Table of Contents

Ultrasound basics-.............................................................................................................2
Fundamentals............................................................................................................................2
Ultrasound Wave........................................................................................................................2
Speed of ultrasound...................................................................................................................3
Piezoelectric materials................................................................................................................4
Piezoelectric effect.....................................................................................................................4
Generation of ultrasound waves.................................................................................................5
Frequency Content of pulses......................................................................................................6
Interactions between ultrasound and surfaces............................................................................7
Loss of ultrasound energy in tissue.............................................................................................9
Producing an ultrasound image..................................................................................................9
Amplification of Received Echos...............................................................................................10
Transducer Designs and Beam Forming.....................................................................................10
Phased Array Transducer..........................................................................................................11
Focusing the Beam...................................................................................................................11
Image Resolution......................................................................................................................11
Tissue harmonic Imaging..........................................................................................................11
Doppler Ultrasound..........................................................................................................12
Ultrasound basics-

Fundamentals
 Ultrasound is a sound wave that is above the audible limit for humans
 It is produced at >20kHz which is above the audible spectrum of sound
 Ultrasound are mechanical pressure waves that propagate through a medium with a
high frequency.
 Sounds needs a medium to travel through (unlike light)

Ultrasound Wave
 Ultrasound is a wave
 In physics, there are two principals of a wave: A cycle and a period
 A cycle is the length of one positive and one negative deflection of the wave
 A period is the length of time to complete one cycle (represented by the symbol T)

 Frequency (represented by the symbol ) is the number of cycles per second (also
known as Hertz, Hz). 1 Hertz is one complete cycle per second.
 Frequency is calculated by 1/period (= 1/T) as it is the number of periods passing
through a point in 1 second.
  Amplitude is the peak (power) of the wave.
 Wavelength is the distance between two points on the curve. This is NOT period.
Period is the time between the two points on the curve. Wavelength is represented
by lambda (λ).

 There is a large range of frequencies of sounds. Humans can only hear from 20Hzz to
2kHz sounds, however clinical ultrasound uses frequencies in the range oef 2MHz to
15Mhz (higher than we can hear)
 A high frequency (more cycles per second) gives us a high resolution, however we are
unable to penetrate as deep
 A low frequency (less cycles per second) gives us less resolution but allows for
deeper images.

Speed of ultrasound
 Sound travels through various media at different speeds (ie- sound travels through
water quicker than through air).
 The speed of sound is noted by ‘c’
 The speed of sound = frequency x wavelength (c= λ), it is measured in meters per
second (m/s)
 The speed of sound depends on the density and compressibility of the material.
 The more dense and more compressible, the slower the wave will travel. The less
dense and less compressible, the faster it will travel.
 The speed of sound is different from different tissues in the body. Knowledge of the
speed of sound is needed to determine how far an ultrasound wave has travelled.
 In ultrasound machine, the assumption is made that the speed of sound is the same
in all tissues= 1540m/s

Piezoelectric materials

 Piezoelectric materials
 A crystal is any solid with atoms or molecules that are arranged in a very orderly way
based on repetitions of the same basic atomic building block (the unit cell). In most
crystals (such as in metals), the unit cell is symmetrical.
 In Piezoelectric materials, they are not symmetrically ordered.
  The atom arrangement may not be symmetrical, but the electrical charges are
perfectly balanced: a positive charge in one place cancels out a negative charge
nearby
 Stretching or squeezing a piezoelectric crystal deforms the structure, pushing some
of the atoms closer together or further apart. This upsets the balance of positive and
negative, and causes net electrical charges to appear.
 The most common piezoelectric material is quartz. Lead zirconate titanate is usually
used in ultrasounds.

Piezoelectric effect

The piezoelectric effect refers to a change in electric polarization that is

produced in certain materials when they are subjected to mechanical stresses.

