Basic Physics of Ultrasound

BASIC PHYSICS AND TECHNOLOGY OF
MEDICAL DIAGNOSTIC ULTRASOUND

In memory 01 my late lather
and in honour of my dear mother
BASIC PHYSICS AND
TECHNOLOGY OF
MEDICAL DIAGNOSTIC
ULTRASOUND
MATTHEW HUSSEY, PhD, FInstP

Head, Physics Department,
Dublin Institute of Technology
M
MACMILLAN
II:) Matthew Hussey 1985
All rights reserved. No part of this publication

may be reproduced or transmitted, in any form
or by any means, without permission
First published 1985 by

Higher and Further Education Division
MACMILLAN PUBLISHERS LTD
London and Basingstoke
Companies and representatives throughout the world
British Library Cataloguing in Publication Data

Hussey, Matthew
Basic physics and technology of medical
diagnostic ultrasound.
I. Diagnosis, Ultrasonic
I. Title
616.07'543 RC78.7.U4
ISBN 978-0-333-36605-9 ISBN 978-1-349-17737-0 (eBook)
DOI 10.1007/978-1-349-17737-0
Filmset in Monophoto Times New Roman by

Latimer Trend & Company Ltd, Plymouth
Contents
Preface X
Acknowledgements Xl
1 The Scope of Medical Diagnostic Ultrasound 1

1
1.1 Introduction and Objectives 1

1.2 Basic Features of Ultrasound 2
1.3 Range of Uses of Diagnostic Ultrasound 4
1.4 Why Ultrasound Methods are Being Increasingly Used 5
1.5 Aims and Standard of this Book 6
1.6 Quantities and their Units 6
1.7 Bibliography 7
2 Basic Features of Ultrasound Propagation 12

2.2 Sound Waves 12
2.3 Ultrasound 17
2.4 Decibel (dB) Scale 18
2.5 Specular Reflection and Refraction at Boundaries 19
2.6 Scattering 23
2.7 Absorption 23
2.8 Attenuation 24
2.9 Bibliography 28
3 Generating and Detecting Ultrasound 29

3.2 Piezoelectric Effect 30
3.3 Piezoelectric Materials 31
3.4 Single-element Transducer 32
VI CONTENTS
3.5 Circular Ultrasound Beam 35

3.6 Focussing 38
3.7 Continuous Wave Excitation of Transducer 40
3.8 Pulsed Excitation of Transducer 40
3.9 Rectangular Ultrasound Beam 42
3.10 Multi-element Array Transducers 42
3.11 Piezoelectric Transducers as Detectors of Ultrasound 44
3.12 Other Detectors of Ultrasound 45
3.13 Care of Transducer Probes 47
3.14 Testing of Transducers 47
3.15 Bibliography 49
4 A-Mode Scanning Instruments 51

4.2 Pulse-echo Ranging 51
4.3 A verage Speed of Propagation 53
4.4 The A-Mode Display 54
4.5 Schematic Outline of A-Mode Instrument 55
4.6 Operator Controls on Instrument 59
4.7 Caliper Measurements 63
4.8 Axial Resolution 63
4.9 Sensitivity 65
4.10 Artifacts 65
4.11 Clinical Applications 68
4.12 Permanent Records of Examinations 69
4.13 Instrument Performance Checks 69
4.14 Limitations 72
5 Motion (M-) Mode Scanning Instruments 74

5.2 M-Mode Display 74
5.3 Schematic Outline of the Instrument 75
5.4 Recording of Examinations 77
5.5 Artifacts 79
5.7 Clinical Applications 79
5.8 Main Limitations 80
5.9 Bibliography 81
CONTENTS vii
6 Static B-Mode Instruments 83

6.2 B-Mode Display or Image 84
6.3 Schematic Outline of the B-Mode Instrument 84
6.4 Patient Position/Image Reference Conventions 88
6.5 Bistable Displays 90
6.6 Analogue Grey-scale Displays 92
6.7 Digital Grey-scale Displays 95
6.8 Operator Machine Controls 96
6.9 Axial and Lateral Resolutions 97
6.10 Artifacts 99
6.11 Permanent Records of Images 10 1
6.13 Contact Scanning and Water Path Delay-line Scanning 104
6.14 Critique of Static B-Mode Imaging in Clinical Applications 105
7 Dynamic (Real-Time) B-Mode Scanning 108

7.2 Rapid Mechanical Scanning Units 109
7.3 Multi-element Array Techniques 110
7.4 The Multi-element Array Instrument 112
7.5 Beam Focussing and Guidance by Phased Arrays 113
7.6 Problems and Difficulties 116
7.7 Permanent Recording of Dynamic Images 117
7.9 General Remarks about Clinical Applications of Dynamic
B-Mode Units 118
7.1 0 Bibliography 119
8 Doppler Instrumentation 120

8.2 Doppler Effect 121
8.3 Schematic Outline of Basic Continuous Wave (cw) Doppler
Instrument 123
8.4 Signal Analysis and Recording 125
8.5 Directional Doppler Systems 128
8.6 Calibration and Performance Checks 129
8.7 Clinical Uses and Limitations 130
8.8 Schematic Outline of Range-gated Pulsed Doppler Instruments 132
8.9 Imaging with Pulsed Doppler Units 135
VllI CONTENTS
8.10 Performance Checks for Pulsed Doppler Instruments 137

8.11 Clinical Uses and Limitations of Pulsed Doppler Instruments 137
9 Permanent Records of Ultrasound Examinations 139

9.2 Human Visual Perception 140
9.3 Images and Image Science 141
9.4 Cameras 145
9.5 Films and Developing 147
9.6 Properties of Transparency Film 149
9.7 Positive Transparencies and Prints 151
9.8 'Instant' Photography 153
9.9 Oscilloscope Photography 154
9.1 0 Photography of Grey-scale Images from Oscilloscope
Displays 157
9.11 Electronic Image Storage Devices 160
9.12 Chart Recording 162
9.13 Recording of Auditory Signals 162
10 Special Instruments and New Topics 164

10.2 PPI-Mode Scanning Instruments 164
10.3 C-Mode Techniques 166
10.4 Through-transmission Computerised Reconstruction
Tomography 168
10.5 Small Organ Scanning Instruments 170
10.6 Breast Scanning Units 171
10.7 Special Transducers 172
10.8 Automatic Scanning 174
10.9 Duplex Scanners 176
10.10 Tissue Characterisation 177
10.11 Tissue-equivalent Phantoms 179
10.12 Instrument Standardisation 182
11 Safety of Diagnostic Ultrasound 184

CONTENTS IX
11.2 General Physical Effects of Ultrasound on Living Tissues 184

11.3 Bioeffects and Thresholds 187
11.4 Epidemiology 190
11.5 Diagnostic Ultrasound Dosimetry 191
11.6 Protection Against III Effects of Ultrasound 191
Appendixes
A: Exponential Decay 194

B: Logarithms 195
C: Mechanical Energy and Vibrations 197
D: Heat 201
E: Electricity 202
F: Electronics 206
G: Cathode-ray Oscilloscope 209
H: Storage Oscilloscope 213
I: TV Monitor 215
J: Analogue Scan Converters 218
K: Digital Computers 223
L: Digital Scan Converter 227
Index 233
Preface
The applications of medical diagnostic ultrasound grow year by year. New

diagnoses are described in the literature and novel instruments are de-
veloped and marketed.
For the clinicians involved and for their clinical/technical assistants, a
knowledge of (a) the basic concepts of ultrasound physics, (b) the interactions
possible between ultrasound and tissues and (c) the range of technologies
actually harnessed in ultrasound instruments, is of central importance.
These practitioners of diagnostic ultrasound, in radiology, obstetrics,
cardiology, neurology, ophthalmology and various other medical disciplines,
all need a systematic exposition of these ideas, well-rooted in their back-
ground knowledge of physics and physiology but transcending the level
provided in manufacturers' manuals for instruments.
The aim of this book is to provide this framework and this groundwork.
An elementary acquaintance with general physics is assumed. Only a minimal
knowledge of mathematics is required. A clinical involvement with diagnostic
ultrasound is, however, fundamental.
After studying this book, the ultrasound practitioner should be much
better able to understand the various clinical instruments and the practical
methods for using them. More thorough and more fruitful diagnoses of
diseases should result.
But other advantages should also emerge: better informed choices of new
instruments; more rounded and critical evaluation of new technologies; and
more efficient expenditure of limited health-care resources.
Furthermore after studying this book, the student should be capable of
delving into the clinical ultrasound literature, both books and periodicals,
and should be able to develop hisjher career as the field of diagnostic ultra-
sound evolves.
Dublin, 1984 M.H.

Acknowledgements
I wish to thank sincerely the following, who helped to complete this work:
Ms Gerardine Keating, who typed the manuscript.

Ms Joan C. Miller, who supplied all of the B-mode images.
Mr Gerard King, who supplied the M-mode recordings.
Mr James Robinson, who produced the prints of all of the images.
The author's many students of medical ultrasound, who over the past
decade have helped to clarify the need for, and the approach adopted,
in this book.
1 The Scope of
Medical Diagnostic Ultrasound
1.1 INTRODUCTION AND OBJECTIVES
Ultrasound now ranks as a major diagnostic tool in medicine. Its applications

are constantly expanding to new areas of the body with novel examination
procedures being described in the literature. The types and sophistication of
diagnostic ultrasound equipment are constantly being increased and im-
proved. Ultrasound literature is expanding each year. Within this developing
context, many firmly established ultrasound examination procedures now
exist in the areas of obstetrics and gynaecology, neurology (brain and spinal
chord), ophthalmology, cardiology, thyroid and breast, together with general
abdominal imaging investigations. Techniques are also widely used for the
study of blood flow throughout the cardiovascular system and for the
assessment of the arteries, using ultrasound equipment based on the Doppler
effect.
Within this wide and widening gamut of diagnostic ultrasound many
different medical and paramedical personnel use ultrasound equipment or
call for and interpret the ultrasound examinations. Medical specialists, a
variety of medical technicians including radiographers, physiological meas-
urement technicians and specialist technicians in ultrasound (ultrason-
ologists), as well as medical engineers and physicists play roles in medical
diagnostic ultrasound. All of these various layers of the medical care team
need to possess certain minimal levels of expertise in the science of ultra-
sound. The aim of this book is to cover the basic physics and engineering of
medical ultrasound to the level needed by the routine user of this modality
for medical diagnosis.
After reading this chapter, the student should be able to:
(a) outline the broad features of ultrasound as a medical diagnostic tool;
(b) contrast ultrasound with other imaging and investigative technologies
such as X-rays and radio nuclides ;
(c) broadly describe the range of uses of ultrasound in medical diag-
nosis;
(d) appreciate the major advantages of ultrasound methods within the
battery of diagnostic techniques available.
2 BASIC PHYSICS AND TECHNOLOGY OF ULTRASOUND
1.2 BASIC FEATURES OF ULTRASOUND
The main reasons why ultrasound is becoming so popular in medical diag-

nosis are that it is non-invasive, painless, without side effects and relatively
inexpensive. It is possible to direct a narrow beam of ultrasound into the
tissues like a light beam from an electric torch into the night, and thereby to
investigate specific regions of the body to the exclusion of other regions.
Most of the ultrasound techniques provide images or pictorial representa-
tions of the shapes of the tissues of interest and therefore allow immediate
evaluation and diagnosis. Some of the Doppler methods offer audible
signals to the clinician and if necessary, digital and graphical information,
which can be readily interpreted.
The ultrasound beam consists of a mechanical vibration travelling through
the tissues. The levels of energy involved are of the order of magnitude of the
energy levels in the sound of normal conversation. It is not difficult to accept
that it is highly unlikely that such levels would produce damaging side effects.
The interactions between this travelling ultrasound wave and the tissues
concern the palpable and simple properties of the tissues such as the density
and the stiffness or flexibility of those tissues. The ultrasound images pro-
duced, examples of which are shown in figure 1.1, are representations of the
distribution of these properties within the organs and tissues of the region of
the body interrogated by the ultrasound beam. Such images therefore are
completely different from X-ray images which represent broadly the electron
density in the tissues. They also contrast with radionuc1ide images, which
are representations of the concentration of specific radio nuclide markers
within the tissues. In general, the ultrasound imaging techniques can be
viewed as complementary to these other techniques.
The ultrasound images are cross-sectional representations of the tissues
rather than shadow representations as the conventional X-ray pictures are.
The pictures may thus be described as tomograms just like the X-ray com-
puter axial tomograms.
One family of ultrasound imagers, the dynamic B-mode scanners, can
present real-time cross-sectional tomograms of moving structures such as the
heart or the abdominal structures associated with the diaphragm or the
shifting foetus. This equipment allows study and diagnosis of the motion as
well as the size and position of many structures within the body.
The family of Doppler ultrasound units allows alternative types of assess-
ment of moving structures within the body. They allow more quantitative
measurements to be made of such motion as the flow of blood or the motion
of heart valves. New pulsed Doppler techniques allow the construction of
images of cross-sections through the blood vessels carrying the flowing
blood.
All this range of diagnostic studies may be carried out from outside the
body, outside the skin, without discomfort, pain or risk to the patient.
THE SCOPE OF MEDICAL DIAGNOSTIC ULTRASOUND 3
(a)
(b) ' - -_ _
Figure 1.1 Some examples of B-mode ultrasound images. (a) A foetal head with
portions of trunk, arm and fist. (b) A longitudinal section through the abdominal aorta
showing some of the branches. (c) A section through the liver showing dilated hepatic
veins
Studies may therefore be repeated as often as desired. Patients may be

followed up after different treatments. The development of the foetus within
the womb can be continuously monitored. The progress or regression of a
variety of disease conditions may also be monitored.
Ultrasound techniques have proved to be invaluable for the imaging of
soft tissues--in contrast with conventional X-ray methods which are sensi-
tive principally to hard tissues. Only the more expensive xeroradiography or
computerised tomography. both based on X-rays. can display such differen-
tiation and contrast between the soft tissue.
1.3 RANGE OF USES OF DIAGNOSTIC ULTRASOUND
As mentioned previously ultrasound techniques have been applied through-

out the body for imaging of structures and for studying internal movement.
For over twenty years ultrasound methods have been used for determining
the position of the sulcus and associated structures between the two hemi-
spheres of the brain. Mid-line shifts are primary indicators of injury or
pathology on one side of the brain. More recent developments allow imaging
of the ventricles around the mid-line and the motions associated with these
due to blood flow. Newer techniques are also being applied to the measure-
ment of blood flow to the brain mainly along the carotid arteries. and to
imaging these arteries to assess their patency.
Imaging and quantitative measurements of the eye and the other orbital
structures are long-established techniques. They are especially useful when
the lens and/or eye chambers are opacified due to haemorrhage or pathology.
The thyroid is an especially convenient organ for ultrasound examination.
Such examinations are useful for determining whether masses in the thyroid
are malignant or cystic and also for measuring the size and location of such
masses.
In recent years considerable effort has been expended to apply ultrasound
imaging techniques to the study of the breast and a number of specialised or
dedicated instruments are on the market. Doppler ultrasound techniques
have also been used to study and measure the changes in blood flow patterns
associated with masses in the breast.
Study of the heart. its chambers. walls and valves. has been a major com-
ponent of diagnostic ultrasound for over fifteen years. Dedicated equipment
exists for obtaining graphical displays of the valve motions as well as the
movement of the walls. Specialised B-mode units have been developed for
dynamic- so-called real-time -- two-dimensional imaging of those structures.
Even the dimensions of the cardiac chambers may be measured.
Doppler ultrasound equipment has been specially adapted for the measure-
ment of the blood flow out of the heart in the arch of the aorta, the cardiac
output.
The abdominal aorta is readily imaged with general purpose B-mode
ultrasound imaging devices. In many patients certain of the branches and
smaller arteries in the abdominal region may also be imaged and Doppler
techniques applied to measure the blood flow within them.
Ultrasound is invaluable for the imaging of the abdominal organs-
liver, kidneys, spleen, pancreas, biliary tree -.. their mutual positioning and
interconnections. Nowadays this part of the body is the major region in-
vestigated with imaging ultrasound techniques.
Another major area of interest in medical diagnostic ultrasound is ob-
stetrics. Doppler ultrasound may be used to detect early foetal heart motion
and is also widely used to monitor the foetal heartbeat during labour. It has
also been used to study placental blood flow. Imaging methods are very
widely used for monitoring foetal growth, for studying the foetal head,
neural tube, abdominal organs as well as for determining the position and
orientation of the foetus within the womb.
Doppler ultrasound is coming to be increasingly used in the detection and
measurement of blood flow in arteries and veins throughout the body.
Doppler ultrasound measurements are also used to characterise the state of
arteries - stiffness, stenosis, aneurysm, collateral flow, etc.
Reliable use of diagnostic ultrasound in all of these medical specialities
requires a knowledge of the nature of ultrasound, how it behaves as it
travels through the body tissues as well as the main features and functioning
of the actual ultrasound equipment. A keen appreciation of the limitations
of ultrasound techniques is also a requirement.
Because ultrasound methods are complementary to some diagnostic
techniques and superior to others, an appreciation of the role of ultrasound
in the wide battery of diagnostic procedures is also desirable.
1.4 WHY ULTRASOUND METHODS ARE BEING

INCREASINGL Y USED
The major advantages of ultrasound diagnostic methods over alternative

procedures are its attributes of:
(a) non-InVaSiVeness,
(b) lack of any known side effects, either immediate or long-term,
(c) no associated discomfort to the patient,
(d) relative cheapness.
All of these features point to the use of ultrasound methods, if appropriate,
as the first in any battery of diagnostic tests. This would certainly be the case
where the alternatives involve surgery or even puncturing the skin, ionising
radiation, or injection/ingestion/inhalation of a foreign substance into the
body.
Because ultrasound interrogates the mechanical properties of the body,
in particular of the deep structures, it may be viewed as an extension, albeit
a sophisticated one, of the traditional palpatory techniques of medicine.
A number of new developments in diagnostic ultrasound, in particular the
emerging possibilities for tissue characterisation, help to deepen the diag-
nostic information obtainable from ultrasound examinations. Therefore the
currently growing applications of ultrasound in medical diagnosis can be
expected to continue to grow and expand in the years ahead.
A prerequisite for this continued growth and development is increasing
the knowledge about the basics of ultrasound physics and the technology of
the diagnostic equipment, among the medical practitioners and associated
technicians in the field.
1.5 AIMS AND STANDARDS OF THIS BOOK
The primary aim of this book is to describe the basic physics of ultrasound
in so far as it is applied in medical diagnostic equipment. The next aim is to
describe the ways in which this fundamental knowledge is harnessed and
applied in the design of diagnostic equipment and in the use of such equip-
ment.
This material is covered with the minimum of mathematics. Some basic
mathematics and technical matter are accumulated in appendixes at the end
of the book. A person with an 'O'-Ievel in Physics or Mathematics should
not have difficulty with the standard of the subject matter in this text.
The book contains a digest of the most widely available types of diagnostic
ultrasound equipment. But there are many specialised and even research
units in use in hospitals and clinical laboratories which are not described.
However, the fundamentals actually covered should allow the student or
general reader to follow fairly readily the operation and controls of such
special equipment.
1.6 QUANTITIES AND THEIR UNITS
A number of physical quantities are discussed and utilised in this book and
occasionally represented with symbols. For reference, table 1.1 lists these
quantities, their symbols and units.
Table 1.1 The Quantities Used in this Book, their Units and Symbols
Quantity Symbol Units Abbreviation

------
Time Second
Millisecond (10 -3 S) ms
Microsecond (10 -6 S) ps
Length Lor z Metre m
Centimetre (10 2m) cm
Millimetre (10 -3 m) mm
Area A Square metre m2
Square centimetre (l0-4m 2) cm 2
Volume V Cubic metre m3
Speed or Velocity cor \' Metres per second m/s
Angle B or :x or () Radian rad
Degree (n/180 rad)
Frequency f Hertz Hz
Kilohertz (10 3 Hz) kHz
Megahertz (10 6 Hz) MHz
Mass M Kilogram kg
Force F Newton N
Pressure or Stress p or P Pascal (N/m2) Pa
Energy or Work E or Wk or H Joule (Nm) J
Power P Watt (J/s) W
Intensity 1 Watts per square metre W/m2
Watts per square centimetre
(l04W/m2) W/cm 2
Potential Difference E or e Volt V
Current lor i Ampere A
Resistance R Ohm Q
Temperature Degree Celsius C
1.7 BIBLIOGRAPHY
Journals
Acta Ohstetrica et Gynecologica Scandinavica
Acustica
A merican Journal of Ohstetrics and Gynecology
A merican Journal of Roentgenology
British Journal of Ohstetrics and Gynaecology
British Journal of Radiology
European Medical Ultrasonics
Journal of Clinical Ultrasound
Journal of Medical Engineering and Technology
journal of the Acoustical Society o(America
Medical Ultrasound
Radiology
Ultrasonics
Ultrasound in Medicine and Biology
Annual Reviews
Bock, J. and Ossoinig, K. (Eds), Ultrasonographia Medica, Verlag der Wiener
Medizinischen Akademie, Vienna
Clinical Ultrasound Purchasers Catalogue
Case Studies in Diagnostic Sound, Churchill Livingstone, Edinburgh
Kurjak, A. (Ed.), Progress in Medical Ultrasound: Reviews and Comments, Excerpta
Medica, Amsterdam
Kurjak, A. (Ed.), Recent Advances in Ultrasound Diagnosis, Excerpta Medica, Am-
sterdam
Case Studies in Diagnostic Ultrasound, John Wiley, New York
Linzer, M. (Ed.), Ultrasonic Tissue Characterization, U.S. National Bureau of Stand-
ards, Washington
Winsberg, F. (Ed.), Clinical Ultrasound Review, John Wiley, New York
White, D. N. (Ed.), Ultrasound in Medicine, Plenum Press, New York
Whitehouse, W. M. (Ed.), The Year Book of Diagnostic Radiology, YB Medical Pub-
lishers, New York
Various editors, Acoustical Imaging, Plenum Press, New York
Various editors, Clinics in Diagnostic Ultrasound, Churchill Livingstone, New York
Basic Physics and Instrumentation
Dunn, F. and O'Brien, W. D., Jr. (Eds), Ultrasonic Biophysics, Dowden Hutchinson &
Ross Inc., Stroudsburg, Pa, 1976
Edmonds, P. D. (Ed.), Ultrasonics, Academic Press, New York, 1981
Hussey, M., Diagnostic Ultrasound: An Introduction to the Interactions Between Ultra-
sound and Biological Tissues, Blackie & Son, Glasgow, 1975
Kinsler, L. E. and Frey, A. R., Fundamentals of Acoustics, 3rd edn, John Wiley, New
York, 1982
Kremkau, F. W., Diagnostic Ultrasound: Physical Principles and Exercises, Grune &
Stratton, New York, 1980
McDicken, W. N., Diagnostic Ultrasonics: Principles and Use of Instruments, 2nd edn,
John Wiley, New York, 1981
Millner, R. (Ed.), Ultrasound Interaction in Biology and Medicine. Plenum Press, New
York,1983
Moores, B. M. et al. (Eds), Physical Aspects of Medical Imaging, John Wiley, Chichester,
1981
Preston. K. et al. (Eds), Medical Imaging Techniques: A Comparison, Plenum Press,
New York. 1979
Repacholi, M. H. and Benwell, D. A. (Eds), Essentials of Medical Ultrasound,
Humana, Clifton, N.J., 1982
Rose. J. L. and Goldberg. B. B .• Basic Physics in Diagnostic Ultrasound, John Wiley,
New York, 1979
Stroke, G. W. et al. (Eds), Ultrasonic Imaging and Holography: Medical, Sonar and
Optical Applications. Plenum Press, New York, 1974
Wells. P. N. T. and Ziskin. M., New Techniques and Instrumentation in Ultrasono-
graphy, Churchill Livingstone. Edinburgh. 1980
Woodcock, J. P., Ultrasonics. Adam Hilger Ltd, Bristol. 1979
General Ultrasound Imaging
Carter. B. L. et aI., Cross-sectional Anatomy: Computed Tomography and Ultrasound

Correlation, Appleton-Century-Crofts, New York. 1977
Fleischer, A. C. and James, A. E., Introduction to Diagnostic Sonography, John Wiley,

New York, 1980
Gosink, B. B. and Squire, L. F., Exercises in Diagnostic Radiology. 8: Diagnostic
Ultrasound, W. B. Saunders Co., Philadelphia, 1976
James, A. E. Jr. (Ed.), Radiological Clinics of North America, Vol. 18-1: Symposium on
Advances in Ultrasonography, W. B. Saunders Co., Philadelphia, 1980
Kratochwil, A. and Reinhold, E., Ultraschalldiagnostik 81, Georg Thieme Verlag,
Stuttgart, 1982
Love, M. B., An Introduction to Diagnostic Ultrasound, Charles C. Thomas, Springfield,
Ill,1981.
Lunt, R. M., Handbook of Ultrasonic B-Scanning in Medicine, Cambridge University
Press, Cambridge, 1978
Rand, E., Recent Advances in Diagnostic Ultrasound, Charles C. Thomas, Springfield,
Ill, 1971
Taylor, K. J. W., Atlas of Grey Scale Ultrasonography, Churchill Livingstone, New
York, 1978 (reprinted 1979)
Taylor. K. J. W. et aI., Manual of Ultrasonography, Churchill Livingstone, New York,
1980
de Vlieger, M. et al. (Eds), Handbook of Clinical Ultrasound, John Wiley, New York,
1978
Wells, P. N. T. (Ed.), Ultrasonics in Clinical Diagnosis, Churchill Livingstone, Edin-
burgh, 1977
Applications in Obstetrics and Gynaecology

Borruto, F. and Wladimiroff, J. (Eds), Fetal Ultrasonography: the Secret Prenatal Life,
John Wiley, Chichester, 1982
Cadkin, A. V. and Motew, M. N., Clinical Atlas of Grey Scale Ultrasonography in
Obstetrics, Charles C. Thomas, Springfield, Ill., 1979
Garrett, W. J. and Robinson, D. E., Ultrasound in Clinical Obstetrics, Charles C.
Thomas, Springfield, III, 1970
Kobayashi, M. et aI., Atlas of Ultrasonography in Obstetrics and Gynecology, Appleton-
Century-Crofts, New York, 1972
Orlandi, C. et al. (Eds), Recent Advances in Prenatal Diagnosis, John Wiley, Chichester,
1981
Sabbagha, R. E. (Ed.), Diagnostic Ultrasound Applied to Obstetrics and Gynecology,
Harper & Row, Lindenlaan, Holland, 1980
Sabbagha, R. E., Ultrasound in High-risk Obstetrics, Lea & Febiger, Philadelphia, 1979
Sanders, R. C. and Everette James, A., Jr., The Principles and Practice of
Ultrasonography in Obstetrics and Gynecology, 2nd edn, Appleton-Century-Crofts,
East Norwalk, Ct, 1980
Thompson, H. E. and Bernstine, R. L., Diagnostic Ultrasound in Clinical Obstetrics and
Gynecology, John Wiley, New York, 1978
Uses in Brain Disorders
Mostafawy, A. (with Nagle, J. B.), Pediatric Sonoencephalography, Springer Verlag,

Heidelberg, 1971
Uematsu, S. and Walker, A. E., A Manual of Echoencephalography, Williams & Wilkins
Co., Baltimore, 1971
White, D. N. (Ed.), Ultrasonic Encephalography, Pergamon Press, Oxford, 1980
General Abdominal Applications
Barnett, E. and Morley, P., Abdominal Echography, Butterworths, London, 1974

Brascho, D. J. and Shawker, T. H., Abdominal Ultrasound in the Cancer Patient, John
Wiley, New York, 1980
Cosgrove, D. O. and McCready, V. R., Ultrasound Imaging-Liver, Spleen, Pancreas,
Gates, G. F., Atlas of Abdominal Ultrasonography in Children, Churchill Livingstone,
New York, 1978
Goldberg, B. B. (Ed.), Abdominal Grey Scale Ultrasonography, John Wiley, New York,
1977
Holm, H. H. et aI., Abdominal Ultrasound, Munksgaard, Copenhagen, 1976
Meire, H. B. et al., Ultrasound Teaching Cases, London Ultrasound Publishing Ltd,
London, 1983
Meire, H. B. and Farrant, P., Basic Clinical Ultrasound, British Institute of Radiology,
London, 1982
Metreweli, c., Practical Abdominal Ultrasound, Heinemann, London, 1978
Raymond, H. W., Fundamentals of Abdominal Sonography: A Teaching Approach,
Grune & Stratton, New York, 1979
Rosenfield, A. T., Genitourinary Ultrasonography, Churchill Livingstone, Edinburgh,
1979
Taylor, K. J. W. (Ed.), Diagnostic Ultrasound in Gastrointestinal Disease, Churchill
Livingstone, Edinburgh, 1979
Weill, F. S. et aI., Renal Sonography, Springer Verlag, Heidelberg, 1981
Ultrasound in Ophthalmology
Fram;ois, J. and Goes, F., Ultrasonography in Ophthalmology, S. Karger, Basel, 1975
Hassani, S. N. (with Bard, R. L.), Real Time Ophthalmic Ultrasonography, Springer
Verlag, New York, 1978
Vanysek, J. et aI., Ultrasonography in Ophthalmology, Butterworths, London and
Prague, 1972
Cardiological Applications
Benchimol, A., Non-invasive Techniques in Cardiology for the Nurse and Technician,
Chang, S., Echocardiography: Techniques and Interpretation, 2nd edn, Lea & Febiger,
Philadelphia, 1981
Feigenbaum, H., Echocardiography, 3rd edn, Lea & Febiger, Philadelphia, 1981
Gutesell, H. P. and Paquet, M., Atlas of Pediatric Echocardiography, Harper & Row,
Lindenlaan, Holland, 1978
Harrison, D. C. et al. (Eds), Cardiovascular Imaging and Image Processing: Theory and
Practice-1975, Society of Photo-Optical Instrumentation Engineers, Palos Verdes
Estates, Ca, 1975
Kisslo, J. A. (Ed.), Two-dimensional Echocardiography, Churchill Livingstone, New
York, 1980
Linhart, J. W. and Joyner, C. R., Diagnostic Echocardiography, C. V. Mosby Co., St
Louis, Mo, 1981
Meyer, R. A., Pediatric Echocardiography, Lea & Febiger, Philadelphia, 1977
Miskovits, c., Echocardiography: A Manual for Nurses, Medical Examination
Publishing Co. Inc., Flushing, NY, 1977
Reneman, R. S. (Ed.), Cardiovascular Applications of Ultrasound, North-Holland,

Amsterdam, 1974
Roelandt, J., Practical Echocardiology, Research Studies Press, Forest Grove, Or, 1977
Salcedo, E. E., Atlas of Echocardiography, W. B. Saunders Co., Philadelphia, 1978
Short, M. D. et af. (Eds), Physical Techniques in Cardiological Imaging, Adam Hilger
Ltd, Bristol, 1983
Weissler, A. M., Non-invasive Cardiology, Grune & Stratton, New York, 1974
Weyman, A. E., Cross-sectional Echocardiography, Lea & Febiger, Philadelphia, 1982
Winsberg, F. and Cooperberg, P. L. (Eds), Real Time Ultrasonography, Churchill
Uses of Doppler Ultrasound

