MODULE 2

BASIC ULTRASOUND PHYSICS

Introducing Ultrasound 2-3

Ultrasound Applications 2-4
Ultrasound Imaging 2-5
Transducers 2-6
Ultrasound Beam Focusing 2-11
Ultrasound Wave Reception 2-13
2-D Artifacts and Enhancements 2-15
2-D Image Acquisition 2-19
Scan Conversion 2-20
Components of Image Quality 2-22
Other 2-D Features 2-25
Doppler Principles 2-26
Spectral Doppler 2-27
Understanding Blood Flow 2-30
Artifacts of Spectral Doppler 2-31
Color Doppler 2-32
Color Doppler Modes 2-34
Module 2 - Basic Ultrasound Physics Acuson Confidential

M-Mode 2-35
Ultrasound Module Questions 2-37

REVISION HISTORY

QRC P/N-REVISION INITIATOR APPROVAL DATE CHANGE

A2987 58212 Rev. 1 J. Madarasz S. Williams Sept. 2000 Initial Release

A3175 58212 Rev. 2 J. Madarasz S. Williams Dec. 2000 Incorporate reviewer comments

Module 2-2 Service Training Manual P/N 58212 Rev. 2

Acuson Confidential Introducing Ultrasound

INTRODUCING ULTRASOUND
OVERVIEW The field of diagnostic ultrasound has developed rapidly over the
past decade, but the basic physical principles have remained
consistent. The individuals who perform routine maintenance and
work with ultrasound equipment must understand the underlying
physical principles. This module prepares the reader to
conceptualize basic ultrasound principles in order to communicate
with the clinical user and to troubleshoot Acuson ultrasound
equipment when required.

SOUND WAVES Sound is mechanical energy that is transmitted through a medium

such as air, water, or metal. The sound waves (energy) exert
pressure on the medium, which causes periodic changes by causing
molecules to oscillate around their mean or average positions. There
are several kinds of sound waves: Infrasound, Audible Sound,
Ultrasound, Hypersound.

MEDICAL In medical applications, ultrasound waves are transmitted into a

ULTRASOUND patients body, and the echoes or reflections of those waves are
processed and displayed as an image. The different densities of
tissues in the body absorb different amounts of energy and these
differences are expressed as different shades of gray in the
ultrasound image. Ultrasound waves are high-frequency sound
waves that are beyond the range of normal human hearing.

wavefronts

Figure 2-1 Audible Sound Waves and Ultrasound Waves

TYPICAL FREQUENCY The following table displays the typical frequency ranges of sound
RANGES waves.

DESIGNATION RANGE EXAMPLE

Infrasound 0 to 16 Hz Seismic waves

Audible Sound 16Hz to 20 kHz Speech, music

Hypersound 10GHz to 1THz Acoustic microscopy

Ultrasound 20kHz to 10GHz Bats, dolphins, navigation, and

medicine

Medical 1MHz to 15MHz Acuson Ultrasound systems used for

Ultrasound anatomical imaging

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ULTRASOUND APPLICATIONS
Diagnostic ultrasound is one of the fastest growing and most
exciting imaging technologies. High performance ultrasound is
now the primary diagnostic imaging modality for many
applications. Acuson is a leading manufacturer, international
marketer, and service provider of diagnostic ultrasound systems
and image management products in the following main
applications: cardiology, OB/GYN, radiology, and vascular
imaging.

RADIOLOGY Because of its diagnostic efficacy and growing range of clinical

applications, ultrasound is the second most widely used imaging
modality overall, exceeded only by x-ray. Primary applications for
ultrasound in 2-D imaging include gall bladder, kidney, liver, and
spleen in the abdomen, and breast, thyroid, and testes in small parts
applications.

CARDIOLOGY Echocardiography or cardiac ultrasound has become an integral

part of the field of cardiology, playing an important role in
noninvasive evaluation of heart function. M-mode scanning has
been supplemented by improved real-time imaging with higher
frame rates in CW, AUX CW, PW Doppler, and Color Doppler
modes.

VASCULAR Both 2-D and Doppler modes are utilized extensively in vascular
work. The 2-D image provides anatomical information about blood
vessels, while Doppler modes display and measure blood flow.
Clinical applications of ultrasound in vascular work include the
detection and evaluation of abnormalities such as aneurysm and
stenosis.

OB/GYN Obstetrical imaging utilizes ultrasound for viewing fetal structures

such as heart, kidneys, spine, stomach, the umbilical cord insertion
on the fetal abdominal wall, as well as placental location. Maternal
structures such as the urinary bladder can also be viewed.
Gynecological imaging involves the use of ultrasound in an external
pelvic exam to view the ovaries, fallopian tubes, and uterus, and in
an endovaginal exam to rule out ectopic pregnancy and evaluate
early gestation.

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Acuson Confidential Ultrasound Imaging

ULTRASOUND IMAGING

2-D Mode Ultrasound is used most commonly in the basic 2-Dimensional

(2-D) mode, also called B-mode or brightness mode. The images
generated represent a two dimensional slice or cross-sectional
image of the patients anatomy.

