Basics of

Ultrasound
 Ultrasound imaging, also called sonography, involves exposing
part of the body to high frequency sound waves (2-15 MHz)
to produce pictures of the inside of the body.

Tip: Ultrasound is also known as Sonography: the word sono-is from “sonar” –which
is a system for the detection of objects under water and for measuring the water's
depth by emitting sound pulses and detecting or measuring their return after being
reflect, used by boats and submarines.

As because US has the principles similar to sonar is also called sonography.

Characteristics of US:
 Ultrasound examinations do not use ionizing radiation (as used in x-
rays).

 Because ultrasound images are captured in real time, they can show
the structure and movement of the body's internal organs, as well
as blood flowing through blood vessels (US is not just a picture like X-ray,
CT-scan …).

 For example:

 Echocardiography: can show the movement of cardiac wall, heart valves

movements …
 Ultrasound (US) is the most widely used imaging technology
worldwide

 Popular due to availability, speed, low cost, patient-friendliness

(no radiation)

 Applied in obstetrics, cardiology, inner medicine, urology,...

 Ongoing research to improve image quality, speed and new

application areas such a intraoperative navigation, tumor
therapy,...
History
Interesting Information: The bat
use Ultrasound for navigation
History of Ultrasound:
 1877: Lord Raleigh - "Theory of Sound"

 1880: Pierre & Jacques Curie – Piezoelectric effect

 The basis of the well-known today, ultrasound equipment laid down

opening piezoelectricsin 1880 by Pierre and Jacques Curie. Since that time,
and began active work on the development of ultrasonic transducers.

 (Piezoelectric elements/ Crystals are a part of the Transducer that produce US pulse)

 1914: Langevin - First Ultrasound generator using piezoelectric effect

 1928: Solokov - Ultrasound for material testing

 1942: Dussik - First application of Ultrasound in medical diagnostics

 1942: Dussik - First application of Ultrasound in medical diagnostics

 Shortly after WWII, researchers in Japan began to explore medical

diagnostic capabilities of ultrasound.

 different medical applications (gall stones,tumours)

 End of 1960's: Boom of Ultrasound in medical diagnostics

Pan-Scanner - The transducer rotated in a
semicircular arc around the patient (1957)
 Early 1970s

 Gray scale static images of internal organs

 Mid 1970s

 Real-time imaging

 Early 1980s

 Spectral Doppler

 Color Doppler

 Also produced was a hand-held “contact” scanner for clinical use.

Physics
Basic Ultrasound Physics
 Sound is a mechanical, longitudinal wave that travels in a straight line
and measured by cycle per second by Hertz (Hz) unit.
 Audible Sound is 20-20,000 Hz (20Hz -20kHz).
 Sound requires a medium through which to travel.

 Ultrasound is a mechanical, longitudinal pressure wave with a frequency

exceeding 20,000 Hz or 20 kHz.

 Medical Ultrasound is > 2MHz (2MHz to 15MHz).

*kHz= kilohertz (103 Hz =1000 Hz),

*MHz = megahertz (106 Hz= 1000000 Hz)

ULTRASOUND – How is it
produced?
 Produced by passing an electrical current through a
piezoelectrical crystal (material that expands and contracts
with current)

 Piezoelectrical effect:

 Definition: The principle of converting energy by applying pressure to a crystal.

 The reverse of the piezoelectric effect converts the energy back to its original
form
Piezoelectric effect Ultrasound Transducers
 A transducer converts one type of energy into another

 Based upon the occurring of pulse-echo principle with ultrasound

piezoelectric crystals, ultrasound transducers convert:

 Electricity into sound = pulse

 Sound into electricity = echo

 Transducer contains piezoelectric elements/crystals which

produce the ultrasound pulses (transmit 1% of the time)

 These elements convert electrical energy into a mechanical

ultrasound wave
 The frequency of the scanhead is determined by the thickness
of the crystals

 Thinner element produce HIGHER frequencies

 Thicker elements produce LOWER frequencies

Low High
Frequency Frequency
3 MHz 10 MHz
The returning Echo
 Reflected echoes return to the scanhead where the piezoelectric
elements convert the ultrasound wave back into an electrical
signal

 The electrical signal is processed by the ultrasound system.