Atkinson, P. and Woodcock, J. P., Doppler Ultrasound and its Uses in Clinical Measure-
ment, Academic Press, London, 1982
Biidingen, H. J., Doppler-Sonographie der Extrakraniellen Hirnarterien, Georg Thieme
Verlag, Stuttgart, 1982
Hatle, L. and Angelsen, B., Doppler Ultrasound in Cardiology: Physical Principles and
Clinical Applications, Lea & Febiger, Philadelphia, 1982
Hwang, N. H. C. and Normann, N. A. (Eds.), Cardiovascular Flow Dynamics and
Measurements, University Park Press, Baltimore, 1977
Kriessmann, A., Praxis der Doppler-Sonographie, Georg Thieme Verlag, Stuttgart,
1982
Rolfe, P. (Ed.), Non-invasive Physiological Measurements, Vol. I, Academic Press,
New York, 1979
Miscellaneous Applications
Evans, K. T. and Gravelle, 1. H., Mammography, Thermography and Ultrasonography
in Breast Disease, Butterworths, London, 1973
Goldberg, B. B. (Ed.), Ultrasound in Cancer, Churchill Livingstone, Edinburgh, 1981
Haller, J. O. and Shkolnik, A. (Eds), Diagnostic Ultrasound in Pediatrics, Churchill
Holm, H. H. and Kristensen, P., Ultrasonically Guided Puncture Technique, W. B.
Saunders Co., Philadelphia, 1981
Kobayashi, T., Clinical Ultrasound of the Breast, Plenum Press, New York, 1978
Rhyne, T. L., Acoustic Instrumentation and Characterisation of Lung Tissue, Research
Studies Press, Forest Grove, Or, 1977
Sigel, B., Operative Ultrasonography, Lea & Febiger, Philadelphia, 1982
Taylor, K. J. W. and Viscomi, G. N., Diagnostic Ultrasound in Emergency Medicine,
Churchill Livingstone, Edinburgh, 1981
Thijssen, J. M. (Ed.), Ultrasonic Tissue Characterization: Clinical Achievements and
Technological Potentials, Stafleu's Scientific Publishing Co., Brussels, 1980
2 Basic Features of
U Itrasou nd Propagation
This chapter deals with the basic ideas and aspects of ultrasound as it travels
through a medium. The main questions addressed are the following: what
are sound and ultrasound, what does the medium through which the ultra-
sound is passing do to the ultrasound, and finally, what does the ultrasound
do to the medium?
After reading this chapter the student should be able to:
(a) describe the main features of a sound wave disturbance;
(b) discuss the factors that affect speed of propagation and acoustic
impedance;
(c) distinguish between sound and ultrasound;
(d) define intensity and Intensity Level (the decibel scale);
(e) describe perpendicular reflection and transmission at a plane bound-
ary;
(f) discuss oblique incidence at a plane boundary and the consequent
reflection and refraction;
(g) describe scattering;
(h) discuss the mechanisms of absorption and its consequences;
(i) describe attenuation, its causative mechanisms, its quantification in
tissues and its frequency dependence in tissues.
2.2 SOUND WAVES
Sound is a mechanical disturbance in the air which is initiated by the vibra-

tion of the source of the sound, then travels through the air and impinges on
and is received by the ears. It consists of local vibratory disturbances in the
air between the source and the receiver, and these disturbances propagate
from source to receiver. This type of phenomenon is described as a wave. In
BASIC FEATURES OF ULTRASOUND PROPAGATION 13
the sound wave the local disturbance of the medium consists of vibrations of
the particles of the air. These vibrations, back and forth, occur along the
line of travel of the sound wave as shown in figure 2.1. But they are vibratory
and in consequence, the particles of the air remain in their original positions
when the sound stops. The particles of the air, therefore, do not move from
the source to the receiver of the sound. What does travel from the source to
the receiver is mechanical energy (see Appendix C).
Other examples of wave movements are of interest. For instance when a
stone is dropped into a pool of water, a disturbance in the form of a circular
set of ripples radiates out from the point of impact of the stone to the edge
of the pool. The waves or wavelets propagate radially.
DIRECTION OF SOUND PROPAGATION (z)

~
ORIGINAL POSITION
\ DISPLACEMENT
Figure 2.1 The oscillatory displacement of each particle of the medium carrying the
sound wave, as a function of time. The displacement is along the same direction as the
wave is travelling and the particle oscillation is repeated once each period, T
If one end of a piece of string is tied rigidly and the other end is loose and
if the loose end is shaken vertically up and down, a wave travels along the
string. The wave consists of vertical vibrations of the individual parts of the
string. But these particles of the string do not move along the string. They
remain in their original positions when the vibration of the loose end of the
string is stopped.
In both of these examples, while energy travels from the source of the
disturbance to a remote location, the particles of the medium do not move
in this way. Figure 2.2 illustrates what happens to the particles of the medium
when a sound wave is initiated. The particles close to the source are first
driven into vibration. Subsequently particles more remote from the source
experience the disturbance and begin to vibrate. The fact that the direction
of vibration of the particles and the direction of motion of the wave are the
0 0 0 0 0
0
0 0
-----0-
0
0
0 Z
0 0
(a) 0 0 0
0 0
~ <1-0-<> 0 0 0
0
4-O-t> 0
0 -----0-
0 Z
<I-<H>
0 0 0
(b) ~ 0 0
0
4-<>P ~ <1-0-1> 0 0
<1-0-1>
<1-0-1> 0
-----0-
<1-0-1>
0 Z
<1-0-<>
~ <1-0-1> 0
0
(c) <1-0-1> <1-0-1> 0
<1-0-1> <1-0-1> <1-0-1> <1-0-1> <1-0-1>

<1-0-1>
<1-0-1> ~
-----0-
<1-0-1>
<1-0-1> Z
~
<H)-O> <1-0-1> ~<I-O-I>
(d) <1-0-<> 4-<H> <1-0-1>
Figure 2.2 As the plane sound wave propagates along the z direction the particles of
the medium initially undisturbed (a). are driven into vibration of successively farther
distances along this direction (b). (c) and (d)
same, makes this wave a longitudinal wave. The fact that all of the particles
in a plane perpendicular to the direction of travel of the wave move in unison
gives rise to the description plane longitudinal wave for this type of sound
wave. In the water wave described above, the particles of the water vibrate
in a direction perpendicular to the direction of movement of the wave and
therefore. that wave is described as a transverse wave.
Within the medium through which the sound is travelling, there are
regions towards which the particles are moving from both directions as well
as regions away from which the particles are moving in both directions. The
former regions therefore, experience an elevation of pressure and are de-
scribed as compressions. The latter regions experience a reduction in pressure
and are referred to as rarefactions. As the wave propagates, the compressions
and rarefactions also travel along so that from one moment to the next each
region of the medium experiences compressions and rarefactions in turn. It
is possible to conceive of the source of the sound as being the source of
successive compressions and rarefactions, with these pouring out from the
source and travelling in the direction of the receiver. A complete cycle of the
disturbance therefore consists of a compression followed by a rarefaction up
to the beginning of the next compression. In reality, there is a smooth

gradation between compression and rarefaction, in fact a sinusoidal varia-
tion in the pressure along the medium as shown in figure 2.3.
The number of such complete cycles occurring at a point each second is
called the frequency (f) and is measured in hertz (Hz). This unit was formerly
called 'cycles per second'. By convention sound consists of waves of fre-
quency between 20 Hz and 20 kHz. Frequencies lower than 20 Hz are
referred to as infrasound and frequencies above 20 kHz are called ultrasound.
The 'sound' frequency range is approximately the range of frequencies to
which the ear is sensitive.
RAREFACTION
I
I I
I
1I..l.?~~R~SI?~
IIIIII I I
I
I
I 110000
1111111
I
I
I
I
I I I 11111 I I I 1111111 I I I
1111111 I I 1111111 I I
I r 11111 I I I 1111111 I J
I 111111 I I I 11111111 I I
~
Z
PRESSURE~---r-C\_:<J~A--+-6_":~.
, \J ~
Figure 2.3 At anyone instant in the sound wave, the compression/rarefaction/
compression sequence extends along a wavelength, },' in the direction of travel of the
wave. The elevations in acoustic pressure correspond to compressions of the medium
while the reductions in this pressure correspond to the rarefactions in the medium
Sound or ultrasound travels through a medium at a constant speed, the

speed of propagation, which is measured in metres per second (m/s). This
speed of propagation (c) is determined by two properties of the medium
through which the sound is travelling, the density (p) and the compressibility
(K). The relationship between the speed of propagation and these parameters
is given in equation (2.1)
c= II .JKP (2.1)
As mentioned previously, a source of sound may be viewed as an appliance
which pours out successive compressions and rarefactions into the medium.
Each compression travels at the speed of propagation into the medium and
is followed by the next rarefaction and then by the next compression. Sub-
sequently, at any instant in time, the medium between the source and the
receiver is experiencing a train of compressions and rarefactions as in figure
2.3. There is a characteristic distance between successive pairs of compressions
or between successive pairs of rarefactions. This characteristic distance,
travelled by the wave in one period, is called the wavelength (.il) and is
determined as shown in equation (2.2) by the speed of propagation (c) and the
frequency (f) of the sound,
A=c/f (2.2)
For a given elevation of pressure (p) in the sound/ultrasound wave there
is a consequent particle velocity (v) and the constant of proportionality be-
tween these two quantities is the characteristic acoustic impedance (Z) of the
medium (equation 2.3)
Z=p/v (2.3)
Z in turn for a plane longitudinal wave, is the product of the density of the
medium and the speed of propagation in it (equation 2.4)
Z=pc (2.4)
=yp/K
Clearly the acoustic impedance is a constant for each medium.
Sound travels through air but in fact it can travel through any material
medium, gas, liquid or solid. It requires a mechanical medium. The particles
of the medium must be disturbed and vibrated in order that the wave may
propagate. In this regard, what is meant by a mechanical medium is a
medium which possesses density and compressibility. Sound does not propa-
gate through a vacuum and this can be shown by the classical experiment
which has an electric bell inside a bell-jar as in figure 2.4. As the chamber
beneath the bell-jar is evacuated, the bell gradually becomes inaudible
outside.
BELL
JAR
BELL
TO VACUUM PUMP
Figure 2.4 A source of sound, an electric bell, located under a glass jar in which a
vacuum may be established
2.3 ULTRASOUND
As mentioned previously, ultrasound consists of sound of frequencies

greater than 20 kHz. For diagnostic purposes ultrasound of frequencies in
the range 1-20 MHz (megahertz) is used.
Ultrasound travels through a medium at a constant speed, c, the same
speed at which sound travels through the medium. Table 2.1 contains the
values of the speed of propagation for a number of media including body
tissues. The table also lists the corresponding values of ultrasound wave-
lengths at 1 and 10 MHz.
Table 2.1 Values of Speed of Propagation in some Biological Tissues and Media,
together with Values of Wavelength at 1 MHz and 10 MHz
Medium Speed (m/s) Wavelength (mm)
1 MHz 10MHz
Air 330 0.33 0.033

Water 1530 1.53 0.153
Fat 1460 1.46 0.146
Liver 1570 1.57 0.157
Muscle 1630 1.63 0.163
Bone 3050 3.05 0.305
The ultrasound disturbance is exactly similar to the sound disturbance,

with particle vibration, excess pressure developed and mechanical energy
transported along by the wave. One of the most important parameters of a
sound or ultrasound wave is the rate at which energy is transported by the
wave. The parameter which measures the rate of energy transfer is the
intensity, defined as the amount of energy in joules, transported each second
through each square metre of the medium perpendicular to the direction in
which the sound is travelling (see figure 2.5). Thus the intensity is the power
\
ULTRASOUND y,,\
f
WAVE
\ /
~P~RO~PA~G~A~J~IO~N ________________~~
Figure 2.5 A portion of the ultrasound wave passing through a unit area of 1 m 2
perpendicular to the direction of propagation of the wave
in watts per square metre. The more intense the ultrasound wave, the more
energy is transported each second through each square metre, but also the
greater the vibratory disturbance of the medium and the greater the excess
pressure developed at each location in the medium disturbed by the wave.
2.4 DECIBEL (dB) SCALE
In many situations relating to sound and ultrasound one is interested in

comparing intensities. Two intensities may be compared by calculating the
ratio of one to the other. In sound and ultrasound work, very wide ranges
of such ratios are encountered and a linear scale would be very awkward. A
logarithmic scale has been adopted to provide a more manageable scale (see
Appendix B). This logarithmic scale is the decibel (dB) scale and on this
scale the Intensity Level in dB of intensity I is compared with the reference
intensity 10 in equation (2.5),
Intensity Level=1010g 10 (//10) (dB) (2.5)
There are two important attributes of the decibel scale which make it very
convenient. The first of these attributes is illustrated in table 2.2, which
shows the values of the Intensity Levels in dB for a number of intensity
ratios. Clearly, a very wide range of intensity ratios may be compressed into
a more convenient set of dB readings. The other important feature of the
decibel scale is that it is additive or subtractive when the intensities are
multiplied or subdivided. For instance, if an intensity I is compared with an
intensity 10 and yields an Intensity Level of dBA' and a third intensity 11
Table 2.2 Comparison of Linear Ratio Scale and Logarithmic (dB) Scale
dB Scale
10 10 100
104 40
10 2 20
10 10
3.16 5
1.26 1
1.0 o
0.79 -1
0.32 -5
0.1 -10
10 - 2 -20
10-4 -40
10- 10 -100
when compared with I has an Intensity Level of dB B , then the intensity 11 ,

when compared with the first or original reference intensity 10 would have
an Intensity Level of dB A +dBB . Furthermore, for intensity ratios less than
one, Intensity Levels in dB are negative. Negative dB values thus represent
attenuation or reduction of intensity.
2.5 SPECULAR REFLECTION AND REFRACTION

AT BOUNDARIES
Up to this point in the discussion, the medium through which the ultrasound
is travelling has been assumed to be homogeneous and unbounded. If there
is a boundary or an interface between one medium and another, this can
drastically effect the propagation of the ultrasound wave. Consider the
situation shown in figure 2.6, where the boundary is plane and perpendicular
to the direction of propagation of the ultrasound wave. This boundary
separates two media which are different by virtue of having different values
of acoustic impedance (Z) (equations 2.6 and 2.7)
(2.6)
and
(2.7)
MEDIUM 1
Z,
I,
Figure 2.6 Specular reflection and transmission at a plane boundary between two
acoustically different media, on which the in-coming wave is perpendicularly incident
When the ultrasound wave of intensity Ii encounters this boundary, some of

the incident intensity continues into the second medium as the transmitted
wave of intensity It. The rest of the incident intensity is reflected directly
back along the original path of travel and has intensity I r , the reflected
intensity. The actual partitioning of the incident intensity is determined by
the values of acoustic impedance of the two media. The fraction (R) of the
incident intensity reflected, the intensity reflection coefficient, is given in
equation (2.8),
(2.8)
The fraction transmitted across the boundary, T, is given by equation (2.9),

4Z1Z2
T=-----;o (2.9)
(ZI +Z2)2
T is the intensity transmission coefficient.
Thus reflection occurs and an acoustic boundary is said to exist only when
the two media differ in the values of their acoustic impedances. The re-
flection coefficient is insensitive to whether the acoustic impedance of the
first medium is greater or less than that of the second medium. Thus the
reflection coefficient for a boundary is the same no matter which direction
across the boundary is being travelled by the ultrasound wave.
The reflection coefficient R is related to the transmission coefficient T by
T=I-R (2.10)
because energy is neither created nor deposited in the boundary itself. Table
2.3 lists the approximate values of acoustic impedance for some tissues.
Next consider the situation illustrated in figure 2.7 where the incident
wave strikes the boundary at an angle other than 90 In this case, the re-
G •
flected wave travels back into the first medium from the boundary, but not
along the same line as the incident wave. The angle of reflection (8 r ) is equal
to the angle ()fincidence (8), and the reflected wave is on the opposite side of
the perpendicular line or normal to the boundary at the point of incidence.
Neither does the transmitted wave continue along the same line of propa-
gation as it originally occupied in the first medium. It is refracted and the
Table 2.3 Values of Speed of Propagation and Characteristic Acoustic Impedance

for Certain Body Tissues (at 37'C, unless otherwise stated)
Propagation speed Acoustic impedance

Tissue c (m/s) Z (10 -6 x kg/m 2 s)
Fat 1460 1.39

Water 1530 1.52
Brain (25 C) 1520 1.57
Nerve (Optic) 1615 1.68
Muscle 1630 1.73
Liver (25 C) 1570 1.65
Kidney 1560 1.64
Aqueous Humour 1500 1.51
Lens 1620 1.84
Lung 650 0.26
Bone (Skull) 3050 5.0
Enamel 5800 17.1
z,
Figure 2.7 Specular reflection and transmission at a plane acoustic interface on which
the wave is obliquely incident
refraction angle or angle of transmission, marked 8t in figure 2.7, is related to

the incident angle as indicated in equation (2.11),
(2.11 )
often referred to as Snell's law. This relationship is illustrated in figure 2.8. If

the ultrasound wave passes from a medium of lower propagation speed to a
medium of higher speed, the wave is deflected away from the normal. When
passing in the opposite direction, the beam is deflected towards the normal.
Figure 2.8 The angle of transmission B, as a function of the angle of incidence Bi • for
different values of the ratio of the propagation speeds, C 2 /C 1
The intensity reflection coefficient, R, in this case is more complex than

when normal incidence occurs, depending on the angles of incidence and
refraction as well as on the two acoustic impedances (equation 2.12)
(2.12)
The intensity transmission coefficient T may be derived as in equation (2.13),
It
T=-
Ii
=1-R
4(Z 1/cos8J(Zz/cos8t)
(2.13)
(Z 1/cos8i + Zz/cos8Jz
If the boundary between the two media is convex as in figure 2.9(a), the
refraction experienced by the transmitted wave varies with vertical distance
from the central axis AN. The transmitted wave is concentrated or focussed
some distance into the second medium. Also the reflected wave returns into
the first medium as a divergent wave. If the boundary is concave as in
figure 2.9(b), the transmitted wave is divergent and the reflected wave is
focussed.
z,
A --~-----+-------i;'A
(a)
z,
(b)
Figure 2.9 (a) A convex acoustic boundary causes focussing of the transmitted wave
and divergence of the reflected wave. (b) A concave boundary produces divergence of
the transmitted wave and convergence or focussing of the reflected wave
In both of these cases the focussing and diverging action is strongly de-
pendent on the radius of curvature of the boundary. The smaller the radius
of curvature the sharper the focussing action and the closer to the boundary
along the axis is the focus in each case.
2.6 SCATTERING
If the boundary between two media has surface irregularities of the order of
magnitude of the wavelength or less, then the reflected wave is fragmented
into random directions relative to the boundary. This is shown in figure 2.10.
If there are small (order of wavelength or less) reflecting inhomogeneities
in the medium, similar scattering can occur in every direction and the in-
tensity of the wave beyond the inhomogeneities is reduced relative to that
before the inhomogeneities. This is shown in figure 2.II.In this way, scatter-
ing reduces the intensity in the ultrasound wave. It also produces along the
original direction of travel of the wave, the so-called back-scattered waves.
Figure 2.10 When the reflecting surface has roughnesses of the order of magnitude of
the wavelength of the ultrasound, the reflection is no longer specular but consists of
less directional scattering
>I
INCI=D_E_NT-j;;~~_~~
WAVE ~ ~
-~-~
Figure 2.11 Scattering occurs if discrete reflectors of the order of magnitude of the
ultrasound wavelength. or smaller, are located in the incident wave
2.7 ABSORPTION
Up to this point the ultrasound disturbance has been viewed as occurring in

a purely elastic medium in which no energy loss occurs. However. energy-loss
mechanisms do exist to one extent or another in all propagation media of

interest. They result in the conversion of some of the ultrasound mechanical
energy into heat. Thus, as the particles of the medium vibrate, viscous fric-
tion between them and their immediate neighbours reduces the amplitude of
the vibration (see Appendix C). Consequently, not all of the energy in the
wave is transmitted along the direction of propagation, but some remains at
each individual location as heat. The intensity, therefore, declines as the
wave travels. The ultrasound wave is said to suffer absorption as it propa-
gates. The mechanical energy extracted from the wave by absorption mechan-
isms is converted into heat in the medium.
A wide range of mechanisms can give rise to this absorption as well as
simple viscous friction. Such mechanisms generally involve the coupling of
the ultrasound energy into chemical or physical reaction equilibria in the
medium. Figure 2.12 is an illustration of such a process. The ultrasound
wave disturbs the equilibrium during one of the phases of the wave (for
instance the positive pressure phase) and energy is absorbed by the reaction
during this phase. Then, when the ultrasound wave moves into the next phase
(say the negative pressure phase) the energy is not returned from the reaction.
The reaction does attempt to return the energy and relax back to its original
equilibrium state but the energy-returning mechanism is not rapid enough.
These mechanisms are relaxation processes.
ADVANCED DURING
.....-------...
COMPRESSION
0~G
RELAXATION DURING
RA~FACTION
Figure 2.12 An equilibrium between two energy states, A and B, which may be
different chemical reactants or physical states of a material, may be disturbed by the
ultrasound wave. Energy from the wave may drive the reaction to the right during the
compression phase but not all of this energy is recovered by the wave during the rarefac-
tion phase when the reaction relaxes leftwards too slowly
2.8 ATTENUATION
Reduction of the intensity, for whatever reasons, as the wave propagates is

described as attenuation. Such attenuation can be caused by absorption,
scattering and specular reflection at a plane reflecting boundary as shown
diagrammatically in figure 2.13. In a complex inhomogeneous medium such
;.
~
IiO'
IiO'
ABSORPTION ;.
IiO'
.......
IiO'
,,...
;.
.4
;. r IiO'
-t-
~
EOo
SCATTERING
.,
~~
IiO'
90
i
IiO'
REFLECTION
~
I ~
/
EOo
\
OVERALL E;Io
ATTENUATION
,lo 41
EOo /
Figure 2.13 A schematic representation of how the main mechanisms of attenuation
act. In absorption, ultrasound energy is converted to heat all along the path of the wave,
thereby resulting in reduction of ultrasound intensity along the path. Scattering occurs
at small reflectors in the wave and results in reflection of the ultrasound energy away
from the original propagation path, thereby reducing the intensity downstream. In
specular reflection some of the energy in the wave is reflected backwards, thereby
reducing the intensity downstream. In general in tissues all of these mechanisms act
simultaneously
as the tissues of the body, all three of these mechanisms come into play to one
extent or another and produce an overall attenuation of the wave.
This attenuation is manifested as an exponential decline of intensity (I)
with distance (z) travelled by the wave (equation 2.14)
(2.14)
This relationship is illustrated in figure 2.14. 10 is the initial value of the
intensity at z = 0 while 0( is the overall intensity attenuation coefficient (see
Appendix A). The intensity declines by a factor of 0.5 in every (0.7/0() (m),
the half-value thickness in the medium. Thus the greater the value of the
attenuation coefficient the more rapid is the decay, as shown in figure 2.14,
and the shorter the half-value thickness.
Since overall attenuation is caused by the combination of absorption,
z
Figure 2.14 Attenuation results in exponential decline of the ultrasound intensity
with distance travelled. IX is the attenuation coefficient
scattering and reflection, each of these mechanisms may be viewed as con-

tributing to the overall attenuation coefficient (equation 2.15)
oc=oc (absorption)+oc (scattering)+oc (reflection) (2.15)
The exponential decline of intensity with distance may be alternatively dis-
played on the logarithmic Intensity Level (dB) scale, where the reference
intensity used is the initial intensity (10) (equation 2.16)
1010g 10 (///0)= -(lOoclog 10 e)z
= -4.3ocz (2.16)
=J1Z
This relationship is shown graphically in figure 2.15. It is a straight line
through the origin, of slqpe J1 (dB/m) where
J1= -4.3 oc (2.17)
The greater the value of oc, the steeper the slope (J1 greater) indicating a more
highly attenuating medium.
INTENSITY
LEVEL (dB)
112 > III
z(m)
Figure 2.15 The attenuation which occurs with distance, z, may be represented as a
linear reduction of the Intensity Level in dB (reference intensity taken as the initial
intensity, 10)' The steeper slope, higher value of /-l, relates to a more highly attenuating
medium
The logarithmic overall attenuation coefficient /1, in dB/m is the most

commonly used parameter to quantify attenuation in biological tissues.
Table 2.4lists approximate values of /1 at 1 MHz for a range of tissue media.
Table 2.4 Values of Logarithmic Attenuation Coefficient at 1 MHz for some Tissue
Types
Overall attenuation coefficient

Tissue at 1 MHz, fJ- (dB/m)
Water 0.002
Blood 9
Fat 60
Brain 90
Nerve 90
Muscle 350
Liver 90
Kidney 90
Aqueous Humour 7
Lens 250
Lung 4100
Bone 870
Both absorption and scattering are strongly dependent on frequency and

in consequence the overall attenuation is also frequency dependent. Figure
2.16 illustrates some of the observed general dependencies of the logarithmic
attenuation coefficients on frequency, in the vicinity of the ultrasound diag-
Il (dB/m)
10'
MUSCLE
BRAIN FAT
LIVER
lONE
10~--------~----------~------
.1 10 f (MHz)
Figure 2.16 The attenuation characteristics of most tissues increase as the frequency
mcreases
nostic frequencies, for some tissues. The dependence on frequency may be

roughly summarised in equation (2.17)
(2.17)
where k is a constant, different for different tissues, and f is the frequency in
MHz. The logarithmic attenuation coefficient increases slightly more
strongly than the frequency rise.
2.9 BIBLIOGRAPHY
Dunn. F. and O·Brien. W. D .. Jr. (Eds). Ultrasonic Biophysics. Dowden. Hutchinson &
Ross Inc .. Stroudsburg. Pa. 1976
Edmonds. P. D. (Ed.). Ultrasonics. Academic Press, New York, 1981
Ensminger. D .. Ultrasonics. Marcel Dekker Inc., New York, 1973
Hazzard. D. G. and Litz. M. L., Biological Effects and Characterizations of Ultrasound
Sources. Castle House Publications Ltd. 1979
Hussey. M .. Diagnostic Ultrasound: an Introduction to the Interactions between Ultra-
sound and Biological Tissues. Blackie & Son, Glasgow, 1975
Kinsler. L. E. and Frey, A. R .. Fundamentals o{Acoustics. 3rd edn. John Wiley, New
York. 1982
Kremkau, F. W., Diagnostic Ultrasound: Physical Principles and Exercises. Grune &
Stratton. New York. 1980
McDicken. W. N .. Diagnostic Ultrasonics: Principles and Use o{Instruments, 3rd edn,
John Wiley. New York. 1981
Millner. R. (Ed.). Ultrasound Interaction in Biology and Medicine. Plenum Press. New
York. 1983
Rose. J. L. and Goldberg. B. B .. Basic Physics in Diagnostic Ultrasound, John Wiley.
New York. 1979
de Vlieger. M .. White. D. N. and McCready. V. R., Ultrasonics in Medicine, Excerpta
Medica. Amsterdam, 1974
de Vlieger. M. et al. (Eds). Hamlhook of Clinical Ultrasound. John Wiley. New York.
1978
Wells. P. N. T .. Biomedical Ultrasonics, Academic Press, London, 1977
White. D. N. (Ed.). Recent Advances in Ultrasound in Biomedicine. Vol. I, Research
Studies Press, Forest Grove, Or. 1977
Woodcock. J. P .. Ultrasonics. Adam Hilger Ltd. BristoL 1979
Annual Reviews
Linzer. M. (Ed.). Ultrasonic Tissue Characterization, U.S. National Bureau of Stan-
dards. Washington, annually since 1976
3 Generating and Detecting Ultra-
sound
In this chapter the basic means of creating and detecting ultrasound are dis-
cussed, together with the structure and operation of diagnostic transducers,
the ultrasound beam produced by these transducers and the main ways of
checking their performance.
(a) describe the piezoelectric effect;
(b) discuss the roles of half-wavelength resonance, damping and quarter-
wavelength matching in the operation of a piezoelectric transducer;
(c) draw the beam, with near field and far field, produced by a circular
transducer;
(d) show the ways of focussing such a beam by a refractive lens, by
internal crystal shaping and by a reflecting mirror arrangement;
(e) describe how a transducer may be operated in continuous wave
mode;
(f) show the ways that such a transducer may be driven in pulsed mode
and discuss the factors that affect pulse duration;
(g) broadly describe how the beam from a rectangular crystal differs
from the circular beam;
(h) describe a multi-element array transducer probe;
(i) show how composite beams from an array transducer can be elec-
tronically focussed;
(j) discuss the role of the piezoelectric transducer as a receiver/detector
of ultrasound;
(k) briefly describe the operation of a thermometer, a radiation balance
and liquid crystal layers as detectors of ultrasound;
(I) appreciate the need for measures to take care of the transducer probe;
(m) describe methods for testing the beam and measuring the overall
average intensity and the spatial and temporal distributions of in-
tensity, produced by a transducer.
3.2 PIEZOELECTRIC EFFECT
At the heart of all the diagnostic instruments used to generate and receive
ultrasound waves are crystals which display the property of piezoelectricity.
This property may be illustrated by considering the flat disc of the crystal
illustrated in figure 3.1. This crystal has a conducting silver alloy layer on
each of the opposite parallel faces. The piezoelectric effect has two comple-
mentary attributes.
(a) When a pressure is exerted tending to squeeze the crystal, an electrical

voltage develops between the two opposite faces. When there is no pressure,
there is no voltage and when the pressure is reversed in direction, the voltage
is also reversed in polarity. The voltage developed is directly proportional to
the pressure. Furthermore, if the pressure is alternating, that is cyclically or
sinusoidally changing in polarity, the voltage developed follows the same
pattern and is also alternating.
(b) If, on the other hand, a voltage from an external source is connected
(a) VOLTAGE +
+
PRESSURE
(b)
STRAIN +
+
VOLTAGE
(c)
Figure 3.1 (a) A piezoelectric disc has electrodes on the two parallel faces, with
electrical connections soldered to these electrodes. (b) When a stress or pressure is
applied across such a disc, a strain results and also a voltage develops between the
electrodes. The voltage is proportional to the pressure, whether the pressure is
positive or negative. This is the forward piezoelectric effect. (c) When a voltage is
applied across the piezoelectric disc, a strain develops across the thickness. This strain
is proportional to the voltage, whether the voltage is positive or negative. This is the
reverse piezoelectric effect
GENERATING AND DETECTING ULTRASOUND 31
across the crystal, it causes the thickness of the crystal to change, i.e. the
crystal is deformed or strained. The magnitude of the strain is directly
proportional to the voltage applied. When there is no voltage, there is no
strain. When the voltage is reversed in polarity the strain is also reversed in
polarity. If the voltage applied is an alternating voltage, so also is the
resulting strain, and that strain alternates in step with the applied voltage.
Thus, the piezoelectric effect has a number of reciprocal aspects. The

property described in (b) above, may be exploited to generate ultrasound. If
the applied alternating voltage has a frequency of 1 MHz, then the crystal
vibrates at 1 MHz, and ultrasound of that frequency is generated. The
property described in (a) above may be utilised to detect or receive an ultra-
sound wave. If such a crystal is placed in an ultrasound wave it experiences
an alternating pressure of the frequency of the ultrasound. As a result an
alternating voltage of the same frequency is created across the crystal disc. If
means are available to display or record that voltage, one obtains a record of
the ultrasound wave. Thus, property (b) is the ultrasound-generating aspect
of the effect, while property (a) is the ultrasound-detecting aspect of the
piezoelectric effect.
3.3 PIEZOELECTRIC MATERIALS
A number of naturally occurring crystalline materials display the property of

piezoelectricity. Single crystals of quartz, Rochelle salts and tourmaline have
been widely used. In each of these crystals there is an orderly three-
dimensional arrangement of positively and negatively charged ions. When
these arrangements are distorted in certain ways, the charges are either
moved apart or closer together. In this wayan electrical voltage of either
polarity is generated. On the contrary when an electrical voltage is applied
across certain directions, the arrays of charges are either moved apart or
closer together. Thereby strain is developed along the direction of movement
of the charged layers.
Certain materials that can be artificially produced also display piezo-
electricity. Such materials as barium titanate, lead zirconate titanate (PZT),
lead titanate and lead metaniobate, all can have piezoelectric properties
induced in them. Structurally, they are also crystalline, but because any given
piece consists of many discrete crystals or grains interlocking and adhering
together, they are often described as polycrystalline. Piezoelectric properties
are induced in them by applying a high D.C. voltage across a disc of the
material in the required direction. This ability to have the piezoelectricity
induced electrically has led to these materials being classified asferroelectric
materials. This follows from analogy with soft iron, which can have magnet-
ism induced in it by surrounding it with a D.C. current-carrying coil, and is

classified as a ferromagnetic material (see Appendix E).
If the temperature of a ferroelectric material is raised above a critical
value, called the Curie temperature, the piezoelectric properties are lost.
3.4 SINGLE-ELEMENT TRANSDUCER
The transducer probe is the mount, or housing, for the appropriate piezo-
electric crystal disc. Most commonly, the transducer discs are circular or
semicircular but rectangular transducers also find application. One import-
ant dimension of the disc is its thickness, which determines the resonant
frequency of the disc or the frequency of maximum sensitivity of the disc.
For a disc of constant thickness subjected to an alternating voltage of con-
stant amplitude but varying frequency, the amplitude of the strain behaves
as shown in figure 3.2(a). At a particular frequency, the fundamental fre-
quency fo, which is related to the thickness of the disc (d) by equation (3.1):
.f~ = c/2d (3.1)
STRAIN
(a)
f (Hz)
VOLTAGE
(b) f (Hz)
Figure 3.2 The resonant behaviour of the piezoelectric disc: (a) In response to an
alternating voltage of constant amplitude and increasing frequency, the alternating
strain amplitude undergoes resonances atio' 3io' Sio' etc. (b) In response to an alter-
nating pressure of constant amplitude and increasing frequency, the alternating voltage
amplitude experiences resonances at i o' 3io' Sio' etc.
the disc undergoes maximum strain. The piezoelectric disc resonates. As the
frequency is further increased, other strain resonances occur at higher odd
harmonic frequencies, i.e . at 3fo, 5fo, 7j~, etc.
Equation (3.1) may be re-arranged tus,
d=c/2fo (3.2)
= Ao/2
or the disc is a half-wavelength thick at the fundamental frequency f o. Thus

