Physics of Echocardiography

• Physical principles
• The basis of Image generation
• The basis of Image Resolution
• Relation Between Penetration & Resolution
• Doppler Echo
• Image Artifacts
• Image optimization
 Physical principles
Ultrasound has several characteristics that contribute to its
diagnostic utility.

• Includes that portion of the sound spectrum having a frequency greater than
20,000 cycles per second (20 KHz)

• It can be directed as a beam and focused.

• Targets of relatively small size reflect ultrasound and can be characterized.

• It obeys the laws of reflection and refraction.

• A major disadvantage of ultrasound is that it is poorly transmitted through a

gaseous medium and attenuation occurs rapidly.
 Piezoelectricity
• Piezoelectric crystals : 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.
 The anatomy of a wave

• The spatial distance between subsequent compressions is called the wavelength (λ) and
relates to the frequency (f) and sound velocity (c) as:

λf = c.
• The amplitude is the pressure difference between nadir and peak. which
is a measure of the strength of the sound wave

• Waves are emitted as pulse consisting of wave cycles. Therefore, the spatial pulse
length is the distance from the beginning of a single pulse train to its end.
 The Basis of Image Generation
• Due to application of an electric field the crystal will momentarily
deform.
• This induces a local compression of the tissue with which the
crystal is in contact resulting in an increase in local pressure; this
is the so-called acoustic pressure
• This local tissue compression (with subsequent decompression,
i.e., rarefaction) will propagate away from the piezoelectric
crystal at a speed of approximately 1530 m/s in soft tissue. This is
called the acoustic wave.
• The rate of compression/decompression determines the
frequency of the wave and is typically 2.5–10 MHz for ultrasonic
imaging.
 The Basis of Image 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
• The ability to differentiate two structures lying along the axis of the ultrasound
beam (i.e., one behind the other)
• It is dependent not only on the wavelength but also the number of wave cycles in
that ultrasound pulse.
• The shorter the SPL, the better the resolution.
• The best possible axial-point separation resolution is equal to 1/2 of the spatial-
pulse length .
• High frequency probe - better axial resolution
 Lateral Resolution
• Lateral resolution is the ability to resolve objects that are perpendicular to the
beam axis
• The ultrasonic beam consists of a near field with narrow beam width and good
lateral resolution (the Fresnel zone) and a far field where the beam width diverges
rapidly limiting resolution (the Fraunhofer zone)

• Both strong and weak reflectors can be resolved within the central portion of the beam,
where intensity is greatest.

• At the edge of the beam, however, only relatively strong reflectors may produce a
signal.
D = depth of near field
d = diameter of transducer
υ = transmission frequency of transducer
c = speed of sound
• Gain is the degree of amplification, of the received signal.
• When gain is low, weaker echoes from the edge of the beam may not be recorded and the
beam appears relatively narrow.
• If system gain is increased, weaker and more peripheral targets are recorded and beam
width appears greater.
• Thus, to enhance lateral resolution, a minimal amount of system gain should be employed.
 The Basis of Temporal Resolution
• Ability of the system to accurately track moving targets over time.

• The time required for the pulse to travel down one scan line to the depth of
interest and back to the transducer imposes a restriction on how quickly the
next element is stimulated, how rapidly a frame is acquired, and how soon the
next frame can be produced. The frame rate (expressed in Hz) quantitates the
speed of this process.

• Temporal resolution can be optimized by narrowing the sector size (of both the
image and the color Doppler region), thereby decreasing the number of scan
lines, or by decreasing the depth range.

• Since M-mode and Doppler echocardiography have better temporal resolution,

these modalities may be more useful when measuring events that are occurring
quickly.
 The Yin–Yang Relationship Between
Resolution and Penetration
• The energy of the ultrasound wave is decreased by tissue interactions.

• Attenuation describes the loss of intensity resulting from scattering (reflection at small interfaces) and
absorption (energy transformation)

L= µuz

• L = intensity attenuation loss (in decibels)

• μ = intensity attenuation coefficient ∼0.8 dB/cm/MHz for soft tissue
• υ = transducer frequency (in MHz)
• z = distance traveled in the medium by ultrasound wave (in cm)

• Intensity loss is greatest (or penetration is poorest) not only at deeper tissue depths (z) but also when
using a transducer with a higher frequency, precisely the frequency needed to enhance resolution.

• Thus, echocardiography requires a constant balancing act between optimizing resolution without
sacrificing penetration and vice versa.
 The Doppler Echo
• Doppler imaging is concerned with the direction, velocity, and the 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 principle is applied using transmitted sound waves to strike
moving red blood cells.
• The returning “backscattered” sound pulses are Doppler shifted in frequency
in relation to the velocity and direction in which the blood cells are moving.
• Doppler principles are also applied to evaluate tissue motion by Doppler
tissue imaging.
• Doppler ultrasound is used primarily to assess velocity of moving structures,
whether it be the velocity of blood flow through the heart and vasculature or
the velocity of the ventricular myocardium.
• V velocity of moving object
• As the speed of sound( c ) and the transmitted frequency (υ0) are constant, and
the frequency shift (υd) can be accurately measured; the main source of potential
error in Doppler estimation of velocity arises from the intercept angle, θ, between
the sound beam and the direction of blood/tissue motion.