Ultrasound Production:

 Transducer produces ultrasound pulses (transmit 1% of the time)

 These elements convert electrical energy into a mechanical

ultrasound wave.

 Reflected echoes return to the scan head which converts the

ultrasound wave into an electrical signal
Frequency vs. Resolution
The frequency also affects the QUALITY of the ultrasound image

 The HIGHER the frequency, the BETTER the resolution

 The LOWER the frequency, the LESS the resolution

 A 12 MHz transducer has very good resolution, but cannot penetrate very
deep into the body

 A 3 MHz transducer can penetrate deep into the body, but the resolution
is not as good as the 12 MHz

 Low Frequency 3MHz. High frequency 12 MHz

Interactions of Ultrasound with
Tissue
 Reflection.

 Refraction.

 Transmission.

 Attenuation.
 Reflection‫عكاس‬R‫االن‬

 The ultrasound reflects off tissue and returns to the transducer, the

amount of reflection depends on differences in acoustic impedance.

 The ultrasound image is formed from reflected echoes.

Refraction
Transmission

 Some of the ultrasound waves continue deeper into the body.

 These waves will reflect from deeper tissue structures.

Attenuation
 Defined - the deeper the wave travels in the body, the weaker it
becomes -3 processes: reflection, absorption, refraction

 Air (lung)> bone > muscle > soft tissue >blood > water.

 Speed of sound in Air= 330 m/s, Bone=4030 m/s, Tissues

=1040m/s.
Doppler Effect:
 Doppler effect - this change frequencies and
wavelengths (it is registered receiver) generated by
displacements as the wave source and the receiver.
 The most popular example
of the spread of the Doppler
effect: the car with a siren.
When she goes to you or from
you, you hear a sound, and
when it passes by, something
completely different - lower.
The Ultrasound Machine
A basic ultrasound machine has the following parts:

1. Transducer probe - probe that sends and receives the sound waves

2. Central processing unit (CPU) - computer that does all of the calculations
and contains the electrical power supplies for itself and the transducer probe

