WAVE AND SOUND

CHAPTER 3
 Sound & Ultrasound
• Sound is a vibration that is transmitted in a medium, that
can be heard by a human ear.
The human ear cannot hear below 20 Hz and the
frequencies below this are called “infra sounds”.
We cannot also hear frequencies that is above
20,000 Hz and this frequencies is known as
“ultrasound”.
Ultrasound is sound having a frequency greater
than 20,000 cycles per second, that is, sound above
the audible range.
Frequencies in the range of millions of cycles per
second are used for medical diagnostic purposes.
There are at least four advantages of ultrasound energy in
medical diagnostic imaging:
a) ultrasound can be directed in a beam
b) ultrasound obeys the laws of reflection and refraction
c) ultrasound energy is reflected off of small objects
d) ultrasound brings no injuries to health.
There are two principal disadvantages of ultrasound.
a) The energy propagates poorly through a gaseous
medium (ultrasound transducers must have airless
contact with the body during examinations).
b) Ultrasound images are relatively noisy, and have
poorer contrast than X-ray and MR modalities.
• Sound waves are also known as ‘Acoustic’ waves.
• Sound waves are an organized vibrations of the molecules of
a medium that is able to support the propagation of these
waves.
• Usually the vibrations are organized in a sinusoidal fashion
(figure 1)

Figure 1
• Sinusoidal sound wave is actually a series of areas of
compression and rarefactions.
• Sine wave with the peak (or the “hill”) representing the
pressure maximum, and the nadir (or the “valley”)
representing the pressure minimum.
• The combination of one compression and one
rarefaction represents one cycle.
• The distance between the peak of one compression to
the peak of the next is a wavelength.
• The wavelength λ (m) of the sound wave shown in
Figure 1 :
2

k
• The velocity c (m/s), or the speed at which sound
waves travel through a particular medium:


2f
c 
k k

where ω and f represent the frequency

(rad/s and Hz) of the energy delivered to the tissue.
 The speed of sound in the medium, phase velocity:
c  f

The frequency and wavelength are inversely related; the

higher the frequency, the shorter the wavelength.
 The speed of sound in a medium depends on the average
density, o (kg/m3) and the compressibility, K (m2/N) of
the material (or tissue in our case). The relationship is
given by:

1
c
o K
 It is convenient way to express relevant tissue
properties by using the characteristic (or acoustic)
impedance Z (kg/m2s), which is defined by

Z  oc
 Generation of Ultrasound Waves (Pressure
Waves)
• The use of ultrasound as a medical imaging modality
became practical with the development of small
piezoelectric crystal transducers.
• “Piezo” means pressure, so piezoelectric means that
pressure is generated when electrical energy is applied to
the crystal.

When electrical energy is

applied to the face of the
crystal, the shape of the
crystal changes (expand) as
a function of the polarity of
the applied electrical energy.
• As the crystal expands and contracts it produces
compressions and rarefactions, and corresponding
sound waves.

• Effect of high-frequency sinusoidal electrical stimulation

1) on piezoelectric crystal causing the crystal to vibrate
2) and produce a sinusoidal vibration
3) sent through the conducting medium (human
tissue).
 Receiving Ultrasound
Piezo electric crystals have another very useful property
that enables it to be also used for receiving ultrasound
waves.
When a piezo electric crystal is compressed, it generates a
voltage. This property is used to “listen” for the ultrasound
waves that return after striking objects.
When returning sound waves hit the piezo electric crystal,
it gets compressed. The crystal then generates a voltage
that corresponds to the intensity of the ultrasound wave
that hits it.
 The ultrasound machine
conveniently uses the same
piezo electric crystal to
transmit and to listen to
ultrasound waves.
 First the machine applies a
voltage to the crystal to
expand it and transmit.

• The ultrasound machine

then very quickly switches
to a listening mode by
monitoring the voltage
across the piezo electric
crystal.
• This transmit and receive
cycle is repeated very
rapidly.
• The above examples show only one crystal for
clarity. In reality, ultrasound probes are composed
of a large number of individual piezo electric
crystals.
• The information gathered from the crystals are
processed by a computer to display the images on
a screen.
• Air is the enemy of ultrasound. Ultrasound waves
tend to reflect strongly wherever air meets
biological tissue. If there is even a small bubble
between the probe and the patients skin, the
ultrasound waves will be reflected away instead of
penetrating the skin.
• Without the waves going into the patient, you will
not be able to get a descent image. Therefore, it is
absolutely vital to make sure that there are no air
bubbles between the probe and the skin of the
patient.
• Ultrasound travels very easily through liquids.
• For this reason, it is common to use a thick liquid ( jelly )
between the probe and the patients skin.
• The thick liquid helps to keep away air bubbles and
allows easy passage of the ultrasound waves.
 What Happens to The Ultrasound
Waves?

 Once the ultrasound enters the body, some of it returns

back to the probe to help the machine form a image and
the rest is lost.
 When ultrasound enters the body, some of it undergoes:
1)attenuation
2)refraction
3)reflection
 What Happens to The Ultrasound
Waves?

