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Definition of Ultrasound
ultrasound is sound with frequency greater than 20,000 cycles per second or 20kHz.
Audible sound sensed by the human ear are in the range of 20Hz to 20kHz.
Advantages
Ultrasound can be directed as a beam.
Ultrasound obeys the laws of reflection and refraction.
Ultrasound is reflected by objects of small size.
Disadvantages
Ultrasound propagates poorly through a gaseous medium.
The amount of ultrasound reflected depends on the acoustic mismatch.
• The sound waves are emitted from the crystal similar to sound waves being
emitted from a loud speaker. The frequencies emitted are in the range of (2- 15MHz) and
are unable to be heard by the human ear. Several crystals are arranged together to form a
transducer. It is from the transducer that sound waves propagate through tissue to be
reflected and returned as echoes back to the transducer.
• Sound is produced using Piezoelectricity which is the ability of some materials
(notably crystals and certain ceramics) to generate an electric charge in response to
applied mechanical stress, the reverse applies when
• The word is derived from the piezoelectric effect is reversible in that materials
exhibiting the direct piezoelectric effectconverse piezoelectric effect (the production of
stress and/or crystals will exhibit a maximum shape change of about 0.1% of the original
dimension.
• Precise electrical pulses from the ultrasound machine make the transducer create
sound waves at the desired frequency. The sound is focused either by the shape of the
transducer (Curved, Linear, Sector) or a set of control pulses from the ultrasound
machine. This focusing produces the desired shaped sound wave from the face of the
transducer. The wave travels into the body and comes into focus at a desired depth.
Apparatus
Scanner types
For abdominal ultrasound curved type scanners are used as the best
compromise of two other standard type probes the linear and
the sector scanner.
Linear - the linear array scanners produce sound waves parrallel to each other
and produces a rectangular image. The width of the image and number of scan
lines are the same at all tissue levels. This has the advantage of good near field
resolution. Often used with high frequencies ie 7MHz. Can be used for viewing
surface texture of the liver. There disadvantage is artifacts when applied to a
curved part of the body creating air gaps between skin and transducer.
Sector/Vector - Produces a fan like image that is narrow near the transducer
and increase in width with deeper penetration. It is useful when scanning
between the ribs as it fits in the intercostal space. The disadvantge is poor near
field resolution.
Curved - Often with frequencies of 2 - 5 MHz (to allow for a range of patients
from obese to slender). It is a compromise of the Linear and Sector scanners.
The density of the scan lines decreases with increasing distance from the
transducer. Can be difficult to use in curved regions of the body eg. the spleen
behind the left costal margin.
3D Transducers
Matrix Transducer
Controls
Ultrasound machines have a large array of options and features. The basic
controls that you need to familiarize yourself in the early stages of learning are
Trackball - used for moving objects on the monitor (similar to using a mouse on
the PC), it is used in conjunction with measuring, annotating, moving Res/Dopler
boxes to the desired location. It has kidney buttons either side which are used to
select functions (the same as clicking buttons on a mouse for the PC).
Freeze - This allows the image to be held (frozen) on the screen. While the
image is frozen measurements can then be taken and organ annotations can be
applied to the image before saving it.
Res or Zoom - This will allow magnification of areas of the ultrasound picture.
Looking at Res/Zoomed areas of interest has the advantage of a more detailed
view with the drawback of less anatomy visible to guide your movements.
Gain - This function is very similar to a brightness control. The echo signal
returning to the body is converted into an electronic signal by the transducer.
This electronic signal has to be amplified to produce images on the monitor. This
signal amplification is called Gain and will regulate the strength of the echo’s
being received.
Depth/F.O.V. Control- Varying the depth of the F.O.V. varies the write zoom and
therefore the number of pixels per cm and spatial resolution potential of the system.
It is important not to use excessively large F.O.V’s that reduce spatial resolution
achievable but also not to ‘clip’ the F.O.V. too tightly around the region of interest
such that relationships with other structures are not shown.
Gain- Refers to the degree of amplification applied to all returning signals. If set too
low there will be underwriting of the image and real echo will be lost from the display.
If set too high there will be overwriting of the display with artefactual noise introduced
and also a reduction in contrast resolution as all echoes get progressively brighter.
Power or Output Control- This controls the strength of the voltage spike applied to
the crystal at pulse emission. Increasing power output increases the intensity of the
beam and therefore the strength of echo return to the transducer. i.e. increases
signal to noise ration (SNR). However it also increases the patients ultrasound dose.
It is best practice to operate on minimum power and maximum gain, remembering
though that no amount of gain can compensate for insufficient power. The obvious
alternative to increasing power output if ‘dropout’ artefact is encountered at depth is
to use a lower frequency transducer.
Dynamic Range- Refers to the range of echoes processed and displayed by the
system, from strongest to weakest. The strongest echoes received are those from
the ‘main bang’ and transducer-skin interface and they will always be of similar
strength. As DR is reduced therefore it is the echoes at the weaker end of the
spectrum that will be lost. DR can be considered as a variable threshold of writing for
weaker signals. For general imaging the DR should be kept at its maximum level to
maximise contrast resolution potential. However in situations where low-level noise
or artefacts degrade image quality the DR can be reduced to partially eliminate these
appearances.
Focal Zones- Throughout the scan the sonographer should constantly check the
position of the focal zone(s) and ensure they are at the depth of interest. Multiple
focal zones can be used to maximise lateral resolution over depth if motion is not
encountered, but it is important to minimise the focal zones used when assessing
moving structures i.e. a fetal heart.
Artefacts
-Frequency
-Format/F.O.V
-Footprint
-Frame Rate
-Focal Characteristic
-Functional Aspects
Frequency- It is best to use the maximum frequency possible to image the region of
interest, allowing for adequate penetration to this depth and thus avoiding ‘dropout’
artefact. There are several reasons for this, increasing frequency will; improve axial
resolution, produce a better beam shape (longer near field) and increase the return
from non-specular interfaces. Transducer frequencies common today are 5-15MHz
for superficial work and 2-7MHz for deeper areas.
Format- The depth of interest also influences the decision on transducer format
used. Linear arrays with their rectangular field of view ( F.O.V.) provide the widest
superficial F.O.V and best spatial resolution in the superficial zone. However when
imaging to depth a transducer with a radiating scan format is needed to give a useful
width to the F.O.V with depth. i.e. Convex, Phased and Annular arrays all have this
radiating scan format. Convex arrays are the most common today.
Footprint- This refers to the area of the transducer face that contacts the patient.
Footprint becomes significant when access is limited (i.e. between ribs or through
cranial fontanelle). In these situations phased and annular arrays provide the
smallest footprint. In contrast the wide footprint linear and convex arrays provide
superior superficial imaging but can be more difficult to keep in complete contact
with the skin.
Frame Rate- This refers to how many times a second the image is updated. The
frame rate determines the temporal resolution potential of the system and therefore
is important when assessing moving interfaces. Cardiac ultrasound is a classic
example of a situation where frame rate is very important. Mechanical transducers
are generally unsuitable for this work because their frame rates are too slow.
Multiple focal zones are unheard of and the line densities used are much lower that
for general imaging.
Focal Characteristics- Most systems now allow a variable depth of focus by varying
the firing delays of the crystal elements across the array. It is important to keep the
focal zone(s) to the depth of interest.
Functional Aspects- Will you need to perform colour or PW doppler during the
examination and does the transducer have this capability. Not all transducers allow
biopsy guides to be attached and specialised transducers need to the used for
intracavity exams.