the resonance is termed the half-wavelength resonance for the crystal.
Furthermore, the higher harmonic resonances occur at frequencies at which
the crystal thickness is an odd number of half-wavelengths.
When the crystal is operated in the reciprocal mode and is receiving or
detecting ultrasound, it displays resonances at the same discrete frequencies.
This is illustrated in figure 3.2(b).
The two opposite parallel faces of the crystal are electroded or coated with
a thin metallic layer. Silver may be used for this application and the coating
is achieved by vacuum deposition. The flat surfaces of the disc are exposed
under a bell-jar, in which a vacuum is established. A high electric current is
passed through a fine-gauge silver wire under the bell-jar, melting and vapor-
ising the wire. This vapour condenses and solidifies on the exposed surfaces
of the crystal.
Subsequently, two electrical connections are soldered to those opposite
faces, close to the periphery. In the soldering operation care must be taken
to use the minimum of heat so that there is no danger of heating the crystal
to the Curie temperature.
The disc is mounted close to one end of a cylindrical tube housing (see
figures 3.3 and 3.4). The flat side of the disc closer to the end of the tube is the
front face of the crystal, from which the ultrasound wave is emitted. The
tube is metallic or contains a layer of metal to serve as a Faraday cage. This
ensures that no external electromagnetic fields induce interference voltages
in the crystal or its connecting wires. It further minimises the emission of
such electromagnetic radiation from the crystal and the connectors.
The front face of the crystal is coated with a thickness of a polymeric or
plastic substance. This layer serves two purposes. The first is to mechanically
PL ASTIC FACING
CRYSTAL HOUSING
A IR or
PLASTIC ELECTRICAL
CONNECTIONS
Figure 3.3 The construction of a transducer probe, incorporating the piezoelectric

disc with electrodes and electrical connections, the housing, the front facing and the
non-damping backing, for continuous wave operation
PLASTIC FACING
Figure 3.4 The construction of a transducer probe, incorporating the crystal with
electrodes and electrical connections, the housing , the front facing and the damping
backing block, for pulsed operation
protect the crystal from scratching and impact. Scratching could remove the
electrode layer and impact forces could shatter the brittle crystal. The second
purpose is to provide acoustic coupling between the crystal and the body
tissue medium into which ultrasound is to be transmitted. Strong reflection
prevents good coupling, and this would occur iffor instance, the crystal were
placed directly on the skin . This is because the acoustic impedance of the
transducer crystal material is much greater than that of the skin. For opti-
mum coupling between the two , a layer of material having an acoustic
impedance Z" which is equal to the geometrical mean of the two impedances
involved, is required . This criterion is shown in equation (3.3) :
(3 .3)
where Z c and Z s are the acoustic impedances of the crystal material and skin
respectively. An epoxy resin may be formulated with added. aluminium
powder to have this requisite acoustic impedance.
If, furthermore, the thickness of this plastic matching layer is set to one
quarter-wavelength at the working frequency , usually fo , the fundamental
resonant frequency of the crystal , perfect transmission of the ultrasound of
that frequency occurs through the layer in both directions. The installation
of such a layer ensures so-called quarter-wavelength matching between
crystal and skin.
If the transducer is to be used to generate and/ or receive continuous wave
ultrasound , then this may be all there is to the transducer probe, as shown in
figure 3.3. Often a plastic plug is installed behind the crystal for ease of con-
struction . If the transducer is to be used for pulsed mode operation, a further
element is required in the transducer probe as shown in figure 3.4. This
element is a damping layer behind the back face of the crystal. It consists
usually of a plug of an epoxy resin packed with tungsten metal powder. It
extracts and absorbs some of the energy associated with the crystal and so
helps to reduce the duration of pulsed ringing of the crystal.
Some additional damping is often incorporated in the form of a small
electrical resistance in parallel with the transducer crystal. This electrical
damping complements the mechanical damping action of the damping block

behind the crystal.
One overall effect of these mounting techniques is to modify the resonant
response of the transducer disc from that shown in figure 3.2 to one extent
or another. Broadly, the effect of added damping is to reduce the magnitude
of the resonance, i.e. to make the disc less sensitive, and also to broaden the
width, on the frequency scale, of the resonance curve. This effect is shown in
figure 3.5.
STRAIN
(a)
f
VOLTAGE
(b)
f
Figure 3.5 The damped resonant behaviour of a piezoelectric disc with damping
backing block: (a) Same situation as in figure 3.2 (a), the resonance is less high and is
spread over a wider range of frequency atIo' 310 , 510 , etc. (b) Under the same circum-
stances as in figure 3.2 (b), each resonance is less high and less sharp
3.5 CIRCULAR ULTRASOUND BEAM
When a circular crystal transducer is caused to vibrate in the thickness mode

by an appropriate electrical voltage, it creates an ultrasound wave disturb-
ance in the medium in contact with the probe as shown in figure 3.6. This
disturbance is confined to that portion of the medium in front of the trans-
ducer. This spatially delimited ultrasound wave is called the ultrasound
beam.
The beam initially remains cylindrical along the direction of the beam
axis, a line perpendicular to the centre of the transducer crystal. After some
r·
r
- - - - - - - - - - - - - - - - - - - - - - - - -A;)(-t5- -
L·~------K.:
I
~"=l<lf----- Zn.f.----cC:O~...:
I
d I C'
NEAR FIELD : FAR FIELD
Figure 3.6 A cross-sectional cut through a diameter of the circularly symmetrical
ultrasound beam produced by a circular transducer of radius r, under continuous wave
operation. The beam may be broadly divided into the Near Field and the Far Field
distance, however, the beam starts to diverge as is shown in figure 3.6.

Before the point of divergence of the beam, it is described as the near field,
or Fresnel zone, and the diverging part of the beam is the far field, or Fraun-
hofer zone.
If the transducer disc is behaving ideally, i.e. the front face is vibrating in
perfect parallelism in relation to the back face, it is possible to calculate the
amplitude of the pressure changes in the medium into which the wave is
travelling. If this calculation is done for points along the axis of the beam,
then the result is as shown in figure 3.7. Within the near field region, there is
a series of pressure maxima and pressure nulls along the axis. At the higher
frequencies, the number of such maxima and nulls is increased. And, the
larger the radius of the crystal, the more such variations in the amplitude of
~ax
o 2
z (m)
Figure 3.7 Along the beam axis, the z axis, the amplitude of the ultrasound pressure
fluctuates between a maximum and zero within the Near Field. The variation shown
refers to a transducer of 5 mm radius transmitting at 10 MHz into water. The actual
number of such fluctuations and their locations along the axis would depend on both
the radius and the frequency
the pressure on the axis occur. Where the last of these pressure amplitude
maxima on the axis occurs is the point of transition from near field to far
field.
The length of the near field (zn.r.> is a function of ultrasound frequency (f)
and transducer disc radius (r), as well as the speed of propagation of
ultrasound, as shown in equation (3.4):
r2f c
Z ----
nf. - C 4f
Ie 4
r2
~ T at ultrasound frequencies (3.4)
Table 3.1 shows the values of the length of the near field for a number of
ultrasound frequencies and disc radii for ultrasound propagation in water at
3TC.
In the far field, where the beam is diverging, the amplitude of the pressure
variation varies in extremely complicated ways depending upon the frequency
and the diameter of the crystal as illustrated in figure 3.8. When the radius of
the crystal is reduced, more sidelobes tend to develop. This means that there is
some of the power in the be?m in pockets to the side of the main lobe. It is the
main lobe that is depicted in figure 3.6. The angle of divergence of the far field
15, shown in figure 3.6, depends on the same three parameters controlling the
length of the near field, as indicated by equation (3.5):
. " 0.61 c
sin u = - -
fr
0.6l1c
(3.5)
r
Various relevant values of this angle are tabulated in table 3.1.
Table 3.1 Lengths of Near Field (zn f) and Angle of Divergence in Far Field (b) in
Water at 37 C
G
Disc radius Frequency zn,f. 0

(m) (MHz) (m) (0)
0.005 1.0 0.016 10.8

10.0 0.167 1.1
0.010 1.0 0.065 5.4
10.0 0.667 0.5
0.020 1.0 0.263 2.7
10.0 2.667 0.3
MAIN LOBE
Figure 3.8 Two of the complications of the Far Field of an ultrasound beam are the
divergence of the main lobe of the beam, as indicated in figure 3.6, and the emergence of
side lobes, which take some of the energy available and are not directed along the axis.
The number and actual directionality of the side lobes depend on transducer radius and
the operating frequency
As indicated by figure 3.6 the ultrasound beam is directional, travelling

out from the front face as an extension of the probe. Virtually all of the
power is confined within this beam. In the near field the wave is largely plane
longitudinal and if attenuation can be neglected, the average intensity re-
mains constant along the beam. In the far field the wave becomes spherical
rather than plane and the average intensity declines inversely as the square
of the linear distance from the centre of the crystal, since the power is spread
over an increasing area as it propagates.
For medical diagnostic uses, it is desirable to operate as close to the near
field as possible and to avoid operating far into the far field. In most practical
situations some of the far field is used and the undesirable effects of the
widening and weakening of the beam must be tolerated. To minimise these
ill effects, reference to table 3.1 shows that a high-frequency transducer with
a small radius can have a near field long enough to extend to tissue depths
of interest. If the frequency is lowered, the transducer radius must be in-
creased in order to achieve a long near field.
3.6 FOCUSSING
Occasionally it is useful to further intensify or narrow the ultrasound beam

in the near field. This can be achieved by using focussing techniques. Such
focussing can be achieved, for example, by use of an acoustic lens as shown
in figure 3.9(a), which is attached to the front face of the transducer disc.
Indeed the protective matching layer at the front of the crystal may be
accurately machined or ground to form such a lens. The refraction which
occurs at the curved surface of the lens as the ultrasound encounters this
boundary travelling out from the crystal, causes the part of the ultrasound
wave around the periphery of the beam to be directed more towards the axis
of the beam than the part of the wave travelling closer to the axis. In this
way a focussed beam is achieved as shown in the figure.
The use of the artificial ferroelectric piezoelectric crystals allows another
type of focussing to be achieved by appropriate preforming of the crystal
itself, as shown in figure 3.9(b), before the piezoelectricity is induced electric-
ally. This internal focussing technique achieves the required intensification of
the beam. It also allows the protective matching on the front face of the
crystal to remain a constant quarter wavelength thickness, which, of course,
does not happen when the layer is used to form an acoustic lens. In this way
such a transducer can be made much more sensitive than one with an
acoustic lens. Another focussing method is shown in figure 3.9(c) using a
mirror or reflector technique.
C YSTAL
(a) FOCAL
ZONE
CRYSTAL
(b)
MIRROR
(c)
Figure 3.9 The main techniques for focussing the beam of ultrasound produced by a
single-element transducer: (a) Refraction at the front surface of the converging lens
directs the outer portions of the beam towards the axis, thereby effecting focussing.
(b) A bowl-shaped crystal similarly directs the outer parts of the beam towards the
axis, thereby producing the so-called internal focussing.
(c) The diverging beam from a small transducer when reflected from a spherical or
paraboloidal mirror, produces convergence or focussing of the beam
The result of focussing is to produce a higher average intensity of the

beam in the focal region, i.e. all of the power is made to travel through a
much smaller cross-sectional area. Intensification of the order of ten-fold
can be achieved. Beyond the focal zone, the beam proceeds to diverge again.
It is not possible with ultrasound to achieve a very small focal point or focus,
rather a focal zone of finite cross-sectional area and also of some length is
what occurs.
3.7 CONTINUOUS WAVE EXCITATION OF TRANSDUCER
The transducer, of the type shown in figure 3.3, may be caused to transmit
ultrasound continuously if it is constantly supplied with an appropriate
alternating voltage. For the maximum output ultrasound intensity, the fre-
quency of this alternating voltage must match the resonant frequency of the
crystal, as determined by the thickness of the crystal. Such an alternating
voltage may be generated by an electronic oscillator. This is the mode of
operation used in most diagnostic Doppler instruments.
3.8 PULSED EXCITATION OF TRANSDUCER
A transducer such as that shown in figure 3.4, may be pulse excited simply
by discharging a capacitor through the transducer crystal. The circuit dia-
gram for achieving this is shown in figure 3.10. The capacitor is first charged
to a high voltage, perhaps 500-1500 V. Then as required, the capacitor is
discharged through the crystal, through a switch S2. This switch is an
Figure 3.10 The basic elements in the circuit used to pulse-excite the transducer
electronic device which is caused to close at some desired repetition fre-

quency, the pulse repetition frequency (p.r.f.). The resulting spike of current
passing through the transducer acts on the piezoelectric disc in a manner
similar to a drumstick blow to the membrane of a drum. The transducer
proceeds to vibrate or ring in the thickness mode. This vibration is damped
and decays after a short period of time. The resulting movement of the
crystal face (and also the resulting voltage developed across the crystal) looks
something like the damped sinusoid shown in figure 3.11. The basic ringing
frequency of the vibration is the same as the resonant frequency determined
as indicated earlier by the thickness of the crystal. The severity of the damping
is determined by the damping incorporated in the transducer probe backing.
Thus the pulse width, or more correctly the pulse duration, is set by the degree
of damping.
CURRENTl
SPIKE
(a) L-.......;~_ _ _ _ _ _ _ _ _ __
CRYSTAL
STRAIN
or
VOLTAGE
t
(b)
Figure 3.11 (a) When a capacitor is discharged through the crystal, a spike of current
flows through the crystal. (b) As a result of the current spike, the crystal undergoes
damped oscillation or ringing across its thickness. Accompanying this vibratory strain
there is also a damped voltage oscillation across the crystal. The greater the damping
present the shorter is the duration of this ringing
Another way of producing pulsed excitation of a transducer is to gate a

continuous alternating voltage before connecting it to the crystal as shown
in figure 3.12. This involves electronically switching the A.C. voltage source
into contact with the transducer and switching it off after a desired pulse
duration. The frequency of the applied voltage is chosen to match the funda-
mental resonant frequency of the crystal. The duration of the gate is a major
determinant of the ultrasound pulse duration. Damping is also required to
rapidly reduce the ringing when the A.C. voltage is switched off.
In either form of pulsed operation, it is necessary that there be a minimum
number of cycles of the main operating frequency (some five or more) in the
pulse, so that the pulsed ultrasound produced be coherent or mainly of that
one frequency. If a very brief pulse were used, then very many higher fre-
quencies would be present in the transmitted wave and there would be less
power in the operating frequency. Clearly the higher the operating fre-
quency, the shorter the useful pulse that can be generated.
(a)
(b) I
PULSE I
;--OU RAT 1c)N"";

Figure 3.12 Pulsed excitation of a transducer may be achieved by switching a source of
continuous alternating voltage as in (a), across the electrodes of the transducer for a
controlled duration as in (b). Such switching is sometimes referred to as gating
3.9 RECTANGULAR ULTRASOUND BEAM
In a number of diagnostic instruments rectangular crystals find application.

Since such a transducer is not symmetrical about its centre point 0 (figure
3.13), neither is the beam produced symmetrical about the axis. The beam
cross-section is broadly rectangular. But, there is not in this case as clear-cut
a transition between near and far fields. Indeed, this transition range may be
viewed as a third part of the beam. This transition range roughly stretches
from b2 /4), to a 2 /4)" the approximate lengths of the near fields for circular
transducers of diameters a and b, as shown in figure 3.13.
The approximate length of the near field is thus broadly determined by the
narrower width of the crystal.
3.10 MULTI-ELEMENT ARRAY TRANSDUCERS
Of increasing importance in diagnostic applications are instruments based

on multi-transducer arrays. In most cases these are linear arrays ofrectangu-
lar transducers as shown in figure 3.14. The construction of the total probe
is reminiscent of that for a single element damped transducer as shown in
GENERA TING AND DETECTING ULTRASOUND 43
(a)
TOP VIEW
b
~
---------------------------Z
<>---- b 2/4 A - - - t >
(b)
(c)
Figure 3.13 (a) The front of a rectangular crystal of dimensions a x b. (b) The top
view of the approximate shape of the beam of ultrasound produced by such a rectangular
crystal, with Near Field and Far Field features . (c) The side view of the beam produced
by the rectangular crystal, showing a Near Field longer than that seen in top view.
There is therefore a span of the beam intermediate between the Near Field proper (that
shown in top view) and the Far Field proper (that shown in side view)
PLASTIC FACING
\ n CRYSTAL ELEMENTS
c, DA~:~K:
HOUSING
I ~CTRICAL
~~:,:::::::::::::::::::::::::=====~.I CONNECTIONS
ISOLATORS
Figure 3.14 The main features in a multi-element linear array transducer, incorporat-
ing the n crystal elements with their electrodes and electrical connections, the front
facings, the insulating isolators between the elements, the damping block and the
overall housing
figure 3.4. A new vital component in the array probe is the set of slices of
mechanical and electrical isolating material, cork or rubber, located between
each pair of crystals to minimise any mechanical or electrical coupling be-
tween the crystals .
Each crystal element has a much lower height (along the array) than
width and if operated alone would have a very short near field. Usually,
however, they are pulse activated in neighbouring groups. Such a group

would approximate to a rectangular transducer with a longer near field than a
single element. The composite beam would have as its axis, the axis of the
central element of the group.
Among the useful possibilities with the multi-element linear array, is
dynamic focussing of the beam by electronic means. Such focussing of the
beam may be achieved by careful control of the sequence of excitation of the
active elements. Thus, as shown in figure 3.15, consider five elements to be
active at any moment. Elements one and five are first excited, then after a
small delay elements two and four, and finally element number three after a
further delay. The effect of this is to produce a composite beam which is
initially directed towards the axis of element number three, in effect a
focussed composite beam. By controlling the delay between the times of
1fZl
21Zl
30
4fZl
V(
) '!YVAVEFRONT
) 'MOTION
5~
Figure 3.15 Electronic beam focussing, achieved by controlling the phase of the
pulsed excitation of the five elements acting as a group at a time
excitation of the different elements, the degree offocussing can be controlled,

and the beam can be focussed close to the transducers or far away. Such
focussing is in the plane of the array but does not appreciably affect the
width of the beam in the direction perpendicular to this plane. To achieve
some focussing in the width direction either internal focussing by means of
concavity in the shape of each element or shaping of the plastic protective
layer into a cylindrical acoustic lens is employed.
3.11 PIEZOELECTRIC TRANSDUCERS AS DETECTORS

OF ULTRASOUND
A piezoelectric element may also be used to detect and measure ultrasound.

As discussed in section 3.2, when such an element experiences a pressure, a
voltage is generated across it, with a higher voltage being produced by a
higher pressure. Indeed, the sensitivity S, of such crystal as a detector may be
defined as the ratio of voltage (e) produced to acoustic pressure (p) applied
(equation 3.6)
S=e/p (3.6)
In practice the sensitivity depends on the material of the crystal, the use
of the crystal at resonance, the amount of damping, the use of quarter
wavelength matching and the electrical circuit (the amplifier) into which the
transducer is connected.
Thus lead zirconate titanate (PZT) is more sensitive than barium titanate
which is in turn more sensitive than quartz. Sensitivity is greatest at the half-
wavelength thickness resonant frequency, but the sensitivity is reduced when
more damping is associated with the probe. Quarter wavelength matching
optimises the transfer of acoustic pressure from the medium to the piezo-
electric element and hence improves sensitivity. Finally, electrical matching
into a high input impedance tuned amplifier ensures that the overall sensi-
tivity is maximised.
Note that the acoustic pressure causing the crystal to generate the voltage
is the instantaneous average pressure on the front face of the crystal. If the
crystal is small relative to the wavelength, this averaging is over a small
possible range of pressure. But if the crystal is large relative to the wave-
length, there may be a wide range of pressures involved in the averaging and
the orientation of crystal to ultrasound wave also affects the response. Note
that the best response is found when the plane longitudinal wave is per-
pendicularly incident on the front face. As the direction of approach of the
wave to the transducer face swings away from the perpendicular the re-
sponse falls off. Thus, in the situation that is assumed to approximately
pertain in diagnostic ultrasound, where the plane longitudinal wave travels
out from the generator probe and back to the receiver probe (often the same
probe as the generator probe) along the direction of the beam axis, the
optimum wave detection is achieved.
3.12 OTHER DETECTORS OF ULTRASOUND
The ultrasound wave may also be conveniently detected and measured in a

number of other ways.
If the medium is absorbing, and therefore being heated by the ultrasound
wave, the resulting local temperature rise can be measured with a small
thermocouple or thermistor. In such a set-up the measured temperature
rises after the switch-on of the wave as shown in figure 3.16. The initial rate
of rise of the temperature is related to the ultrasound intensity and from the
initial slope of the graph of figure 3.16, the intensity may be calculated.
When a reflecting surface is placed perpendicular to the ultrasound beam,
HIGH INTENSITY
ENSITY
~ t
START
Figure 3.16 The rise in temperature at a point in an absorbing medium, after the start
of ultrasound irradiation, at two different intensities
a radiation force acts on that surface. This force F, is proportional to the

intensity (equation 3.7)
2AI
F=- (3.7)
c
for a perfectly reflecting surface (i.e. R = 1). Here A is the area of the beam
intercepted by the reflector, c is the speed of propagation in the liquid
medium before the reflector and I is the average intensity in the intercepted
part of the beam.
This force may be measured with a sensitive balance as shown in figure
3.17. The smaller the reflector surface intercepting the beam, the finer the
intensity measurement in the beam.
PROBE
UID MEDIUM
Figure 3.17 An experimental set-up in which a sensitive balance may be used to

measure the radiation force due to an ultrasound wave
Relative distribution of intensities in a beam may be envisaged by means

of colour changes in either cholesteric liquid crystals or starch/iodine blue,
caused by the ultrasound intensity. A plastic membrane coated with either
of these substances is placed perpendicular to the beam axis. The distribution
of intensities in the beam produces a distribution of coloured profiles which

image the intensity pattern as shown in figure 3.18.
Figure 3.18 Different coloured rings, or other shaped regions, of the liquid crystals,
would denote areas of different intensities in the ultrasound beam traversing the crystals
3.13 CARE OF TRANSDUCER PROBES
The piezoelectric materials used in the transducers are very brittle. Therefore,
care must be taken not to subject the probes to impact forces, such as being
dropped on the floor. If the crystal is cracked the probe can be useless. The
metal electrodes on the crystals are not strongly bonded to the crystal ma-
terial and can be readily detached by scratching. Occasionally, the protective
plastic layer may also be removed by abrasion and scratching. Surface
scratches on this plastic layer affect the focussing and the matching proper-
ties of the layer. The front face of the probe should therefore be handled with
great care and when being cleaned should be washed and, if necessary, dried
very gently.
The housing of the probe is usually fairly robust, but the probe as a whole
should not be dropped as this may dislodge or crack the crystal inside.
Finally, the electrical connections to the crystal should be kept clean, free
of oil, coupling agent, grease and dust, since these could affect the electrical
matching to the pulse generator and receiver amplifier.
3.14 TESTING OF TRANSDUCERS
Many techniques may be employed to assess the performance of a transducer

either as a generator/transmitter or as a detector/receiver of ultrasound.
The absolute intensity in a beam may be measured with a radiation bal-
ance. By choosing the size of the reflector on the balance the overall average
intensity may be measured or else the average intensity in a portion of the

beam.
The profile of the intensity distribution at particular locations in the beam
may be determined using a cholesteric liquid crystal method.
The fine details of the intensity distribution in all three dimensions may be
measured with the system of figure 3.19, and depicted as beam profiles. A
beam profile is a graph of the intensity at points across a diameter of the
beam. Usually, beam profiles must be measured at different distances from
the transmitting transducer crystal. The experimental set-up of figure 3.19
consists typically of a bath of water in which the transducer whose beam is
to be studied is placed. There is also a relatively small detector (either a
crystal hydrophone or a thermocouple) which is placed in the ultrasound
beam and which can be moved in that beam to any required location.
x
FIXED
TX PROBE
BASE
Figure 3.19 An experimental set-up, using a receiving transducer or hydrophone which

can be moved in a controlled fashion in three perpendicular directions, to measure the
distribution of intensities in the beam of a transducer of interest
The results of some measurements of beam profiles are shown in figure

3.20. In the case shown in figure 3.20(b), there is not symmetry in the beam
profile about the axis. When a circular transducer is in question, it is common
to assume circular symmetry in the beam and therefore symmetry of the
beam profiles across the diameter as shown in figure 3.20(a). However, due
to erroneous mounting of the transducer crystal, or else incomplete e1ec-
troding of the crystal faces with conducting metal, asymmetry can occur in
the beam profiles.
These beam profiles plot relative intensity rather than absolute intensity
(a)
o 10mm
(b)
o 10mm
<I
TRANSDUCER
DIAMETER
Figure 3.20 Two possible relative intensity profiles across diameters of the ultrasound
beam, one (a) symmetrical and the second (b) quite asymmetrical
against distance across the diameter. In order to use this technique to

measure absolute intensity, the detector probe must be calibrated in ab-
solute intensity.
Another useful method of assessing the beam of a pulsed transmitter
transducer also acting as a receiver is the determination of iso-echo contours.
This is described in section 4.13.
The sensitivity of a transducer as a receiver may be measured by placing
it in an ultrasound beam of known intensity (measured by means of radiation
balance or thermal detector) or acoustic pressure and measuring the voltage
produced. By choosing beams of different intensities a graph of generated
voltage versus intensity or ultrasound pressure may be drawn for the
transducer.
3.15 BIBLIOGRAPHY

Ensminger, D., Ultrasonics, Marcel Dekker Inc., New York, 1973
Hazzard, D. G. and Litz, M. L., Biological Effects and Characterizations of Ultrasound
Sources, Castle House Publications Ltd, 1979
Hussey, M., Diagnostic Ultrasound: An Introduction to the Interactions between Ultra-
sound and Biological Tissues, Blackie, Glasgow, 1975
Kinsler, L. E. and Frey, A. R., Fundamentals of Acoustics, 3rd edn, John Wiley, New
York, 1982
Millner, R. (Ed.), Ultrasound Interaction in Biology and Medicine, Plenum Press, New
York, 1983
Rose, J. L. and Goldberg, B. B., Basic Physics in Diagnostic Ultrasound, John Wiley,
New York, 1979
de Vlieger, M., White, D. N. and McCready, V. R., Ultrasonics in Medicine, Excerpta
Medica, Amsterdam, 1974
de Vlieger, M. et al. (Eds), Handhook of Clinical Ultrasound, John Wiley, New York,
1978
Wells, P. N. T., Biomedical Ultrasonics, Academic Press, London, 1977
Woodcock, J. P., Ultrasonics, Adam Hilger Ltd, Bristol, 1979
Annual Reviews

ards, Washington, annually since 1976
4 A-Mode Scanning Instruments
The earliest medical diagnostic ultrasound instrument was the A-Unit.

Nowadays it is not itself of great importance but it is still at the heart of the
more advanced types of instruments and therefore warrants some special
attention. An understanding of the A-mode instrument is in many respects a
prerequisite for understanding the more developed machines.
(a) describe the principle of pulse echo-ranging;
(b) explain the importance of knowing the average speed of propagation
in echo-ranging;
(c) describe the A-mode display;
(d) outline schematically an A-mode instrument, and indicate the role
and action of each functional block in the device;
(e) describe how linear measurements may be made using the caliper;
(f) broadly define axial resolution and discuss the factors that affect this
index of performance and how it may be measured;
(g) define sensitivity and discuss how it may be measured;
(h) describe the main artifacts that can occur in A-mode scanning;
(i) describe in general terms, the clinical applications of A-mode tech-
niques;
(j) outline the ways of obtaining permanent records of A-mode examina-
tions;
(k) describe the main types of tests to assess the performance of the
A-mode instrument;
(I) broadly indicate the limitations of A-mode scanning.
4.2 PULSE·ECHO RANGING
The basic principle of all the pulse-echo ultrasound instruments, in common

with the A-mode instrument, is the idea of echo-ranging. This is illustrated in
figure 4.1. The transceiver probe (probe capable of transmitting and re-
ceiving) sends out a pulse of ultrasound and then remains quiescent for a
period of time. The pulse of ultrasound travels through the medium at the
speed of propagation of sound in the medium. After some distance, it
encounters a reflecting boundary. At the boundary, the incident pulsed
wave is partitioned into reflected and transmitted components. The re-
flected component travels back towards the probe at the speed of propaga-
(c) ]
(d)
Figure 4.1 Ultrasound pulse echo formation. (a) A pulse of ultrasound is transmitted
from the transducer towards the reflector, L m away. (b) The pulse reaches the re-
flector Lie s later and some of the pulse is reflected back towards the transducer while
some is transmitted into the next medium (c). (d) After a subsequent Lie s the reflected
pulse arrives back at the transducer as an echo. Note that e mls is the speed of
propagation in the medium between the probe and the reflector
tion of ultrasound in the medium. At some time later this reflected pulse
reaches the transceiver as an echo and is detected by the transceiver. By
measuring the time (LIt) taken for the echo to return and knowing the speed
of propagation (c) in the medium, the depth (L) of the boundary producing
the echo may be calculated by equation (4.1)
cLlt
L=- (4.1)
2
This pulse-echo, or echo-ranging technique was developed during the Second

