultrasound in tissue is

between 0.5 and 1.0 dB/cm/MHz.
Acoustic impedance

The velocity and direction of the ultrasound beam as it

passes through a medium are a function of the acoustic
impedance of that medium

Acoustic impedance (Z, measured in rayls) is the product of

velocity (in meters per second) and physical density (in
kilograms per cubic meter).
Acoustic impedance
 Acoustic impedance Importance :

The phenomena of reflection and refraction obey the laws of

optics and depend on the angle of incidence between the
transmitted beam and the acoustic interface as well as the
acoustic mismatch, i.e., the magnitude of the difference in
acoustic impedance

Use of a acoustic coupling gel during transthoracic imaging

Specular echoes and scattered echoes

The interaction between an ultrasound beam and a reflector

depends on the relative size of the targets and the wavelength
of the beam

As the size of the target decreases, the wavelength of the

ultrasound must decrease proportionately to produce a
reflection and permit the object to be recorded.
 Specular echoes

Specular echoes are produced by reflectors that are large

relative to ultrasound wavelength

The spatial orientation and the shape of the reflector determine

the angles of specular echoes.

Examples of specular reflectors include endocardial and

epicardial surfaces, valves, and pericardium
Specular echoes
Scattered echoes

Targets that are small relative to the wavelength of the

transmitted ultrasound produce scattering

Such objects are referred to as Rayleigh scatterers.

The resultant echoes are diffracted or bent and scattered in

all directions.
Scattered echoes

Scattered echoes contribute to the visualization of

surfaces that are parallel to the ultrasonic beam and also
provide the substrate for visualizing the texture of grey-
scale images

The term speckle is used to describe the tissue-

ultrasound interactions that result from a large number
of small reflectors within a resolution cell.
Importance :

Without the ability to record scattered echoes, the left

ventricular wall, for example, would appear as two bright
linear structures, the endocardial and the epicardial
surfaces, with nothing in between .

High-frequency ultrasound though has good resolution , is

reflected by many small interfaces within tissue, resulting
in scattering, much of the ultrasonic energy becomes
attenuated and less energy is available to penetrate deeper
into the body..
THE TRANSDUCER
Piezoelectricity
 Piezoelectricity

A period of quiescence during which the transducer listensfor

some of the transmitted ultrasound energy to be reflected back is
known as dead time
.

The amount of acoustic energy that returns to the transducer is a

measure of the strength and depth of the reflector.

The time required for the ultrasound pulse to make the round-
trip from transducer to target and back again allows calculation
of the distance between the transducer and reflector
Piezoelectricity
Piezoelectric ceramics : ferroelectrics, barium titanate, and lead
zirconate titanate

Piezoelectric elements are interconnected electronically

The frequency of the transducer is determined by the thickness

of these elements.

Each element is coupled to electrodes, which transmit current

to the crystals, and then record the voltage generated by the
returning signals.
Backing material

The dampening material shortens the ringing response of

the piezoelectric substance after the brief excitation pulse.

An excessive ringing response (or ringdown

) lengthens the
ultrasonic pulse and decreases range resolution.

Thus, the dampening material both shortens the ringdown

and provides absorption of backward and laterally
transmitted acoustic energy
Matching layers

At the surface of the transducer, matching layers are

applied to provide acoustic impedance matching
between the piezoelectric elements and the body.

This increases the efficiency of transmitted energy by

minimizing the reflection of the ultrasonic wave as it exits
the transducer surface.
Wave motion

An ultrasound beam as it leaves the transducer is parallel and

cylindrically shaped beam. Eventually, however, the beam
diverges and becomes cone shaped .

The proximal or cylindrical portion of the beam is referred to

as the near field or Fresnel zone.

When it begins to diverge, it is called the far field or

Fraunhofer zone.
Near field

Imaging is optimal within the near field

The length of the near field (l) is described by the formula:

where r is the radius of the transducer and is the wavelength

of the emitted ultrasound.
Near field

From the above formula optimal ultrasound imaging : large-

diameter & high-frequency transducer maximize the length of
the near field.
Near field

Factors preventing this approach from being practical.

