University of Zagreb

Faculty of Electrical Engineering and Computing

Biomedical Instrumentation
Medical applications of ultrasound

prof.dr.sc. Ratko Magjarević

 Ultrasound
• Physical Principles of Ultrasound
• Ultrasound (as well as sound) is mechanical vibration of
particles of the medium through which it extends
• The frequency domain we consider ultrasound is above
the auditory area, i.e. over about 20 kHz

• Physical Principles of Ultrasound in Medicine

• Ultrasound Diagnostics - Ultrasonography:
• pulse ehoscopes for obtaining layered images of the interior of
the body
• devices based on the Doppler principle for measuring and
displaying movement of body structures
• In medical diagnostics, ultrasound frequencies used ar in span
from 1MHz to 18MHz
• Ultrasound Treatment and Therapy
• breaking of kidney and urethral stones - Shock Wave Lithotripsy
• deep tissue warming
2
 Ultrasound imaging: development of a pregnancy

24 weeks

8 weeks gestation (out of a 40 week pregnancy)

18 weeks
 Ultrasound imaging: foetus feet

This is a 2D ultrasound scan We can process the image in a

through the foot of a foetus. You computer to find the outline of the
can see some of the bones of the foot. This is called surface
foot. rendering. Here, the foot has been
surface rendered
Ultrasound imaging: more surface rendering
Ultrasound imaging: imaging the heart

atrium

heart valves

ventricle
2D ultrasound images
US imaging of the heart in real time
US including Doppler measurement of blood flow
Doppler measurement of heart muscle movements
 Ultrasound propagation
➢ Mechanical displacement of particles of the media may be
described by the equation
combining displacement s of a particle induced by ultrasound
propagating through the media at velocity c and at the
distance x from the position where US entered the media
and at the instantaneous time t from the moment US
entered the media, where ω is the US frequency
Matter Velocity c (m/s)
 x
s  A  sin   t   Water 1480
 c Air (normal pressure) 331
Plexiglass 2680
Aluminium 6400
Muscles 1585
Blood 1570
Bones of the skull 4080
Brain 1541
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 Ultrasound propagation
➢ The velocity v of the particle
ds
v  A    cos   t
dt
➢ i.e. the displacement velocity of the particle
is lower that the velocity of US along the
directin x.
➢ The motion of the particles is longitudinal
(in nthe direction of US wave propagation).
➢ Transverse oscillations are considered
negligible.
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Ultrasound propagation

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 Ultrasound propagation
➢ Local density   x 
  0  m sin   t     
  c 
➢ Local pressure   x 
p  p0  P  sin   t     
  c 

➢ where ρo is mean
density, and po mean
pressure
➢ Δρm is the maximal
change in density, ΔP
maximal change in
pressure caused by US

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US interaction with tissue

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 US interaction with tissue
➢ Scattering

16
 US interaction with tissue
➢ Refraction and Reflection

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 Acoustic Impedance
Matter
➢ Acoustic impedance is the
Air (normal 0.0004
resistance to sound wave
conditions)
propogation. The denser the
Water 1.48
material, the larger is the
Aluminium 17.4
acoustic impedance
Steel 45.7
Muscles (middle 1.70
➢ Acoustic impedance of tissue type)
Blood 1.61
P  Ns kg  Bones of the 7.80
Za    c  m3  m 2 s  skull
v
Brain 1.58
Fat 1.38
Kidney 1.62
Liver 1.65
Aorta 1.69
Lung 0.18
 Reflection coeficient
➢ at the boundary of the media (internal organs), a part of the emitted
energy is transmitted to the second layer, and a part of the energy is
reflected (back to the US transducer)
➢ Reflection coeficient R is defined as:
2
I R  Z1  Z 2 
R  
I1  Z1  Z 2 
Ultrasound intensity I is defined as
ultrasound energy E that passes
through volume A in a time unit t

E W 
I  m3 
At

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 Transmission coeficient
➢ Transmission coeficient T is defined as:
IT 4 Z1Z 2
T 
I1  Z1  Z 2 2

where
T  R 1

➢ Considering transmission and reflection in terms of pressure, the

coeficients are defined as:
pR Z 2  Z1
R*  
p Z1  Z 2
pT 2 Z1
T 
*

p Z1  Z 2

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 Example:
➢ Reflection coeficient at the boundary Matter
between muscle (mi) and fat (ma) tissue: Air (normal 0.0004
conditions)
2
 