World War, using sound rather than ultrasound for the detection and
A-MODE SCANNING INSTRUMENTS 53
location of submarines under water. In more recent times, it has been used
for so-called echo location of shoals offish by trawlers and also for measuring
the depth of the sea. It is also widely used in industry for the detection of
flaws and cracks in metal structures, such as airplane frames. This application
is referred to as non-destructive testing (NDT). The echo-ranging principle
is the basis for the ultrasound navigation system of bats. It appears that bats
constantly emit pulses of ultrasound and are able to gauge their proximity
to buildings and other structures by echo-ranging. The principle is also used
for navigation by dolphins under water.
4.3 AVERAGE SPEED OF PROPAGATION
If the path of the ultrasound wave includes segments with different speeds of
propagation, use of the pulse echo equation of the previous section to calcu-
late the depth of reflection requires knowledge of the average speed of
propagation. Consider the case illustrated in figure 4.2, of two tissue layers
Figure 4.2 Pulse echo propagation across two different media of different thicknesses,
L and L z ' and with different speeds of propagation. (" j and ("2
j
with speeds c \ and c 2 • The time delay ,1 t for the echo to return from boundary
B, is the time taken to travel twice across both layers (equation 4.2)
2L\ 2L2
=-+-- (4.2)
c\ C2
This is the time taken to travel twice the total depth at the average speed Cay
(equation 4.3)
2(L\ + L2 )
,1/=----- (4.3)
Cay
The average speed of propagation therefore depends on the thickness of the

two layers as well as on their speeds of propagation (equation 4.4)
(4.4)
It must not be taken to be the arithmetic mean of the two speeds. In practice
the average speed used to compute depths and thicknesses of tissues is
pragmatically taken as the value that minimises the errors in these
calculations. Thus for human soft tissues in vivo, the accepted or standard
average propagation speed is 1540 m/s. In the situation where the foetal skull
bone is interposed in the beam the average speed used is 1600 m/s.
Thus in the calculation of depth in a multi-layered slice of soft tissue the
pulse-echo equation becomes
(4.5)
4.4 THE A-MODE DISPLAY
An example of an A-mode display is shown in figure 4.3 . Usually appearing

on an oscilloscope screen , it is basically a plot of echo signal amplitude (A)
against time delay (LIt) after initial pulse transmission. Thus at the origin of
the time delay axis there is a large amplitude deflection corresponding to the
transmission pulse. This is the so-called transmission artifact.
Because the pulse-echo equation relates time delay with depth via the
multiplying constant (cAv/2), the time delay axis of the A-mode display may
VOLTAGE t
AMPLITUDE I
Figure 4.3 A typical A-mode display, showing a train of echo pulses. displayed each
in turn further to the right (i.e. deeper) from the initial transmission pulse which
corresponds to the skin surface
be readily converted, by appropriate scaling, to a depth axis. Thus most
usually the A-mode display is considered a plot of echo amplitude versus
depth of the reflecting structure below the point of initial pulse transmission
(often the surface or skin).
4.5 SCHEMATIC OUTLINE OF A-MODE INSTRUMENT
Figure 4.4 is a schematic diagram of the important components in an A-mode

unit.
MASTER
TIMER
PULSE (p.r f.)
TIME GAIN
COMPENSATION
DISPLAY
T<>-+------'
L-----f_----!-<>Y
Figure 4.4 A schematic or block diagram of an ultrasound A-mode instrument,

showing the main functional components and the interconnections between them
(a) Probe
The probe houses the piezoelectric crystal and all of its important aspects
were discussed in the previous chapter. In this instrument it functions both
as a transmitter and a receiver of ultrasound. i.e. it is a transceiver.
(b) Pulse Generator
The nature of the electrical pulse generator was also described in the previous
chapter. Its task is to provide an electrical current pulse or hammer-blow to
the transducer crystal. It produces this electrical stimulus when demanded
by the pulse repetition frequency controller, the master timer.
(c) Receiver Amplifier
The amplifier is an electronic component which takes into its input the
voltages produced on the transducer crystal by ultrasound echoes, and sends
out from its output larger, i.e. amplified, versions of these voltage pulses. It
should amplify each voltage linearly, i.e. all voltages multiplied by the same
factor.
In many instruments this amplifier is tuned to preferentially amplify the
main operating frequency (occasionally termed the rf or radio frequency)
thereby improving the signal amplification in comparison with that of any
extraneous or noise voltages. However, the multiplying factor or amplifica-
tion factor, is varied during the receiving phase of the transceiver by the time
gain compensation component in the A-mode instrument.
(d) Time Gain Compensation (TGC)
Time Gain Compensation (TGC) is also referred to as Swept Gain. The idea
behind this element in the instrument is the fact that the deeper the echoing
structures, i.e. the further away from the probe is the echo-producing
boundary, the more attenuation does the echo from that boundary ex-
perience before it is received at the probe. Thus, two similar boundaries, one
positioned close to the probe and the other positioned far from the probe,
would produce widely different echo strengths. The more remote boundary
would produce a very weak echo compared with that from the nearer
boundary. One might deduce that there are significant differences between
the two boundaries, whereas they are in fact similar. In order to try to display
the two echo strengths as being comparable, as should happen from the
nature of the boundaries, time gain compensation is introduced. This com-
pensation consists of amplifying the deeper (later) echo signal voltages more
than the closer (earlier) echo signals. Thus, the later an echo arrives, the
more gain it experiences in the receiver amplifier. The so-called Time Gain
Compensation (TGC) curve, illustrated in figure 4.5 is a graph of the ampli-
fication factor plotted against the time delay after the initial pulse is trans-
mitted. Since from the basic principle of echo-ranging, these time delays are
directly proportional to depth, this graph may also be regarded as a graph of
GAIN
(dB)
FINAL
~----------------------r----------
GAIN
IN ITIA~r---_______ SLOPE ~
GAIN DELAY--<>
DEPTH(m)
or TIME DELAY
Figure 4.5 A simple time gain compensation (TGC) function, showing the four
parameters which may be varied, the initial gain, the delay, the slope and the final gain
the gain or amplification factor plotted against the depth of the echoing
surface or reflectoL
Usually four separate parameters of the TGC curve may be varied. Firstly
there is the initial gain, the amount of amplification applied to the very
earliest (superficial) echoes. Then there is the delay, the depth below the
probe from within which echo signals receive the same amplification as the
very earliest echoes. This would be the superficial layer of tissues of least
diagnostic interest. Thirdly, there is the slope or the TGC proper, during
which range of depth a steadily increasing amplification factor is applied. The
slope of this part of the graph is chosen to compensate for the attenuation
factor in the tissue in question. Finally, there is the final gain, usually the
maximum gain attainable by the amplifier, which is applied to the latest
(most remote) echo signals. Usually. the echoes from the tissues of greatest
interest are positioned in the slope region of the curve.
In most instruments. these four parameters can be varied to suit a particu-
lar tissue or region of the body and to match the attenuation at the operating
frequency in those tissues.
In some applications the slope portion of the curve may be segmented into
slabs with different slopes. in order to compensate for layered tissues with
distinctly different attenuation properties.
In other applications. particularly in studies of heart valves. a higher step
of amplification may be applied to a specific layer of tissues within the slope.
in order to accentuate the echoes from reflectors within that layeL
(e) Demodulator
The action of the demodulator is shown in figure 4.6. Each damped alternat-
t
(a)
(b)
t
(c)
t
Figure 4.6 The processing steps experienced by a received radio frequency (rt) echo
signal (a), in an A-mode scanner. (b) Full-wave rectification and (c) demodulation or
envelope extraction
ing (rf) echo pulse is first rectified. Next a voltage output is developed which
follows the amplitudes or the smoothed envelope of the half cycles of the
rectified pulse. The resulting pulse shape represents the amplitude of the
original pulse at each moment during the pulse. The amplitude pulse is
then displayed to form the amplitude on the A-mode display.
(t) Display
The normal type of display for these amplitude (or A-mode) signals emanat-
ing from the demodulator is a cathode-ray oscilloscope (eRO) (see Ap-
pendices G and H). The sweep or horizontal deflection (X axis) of the
oscilloscope display is initiated or triggered by a pulse from the pulse
repetition frequency master controller and the amplitude signals from the
demodulator are fed to the vertical deflection or Y plates of the oscilloscope.
The time base of the oscilloscope or the rate of sweep of the electron beam
across the X axis is arranged so that distance across the screen is a known
factor ( x 0.25, x 0.5, xl, x 2) of the depth in the medium or tissue. In this
way, a display such as is shown in figure 4.3 is presented.
The typical A-mode display, therefore, consists of a train of echo pulses
arranged to the right of the transmission pulse artifact and separated by
distances proportional to the depths of the reflecting structures. The ampli-
tudes of the echo pulses depend on the reflection coefficient and the angle of
incidence at the reflecting surface, on the attenuation in the tissues and on the
TGC used.
In order to produce a stationary or visually persistent image on the
oscilloscope screen, it is necessary that the train of echo signals be displayed
at least 30 times each second, that is above the critical flicker fusion fre-
quency for the human eye. The number of times per second that it is in fact
presented is also the number of times per second that an ultrasound pulse is
transmitted. This is determined by the pulse repetition frequency master
timer, the system clock.
(g) Pulse Repetition Frequency (prt) Controller
The pulse repetition frequency (prO is set by an oscillator which simultane-

ously sends out clock or timing pulses to the pulse generator, to the TGC
controller and to the triggering input of the oscilloscope. This master timing
pulse starts ultrasound transmission and the oscilloscope display at the same
time, while ensuring that the appropriate gain compensation is applied to the
echo signals from different depths. In some instruments the prf may be
varied from about 50 up to 2500 Hz.
The maximum prf depends on the tissue depth of interest. Sufficient time
must be available between transmission pulses for the echoes from the
deepest tissues to return to the transceiver and be displayed. For instance if
a prf of 1 kHz is used, this entails a receiving time of almost 1 ms. According
to the pulse-echo equation, this would allow depths in soft tissue of about
77 cm to be interrogated.
4.6 OPERATOR CONTROLS ON INSTRUMENT
The control panel of the A-mode instrument is equipped with a variety of

control knobs which allow one to modify different aspects of the display.
(a) Output Power or Transmitter Attenuator
In many units it is possible to vary the amplitude of the current pulse used to
excite the transducer and thereby to control the intensity of the transmitted
ultrasound pulse. The knob or switch which performs this electronic attenu-
ating function is often calibrated in dB units. If the amount of electronic
attenuation is reduced, not only is higher intensity ultrasound transmitted,
but the echoes from weakly-reflecting structures may also be enhanced.
Thus, the amplitude detail of the A-mode display can be modified with
this control.
(b) The Parameters of the Time Gain Compensation (TGC) Curve
As discussed in the previous section, four different parameters in the TGC

can often be varied, namely the initial gain, the duration or depth of the
initial gain (delay), the slope and thefinal gain. The initial gain is usually kept
low to keep the transmission pulse artifact and superficial echoes from being
too strong and saturating the display. The delay allows control over the
depth to which this initial low gain processing extends. The slope is chosen
to compensate for the ultrasound attenuation actually encountered in the
tissue in question at the operating frequency. The final gain is the maximum
fixed gain applied to the most remote and deepest echoes. Clearly, varying
these four parameters, or indeed anyone of them can have major effects on
the A-mode display.
(c) Suppressor /Limiter /Dynamic Range
Some A-scan machines are equipped with a suppressor (reject) control. This
control allows the operator to eliminate or reject low amplitude echo signals
and noise signals of amplitude less than a certain set minimum or threshold
level. This control can help to produce a clean A-mode display.
Some machines are also equipped with a limiter or peak-clipping control
which sets the value of the maximum echo amplitude which is displayed. The
limiter control sets the echo amplitude adequate to saturate the display.
Figure 4.7 illustrates these parameters.
The range of echo signal amplitudes on the display between the minimum,
which may be set by the suppressor control, and the maximum which may be
set by the limiter control or by the characteristics of the amplifiers used in
the system, is called the dynamic range of the display. Echo signal amplitudes
which fall within the dynamic range are displayed on the screen with dis-
tinguishably different amplitudes. Echo signals greater than the maximum
of the dynamic range may not be distinguished from each other because they
simply saturate the display, i.e. they are all displayed as maximum deflections
on the display. Echo signals of amplitudes below the minimum of the dynamic
range are not displayed at all. Control of the suppressor and limiter, there-
fore, help to determine the dynamic range, i.e. the range or span of echo
strength which can be distinguishably displayed on the screen.
Usually the dynamic range is measured as the ratio of the maximum dis-
playable signal amplitude to the minimum amplitude. Alternatively it can
be expressed in dB, the logarithmic version of this ratio.
(d) Pulse Repetition Frequency (prt)
A-mode instruments are often equipped with a knob to control the pulse
(a)
(b)
(c)
Figure 4.7 A train of echo signals shown in (a) may be modified by increasing the
level of suppression as in (b), thereby eliminating the low amplitude signals including
electronic noise from the display. The echo train may also be modified by changing the
limiter level or level at which peak-clipping occurs as in (c). Both of these controls
change the dynamic range of the display
repetion frequency (prf). This control sets the frequency of the master timer
pulse generator. This, in turn, sets the repetition frequency for the complete
operation cycle of the instrument comprising transmission of pulse, re-
ceiving of echo pulses and their display. In practice, increasing the prf
produces a brighter display on the screen because of more frequent renewal
of the registration on the oscilloscope screen. But, there is an upper limit to
the prf as mentioned earlier and for typical depths in the human body, this
upper limit is something in the vicinity of 2500 Hz.
(e) Transmitted Frequency/Receiver Tuning
The ultrasound transmission frequency, as was described in the previous

chapter, is determined by the thickness of the piezoelectric crystal used in the
probe. Therefore, choice of transmitted frequency is made by choosing the
appropriate transducer probe.
In many machines, the receiver amplifier is a tuned amplifier of narrow
bandwidth, that preferentially amplifies a narrow band of frequencies en-
compassing the transmitted frequency. The receiver amplifier is said to be
tuned to the transmitted frequency. Therefore it is important that the re-
ceiver be tuned to the frequency of the probe being used. Use of tuned
amplifiers allows much better signal-to-noise ratios to be achieved, entailing

much better distinguishing of weak echo signals from signals due to elec-
tronic noise and other sources of interference voltages in the system.
(f) Demodulator
In some machines, it is possible to vary the time constant of the demodulator.

The effect of reducing the time constant in the demodulator is shown in
figure 4.8, and in an A-mode echo signal with much fine detail, it reduces the
smoothing in the demodulation. More fine detail becomes apparent. In some
cases, this added detail can be confusing and may therefore be undesirable.
(a)
(b)
Figure 4.8 Increasing the time constant of the demodulator causes smoothing in (b)
of the sharp (very fast) components of the echo signal in (a)
(g) Average Propagation Speed
The time base setting of the oscilloscope is arranged so that a distance along
the oscilloscope sweep is proportional to depth in tissue. The relationship
between the two involves the average propagation speed of ultrasound in
tissue. The assumed average propagation speed for ultrasound travelling
through soft tissues is 1540 m/s. However, for some tissues, for instance in
biparietal diameter measurement in the foetus, where there is some bone in the
pathway, a higher average propagation speed of 1600 m/s is more appropriate.
For some tissues with a high fat content, a propagation speed below 1500 m/s
is more appropriate. Consequently some machines are equipped with a
control to enable the assumed average propagation speed to be varied as
required. In most normal operations, however, this is not a control which is
tampered with.
(h) Oscilloscope Controls
The A-mode instrument is also equipped with many of the normal knobs
that control the oscilloscope display. One of these is the brilliance or bright-
ness control which sets the brightness or luminance of the oscilloscope trace.
Occasionally this needs to be increased or decreased, in particular when
photography is required.
Another control is the focussing control which ensures that the electron
beam in the oscilloscope is focussed on the screen to produce a sharp thin
trace.
Two further controls are also occasionally available, position controls,
which enable the trace of the oscilloscope to be positioned as required on the
screen. These controls can move the display in the vertical and horizontal
directions.
4.7 CALIPER MEASUREMENTS
Since distance across the sweep of the A-mode display is proportional to

distance in the tissue, measurements of tissue dimensions can be made on the
oscilloscope screen. However, this is not very accurate or reproducible when
the trace is moving, and is very much dependent upon how steadily the
transducer is held. The caliper is an electronic unit which, when switched into
the circuit, imposes extra bright spots on the trace. The location of the spots
on the trace may be varied, and the separation between the two also varied.
The caliper displays the distance in the tissue medium between these two
bright spots. This display is usually a digital display, calibrated in mm units.
The reading of the caliper is dependent upon the assumed average speed of
propagation in the tissue just like the A-mode display time-base.
4.8 AXIAL RESOLUTION
The question of the resolution of the A-mode technique refers principally to

axial or depth resolution, the ability of the display to distinguish echoes from
two reflecting surfaces close together along the axis of the beam. As shown
in figure 4.9, when two succeeding echoes come from reflectors too close to
each other, it becomes increasingly difficult to distinguish the signals on the
display as being separate. The minimum separation between two such
identical reflectors such that their echo signals may be distinguished on the
display is the axial resolution.
The width or duration of the echo signal pulse on the display is the main
factor which determines the axial resolution. The pulse duration is set mainly
by the amount of damping in the pulse echo probe. At higher frequencies the
DISPLAYS
(a)
TRANSDUCER
REFLECTORS
~ • •
(b) b
Figure 4.9 Depth or axial resolution may be assessed by placing two identical re-
flectors side by side along the axis of the beam. The A-mode display is then inspected
as they are brought closer together. The minimum separation between them which
allows the two echo signals to be distinguished is a measure of the axial resolution. In
display (a) the signals are resolved while in (b) they are not
minimum number of about 5 rf cycles can be accommodated in a shorter

pulse than at lower frequencies. Consequently greater damping is used in
higher frequency probes and a shorter pulse results. Axial resolution im-
proves as the transmitted frequency increases, as shown in figure 4.10.
It should be borne in mind that the amplitude and indeed width of the
pulses displayed on the screen of the A-mode instrument depend to some
extent also on a number of variables other than transmitter frequency. For
instance the setting of the transmitter electronic attenuator, the Time Gain
Compensation parameters, the suppressor level, the limiter level, the
RESOLUTION
(mm)
2 3 4 567 10 20 f(MHz)
Figure 4.10 The axial resolution in mm as a function of the operating frequency in
MHz, for optimally damped transducers
demodulation time constant, all can modify the appearance of the displayed
pulses. Hence the axial resolution achieved in any situation depends strongly
on the machine settings chosen.
The question of lateral resolution, the ability to distinguish echoes from
two neighbouring structures close to each other at the same depth, is not so
important in A-mode scanning. But, it will be considered in detail in relation
to B-mode two-dimensional scanning in chapter 6.
4.9 SENSITIVITY
The sensitivity of the A-mode instrument combines the sensitivity of the

transducer and those of the signal processing and of the display. It further-
more involves the transmitting efficiency of the transducer. Crudely the
sensitivity may be defined as the ratio of the amplitude deflection on the
display to the strength of the reflector. Recollect that the reflector strength
is determined by the reflection coefficient and the area of the reflector
intercepting the beam.
Normally the design of an A-mode instrument for medical diagnosis must
have a sensitivity sufficient to produce a range of deflections, within the
dynamic range of the instrument, from the actual range of reflectors found
in soft tissues.
4.10 ARTIFACTS
Artifacts in the A-mode display are pulses or deflections on the display

which do not directly correlate with reflecting structures in the tissue. The
absence of a deflection to correlate with an actual reflector is also an artifact.
Such an artifact is the reverberation artifact illustrated in figure 4.11. In
this case the transmitted pulse travels out to the reflector producing an
I STRONG DISPLAY
REFLECTOR
Figure 4.11 The production of reverberations between the probe and a strong re-
flector. causing artifactual reverberant echo signals on the A-mode disnlav
echo, which returns at the appropriate time delay. However, some of this
echo is reflected from the transducer face, travels out to the reflector to be
reflected again. This returns to the transceiver and is displayed twice as deep
as the true echo. Indeed, a number of such successive spurious echoes or
reverberations may be strong enough to be displayed if the medium is not
highly attenuating. From the appearance of the display, one would falsely
picture a layered medium with each layer of the same thickness. The most
obvious mark of reverberation is the equal distance between the reverbera-
tion 'echo' signals, and this feature allows one to recognise this artifact.
Another type of artifact is the multiple path artifact. In viewing the A-mode
display one assumes that the ultrasound beam travels in a straight line. One
interprets the display by correlating the echo signals with structures along
that assumed straight-line path. However, occasionally the ultrasound could
travel by more circuitous routes such as illustrated in figure 4.12. Here the
transmitted pulse travels out and is reflected at an angle from surface A. The
--t>' (L,+LAi--
2
DISPLAY
Figure 4.12 A multiple path artifact can occur when the echo returns to the probe by a
circuitous path, while the A-mode display assumes that the echo arises along the beam
axis and returns along the same path. An echo signal is displayed at a depth which does
not correspond to any reflector
obliquely reflected pulse then travels to reflector B, where it is again re-

flected back towards the transceiver. Clearly, the echo pulse which then
arrives at the transceiver, is displayed deeper along the A-mode display than
corresponds to the depth of structure A. In fact, the A-mode display does
not accurately 'see' structure A, and places an artifactual ghost echo signal
deeper along the display.
Another source of ghost echoes is the refraction artifact illustrated in
figure 4.13. Here, refraction at boundary A directs the beam at right angles
towards reflector B. From there an echo returns to the transceiver by the
same path that the transmitted beam had travelled. However, the display
positions that echo signal at a depth which does not correspond to the depth
of any reflector along the original transducer beam axis.
Errors in the positioning of an echo pulse on the display occur when the
actual tissues traversed by the ultrasound beam have propagation speeds
either greater or less than the assumed average propagation speed. If the
t
ECHO
t\
DISPLAY
Figure 4.13 Refraction at boundary A, causes the beam to bend from the original axis.
The assumption of the A-mode instrument that straight-line propagation occurs is
violated, and the echo which returns from boundary B is then erroneously located by
the instrument. It is wrongly taken to be a distance Ll + L2 along the original axis
actual propagation speeds are greater than the average, then the echo pulses
are displayed closer to the surface (shallower) than they ought to be, and the
reverse occurs if the actual propagation speeds are less than the average.
Shadowing is a phenomenon which can cause echoes from certain deep
structures to be negligibly small or absent from the display. Such shadowing,
illustrated in figure 4.14, can happen if there is a very strong reflector, such
as a gas or a hard tissue boundary early in the beam. These very strong
reflectors allow very little ultrasound to penetrate to deeper structures, with
the result that these latter structures do not produce echo signals strong
enough to register on the display. Another mechanism for shadowing is a
highly attenuating medium in the early part of the path of the beam. This
allows negligible amounts of ultrasound to penetrate to deeper structures,
with the result that appreciable echoes are not obtained from such structures.
REFLECTORS
PROBE \B\
/' DISPLAY
VERY STRONG
REFLECTOR
Figure 4.14 A strong reflector (or a strong attenuator) located early in the beam path
reduces the intensity of the beam such that deeper reflectors fail to produce echo signals
strong enough to register on the display. Thus reflectors Band C are shadowed by
reflector A
The finite width of the ultrasound beam which as will be seen later, is the
main determinant of lateral resolution in the B-mode instrument, also re-
sults in structures, as shown in figure 4.15, which are well away from the
ECHOES
PROBE
~ ~ AXD D~]1\
I I
A D
DISPLAY
OFF-AXIS
REFLECTORS
Figure 4.15 Off-axis reflectors which are still at the edges of the beam, produce echoes
which register on the A-mode display and are assumed to be on the axis. Also two
off-axis reflectors at the same range as C and D, are registered as one echo signal on the
display and the erroneous assumption of a single reflector at that range made
axis of the beam, producing echoes which are displayed and assumed to be
on the axis.
Poor adjustment of the controls of the instrument can accentuate many of
these artifacts. Careful tuning, especially of the receiver, i.e. the TGC and
the suppressor, minimise these effects. But some of these artifacts are in-
herent in the technique and often have to be accepted in the A-mode display.
They may usually be reduced in B-mode imaging as will be discussed in
chapter 6.
4.11 CLINICAL APPLICATIONS
In practice, the transducer probe is placed on the skin of the patient with the
ultrasound beam directed towards the tissues of interest. For contact scanning
to be effective, an acoustic coupling agent is needed between the probe
surface and the skin. This coupling is necessary to eliminate all air from that
region. Various water based gels and vegetable oils, such as olive oil, are used
for this purpose. Most of these agents have acoustic properties similar to the
soft tissues of the body. Furthermore they adapt to the shape of the probe
and that of the body surface as shown in figure 4.16. In this way, air bubbles
are excluded and the maximum transfer of ultrasound into and out of the
body is achieved quite simply. It is desirable that these coupling agents
should not be very fluid so that they remain in position as much as possible
for the duration of an examination. Also one needs to use only a small
amount of the couplant so that the temperature of the superficial tissues is
not lowered appreciably below the normal level.
A-mode scanning was the earliest ultrasound technique developed for
AGENT
Figure 4.16 The action ofa coupling agent-an oil or a gel-is to provide an acoustic
pathway between the transducer face and the skin surface. It eliminates air bubbles and
adapts to the contours of the skin and the probe
medical diagnostic purposes, but nowadays it is not widely used in isolation

from M- or B-mode techniques. One fairly widespread application is in
echoencephalography, where the position of the midline structures of the
brain may be easily checked. This investigation is of use in order to detect
shifts in the midline due to disease or accident. Another area in which the
A-mode technique is used is in ophthalmology. Here the application is to
measure the distances between various structures of the eye. The A-mode
display is also used to measure the biparietal diameter of the foetus in utero.
Also in pregnancy, the A-mode display may be qualitatively used to detect
the motion of the foetal heart: In this case, the movement of the echoes
signals from the heart horizontally back-and-forth may be observed on the
display.
4.12 PERMANENT RECORDS OF EXAMINATIONS
One of the problems with the oscilloscope display is that it is transitory,

while it is generally desirable to have a permanent record of an A-mode
display. Such a permanent record can be acquired by photography from the
screen of the oscilloscope, by means of an instant Polaroid camera or a
35 mm camera. This aspect is discussed in detail in chapter 9.
4.13 INSTRUMENT PERFORMANCE CHECKS
Various aspects of the A-mode unit can be readily tested. Such tests should
be regularly carried out to ensure the consistency of the performance of the
instrument and the day-to-day reliability of any measurements made with it.
The various types of beam measurements described in chapter 3 are ap-
plicable to this instrument. But since this machine is based on the pulse-echo
principle, the determination of the iso-echo contours in the pulse-echo beam
is especially relevant. It checks the beam and the signal processing and
display of the system.
Iso-echo contour plots are lines connecting points in the beam from
which equally strong echo signals are received, when some standard re-
flector is moved around in the beam. In this case the ultrasound transmitting
probe acts as receiver in order to receive the echoes reflected from the
standard reflector. This is usually a spherical steel ball in a water bath. An
arrangement such as is schematically shown in figure 4.17, is used to derive
the data. When the data have been derived, iso-echo plots can be drawn as
z
y
x
FIXED
PROBE
LI U I D----..""
M DIUM
Figure 4.17 An experimental set-up to determine the iso-echo contours of a given

transducer. The spherical reflector may be moved about in three perpendicular direc-
tions within the liquid bath supporting the ultrasound beam
shown in figure 4.18. The result is a contour map of the beam on which the
contours connect points in the beam from which equal amplitude echoes are
received.
A simple test of dynamic range is to direct the beam vertically downwards
into a vessel with a flat horizontal sheet of metal on the bottom. The vessel
contains one of the solutions described in section 10.11, which has a speed
of propagation of 1540 m/s. The probe face is located 1 cm from the surface
of the metal sheet. The delay of the TGC is made longer than the width of
the display.
Figure 4.18A possible pattern of iso-echo contours in the beam of a probe. The
maximum echo amplitude is taken as the 0 dB reference
The display then consists of a number of reverberations with amplitudes

decreasing from left to right as shown in figure 4.19. Directing attention to
anyone of these reverberation signals, say the fifth, the initial gain of the
TGC is reduced until that fifth reverberation sinks into the baseline. Then the
initial gain is increased until the same signal is just saturated. This range of
initial gain, in dB, is the dynamic range of the system.
Figure 4.19 A simplified set of reverberation signals obtained from a shallow water
bath of fixed depth with a fiat base perpendicular to the beam
Regular repetition of this test on the same reflector set-up would allow
changes in system sensitivity to be noted. A reduction in sensitivity would
require a higher initial gain to just raise the fifth reverberation above the
baseline. It would also need a greater gain to saturate that reverberation
signal.
Because this medium has a speed of propagation of 1540 m/s each rever-
beration signal should appear on the display at 1 em intervals exactly.
Therefore the display, as shown in figure 4.19, is a test of the measurement
accuracy of the A-mode unit. In the same way the caliper accuracy may be
checked.
The axial resolution can best be measured with a target system such as the
AlUM (American Institute of Ultrasound in Medicine) target which is de-
scribed in detail in chapter 6. The portion of the target used to measure
axial resolution is the set of wires in the middle as are shown in figure 4.20.
The target is filled with a liquid solution with propagation speed 1540 m/s.
When the probe of the A-mode unit is moved as shown in figure 4.20, from
left to right, initially the wire reflectors are separated along the depth direc-
tion by a sufficient amount for the echo signals on the display to be dis-
tinguishable. But at some stage the depth separation is not enough to allow
the echo signals to be resolved. The smallest such separation between the
wires to allow resolution is the axial resolution.
-d-
il~:~··
2 .. ---..
1 (:.-.-..-\
Figure 4.20 A cross-section through the part of the American Institute of Ultrasound
in Medicine (AlUM) test object which may be used to measure the axial resolution.
The separations between the wires are given in mm and more than two of the wires may
be located within the beam at any position of the probe (see figure 6.16)
4.14 LIMIT ATIONS
The first and major limitation of the A-mode technique is the fact that it
displays information about structures along a single line through the tissue,
or more accurately, about structures along the cylindrical path of the ultra-
sound beam. Essentially, it provides one-dimensional data. If information
about another path through the tissues is required, the transceiver probe
must be moved to interrogate the new region of tissue, but the display retains
no memory of the previously-examined tissue. The operator must retain this
memory and also must remember the movement and positions of the probe.
Another limitation of the A-mode system, particularly when permanent
records of the displays must be kept, is its difficulty with moving structures.
If the moving structures remain in the beam, they produce a display with a
constantly moving echo voltage pulse. If they occasionally move outside the
beam, then their appropriate echo voltage pulses are only occasionally
displayed.
These two limitations are solved respectively by the development of B-
mode scanning and M-mode scanning techniques. These topics will be
considered in chapters 6, 7 and 5, respectively.
4.15 BIBLIOGRAPHY
Fran"ois, J. and Goes, F., Ultrasonography in Ophthalmology, S. Karger, Basel, 1975

Metreweli, C., Practical Abdominal Ultrasound, Heinemann, London, 1978
New York, 1979
Taylor, K. J. W. et aI., Manual of Ultrasonography, Churchill Livingstone, New York,
1980
Prague, 1972
1978
5 Motion (M-) Mode
Scanning Instruments
One of the drawbacks of A-mode scanning is the fact that it yields only crude
qualitative appreciation of the motion of structures. In order to overcome
this difficulty, in particular for applications dealing with rhythmically-
moving structures such as the heart and its valves, motion (M-), also called
time-position (T-P), mode scanning, has been developed.
(a) describe the M-mode display;
(b) outline schematically the M-mode instrument and describe the role
and operation of each functional block in the unit;
(c) show the main ways in which permanent records of M-mode exam-
inations may be obtained;
(d) discuss the most likely artifacts which may be encountered in M-mode
scanning;
(e) describe how simple tests may be done to check the performance of the
instrument;
(f) outline broadly the areas of clinical application of this technique;
(g) discuss the limitations of M-mode scanning techniques.
5.2 M-MODE DISPLAY
The M-mode display is a two-dimensional set of graphs as shown in figure

5.1. Along one axis is time, and along the other axis is pulse-echo delay or
depth into the tissues. Points are registered at those depths from which
echoes are returned, at each successive instant during the build-up of the
whole dispiay.
MOTION (M-) MODE SCANNING INSTRUMENTS 75
.... -.
.-~------~--
. . - .... - -
-~------.------
- - -
- -
- -
... -.- - - - - - - - - - ... - --e
- 4- -
- ------
- - - -
- - - ... - - - -
-
...
..
..
!TIME
• - ... - - - - - - - - - -e- - - - •
..... -.-...... ...-. .... ..