1) The transducer size is predominantly limited by the size of

the intercostal spaces.

2) Although higher frequency does lengthen the near field, it

also results in greater attenuation and lower penetration of
the ultrasound energy
MANIPULATING THE
ULTRASOUND BEAM

the ultrasound beam is both focused and steered

electronically

it is primarily achieved through the use of phased-array

transducers, which consist of a series of small
piezoelectric elements interconnected electronically
 By adjusting the timing of excitation, the beam can be
steered
Dynamic transmit focusing
Near field Focusing
 An undesirable effect of focusing is its effect on beam
divergence in the far field. Because focusing results in a
beam with a smaller radius, the angle of divergence in the
far field is increased.

Divergence also contributes to the formation of important

imaging artefacts such as side lobes
Resolution

Resolution is the ability to distinguish between two

objects in close proximity.

two components:

spatial

temporal.
Spatial resolution

It is defined as the smallest distance that two targets can be

separated for the system to distinguish between them.

Two components:

Axial resolution

lateral resolution
Axial resolution

Ability to differentiate two structures lying along the axis of

the ultrasound beam

The primary determinants are the frequency of the

transmitted wave and its effect on pulse length.
Lateral resolution
the ability to distinguish two reflectors that lie side
by side relative to the beam

affected by the width or thickness of the interrogating

beam, at a given depth

lateral resolution diminishes as beam width (and

depth) increases.
Lateral resolution

The distribution of intensity across the beam profile will also

affect lateral resolution

both strong and weak reflectors can be resolved within the

central portion of the beam, where intensity is greatest.
 Gain
Gain is the amplitude, or the degree of amplification, of the
received signal.
Contrast resolution

Contrast resolution refers to the ability to distinguish

and to display different shades of grey
For accurate identification of borders display texture or detail
within the tissues.
Useful to differentiate tissue signals from background noise.
Dependent on target size.
A higher degree of contrast is needed to detect small structures
Temporal resolution

Ability of the system to accurately track moving

targets over time.

It is dependent on speed of ultrasound and the depth of the

image as well as the number of lines of information within the
image.

Greater the number of frames per unit of time, the smoother

and more aesthetically pleasing the real-time image.
CREATING THE IMAGE
TRANSMITTING ULTRASOUND
ENERGY
The pulse, which is a collection of cycles traveling together,
is emitted at fixed intervals
How one can use ultrasound to obtain an
image of an object.
Modes :
SIGNAL PROCESSING
Concept of dynamic range
Dynamic range is the extent of useful ultrasonic signals
that can be processed to reduce the range of the voltage
signals to a more manageable number

It is defined as the ratio of the largest to smallest signals

measured at the point of input to the display

It is expressed in decibels
Grey scale :
The range of voltages generated during data acquisition, by
post-processing, is transformed to 30 shades of grey which the
human eye is able to distinguish
Tissue harmonic imaging

The new frequencies generated due to nonlinear

interactions with the tissue ,which are integer multiples of
the original frequency, are referred to as harmonics.

The returning signal contains both fundamental and

harmonic frequencies. By suppressing or eliminating the
fundamental component, an image is created primarily
from the harmonic energy
 After destructive interference the remaining harmonic
energy can then be selectively amplified, producing a
relatively pure harmonic frequency spectrum.
Tissue harmonic imaging

The strong fundamental signals produce intense

harmonics and weak fundamental signals produce
almost no harmonic energy thus reducing artefacts.

The net result is that harmonic imaging reduces near

field clutter ,the signal-to-noise ratio is improved and
image quality is enhanced.
 ARTIFACTS : Side lobes
Side lobes occur because a portion of the energy concentrate
off to the side of the central beam and propagate radially, a
phenomenon known as edge effect

A side lobe may form where the propagation distance of

waves generated from opposite sides of a crystal differs by
exactly one wavelength.