3. Transducer pulse controls - changes the amplitude, frequency and

duration of the pulses emitted from the transducer probe

4. Display - displays the image from the ultrasound data processed by the CPU

5. Keyboard/cursor - inputs data and takes measurements from the display

6. Disk storage device (hard, floppy, CD) - stores the acquired images

7. Printer - prints the image from the displayed data

 Equipment
 Ultrasound scanners consist of a console containing a computer and
electronics, a video display screen and a transducer that is used to do the
scanning.
 The transducer is a small hand-held device that resembles a microphone,
attached to the scanner by a cord.
 The transducer sends out inaudible high frequency sound waves into the body
and then listens for the returning echoes from the tissues in the body.
 The principles are similar to sonar used by boats and submarines.
 The ultrasound image is immediately visible on a video display screen that
looks like a computer or television monitor.
 The image is created based on the amplitude (strength), frequency and time it
takes for the sound signal to return from the area of the patient being
examined to the transducer and the type of body structure the sound travels
through.
How does the procedure
work?
Ultrasound imaging is based on the same principles involved in the sonar
used by bats, ships, fishermen and the weather service.
 When a sound wave strikes an object, it bounces back, or echoes.
 By measuring these echo waves, it is possible to determine how far away
the object is and its size, shape and consistency (whether the object is
solid, filled with fluid, or both).
 In medicine, ultrasound is used to detect changes in appearance of
organs, tissues, and vessels or detect abnormal masses, such as tumors.
 In an ultrasound examination, a transducer both sends the sound waves
and receives/records the echoing waves.
 When the transducer is pressed against the skin, it directs small pulses of
inaudible, high frequency sound waves into the body.
 As the sound waves bounce off of internal organs, fluids and tissues, the
sensitive microphone in the transducer records tiny changes in the
sound's pitch and direction
 These signature waves are instantly measured and displayed by a
computer, which in turn creates a real-time picture on the monitor.
 One or more frames of the moving pictures are typically captured as still
images.
 Small loops of the moving “real time” images may also be saved.
 Doppler ultrasound, a special application of ultrasound, measures
the direction and speed of blood cells as they move through
vessels.
 The movement of blood cells causes a change in pitch of the
reflected sound waves (called the Doppler effect).
 A computer collects and processes the sounds and creates graphs or color
pictures that represent the flow of blood through the blood vessels.
 How is the procedure
performed?
For most ultrasound exams, the patient is positioned lying face-up
on an examination table that can be tilted or moved.
 A clear water-based gel is applied to the area of the body being
studied to help the transducer make secure contact with the body
and eliminate air pockets between the transducer and the skin that
can block the sound waves from passing into your body.
 The sonographer (ultrasound technologist) or radiologist then
presses the transducer firmly against the skin in various locations,
sweeping over the area of interest or angling the sound beam from
a farther location to better see an area of concern.
 Doppler sonography is performed using the same transducer.
 When the examination is complete, the patient may be asked to dress and wait
while the ultrasound images are reviewed.
 In some ultrasound studies, the transducer is attached to a probe and inserted
into a natural opening in the body.
These exams include:
 Transesophageal echocardiogram. The transducer is inserted into the
esophagus to obtain images of the heart.
 Transrectal ultrasound. The transducer is inserted into a man's rectum to
view the prostate.
 Transvaginal ultrasound. The transducer is inserted into a woman's vagina to
view the uterus and ovaries.
 Most ultrasound examinations are completed within 30 minutes to an hour.
What are the benefits vs.
risks?
Benefits
 Most ultrasound scanning is noninvasive (no needles or injections) and is usually
painless (some invasive forms: TEE, Transvaginal, Transrectal …)
 Ultrasound is widely available, easy-to-use and less expensive than other
imaging methods.
 Ultrasound imaging does not use any ionizing radiation.
 Ultrasound scanning gives a clear picture of soft tissues that do not show up well
on x-ray images.
 Ultrasound is the preferred imaging modality for the diagnosis and monitoring of
pregnant women and their unborn babies.
 Ultrasound provides real-time imaging, making it a good tool for guiding
minimally invasive procedures such as needle biopsies and needle
aspiration.
 Risks
For standard diagnostic ultrasound there are no known harmful effects on humans.
 Unlike X-rays, ultrasound involves only sound waves
 No radiation danger
 However, sound waves can increase body temperature
 This is known as cavitation
 Significant only for long exposure time

 Many studies have been conducted to determine the physiological effects of

ultrasound cavitation
 No direct correlation has been found between ultrasound imaging and cancer, low
birth weight, dyslexia or delayed speech development
 Reliable data from ultrasound techniques is hard to come by additional studies are
ongoing
 Biggest risk is misdiagnosis
What are the limitations of General
Ultrasound Imaging?
 Ultrasound waves are disrupted by air or gas; therefore ultrasound is
not an ideal imaging technique for air-filled bowel or organs
obscured by the bowel. In most cases, barium exams, CT scanning,
and MRI are the methods of choice in this setting.
 Large patients are more difficult to image by ultrasound because
greater amounts of tissue attenuates (weakens) the sound waves as
they pass deeper into the body.
 Ultrasound has difficulty penetrating bone and, therefore, can only
see the outer surface of bony structures and not what lies within
(except in infants). For visualizing internal structure of bones or
certain joints, other imaging modalities such as MRI are typically used.
Machines and
Transducers
Orientation

 Transverse Plane. Longitudinal

Plane.
Terminology:
 Anechoic= Black (Fluid-filled: Cyst, Blood vessels,
Gallbladder, Urinary Bladder …)

 Hypo-echoic= Darker (Tumor, Lymph nodes …)

 Hyper-echoic=Bright (Fat tissue, Stones …)

 Isoechoic= Same
Ultrasound Applications
Visualisation Tools:

 Nerves, soft tissue masses

 Vessels - assessment of position, size, patency

 Ultrasound Guided Procedures in real time – dynamic

imaging; central venous access, nerve blocks
Imaging

 Know your anatomy – Skin, muscle, tendons, nerves and

vessels

 Recognise normal appearances – compare sides!