 When the ultrasound waves are attenuated, that is

when the body absorbs the ultrasound energy,
making the waves disappear. These waves don't
return to the probe and are therefore "wasted".
 The more the body tissues that the ultrasound
waves have to cross, the more attenuation the
waves suffer. That is one reason why it is more
difficult to image deeper structures.
• Attenuation is loss of energy, expressed as change in intensity, as the
energy travels through a medium.
• Ultrasound intensity is measured in watts per square centimeter.
• Decibels are used to express difference between ultrasound intensities.
For example, when ultrasound becomes one hundred times less
intense, the attenuation is -20 decibels (dB); when ultrasound is one
thousand times less intense, the attenuation is -30 dB.
• Rate of attenuation is called attenuation coefficient. For soft tissue,
the attenuation coefficient is half the frequency per cm.
For example, an 8 MHz signal will lose 4 dB per centimeter of travel.
Every substance, such as a nerves, muscles, or fat, has a unique
property called "acoustic impedance".
Acoustic impedance basically depends on the density of the
substance and the speed of ultrasound in that substance.
Substances with different acoustic impedances alter the course
of ultrasound waves in an important manner.

Z  oc
• Figure above shows what happens when an ultrasound wave (shown as
a red arrow in image above) tries to pass from one substance to
another substance with a different acoustic impedance.
1) Part of the ultrasound waves continues into the second substance, but
becomes slightly bent away from their original direction (pink arrow). The
bending away when ultrasound passes from one substance to another
substance with a different acoustic impedance is called refraction.

2) Part of the wave (shown as blue arrow in image below) is reflected back
to the probe .The amount reflected back depends on the difference of the
acoustic impedance between the two substances, more the difference,
more the reflection. Reflected waves are extremely important, since it is
only these waves that return back to the probe and provide information
for the machine to show an image.
• As the ultrasound wave crosses from one tissue to the next,
each with a different acoustic impedance, some of the wave is
reflected back at each crossing (two blue arrows in image
above).
• Therefore, multiple reflected waves return to the probe and the
machine uses this information to display an image showing the
different tissues.
• Irregular surfaced objects such as nerves scatter the
ultrasound waves in all directions.
• A small portion of the waves are reflected back to the probe
(shown as blue arrow in image above).
• This is called "scattered reflection".
If an object is large and smooth like a nerve blocking needle,
all the ultrasound wave is reflected back.
This is very useful since it helps us to clearly see needles when
performing ultrasound guided nerve blocks.
This mirror like reflection, where the waves are reflected back
mostly in one direction is officially called "specular reflection".
 Ultrasound Scanning Modes

 “Modes is referring to how an ultrasound probes can “look” at things.

A Mode Scanning (Amplitude mode)
The A mode is the simplest form of ultrasound imaging and is not
frequently used.
The ultrasound wave that comes out of the probe travels in a narrow
pencil like straight path.
One use of the A scan is to measure length. For an
example, ophthalmologists can use it to measure
the diameter of the eye ball.
Imagine that the red circle is the eye ball and you
want to measure the diameter of it.

The probe is placed on one end of the eye ball.

 An ultrasound wave is sent from
the probe and at the same
instance, a line from the left of the
screen starts to be drawn.
 This line moves horizontally
measuring time.

 As the wave reaches the first wall

of the eye, some of the ultrasound
is reflected back into the probe.
 The returned wave is recorded on
the line as a bump.
 The stronger is the returned wave,
higher the height of the bump.
 The height of the bump is called
Amplitude which is what the "A" of
"A scan" stands for.
 The ultrasound wave continues
further in the eye.

 The wave then meets the wall that

is furthest away.
 Again some of the ultrasound
wave is reflected back into the
probe and another bump is drawn.
The time difference between the first bump and the second bump
represents how long the ultrasound wave took to travel between the
two walls.
Longer the length, longer is the time difference. The speed of
ultrasound in the eye is known to be 1500 meters per second.
So if we know the time difference (the interval between the two
bumps), we can calculate how far the wave traveled between the two
walls of the eye, giving us the eyeball length.
 B Mode Scanning (Brightness mode)

The B scan mode is very similar to the A scan mode.

Just like the A scan, a wave of ultrasound is sent out in a pencil
like narrow path.
The horizontal line represents the time since the wave was
released.
Again using the eye ball as an example, the probe is placed on one
end.
When the wave meets the first wall, a part of the wave is reflected
back into the probe. Instead of a bump, the strength of the
returning wave is recorded by a bright dot.
The brightness of the dot represents the strength of the returning
wave.
The brighter the dot, the stronger is the returning wave.
The letter "B" of "B scan" represents Brightness.
 The wave continues.

 When the wave reaches the other

wall, part of it is reflected back into
the probe.
 This returning wave, like the
returning wave from the previous
wall, is represented as a bright dot
on the screen.
 If a B scan is done at different
levels of the object, we will get a
two dimensional image on the
screen.
 First a B scan is done at the top of
the structure chosen,

 The first B scan line is kept on the

screen.
 Then at a slightly different level,
the B scan is repeated.