2
IR Z mi  Z ma  1, 7  1,38  Water 1.48
R      0, 01
I1  Z mi  Z ma   1, 7  1,38  Aluminium 17.4
Steel 45.7
and between bone (ko) and soft tissue (mt): Muscles (middle 1.70
2 type)
I R  Z ko  Z mt   7,8  1, 7 
2

R      0, 42 Blood 1.61
I1  Z ko  Z mt   7,8  1, 7 
Bones of the 7.80
skull
Brain 1.58
Fat 1.38
Kidney 1.62
Liver 1.65
Aorta 1.69
Lung 0.18
 Attenuation in tissue
➢ US intensity by passing through the homogeneous substance (tissue) is
reduced by the exponential law :
I  I 0e x
The reflected intensity of US equals
I2
 R  e   d
I0
where a is the attenuation coeficient
which is different for different tissue

a is also frequency dependnet:

fn
where the value of n for biological tissue equels between 1 and 1.2

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 Attenuation in tissue
The transducer ha the function of transmitter
and receiver of US waves
 US divergence
➢ The angle of divergence of the US wave equals
  
  arcsin  0, 61   0, 61 za  << D
 D D

where D=2R, R is the radius of the transducer plate

➢ Compromise in design: D /   

25
 US resolution
➢ Resolution depends on:
c
• Diameter of the US beam (d) d  
f
• Wavelength of US()
m
➢ Npr. c  1500
s
f  2 MHz
 d  0, 75 mm

➢ Lower frequency (larger organs, larger depth, smaller

resolution)
➢ High frequency (smaller organs)  larger attenuation
• gynecology  deep  LF 2-5 MHz
• Tyroid gland, brain, brest  middle size  5-8 MHz
• oftalmology  shallow  HF 5-10 MHz
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 Discussion
➢ Is US biopsy possible?
• Think of US physical properties!
• What is the size of a typical human cell?
 Discussion
➢ Is US biopsy possible?
• Think of US physical properties!
• What is the size of a typical human cell?
 US transducers - sensors
➢ Reflected US causes pressure ΔP at the surface of
the US transducer/sensor

➢ v is particle velocity,
➢ ρo average density,
➢ c US velocity
➢ The pressure change causes vibration of the US
sensor (having the capacity C) and induces charge
q
q  u C

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 US transducers
➢ piezoelectric
(do 1GHz)
➢ Magnetostrictive (10-100kHz)
➢ Materials:
• Crystals
• Quartz
• Lithium niobate
• Amorphous materials:
• Microcrystal struktures
• Ceramics

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Quartz crystal

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 US transducers - principle

q  d x  Fx u d x Fx
Ex    g  x
S  0  S
'
C  0  ' 
  x 0  ' 1
d d    Fx   Ex  Ex
u  x Fx  x  0 Em d x  Em h
C 0   S

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 US transducers
➢ Equivalent circuit
➢ Quality factor
RP  L
Q 
 L RS

➢ Resonant frequency
c
f0 
2

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 US transducer
➢ Single sensor & US lens

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 A mode (obsolite)
➢ Propagation through the scull and brain, in oftalmology:

A  A0  e
k1u p

 A0  e k1k2t
AI r  A0 I0 R  konst.

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 Exponentila amplifier
➢ With diodes

➢ With MOSFET

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 B mode
Darkness

Brightness

Brightn ess

Brightness or B-mode is obtained by physically moving the scan line to

a number of adjacent locations. The transducer is moved in steps
mechanically across the medium to be imaged. Typically 100 to 300
steps are used, with a spacing between 0.25λ and 5λ. At each step, a
short pulse is emitted followed by a period of passive registration of
the echo. In order to prevent mixing the echoes from different scan
lines, the registration period has to be long enough to allow all echoes
from a given emitted pulse to be received. 37
 Medical US diagnostic device
➢ Block diagram

38
 Medical US diagnostic device
➢ Block diagram

39
 Medical US diagnostic device
➢ Block diagram

40
US imaging devices
➢ Bedside US device

41
US imaging devices
➢ Handheld or point-of-care
ultrasound imaging device

➢ Ultrasoundprobe compatible
with smart phone

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 US probes

( a ) A single element US probe with its components. ( b ) A linear array transducer

with indication of a line of view and the three directions corresponding to axial ( X ),
elevational ( Y ) and lateral ( Z ) US beam dimensions from a single acoustic
aperture. ( c ) The field of view of a linear probe; a single line of view (A-mode) is
highlighted and the scanning direction is indicated by an arrow. ( d ) A curvilinear
probe with the field of view divided in its lines of view.