 The piezoelectric effect occurs when a piezoelectric material produces electricity. It

occurs when there is a conversion of kinetic or mechanical energy due to crystal
deformation, which turns into electrical energy.
 Piezoelectric materials are those that can produce electricity due to mechanical
stress.
 When materials are placed under mechanical stress, there is a shift in the positive
and negative charge centers of the materials. This rapid mechanical stress causes an
external electric field.
 The inverse piezoelectric effect is when an external electrical current causes a
physical deformation in the material.
 In 1880 Jacques and Pierre Curie discovered that pressure generates electrical
charges in certain types of crystals such as quartz and tourmaline. They called this
phenomenon the "piezoelectric effect". The word "piezo" is derived from the Greek
word ‘piezein’, which means to squeeze or press.
  If we think about a hexagon of a quarts crystal, there are positively charged silicon
and negatively charged oxygen.
 If a force is applied onto the crystal, one of the crystal becomes more positive and
the other becomes more negative
 If a force is applied in a different direction, the positive and negative ends invert.
 If this happens in rapid succession, you create an alternating electric field and
therefore alternating current.
 When SOUND WAVES hit the crystal, it causes it to vibrate and move back and forth
 thereby creating an alternating current.
 This is how mechanical energy is transformed into electrical energy.
 Alternatively, if we apply an alternating current to the crystal, it will cause the lattice
to move back and forth, thereby creating mechanical energy (and hence sound
waves).
 In ultrasound, application of an electric field to the crystals in the transducer will
create sound waves in extremely high frequency.
 In order to ‘mechanically’ change the crystal or have a change in mechanical
structure to create an electrical wave, it is hit with sounds waves. These sound waves
distort the crysal, create polarity in the crystal and thereby an alternating force.

Good Youtube video: https://www.youtube.com/watch?v=v1enr8PIMOw

Generation of ultrasound waves

 A transducer is a device that converts one form of energy into another.

 In an ultrasound, conversion is from electrical energy into mechanical vibration and
vice versa.
 The piezoelectric effect is the methods by which most ultrasound is created (see
above)
 The piezoelectric effect is the ability of certain materials to generate an electric
change in response to applied mechanical stress
 They are used to create sound waves of extremely high frequencies (in the millions of
Hz).
 The frequency of the voltage applied will affect the frequency with which the
piezoelectric material vibrates. The thickness of the piezoelectric element will
determine the frequency at which the element will vibrate most efficiently.
 A voltage is applied to the piezoelectric material at a specific frequency. When gel is
used the vibrations are transmitted into a surrounding medium (such as the body).
The returning ultrasound vibrations are converted into electrical signals which are
then amplified, analysed and displayed to provide anatomical images.
 Electrical pulses  Sound Waves (mechanical energy)  Electrical Energy
  Modern transducers operate over a range (eg 3-9 MHz). A broad-band and narrow
band transducer wil individually be useful. A broad band transducer is more efficient
over a wider rrange of frequencies, a narrow band transducer is not.
 The active element, which is often referred to informally as the crystal, is protected
from damage by a wearplate or acoustic lens, and backed by a block of damping
material that quiets the transducer after the sound pulse has been generated. This
ultrasonic subassembly is mounted in a case with appropriate electrical connections.

THERE ARE THREE TYPES OF ULTRASOUND: B-MODE, COLOUR FLOW, PULSED WAVE
DOPPLER

Pulsed ultrasound
- All ultrasound is pulsed doppler.
- This is because it is was continuous, the ultrasound would be continuously transmitted
along a path and the energy (sound waves) will be continuous reflected back from the
boundary in the path of the beam it is impossible to see where the returning echos
have come from
- When we pulse a eave, we are able to predict where is has come from due to this
formula: d=tc/2

- d= tc/2
- d= distance
- t= time between transmission and reception of the pulse
- c= velocity of the ultrasound along the path

- The division of 2 is due to the pulsed wave travelling along the path twice.
- From this equation, you can determine the distance and therefore what it is reflecting.