2-D view of Liver and Kidney

Skin line
Viewed Plane

Transducer

Direction of ultrasound travel

(depth into the body)

Figure 2-2 2-D Ultrasound Imaging

ULTRASOUND WAVE When a transducer is applied to a patient with a coupling medium

(gel), the ultrasound wave output from the transducer travels into
the patients body. In human tissue, these waves travel at
approximately 1,540 meters per second. Medical ultrasound does
not allow imaging through bones or air.
Energy is reflected back to the transducer when the wave hits
different tissue densities of anatomy in the body.

Transmitted Energy

Transducer

Anatomy

Reflected Energy

Figure 2-3 Ultrasound Wave Reflection

The strength of the signal reflected back is related to the tissue
density and displayed in grayscale. The highest amplitude signals
are displayed white and lowest amplitude signals are displayed
black. The levels in between are shown as different levels of gray.

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Module 2 - Basic Ultrasound Physics Acuson Confidential

TRANSDUCERS
DEFINITION A transducer is a device that converts one form of energy into
another.
In ultrasound, the transmission and reception of ultrasound waves
is achieved by using a transducer. An ultrasound transducer
converts voltage impulses into ultrasound waves, transmits those
waves into the body, and converts returning echoes into voltages.
The transducer is acoustically coupled to the patient by means of a
water-based gel that matches the transducer-to-patient acoustic
impedance. Transducers come in various shapes and sizes to meet
the needs of various medical diagnostic applications.

Figure 2-4 Ultrasound Transducer

INSIDE A A transducer is composed of one or more elements of piezoelectric
TRANSDUCER (pie-ee-zo electric) material (or crystals).
When a voltage is applied
across it, the crystal changes
shape in the direction of the
electric field. This is used to
send ultrasound waves out
into the patient.
When a transducer
receives a ultrasound echo
returning from the patient,
the piezoelectric element
produces a voltage. The
magnitude of the voltage is
directly proportional to the
magnitude of the echo.
Figure 2-5Piezoelectric
Crystals

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Acuson Confidential Transducers

TRANSDUCER Each transducer is optimized for a particular frequency and has

FREQUENCY piezoelectric crystals with that natural vibrating frequency. The
operating frequency of a crystal is determined by the propagation
velocity in the transducer material and the thickness of the
transducer element.
Broadband transducers are created by using composite piezoelectric
elements which are sensitive to a much wider range of excitation
frequencies. Broadband transducers benefit from shortened pulse
length for better axial resolution and increased penetration.
Broadband transducers also offer flexibility, since imaging
parameters can be changed during scanning.
Transducers with a primary frequency usually still allow the
sonographer to change to alternate frequencies. The alternate
frequencies are controlled electronically and are chosen by the user
through the MultiHertz key on Acuson ultrasound systems.
Lower frequencies (1-3MHz) provide better penetration and
good signal strength at greater depths into the body.
Higher frequencies (7-10MHz) provide better resolution when
scanning at shallower depths in the body.

TRANSDUCER Each transducer format offers advantages for a certain imaging

FORMATS task. The transducers act as lenses and sonographers choose
transducers in much the same way that photographers choose
lenses based on the imaging distance and desired focal
characteristics. Transducer formats include linear array, curved
linear array, sector array, and Vector wideview array.
Array Transducers Array transducers use multiple crystals arranged in a straight row.
The transducer is controlled electronically to focus and steer the
ultrasound beam over the region of interest.
Linear and curved array transducers have a larger aperture and are
used when bones are not in the way of imaging.

Figure 2-6 Linear Arrays in Transducers

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Linear Array

Linear Transducer
Format
Nearfield Scan
Lines

Farfield

Figure 2-7 Linear Format Transducer Scan Lines

Curved Linear The curved linear array format provides a wide field of view. The
Array Transducers piezoelectric elements are arranged along a curved arc in linear
fashion.

Transducer

Figure 2-8 Curved Linear Array Transducer Scan Lines

Phased Array A phased array transducer is operated by applying voltage pulses

Transducers to all the elements in the transducer with a very small time
difference. The phased array transducer is smaller, and so has a
smaller foot print or aperture to fit between rib spaces. These are
generally used for echocardiography or abdominal scanning.

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Acuson Confidential Transducers

Vector and Sector The Vector wideview array transducer format is designed
Transducers exclusively by Acuson and was introduced in 1991. The Vector
transducer increases the near field of view without increasing the
transducer footprint. This is achieved with Acusons proprietary
software control and solves the usual sector problem of an over-
sampled near field. Vector transducers obsolete conventional sector
technology.

Vector Apex Transducer

Additional Nearfield
Ribs

Transducer
Footprint Size
Sector Apex
Ribs
Scan Lines

Figure 2-9 Vector and Sector Array Transducer Scan Lines

NewView Format

The NewView enhanced access imaging

format was developed exclusively for Aspen
systems. It improves on existing vector arrays
by moving the apex of the sector image further
away from the transducer, which allows for
acquisition of images through a smaller
window, such as between the ribs.