-.-
•.._ - - - - - - -e -e-
. _______ - - - - ••
______
-- ---- ------- ....
- -- - - - - - - -- - -
- - - - - - -- - - - -
• - + - - .. - - - - - - - - - - , .
... -e- - - - .. - - - - - - - - - ..
• -+-----e--------e
----<>
DEPTH
Figure 5.1 An M-mode display is essentially a recording of the depth of all reflecting
structures at each successive instant during the examination. This M-mode display
shows one moving structure in the middle of the field and three stationary structures,
one at depth and two in the superficial region
5.3 SCHEMATIC OUTLINE OF THE INSTRUMENT
Figure 5.2 is a schematic diagram of an M-mode instrument. The instrument

differs from the previously-described A-mode instrument in only two main
details.
The first of these is an addition to the echo-signal processing path after
the demodulator. This extra component generates a brief voltage pulse at
the moment of arrival of each echo signal. This process is indicated in
figure 5.3. In some cases these standardised pulses have amplitudes pro-
portional to the echo signal amplitudes. These voltage pulses are then fed to
the brightness modulation (Z) input of the oscilloscope and produce a series
of bright spots on the oscilloscope screen. Each bright spot is located at a
distance from the left-hand side, proportional to the depth of the reflecting
surface giving rise to the relevant echo. Thus, reflectors which are stationary
produce spots fixed in position along the time axis, and vertical lines on the
display. Reflectors which are moving produce curves on the display.
The second difference between this instrument and the A-mode instrument
lies in the additional time-base ramp voltage which is supplied to the Y plates
of the oscilloscope. This time-base is much slower than the normal horizontal
time-base, but it produces the effect of moving the baseline which carries the
bright spots either up or down the screen. A resulting M-mode display is
shown in figure 5.1. Stationary reflectors produce straight vertical lines while
moving reflectors produce position-time curves characteristic of the motions
of the reflectors. The time scale of the Y-axis can be varied. If it is slowed
down, this produces a compressed position-time graph, while if it is speeded-
MASTER
TIMER
PULSE fL (P. r. f.)
GENERATOR
~ PROBE~
~ L
~
RECEIVER
.......... TIME GAIN
-
AMPLIFIER CONTROL
t~
DEMODULATOR
, -- 1M
BRIGHT-UP
PULSE
GENERATOR
rL.JL
ZO
SLON SWEEP ~ Y T
SIGNAL
GENERATOR DISPLAY
Figure 5.2 A block diagram of an ultrasound M-mode scanner, showing the func-
tional components and the interconnections between them
(a)
(\ 0 f\ ~
(b) n n n rL
(c) eo- - - - - - - .... - - - - - - - - - -e- - - - - - - - - ..
(d) ~ ~ n L
Figure 5.3 The signal processing steps involved in converting the A-mode signal
shown at (a) into the line element of the M-mode display as shown at (c). At each
leading edge in (a) a brief voltage pulse of constant height and duration is generated
(b), and this in turn is used to bright-up (Z input) the oscilloscope display (c). Alter-
natively voltage pulses of heights proportional to the A-mode echo signal height may
be generated (d) and used to modulate the display brightness, thereby effecting a grey
scaling in this display
up , ihis reduces the amount of the reflector motion that is fitted into the
screen.
Clearly, a picture such as that shown in figure 5.1 may be used to calculate
the speed of a moving structure at any instant during the display period.
An alternative and more satisfactory way of achieving a time axis is to
dispense with the above additional time-base and to move a recording
photographic paper at a steady rate past the stationary baseline which con-
tains the pulse-echo information. In this way a chart recording may be made
of the moving structures under study, for as long as is required. Indeed
typically in a study of cardiac valve motion , the beam is caused to gradually
swing through a sector of the heart, producing a continuous recording of the
motions of each successive portion of the valves and walls. The instrumenta-
tion needed for such a technique is described in the next section.
In those instruments in which the amplitudes of the bright-up pulses are
proportional to the relevant echo amplitUde, the result of the above photo-
graphic recording technique is a grey scaled recording. The stronger echoes
produce a darker grey while weaker echoes yield a lighter grey on the black-
on-white display. An example of this latter is shown in figure 5.4.
5.4 RECORDING OF EXAMINAnONS
A number of techniques are used to obtain a permanent record of the

M-mode display.
- TIME
Figure 5.4 A grey-scaled M-mode recording of cardiac valve and wall motion . A
simultaneous ECG recording is located at the top of the trace
One technique is to obtain a time-exposure photograph of the oscilloscope

screen as the display sweeps up or down the screen. Another related technique
is to obtain the complete display on a storage oscilloscope and then to
photograph that display using a Polaroid instant camera (see chapter 9).
These techniques have a number of drawbacks. Only a limited amount of
movement can be incorporated into one oscilloscope screen tracing. Any
movement of the probe during the formation of that tracing may ruin the
display as a whole. Also, it may not be possible to initiate a display until the
previous display has been completed.
In order to overcome some of these difficulties, the most popular technique
for recording M-mode display is the use of a continuously moving ultra-
violet chart recorder. In these instruments, the baseline is not made to sweep
up or down the screen but remains stationary in the centre of the screen.
Light sensitive paper is continuously drawn past a narrow aperture in front
of the screen as shown in figure 5.5 and this paper subsequently develops
when exposed to ultraviolet light. Alternatively a linear array of fibre optics
carries the brightness of each part of the baseline trace to the moving re-
cording paper.
u.v. LIGHT
•t t t •
PAPER
MOVEMENT
r
I
CRO~:
TAKE-UP
SCREEN REEL
UNUSED
ROLL
LIGHT-TIGHT BOX
Figure 5.5 The main components in an ultraviolet chart recorder for registering
M-mode scan information
In these cases the movement of the paper is equivalent to the sweep of the
baseline on the screen in the system of figure 5.2. The paper speed may be
reduced or increased as required.
Some machines use photographic paper which must be developed in a
dark room, by conventional wet processing techniques (see chapter 9). The
advantage of the continuous chart recorder is that long periods of recording
can be used. For instance, if the heart is being examined, very many heart-
beats can be included in a single trace. In all of these techniques where heart
studies are involved, tracings of an electrocardiogram (ECG) lead and of the
phonocardiogram (peG) may also be included on the display. It is usually

possible to include many more of these ancillary channels of related cardiac
information with the chart recorder system than with the direct screen
photography methods.
5.5 ARTIFACTS
Since the M-mode instrument has very much in common with the A-mode
unit, all of the artifacts described in section 4.10 may also be encountered
when using the M-mode instrument in the clinical setting.
One further artifact may also be mentioned - that of the incomplete or
gapped trace. If the motion of the reflector under study is not along the
beam axis, it may not be in the beam or else it may present to the beam at an
oblique angle, for some of the time. The result is a time-position trace
which has gaps at those phases when the reflector is not returning an echo
strong enough to register.
All of the performance tests discussed in section 4.13 are relevant to the
M-mode instrument.
In addition the time scale needs to be checked and calibrated. A simple
way of doing so is to use a small vessel with a flexible rubber base as shown
in figure 5.6. The flexible base is vibrated in a sinusoidal manner with an
electromagnetic vibrator at a known frequency and a known amplitude. The
vessel is filled with a solution of propagation speed 1540 mls (see section
to.11). The probe is directed vertically downwards and an M-mode recording
made. The recording of the moving membrane should be sinusoidal and its
frequency and amplitude should correspond to that of the membrane. This
is a sample check of the time scale and the depth scale of the display.
5.7 CLINICAL APPLICATIONS
The main uses of M-mode scanning are in the detection of the motion of
intracardiac structures (especially the heart valves) but also of the walls of
the heart. Various portions of all four heart valves may occasionally be
PROBE
L1Q ID
ME IU~
~FLEXIBLE
r-----r----'---'---l BASE
L.----L_-----1VI BRATOR
Figure 5.6 An experimental vessel with a flexible base, driven sinusoidally by an
electromagnetic vibrator, which may be utilised to check the depth scale and the time
scale of an M-mode instrument
detected with the technique, but the easiest to detect is the mitral valve. The
normal valve has a characteristic motion and departures from the normal
can be readily diagnosed.
As well as the movement of the valves, the detection of the movement of
the walls can give very useful information about the chamber sizes. The
size, thickness and movement of the interventricular septum may be as-
sessed. Pericardial effusion may be detected and quantified. The performance
of prosthetic cardiac valves may also be studied with the technique.
Other uses of M-mode ultrasound scanning techniques are the detection
of foetal heart movement in pregnancy, studies on the movement of blood-
vessel walls, such as the abdominal aorta, and also studies of the pulsations
due to blood movement within the brain.
5.8 MAIN LIMITATIONS
While overcoming that feature of the A-mode technique which disallows

quantitative detection of the movement of a structure, the M-mode tech-
nique retains many of the drawbacks and limitations of the A-mode approach.
It can suffer from the same range of artifacts as the A-mode. Furthermore, it
is a one-dimensional display as far as tissue dimensions are concerned.
In order to overcome this limitation, in particular when studying the
motions of cardiac structures, the probe can be rotated through an arc
during the recording period. In this way the permanent record contains in-
formation about a number of structures in the heart, together with the
relationship between them. In obtaining this recording, however, it is
necessary that the rate of movement of the transducer be considerably
slower than the speeds of the moving tissues being examined.
That feature of the M-mode display whereby the EeG or peG can be
simultaneously recorded, adds an important dimension to the display. These
enable the relative phases of the different events and movements during the
cardiac cycle to be correlated. Use of the EeG involves the correct placement
of electrodes on the patient and the choice of EeG lead for the display. This
requires a suitable preamplifier to be present in the instrument. Use of the
peG involves the placement of a small microphone on the patient's chest
and also requires an appropriate preamplifier in the unit. Usually, these
tracings are positioned at a location on the display as a whole, where there
are no useful echo tracings as in figure 5.4.
A final important point about the M-mode display is that for accurate
measurements of speed of different structures, both the depth, i.e. the dis-
tance in tissue, calibration must be accurate and also the speed of movement
of the slow time-base or of the recording paper must be accurately known.
5.9 BIBLIOGRAPHY
Benchimol, A., Non-invasive Techniques in Cardiology for the Nurse and Technician,
Philadelphia, 1981
1977
York,1980
Louis, Mo, 1981
Metreweli, c., Practical Abdominal Ultrasound, Heinemann, London, 1978
Meyer, R. A., Pediatric Echocardiography, Lea & Febiger, Philadelphia, 1977
Miskovits, c., Echocardiography: A Manual for Nurses, Medical Examination Publish-
ing Co. Inc., Flushing, NY, 1977
Reneman, R. S. (Ed.), Cardiovascular Applications of Ultrasound, North-Holland Pub-
lishing Co., Amsterdam, 1974
Roelandt, J., Practical Echocardiography, Research Studies Press, Forest Grove, Or,
1977
Salcedo, E. E., Atlas of Echocardiography, W. B. Saunders Co., Philadelphia, 1978
Short, M. D. et at. (Eds), Physical Techniques in Cardiological Imaging, Adam Hilger
Ltd, Bristol, 1983

Weissler, A. M., Non-invasive Cardiology, Grune & Stratton, New York, 1974
Wells, P. N. T.(Ed.), Ultrasonics in Clinical Diagnosis, Churchill Livingstone, Edin-
burgh, 1977
Weyman, A. E., Cross-sectional Echocardiography, Lea & Febiger, Philadelphia, 1982
6 Static B-Mode Instruments
It was pointed out previously that one of the major drawbacks of the A-mode
scanning technique is the fact that it acquires information about only a single
line through the tissue at any particular position of the probe. The most
common method for overcoming this one-dimensionality is the B-mode
technique.
(a) describe the salient features of a B-mode display;
(b) draw a block diagram of a basic instrument for obtaining B-mode
images;
(c) describe the operation of each component block in this instrument;
(d) justify the uses of linear, sector and compound scanning in con-
structing the B-mode display;
(e) outline the main conventions used to define and label B-mode images
of body tissues;
(f) describe the ways of obtaining bi-stable B-mode images;
(g) discuss the role of scan converters in obtaining images with ranges
of greys;
(h) describe in general terms, analogue scan converters;
(i) show how the scan converter fits into the block diagram of a B-mode
instrument to obtain grey scale images;
(j) broadly describe the operation of digital scan converters;
(k) discuss the functioning of the instrument controls, available to the
operator on B-mode instruments;
(I) define axial and lateral resolution in B-mode scanning, and discuss
the factors which affect them;
(m) describe the principal artifacts that can occur in B-mode imaging and
how they may be eliminated or their effects minimised;
(n) show in general terms how permanent photographic records of B-
mode images may be obtained;
(0) describe instrument performance tests for B-mode units;
(p) contrast the use of skin contact B-mode scanning with water-path
delay line B-mode scanning;
(q) critically review the application of static B-mode scanning in the
clinical setting.
6.2 B-MODE DISPLAY OR IMAGE
The B-mode display or image is a scaled (x 0.5, x 1.0, x 2.0) two-dimen-

sional representation or map of a cross-section through the tissues as shown
in figure 6.1. The locations of the reflectors in the cross-section are rep-
resented in the image by bright spots on the dark background (or vice versa).
The brightnesses or grey levels of the spots can be made to correlate with the
echo signal strengths from those reflectors.
DEPTH~
- WIDTH OF CROSS-SECTION
INTO
TISSUES
Figure 6.1 A B-mode display is a two-dimensional cross-sectional representation of

the reflecting structures within the tissues. The reflecting structures are represented by
bright spots on the display (white on black background display) or by dark spots (black
on white background). The two dimensions represented are the depth into the tissues
and the width of the cross-section. Both of these dimensions must be to the same scale
so that the display is a dimensionally accurate map or image of the cut through the
tissues
6.3 SCHEMATIC OUTLINE OF THE B-MODE INSTRUMENT
Figure 6.2 is a schematic diagram of a simple B-mode scanning instrument.

This unit differs from the A-mode unit of figure 4.4, in two important
respects.
The first of the differences, shown in the diagram as the pulse former
which is connected to the Z or brightness modulation input of the oscilloscope,
was described in connection with the M-mode instrument in the previous
chapter. It produces the effect of a train of bright spots on the oscilloscope
screen correlated with the depths of the reflecting structures at any particular
position of the transceiver probe.
The second point of difference between the B- and the A-mode instru-
ments is the fact that the former has a probe co-ordinate measuring device.
STATIC B-MODE INSTRUMENTS 85
MASTER
TIMER
(p.rO
PULSE
r---
GENERATOR
RECEIVER TIME
~PROBE
~O-oRDINATE
MEASURING
,
AMPLIFIER
DEMODULATOR I
GAIN
t--
SCHEME -!
PULSE
FORMER
~
DISPLAY
Z
T
X Yr
I
Figure 6.2 A block diagram of a basic B-mode scanning instrument, showing the
functional components in the system together with the interconnections between them
This device detects the position and orientation of the probe at all times and
this co-ordinate information is fed to the display oscilloscope in order to
generate the B-mode image. It causes the sweep baseline of the oscilloscope
display to be moved around the screen in step with the movements of the
probe. The direction of the baseline sweep on the screen is made to reproduce
the orientation of the probe and hence the orientation of the axis of the
ultrasound beam travelling out from the probe.
Consider the situation shown in figure 6.3, where the motion of the probe
is a simple linear translation. As the probe moves through successive loca-
tions, the baseline on the display also moves in step with the probe. When-
ever an echo is detected by the probe a bright spot is displayed on the screen.
Thus the B-mode display is a cross-sectional representation or image of the
structure under examination. The linear B-mode display can be fairly in-
complete because, as discussed in a previous chapter, echoes are received
only from structures positioned at or close to 90' to the interrogating
ultrasound beam. Structures and surfaces at more acute angles to the beam
do not produce appreciable echoes and so are not displayed.
Simple sectoring of the probe as shown in figure 6.4(b). can sometimes
SKIN ORGAN
~
PROBE]
MOTION
STRUCTURE
IMAGED
•I·
,.
~
~
• 2-D B-MODE
DISPLAY
Figure 6.3 The production of a linear B-mode image involves slowly moving the probe
in a straight line over the skin. The resulting display of a complex structure is in-
complete
•
1- - - - ,- - -; ..
~
i I
i
i
~__- -_ -:.' 1- -
L ___
- :
i I
1 1
1
(a)
, \
,, ,\
,
\'v' , / \
I i - - ,
, \
I L __ J \
I \ \
\
/ \
\
(b)
I / \ \
/ \
,r---, ---,r--'\
,'............ I,: 1\ ,.'
, )~ I , i \ t-:!' _~
~ \.-7 .\')r- __ r ...... \
x.......)'
I / "... ....... ./ ____ I
,...... I ....... I I I \
(....f I..... L - - _. I \ .. " \ I I \ • J.
I -, I I / 1 1,',\ -;' \ i r-- ~
l
I
I I , I I " ~/ ~- - -, \_ ....... \
I I 1 1 / I I /\ ~- - - J \ \
/ I iii t\ 1 \
/ ./ I /
I \
(c) / !/ I I \ : .. \
Figure 6.4 The main types of probe motion used in ultrasound scanning. (a) Linear;
(b) angular rotation or sectoring; (c) a combination oflinear translation in two directions
and sectoring, the so-called compound scanning motion
improve the image achieved but in most cases it suffers from the same
drawback as the linear type of movement.
In most B-mode instruments, both the linear and sectoring movements
of the probe are combined or compounded as shown in figure 6.4(c). In this
case, a much more complete and identifiable image of the organ of interest
can be achieved as in figure 6.5.
,.
••• ..• .-•
•
•• •
• •.,
•••
2-D B-MODE
e,... DISPLAY
Figure 6.S The result of compound scanning action is a more complete B-mode image
of a complex structure
The compound movements of the probe can be detected and measured in

either Cartesian co-ordinates or polar co-ordinates as shown in figure 6.6.
Different B-mode instruments incorporate probe co-ordinate measuring
devices based on one or other of these systems. In each of these cases the X
(a)
(b)
Figure 6.6 The two alternative probe co-ordinate measurement systems used in
ultrasound B-mode scanners. (a) A Cartesian co-ordinate system; (b) a polar co-
ordinate scheme
and Y co-ordinates of a reflector, P, an axial distance L m into the tissues may

be readily calculated.
In the case of the Cartesian system, referring to figure 6.6(a),
x = X 0 + 1cos () + Leos () (6.1)
and
Y = Yo - 1sin () - L sin () (6.2)
Here 1is the fixed length of the transducer probe from pivot point to front
face. L is measured ultrasonically by the pulse-echo method. Xo and Yo are
the measured co-ordinates of the probe pivot point. The measurement
device therefore measures X o, Yo and (J.
In the case of the polar co-ordinate scheme, the co-ordinates relative to the
fixed origin (0, 0), of the reflector P are, referring to figure 6.6(b),
X = Rl sin (Jl + R2 sin «(Jl + (J2) -I sin ()3 - L sin (J3 (6.3)
and
Y=R 1 cos (Jl +R2 cos «(Jl +()2)-1 cos ()3-L cos (J3 (6.4)
Here Rl and R2 are fixed arm lengths, 1is the fixed probe length and L is the
pulse-echo determined reflector depth. The angles (J1' (J2 and (J3 are the
measured quantities in this scheme.
Most fundamental is the fact that for any particular B-mode display, the
movement of the probe is confined to a single plane, the scan plane, the
plane of the cross-section of interest through the body.
There is one other important area of difference between the basic B-mode
instrument and the simple A-mode unit, and that is the type of display used.
Because it requires to sweep the probe through the plane of view and retain
an image of the tissues, the display must retain a memory of the earlier parts
of the image while the rest of the image is being acquired. In the simplest
instruments, this memory is achieved by use of a storage oscilloscope (see
Appendix H). In the more advanced instruments a scan converter serves as
the memory and a TV monitor carries the display (see Appendices I, J
and L).
6.4. PATIENT POSITION/IMAGE REFERENCE CONVENTIONS
Because the image of a cross-section or slice through the tissue may be dis-
played on the screen right to left or upside down, it is necessary for the sake
of clarity, to adopt certain agreed conventions for the image presentation.
Uniform conventions allow ready comparison among images from different
centres and different machines. Careful labelling of images is also an essen-
tial step.
For most studies the patient position is supine and the probe is in contact
STATIC 8-MODE INSTRUMENTS 89
with the front (upper surface) of the patient. Occasionally the patient is
prone or even propped in various other positions. This information is im-
portant in interpreting images and should be inscribed on the image.
Images of transverse planes, i.e. planes running from left to right and front
to back of the patient, are presented as if viewed from the patient's feet.
Thus such a view of a supine patient has the patient's front on top, back on
bottom, left on right and right on left. The location of the transverse section
along the length of the patient must be specified in the labelling. Horizontal
distances in centimetres cephaled ( + ) or caudad ( - ) relative to anatomical
landmarks indicated in figure 6.7, must be specified. The landmarks used are
the symphysis pubis (SP), umbilicus (U), xiphoid process (X) and supra-
sternal notch (SN). If the plane of the transverse section is angled, the angle
towards the head or towards the feet should be specified on the image.
Images on longitudinal (sagittal) cross-sections, i.e. planes running from
front to back and from head to foot of the patient, are presented with the
patient's feet to the right of the display. In a supine patient therefore the
image has the patient's head to the left, feet to the right, front to the top and
back to the bottom. The actual longitudinal plane of the image is labelled
with the number of centimetres horizontally to the right (R or +) or to the
...IX
I
Figure 6.7 The locations ofthe main anatomical landmarks on the trunk of the patient,
as used for longitudinal and transverse sectional images
left (L or -) of the reference longitudinal cross-section along the central

head/foot axis of the body. Any angulation of the scan plane towards or
away from the midline should be recorded.
Images of coronal planes, i.e. cross-sections running from right to left and
from head to foot of the patient, are presented with the patient's feet to the
right of the image. The distance of the coronal plane in centimetres from
either the posterior (P) or anterior (A) surface of the patient must be specified.
Also the horizontal distance in centimetres of the mid-point of the coronal
section from longitudinal and transverse reference planes should also be
specified.
In imaging some parts of the body such as eyes, intracranial structures,
neck, breast, limbs, penis, scrotum and the heart, local anatomical land-
marks are more useful than the general trunk landmarks. In any such cases
the reference marks chosen must be specified.
In general sufficient information about the plane of each scan must be
provided so that the image can be properly interpreted and indeed so that
the scan could be repeated by re-setting the scanning plane of the machine as
specified.
6.5 BISTABLE DISPLAYS
The most basic B-mode displays are so-called bistable displays. The display
modality is a storage oscilloscope or a long persistence oscilloscope. In
particular with the storage oscilloscope, it is not possible to vary the bright-
ness of the bright spots stored on the display face. This basic feature is the
reason for the name 'bistable'. If a signal is strong enough to produce a
bright spot on the display, a bright spot of a fixed intensity is produced. If the
signal is not strong enough to produce a bright spot then the display has a
blank and is black at that point. An example of such a bistable display or
image is shown in figure 6.8.
In determining what signal strength will produce a bright spot on the
display, not only are the reflection coefficients in the tissues important but
also the intensity of the beam of ultrasound being transmitted, and also the
sensitivity and suppressor settings of the receiver. In practice, the receiver
settings are arranged so that only the strongest echo signals, i.e. those re-
ceived from plane specular reflectors, are displayed. In general, such specular
reflection is achieved mostly from the walls of the various organs in the body
and therefore the bistable display tends to be an image of the outlines of the
organs together with any strongly-reflecting blood vessels and other ducts in
the interior of the organ. The parenchyma of tissues tends not to be imaged.
By manipulating the receiver parameters, and especially by increasing the
gain or lowering the suppression level, succeedingly weaker signals can be
(a) __....foi
(h)
Figure 6.8 (a) A bistable image of the right kidney and a portion of the liver and for
comparison a more complete grey-scale image of the same section through the tissues,
shown in (b)
displayed and still more of the organ interior represented in the image.
However on the display, such weaker reflecting structures are then rep-
resented by spots as bright as more strongly reflecting organ walls. To
overcome this difficulty various efforts have been made to produce grey-scale
displays in order to represent the different echo strengths on the image as a
range of greys between black and white.
6.6 ANALOGUE GREY-SCALE DISPLAYS
The basic idea behind the grey-scale display is the assignment of a grey level
to each echo signal amplitude as shown in figure 6.9. Thus, the stronger the
echo signal amplitude, the brighter the related spot on the display. In some
cases the reverse type of display, a negative image, is used, in which the
stronger echo amplitudes produce a darker spot, or rather a less bright spot
on the display. Thus, the final display can be white on a dark background or
else dark on a white background (negative).
One method of achieving such a grey-scale display is the use of time-
exposure photography during the image acquisition, in conjunction with a
long persistence oscilloscope display. The stronger echo signals produce a
brighter spot and a longer persistence of the bright spot on the screen than
the weak echo signals. The registration of these bright spots on the photo-
graphic film consequently reproduces a scale of greys depending upon the
brightness and time persistence of the oscilloscope image. Since the photo-
graphic exposure depends on the time of exposure, this grey-scale image is
very strongly dependent on the time taken to acquire the image and on the
rate of scanning movement of the probe over the skin. A steady rate of
WHITE 9
8
GREY
LEVELS ~
5
4
3
2
BLACK 10L--.l..--6.1..--.l..--12L--L--18L--L...-
24L.........J'----
ECHO AMPLITUDE (dB)
Figure 6.9 The assignment of shades of grey to the range of echo amplitudes, as
achieved by the scan converterjTV monitor combination. For example echo amplitudes
between 6 and 9 dB are assigned in this case to the third grey level above the black
movement, uniform from day to day, is needed to achieve reproducible
Images.
The mostly widely used means of achieving a grey-scale display is the use
of a scan converter in conjunction with a closed-circuit television monitor
(see Appendices I, J, K and L). A schematic diagram of a B-mode imaging
unit incorporating these features is shown in figure 6.10. The scan converter
tube is capable of storing an intermediate, latent image containing a contrast
range which in turn is determined by the range of echo signal strengths used
to construct the image in the first place. The link-up with the television
monitor allows this stored image to be continuously examined and displayed
on the television screen with all the contrast maintained. Permanent records
can be obtained by use of a photographic technique from the television
screen.
Thus, the scan converter functions in two modes. First, its storage screen
can be written all in order to store the two spatial dimensions and one
brightness dimension of the image information. Secondly, it can be interro-
gated in order to display the stored image on the television monitor. In
normal use, the scan converter is automatically switched to the store mode
PULSE MASTER
~
GENERATOR TIMER
0
RECEIVER
~PROBE
(with lG.q
COORDINATE AMPLIFIER A-MODE
MEASURING DISPLAY f---a-
SYSTEM t
/DEMODULATOR /
l -"
SCAN
CONVERTER
,
C)
B-MODE
TV
DISPLAY
Figure 6.10 A block diagram of a 8-mode instrument for producing grey-scale images.
It differs from the basic system of figure 6.2 in having a scan converter and a TV display
instead of the oscilloscope display
when the ultrasound probe is being scanned over the tissues. Then when the
probe motion is stopped, the system reverts to the read and display mode.
Manual switching into either of these modes is also possible. Also , it is
usual to have the capability to manually switch either to the black on white
display or to the white on black display . Figure 6.11 displays a white on
black and a black on white image of the same tissue section as obtained
from an analogue instrument.
(a)
( b)
Figure 6.11 Two images of the same tissue cross-section , (a) white image on a black
background and (b) black information on a white background
6.7 DIGITAL GREY-SCALE DISPLAYS
An alternative approach to achieving a grey-scale B-mode display is the use

of computer techniques. In such a system, the B-mode scan plane is sub-
divided into a matrix of square sections or elements as indicated in figure
6.12.
Each one of these unique scan plane elements is assigned a location or
address in the sequential computer or microcomputer memory. During the
acquisition or store operation, the store mode, the echo signal strength
appropriate to each element of the scan plane, is assigned a number pro-
portional to that signal strength and that number is deposited in the
appropriate address or pigeon-hole in the computer memory. Thus, the
SCAN
PLANE
IMAGE
Figure 6.12 The orderly mapping of elements of the scan plane through the tissues
on to the successive computer memory locations and the subsequent mapping of these
memory locations on to the picture elements (pixels) of the image or display, as achieved
by a digital scan converter. The overall effect is the orderly mapping of the elements of
the scan plane on to the pixels of the image
signal strength for the image of each portion of the scan plane is digitised or
converted into a number. Then, when the system is in the read or display
mode, the number stored in each memory location is used to determine the
grey level of the display on a television monitor for that particular pixel or
picture element location. In this way, the image is stored as a matrix (128 x
128,256 x 256 or 512 x 512) of numbers in the memory of the computer and
it may be rapidly read and displayed as desired.
This mode of storage is more reliable, more reproducible, and less subject
to difficulty with noise in the system than the analogue method, and is
coming into more use in the present period. It also opens up the possibility
of using more elaborate computer techniques for analysing and manipulating
the images .
The number of pixels used is a measure of the spatial detail or resolution
that can be achieved on the display. For a given field of view or area of cross-
section to be displayed , the more pixels in each dimension the finer the
details that can be distinguished on the display. The larger the pixels the
blockier the image presented. Figure 6.13 is an example of an image obtained
with a B-mode unit with a digital scan converter. On close examination the
pixels may be seen in some parts of the image.
Figure 6.13 A sectional image of the liver and right kidney obtained from a digital
scan converter
6.8 OPERATOR MACHINE CONTROLS
Practically all of the controls which are available on the A-mode unit, are
also used on the B-mode instrument. Thus the transmission pulse can be
electronically attenuated; the appropriate frequency tuning must be used to
suit the transducer ; the Time Gain Compensation must be set to suit the
tissues being examined; the suppressor and the limiter must be arranged to
set the appropriate dynamic range and the oscilloscope settings or the
television monitor settings must be arranged to achieve an acceptable
displayed image.
A most important variable in deriving a B-mode image is the time taken to
build up the image and also the rate of image build-up. Since this is achieved
by manually moving the probe, there is a certain amount of. subjective
variability involved. Furthermore, if the rate of image build-up is slow, all
of the other controls must be set to suit. Conversely, if the rate of probe
movement is high, different settings of the machine controls must be used.
Another variable which is usually available on the B-mode unit is a scale
factor. One can choose to display an image which is lifesixe (x 1), some
fraction thereof (x 0.5, x 0.2, etc.) or larger than lifesize (x 2, etc.).
Other controls which must be available for B-mode scanning are a switch
to erase the stored image whether it be a bistable display or a scan converter
grey-scale display, and also a means of taking a photograph of the image.
The camera controls, shutter speed, diaphragm setting and distance to screen
must be optimised, bearing in mind the brightness and contrast of the
image as well as the type of film used (see chapter 9).
6.9 AXIAL AND LATERAL RESOLUTIONS
Axial or depth resolution was discussed in respect of A-mode instruments in

chapter 4. Basically, the same considerations apply to B-mode scanning.
Lateral resolution, the ability to distinguish on the image two neighbouring
reflectors positioned close to each other, is clearly of great importance in
B-mode scanning. The problem of lateral resolution is illustrated in figure
6.14. A cylindrical beam is interrogating a medium containing the wire
reflectors shown in that figure and the motion of the probe starts at the left
of the figure. The moment the beam is intercepted by the left-most reflector,
the echo is received by the transceiver and an appropriate bright spot is dis-
played on the screen. As the probe is moved right-wards and the beam cuts
the scan plane, the beam is still intercepted by the same reflector and a bright
spot is displayed at each successive position of the probe. In other words, a
line is displayed on the screen and the length of this line is approximately the
width of the ultrasound beam. At some points in this motion, it is possible
that two neighbouring reflectors are simultaneously positioned within the
beam, but since they are both at the same depth only one bright spot can be
displayed, i.e. the two reflectors are not resolved on the display. Clearly, the
beam width is the primary determinant of lateral resolution.
It is significant also that the image displayed for a small spot reflector is a
line rather than a spot. Small features in the scan plane are erroneously
imaged-small spaces are lost, small reflectors displayed as larger lines.
The width of a cylindrical beam is set by the crystal diameter. A crystal
diameter of any desired size may be chosen. But at any given frequency, the
length of the near field varies as the square of that diameter. Also, the angle
of divergence in the far field increases inversely as the diameter. So if a small
~- I
f+- - --+1--.--
-
(a)
B-MODE DISPLAY
~tJ- ,
\\ /
- -,1-' - --
'-!....WIRE;1
! \REFLECTORS B-MODE DISPLAY
(b) I '.
Figure 6.14 The lateral resolution of the B-mode scanner may be assessed by utilising
an array of wire reflectors, suspended in a medium with speed of propagation of 1540
m/s. The wires have successively smaller separations. When scanned the display consists
of a set of short lines, each representing one of the wires. When neighbouring lines
abut, lateral resolution is lost. An unfocussed beam as in (a) has poorer lateral
resolution than the focussed beam in (b) has at the focus
diameter is chosen, the cylindrical near field is very short and will not reach
to the depths of interest in the tissues. Depth information and beam direction-
ality at depth would therefore be sacrificed for the better lateral resolution
close to the probe.
A narrow beam with long near field can be achieved at higher frequencies
as discussed in chapter 3. Therefore, if the higher attenuation experienced in
tissues at higher frequencies can be compensated for, better lateral resolution
is achieved and depth directionality is maintained by choosing to scan at
higher frequency with a small diameter probe.
In practice, while it is possible to directly relate lateral resolution to the
frequency, the lateral resolution is some 5 or more times worse than the axial
resolution at the same frequency (see figure 4.1 0).
In all such cases the divergence of the beam in the far field, producing as it
does a wider beam, causes a degradation of lateral resolution. This degrada-
tion becomes progressive with distance into the far field.
Clearly, the lateral resolution in the near field can be improved if the beam
is focussed as indicated in figure 6.14(b). Effectively, focussing narrows the
beam and has the dual effect of improving the resolution and producing the
more accurate image of the small reflectors as well. The higher intensity at
the focus produces stronger echoes from any reflector located there. Hence,
small reflectors are better highlighted, while small spaces also are imaged
correctly. Focussing is also more effective at higher frequencies, so that the
lateral resolution at the focus improves as the frequency increases. It must be
remembered however that the lateral resolution is very dependent on where
along the axis of the beam one is concerned with. It is best in the focal
region, it is worse closer to the probe and it degrades progressively farther
away from the probe. The more extreme the focussing, the better the lateral
resolution in the focal region, but the worse it is closer to and further from
the transducer face.
6.10 ARTIFACTS
The artifacts discussed in relation to A-mode scanning can also arise in B-