• For intercept angles <20 degrees, cos θ is small, and is not felt to result is
significant underestimation of the flow velocity. At greater intercept angles,
correction for cos θ is needed.
 Pulsed Wave Doppler
• Pulsed Doppler causes the transducer to alternately transmit and receive short
ultrasound bursts.
• The time between transmission and reception allows calculation of the depth
of the signal or “range-gating”
• .An important limitation of pulsed Doppler imaging is the maximal velocity
that can be accurately resolved.
• This occurs because of the phenomenon referred to as aliasing.
 The Basis of Aliasing
• Aliasing is the inability of a pulsed wave Doppler system to detect the higher
frequency Doppler shifts.
• The upper limit of frequency that can be detected by a given pulsed system is the
Nyquist limit, which is defined as one half the PRF.
• To avoid aliasing, the PRF needs to be increased
• Depending on the system, the PRF setting is referred to as “Nyquist velocity,”
“Scale,” or “Velocity range.
To accurately represent a given frequency,
it must be sampled at least twice, that is
PRF = 2 × fDOP

In each panel, a constant sampling rate, or

PRF (11 times over time, t, indicated
by the vertical arrows), is maintained.
This results in a Nyquis limit of 5.5.
This sampling rate is adequate to
characterize the relatively low frequency
wave .

In the middle panel, the frequency is 5

cycles per time t. This frequency is still
below the Nyquist limit,
so aliasing does not occur

In the bottom panel, at a frequency of 8

cycles per time, t, the Nyquist limit of 5.5
has now been exceeded and
aliasing occurs.
• As the depth increases, the maximal velocity that can be accurately
detected decreases.
• However, for any given depth, a lower frequency transducer permits
higher velocities to be resolved compared with a higher frequency
transducer.
• Therefore, it may be advantageous to consider echocardiographic
windows associated with less depth to the heart when sampling a
high-velocity jet.
 Color Flow Doppler
• Pixels in the image are arbitrarily assigned a color (red for flow toward
the transducer and blue for flow away from the transducer) and a color
intensity based on the magnitude of the mean velocity.
• High variance, or turbulence, is coded green, which, when mixed
with red or blue, yields yellow or cyan, respectively, often with a
mosaic appearance
• The color Doppler scale should be actively manipulated throughout the
examination—using low-velocity scales when interrogating venous
velocities or velocities generated from lower pressure gradients
coronary arteries, across a large ventricular septal defect [VSD]
• High velocity scales when interrogating arterial flows or flows
generated from high pressure gradients (e.g., atrioventricular valve
regurgitation, restrictive VSD or PDA).
Color Flow doppler
 Continuous Wave Doppler

• The transducer is continuously transmitting and receiving ultrasound

signals.
• The disadvantage of this process is the absence of range gating, but a
major advantage is that the sampling rate is infinite, so there is no
longer a limit to the maximal frequency shift.
• The spectral display consists of a composite of signals with the
maximal velocity representing the peak velocity at any depth in the
plane of the ultrasound beam.
• Lower velocities are often visible within the spectral envelope allowing
for calculation of “corrected gradients” in which the lower proximal
velocity (V1) is subtracted from the higher distal velocity (V2) as is
performed for the evaluation of a gradient across an aortic
coarctation.
 Image artifacts
• Side Lobe Artifacts
• Reverberation Artifacts
• Shadowing
• Doppler Afrtifacts
 Side lobe artifacts

• Assumption is made that all reflections originate from a region directly in front
of the transducer

• Because the reflections originating from these side lobes are much smaller in
amplitude than the ones coming from the main lobe, they can typically be neglected.

• However, image artifacts can arise when the main lobe is in an anechoic region (i.e.,
inside the left ventricular cavity) causing the relative contribution of the side lobes to
become significant.
 Reverberation artifacts

• When the reflected wave arrives at the transducer, part of the energy is
converted to electrical energy.
• But another part of the wave is simply reflected on the transducer surface and
will start propagating away from the transducer as if it were another
ultrasound transmission.
• These higher-order reflections are called reverberations and give rise to ghost
(mirror image) structures in the image.
 Shadowing and dropout artifacts
• When perfect reflections occur, no acoustic
energy is transmitted to more distal structures
• As a result, a very bright structure will appear
in the image followed by a signal void, that is,
an acoustic shadow
• One of the most relevant example of
shadowing occurs in the setting of prosthetic
valves
 Doppler Artifacts
• Aliasing- occurs when pulsed wave Doppler
techniques are applied to flow velocities that
exceed the Nyquist limit.
• Mirror imaging- It is the appearance of a
symmetric spectral image on the opposite side
of the baseline from the true signal.
• These artifacts can be reduced by decreasing the
power output and optimizing the alignment of
the Doppler beam with the flow direction
 Image optimization in pediatric
echocardiography
• As children are smaller, less penetration is required.
• The heart rates are higher requiring higher temporal resolution.
• Always use the highest possible transducer frequency to optimize
spatial resolution.
• Often different transducers have to be used for different parts of
the exam.
• So, for instance, for subcostal imaging in a newborn, a 5- or 8-MHz
probe can be used while for the apical and parasternal windows a
10–12-MHz probe often provides better spatial resolution.
• For larger children and young adults 5-MHz and rarely 2.5–3.5-
MHz probes can be used, although for the parasternal windows
the higher frequency probes generate good quality images.
• For optimizing temporal resolution the narrowest sector possible
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