Figure 2-10 NewView Transducer Scan Pattern

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Other Transducers Besides the basic transducer formats, there are many other types of
transducer available for speciality applications, including
transesophageal, endovaginal, endorectal, interoperative, and
catheter.

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Acuson Confidential Ultrasound Beam Focusing

ULTRASOUND BEAM FOCUSING

TRANSMIT FOCUSING As with optics, ultrasound waves need to be focused. Acuson
ultrasound systems focus the ultrasound waves electronically.
The timing of the transmit drive voltage to each element is arranged
so that the wavefronts from all the transmitting elements arrive at a
selected spatial point at the same time. This is accomplished by
introducing a curve into the timing delays, whose center is the
desired focal point.
This in effect is the same as using an acoustic lens, since a lens
implements focus by delaying waves to a specific degree so that the
same result is achieved. Using electronic instead of physical delay
allows the transmit focal point to be changed simply by changing
the delay relationship.

Acoustic Lens

Summation produces
Electronic Focus spherical wavefronts con-
verging toward the focal point
Timed Transmit Pulses

Focal
Point

Circular waves from

individual elements
Figure 2-11 Ultrasound Beam Focusing
TIMING DELAYS The transmit delay lines produce the pulse sequence that
electronically focuses the ultrasound beam. Delay lines can be
programmed to focus the beam to any desired point. It is also
possible to change the direction of the composite wave with respect
to the direction of the array by changing the relative delays across
the array at right angles to the desired direction. This allows the
direction of the transmitted beams to be changed or steered
between consecutive ultrasound lines, allowing the array to
generate a different image format like curved linear or vector
transducers.

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The following two examples show how the focal point is positioned
at the center of the image or off-axis by adding a linear delay across
the array of the piezoelectric elements.

Delay
Line t0

Delay
Line t1

Delay
Line t2
Focal Point
Delay
Line t1

Delay
Line t0 Piezoelectric
Start Pulse Elements

Delay
Line t0

Delay
Line t1

Delay
Line t2

Delay
Line t3

Delay
Line t4 Piezoelectric Focal Point
Start Pulse Elements
Figure 2-12 Beam Steering

IMPROVED FOCUS In a phased array transducer, the number of piezoelectric elements

determines the focusing properties of the transducer. With few
crystals, the area of focus is large, and spatial resolution is poor.
With more crystals, the focus is nearly perfect, and spatial
resolution is greatly improved.
Acuson uses all crystals (up to 128) to focus each Ultrasound line.

Focal Point

Focal Point
Figure 2-13 Improved Focus

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Acuson Confidential Ultrasound Wave Reception

ULTRASOUND WAVE RECEPTION

The transmit phase is considered static, since the wavefronts
propagate uncontrolled once they leave the transducer; there is no
way to alter the transmit energy pattern. However, during the
receive or dynamic phase, dramatic enhancement of the focal
capabilities of the system can be implemented. The reception phase
is a continuous process.
As ultrasound waves
strike various interfaces
in the body, some of the
energy is transmitted and
some reflected. The
reflected energy, or
echoes, return toward the
transducer.
Acuson systems use
electronic controls to
Reflected Energy
dynamically adjust
during receive to provide
superior image quality.

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DYNAMIC FOCUS Through software control, an electronic lens is continuously

reshaped as the focal point moves away from the array at half the
velocity of ultrasound to maintain precise focus along each scan
line. Thus the resolution can be maintained throughout the field of
view, and image resolution is not limited by a small transducer
aperture or by a fixed focal zone as in conventional systems.

Delay
Dynamic focus is achieved by controlling the delay of each signal
arriving at each element through each channel, such that only
signals from the computed sliding focal point arrive at a final
summation point at the same time. Signals originating from other
points do not sum in phase at the final output, and therefore tend to
cancel each other out, providing insignificant addition.
The system computer runs the proprietary software necessary to
accomplish this in real time.

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Acuson Confidential 2-D Artifacts and Enhancements

2-D ARTIFACTS AND ENHANCEMENTS

DEFINITION An artifact is an incorrect representation of data displayed on the
monitor.

A problem with the electronic array is the formation of secondary

lobes. These lobes originate at the transducer and are transmitted
with the main beam. These lobes create artifacts in the ultrasound
image and create misregistration of the interface position. There are
two types of secondary lobes:
Side Lobes
Grating Lobes

SIDE LOBES Side lobes are caused

by width and length
mode oscillations,
intermediate
reverberation at the
transducer-to-tissue
interface, and
interference. The side
lobes are of lower
intensity than the
main beam. A
technique called
apodization is used to
reduce the effects of
the side lobes.
Figure 2-14 Side Lobe Artifacts

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GRATING LOBES Grating lobes are

Transducer Array
caused by sequential Array Group Array Group
spacing between the
piezoelectric
elements within the Main Beam
transducer array.
Grating lobes also Grating Lobe
create an image
artifact by creating a
ghost or false image False Image
of an object along True Image
with the original or
true image. False Image

The effect of grating

lobes is reduced by a
technique called subdicing. In this technique, the normal elements
of an array are divided into a number of smaller sub-elements
which are electronically wired together to form an element the same
size as the original element.