Frequency Content of pulses

- The pulses used in imaging ultrasound are very short and only contain 1-3 cycles (a
positive and negative reflection is a cycle).
- This is so that reflection from boundaries of different tissues that are close together can
be separated and visualised more easily.
- Pulsed doppler signals are longer and contain several cycles with a RANGE OF
FREQUENCIES of different AMPLITUDE.
- Different shaped pulses will have different frequency contents (it is made up of multiple
different frequencies).

Beam Shape
- The shape of the ultrasound beam produced by a transduceder will depend of the
1. shape of the element
2. if the beam is focussed.

Interactions between ultrasound and surfaces

- The creation of an ultrasound image depends on how it interacts with the tissue as it
passes through the body.
- When the ultrasound meets the interface (part) between two different media (or tissues
in the body) some of the energy is reflected back.
- The proportion of the energy reflected and transmitted depends on the change in the
acoustic impedence of a medium.
- The great the impedance of a medium, the more of the ultrasounds that are reflected
back
- Eg- there is a large difference between soft tissue and bone with regards to acoustic
impedence. Therefore, there will be a lot of reflection of the waves back from the bone.
- For this reason, if is impossible to image below bones too much of the ultrasound
waves are reflected back and you can’t see what is beneath.
- Sound waves can’t be transmitted through gas, therefore there is acoustic shadowing
beyond on images.

- The path back to transducer will also affect the amplitude of the signal.
- If the transducer is perpendicular to the thing it is imaging, more rays will bounce
directly back and there will be more
- If the probe is at 60 degrees, less will be reflected back, but off away from the probe.
- This is why the best image of an interface is what the inferface is at right angels to the
beam. The poorest images are when interface is parallel to the beam.
- When an artery is imaged in transverse section, the anterior and posterior walls
Loss of ultrasound energy in tissue
- Attenuation of the loss of energy from the ultrasound beam as it passes through tissue.
- The more the ultrasound energy is attenuated by the tissue, the less energy will be
available to return to the probe
- Attenuation is caused by. Several different processes: absorption, scattering, reflection,
and beam divergence.
- Absorption causes ultrasound energy to be converted into heat. The rate of absorption
varies in different tissue types
- Ultrasound energy can also be lost by scattering from small structures within the tissue
or reflection from large boundaries that are not perpendicular to the beam, preventing
the ultrasound from returning to the transducer
- The rate of attenuation depends on the frequency of the ultrasound
- The higher the frequency, the more quickly they are attenuated when comparted to
lower frequencies.
- This is why higher frequencies penetrate tissue less effectively than lower frequency
ultrasound.
- The rate of attenuation per unit distance is called the attenuation coefficient
(decibels/centimeter)
- It depends on both the medium at the sound frequency.
- Attenuation is high for muscle and skin, intermediate for larger organs such as liver and
very low for fluids.

Producing an ultrasound image

- There is an assumption tha the ultrasound waves travel through tissue at a constant
speed.
- Based upon this, it is possible to predict the distance from a reflective boundary or
scattering particle.
- When an ultrasound returns to the transducer, it will cause the transducer to vibrate and
this will generate a voltage across the piezoelectric element.
- The amplitude of the returning pulse will depend on the proportion of the ultrasound
reflected back or scatterd back to the transducer.
- The amplitude of the pulse received back at the transducer can be displayed against
time. This delay is calibrated against time and the returning pulse represents the
distance of the boundary from the transducerthereby showing the depth of the
boundary in tissue.
- The varying amplitude of the signal can be displayed as a spot of varying brightness that
travels across the display with time. This is called a B-mode scan (Brightness Scan).
-
- If a second pulse is sent into the tissue along the same path the B scan generated by the
second pulse is displayed next to the first.

- This shows the time of travel of the pusles converted into distance.

Amplification of Received Echos

- There are two ways of increasing the amplitude of a returning signal: increase the output
power and increase the receiver gain.
- Increasing the voltage of the excitation pulse across the transducer will cause the
transducer to transmit a larger amplitude ultrasound pulse.
- However, increasing the output power will mean the patient is exposed to more
ultrasound energy. The alternative is to amplify the received signal- but there is a limit.
- The limit exists as the greater the amplitude of received signals, the greater the
background noise at some point you will get more background noise and worse
images.
- There is a method called Time Gain Compensation (TGC)- this allowed for the varying
gain over time. BY changing gain over time the retunring echos from the boundaries can
be displayed at similar brightness.

