ULTRASOUND

DR RUBEENA ALI
SR RADIOLOGY DEPTT
AMTH/RLMC
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What Is Ultrasound?
• Sound waves whose frequency is beyond the human ear

• That is >20 kHz

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ULTRASOUND IMAGING
Ultrasound imaging, also called sonography,
involves exposing part of the body to HIGH FREQUENCY
SOUND WAVES to produce pictures of the
inside of the body.

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• Ultrasound examinations do not use
ionizing radiation (as used in x-rays).
• Because ultrasound images are No
captured in realtime, they can show a t i o n
Io ni z
the structure and movement of the
body's internal organs, as well as blood
flowing through blood vessels.

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• 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

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INDICATIONS
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OTHER USES

• Interventional ultrasonography; biopsy, emptying fluids,

intrauterine Blood transfusion (Hemolytic disease of the
newborn)
• Contrast-enhanced ultrasound
• Quantitative ultrasound: an adjunct diagnostic test for
myopathic disease in children;estimates of lean body mass in
adults

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HOW THE PROCEDURE
IS 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.

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• 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.

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In some ultrasound studies, the transducer is attached to a
probe and inserted into a natural opening in the body.
• Transesophageal echocardiogram. The transducer is
inserted into the esophagus to obtain images of the heart.
• Transrectal ultrasound. The transducer is inserted into the
rectum to view the prostate.
• Transvaginal ultrasound. The transducer is inserted into the
vagina to view the uterus and ovaries.

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ULTRASOUND
MACHINE
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COMPONENTS
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 data

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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

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THE TRANSDUCER
• The transducer is a small hand-
held device that resembles a
microphone, attached to the
scanner by a cord.

• It contains PIZOELECTRIC
CRYSTAL

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• A transducer is a device that can
convert one form of energy into
another
• Piezoelectric transducers convert
electrical energy into ultrasonic
energy and vice versa
• Piezoelectric means pressure
electricity

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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.

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The principles are
similar to sonar used by
boats and submarines.

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TYPES OF TRANSDUCERS
• CURVILINEAR PROBE
• PHASED ARRAY PROBE
• LINEAR TRANSDUCER

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CURVILINEAR PROBE

• Large foot print

• Low Frequency = Increased Depth
• Abdominal US , Pelvic and
obstetrical US

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PHASED ARRAY PROBE

• Smaller foot print (fits between

the ribs)
• Low frequency
• Echocardiography or abdominal
US

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LINEAR PROBE

• Flat foot print

• High frequency
• Maximum depth 10-13 cm
• Musculoskeletal or vessel US

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ENDOCAVITY PROBE

• Small foot print

• Used for transvaginal and
transrectal US

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HOW DOES
ULTRASOUND WORK??
• Ultrasound transducer produces “pulses” of ultrasound
waves
• These waves travel within the body and interact with various
tissues
• The reflected waves return to the transducer and are
processed by the ultrasound machine
• An image which represents these reflections is formed on
the monitor

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INTERACTIONS OF ULTRASOUND
WITH THE TISSUES
• Reflection
• Transmission
• Attenuation
• Scattering

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1.REFLECTION
• Occurs at a boundary between 2 adjacent tissues or media
• The amount of reflection depends on differences in
acoustic impedance between media
• The ultrasound image is formed from reflected echoes

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• ACOUSTIC IMPEDANCE (Z) is a physical property of tissue. It
describes how much resistance an ultrasound beam
encounters as it passes through a tissue. Acoustic impedance
depends on: the density of the tissue (d, in kg/m3) the speed
of the sound wave (c, in m/s)

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2.SCATTERING
• Redirection of sound in several directions
• Caused by interaction with small reflector or rough surface
• Only portion of sound wave returns to transducer

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3.TRANSMISSION
• Not all the sound wave is reflected, some continues deeper
into the body
• These waves will reflect from deeper tissue structures

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4.ATTENUATION
• The deeper the wave travels in the body, the weaker it
becomes
• The amplitude of the wave decreases with increasing depth

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DISPLAY MODES OF
ULTRASOUND
• A mode (Amplitude)
• Measures depth of a structure
• Used in ophthalmology

• B mode (brightness)
• 2D gray scale imaging

• M mode (motion)
• Allows visualization of interface motion
• like mitral valve leaflets movement
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BASIC ULTRASOUND
INTERPRETATION
THE
WORLD
OF
ECHOES
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Hyperechoic

Isoechoic

Hypoechoic

Anechoic

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• Hyperechoic

• Hypoechoic

• Anechoic

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HYPERECHOIC
• BONE
• CALCULI
• AIR

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HYPOECHOIC
• SOFT TISSUE ORGANS
• MASSES/TUMORS
• FAT

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ANECHOIC
• FLUID
• CYST
• COLLECTION
• URINARY BLADDER
• GALL BLADDER
• VESSELS

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IMAGING PLANES
• TRANSVERSE

• SAGITTAL

• CORONAL

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DOPPLER USG
THE DOPPLER EFFECT
Apparent change in received frequency due to a relative
motion between a sound source and sound receiver
– Sound TOWARD receiver = more frequency
– Sound AWAY from receiver = lesser frequency

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• Used to evaluate and quantify blood flow
– Transducer is the sound source and receiver
– Flow is in motion relative to the transducer
• Doppler produces an audible signal as well as a graphical
representation of flow = Spectral Waveform

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• The ultrasound probe emits
an ultrasound wave
• A blood cell moving away
from the probe reflects the
incoming wave with a longer
wavelength

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• Now, the blood cell moves
towards the probe. It reflects
the incoming wave with a
shorter wavelength

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USES
• Blood clots
• Poorly functioning valves in leg veins, which can cause blood
or other fluids to pool (venous insufficiency)
• Heart valve defects and congenital heart disease
• A blocked artery (arterial occlusion)
• Decreased blood circulation in extremities (peripheral artery
disease)
• Aneurysms
• Narrowing of an artery, (carotid artery stenosis)
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CASES
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BENEFITS VS RISKS
BENEFITS
• Most ultrasound scanning is noninvasive (no needles or
injections) and is usually painless.
• 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.

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• 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.

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RISKS
For standard diagnostic ultrasound there are no known
harmful effects on humans.

Biggest risk is misdiagnosis

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• Sound waves can increase body temperature. This is known
as CAVITATION
• Significant only for long exposure time
• No direct correlation has been found between ultrasound
imaging and cancer, low birth weight, dyslexia or delayed
speech development

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LIMITATIONS OF USG
• 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.
• 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 used.
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