DYNAMIC Dynamic apodization is used during reception to minimize the

APODIZATION effect of side lobes. Side lobes are minimized by reducing the gain
levels on the channels away from the center of the ultrasound line.

No Apodization Large Side Lobes

Equal gain on all

active channels

With Apodization
Reduced Side Lobes

Gain reduced on the

channels away from
center of Ultrasound line

Figure 2-15 Apodization Image Enhancement

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Acuson Confidential 2-D Artifacts and Enhancements

DYNAMIC APERTURE Computed sonography uses the aperture size effectively to

maintain uniform image clarity throughout the entire field of view.
The number of active elements depends on the location of the
tracking focal point. This optimizes focusing at a particular depth.
The ratio of aperture to focal depth is maintained as a constant, one-
to-two.

Focus 40 mm Focus 80 mm

Aperture 20 mm Aperture 40 mm

Focus 120 mm Focus 160 mm

Aperture 60 mm Aperture 80 mm
Figure 2-16 Dynamic Aperture
BEAMWIDTH Beamwidth is the size of the ultrasound beam at any location. It is
narrow at the near field and widens as depth increases. Focusing is
used to maintain beamwidth over depth. Since lateral resolution is
related to the ability of the ultrasound beam to detect small objects
across the width of the beam., decreasing the beamwidth improves
lateral resolution.

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TRANSMIT ZONE The Acuson Aspen

ENHANCEMENTS Ultrasound system uses
A B C both fixed transmit
focusing and dynamic
receive focusing.
Effective beamwidth is
the product of fixed
ctive beamwidth C = Transmit Focal zone B transmit focal zone
+ Receive Beamwidth A beamwidth and the
received beamwidth. As
the number of fixed
transmit zones
increases, the effective
beamwidth becomes
narrower. Each segment
along the ultrasound
line is optimized for a
certain focal length. The
ultrasound beam
diverges rapidly beyond
the focal zone, hence
Effective Beamwidth is narrower when the
number of transmit focal zones is increased multiple focal zones are
necessary to maintain
the narrow beamwidth.
Figure 2-17 Effective Beamwidth Enhancement

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Acuson Confidential 2-D Image Acquisition

2-D IMAGE ACQUISITION

In 2-D imaging, the ultrasound lines are fired sequentially.
Amplitude data gathered from the returning echoes along each
ultrasound line is amplified, rectified, and processed. The processed
analog signal undergoes an analog-to-digital conversion (ADC).
The digital data is then stored in video memory. When the last
ultrasound line in the frame has been fired, the sequence starts over,
and the video memory is overwritten with new data.

The amplified
reflectors are sent to
an ultrasound Scan
Converter where
Ultrasound they are converted to
Scanner brightness and
XMT RCV formatted to a specific
location on the CRT.

XDCR

The Body

Focused
Wave Front

Amplitude of
reflections at Anatomical
specific depths Structure

One Theoretical
Ultrasound (or Scan) Line

Transducer

Line1
Line2
Line3
Line4
Line5
Line6
Line7
Line8

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SCAN CONVERSION
DEFINITION Scan conversion is the process of reformatting ultrasound data for
display on a raster. Ultrasound data must undergo a scan
conversion before it can be displayed on a monitor. Ultrasound data
acquired from the returning echoes is in the vertical format, but can
be displayed only in the horizontal raster format.

Linear Format Sector Format

TV Raster Format

MEMORY MAPPING In scan conversion, incoming echo information has been digitized.
This digital information is then stored in a memory map and
manipulated. The (digital) output of the memory map is converted
into analog horizontal television raster lines and displayed on a
CRT.

Data In

Data Out

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Acuson Confidential Scan Conversion

ULTRASOUND FRAME When the ultrasound system has completed transmitting and
RATE receiving across the 2-D image area, the information is stored and
displayed as a full frame.
The ultrasound frame rate is the number of frames captured per
second. The acoustic or ultrasound frame rate depends upon the
number of lines fired, depth, number of focal zones applied, and the
application used. The more ultrasound lines fired, the longer it
takes to produce a single frame.
Depth = 16 cm
Lines = 128
Setup time = 32s
Round triplets = 16 cm x 13
s/cm = 208 s
208 s + 32 s setup time =
160 mm 240 s
240 s x 128 lines = 30.7 ms/
frame
= 32.25 frames/second
~128 Ultrasound Lines

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COMPONENTS OF IMAGE QUALITY

The objective of an ultrasound exam is to obtain a specific
pathological diagnosis. While scanning a patient, the sonographer
or physician observes the ultrasound image pattern, looking for
abnormalities. Certain pathological conditions present distinctive
features in an ultrasound image, for example, the differentiation
between cysts and solid masses. Image quality is very important
and has many components.