Transducer Designs and Beam Forming

Linear Array Transducers
- Most modern transducers are made up of 128 elements arranged in a row, around 4cm
long.
- When the wavelets are all excited simultaneously, the wavelets will interefere to produce
a beam that is perependicular to the transducer face.
- This produces a field of view which is the same at depath as it is lose to the transducer.
Curvilinear transducer
- A Curvilinear transducer is used for deeper imaging. As the paths diverge the image fans
out and the scan lines run more cloely in the proprtio of the image closer to the
 transducer (and are more spread out at depth- allowing for a larger field of view
compared with a linear array- hwoever the image does lose some of it’s quality at depth.
Phased Array Transducer
- Phased array transducers- these are used to manipulate the beam of the ultrasound
based upon excitation of the elements at different times.
- If the elements used to form the beam are excited at the slightly different times, the
wavefronts produced by the elements will interfere differently than they would if they
were excited at all the same time.

- This way you can steer the beam through a range of angles.
- Phased transducers use a smaller array of elements and steer the beam in this way to
produce a sector image. This produces a large field of view compared to the size of the
transducer (used for things such as echo).
- Compound imaging is when the target is isonated several times with the beam steered
at different angles and then these are combined to create a single image.

Focusing the Beam

- The focus of the beam is created via changing the focal length of the beam
Need to do more

Image Resolution

Tissue harmonic Imaging

Doppler Ultrasound

Doppler effect
- The Doppler effect is the change in the observed frequency due to the relative motion of
the source and the observer.
- It is why sounds are different from an ambulance coming to and from you
- If you and an object giving off doppler signals are static then the sounds are hitting you
at the same frequency
- However if you start to move towards the object, they are hitting you at a quicker pace
(a higher frequency, therefore a higher pitch)
- If you move away from the object, the wave forms will hit you less often and therefore
at a lower frequency (and therefore lower pitch)
- The change in observed frequency is the Doppler Effect
- It was first discovered in 1842 by Christian Doppler – an Austrian Physicist.
-

The haemodynamic of Vascular Disease -POLAK

 For blood flow to occur between two points, there must be an energy difference
between the two points.
 This difference is due to a blood pressure distance.
 The circulatory system generally consists of a high-pressure, high kinetic energy arterieal
reservoir, a large venous pool with low pressure and low kinetic energy.
 As blood flows throughout the circulatory ystem, energy is continuously lost because of
the friction between the layers of flwoing blood.
 Both pressure and kinetic energy decrease as the red cells transit from arterial to
venous. The blood flow is created by continuously pumping via the heart.
 Blood flow to all body tissues is adjusted according to tissue’s need at a particular time.
 The adjustments is accomplished by local alteration in the level of arterial and venous
constriction within a certain organ.
 Maintenance of arteries ensures distribution of blood floow.

Potential and kinetic energy

 The physical factors that govern how blood once ejected from the ehart dissipates as it
transits is due to four things: friction, resistance and the influence of laminar and
turbulent flow.
 These things are summarized by Bernoulli equation, Poiseulli’s law and Poiseuliie;s
equiation.

 Over straight blood vessels, the sum of kinetic (blood flow) and potential (blood
pressure) energy is constant.
 This is summarised by Bernoulli’s equation.
 If the artery lumen increases, kinetic energy is converted back into pressure and the
velocity decreases.
 However, if the lumen narrows, the potential energy is converted into kinetic energy.

Energy differences related to different body parts.

 There are large variations in the potential energy of blood due to difference in posture.
 Eg- pressure in feet is proportional to height fo column.