Side lobes are three-dimensional artefacts, and their

intensity diminishes with increasing angle.
ARTIFACTS : Side lobes

The artefact created by side lobes occurs because all

returning signals are interpreted as if they originated from
the main beam.

A prerequisite for a dominant side lobe artefact is that the

source of the artefact must be a fairly strong reflecting
target like The atrioventricular groove and the fibrous
skeleton of the heart
ARTIFACTS : reverberations
Result from the beam reflecting from the transducer or
from other strong echo-producing structures within the
heart or chest .

Typically, a reverberation artefact that originates from a

fixed reflector will not move with the motion of the heart.

It appears as one or more echo targets directly behind the

reflector, often at distances that represent multiples of the
true distance
ARTIFACTS : shadowing

Shadowing occurs beyond a region of unusually high

attenuation, such as a strong reflector.

It results in the absence of echoes directly behind the target .

Eg: prosthetic valves & heavily calcified Native structures.

ARTIFACTS : shadowing
ARTIFACTS : near field clutter

Ring down artefactarises from high-amplitude oscillations of

the piezoelectric elements.

This only involves the near field

Eg : right ventricular free wall or left ventricular apex

ARTIFACTS : near field clutter
 DOPPLER ECHOCARDIOGRAPHY

Doppler imaging is concerned with the direction, velocity,

and then pattern of blood flow through the heart and great
vessels.

The primary target is the red blood cells

It focuses on physiology and hemodynamics

The Doppler equations rely on a more parallel alignment

between the beam and the flow of blood.
Doppler shift

The increase or decrease in frequency due to relative

motion between the transducer and the target is referred
to as the Doppler shift.

It is the mathematical relationship between the

magnitude of the frequency shift and the velocity of the
target relative to the source
 Doppler shift
the Doppler shift (f) depends on the transmitted frequency (f )
of the ultrasound, the speed of sound (c ), the intercept angle
between the interrogating beam and the flow ( ), and, finally,
the velocity of the target (v ).
 Doppler shift

Because the velocity of sound and the transmitted frequency

are known, the Doppler shift depends on the velocity of
blood and the angle of incidence, ( )
Doppler shift
Transducer or carrier frequency is the primary
determinant of the maximal blood flow velocity that
can be resolved

A lower frequency is advantageous because it allows

high flow velocity to be recorded.
Doppler Formats
Five basic types

1 ) continuous wave Doppler

2 ) pulsed wave Doppler

3) color flow imaging

4 ) tissue Doppler

5 ) duplex scanning
 Pulsed wave Doppler

It is similar to echocardiography. Short, intermittent bursts

of ultrasound are transmitted into the body and listensat a
fixed and very brief time interval after transmission of the
pulse.

This permits returning signals from one specific distance

from the transducer to be selectively received and analysed,
a process called range resolution
 Aliasing

The number of pulses transmitted from a Doppler

transducer each second is called the PRF.
To accurately represent a given frequency, it must be
sampled at least twice, that is

This formula establishes the limit (Nyquist limit)

below which the sampling rate is insufficient to
characterize the Doppler frequency.
 Continuous wave Doppler
This Imaging simultaneously transmits and receives ultrasound
signals continuously.

2 types

1) Transducer employs two distinct elements: one to

transmit and the other to receive

2) With phased-array technology, one crystal within the array

is dedicated to transmitting while another is simultaneously
receiving.
 A major advantage of continuous wave Doppler imaging is
that aliasing does not occur and very high velocities can be
accurately resolved.
Colour Flow Imaging

A form of pulsed wave Doppler imaging that uses

multiple sample volumes to record the Doppler shift

By overlaying this information on a two-dimensional or

M-mode template, the colour flow image is created.