DEFINITION The parameters that influence image quality include:

Detail/Spatial Resolution - the ability to distinguish small
structures (includes axial and lateral resolution)
Image Uniformity - comparable detail and contrast throughout
Contrast resolution - the ability to differentiate different tissue
types without introducing noise
Temporal Resolution/Frame rate - the rate to acquire frames
and display them
Dynamic range - largest and smallest signals acquired and
displayed
Spatial Discrimination - the ability to limit artifacts and
reflections from other locations
Bandwidth - the system ability to reproduce signals
appropriately

SPATIAL Detail or spatial resolution is the ability of the ultrasound system to

RESOLUTION discriminate between two closely-spaced objects. It is defined as the
shortest distance in millimeters between two discrete objects at
which the objects can be differentiated. Resolution figures are
commonly measured at the focal point and represent the best
attainable values. Resolutions in the axial and lateral dimensions
are usually specified independently.

Not Resolved Just Resolved Completely

Resolved
Figure 2-18 Spatial Resolution

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Acuson Confidential Components of Image Quality

AXIAL RESOLUTION Axial resolution is the ability of an ultrasound system to resolve

two closely-spaced objects along the axis of the beam. It is
dependent upon the wavelength and transmit pulse wavelength,
and affects image quality and information.

LATERAL Lateral resolution is the ability of the ultrasound system to resolve

RESOLUTION structures that are very close to one another at the same depth. It is
dependent on the beamwidth as determined by the transducer
active aperture, depth, and focusing

Axial

Lateral

Figure 2-19 The Two Planes of Resolution

DYNAMIC RANGE There are two definitions for the dynamic range. The signal dynamic
range is the measure of the ultrasound signal magnitudes that can
be processed by the ultrasound system. The display dynamic range is
the measure of the signal magnitudes that can be displayed by the
system. The amplitudes of the returning echoes may be up to 100dB
to 150dB below the original intensity transmitted. This wide range
of echo strength is also reflected in the induced signals at the
receiver section. Logarithmic amplification reduces the dynamic
range of the induced RF signal. This decreasing of the dynamic
range is called log compression. Further processing of the signal
reduces the dynamic range as displayed below.

Anatomical
Interfaces
Overall Processing Display
Transducer Gain &
DGC

150dB to 80dB 60dB 30dB to

100dB 40dB

Figure 2-20 Dynamic Range Reduction

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SIGNAL STRENGTH The ultrasound signal is attenuated (reduced in signal strength) the
farther it goes into the body and depending on what it comes in
contact with. The attenuation reduces the intensity of the beam.
The transmit signal strength can be made stronger by using a lower
transmit frequency. This however will compromise resolution.
The received signal strength can be increased using overall 2-D gain
control or Depth Gain Compensation (DGCs). DGCs allows the user
to enhance specific areas of interest by increasing or decreasing the
amplification of echoes at different depths. It compensates for losses
in signal strength as the ultrasound wave passes through
anatomical structures. Normally, the field of view is divided into
eight DGC zones. A DGC slider controls the DGC for one zone. The
positions of the eight controls with respect to each other define the
DGC curve displayed with the image.

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Acuson Confidential Other 2-D Features

OTHER 2-D FEATURES

RES In Regional Expansion Selection (RES), a portion of the 2-D image
can be expanded. RES not only magnifies the selected area, but also
increases the displayed resolution by increasing the number of real
ultrasound lines and the number of pixel points displayed on the
television lines.
Linear Transducer
RES Mode
80 mm Aperture
Depth = 160 mm x2 Magnification

80 mm 40 mm
40 mm

64 Real
Ultrasound
Lines 80
mm
160
mm 400
80 mm TV Lines
400
TV Lines 200 TV Lines

2N Ultrasound Lines
N Ultrasound Lines
Figure 2-21 Regional Expansion Selection (RES)
CINE In Cine mode,
f1
multiple f2
frames are f3 Time
f4
captured and f5
then viewed in
looping
playback, one
frame at a time.
The review of
captured
frames is
controlled by
increasing or
decreasing the
review speed.

Figure 2-22 Cine Frame Capture

B-COLOR In B-color mode, the 2-D image is displayed in a range of colors
instead of grayscale. This provides greater definition, since the
human eye can perceive more shades of color than of grayscale. The
B-color mode can also be applied to the M-mode and spectral
Doppler modes.

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DOPPLER PRINCIPLES
DOPPLER EFFECT

In Ultrasound imaging, echoes

received from most tissues are at the
TX
same frequency as the transmitted
beam.
ftx = frx RX

However, if the echoes were received from moving tissue, such as

blood cells, the transmitted and received frequencies will not be the
same. The shift in frequency can be used to determine the relative
velocity and direction of these moving objects. This is known as the
Doppler effect. Essentially, the greater the frequency shift, the
higher the velocity of the moving object. Movement toward the
transducer results in an increased frequency, and movement away
from the transducer, in a reduced frequency.

If the object or blood flow is

travelling toward the transducer, TX
the received frequency is higher
than the transmit frequency.
ftx < frx
RX

If the object or blood flow is

travelling away from the TX
transducer, the received frequency
is lower than the transmit
frequency.
RX
ftx > fr

ANGLE If the motion is directly perpendicular to the ultrasound beam, the

CORRECTIONS signal cannot be properly calculated. The sonographer must angle
the transducer physically or use the software in the ultrasound
system to angle or steer the beam to be more parallel with the blood
flow.
The ultrasound system calculates the velocity of blood flow based
on the frequency shift. When the motion of the object and the
transmitted beam are not parallel, it results in a decrease in the
magnitude of the frequency shift and, therefore, a lower calculated
velocity. The user should use the Angle key on the keyboard to
adjust the calculation properly.

