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THIS is the first of three articles about Doppler ultrasound and its role in the investigation of diseases
in dogs and cats. For small animal practitioners already familiar with two-dimensional, grey-scale
ultrasonography, Doppler ultrasound represents the next level of sophistication, and is a more technically
demanding modality. These articles aim to provide a basis for an understanding of the techniques and
to assist in case selection, both for practitioners wishing to perform these studies and those requesting
examinations by specialists. This first article describes the Doppler principle and the different types of
Doppler techniques that are used for diagnosis. The second and third articles, to be published in the
Chris Lamb is Senior
May and June issues, will discuss the applications of Doppler ultrasound in the abdomen and in the Lecturer in radiology
assessment of cardiac diseases, respectively. in the Department
of Veterinary Clinical
Sciences at The Royal
Veterinary College
SOUND, ULTRASOUND AND (RVC). He is a
THE DOPPLER EFFECT diplomate of both the
American College of
Veterinary Radiology
Sound is mechanical energy in the form of pressure and the European
College of Veterinary
waves that travel through a medium by transferring ener- Diagnostic Imaging.
gy from one particle to the next. The velocity of sound is
determined by the rate at which energy is transferred.
Denser materials, which contain closely packed parti-
cles, transmit sound faster than less dense materials.
The speed of sound in tissue is approximately 1540 m/
second.
Ultrasound is defined as sound at a frequency above
the audible range – that is, any sound with a frequency
greater than 20,000 Hz. Medical diagnostic ultrasound
Adrian Boswood
machines use frequencies in the range 2 to 15 million Hz Example of the Doppler effect. is Senior Lecturer in
(MHz), because these frequencies have a short wave- The pitch of the siren of an internal medicine in
ambulance appears to be higher the Department of
length in tissue, which is necessary for adequate resolu- when approaching the observer Veterinary Clinical
tion of anatomical details. and lower as the ambulance Sciences at The RVC.
speeds away. For the driver of the He is an RCVS
Doppler ultrasound techniques are based on the prin- ambulance, the pitch of the siren specialist in veterinary
ciple of Doppler shift – that is, a change in the frequency remains constant cardiology and holds
of sound that is observed when the source is moving the European College
of Veterinary Internal
relative to the observer. A familiar example of Doppler original ultrasound pulse if the RBCs are moving Medicine’s cardiology
shift is the change in pitch of a siren on a passing ambu- towards the transducer and a lower frequency if the diploma. His main
area of interest is
lance or police car, which is high on approach, then RBCs are moving away from the transducer (as illustrat- small animal
suddenly becomes lower as the vehicle moves away. In ed at the top of page 184). Echoes originating from sta- cardiorespiratory
medical ultrasound, this principle may be used to detect tionary objects in the body will have the same frequency medicine.
and measure the flow of blood because red blood cells as the transmitted ultrasound beam (ie, there will be no
(RBCs) reflect ultrasound waves, producing echoes that Doppler shift).
can return to the transducer. The echoes returning from RBCs are very small (diameter 7 µm) compared to a In Practice (2005)
moving RBCs will have a higher frequency than the typical ultrasound wavelength (0·2 to 0·5 mm), and they 27, 183-189
30
25
1 2 3
20
Grey-scale
Depth (cm)
Doppler
15
v= fD.c
2f.cosθ
where v = Blood flow velocity, fD = Doppler shift,
It is important to maintain a fairly small angle of
f = Frequency emitted by transducer, c = Speed of
insonation when attempting to measure blood flow veloc-
ultrasound propagation in tissue, cosθ = Cosine of
ity because the effect of any error in angle measurement
the angle of insonation
is magnified at wider angles. Cardiologists use windows
that align the Doppler beam within 15º of blood flow
and ultrasonographers examining abdominal or peripheral
30 vessels attempt to use angles of insonation of less than
60º.
The magnitude of the Doppler shift is given by the
formula:
10 MHz
fD = f(2v/c-v)
where fD = Doppler shift, f = Frequency emitted by
transducer, v = Blood flow velocity, c = Speed of
ultrasound propagation in tissue
10 5 MHz
HV
PV
CVC
Variance maps
Colour Doppler image of the liver of a dog. Flow in portal
Examples of different colour maps. In each of the maps on branches (PV) is in the opposite direction to flow in hepatic
the left, positive Doppler shifts are colour-coded red or veins (HV). Note the colour map in the top left corner, which
yellow whereas negative Doppler shifts are colour-coded explains the meaning of the various colours displayed: red
blue or green. The group of maps on the right have an represents flow towards the transducer, and blue flow away
additional colour along their right edge to depict variance from the transducer. Flow in the caudal vena cava (CVC) is
in Doppler shifts aliased (see text)
LV
LA
(A) (B)
Use of colour Doppler ultrasonography in a cat with a ventricular septal defect (VSD). (C)
(A) Two-dimensional grey-scale image obtained from a right intercostal window shows the
VSD as a focal lack of echoes in the interventricular septum (arrow). RV Right ventricle,
LV Left ventricle, LA Left atrium. (B) Corresponding colour Doppler image shows red-coded flow from the left ventricle towards the VSD that turns into
a multicoloured pattern through the VSD and in the right ventricle. The blue shades indicate aliasing; in other words, the blood flow velocity exceeds the
Nyquist limit (0·64 m/second) and so cannot be correctly depicted by the colour map. (C) Continuous wave Doppler spectrum obtained using the colour
Doppler image as a guide. Peak blood flow velocity through the VSD exceeds 5·5 m/second. This is a more accurate assessment of flow velocity than was
possible using the colour Doppler image. Turbulent flow is indicated by simultaneous negative Doppler shifts (curved arrow)
Aliasing in colour Doppler. Just as described for pulsed wave Doppler, any flow velocities that exceed the Nyquist limit will be displayed on the wrong side
of the baseline. (A) Colour Doppler image of the carotid artery in which the velocity range is too low (0·029 m/second) and the signal is aliased, appearing as
a mixture of colours with red, white and blue merging. (B) The velocity range has been increased (0·69 m/second) and aliasing has been eliminated, so that
the flow appears correctly (ie, is unidirectional); however, the velocity range is now too high and lower velocity flow is not displayed, resulting in a lack of
signal from the margins of the vessel lumen. (C) Correctly adjusted velocity range (0·23 m/second). Doppler signal fills the vessel and there is minimal
aliasing
Example of power Doppler imaging in the common carotid SUMMARY OF DOPPLER TECHNIQUES
artery. (A) This image includes no directional information
but shows a single continuous colour-flow signal even Continuous wave Pulsed wave Colour Doppler Power Doppler
where flow is perpendicular to the ultrasound beam.
(B) Although power Doppler is more sensitive to flow at Quantitative assessment ++ + + –
wide angles of insonation, it is nevertheless based on the of blood flow
same Doppler shift principle as other Doppler techniques.
Increasing the scale to 0·30 (from 0·075 in A) results in a Global view of blood flow – – ++ ++
reduced signal where flow is perpendicular to the within an organ
ultrasound beam
– Not used, + Moderately useful, ++ Optimal method