mode scanning. A number of these artifacts are displayed in figure 6.15.
The regularly-repeated echoes of reverberation, due to reflection at a
strong reflector, usually close to the skin surface and hence early in the
path of the beam, are manifested on the B-mode image as sets of parallel
lines. These lines are parallel to the true image of the strongly-reflecting
surface and are separated from each other by the depth of that reflector.
The multiple path artifact can produce a ghost version of the reflecting
structure positioned behind the true position of the structure. However, this
may be noticed and eliminated if compound scanning is used and structures
are interrogated by the beam from a number of different directions.
The refraction artifact can also occur in B-mode scanning. This artifact
also produces a ghost image displaced from the actual position of the re-
flector, but it can often be spotted and eliminated by compound scanning.
Shadowing can be a very dramatic artifact in B-mode scanning. It results
in regions of the image being featureless or blank. Such areas can occur
behind or deeper than very bright regions which constitute the image of the
strong reflector causing the shadow. Shadowing can also occur if some super-
ficial tissue is very strongly attenuating and the beam therefore fails to
penetrate adequately to the deeper structures to yield appreciable echoes.
Sometimes, shadowing can be overcome by interrogating the tissues from a
number of directions, thereby dodging the shadow-producing tissues.
Another artifact, image enhancement or echo enhancement, is roughly the
reverse of shadowing, and occurs frequently in B-mode displays. This artifact
occurs when some of the superficial tissues have very low attenuation and the
(a) (d)
(b) (e)
(c)
(0
Figure 6.15 The appearance of certain artifacts in B-mode images. (a) The repetitive
parallel lines of reverberation, due to air at the junction of a water bath and the skin.
(b) The blank linear shadow posterior to a strongly-reflecting stone in the gall bladder.
To the right of the shadow there is enhancement of the image due to the relatively
smaller amount of attenuation in the liquid-filled gall bladder. (c) Most of the right half
of the image is shadowed by gas in the bowel. (d), (e) and (f) illustrate the effects of
inappropriate setting of the TGC. In (d) it is properly set, while in (e) there is excessive
anterior compensation and in (f) there is inadequate posterior compensation for the
given longitudinal section through the liver
echo signals from some of the deeper tissues are over-compensated by the
TGC system.
Unavoidable artifacts also occur in B-mode images due to the fact that the
beam of ultrasound has a finite width and interrogates a volume of tissues,
but displays the image along a straight line. The B-mode system concentrates
the echo information from each circular cross-section of the beam into a
point on the axis of the beam. As was discussed in relation to lateral resolu-
tion, any structures within the beam at the same distance from the probe are
not distinguished from each other. This results in smoothing of the features
of the image, small reflectors are made larger and small regions empty of
reflectors are filled-in on the image.
If the TGC variables are incorrectly set, artifacts can also appear on the
B-mode image just as in the case of A-mode. Some regions of the image can
be too dark -like shadowing- or too bright as in enhancement.
Errors can arise in the positioning or registration of features on the image
relative to the positions of the echo-producing structures in the tissues. Such
electronic misregistration causes the image of the structure to be displayed at
different locations, when the same structure is interrogated from different
directions by the ultrasound beam. This artifact can arise from the use of an
incorrect average speed of propagation in the instrument. It can also be
caused by misalignment, wear and other problems in the probe co-ordinate
measurement devices.
The artifact of incomplete imaging can occur in the B-mode display if the
scanning movement of the probe is too rapid in relation to the pulse repetition
frequency. The effect is an image consisting of the spokes of the wheel with
blanks between them. This can be corrected by slowing the movement of the
probe or else by increasing the pulse repetition frequency (prf).
Problems can also arise in the B-mode image due to patient movement
during image acquisition. In this case the structures being imaged may be at
different locations in relation to the face of the probe at different instants
during the image build-up. This difficulty can be overcome by ensuring that
the patient remains steady by holding his or her breath and by remaining
motionless.
6.11 PERMANENT RECORDS OF IMAGES
The B-mode instrument presents a two-dimensional cross-sectional rep-

resentation of a slice through the tissues. In general. to interpret and derive
a diagnosis from such an image. it is essential that it be correlated with
neighbouring slices. The third spatial dimension must be presented to the
view of the clinician for the most rounded and unequivocal diagnosis.
Photography of the images is the method most widely used to retain/
memorise the set of images from a complete examination. These hard copy
photographs, either in the form of positive prints viewed in reflected light
or film transparencies viewed by transmitted light on a light box, may be
retained with the patient's case notes. This facilitates later review of the
case in the light of further developments, therapy, etc. The techniques
involved are discussed in chapter 9.
Another method of storing image information is video tape recording.
This also allows later recall and indeed photography as required. A dis-
cussion of this approach is also in chapter 9.
Electronic memory methods may also be employed for image storage,
but have not yet found wide application.
In all of these ways of permanently recording ultrasound images, it is
essential that as well as the image itself, a battery of background data also be
stored. Data such as patient name and number, reasons for the examination,
patient position and orientation, any patient preparation, machine settings
(frequency, type of probe, focussing, transmitter attenuator, limiter, sup-
pressor, TGC settings), plane of section, landmarks, angulation of section,
etc., all are essential information for the clinician. Some of the information
can, in some machines, be written on the image via a keyboard connected to
the scan converter memory. But if such facility is not available, it must be
manually written on the hard copy.
All of the instrument checks for the A-mode unit, described in section 4.13
are directly applicable to the B-mode instrument as well. Two further tests
for lateral resolution and of electronic registration are of particular relevance
to the B-mode instrument. Both of these tests may be carried out with the
AlUM (American Institute for Ultrasound in Medicine) test target, which is
ilIustrated in figure 6.16.
This target consists of an array of wire reflectors stretched between two
vertical walls. They are all immersed in an aqueous solution, such as de-
scribed in section 10.11, with speed of propagation 1540 m/s. The target may
be scanned through the open top of this bath. Also the square test object
can be positioned with any desired side presenting upwards to the probe.
To measure the lateral resolution the target may first be scanned from
direction A in figure 6.16. The right hand column of reflectors are imaged as
a column of parallel lines. The length of each line correlates with the beam
width at that depth. If there is a focus, the line length is least at the focus.
The lateral resolution at the focus may be quantified by turning the test
object around to allow scanning from direction B and arranging the water
depth so that the smalI bunch of wire reflectors at the middle are at the focal
• •
J
• • ••• •
•
• •
•
2em. .1 em
,
.. SPACES • • SPACES
B •
• • •
•
• •
" .\
•
• • • • •
2em SPACES WIRE
REFLECTORS
Figure 6.16 The spatial arrangement of the wire reflectors in the AlUM (American
Institute for Ultrasound in Medicine) test object
length from the probe. When these wires are scanned the image is a series
of short lines arranged roughly end to end, but with each one in turn slightly
behind the previous one. When these neighbouring lines do not overlap,
lateral resolution holds. The separation for which the two neighbouring lines
just fail to overlap, is the lateral resolution at the focus.
This same test may also be done at other distances from the probe, where
the resolved separation would be larger than at the focus.
In the first stage of the previous test, to check the beam focussing, an
image of the column of parallel lines is obtained. Since these reflectors are all
equally spaced at 10 mm, the parallel lines should also be equally spaced at
10 mm separation on the x 1 scale display. If they are, this indicates that the
system average speed of propagation is indeed 1540 mis, the speed in the
liquid of the bath. If the image spacings are larger the system speed is too
great, and if smaller it is too small.
The latter test is a valuable adjunct to the test of electronic registration.
Two sets of data help to determine registration. One is the system average
speed of propagation and the other is the probe co-ordinate measurements.
The registration can be readily checked by sector scanning the test object
in two steps from the two upper corners. Each reflector wire should be
imaged as two crossed curved lines. In the case of correct registration each
such line should bisect its companion. If the lines otherwise intersect or fail
to touch each other, the machine registration is not in order. If in this latter
case the system speed is correct, the fault must lie with the probe position
and orientation sensors and servicing is called for.
A further check on the registration may be made by comparing the known
separations between wire reflectors in the test object and the distance be-
tween the corresponding points of intersection of the pairs of curved lines.
These should correspond regardless of the direction of the measurment.
6.13 CONTACT SCANNING AND WATER PATH DELAY-LINE

SCANNING
In contact scanning the probe is moved across the skin overlying the tissues
of interest, acquiring the pulse-echo information about those tissues as it
moves. The image is built up during this scanning motion. An acoustic
coupling medium is needed between probe and skin to eliminate air from the
ultrasound beam path.
The main requirements of this coupling medium are that its acoustic
impedance be close to that of water and soft tissues; that it be biologically
acceptable on the skin (non-toxic, non-irritant, non-staining, easily re-
moved); that it flow and wet the skin and the probe, so as to take the various
shapes of these; that its fluidity be low so that it does not flow away from the
area of study too quickly, either under gravity or under the sweeping action
of the scanning probe.
Vegetable oils such as olive oil have been successfully used for this purpose.
They are possibly too fluid but can be readily removed between scans.
Aqueous gels have more favourable flow properties and are very widely used.
If during contact scanning excessive pressure is used, the tissues and
organs being examined can be deformed and erroneous images produced.
This is an especial problem with B-mode imaging of the breast and thyroid.
It also occurs with obese patients. In such situations it is common to use a
water path delay-line instead of contact scanning. This method is shown in
figure 6.17. A path of water solution with speed equal to 1540 m/s is inter-
posed between the transducer probe and the skin surface. This may be
achieved in various ways, but one typical method is to use a plastic bag, open
at the top with the bottom on the skin, as shown in the figure. Good contact
between the skin and the bottom of the plastic bag is achieved by using a gel
or oil. The probe may be freely moved about near the surface of the water
and the tissue imaging achieved in this way. The TGC curve would have a
delay at least as long as the water delay-line depth. Since reverberation occurs
due to the strong reflection at the bottom of the water bag the reverberation
artifacts are prevented from interfering with the tissue echoes signals of
interest by ensuring that the depth of the water, hw' is greater than the maxi-
mum depth of the tissue being investigated.
Figure 6.17 A possible scheme for achieving non-contact delay-line scanning. A plastic
bag filled with a solution having a speed of propagation of 1540 m/s has an open surface
into which the probe is placed and about which the probe can freely move. The under-
side of the bag is acoustically coupled to the skin. The depth of the solution below the
probe provides the delay line
6.14 CRITIQUE OF STATIC B-MODE IMAGING IN CLINICAL

APPLICA TIONS
Static B-mode imaging, so-called because the target tissues must remain
motionless while the image is being acquired, is now widely applied to
regions throughout the body. It yields information about the shapes, sizes,
orientations and relative positions of different organs and tissues, in normal
and diseased states. It can be used to guide biopsy and aspiration needles to
the requisite target tissue.
Thus it is used at various stages during pregnancy to determine the position
and size of the foetus, to assess the internal anatomy and the maturity of the
foetus, to determine the location of the placenta, to evaluate a wide range of
problems and abnormalities of pregnancy , to safely guide the needle puncture
for amniocentesis and even foetal blood transfusion.
Static B-mode ultrasound is also the technique of choice in evaluating
gynaecological masses.
It is also widely used in examinations of the eyes, the thyroid gland,
abdominal aorta, liver, gall bladder, pancreas, spleen, kidneys, bladder,
scrotum and penis.
A very wide literature is available dealing with the multiplicity of applica-
tions and clinical conditions in which static B-mode imaging can with
advantage be used.
Even though static B-mode methods have proved a powerful tool for
investigating soft tissue structures throughout the body they do have limita-
tions. The acquisition of a B-mode image requires a long period of time, up

to 5-10 s, and can produce a blurred image if the patient as a whole or the
internal organs of the patient move during the image build-up. It is not
therefore a useful technique for imaging the heart or any other structures
which are constantly moving. To overcome this disadvanatage, more rapid
B-mode scanning methods have been developed and these are called the
dynamic or real-time B-mode scanning methods. These are discussed in
chapter 7.
Another limitation of static B-mode instruments can be their lack of
portability. The patient must be brought to the machine in order to be
examined. Consequently it can not be used in some emergencies and in most
circumstances a time-consuming logistical process of booking patients and
transporting them to the ultrasound laboratory and back to the wards must
be implemented. Many of the newer dynamic B-mode instruments overcome
this drawback by being readily portable.
6.15 BIBLIOGRAPHY
Andrews, H. C. et aI., Computer Techniques in Image Processing, Academic Press,

New York, 1970
Barnett, E. and Morley, P., Abdominal Echography, Butterworths, London, 1974
Cadkin, A. V. and Motew, M. N., Clinical Atlas of Grey Scale Ultrasonography in
Obstetrics, C. C. Thomas, Springfield, III, 1979 .
Carter, B. L. et al., Cross-sectional Anatomy: Computed Tomography and Ultrasound
Correlation, Appleton-Century-Crofts, New York, 1977
Cosgrove, D. O. and McCready, V. R., Ultrasound Imaging--Liver, Spleen, Pancreas,
Finberg, H. J., Case Studies in Diagnostic Ultrasound, Vol. 9, Churchill Livingstone,
Edinburgh, 1982
New York, 1980
Fran90is, J. and Goes, F., Ultrasonography in Ophthalmology, S. Karger, Basel, 1975
Gates, G. F., Atlas of Abdominal Ultrasonography in Children, Churchill Livingstone,
New York, 1978
1977
Hassani, S. N. (with Bard, R. L.), Real Time Ophthalmic Ultrasonography, Springer-
Verlag, New York, 1978
Holm, H. H. et al., Abdominal Ultrasound, Munksgaard, Copenhagen, 1976
Kobayashi, T., Clinical Ultrasound of the Breast, Plenum Press, New York, 1978
Lunt, R. M., Handbook of Ultrasonic B-Scanning in Medicine, Cambridge University
Press, Cambridge, 1978
ST ATIC B-MODE INSTRUMENTS 107
Metreweli, C., Practical Abdominal Ultrasound, Heinemann, London, 1978
Raymond, H. W., Fundamentals of Abdominal Sonography: A Teaching Approach,
Grune & Stratton, New York, 1979
Rosenfeld, A. and Kak, A. c., Digital Picture Processing, Academic Press, New York,
1976
1979
Sabbagha, R. E., Ultrasound in High-risk Obstetrics, Lea & Febiger, Philadelphia, 1979
Sanders, R. C. and James, A. E. Jr, The Principles and Practice of Ultrasonography
in Obstetrics and Gynecology, 2nd edn, Appleton-Century-Crofts, East Norwalk, Ct,
1980
Sherr, S., Electronic Displays, John Wiley, New York, 1979
Optical Applications, Plenum Press, New York, 1974
Taylor, K. J. W., Atlas of Grey Scale Ultrasonography, Churchill Livingstone, New
York, 1978 (reprinted 1979)
1980
Prague, 1972
1978
Wells, P. N. T. (Ed.), Ultrasonics in Clinical Diagnosis, Churchill Livingstone, Edin-
burgh, 1977
Annual Reviews

Medica, Amsterdam, annually since 1980
White, D. N. (Ed.), Ultrasound in Medicine, Plenum Press, New York, annually since
1975
7 Dynamic (Real-Time) B-Mode
Scanning
As mentioned in the previous chapter, if the structures being imaged by the

static B-mode technique are moving, the image which results is blurred. In
order to overcome this drawback, techniques for taking rapid B-mode
images or, as they are more commonly described, real-time B-mode scanning
techniques have been developed. These techniques fall into two broad
categories, rapid mechanical scanning and multi-transducer methods.
(a) describe how rapid mechanical sector scanning B-mode instruments
differ from static B-mode scanners;
(b) broadly show how a multi-element array transducer may be used to
obtain a dynamic B-mode display;
(c) outline the functional elements together with their interconnections
in a multi-element array dynamic B-mode scanner;
(d) describe how the composite beam from a multi-element array may be
focussed and how such an array may also be focussed in the receive
mode;
(e) show how the composite beam may be electronically sector-scanned
and a group of elements made to electronically orient in the receive
mode;
(f) outline some of the limitations of linear array scanning;
(g) broadly describe how to obtain permanent photographic or video
tape recordings of dynamic B-mode images;
(h) discuss the basic performance tests applicable to dynamic B-mode
units;
(i) outline the areas of clinical application of dynamic B-mode or 2-D
Imagmg.
DYNAMIC (REAL-TIME) 8-MODE SCANNING 109
7.2 RAPID MECHANICAL SCANNING UNITS
The basic idea in this technique is simply to rotate the sector scanning probe
very rapidly, i.e. much faster than any of the internal body structures being
imaged. In this way, the image can be acquired so quickly that there is not
appreciable movement of the structures during an image acquisition.
This can even be done manually. All that is required is that the pulse
repetition frequency be as high as possible, that the scan converter be
double-ended and that the operator be able to maintain the rapid sectoring
motion for a period of time. The image acquired is then a moving image if the
structures are moving, and therefore can only be viewed on an oscilloscope
screen with very short persistence or on a television monitor. For permanent
storage, a moving film or a video tape is needed.
Usually the rapid sector scanning is carried out automatically, with the
probe motion being motor-driven. Two typical systems for achieving this
are shown in figure 7.1. In figure 7.I(a), is shown a system where the probe
is rocked back and forth, by an appropriate drive mechanism. The probe is
totally immersed in an oil bath and the ultrasound passes from the probe
DRIVE
MECHANISM
(a) 'WINDON
. OIL"
4 P
(b) '»'WINDOW
Figure 7.1 Two alternative ways of implementing a rapid angular motion of the probe
for real-time scanning. (a) A single probe which is made to execute reciprocating
motion. (b) Four probes in cruciform arrangement which rotate, but of which only one
transducer is active at any instant
through a layer of oil out into the patient through a thin plastic window.
Thus, the probe holder as a whole may be placed on the patient's skin and the
sectoring achieved by the probe motion inside the overall probe holder. A
coupling gel is required between the window and the skin. Another technique
which is more simply implemented is that shown in figure 7.1(b). Here there
are four identical probes attached to a common axle which rotates in one
direction with only the probe which is positioned in the quadrant facing the
window, electrically active and connected to the B-mode instrument at any
moment. Thus, each single probe follows its predecessor into the active
region, and only one probe is active at each instant. The continuous rotation
is more simply implemented than the reciprocating motion required with the
set-up of figure 7.1(a).
In each of these cases, the probe co-ordinate measuring device and the
rest of the electronics and display system can be exactly as in the static grey
scale B-mode instrument of figure 6.10. Typically, a grey-scale system in-
corporating a double ended analogue scan converter or a digital scan con-
verter with a television monitor is used. These instruments are also usually
equipped with a stop-action switch or freeze-frame so that a particular static
scan can be obtained and a permanent record obtained as in the case of the
conventional static B-mode images.
Among the drawbacks of this system, is the fact that the transducer probe
holder can be fairly heavy and fatiguing to operate.
The mechanical drive is more liable to faults than an electronic system.
The system as a whole is not portable.
7.3 MULTI-ELEMENT ARRAY TECHNIQUES
Another way of achieving a dynamic or real-time B-mode image is by use of

a multi-transducer array technology. Instead of a single transceiver, an
array of identical transducers, usually rectangular, mounted along a line in
a single probe (such as is shown in figs 3.14 and 7.2) are used in these systems.
The whole array is coupled to the skin in the usual way.
The elements are excited in sequence, from left to right for instance. In the
simplest case, each element is active, i.e. transmitting and receiving, alone
for a short period. Then the next element is electronically switched into the
system to transmit and receive. Then the next element, and so on. As shown
in figure 7.3, a linear scan is achieved electronically in this way, and the plane
00000000 DO
12345678 ................. n
Figure 7.2 A linear array of n rectangular elements in a probe
DYNAMIC (REAL-TIME) B-MODE SCANNING III
SKIN ORGAN
~
MULTI-
ELEMENT STRUCTURE
ARRAY IMAGED
2-D
IMAGE
Figure 7.3 The formation of a B-mode image with a multi-element array. Each
element obtains the pulse-echo data about a line through the tissues and these data are
displayed in a spatial arrangement corresponding to the spatial arrangement of the
transducer elements
of the scan is defined by the set of beams travelling out from the identical
transducers in the array. The resulting image is constructed on the screen by
assigning a particular horizontal line location for the relevant set of bright
spots from each transducer element in the array. The relative positioning of
these horizontal lines in the display corresponds to the relative positions of
the beams emanating from the transducer elements. The actual separation of
these horizontal lines on the screen is set by the actual separation of the
transducer elements as well as by the scale factor assigned in the oscilloscope
controls. The bright spots and their positions across the horizontal direction
are set by the pulse-echo determined depths of the echoing structures
involved.
This complete sequence of activation of all the elements of the transducer
array is carried out repeatedly at a repetition rate something greater than
25 Hz in order to produce aflicker-free image to the viewer. Clearly, if the
organs being investigated are moving, the effect is a moving B-mode image
on the screen.
Certain factors tend to militate against the quality of the image produced
by this technique. For instance, the separations between the transducers and
therefore between the beams of ultrasound, produce gaps between the
horizontal display lines on the oscilloscope and cause blank striations in the
B-mode image. Also, the individual small transducers have a relatively short
near-field and so have poor resolution at much shallower depths than the
single larger transducers of the static scanner or the mechanical sector
scanner. Another cause of image degradation is the fact that the beams
cannot impinge on all the interfaces of a complex organ at 90°. This is the
limitation of the linear scan, discussed in section 6.3.
In an effort to overcome these difficulties, it is more common to activate
the transducer elements in groups of for instance, 3 or 5 at a time thereby
producing composite ultrasound beams. Thus the complete cycle of opera-
tions would start with transducers 1 to 5 active, then transducers 2 to 6, then
transducers 3 to 7 and so on. The echoes are displayed on the screen along the
axis of the middle transducer of the active group. This helps to improve the
resolution and the detail of the image.
7.4 THE MULTI-ELEMENT ARRAY INSTRUMENT
The schematic diagram of the multi-element array unit for generating

dynamic B-mode images is shown in figure 7.4. Many of the features are
held in common with the static B-mode instrument. There is a pulse genera-
tor to drive the transducer(s), a receiver amplifier together with the time
gain compensation (TGC) function. a demodulator, an oscilloscope display
or else a scan converter and a TV monitor display. There is also a master
timer clock to control the timing of the whole system, including that of the
pulser and the time gain compensation.
In this instrument however there is an array of transducers which are
brought into service in specific groups and in orderly sequences. There is
therefore an array of electronic switches which can make or break electrical
contact between the pulser/receiver amplifier and the transducers. The
control over this switching function, the making and breaking sequences. is
exercised by the element address logic module. The sequential steps in the
operation of this circuit are triggered by the pulse repetition frequency
signals from the master clock. The same element address logic circuit de-
termines the locations or addresses in the scan converter to receive the pulse
echo information from each sub-group of transducers. In this function it
replaces the probe co-ordinate measuring device in the static B-mode instru-
ment of figure 6.10.
Thus, each prf pulse from the master clock sets the element address logic
to the next logic state thereby making the contacts in the switch array with
a new group of transducers. The same pulse triggers the pulser to stimulate
those transducers. It also initiates the TGC function. The echo signals from
all the active elements in the transducer probe are first added together
before being processed in the usual way. The summed pulse echo signal is
DYNAMIC (REAL-TIME) B-MODE SCANNING 113
MULTI-
ELEMENT
ARRAY PULSE
GENERATOR
SWITCH
ARRAY 1---1'-----£1--------4 RECEIVER

.------i AMPUFIER
,---'-----'-~
MASTER (with TG.c.)

TIMER
ELEMENT
ADDRESS SCAN
LOGIC I---~--I CONVERTER
C)
TV
DISPLAY
Figure 7.4 Block diagram of a multi-element array dynamic B-mode scanning instru-
ment, showing the interconnections between the functional blocks
then displayed on an oscilloscope screen or stored in the locations in the scan

converter set by the element address logic state.
The number of such pulses from the prf clock needed to acquire a complete
image or frame depends on the number of elements in the array and on the
way the transducer sub-groups are activated. If there are 100 elements and
they are activated in overlapping groups of 5, then 96 such pulses are re-
quired. To ensure a flicker free image with frame repetition frequency of
25 Hz, the pulse repetition frequency needs to be at least 2.4 kHz.
7.5 BEAM FOCUSSING AND GUIDANCE BY PHASED ARRAYS
Among the useful possibilities with multi-transducer linear array systems, is

dynamic focussing of the beam in the plane of the array (i.e. the scan plane)
by electronic means. Such beam focussing may be achieved, as described in
figure 3.15, by careful control of the sequence of excitation of the active
elements. The degree of focussing can be controlled and the focal distance
can be set close to or far away from the transducer.
Furthermore electronic means exist to cause the active groups of trans-
ducers to function in a focussing manner when receiving echoes as well.
Thus there are interposed between each transducer and the summing re-
ceiver amplifier a delay line, as shown in figure 7.5, with the actual delay in
each line controlled electronically. If line 3 has a long delay, lines 2 and 4
shorter delays and lines 1 and 5 no delays, the receiver acts like the focussed
transmitter, in reverse. A plane wavefront approaching the array as shown in
the figure, strikes all the elements simultaneously. But the signals from
elements 1 and 5 reach the summing amplifier and the display, in advance of
the signals from elements 2 and 4. These latter are also displayed in advance
of the signal from element 3. The group acts as an electronically focussed
receiver. Control over the delays allows control over the degree offocussing
and the length of focus. Normally the receiver focussing would be chosen to
match the transmitter focussing.
WAVEFRONT DELAY
MOVEMENT LINES
2
RECEIVER
3
c:=>--HAMPLIFIER
4
PROBE
ELEMENTS
Figure 7.5 A group of elements can act as a focussed receiver if delay lines are inter-
posed between the elements and the mixing receiver amplifier as shown. In this set-up,
the wave front shown produces signals in elements 1 and 5 which reach the mixer first
and in advance of the signals from elements 2 and 4. The last signal to reach the mixer
is that received by element 3. Electronic focussing is achieved in this manner. The
range of delays in the delay lines may be varied and so the degree of focussing in the
receiver array may be controlled
Another interesting feature of the multi-transducer array is the ability

to electronically steer or orient the composite beam being transmitted by the
active elements. Consider the arrangement shown in figure 7.6. The first
composite beam formed by elements 1 to 5 travels along the axis of element
3 perpendicular to the linear array, after all five elements are simultaneously
pulsed. In the next triggering sequence, however, element 2 is not pulsed
simultaneously with 1 but, rather, somewhat later. Likewise, element 3 is
DYNAMIC (REAL-TIME) 8-MODE SCANNING 115
1fZl
21Z1
31Z1
4EZl
5EZl DIRECTION
Figure 7.6 Steering of the composite beam produced by five elements, may be achieved
by introducing a delay between the stimulation of each element in the sequence from
I to 5. Thus element 1 is first stimulated, then after a set delay, element 2 and so on
through all the elements. Control of the delay used sets the orientation of the com-
posite beam
pulsed a little later than element 2, 4 is later than 3 and element 5 is pulsed
last of all. In this way, the effective composite beam is directed downwards
at some angle relative to the original composite beam, and the angle is
determined by the relative delay introduced between the pulsing of 1 and
2,2 and 3, 3 and 4, and 4 and 5. By constantly varying the delay between the
excitation of the active elements, the effective beam can be made to electronic-
ally sector-scan through the body tissues as shown in figure 7.7. In this way
sector-scanning can be achieved electronically and the arrays driven in this
way are sometimes referred to as phased arrays.
PHASED AR RAY
,
/
, / ",
,/ ",
/
BEAM SECTORING
Figure 7.7 Electronic sectoring, by steadily varying the delay used in the steering of the
composite beam, can effect the interrogation of an extensive cross-section of tissues by
a narrow beam. Such an array is called a phased array
The set of active elements may also be electronically oriented in the

receive mode by inserting delay lines of gradually increasing delays, between
the elements and the summing or mixing receiver amplifier, as shown in
figure 7.S. Thus a wave front approaching the five active elements as shown,
WAVEFRONT DELAY
MOVEMENT LINES
RECEIVER
}--+--1
AMPLIFIER
PROBE~
ELEMENTS
Figure 7.8 A group of elements acting as a composite receiver may be endowed with
directionality by introducing delay lines between the elements and the mixing receiver
amplifier. If the delays introduced increase linearly across the array as indicated, the
incident wave on element 5 is detected by that element but the signal is delayed more
than the signal incident on element 4 and so on across the array. In consequence a
wave front approaching as shown produces signals, all of which are added or mixed
into the receiver amplifier simultaneously. The array is oriented in the direction along
which this wave front is travelling. Varying the delays in the delay lines across the
array varies the directionality
first encounters element 5 and its signal is delayed a large amount until the
wave front strikes element 1. Likewise the signal path from each other
element has a proportionately shorter delay so that all the elemental signals
combine simultaneously at the amplifier input. By varying the increase of
the delay from one element to the next, the directivity of the composite
receiver can be controlled.
Such electronic sector-scanning helps to overcome the limitation of linear
scanning whereby only structures more or less at right angles to the beam
can be detected and displayed. Since the effective angle of the beam can be
varied, many more structures and interfaces can be detected and a more
complete image can be formed (see figure 6.5).
7.6 PROBLEMS AND DIFFICULTIES
Some of the specific drawbacks of multi-element array real-time techniques

have already been mentioned. The disadvantages of the linear array have
been partly overcome by the ability to electronically sector-scan and by
electronic focussing. Another difficulty is the large bulk of the multi-
transducer array which is required, if an extensive plane across the body
structures is to be interrogated. Occasionally, if the rib bone or else bowel
gas is in the way or even if the array extends beyond the concavity of the
body, some of the structures of interest will not be seen and the image will
only be partial. As shown in figure 7.7, the phased array technique can help
to overcome this limitation too, since with a relatively small array one can
interrogate much more of the tissues. The ability to have dynamic focussing
does help to improve the resolution of the technique in the focal region, but
the divergence of the beam in the far field remains a problem for imaging the
deeper structures in the body. A drawback of the linear array technique is the
striated nature of the image, due to the necessary spacing between the
elements. Smoothing in the scan converter can help this.
The width of the beam perpendicular to the plane of the linear array gives
rise to other problems. In the linear arrays the beam, effectively a composite
beam, is not circular but mainly rectangular in shape and the width of the
beam perpendicular to the plane of scan is a cause of poor resolution in this
direction. While dynamic focussing improves the lateral resolution in the
direction along the array, the resolution in the direction perpendicular to the
linear array is not improved. Frequently, a small amount of acoustic lens or
internal focussing is used in this direction, but this is a fixed quantity and
usually cannot be a large improvement. Thus it should be borne in mind in
relation to the multi-transducer array systems, that lateral resolution has two
aspects and while dynamic focussing can improve one, it does not affect the
other.
7.7 PERMANENT RECORDING OF DYNAMIC IMAGES
Either photographic or video-tape methods may be employed to obtain

permanent records of examinations with dynamic or real-time B-mode in-
struments. Chapter 9 deals in detail with these techniques but a number of
points can be made at this stage.
Cine-film photography of the dynamic images on the TV monitor can
capture the complete examination. A dedicated monitor is required for this
task since continuous observation by the operator during the imaging pro-
cedure is essential. After development of the film, a projector is needed for
later viewing. Specific frames can be selected for individual magnification
and/or printing and placement in the patient's file. If a freeze-frame facility
is available on the scan converter, such individual views can be directly
photographed just as in the case of static B-mode images.
A video tape recorder can also be used to record the complete examination.
In this case the signal can be taken from the scan converter, while it is
simultaneously viewed on the TV monitor or oscilloscope display. Sub-
sequently the entire examination can be played back and viewed at will. The
freeze-frame facility on the recorder allows any required views to be photo-
graphed for the patient's case notes.
The performance tests to assess sensitivity, dynamic range, axial resolution,

lateral resolution in the scan plane, lateral resolution perpendicular to that
plane, and electronic registration can all be carried out with methods very
similar to those used for static B-mode instruments (see section 6.12).
A target arrangement, as suggested in section 5.6, with a vibrating flexible
bottom on a liquid-filled vessel, may also be usefully exploited, to assess the
ability of the system to dynamically image moving structures. If the fre-
quency of the vibration is gradually raised, the maximum velocity that the
system can image may be determined.
7.9 GENERAL REMARKS ABOUT CLINICAL APPLICATIONS