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Acuson Confidential Spectral Doppler

SPECTRAL DOPPLER
SPECTRAL DOPPLER In spectral Doppler mode, blood flow can be imaged or visualized,
MODES to depict changes in blood flow velocities over time. There are three
spectral Doppler modes:

Pulsed Wave Doppler

Continuous Wave (CW)
Doppler
Aux CW Doppler

Figure 2-23Spectral Doppler

Image

PULSED WAVE In pulsed wave (PW) Doppler, a Doppler cursor is positioned over
DOPPLER the vessel of interest in the 2-D image. The vessel is further focussed
by using a sample volume or range gate to obtain flow information
from a selected depth.
In PW Doppler, one element or group of elements transmits and
receives. The elements transmit and the system waits to receive the
returning echoes. The time delay between transmit and receive
relates directly to the depth of the targeted tissue (reflectors.)
A single ultrasound line is fired. Echoes reflected from moving
blood undergo a shift in frequency. Using the Doppler equation,
echo information obtained within the range gate is analyzed for
frequency shift and amplitude. The frequency data is converted to
velocity and displayed in a scrolling strip format on the system
monitor.

CONTINUOUS WAVE In continuous wave Doppler, one element or group of elements

DOPPLER transmits continuously, and another element or a group of elements
receives continuously. Velocities from all points along the line are
detected, resulting in ambiguous spectral Doppler information.
CW Doppler is used to resolve high-flow velocities. However, its
use is limited by the fact that CW Doppler cannot be used to
measure the depth of the detected velocities. This modality is used
in clinical examinations when the quantification of high velocity jets
is desired, as in cardiology.

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DOPPLER DISPLAY Spectral Doppler is used to separate the complex frequencies

obtained in Doppler shifted by means of fast Fourier transform
(FFT) algorithm. The horizontal axis of the spectral display
measures time and the vertical axis measures velocity. Spectral
information above the zero velocity baseline represents flow toward
the transducer, and spectral information below the baseline
represents flow away from the transducer.

Weak Signal
(Few cells moving at this velocity)
Peak Systolic Velocity
Strong Signal
(Many cells moving at this velocity
Dicrotic Notch Envelope
(Outer Edge)
TV, MV close
Window
(Indicating
normal flow)

Time
Systole Diastole Systole Diastole

Figure 2-24 Doppler Display

DOPPLER AUDIO The shifted frequencies obtained from the moving blood cells are
filtered and amplified for audio use. Typically, flow toward the
transducer is heard from the left speaker and flow away from the
transducer is heard from the right transducer. By listening to the
audio flow pattern, the sonographer can usually differentiate
between forward and reverse flows.

AUXILIARY CW In Auxiliary (AUX) CW Doppler, a special transducer is used. The

DOPPLER AUX CW displays only a CW spectral Doppler strip and no 2-D
image. It has just two piezoelectric elements. One element transmits
and the other receives simultaneously.
Typically, the Aux CW transducer
operates at a lower frequency of
about 2 to 3 MHz.
This transducer combines two
important benefitsa very small
footprint, which allows for data
collection through a very small
window, and increased penetration
due to lower operating frequency.

Figure 2-25 Aux CW Transducer

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Acuson Confidential Spectral Doppler

PULSE REPETITION The number of times the transducer piezoelectric element is pulsed
FREQUENCY per second is called the pulse repetition frequency (PRF.) This
frequency depends on a physical limitation that a transducer cannot
transmit and receive at the same time. The maximum PRF is
constrained by the transmit depth and the propagation velocity. The
time required for an ultrasound beam to transmit and receive once
is called the pulse repetition period (PRP). It is equal to the inverse
of the PRF. PRP = 1 / PRF

NYQUIST LIMIT If the sampling rate is not adequate for high-frequency Doppler
shifts, artifactual Doppler shifts are displayed. The highest Doppler
shift velocity measurable in PW Doppler is limited to one-half of the
sampling rate defined by the PRF. PRF is determined mainly by the
sampling depth. This maximum measurable velocity for a given
transducer and depth is known as the Nyquist limit, and can be
calculated using the following equation: Nyquist Limit = PRF / 2

TX TX TX TX
Amplitude

RX RX RX RX
Ultrasound Line Ultrasound Line Ultrasound Line Ultrasound Line
Time
Pulse Repetition Period

HIGH PRF The Nyquist limit decreases with increasing depth of ultrasound
wave penetration. As this limit reaches 1/2 PRF, the system
automatically increases the sample rate by increasing the PRF and
the number of samples. As a result, multiple wavefronts propagate
through the tissue simultaneously. Therefore, information obtained
may be from more than one location. These other locations are
indicated by ghost gates. The ghost gates are real, and are
positioned by the user such that they are not in the region of flow.