Energy Differences due to laminar flow

Poiseulle;s equation

Loss of laminar Flow patterns

 Change in blood flow velocity

 Alterations of blood flow profiles at curves, bifurcations
 Laminar flow doesn’t restore for quite sometime.
 Certain areas can have froward and backwards flow. The transition point where the
lamina has zero velocity is referred to as the site of boundary layer separation.
 Occurs at branch points
 Carotid an exmaples


 When VELOCITY INCREASES, PRESSURE DECREASES
 Boundary layer separation refers to the loss of laminar flow at a branch point. Associated
with formation of eddies and reversed blood flow.
 Turbulence occurs distal to a stenosis in a region where blood flow velocities are still
elevated.

Arterial Pressure Wave

 Amplitude and shape of arterial pressure depends on multiple facots: stroke volume,
time course and stiffness of walls.
 Increase in any of these factors increases the pulse amplitude,

Pressure Changes
 Large vessels have little loss of pressure energy by friction
 AMPLITUDE OF PRESSURE INCREASES as the wave travels distally.
 The pulsatile nature of the pressure waveform increases with vasoconstriction because
of increased wave reflection and decreases with vasodilatation in the small and
medium arteries of the limbs. The reverse occurs in the very small arteries, arterioles,
and capillaries: vasoconstriction reduces pulsatility while vasodilatation enhances
pulsatility.

Diagnostic Implications
 Brachial systolic pressure is close to aortic or femoral systolic pressures.
 Systolic pressure at the ankle exceed branchial pressure in normal subjected.
 Systolic pressure of digital arteries is lower than the systolic pressure proximal in the
forearm or ankle.

Effects of Arterial obstruction

Narrowing
 Narrowing has to be severe before changes are manifested.
 90% stenotic prior to distal change in distal blood pressure.
 IN iliac, carotid, renal and femoral arteries- stenosis level varies from 70 to 90%.
 Haemodynamic changes results from stenosis with regards to:
(1) the length and diameter of the narrowed segment; (2) the roughness of the
endothelial surface; (3) the degree of irregularity of the narrowing and its shape
(i.e., whether the narrowing is abrupt or gradual); (4) the ratio of the cross-
sectional area of the narrowed segment to that of the normal vessel; (5) the rate of
blood flow; (6) the peripheral resistance beyond the stenosis; and (7) the pressure
gradient between the arterial bed and the venous bed.

Pressure Changes
 Decrease in SBP is sensitive to mean pressure and amplitude.
 Dampening of pressure waveform, increased tim to peak and greater wisth of the
pressure wave at half amplitude can be dectected istal to stenosis.

Blood flow changes

 Arterial obstruction can lead to change in the distribution of available blood flow to
neighbouring regions
 Steal syndrome round the body

VENOUS Haemodynamics

A wave- atrial contraction at end of diastole

C wave- increase in pressure when the tricuspid valve is closed and bulges during isometric
ventricular contraction
V wave- fall in pressure when blood leaves the atria rapidly.

Two periods of increased venous flow: ventricular systole, after tricuspid valve opens and
blood rushes into ventricles.

Good Video

https://www.youtube.com/watch?v=9otb9X8hEeo

Effects of Respiration
 IN respiration, the volume in veins in thorax increases and pressure decreases due to
redcued intrathoracic pressure
 Expiration is opposite. Decreased venoous volume and increased pressure.
INSPIRATION- INREASES VOLUME
EXPIRATION- DECREASES VOLUME

This is reversed in the abdomen

INSPURATION- INCREASED PRESSURE< DECREASED VOLUME
EXPIRATION- INCREASED VOLUME>

IN upper extremities, it is different to lower extremities

UPPER LIMBS-->
INSPIRATION  INCERASED
EXPIRATION  DECREASED VNOUS

Principals and Instruments of Ultrasound

Speed of sound- 1540 m/s

Frequency and Wavelength- see above.

Wavelength= speed/frequency

Attenuation- sound beam slowly breaking up as it passes through tissue.

Reflection-
Scattering
Transucers- done previously

Doppler Principals
 Change in frequency between the source, reflector or the receiver is moving
 Doppler effect used for detecting and evaluating flow and tissue motion.