OF DYNAMIC B-MODE UNITS
The dynamic B-mode instruments may be used in all the clinical situations
in which static B-mode imaging has been used. Indeed since in most tissues
and organs there is considerable small-scale movement due to blood flow,
muscle action, respiration or heart contractions, the dynamic views offered
by the real-time units open a new perspective on ultrasound imaging.
Generally, the multi-transducer array B-mode instruments can be im-
plemented in a more compact and even more portable unit, compared with
static B-mode instruments. This is mainly because they do not require the
complex mechanical systems for determining the probe co-ordinates. These
instruments are coming to be very widely used in obstetrics for investigating
the position and dimensions of the foetus, even when the foetus is moving
about. These investigations can be done at the patient's bed-side in the ward
rather than in a specific examination room. All of the required foetal measure-
ments can therefore be made much more simply and cheaply than with the
static B-mode instrument.
Another major area of application of the real-time instruments is in the
investigation of the heart and the major vessels. The heart wall movements,
the dynamics of the heart valves, the changes in the heart chamber dimen-
sions, etc., all may be studied with the real-time machines. Even foetal heart
activity may be investigated.
The real-time instruments can also be used for the examination of ab-
dominal organs affected by respiration, such as the liver, spleen, kidneys and
gall bladder. In these cases the images achieved up to the present tend not to
be as good as those obtained with the static B-mode instruments. So for
general survey/orientation investigations, the dynamic scanners are best. For
fine-detailed images the static instruments retain the edge.
7.10 BIBLIOGRAPHY
Philadelphia, 1981
New York, 1980
Practice-· 1975, Society of Photo-Optical Instrumentation Engineers, Palos Verdes
Estates, Ca, 1975
York,1980
Louis, Mo, 1981
Short. M. D. et al. (Eds), Physical Techniques in Cardiological Imaging, Adam Hilger
Ltd, Bristol, 1983
1980
1978
Wade, G. (Ed.), Acoustic Imaging: Cameras, Microscopes, Phased Arrays and Holo-
graphic Systems, Plenum Press, New York, 1976
Weyman, A. E., Cross-Sectional Echocardiography, Lea & Febiger, Philadelphia, 1982
Winsberg, F. and Cooperberg, P. L. (Eds), Real Time Ultrasonography, Churchill
Annual Reviews
Medica, Amsterdam, annually from 1980
8 Doppler Instrumentation
Clinical ultrasound instruments based on the Doppler effect are widely used
to detect and measure the movement of internal structures in the body. A
variety of such instruments exist, and they can be broadly categorised into
continuous wave (cw) and pulsed wave (pw) instruments.
After studying this chapter the student should be able to:
(a) define the Doppler effect;
(b) describe the Doppler effect as encountered in echo-based diagnostic
ultrasound;
(c) schematically outline a continuous-wave Doppler instrument and
discuss the functioning of each component block together with their
interrelations;
(d) show how the absolute velocity of body structures may be obtained
from such a Doppler unit;
(e) describe in general terms how such an instrument may be adapted to
measure both magnitude and direction of the reflector velocity;
(f) discuss ways in which such cw Doppler instruments may be cali-
brated and checked;
(g) critically review the clinical applications of cw Doppler units and
their limitations;
(h) outline in block fashion a pulsed Doppler instrument for measuring
blood flow;
(i) describe the functions of the blocks in this instrument together with
their interconnections;
CD show how such a pulsed Doppler instrument may be modified to
yield images, typically of vessels in which blood flow is occurring;
(k) describe tests to check the performance of such pulsed Doppler
instruments;
(I) critically review the clinical applications of these units.
DOPPLER INSTRUMENTATION 121
8.2 DOPPLER EFFECT
The Doppler effect is the occurrence of a shift in observed frequency of a

sound or ultrasound wave when there is relative movement between the
sound source and the observer. In the clinical ultrasound situation two
Doppler shifts occur if a moving reflector is present in the beam from a
fixed source transducer. The first shift occurs upon reflection, in this case the
reflector serving as an observer that is moving relative to the fixed transmitter
transducer. The reflected wave then essentially emanates from a moving
source to be observed or detected by a fixed receiver transducer. This yields
a second Doppler shift in frequency, equal in magnitude to the first shift.
Consider the specular reflection situation shown in figure 8.1(a) where the
reflecting surface is moving towards the source of the ultrasound and along
J
(a) ~
cose,
1
1
--41---
8· --'
f;
~
(b)
Figure 8.1 The Doppler effect occurs when a wave of frequency f; is incident (a)
normal to a reflector moving with a velocity v m/s and (b) obliquely with angle of
incidence OJ to the moving reflector. In the inset is shown the dependence of cos OJ on
the value of (}j
the direction of the beam. If the frequency of the incident wave be 1;, the
reflected wave will have a different frequency,fr' This shift in frequency the
Doppler shift, arises as follows. The incident wave approaches the interface
at a speed c(m/s), which is the speed of propagation of ultrasound in the first
medium. The interface is moving to meet that incident wave at a speed of
v(m/s). Therefore, each succeeding maximum of the incident pressure wave
encounters the reflecting interface thereby producing the pressure maximum
of the reflected wave, sooner than would have been the case if the reflecting
interface were stationary. In fact, the wavelength of the reflected wave (}'r)
is shorter than that of the incident wave (A), or in other words the reflected
frequency is greater than the incident frequency. The shift in frequency jj~
is given by equation (S.1):
iJf=f,-f.
= +t;v (S.l)
- c
If the motion of the reflecting surface is in the opposite direction, with the
surface receding from the source, then the magnitude of the Doppler shift is
negative.
A second Doppler shift of equal magnitude occurs when a static transducer
receives the echo from the moving reflector 'source'. Thus the overall or total
Doppler shift iJfT' in this case is given by equation (S.2):
iJf
2rv
= +_.l_i.
. T - C
(S.2)
If the angle of incidence (}i' of the wave on the reflecting interface is greater
than zero as shown in figure S.1(b), then only a component of the reflector
motion, \. cos (}i' is along the direction of the incident wave and the total
Doppler shift is determined by that component as shown in equation (S.3):
At'T-±---
_ ~t; vcosO i
Ll. (S.3)
c
Once again, if the reflector is moving towards the stationary source/receiver,

the shift is positive and if the interface is moving away from the source/
receiver, it is negative.
Thus, the magnitude of the Doppler shift is set by the original incident
frequency, the speed of movement of the reflecting surface and the cosine of
the angle of incidence, and it is inversely proportional to the speed of
propagation of ultrasound in the first medium. To obtain an idea of the
order of magnitude of the overall Doppler shift, consider the case of a
structure moving at one metre per second (1 m/s) at right angles to the
incident beam, and assume the incident frequency to be 2 MHz. Assume the
speed of propagation to be 1540 m/s. This results in a total Doppler shift of
about 2.6 kHz, a frequency in the middle of the audible range of sound
frequencies.
8.3 SCHEMATIC OUTLINE OF A BASIC CONTINUOUS WAVE

(cw) DOPPLER INSTRUMENT
A schematic diagram of a cw Doppler unit is shown in figure 8.2. It is almost

totally different from the various pulse-echo instruments and it is in order
therefore to consider the various sub-units of the instrument.
···· 11(\(\(\00· ... .

. . .. --I OSC ILLATOR
~TY-l--=...:..:.:.:~~O-.:O~v~v~v~\.~.:.:.:....:.:.::.,
... . rvA''{t'···
r--~--t LOUDSPEAKER
FREOUENCY
ANALYSER
Figure 8.2 Block diagram of a basic continuous-wave Doppler ultrasound instrument ,

showing the main functional components and their interconnections in the system
The probe in this instrument consists of two identical transducers mounted

side by side as shown in figure 8.3. One of these transducers acts as a trans-
mitter only and the other acts as a receiver only. The piezoelectric discs may
be air-backed or backed with a polymeric material, i.e. undamped. They
may be set in the same plane or at an angle of about 5° to the overall axis of
the probe. As usual, the thickness of the disc determines the fundamental
resonant frequency , at which the transducers are driven . Notice that the
backing used ensures minimal damping since these transducers are con-
tinuously driven. The discs are equipped with a protective coating on the
front face , an epoxy resin. This coating provides mechanical protection,
acoustic impedance matching between the discs and the skin and also some
focussing. Various shapes of disc are used including circular, semi-circular

and rectangular as indicated in figure 8.3.
The transmitter transducer in the probe is continuously driven by the
alternating voltage output from the cw oscillator. The output frequency of
this oscillator is chosen to match the resonant frequency of the transducer
disc.
Since the transmitter transducer is constantly transmitting ultrasound, all
reflecting structures in the beam, both stationary and moving, are constantly
CD CD
DDuu
Figure 8.3 Alternative designs of continuous wave (cw) Doppler probes used in
medical applications
returning echoes to the receiver transducer in the probe. This means that the
receiver transducer is constantly receiving echoes of frequencies equal to the
originally-transmitted frequency (from stationary structures) as well as
Doppler-shifted frequency echoes (from moving structures). There is a
tuned amplifier in the unit directly behind the receiver transducer to preferen-
tially boost all of the echo signals. Note that there is no provision for time
gain compensation (TOC) since there is no way of distinguishing the depth
from which echoes are received in this system.
After the amplifier, the echo signals proceed to the discriminator or FM
demodulator. The discriminator is of a different type from the demodulator
in the pulse-echo instrument. The discriminator is aimed at extracting the
magnitude of the Doppler shift from those echo signals which return from
moving structures. It is therefore a frequency demodulator which compares
the frequency of the received echo signals with the frequency originally
generated by the transmitter oscillator. It generates a voltage signal of a
frequency equal to the absolute value of the Doppler shift. This means that
it does not distinguish between whether the Doppler shift is positive or
negative or whether the moving structure is moving towards the probe or
away from it.
As shown by the calculation earlier, the frequencies produced in many
practical clinical applications of these instruments are in the audible sound
range. Consequently, this so-called Doppler signal can be sent through an
amplifier to earphones or to a loudspeaker, and can be listened to. The per-
ceived pitch of the sound is determined by the Doppler shift which, in turn,
is determined by the speed of the moving structure in the body.
This Doppler signal can be recorded on tape or further analysed. This
further analysis will be considered later.
Consider the situation where there are reflectors in the beam which have
a range of speeds, both towards and away from the transmitter transducer.
Assume also some stationary reflectors. The received echo signal now con-
tains a range offrequencies above and below the transmitted frequency, i.e.
it contains a spectrum extending on either side of the transmitted frequency,
1;, as shown in figure 8.4(a). Compare this spectrum with the transmitted
spectrum shown in figure 8.4(b). Discrimination subtracts any of the trans-
mitted frequencies from the received frequency spectrum as shown in figure
8.4(c), and also translates or shifts those frequencies down close to zero.
Those received frequencies which are greater than the transmitted frequency
are transferred to their relevant Doppler-shift frequencies close to zero.
Those received echo signals which have frequencies lower than the trans-
mitted frequency are also transferred close to zero, the frequencies equal to
the absolute value of their Doppler shifts. Therefore, the discriminated
signal is a mixture of the two original sidebands of the received signal, but
now in the low frequency or audio range as shown in figure 8.4(d). Therefore,
the audio signal does not distinguish between positive and negative Doppler
shifts, and so it does not distinguish between echo signals coming from
those reflectors moving towards and those moving away from the transmitter.
This system rejects the directional information in the signal.
8.4 SIGNAL ANALYSIS AND RECORDING
As mentioned previously, the Doppler-shift voltage signals may be listened

to with loudspeaker or earphones, may be recorded for later examination
and analysis, or may be further analysed directly.
A commonly used further analyser is a frequency meter. A zero-crossing
detector is often used for this purpose. This instrument produces a voltage
pulse every time the Doppler shift signal crosses zero, or any set D.C. level.
It then counts the number of these pulses and averages them every given
interval of say 50 ms or so and produces a voltage proportional to the
number of zero-crossings. This in turn is proportional to the frequency
present in the Doppler shift signal. This output voltage may then be displayed
on an oscilloscope screen or on a meter dial or it can be continuously re-
corded on a chart recorder. If there is a number of reflectors with a range of
speeds, the amplitude displayed at any moment correlates with the root
mean square speed of the moving reflectors (e.g. the red blood cells) in the
ultrasound beam.
~II
(a) ~
!f j
~I
(b) A !fj f
I~I ,
(c) ni/\ fj
~II(\
(d)
Figure 8.4 The signal processing implemented on the spectrum of the received echo
signals, shown in (a), by a non-directional Doppler unit. The transmitted spectrum is
shown in (b), so that the Doppler shifted portions of the received spectrum are as shown
in (c). In the discriminator the received spectrum is mixed with the transmitted spectrum,
and the result is a spectrum of the frequency differences between received and trans-
mitted spectra. This new spectrum is down in the audible range of frequencies. In the
non-directional instrument this new spectrum is derived in a process which considers
only the magnitude of the frequency difference between received and transmitted fre-
quencies. The output spectrum in (d) therefore is a blend of components due to the
positive Doppler shifts and the negative Doppler shifts in (c)
The overall action of the system is illustrated in figure 8.5. When used to
measure blood flow the discriminator generates the Doppler signal, the fre-
quency of which is related to the absolute value of the red blood cell velocity.
The zero-cross detector then generates a voltage, whose amplitude is directly
proportional to the root mean square (rms) of the Doppler shift frequencies.
Overall, therefore, the output voltage amplitude of the zero-cross detector
is directly proportional to the magnitude of the rms blood velocity.
In streamline or non-turbulent flow, the rms velocity is proportional to the
average velocity. Then the zero-cross output voltage amplitUde is propor-
tional to the average velocity of the blood and may be calibrated in average
velocity.
(a)
lei
(b)
lei
(c)
Ivl rms
Figure 8.5 (a) The relationship between the magnitude of the Doppler shift frequency
output from the discriminator and the magnitude of the reflector velocity. (b) The
relationship between the amplitude of the output voltage from the frequency meter
circuit and the root mean square Doppler shift signal frequency. (c) The overall per-
formance of the instrument with frequency meter, is summarised in the relationship
between the amplitude of the output voltage signal and the root mean square reflector
velocity
If however the blood flow is turbulent, as it is in many parts of the circula-

tion at times during the cardiac cycle, then the output voltage amplitude can
only be taken as a qualitative indication of the flow.
A circuit which replaces the discriminator and frequency meter and which
generates at each instant during the flow, output voltages proportional to
either the average or maximum velocity as required, is the phase-locked
loop (PLL). This approach is increasingly being used in Doppler units.
With this device a graph of average or peak blood velocity may be recorded
on a chart recorder.
This type of analysis and display neglects much Doppler shift information
if there are simultaneously present in the beam different reflectors with
different speeds, such as the red blood cells in the bloodstream. In that case,
the detector which responds to the rms reflector speed only, gives no indica-
tion of the distribution of speeds present. To extract the full range of such
information, a frequency analyser is needed. Such an analyser yields the
spectrum of the Doppler-shift signal at every instant during the interrogation
of the moving structures and tissues, i.e. it yields the amplitude of each fre-
quency component present. Iffor instance, these amplitudes are varying with
time, this analysis must be performed continuously.
In some cases, such frequency spectrum analysis is carried out off-line.
The Doppler-shift signals are first tape recorded and the analysis is carried
out subsequently. Many analogue spectrum analysers are available on the
market and their operation is equivalent to an array of band-pass filters,
each terminated with a measurement meter. The pass-bands of the filters
cover neighbouring ranges of the frequency scale.
In recent years digital computer techniques using programmes involving
fast Fourier transforms (FFT) are increasingly being used for this purpose.
To implement such analysis the Doppler-shift signal must first be sampled
and digitised (see Appendix L). After the computer analysis the spectrum
can be reconverted to an analogue form for recording and display. The most
common form of display is a graph of Doppler-shift frequency against time
with the spectral amplitudes coded into a grey scale. Thus a high amplitude
spectral component would be darker than a low amplitude component.
8.5 DIRECTIONAL DOPPLER SYSTEMS
To extract the directional information from the composite Doppler-shifted

echo signals, a double channel signal processing scheme such as that of
figure 8.6 is used. This is a quadrature-phase detector.
One channel (A) is initially identical with the system of figure 8.2, where
the frequencies in the echo signals are compared in the discriminator with
the original transmitted frequency. In the second channel (B), the comparison
is with the original transmitted signal shifted by 90°. The outputs of these
two discriminators are out of phase with each other, for instance A leading
B when flow or reflector movement is away from the transducer and B
leading A when flow is towards the probe.
The comparator in figure 8.6 compares the phases and can be used to
control switches or gates either to direct the Doppler-shift signal to two
output meters (for forward and reverse flow) or to direct the signal from a
frequency/voltage converter appropriately to a differential amplifier with
bidirectional output (positive for forward and negative for reverse flow). In
either of these cases, the output Doppler-shift signal(s) may be listened to,
further analysed, chart recorded or tape recorded for later analysis.
TX
RX
PHASE
FREQUENCY TO
COMPARATOR
VOLTAGE
CONVERTER
DI FFERENTIAL
AMPLIFIER
Figure 8.6 Block diagram of a directional Doppler system, showing the main func-
tional components and the inter-relationships between them
8.6. CALIBRATION AND PERFORMANCE CHECKS
The main calibration experiment for a cw Doppler instrument is the estab-

lishment of the slope of figure 8.S(c), the relationship between the amplitude
of the output from the frequency meter (proportional to Doppler-shift
frequency) and the velocity of the reflector producing that shift.
One way of establishing this relationship is to set up a steady laminar flow
(of blood or milk or aqueous suspension of rubber spheres) in a circular
cross-section tube. Measure the outflow quantity over a period such as 60 s,
and calculate the flow rate. The average velocity is the flow rate divided by
the tube cross-sectional area, and the maximum velocity is twice the average
velocity. Meanwhile interrogate the flow in the tube with the Doppler unit
ultrasound beam and measure the output amplitude of the frequency meter.
Gradually increase the steady flow in the tube and obtain a set of data pairs
to draw the graph of figure 8.5(c).
Another method of checking the performance of a cw Doppler instrument
is by using the test vessel with vibrating base described in chapter 5 for
testing M-mode instruments. The vibratory reflecting base has a sinusoidal
velocity, the maximum value of which (2nfA) can be varied either by
changing the frequency (f) of the electromechanical oscillator or the ampli-
tude (A) of that motion. Also note that this motion provides equal reverse
and forward phases of the reflector motion.
The ultrasound beam is set perpendicular to the bottom of the vessel. The
amplitude of the frequency meter output voltage is recorded and should be
a sinusoidal graph of amplitude proportional to 2nfA. The calibration
graph of figure 8.5(c) can be derived from individual points on this sinusoid.
Indeed if the instrument is a directional Doppler unit a calibration graph
such as that of figure 8.7 may be derived, since known forward and reverse
velocities are presented to the ultrasound beam.
lei
Figure 8.7 The calibration graph for a directional cw Doppler instrument is essentially
two graphs which are plots of voltage amplitude versus amplitude of forward reflector
velocity (as registered on one meter) and of voltage amplitude versus reverse reflector
velocity (as registered on a second meter)
8.7 CLINICAL USES AND LIMITATIONS
The continuous-wave Doppler instruments are well established for detecting

the motion of structures in the body. They are used, for instance, to detect
the motion of the foetal heart. For this application, 2 MHz or 5 MHz ultra-
sound may be used and the Doppler signal is simply listened to, either with
earphones or loudspeaker. The main information derived in this case is the
foetal heart rate and it may be continuously monitored with the Doppler
instrument. In particular during labour, when the foetal well-being is being
monitored in a number of ways, the Doppler instrument is an important
component in the assessment instrumentation.
The Doppler instrument has also been used to study the motions of the
adult heart valves and the cardiac walls.
The most widespread use of the continuous-wave Doppler method is in
the detection of blood flow both in arteries and veins. In this case, the moving
reflectors are the red blood cells which travel at a number of speeds at
different points across the diameter of the blood vessel. Frequencies from 2
to 10 MHz are used for this application, with the lower frequencies being
required for the study of deeper vessels. Because the speeds of the red blood
cells in the arteries are much higher than those in veins, the Doppler-shift
frequencies derived from arterial flow are much higher than those from the
veins and can be easily distinguished from them. Furthermore, the fact that
the flow in the arteries is pulsatile whereas the flow in the veins is much
steadier, also aids differentiation between the two types of flow. A very
common application of this technique is in the indirect blood-pressure
measurement with the inflatable cuff, where the Doppler flow detector can
be used to assess vessel patency instead of the auscultation of the Korotkoff
sounds with the stethoscope. Abnormalities of the blood vessels, such as
stenoses or aneurysms in the arteries, can with practice be readily dis-
tinguished and their extent along the blood vessel traced and measured.
The use of a zero-cross type of frequency meter plus a chart recorder
allows certain quantitative measurements to be made on the circulation.
Thus, a typical rms Doppler frequency recording from an artery during the
cardiac cycle is shown in figure 8.8, in which the directional information is
preserved with positive flow above the baseline and negative flow below the
baseline. The ratio of the peak-to-peak range of frequency to the mean or
average frequency is defined as the pulsatility index. This parameter is
useful in diagnosing the state of the artery and the impedance to flow
down-stream or peripherally from the site being examined. For instance, if
this peripheral impedance is increased there is more reverse flow and usually
an increased pulsatility index. This index helps in the diagnosis and assess-
ment of aneurysms and stenoses.
(a) MEAN
t
(b)
Figure 8.8 Two Doppler frequency versus time graphs showing the parameters used
to calculate the Pulsatility Index, (a) for a high index and (b) for a low index
If two Doppler flow detectors are simultaneously applied up-stream and
down-stream on the same artery, a record such as that in figure 8.9 can be
obtained. From this record, the transit time, the time delay between the
arrival of the velocity pulse at the start of the length of artery and its down-
stream end can be obtained. Since the distance between the two measuring
points can be measured, the pulse wave velocity, a measure of the stiffness
of the arterial wall, can be calculated. Furthermore, the ratio of the pulsa-
tility indices at the down-stream and up-stream locations is another useful
parameter called the damping factor. This parameter, if it is high, indicates
stenosis, while a low value correlates with normal flow, and an intermediate
value is often related to an aneurysm.
The Doppler flow detectors can also be used for studying the flow in the
veins and often they are used to indicate the patency of the veins in the limbs.
Thus, the major types of information derived from the Doppler flow
meter concerns heart-rate and the state of the health of the blood vessels.
While they detect the flow of the red blood cells, it is not possible to use
these instruments to accurately measure the volume flow rate because it is
rarely possible to determine accurately the angle of incidence (}p between the
incident ultrasound beam and the moving red blood cells. Also it receives
and analyses simultaneously the Doppler shift signals from red blood cells
moving at a variety of velocities across the diameter of the vessel and is not
capable of yielding the velocity profile across the vessel diameter. Basically,
the instrument yields a qualitative indication of the flow.
UPSTREAM
t
f
DOWNSTREAM
t
Figure 8.9 Two simultaneously measured Doppler frequency versus time graphs
from two points on the same arterial segment, indicate the meaning of the Transit Time
8.8 SCHEMATIC OUTLINE OF RANGE-GATED PULSED

DOPPLER INSTRUMENTS
A more recent development in ultrasound Doppler instrumentation is the

pulsed Doppler range-gated system shown schematically in figure 8.10. In
FREOUENCY
DIVIDER
(p. r. f.)
fm COMPARISON
r-----Oi---!
OSCILLATOR
l...-_,---_ _----'i - - - - o r - - - - - 1 DELAY
DOPPLER
SIGNAL
OUTPUT
Figure 8.10 A block diagram of a pulsed. range-gated Doppler instrument. showing

the functional components and the interconnections between them
this instrument. the driving voltage oscillations from the master oscillator
are gated to produce the effect of a pulsed oscillation drive to the transmitter
probe. A pulse of ultrasound offrequencY.li' is transmitted into the body. In
order to ensure that each pulse being fed to the transmitter is identical to the
others. the gate opening times are keyed to the driving frequency signal but
an exact sub-multiple (for example 10 3) of that frequency. The pulse
repetition frequency would then be 10 3 of .Ii' The received echoes are
amplified before discrimination of FM demodulation. The discrimination
used is similar to that described for the directional Doppler system earlier.
The comparison frequency generated by the comparison oscillator, .1m , is
slightly less than/i' so that when the FM demodulation is done. the positive
and negative Doppler shifts are preserved intact and separate.
Notice that since the voltage drive to the transducer is pulsed in this
instrument. the transducer must have some damping, very similar to the
pulse-echo transducers. Two separate transducers. one for transmitting and
one for receiving can be used, or else a single transceiver.
Finally, the FM demodulated signal is passed through a range gate, which
is opened at some delay after the original transmitted pulse. The delay used
may be varied. so that the pulse-echo signals from different depths can be
examined in isolation as shown in figure 8.11. Also. the duration of the
opening of the sample gate. which is the same as the duration of the output
T X / R X_
fR_O
_B _ ---~ E GATE SLICE
ES=JA-«>IMIPL"'
__
I<>
~ '<I; ~" RANGE TO

SAMPLE
TISSUE
Figure 8.11 The range of distance to the sampled region in the tissues may be varied
and the thickness of the sampled region may also be varied
pulse, can be varied in order to be able to focus attention on Doppler-shift

signals from a particular thin layer of tissues.
Therefore, the output Doppler-shift signals originate from moving re-
flectors within a particular layer of tissues within the beam at a particular
set depth - the so-called sample volume.
Control over the sample volume is exerted by:
(a) the choice of transducer diameter and focussing, which determine the
cross-sectional area of the sample volume;
(b) the pulse duration and the damping in the transducer, together with
the range-gate duration, which determine the length of the sample
volume;
(c) the choice of delay which locates the roughly cylindrical sample
volume at a depth or range from the transducer face.
It is something of an approximation to consider the sample volume as a
cylinder. It would be more accurate to note that the cylinder would have
some tapering at each end and hence a pear or drop-like shape.
This instrument allows one to study the Doppler-shift signals from points
across the lumen of an artery, or from different points along the cusp of a
cardiac valve, etc. It therefore allows one to overcome one of the major
disadvantages of the continuous wave Doppler system which could not
yield information about the depth of the reflecting structures producing the
Doppler-shift signals.
The Doppler-shift signal from the pulsed system can be fed to earphones
or loudspeaker, or it can be analysed in the same ways as previously described.
A zero-cross frequency meter can be used to measure the root mean square of
the Doppler-shift frequencies or else a spectrum analyser can be used to
measure the amplitudes of all the frequencies present.
One drawback still remains with this instrument, and that is the fact that
the angle of incidence between the ultrasound beam and the moving re-
flectors is not known. Therefore actual reflector velocities can not be calcu-
lated. There is one simple way of overcoming this problem and may be used
in cw and pulsed instruments. Two identical probes are used, and are
mounted in a holder as shown in figure 8.12 with each one making the same
angle, IX, with the horizontal front face of the holder but directed in opposite
PROBE HOLDER
Figure 8.12 A scheme which may be used to determine the absolute velocities of the
blood in an artery, whose angle to the skin is not known
directions. The assembly is placed on the skin as shown and a coupling gel
is used to ensure that the ultrasound propagates efficiently into the tissues.
The artery inside is at some angle which is unknown relative to the skin.
The zero-crossing detector output from the machine is monitored, using
each of the two probes in turn. The position of the probe holder on the skin
and its angle relative to the skin are varied until the zero-cross outputs from
both probes are identical but of opposite polarity. At this position of the
assembly, one probe makes an angle rJ. with the positive direction of flow in
the artery while the other makes the same angle rJ. with the negative direction
of flow in the artery. This angle may then be used in the original Doppler-
shift equation instead of the angle 8j • Then the actual velocity of the blood in
the artery and indeed the velocity of the blood at different positions across
the lumen of the artery may be calculated, using the Dopper-shift equation
applied to the output of the pulsed system.
The range-gated instrument can also measure the diameter of the artery
by measuring the difference in range between the closest and furthest points
of no flow, as well as measuring the velocity of the blood flow at different
radial positions across the artery. Therefore, it can be used to provide data
to calculate the volume flow rate of blood in the arteries. It offers the promise
of quantitative information about blood flow in arteries and veins.
8.9 IMAGING WITH PULSED DOPPLER UNITS
The delay setting is proportional to the depth of the moving reflectors in

the range-gated pulsed Doppler instrument. By gradually varying the delay
or by sweeping through a range of delay values, the effect is to sweep the
sample volume through a range of depths. At any depth where there is a
moving reflector, Doppler-shifted echo signals are received. At depths where
there are no moving reflectors, no Doppler-shift signals are received.
The Doppler-shift signal can be continuously analysed with a zero-
crossing detector which produces a voltage proportional to the rms frequency
present at that depth.
If the arrangements shown in figure 8.13 are added to the original system
of figure 8.10, the pulsed-Doppler instrument can be used to image the
location of the moving reflectors, for instance the flowing blood within the
artery. A saw-tooth voltage is used to electronically sweep the delay and also
to provide Y deflection, i.e. depth deflection on the oscilloscope display. The
zero-cross ()utput voltage is used to drive the Z or brightness input of the
oscilloscope. Finally, a linear potentiometer can be used to detect the
position of the probe along a linear track and the voltage from this potentio-
meter is used to move the display on the oscilloscope along the horizontal
or X axis. Thus, as the probe is moved slowly along the X track while also
being drawn over the skin, the delay is repeatedly swept and the Doppler
shifts determined at the various depths. Whenever there is a moving re-
flector producing a Doppler shift, a bright spot is displayed on the os-
cilloscope.
In this way, the full extent of an artery can be imaged on the screen as
indicated in the diagram. Only the positions of moving reflectors producing
Doppler-shift signals are displayed on the image. The level of the voltage
required to produce the bright-up can be arranged with a suppressor
threshold so that small voltages such as would be produced from flow in
veins can be suppressed.
Use of a scan converter allows a grey-scale display to be implemented.
FREQUENCY TO
- __- - - - / VOLTAGE
DOPPLER CONVERTER
SIGNAL
DEP'Hj~ Z
~ fs~::T) 1-------I---~f_4:y POSiTION
PROBE
POSITION
DETECTOR
Figure 8.13 The additional functional blocks to those shown in figure 8.10, that are
needed to image blood vessels with pulsed Doppler techniques
8.10 PERFORMANCE CHECKS FOR PULSED DOPPLER
INSTRUMENTS
Adaptations of the test rigs for cw Doppler units may be used for checking
the performance of pulsed Doppler instruments.
The tube carrying the calibrated luminar flow of milk or blood can be
immersed in a bath of solution with speed of propagation 1540 m/s. This
flow can be measured with the pulsed Doppler unit, by directing the probe
towards the tube from the surface of the bath. The velocity profiles and the
tube diameter may be determined for a range of liquid flow rates. Since the
diameter and the actual velocity profile are known a priori, the instrument
performance can be checked. The same test rig can be used to assess the
imaging performance of the pulsed Doppler imager, at different flow rates.
The bath with vertically vibrating base can also be used to check the
operation of the pulsed Doppler unit. Since the velocity of the base is
known and the depth of solution in the bath can be varied through known
values, both the Doppler-shift function and the range (delay) calibration
may be checked. The Doppler shift for both forward and reverse reflector
velocity can be calibrated in the same manner as for the cw instrument. The
image calibration can be assessed by simply varying the height of the trans-
ducer face above the moving base of the bath. The range according to the
instrument should correspond to the measured depth in the liquid (of
propagation speed 1540 m/s) in each case.
8.11 CLINICAL USES AND LIMITATIONS OF PULSED