Ghost Gates Real Gate

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Module 2 - Basic Ultrasound Physics Acuson Confidential

UNDERSTANDING BLOOD FLOW

Hemodynamics is the study of blood flow and this is a brief
introduction to some things sonographers are looking for.
BLOOD FLOW IN It is important to remember that in the human bodies, arterial flow
ARTERIES is pulsatile, as opposed to steady. Increased flow velocities and plug
flow typically occur during systole (heart contracts and pumps),
decreased flow velocities occur during diastole (heart relaxes and
fills).

BLOOD FLOW IN Blood flow in veins is considered phasic, as it is influenced by

VEINS respiration. For example, when a person inhales, the diaphragm
expands and the lungs fill with air. This puts pressure on the
inferior vena cava (IVC) where it passes through the diaphragm,
restricting venous flow. When the person exhales, the diaphragm
relaxes, and continuous blood flow through IVC is restored.

PLUG FLOW In plug flow, most of the blood moves at the same velocity and in
the same direction. Plug flow occurs in a narrow range of velocities
and primarily in large vessels such as the aorta.

LAMINAR FLOW In laminar flow, the blood flows more slowly along the vessel walls
and somewhat faster at the center of the vessel. Flow is essentially
in one direction. Laminar flow occurs in a narrow range of
velocities and in vessels that are straight, smooth, and
unobstructed.

TURBULENT FLOW In turbulent flow, the blood flows at various speeds and in various
directions, even including opposing directions. Turbulent flow
usually occurs past an area of obstruction or restriction, such as
sharp vessel bends, bifurcation, narrowing, obstruction, or leaks.

Narrowing of vessel Vessel wall

Plug flow Laminar flow Turbulent flow

Figure 2-26 Vascular Blood Flow

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Acuson Confidential Artifacts of Spectral Doppler

ARTIFACTS OF SPECTRAL DOPPLER

ALIASING If blood flow velocity exceeds the Nyquist limit for a given
transducer and depth, a phenomenon known as aliasing occurs.
Aliasing results in the display of erroneous velocity information,
which appears as a wraparound effect on the Spectral display. To
correct aliasing, try changing the Doppler scale.

Figure 2-27 Aliasing Artifact

MIRRORING Another artifact is called mirroring. It occurs when weak Doppler
signals are detected with high Doppler gain settings. The large
amount of clutter from stationary stutterers prevents the receiver
from processing all incoming Doppler signals, resulting in a loss of
directional differentiation..

m/s

Figure 2-28 Mirroring Artifact

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COLOR DOPPLER
In color Doppler,
blood flow in real-
time is displayed
as a color overlay
across the 2-D
image, showing
blood flow
through vessels
and organs. Color Color Box
Doppler can
display either the
velocity of blood
flow, the energy,
or a combination of the two.
When Color Doppler mode is invoked, a color box appears in the 2-
D image. This box is used to select the area of interest for the CD
information. The size and position of the color box are adjustable.

COLOR DOPPLER There are four color Doppler (CD) options:

OPTIONS CDV Color Doppler Velocity
CDE Color Doppler Energy
DTI Doppler Tissue Imaging - for Cardiac transducers only
CCD Convergent Color Doppler - both energy and velocity

SAMPLE VOLUME Multiple range gates are taken along multiple Color Doppler lines
MAPPING to compute the frequency shift of blood flow. This is converted into
velocity information and assigned a color to represent a certain
velocity and direction, and then combined with the 2-D image at the
location of origin.

Transducer Transducer

Multiple
Gates

CD Box

d1 d2d3d4 .....
Scanning Doppler Lines

Figure 2-29 Sample Volume Mapping Diagram and Ultrasound

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Acuson Confidential Color Doppler

Image
VELOCITY DISPLAY Hue indicates direction
(towards or away from
Yellow transducer or ultrasound
Flow towards Increasing line) and intensity.
the transducer Velocities Typically red is blood
flow towards the
transducer and yellow is
Red high flow towards.
0 Typically blue is blood
Blue flow away from the
transducer and green is
high flow away.
Flow away from Increasing The scale must be
the transducer Velocities adjusted higher than
Green maximum velocity of
blood flow or aliasing
(wrap around) will occur.
Figure 2-30 Velocity Color Display Key

VELOCITY Color flow imaging requires location as well velocity of the moving
DETECTION object. To assess the motion multiple echoes from the same object
must be collected using a series of transmitted pulses. The rapid
acquisition and analysis of flow data are achieved with multiple
gate PW Doppler signals. Doppler signal processing is initiated
with a quadrature detection or QD. This results in two output
signals:
Inphase or I Signal
Quardrature or Q Signal (Out of phase)
Just like the 2-D image data, the data acquired from the returning
echoes is analog format. These I&Q signals are then digitized, scan
converted, and color mapped to display the color Doppler
information.
Color velocity estimation does not depict spectral analysis of each
sample volume. An average Doppler shift is estimated, resulting in
a time-averaged velocity estimation.