What are typuical doppler frequencies for blood flow? 122Hz= 1.3kHz.

Continuous wave doppler

constant waves being given off
Doesn’t vie depth discrimination
Records velocities along the pathway
Unable to localise where it is coming from.
Used in echo
Not really used in vascular US
Pulsed Doppler
Provides depth discrimination

Doppler Spectral Analysis

Aliasing in Pulsed Doppler

 Maximum frequency shift that can be measured with apulsed doppler is limited by the
depth of the soppler sample volume
 If exceed, aliasing.
 Sampling frequency is PRF
 Limit PRF to that sufficient time is available to collect the echoes from the one pulsing of
the transducer.
 TO stop aliasing- the smapling rate (PRF) must be at least TWICE the doppler frequency=
Nyguist limit.
 The PRF is lower than the Nyquise rate, you get aliasing. (PRF needs to be twice the
doppler frequency).

 Alaising is when high velocities are converted into reversed flow

Colour Doppler
 High grame rates reduce image quality because fewer acoustic linesa re used to form the
image.
 Firection of blood flow is indicated by the displayed colour
 Red towards and blue away
 Colour is relative to the ultrasound beam direction for each beam line forming the flow
image.

 Aliasing colour doppler is produced with multiple applications of doppler pulses

 Wraparound effect with apparent reversal of flow.
 Increasing PRF eliminates aliasing.

 POWER DOPPLER
Color displayer velocities relative to interrogating deam direction
 Power doppler ignores the velocity and simply estimates the strength of the doppler
signal detected from each location
 It depends on the concetration of blood cells moving in adirection and the velocity of
motion.

 It is not sensitive to relative flow direction

 Not affected by alisasing

 Depicts a value related to the strength of the Doppler signal.

Advantages
 More sensitive to low and weak flow states
 Angles on the doppler frequency are eliminated unless the angles becomes so close to
perpendicular that the doppler signals are below the flow detectability
 Aliasing doesn’t affect energy mode.

BLOOD FLOW PATTERNS

There is a section on interpreting the distribution of velocities - so good- read it. Page 57.

 Brightness of each pixel is proportionate to the relative number of blood cells with a
specific velocity at a specific moment int ime.
 The brightness of the pixel also shows the distribution of flow energy or pwer at each
moment in time.
Flow Direction
 Shown in relation to the spectrum baseline
 Flow towards transducer is dhown above the baseline and flow away is below baseline

Frequency shift to velocity

 The echos reflected show frequency shift information
 The velocity is in cm/s
 If the machine knows to doppler angle, it can compute the velocity
 It can then calculate the velocity from the frequency.
 Never greater than 60 degrees

Waveform Analysis
Pulsatility
 Waveform refers to the shape

 Low pulsaility have broad systolic peaks and forward flow throughout diastole.
 CAROTID,VERTEBRALS, RENAL AND COELIAC all have low pulsatility waveforms

 Moderate pulsatility doppler waveforms have appearance between ow and ghigh

 Tall and and sharp, but with forward flow throughout diastole. Common throughout EIA
and SMA.

 High pulsatility are tall, narrow, sharp systolic peaks and reversed or absent diastolic
flow.
 Extremity artery with sharp systolic peak followed by brief flow reversal and then
forward reversal. High resistance waveforms.

 High can convert to low resistance after vigorous exercise.

 You need to know the proper interpretation of pulsaitity in relation to vessel and
physiological status.

Acceleration
 Rapid acceleration in systole

Laminar and disturbed flow

 Blood flows orderly with blood in the centre of the vessel moving faster than the blood
at the periphery.
 Laminar- moves in parallel lines.
 Laminar flow- window under spectral window is clear.
 Disturbed flow- movement of blood cells is less uniform spectral broadening.
 Degree of broadening is proportionate to the severity of the flow disturbance

Volume flow
Obstruction
 Increased stenotic zone velocity
 First to be abnormal