 This B scan result is also kept on

the screen.
 Then, again at a slightly different
level, the B scan is repeated.
 In this way, a two dimensional (2 D) image of the object is
formed on the screen.
 In real life, the process happens very quickly.
 The structures are scanned and the image redrawn many
times a second.
 The complete description of the mode is "real time, 2
dimensional (2D), B scan".
 The 2 dimensional (2D) refers to the fact that the image has
two dimensions; horizontal (X axis) and vertical ( Y axis).
 Probe Selection - Introduction

Probes are generally described by the size and shape of their face
(“footprint”).
Selecting the right probe for the situation is essential to get good
images, although there may be times where more than one probe
may be appropriate for a given exam.

There are three basic types of probe used in emergency and critical
care point-of-care ultrasound:
a) linear,
b) curvilinear, and
c) phased array.
Linear (also sometimes called vascular) probes are generally high
frequency, better for imaging superficial structures and vessels, and
are also often called a vascular probe.
 Probe Selection – Introduction (2)

• Curvilinear probes may have a wider footprint and lower frequency

for transabdominal imaging, or in a tighter array (wider field of view)
and higher frequency for endocavitary imaging.
• Phased array probe generates an image from an electronically
steered beam in a close array, generating an image that comes from
a point and is good for getting between ribs such as in cardiac
ultrasound.
• Curvilinear and phased array probes generate sector or “pie-shaped”
images, narrower in the near field and wider in the far field.

• Linear probes typically generate rectangular images on the screen.

 Straight Linear Array Probe

This probe is designed for superficial imaging.

The crystals are aligned in a linear fashion within a flat head and
produce sound waves in a straight line.
This probe has higher frequencies (5–13 MHz), which provides
better resolution and less penetration.
 Straight Linear Array Probe

The image produced is rectangular in shape (figure below).

The rectangular shape produced by the probe.

R: rib, P: pleural line, S: rib shadow.
 Straight Linear Array Probe

This probe is ideal for imaging superficial structures and in ultrasound-

guided procedures such as:

• Vascular access (central and peripheral)

• Evaluate for deep venous thrombosis
• Skin and soft tissue for abscess, foreign body
• Musculoskeletal—tendons, bones, muscles
• Testicular
• Appendicitis in thin patients
• Evaluation of the pleural line for pneumothorax, interstitial fluid
• Ocular ultrasound
• Other procedures (arthrocentesis, paracentesis, thoracentesis,
nerve blocks
 Curvilinear Array Probe

The curvilinear array or convex probe is used for scanning deeper

structures.
The crystals are aligned along a curved surface and cause a fanning out
of the beam, which results in a field of view that is wider than the
probe’s footprint.
These probes have frequencies ranging between 1 and 8 MHz, which
allows for greater penetration, but less resolution.
 Curvilinear Array Probe
The image generated is sector shaped (figure below).

The sector shape produced by the probe.

L: liver, K: kidney, D: diaphragm.
 Curvilinear Array Probe

These probes are most often used in abdominal and pelvic

applications.
They are also useful in certain musculoskeletal evaluations or
procedures when deeper anatomy needs to be imaged or in obese
patients.

This probe can be used in procedures such as:

• Abdominal aorta
• Biliary/gallbladder/liver/pancreas
• Abdominal portion of FAST exam
• Kidney and bladder evaluation
• Transabdominal pelvic evaluation
 Endocavitary Probe

The endocavitary probe also has a curved face.

Higher frequency (8–13 MHz) than the curvilinear probe.
This probe’s elongated shape allows it to be inserted close to the
anatomy being evaluated.

This probe is used most commonly for gynecological applications, but

can also be used for intraoral evaluation of peritonsillar abscesses -
Transvaginal ultrasound, Intraoral (tonsillar) evaluation.
 Endocavitary Probe

The curved face creates a wide field of view of almost 180° and its high
frequencies provide superior resolution (figure below).

Transvaginal ultrasound imaging using the endocavitary probe

This probe also produces a sector-shaped image, but a much wider
field of view.
U: uterus, B: bladder.
 Phase Array Probe

Phased array probes have crystals that are grouped closely together.
The timing of the electrical pulses that are applied to the crystals
varies and they are fired in an oscillating manner.
The sound waves that are generated originate from a single point and
fan outward, creating a sector-type image (figure below)
 Phase Array Probe

Parasternal long-axis view using the phased array probe

Sound waves originate from a single point and fan outward,
creating a sector-type image.
RV: right ventricle, AO: aortic outflow, LV: left ventricle, LA: left
atrium, DA: descending aorta.
 Phase Array Probe

This probe has a smaller and flatter footprint than the curvilinear one,
which allows the user to maneuver more easily between the ribs and
small spaces.
These probes have frequencies between 2 and 8 MHz, but they usually
operate at the higher end making them ideal for echocardiography.
The phased array probe can also function at lower frequencies, which
is useful for viewing the abdomen, pelvis, and for procedural guidance.

This probe can be used in procedures such as:

• Cardiac imaging
• Imaging between ribs in the flank or right upper quadrant•
• May be used for transabdominal imaging if curvilinear probe not available