COLOR SCAN Digitized color Doppler data undergoes a scan conversion similar
CONVERSION to that in 2-D mode. The main purpose of the color scan conversion
is to display flow Doppler lines in the raster format. The resultant
flow information is overlaid on top of the 2-D image and displayed
on the monitor. The following figure depicts how flow information
is collected from multiple range gates, flow velocity estimated, and
scan converted for display.

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COLOR DOPPLER MODES

COLOR DOPPLER CDV or color Doppler Velocity is the most common color mode that
VELOCITY displays blood flow information in real time. It uses color to
represent the direction and velocity of blood flow as has been
described so far. The black line in the center of the color bar
indicates zero velocity. The color shown in the upper portion of the
color bar represents flow towards the transducer, and the color in
the lower portion of the color bar represents blood flow away from
the of the transducer. The shades of color indicates the velocity of
the blood flow: deep shades indicate low velocities. As the velocity
increases, the shade either becomes lighter or changes to another
color. The velocity scale limits appear at the end of the color bar.

COLOR DOPPLER CDE or color Doppler Energy

ENERGY capability assigns a color to the
energy of the Doppler signal
generated by the blood cells.
The CDE option displays the
energy from the returning
Doppler signal. The CDE option
is virtually independent of the
incident Doppler angle. Even
though the mean frequency or
velocity spectrum shifts with
changing Doppler angles, the
energy of the spectrum remains
constant. The CDE option displays a wide dynamic range of signals
from blood vessels with varying flow states ranging from high
velocity to very low velocity, simultaneously without aliasing. It
even display the profuse regions where the mean blood velocity
could be zero.

DOPPLER TISSUE The DTI or Doppler Tissue Imaging is exact opposite of color
IMAGING Doppler Velocity. CDV employs tissue motion discrimination to
filter out the Doppler signals being reflected by the moving tissues
in the anatomy in order to display just the blood flow motion.
Unlike CDV, the DTI automatically detects and displays moving
tissues and ignores the Doppler signals from blood flow.
DTI capability introduces new methodology to study myocardial
motion, conduction abnormalities, diastole function, and stress
echo. It is available in three options: Velocity mode, Acceleration
mode, and Energy mode.

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Acuson Confidential M-Mode

M-MODE
DEFINITION M-mode, also called motion mode, is used to display a graphic
representation of a line of interest within the 2-D display, such as
the movement of a heart valve. M-mode displays a graph that
shows how the line changes over time.

M-MODE DISPLAY Normally, M-mode

divides the screen into
two areas, top and
bottom. A reduced 2-D
image appears at the top
of the screen, and the M-
mode strip, at the
bottom. The M-mode
strip can be displayed on
its own on the full screen.
The horizontal axis of the
strip displays time, while
the vertical axis shows
depth.
Figure 2-31 M-Mode
Display
Small breaks in the strip display indicate the timing of events. The
display of the ECG signal along with M-mode data allows for
correlation of valve movements with the heart cycle.

DATA ACQUISITION In M-mode, a single ultrasound line is fired repeatedly, usually

through heart valves or artery walls. Data collected is stored
sequentially in video memory by line count (t1, t2, t3...), rather than
line number.

Transducer Transducer Transducer Transducer

Line 50 t1 Line 50 t2 Line 50 t3 Line 50 t4

Heart Valves
Figure 2-32 M-Mode Data Acquisition

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DATA DISPLAY The lines are displayed side by side on the system monitor. A
motion-time map is created, which can be used to verify valve or
muscle operation.

Figure 2-33 M-Mode Data Display

COLOR M-MODE In color Doppler mode, blood flow is displayed in the form of color
maps. M-mode and color Doppler modes can be combined to form
a complex scanning system. This multimode function is a powerful
tool for evaluating cardiac blood flow.
M-mode and color Doppler data are acquired simultaneously. The
M-mode and color Doppler scan lines are interwoven in a time
sharing manner. Next, both forms of data are combined by
overlaying color Doppler data over the M-mode strip.

RECORDING M-mode strip can be recorded on a page printer, but the most
common archival method is a strip chart recorder, which provides a
continuous reproduction of the M-mode trace. With the advent of
digital image management systems like AEGIS, M-mode data can
be stored digitally on various media, including hard disk and
magneto-optical disk.

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Acuson Confidential Ultrasound Module Questions

ULTRASOUND MODULE QUESTIONS

1 Each transducer crystal is used to fire one ultrasound line in a
frame. True or False?

2 What kind of reflection (echo) would anatomy with dense tissue

create?
strong vs. weak?
displayed as black, white, or gray?

3 How is the ultrasound beam focused on transmit?

4 Could a linear transducer be used for heart scanning? Why or why

not?

5 Regarding Color Doppler, match the following:

Red hue Relative variance
Blue hue Flow away from the transducer
Secondary hue (Green) Flow toward the transducer

6 What would be useful to try if a Pulsed Wave Doppler signal were

weak?

7 What modality is used to measure very high velocity blood

flow?______________________

Is this used by cardiologists or

radiologists?_____________________________

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Module 2-38 Service Training Manual P/N 58212 Rev. 2