Based on the strength of the returning echo , flow

velocity, direction, and a measure of variance are then
integrated and displayed as a colour value
 Technical Limitations of Color
Doppler Imaging

The primary determinant of jet size is jet momentum, which

depends on both flow rate and velocity. Thus, factors that affect
velocity, including blood pressure, will also affect jet size.

If colour Doppler imaging is performed when blood pressure is

either very high or very low, this clinical information should be
noted and taken into account when the study is interpreted.
Technical Limitations

The eccentric jets that become entrained along a wall,

making them appear smaller than they actually are
(Chamber constraint ).

For similar reasons, chamber size can also influence the

apparent area of a colour flow jet
Technical Limitations : Instrument settings

By adjusting the colour scale, PRF is altered, and jet size can
change dramatically.

By lowering the scale (or Nyquist limit), the lower velocity

blood at the periphery of the jet becomes encoded and
displayed, making the jet appear larger.

Increasing the wall filter will reduce the jet size by excluding
velocities at the periphery.
Technical Limitations : Instrument settings

Power and instrument gain will also alter jet size. Increasing
these settings will increase jet area.

Transducer frequency has a complex effect on colour jet area.

The jet size will tend to increase with high carrier frequency
because of the relationship between velocity and the Doppler
shift. On the other hand, greater attenuation at higher
frequency will make jets appear smaller.
 Doppler imaging records velocity, not flow. It cannot
distinguish whether the moving left atrial blood
originated in the ventricle (the filled triangles) or atrium
(the filled circles), simply
that it has sufficient
velocity to be detected.
(billiard ball effect)
Doppler Artifacts

Related directly to the Doppler principle. For example,

aliasing occurs when pulsed wave Doppler techniques are
applied to flow velocities that exceed the Nyquist limit

Mirror imaging / crosstalk :the appearance of a symmetric

spectral image on the opposite side of the baseline from
the true signal
Doppler Artifacts

Shadowing may mask colour flow information beyond

strong reflectors

Ghosting is a phenomenon in which brief swathes of

colour are painted over large regions of the image

It is produced by the motion of strong reflectors such as

prosthetic valves..
Doppler Artifacts

Too much gain can create a mosaic distribution of color

signals throughout the image.

Too little gain eliminates all but the strongest Doppler

signals and may lead to significant underestimation of jet
area.
Tissue Doppler Imaging
By adjusting gain and reject settings, the Doppler
technique can be used to record the motion of the
myocardium rather than the blood within it
1) adjusting the machine to record a much lower range of
velocities

2) additional adjustments to avoid oversaturation because the

tissue is a much stronger reflector of the Doppler signal
compared with blood.
 One obvious limitation is that the incident angle between the beam
and the direction of target motion varies from region to region.

This limits the ability of the technique to provide absolute velocity

information, although direction and relative changes in tissue
velocity are displayed.
BIOLOGIC EFFECTS OF
ULTRASOUND

The biologic effects of ultrasound energy are related

primarily to the production of heat

the amount of heat produced depends on the intensity of

the ultrasound, the time of exposure, and the specific
absorption characteristics of the tissue.
BIOLOGIC EFFECTS OF
ULTRASOUND

The perfusion of tissue have a dampening effect on

heat generation and physically allow heat to be carried
away from the point of energy transfer.

Limited imaging time, occasional repositioning of the

probe, and constant monitoring of the probe
temperature help to ensure an impeccable safety
record
BIOLOGIC EFFECTS OF
ULTRASOUND

Cavitation : Formation and behaviour of gas bubbles

produced when ultrasound penetrates into tissue

Because of the relatively high viscosity of blood and soft

tissue, significant cavitation is unlikely.
BIOLOGIC EFFECTS OF
ULTRASOUND

Few reports have suggested that some changes might occur

at the chromosomal level that would be relevant to the
developing foetus .

No evidence that any of physical phenomena (oscillatory,

sheer, radiation, pressure, and micro-streaming ) has a
significant biologic effect on patients.
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