3.

0 Wave Motion & Sound

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Sound & Ultrasound
• Sound is a vibration that is transmitted in a
medium, that can be heard by a human ear.

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• 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.

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• 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.

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• 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 5
• 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.

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• The wavelength λ (m) of the sound wave shown in
Figure 1 :

• The velocity c (m/s), or the speed at which sound

waves travel through a particular medium:

where where ω and f represent the frequency

(rad/s and Hz) of the energy delivered to the
tissue.

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• The speed of sound in the medium, phase velocity:

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:

• It is convenient way to express relevant tissue properties by

using the characteristic (or acoustic) impedance Z (kg/m2s),
which is defined by

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 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.

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• 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).

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 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.

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• 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.
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• 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.

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• 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.

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• 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.

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 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

• 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.
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• 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.

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• 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.

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• 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.

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• 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.

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• 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".

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• 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".

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 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.

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 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.

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 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.

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 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.

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 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.
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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.

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 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.

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 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.

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 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.

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 In this way, a two dimensional (2 D) image of the object is
formed on the screen.

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 In real life, the process happens very quickly.
 The structures are scanned and the image redrawn many
times a second.

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 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).

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 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.

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 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.

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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.

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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.

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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

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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.
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Curvilinear Array Probe

 The image generated is sector shaped (figure below).

 The sector shape produced by the probe.

 L: liver, K: kidney, D: diaphragm.

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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

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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.

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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.

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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)

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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.

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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

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