Ultrasound imaging and its applications in medicine

Before the application of ultrasound imaging in medicine in 1942 (History of Ultrasound

N.d.), the only way for a physician to look inside the patients body was to make an incision
or later, use X-ray imaging - an imaging technique that exposes the patient to radiation, and
does not show soft tissues very well. This makes diagnosing diseases concerning the
internal organs and structures of the human body very difficult, because physicians can only
make inferences of limited accuracy based on findings from the patients laboratory test
results, medical history and clinical presentations. High-risk procedures such as centesis
and catheterization had to be carried out blind as well, which greatly increases the risk for
life threatening complications.

The properties and behaviour of sound waves allows us to generate images of internal body
structures using ultrasonic beams. They are sound waves with a frequency of over 20,000
Hz - above our hearing range. As an ultrasound transducer is placed over a layer of thick
jelly on the patients skin, beams of ultrasound will penetrate the patients body and
encounter different tissues that differ in density, such as fats, muscles and bones. Seeing
that acoustic impedance is the amount of resistance an ultrasound beam will encounter as it
passes from one type of tissue to another, ultrasonic beams will be heavily refracted and
reflected as it penetrates the human body, especially when it passes through two tissues
with a great difference in density. This is because sound results from the vibration of
particles, and an increase in resistance of medium when beams passes through different
tissues means that the vibration of particles will be inhibited, thus slowed down and change
direction, and partially sent back. In addition, differences in acoustic impedance will cause
one sound wave to have multiple reflections (see Multiple Refraction, Pras N.d.). Upon
returning to the ultrasound transducer, reflected sound waves of different speed and
amplitudes from all directions will generate voltages of different intensities. On the computer
screen, stronger voltages generated by sound waves of greater amplitude will appear
brighter, thereby rendering a cross-sectional image of the complex structures under the
ultrasound transducer (see Conjuring an Image, Pras N.d.). (Pras N.d.)

Socially, the use of ultrasound imaging benefits the patient, the insurance company and the
physician. Generally, the ultrasound scan is more affordable for low-income patients and
insurance companies because it is at least $150 USD cheaper than the computerised
tomography scan (CT scan) and magnetic resonance imaging scan (MRI scan). Moreover,
because it involves no radiation exposure as well, the application of ultrasound imaging is
increasingly prevalent in developing countries such as Zambia and India, and has already
shown to reduce mortality and morbidity rate (Sippel, Stephanie et al. 2011). This is
especially true in Obstetrics and Gynecology, because it can help detect and enable the
management of preterm birth complications, intrapartum-related complications, and
congenital abnormalities (Ridley, Erik L. 2016). Ultrasound imaging is also useful in many
other medical specialties such as cardiology, trauma, and surgery. Unlike the CT scan or
MRI scan, the ultrasound scan machine is portable and generates images in real time. This
makes it possible for physician to assess and triage trauma patients in the field. The use of
ultrasound to guide delicate surgical procedures such as pericardiocentesis reduced the
mortality rate of the surgery to 6%, compared to the 20-50% without ultrasound (Nguyen,
Cam Tu et al. 2011, Kumar, Rajan et al. 2015). Ultimately, this poses significant social
advantage, as it improves procedural efficacy, safety and patient outcomes.

However, the accessibility of ultrasound imaging discussed in the previous paragraph gives
rise to the ethical issue of selective abortion. For example, in India, a country with deep
rooted historical preferences for male children, the ratio of females to males deteriorated
from 972:1000 to 927:1000 between year 1901 to 2006. Some studies contributes this
substantial change to the increasing availability of ultrasound imaging to the general public in
India. Rationales of these studies are generally that ultrasound imaging allow mothers-to-be
to determine their fetus gender, and therefore facilitates the decision of committing
gender-selective feticide, which is an alternative to infanticide - a common practice in India
that requires immense apathy. (Younger, Ashley N.d.). In addition, ultrasound imaging also
allow the detection of structural abnormalities in fetuses, which can suggest congenital
diseases such as Down syndrome. This leads the the ethical dilemma of allowing the
abortion of fetuses with birth defects. The aforementioned examples demonstrates the
controversial ethical implications of scientific innovation.

Overall, ultrasound imaging is a cheap, efficient and non-invasive means in making

diagnosis, monitor fetal growth and to guide surgical procedures. Nevertheless, like any
other scientific inventions and procedures, ultrasound imaging has its limitations.
Specifically, ultrasound imaging is prone to artifacts, mainly because ultrasound imaging
cannot achieve great penetration depth and high resolution at the same time. This is
because high resolution images requires ultrasonic beams of high frequency, since it
produces more reflection (see Composite Compression Pras). However, sound waves of
greater frequency attenuates faster because it collides with the particles in the tissues more
often, thus unable to be transmitted to deeper body structures. (Pras N.d.). As a result,
ultrasound images often provides ambiguous information, and can mislead physicians in
making a diagnosis. Recognition of artifacts and appropriate manipulation of ultrasound
imaging techniques should therefore be adopted to improve accuracy of interpretations and
image qualities.

In conclusion, ultrasound imaging operates based on basic properties and behaviours of

sound waves. It is an affordable,efficient and non-invasive technique that allow physicians to
look inside the patients body in real time, and its application in medicine known to reduce
mortality and morbidity rate. However, its potential misuse as a method to determine the
gender of fetuses is strongly correlated to an increase in feticide in India. Technically,
ultrasound imaging is also prone to artifacts, leading to misdiagnosis. Just as any technology
or scientific discoveries, whether it is doing good or harm depends on the person using it.
This calls for a cautious contemplation on the pros and cons over any application of scientific
advancement.
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Diagrams

Conjuring an image

Multiple Refraction
Attenuation

Composite Compression
Frequency and Image Resolution