From: Basics of Ultrasound Imaging, 2015, doi:10.1088/0031-9155/60/3/R77

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 US probe crossection

Generation of the
ultrasound wave:

Alternating current applied

to the piezoelectric crystal
causes vibrations
(oscillations) of the crystal,
which in turn, generates US
waves directed to the
material/tissue under
investigation

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US probes

45
US probes

46
 US probe with linear array

From 64 to several Crossection a – a’

hunderd transducers Transducer

US lens
Side view

US lens

47
 Electronic focusing
Transducers
Variable Variable Transducers
delay delay

Transversal shift

Focus

49
 B mode images
➢ US image of abdomen

50
B mode images
Images
obtained with
curvilinear
probe and
with linear
array
transducer

51
 M – mode images
➢ US of the heart

52
M – mode images

53
M – mode images

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Color Doppler images

58
Color Doppler images

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 Conclusions
• Continuously improving image quality =>increased clinical use
• Relatively inexpensive compared to CT and MR – 25% of all
imaging exams in hospitals is US
• Many clinical applications
Soft tissues (fetal, liver, kidneys)
Dynamics of blood flow (heart, circulatory system)

• Requires training and skill

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 US Lithotripsy
• electrohydraulic shock-wave lithotripsy (EHL) -
a shockwave is generated immediately
adjacent to a urolith within the urinary bladder
• extracorporeal shock-wave lithotripsy (ESWL) -
the shock-waves are generated outside the
body and directed toward the urolith
•

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 US Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL)
A nonsurgical technique for treating stones in the bladder,
urethra, kidney, or gallbladder using high-energy US shock
waves generated extracorporealy.
The shock waves, which are generated by a lithotripter, are
focused by x-ray onto the kidney stone. Stones are broken into
"stone dust" or fragments that are small enough to pass in
urine.
Stones that are smaller than 2 cm in diameter are the best size
for SWL. The treatment might not be effective in very large
ones.
Introduced clinically in 1980s.

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 Lithotripter
Extracorporeal shock-wave lithotripsy.
Electrically generated shock waves can
fracture renal calculi. From Polaski and
Tatro, 1996.
The technique is based on the
principle that shock waves are not
destructive until they reach a
surface in which there is a change in
acoustical impedance, which is a
form of resistance to the passage of
sound waves. The impedance of
calculi is different from that of
water, bone, and soft tissue;
therefore, tissue through which the
wave travels as well as tissues
surrounding the stone are not
harmed.
Adopted from: Miller-Keane Encyclopedia and Dictionary of
Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by
Saunders, an imprint of Elsevier, Inc.
63
 Lithotripter ESWL

From: Matula TJ et al:

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 Electrohydraulic Lithotripsy (EHL)
Adopted from: Miller-Keane Encyclopedia and
Dictionary of Medicine, Nursing, and Allied
Health, Seventh Edition. © 2003 by Saunders, an
imprint of Elsevier, Inc.
Cavitation is formation of vapour bubbles
within a liquid at low-pressure regions that
occur in places where the liquid has been
accelerated to high velocities, as in the
operation of centrifugal pumps, water
turbines, and marine propellers.
The cavities form when the pressure of the
liquid has been reduced to its vapour
pressure; they expand as the pressure is
further reduced along with the flow and
suddenly collapse when they reach regions
of higher pressure. The sudden growth and
collapse of these vapour cavities cause the
extreme pressures that pit the surfaces
exposed to the cavitating liquid.

Percutaneous ultrasonic lithotripsy (PUL) surgical removal of kidney stones via an incision and insertion of a
nephroscope into the portion of the kidney where the stone is lodged.
An attempt is first made to remove the calculus through the endoscope by basket or forceps.
If this is not successful, an ultrasonic lithotrite that sends out high-frequency sound waves is used to break
up the stone.
A continuous saline irrigation flushes out the particles, which are removed by suction.
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 Literatura:
➢ Šantić, A., “Biomedicinska elektronika”,
Školska knjiga, Zagreb, 1995
➢ Breyer, B., “Medicinski dijagnostički
ultrazvuk”, Školska knjiga, Zagreb, 1991
➢ Brown, BH., Smallwood, RH., et al.,
“Medical Physics and Biomedical
Engineering, IoP Press, Bristol, 1999
➢ Chaussy, C. et al, „Extracorporeal Shock
Wave Lithotripsy in a Nutshell”, Dornier
MedTech Europe GmbH, 2015
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