DOPPLER INSTRUMENTS
The main uses of the pulsed Doppler instruments are in the study of arterial
blood flow and in imaging arteries. Commercial instruments specially
designed for imaging the carotid artery bifurcation are available. Some of
these instruments incorporate grey scaling in the display where the voltage
to the Z input, which is proportional to the Doppler-shift frequency, de-
termines the brightness of the spots on the display. Some instruments
employ a colour coded display to represent the range of frequencies present.
Many new clinical applications are being developed and reported in the
literature and it is likely that these applications will increase as years go by.
There are also on the market a number of pulsed Doppler instruments for
quantitative analysis of blood flow. As mentioned previously these offer the
possibility of quantitatively measuring the blood flow rate in vessels in the
safest and most non-invasive method yet devised. It is certain that these
applications will multiply in the coming years.
New applications are also being developed in which these instruments are
used to quantitatively examine other moving structures in the body such as
the heart valves and walls, the motion of the diaphragm, the various motions
associated with the larynx and other throat structures, the motions of
sphincters and other structures in the abdomen.
The potential and indeed the detailed structures of these instruments are
developing and evolving. Many new developments in this area can be
expected in the years ahead.
8.12 BIBLIOGRAPHY
Atkinson, P. and Woodcock, J. P., Doppler Ultrasound and its Uses in Clinical Measure-
ment, Academic Press, London, 1982
Biidingen, H. J., Doppler-Sonographie der Extrakraniellen Hirnarterien, Georg Thieme
Verlag, Stuttgart, 1982
Harrison, D. C. et at. (Eds), Cardiovascular Imaging and Image Processing: Theory and
Estates, Ca, 1975
Hatle, L. and Angelsen, B., Doppler Ultrasound in Cardiology: Physical Principles and
Clinical Applications, Lea & Febiger, Philadelphia, 1982
Hwang, N. H. C. and Normann, N. A. (Eds), Cardiovascular Flow Dynamics and
Measurements, University Park Press, Baltimore, 1977
James, A. E. Jr. (Ed.), Radiological Clinics of North America, Vol, 18-1: Symposium on
Kriessmann, A., Praxis der Doppler-Sonographie, Georg Thieme Verlag, Stuttgart,
1982
Reneman, R. S. (Ed.), Cardiovascular Applications of Ultrasound, North-Holland,
Amsterdam, 1974
Roelandt, J., Practical Echocardiology, Research Studies Press, Forest Grove, Or, 1977
Rolfe, P. (Ed.), Non-invasive Physiological Measurements, Vol. I, Academic Press,
New York, 1979
New York, 1979
Short, M. D. et at. (Eds), Physical Techniques in Cardiological Imaging, Adam Hilger
Ltd, Bristol, 1983
de Vlieger, M. et at. (Eds), Handbook of Clinical Ultrasound, John Wiley, New York,
1978
Webster, J. G. (Ed.), Medical Instrumentation: Application and Design, Houghton
Mifflin Co., Boston, 1978
Annual Reviews
White, D. N. (Ed.), Ultrasound in Medicine, Plenum Press, New York, annually from
1975
9 Permanent Records of Ultrasound
Examinations
Diagnostic ultrasound is a method of obtaining information non-invasively

about internal body tissues-depth, width, motion, relative positions, etc.
The production of this ultrasound information and its transformation into
cathode-ray oscilloscope or television monitor displays or images for visual
inspection and analysis were discussed in earlier chapters. A further necessary
step is the photographic or electronic reproduction of these images into
film, hard copy or video tape, for later inspection and long-term retention in
the patient's records.
(a) outline the main features of human visual perception as they relate to
viewing ultrasound images;
(b) broadly describe how the spatial resolution of an imaging process
may be assessed;
(c) discuss the modulation transfer function of an imaging process, its
value in determining image quality and its relationship to dynamic
range in the ultrasound imaging system;
(d) describe the main components of a camera for photographing ultra-
sound images;
(e) show the structure of a single emulsion photographic film and discuss
the most important ingredients in the light-sensitive emulsion;
(f) outline the main steps in the chemical development of such a film;
(g) describe the characteristic curve of such a transparency film and show
the relevance of this curve to photography of an ultrasound image;
(h) outline how positive transparencies may be obtained using reversal
film;
(i) show how positive prints may be obtained from negative transparen-
cies and compare the dynamic range of such prints with that of the
transparencies;
(j) describe the process of instant photography;
(k) outline the problems involved in photography of the display on an

oscilloscope screen;
(I) show the ways in which grey-scale photographs of ultrasound images
may be obtained using a simple oscilloscope display and a scan con-
verter with TV monitor display;
(m) broadly describe ways of electronically storing ultrasound images;
(n) discuss how paper chart records of certain ultrasound data may be
obtained;
(0) suggest how auditory signals from Doppler ultrasound units may be
recorded for later examination and/or filing.
9.2 HUMAN VISUAL PERCEPTION
The retina of the eye is equipped with specialised light receptors, the rods
and cones, which when light impinges on them produce nerve impulses
which travel up the optic nerve through various intermediate structures to
the visual cortex of the brain where the actual perception occurs. Each
retina contains some 100 million rods and 5 million cones. The latter are
densely packed in the central portion of the retina, the fovea centralis. while
the rods are distributed mainly over the periphery of the retina. The rods are
sensitive to very low light intensities but are poor at distinguishing fine
details in the pattern presented to the retina. The cones are good at dis-
tinguishing fine detail in the pattern incident on them provided the in-
tensity of the light is great enough. The cones are also sensitive to colour.
brightness and differences in levels of brightness (contrast).
Light is an electromagnetic radiation and the visible part of the electro-
magnetic spectrum extends from wavelengths of about 420.um to 700 pm.
At the higher end, the spectrum stretches into the infrared with wavelengths
greater than 700.um, while at the lower end, at wavelengths less than
400.um the spectrum extends into the ultraviolet. Beyond the ultraviolet
the spectrum passes into X-rays and at still shorter wavelengths, gamma rays.
As the wavelength increases beyond the infrared. the radiation is known as
radio waves.
The wavelength of the light determines the colour or hue perceived by the
eye. In most situations a range or mixture of colours are simultaneously
present and a quantity called the saturation is a measure of the purity of the
colour perceived. A very narrow band of wavelengths would have a high
saturation, while a wide band of wavelengths would yield a low saturation.
For most methods of presenting ultrasound images, a low saturation holds
and the colour perceived is a grey. The luminance or brightness of the grey
can range between the two limits of black and white. This scale is sometimes
referred to as monochromatic or achromatic or grey scale. The brightness is
PERMANENT RECORDS OF ULTRASOUND EXAMINATIONS 141
closely related to the physical intensity of the light or its luminous emittance
the light power per square metre. Since the eye is not equally sensitive to
all colours or hues. the wavelength also has an influence on the brightness
or perceived intensity.
The contrast between different light intensity levels is of great importance in
visual perception since visual sensitivity is best when differences in intensity or
brightness are presented to the retina. Contrast C, is defined as
(9.1)
where 1d and 1'.2 are the two visible luminous intensity levels being com-
pared.
The ability of the eye to distinguish between brightness levels close to
each other is improved if the ambient brightness is minimised and if the eye
is allowed enough time to undergo dark adaptation or acclimatisation to a
dark environment. Even under these optimum conditions the eye is not
equally sensitive to the same contrast at all the brightness levels between
black and white. At very low brightness levels a very large contrast is needed
for its perception. At this stage the rods are the predominant receptors. At
high levels of brightness. contrast levels of around l/r, or 2~{) can be de-
tected. The cones are the receptors producing this type of performance. For
this reason the perceived brightness of a grey level depends on the neighbour-
ing or surrounding brightness level.
Thus viewing ultrasound images on a TV monitor, or transparency film
images on a trans-illumination viewing box. is best achieved in a darkened
room. with the overall image brightness high. The darkened room allows
the viewer's eyes to dark adapt. The high brightness ensures that the minimal
contrast levels are perceived by the predominant cone vision. Fine image
detail is also best perceived by the cones under these conditions.
9.3 IMAGES AND IMAGE SCIENCE
Conventional photographic and TV images are two-dimensional representa-

tions of the pattern of light intensities reflected from the scene being imaged,
and incident on the photographic plate or film or on the photoelectric
surface in the TV camera. When these images are viewed (sec figure 9.1), the
perception must be close to the perception when the original scene is directly
viewed. The imaging process and the image viewing process must be two
manoeuvres which together approximate on the retina of the eye the effect
of the direct viewing step. This requirement places certain limitations on
these imaging techniques.
IIMAGE I
IMAGINr ~~GE
,- ~IEWING
I SCENE I 4 EYE/
DIRECT VIEWING PERCEPTION
Figure 9.1 The effectiveness of a photographic imaging process may be gauged by

comparing visually the original scene with the photographic image of that scene
Conventional X-ray images are two-dimensional representations of the

pattern of X-ray intensities transmitted through the region of the body
being examined, so-called shadow images. Pulse echo ultrasound images are
two-dimensional representations of the echo amplitudes received from a
cross-section through the tissues being examined. These echo amplitudes
are conditioned mainly but not only by the acoustic impedance changes
encountered by the interrogating ultrasound beam as it traverses the tissues
during the scan.
The normal television image produced from a TV camera is spatially
fractionated into 625 horizontal lines. The variation in brightness along a
horizontal line is continuous or analogue while along a vertical line it is
discretely sampled.
Each line of an image derived from a scan converter, either analogue or
digital, is composed of a succession of discrete or sampled brightness levels.
An analogue scan converter with 1000 x 1000 memory locations, would
result in 1000 such samples across a line of the TV raster. The 625 lines of the
TV image would entail some smoothing or sharing of data between neigh-
bouring horizontal lines of the 1000 available in the scan converter. But this
vertical spatial sampling into 625 equal divisions allows much finer spatial
resolution than is possible at normal scale factors, given the axial and lateral
resolutions achieved with conventional ultrasound scanners.
But resolution in the image depends not only on the writing spot diameter
(and hence on line thickness) but also on the ability of the display to accur-
ately reproduce all the shades of grey. The most general measures of image
quality assess both of these resolutions, spatial and contrast. A number of
such measures exist. For example the well-known television test cards, one
of which is shown in figure 9.2, allow one to compare the performances of
different imaging methods by inspecting the image of the test chart and
comparing the regions where the resolution is lost. But this method while
reliable and useful is not quantitative. The modulation transfer function
(MTF) has been developed to yield a more quantitative measure of image
quality.
One way of measuring the MTF is to have the photographic or TV system
image a scene which has a sinusoidal variation of brightness between white
-- III
PERMANENT RECORDS OF ULTRASOUND EXAMINATIONS
III --
143
-- III III
-- III
III !!!!III!!!!!!!!
-== III
== III -- III
Figure 9.2 Portion of a test chart or scene, to assess the spatial resolution of a photo-
graphic or indeed electronic imaging process. Still smaller and narrower black bars and
white spaces are needed to provide still finer resolution tests
and black, but with a spatial separation between the peaks getting narrower
as one moves from left to right. The variation in brightness across the scene
is shown in figure 9.3(a). When the variation in the brightness across the
width of the resulting image is measured, for instance with a linear transla-
tion spot photometer, the result shown in figure 9.3(b) is found. In general
the ability of the imaging method to produce the full contrast falls off at
--. 1/N,-
I
(a)
(b)
Figure 9.3 (a) The variations in the luminance or light intensity from left to right
across a test scene. The maximum luminance is white and the minimum luminance is
black. N, the spatial frequency, which is the inverse of the distance from one white to
the next black strip, increases from left to right. (b) The variations in the luminance
from left to right across the image of the above test scene. As the spatial frequency
increases the dynamic range or the contrast in the image declines
small spatial separations. The modulation Ms or contrast of the input scene,

as measured by a photometer, is defined as
(9.2)
with reference to figure 9.3(a).

Likewise the image modulation Mi or contrast is defined, with reference to
figure 9.3(b), as in equation (9.2),
M. = [i(max) - [,(min)
(9.3)
, [,(max) + [i(min)
The ratio of these two modulations is the modulation transfer function
M.
MTF=-' (9.4)
M,
The plot of MTF against so-called spatial frequency N, defined in figure

9.3(a) as the inverse of the spacing between a peak and a trough of scene
brightness, shown in figure 9.4, is a most useful indicator of the quality of the
imaging process.
Thus, the MTF is unity at low spatial frequency - the imaging is then
accurate spatially and from the point of view of contrast. As the spatial
frequency increases, the MTF falls off and eventually the neighbouring
bands in the image merge and both spatial and contrast resolutions are lost.
In general the MTF goes to zero at a spatial frequency corresponding to a
peak to trough spacing of half the diameter of the writing spot. For a typical
TV monitor with an effective spot diameter of 0.05 mm and a monitor
M.T.F. 1
.5
o~------------------~-----
o .5
N
Figure 9.4 A possible dependence of the modulation transfer function (MTF) of an
imaging process on the spatial frequency (N)
screen over 20 cm x 20 cm, the MTF is well over 0.75. The smaller the
screen however the more condensed the lines and the lower the MTF.
The MTF is a useful objective measure of quality of an imaging process.
The actual value of MTF is a measure of the dynamic range of the image in
comparison with that of scene. The dependence of MTF on spatial fre-
quency allows one to objectively measure the spatial resolution of the image.
For instance the spatial separation (inverse of spatial frequency) at which the
MTF is 0.5 might be defined as the spatial resolution.
In most monochrome TV monitors the ratio of white brightness to black
brightness is about 250: 1. This dynamic range corresponds to 24 dB. An
analogue scan converter has a dynamic range of about 20 dB and there-
fore the TV monitor is adequate to display any latent image in the converter.
A digital scan converter with a 6-bit digitisation covers a dynamic range of
18 dB (see Appendix L). A photographic process accepts the TV display as
the scene to be imaged and must have a dynamic range of at least 24 dB to
be compatible with the TV display.
9.4 CAMERAS
In converting the image produced from the ultrasound scan from the
oscilloscope or TV monitor screen to a permanent photographic image, the
essential instrument is the camera. As shown in figure 9.5, the main features
of a camera are as follows:
(a) a light-proof box;
(b) the film on which the latent image is to be formed, positioned within
this box facing the lens system;
(c) the system oflenses accepts the light from the scene to be imaged and
focuses the image on the plane of the film. The lens system also has
a variable aperture, formed by the iris which controls the amount of
light collected. The focal length of the lens system may be varied to
accommodate objects in the scene near and far away and this control
helps to determine the size of the image formed at the film plane;
(d) interposed between the lenses and the film is the shutter, which is
opened to allow the light to fall on the film - the action of taking the
photograph.
Apart from the choice of film, which is discussed in section 9.5 there are
three variables or controls in the operation of a camera.
The first of these is the focusing control. In conventional ultrasound
imaging applications this is set when the camera is mounted in front of the
oscilloscope or TV monitor screen with the correct distance between camera
HT-TIGHT BOX
FOCUS CONTROL
L NS SYSTEM
SHUT ER
FILM
HOLDER
Figure 9.5 The main elements in a camera
lens and screen. The rigid form of the camera mount ensures that this
distance remains constant thereafter.
The second control variable is the so-called rstop or rnumber, which is
the diameter of the aperture expressed in numbers of lens focal lengths (j).
Thusj22 refers to an aperture diameter, 1/22 of the focal length, a very small
aperture.jI.S is an aperture 1/1.S ofI and is usually a large opening. Usually
rnumbers range thus 122, /16, Ill, fS, j5.6, j4, j2.S, Il.S. Choice of a large
aperture and hence a wide field of view, allows more light through to the
film. Conversely choice of a small aperture and so a narrow field of view
allows only a small amount of light through to the film.
All photographic films must receive an adequate light intensity or lumin-
ance for long enough, that is. an adequate exposure E, where
E=lx t (9.5)
in order to form the latent image. Here 1 is the incident luminance or light
brightness and t is the duration of exposure or exposure time. This latter is
the third control variable in the camera and can usually be set at a variety of
fractions of one second thus, 1/500, 1/250. 1/125, 1/160. 1/30, 1/15, I/S. 1/4,
1/2. 1/1. In many cameras it can also be opened and held open as long as
needed, a'nd then closed.
For a given source or scene luminance, the exposure may be controlled by
varying either the rnumber or the exposure time (the shutter speed). An
adequate exposure can be maintained by opening the iris and decreasing the
time or else by closing down the iris and increasing the time. In most cases
such variability is not very wide. For instance if the source is moving, then a
short exposure time only is allowable to prevent excessive blurring. In such
a case a wide exposure (small rnumber) and brief exposure time would be
applicable.
The specific choice of shutter speed (exposure time) and rnumber for
optimum image acquisition by the film depends on the particular film and
its speed property.
9.5 FILMS AND DEVELOPING
The photographic film, a section of which is shown in figure 9.6, consists

principally of a layer of light-sensitive emulsion mounted on a carrier
medium or base. This base is a transparent polymeric material, usually a
polyester. A layer of adhesive, the substratum, bonds the emulsion to the
base. The emulsion has a covering layer or a protective layer, the supercoat,
to protect the emulsion against abrasion. On the underside of the base is a
layer of dye-laden gelatin, the anti-halation and anti-curling layer. It is a
layer of about the same thickness as the emulsion and during film processing
its removal at the same time as much of the emulsion is removed, helps to
counteract the tendency for the film to curl. During actual exposure to light
during the photographic stage, the dye in this layer prevents light that has
already passed through the emulsion from being reflected from the smooth
~~~~~~~PROTECTIVE LAYER
_ ~.. "'0 <:)-, •P'" C> '"
"-'" p~O'no() _0 ';.~1>:'p~;!I() f-EMULSION
I" .. v gO -0'"'' ADHESIVE
pOLYMER BASE
ANTI-HALATION
Figure 9.6 A section through an undeveloped single emulsion film showing the polymer
base. the adhesive layer. the emulsion. the supercoat protective layer and the anti-
halation and anti-curling back layer
back of the film base back into the emulsion. Thus it prevents the halo effect
on the image.
The emulsion has a number of ingredients as follows:
(a) The photosensitive grains of silver halide (mostly silver bromide
(AgBr), but with small amounts of silver chloride (AgCl) and silver iodide
(AgI)). The average size of these grains helps determine the sensitivity of the
emulsion to light. The larger the grains the more sensitive the film. because
then the incident light is more likely to encounter a grain. The distribution
of grain sizes determines the exposure latitude or range of tolerable ex-
posures for image retention. A wide range of grain sizes allows a wide
exposure latitude. The action oflight on the silver halide may be summarised,
AgBr+ 1ight~Ag + Br
This photochemical reaction has a quantum efficiency of 1 which means
that each quantum of incident light produces one atom of silver. Thus the
more quanta of light are incident (or the greater the luminance or brightness
of the light) the more atoms of silver are produced. The number of silver
atoms produced at each location in the emulsion is directly proportional to
the light luminance which fell on that part of the film. The atomic silver
therefore contains the latent image.
(b) Gelatin forms the medium in which the silver halide grains are dis-
tributed in suspension. It is transparent and spread as a layer on the base.
It prevents the reversal of the above photochemical reaction which would
undo the latent image storage. It can absorb water and swell. It can also
absorb the various chemicals needed for development and fixing.
(c) A range of chemical additives in the emulsion. Often there are certain
dyes or colour sensitisers which serve to broaden the range of wavelengths
oflight to which the emulsion can be made sensitive. This can be vital in that
the silver halide alone is maximally sensitive at wavelengths less than 525 .um
while the maximum sensitivity of the eye is at 550 .um. The action of the dye
is to absorb the light energy and transfer it to the silver halide. In the emulsion
there are also additives to prevent growth of bacteria and fungi, to improve
the storage properties of the film, to prevent the emulsion from becoming too
brittle when dry and generally to maintain the mechanical properties of the
emulsion. Finally, in the emulsion are halogen-absorbing chemicals such as
sodium nitrate which sequester the halogen product of the photochemical
reaction.
Development of the film to convert the latent image into a visible image
involves the treatment of the film with an aqueous solution of developer.
The developer is a reducing agent such as hydro quinone which converts
silver halides to silver. This reduction happens selectively, being much more
rapid in those crystals which had been exposed to light than in the unexposed
ones. Also present in the developing solution is an alkaline component
with high buffering capacity such as sodium carbonate or borax. Most de-
velopers function in an alkaline pH and since hydrogen ions are produced
by the development reactions, these must be mopped up by the buffer.
Another ingredient in the developer solution is the restrainer which holds
back the development of unexposed silver halide grains. Potassium bromide
acts in this way to maximise the difference in the rate of development of
exposed and unexposed grains. Absence of a restrainer results in fogging of
the film. In many film emulsions there is also some sodium sulphite which
retards the oxidation of the developing agent and so acts as a preserver.
A number of physical factors in the development process strongly affect
the time needed for adequate development. The higher the temperature the
more rapidly is the development achieved. The rate is approximately
doubled for a rise in temperature of lO°C. The developing solution must
first diffuse into the gelatin to reach the silver halide particles before de-
velopment can begin. Agitation of the solution relative to the film aids this
process and advances the development rate. The exact composition of the
solution is of maximum importance and it can deteriorate with age and
repeated use. As examples, absorption of oxygen from the air can cause
oxidation of the reducing agent, the bromide concentration can increase due
to evaporation of water and cause reduction of the development rate, the
pH may fall for similar reasons, etc. Care must therefore be taken to protect
the composition of the solution and replace it as needed.
After the appropriate period of development, the film is rinsed in clean
running water to remove any excess developer solution. It is then immersed
in a fixing solution-an aqueous solution of sodium thiosulphate. This
fixing agent forms soluble silver complexes with any unreduced silver halide.
on the film, i.e. the unexposed portions of the emulsion. This stage leaves the
film with varying amounts of opaque silver wherever light fell on the film,
with large amounts where the light had been intense and in general with
amounts in proportion to the incident light luminance. The opacity of the
film is greatest where the light had been most intense and so the film is a
negative representation or image of the scene originally viewed.
Either in the fixing bath or in a subsequent step it is desirable to harden
the remaining gelatin, containing the silver image. Alum is usually used as a
hardening agent. It provides aluminium ions which act to cross-link the
gelatin molecules.
Finally, the film must be thoroughly washed in running water to remove
all traces of the fixing chemicals and the film is then dried.
Automatic film processors, widely used for X-ray films, carry out the
development/rinsing/fixing/hardening/washing/drying process in about 90
seconds.
9.6 PROPERTIES OF TRANSPARENCY FILM
In the developed film or transparency the image is stored as a variation of

opacity or optical density, spatially distributed over the surface area of the
film. The optical density D, of the film at any point, is defined, with reference to
figure 9.7,
(9.6)
Figure 9.7 Light transmission through a transparency film. Ii is the incident

luminance and I, is the transmitted luminance. The quantity of developed silver affects
the transmission at each point on the film
where Ii is the light intensity or luminance incident on one side of the

transparency and It is the luminance transmitted through the film.
The single most important characteristic of a photographic film is the
relationship between the exposure E and the resultant optical density D.
This relationship is conventionally plotted as a graph of D against loglo E
and a typical characteristic curve is shown in figure 9.8. There are a number
of significant landmarks on this curve. A marks the basic fog or light noise
level of the film. B is the threshold point, and marks the exposure needed to
just overcome the basic fog. C-F is the straight line part of the curve and
marks the useful range of density and the useful range of exposure of the
film. Finally, G marks the maximum density achievable by the film, the
saturation level.
D
-Drn~_v
- - - - - - - - - - - -- - - - - - - - - - - - -
G
-~-~-
loglG E
Figure 9.8 The characteristic curve for a transparency film. A number of landmarks,
A, B, C, F and G are referred to in the text
The useful density range is a measure of the dynamic range of the film, the
span of greys from black to white. Clearly the wider this range is, the more
shades of grey can be accommodated. In a typical transparency the optical
density of the clear or white is practically zero while the density value of the
black is about 3. On the dB scale there is a 30 dB dynamic range. The steeper
the slope of the straight line part of the characteristic curve the greater the
contrast within the image. This slope is the gamma of the film and is defined in
equation (9.7)
(9.7)
A high gamma film connotates a high contrast film.

The denominator of the above equation is the exposure latitude of the
film. It indicates the range of exposure that the film can tolerate and still
produce linear behaviour. Since any scene or TV display contains a range of
intensities, and the whole film is exposed for a fixed duration, different
regions of the film experience different exposures. All this range of exposures
must fall within the exposure latitude for proper photographic reproduction.
The composition and concentration of the emulsion determine the speed
of a film. A number of definitions of film speed are used. The ASA scale of
the American Standards Association is defined as 0.8/Em where Em is the
exposure value at a D level of 0.1 + basic fog. This is a measure of the inverse
of the exposure needed to bring the film to the threshold of the straight line
part of the characteristic curve. Low ASA numbers would indicate a slow
film. Clearly together with the gamma parameter, the ASA number en-
compasses much of the information in the characteristic curve.
A number of features of the development and processing stages can affect
the characteristic curve. The longer the development time the greater the
gamma. The higher the temperature of the developer the faster the speed and
the greater the gamma. Contamination of the developer solution can have
various effects on speed, gamma and basic fog.
The characteristic curve allows one to choose a film appropriate to a
particular imaging task. The film, the exposure conditions and the develop-
ment processes are parts of an integrated package. For optimum results they
must be matched to each other.
9.7 POSITIVE TRANSPARENCIES AND PRINTS
Positive images on transparencies can be prepared by the reversal develop-

ment process, the steps of which are illustrated in figure 9.9. The first step is
a development to produce a negative transparency. The next step is the
bleaching of the negative image with a bichromate or permanganate which
produces compounds of the silver which can later be washed out. The third
step is to evenly expose all of the remaining silver halide. There follows a
second development to reveal the positive image in the silver produced in
step three. Finally, the film is fixed to remove any silver halide remaining
after the second development.
This process can be carried out with a film designed for the production of
negatives but it is best to use a film specially formulated and designed for
reversal work. The general properties of such a film can be described in the
same way as the negative films described previously.
Usually positive images are derived from negative transparencies on to
photographic paper by a printing process. Photographic papers for printing
are very similar in general structure to the film of figure 9.6 except that the
base is now an opaque white paper. Two categories of printing are common.
4 0 c:,C> 0 ()
o <>
. .. .,..-
0c;:l 0 0 0 Q ()
Q 0 o 0 0
•
.
Figure 9.9 The sequential steps in the development process for a reversal film
Contact pnntmg involves the placement of the negative directly on the

emulsion side of the paper and shining a tungsten light through the negative
to expose the paper emulsion. In projection printing a lens arrangement
produces an enlarged positive latent image on the paper emulsion.
After exposure, the paper is developed. Occasional visual inspection
during development is desirable and this can be done under a safelight, a
light of wavelength to which the emulsion is not sensitive. The manufacturer
of the paper usually recommends an appropriate safelight. After develop-
ment , the print is placed in a stop bath of acetic acid , which stops develop-
ment by any solution adhering to the paper. The next stage is fixing, followed
by rinsing, washing in running water and finally drying. During drying it is
important to keep the print flat so that the dried print will be flat. Sometimes
this is done by placing the wet print between two flat hot plates.
In assessing the performance of such a paper print, a parameter analogous
to the transmission density of transparencies is defined, the reflection density,
D. This parameter is defined with reference to figure 9.10,
(9.8)
where Ii is the incident light luminance at 45° and Ir is the reflected luminance .
Figure 9.10 Light reflection from a photographic print. Ii is the incident luminance
and I, is the reflected luminance which is viewed by the eye
Printing papers have characteristic curves (D vs log E), of very similar

shapes to the negative films. However their optimum dynamic ranges are
much less than those of transparencies. Thus matt paper has a maximum
range of D of about 1.2 which would indicate a dynamic range of some
12 dB. A medium gloss paper would have a usable range of D of about
1.5, a dynamic range of 15 dB. A gloss paper can have a D range of 1.7
which indicates a dynamic range of about 17 dB.
There are a number of printing papers on the market which allow one to
create a print in less than one minute in an automatic processor. These
papers have the developing agent in the paper emulsion and after exposure
they are inserted in the processor machine. Therein they are conveyed
through an alkaline solution where the development happens and then
through a stabilising solution which renders any unexposed silver halide
particles insensitive to any further light exposure. Without the need for
washing, the print dries very quickly after it leaves the machine.
9.8 'INSTANT' PHOTOGRAPHY
A number of 'instant' photographic techniques have been developed in

which the camera produces the final print. The Polaroid Land technique or
diffusion transfer reversal process, is such a method and is widely used for
photographing ultrasound images.
Figure 9.11 illustrates the Land film pack. The camera focusses the scene
on the negative when this is in front of the pressure plate, and a latent image
is formed. Tab 1 is then pulled and this draws the negative behind the pressure
plate into contact with the positive print paper. Then tab 2 is pulled and this
draws both negative and paper between two rollers. But before they pass
through, the rollers puncture a blister of developer which is spread evenly
between negative and positive paper. Development happens at this stage.
The developer reagent contains both developer and halide solvent. The
top surface (see figure 9.12) is primed with a distribution of reduction
catalyst. At the start of development both the developer and the solvent are
free to act on both exposed and unexposed silver halide. But the developer
reduces the exposed silver halide to atomic silver and so prevents it being
-
POSITIVE BLISTER
Figure 9.11 The main features in a Polaroid-Land film pack
NEGATIVE
hn"........n~...,n""'""";.,.n:::r--:::L:-n~n'-'=-d..-_DEVELOPI
Q-->--
NG
p p p p p P CHEMICALS
OSITIVE
Figure 9.12 A section through a diffusion-transfer (Polaroid) film during the de-
velopment phase
dissolved. The reduction of the exposed silver halide and the dissolution of
the unexposed crystals proceeds practically simultaneously. The silver ions
formed from the dissolution of the unexposed crystals encounter the reduc-
tion catalyst on the positive sheet in immediate contact and these are the
atoms which form the positive image. The atoms developed from the ex-
posed grains are reduced at the point of their formation and do not contribute
to the positive image-except to the extent that their presence reduces the
darkness of the positive image. Development starts from the instant that the
second tab is pulled through the rollers and the development time must be
accurately set for good results. The time needed drops as the ambient
temperature rises, and the specific dependence on room temperature is
supplied by the manufacturer.
Polaroid film comes in a wide range of speeds from ASA 200 to ASA
10000. The image has a dynamic range like a gloss print, of about t 5 dB.
9.9 OSCILLOSCOPE PHOTOGRAPHY
In order to photograph a pattern on the screen of an oscilloscope it is

necessary to bear in mind a number of aspects of the display as well as of
photography. Consider in the first case the display to be a simple voltage
variation with time as shown in figure 9.13. Recall the following points in
relation to the display:
(a) The spectrum of wavelengths of the light emitted by the screen depends
solely on the phosphor used in the tube. For the best results the spectral
response of the film to be used should match the spectral output of the phosphor
e
t
Figure 9.13 A voltage varying with time, as displayed on an oscilloscope screen
(figure 9.14). The spectral response of the eye differs between the dark-
adapted and light-adapted eye and also differs from that of the photographic
film of choice. Therefore, an oscilloscope display which may seem perfectly
adequate for visual observation either in a darkened room or in ambient
light, may not at all be suitable for a given film. Often therefore if a con-
siderable amount of oscilloscope photography has to be done, it is advisable
to have a dedicated oscilloscope tube, with phosphor chosen to match the
SPECTRAL
SENSITIVITY
(RELATIVE)
300 500 700

WAVELENGTH (nm)
Figure 9.14 The relative spectral sensitivities of two commonly used Polaroid films
film and used solely for photography, while another display with appropriate
phosphor is used for direct viewing.
(b) The oscilloscope display is formed by the sweeping of the electron
beam over the phosphor, as dictated by the variations in the voltage to be
displayed and by the ramp voltage of the time base. The intensity of the light
output from any point on the display is primarily dependent on the magni-
tude of the electron current in the tube but also on the dwell-time of the
writing electron beam on that point (a function of the time base ramp slope
and of the rate of change of the displayed voltage). In a given single sweep of
the display, there will be a range of luminances of the light spot output from
the screen.
(c) A further factor that affects the brightness of the display at any point
and at any instant after the first impact of the electron beam on the phosphor,
is the persistence of the light output from the phosphor. Usually, for photo-
graphy and in order to obtain clear images of rapidly changing voltages, a
phosphor with very short persistence is used. This is especially the case
when it is desired to capture on the image the variations in light intensity as
the sweep proceeds. As will be seen later, photography is also possible
from storage oscilloscopes, i.e. very long persistence displays.
(d) The phosphor in the tube also helps to determine the minimum light
spot size and hence the spatial resolution possible on the screen.
(e) For normal relaxed viewing, the oscilloscope display sweep is trig-
gered by some feature of the voltage signal to be viewed - if that voltage is
repetitive or periodic. If the repetition frequency is greater than about

25 Hz the visual appearance is of a stationary display because flicker-fusion
occurs. The perceived picture is in fact summed or integrated over a number
of repetitions. In such cases it is also possible to integrate over a number of
repetitive cycles in the formation of the latent image on the photographic
film. For non-repetitive voltage variations, the photographic image must be
formed during one sweep.
F or photography of the display on the oscilloscope screen, the camera must
first be focussed by positioning it at the appropriate distance from the
screen. It must be mounted rigidly relative to the screen.
If there is a plastic graticule in front of the screen it should be removed as
it would greatly attenuate the light output from the screen. In more modern
oscilloscopes the graticule is usually internal, inscribed on the inner surface
of the phosphor, and this problem does not arise.
For photographing a single shot display, which would have low intensity,
it is sometimes advisable to post-fog the film. This entails exposing the whole
film to an even low light intensity, such as by flashing a light or the internal
graticule illumination under the light-tight box between the screen and the
camera, with shutter open. This exposes the film above the toe of the charac-
teristic curve so that when it is later exposed to the single-shot display it is
at its most sensitive stage. This latter exposure is referred to as post-sensitised
exposure. Post-fogging sensitises the film.
In the actual exposure, the maximum aperture (lowest f-stop available)
should be used to maximise the light-gathering by the camera. An exposure
duration must be chosen which is longer than the duration of the oscilloscope
sweep. In fact it is often advisable to hold the shutter open for much longer
to avail of the light persistence of the phosphor.
If the voltage is periodic and the display can be triggered, the shutter need
only be held open long enough, for a sufficient number of repetitions to
allow the film to accumulate enough exposure at each part of the voltage
variation. For instance an A-mode voltage display, for a fixed-location
transducer would be repeated at the pulse repetition frequency of the instru-
ment. A low pulse repetition frequency would require a longer total exposure
duration than would a high pulse repetition frequency.
If the voltage variation can be stored on the oS,cilloscope screen then the
scene to be imaged is indeed stationary and the camera Fnumber and
shutter speed can be chosen to suit the range of luminances in the stored
display. Different pairs of f-numbers and shutter opening durations could
suit. Similarly if the display in question is a stored bistable ultrasound image,
the photography is elementary. Furthermore, since there are only black and
white with no grey shades in the display, a film type with a high gamma can
be selected.
9.10 PHOTOGRAPHY OF GREY-SCALE IMAGES FROM
OSCILLOSCOPE DISPLAYS
Broadly there are three main ways in which grey-scale images are obtained
on films or prints: first, one uses a normal short persistence oscilloscope dis-
play with the camera shutter open for the duration of the scan; the second
is photography of the TV monitor display of the grey-scale image stored in
a scan converter; in the third method, the image brightness patterns are
guided line by line to the print paper emulsion by means of a fibre optic
array and a positive print is quickly developed to yield immediate hard
copy prints.
In the open shutter technique, the ultrasound echo amplitudes modulate
the intensity of the writing spot in a conventional short-persistence oscillo-
scope while the location of the writing sweep is determined by the orientation
of the ultrasound beam and the positioning of the bright spots along the
sweep is set by the pulse echo return times and the average speed ofpropaga-
tion. Thus as the probe is scanned over the skin, a B-mode image is con-
structed but in this case it is stored on the photographic film which is exposed
to the display throughout the scan. The intensity of the picture to be thus
imaged is controlled by the echo amplitude and the set basic oscilloscope
intensity while the camera aperture or f-number controls the amount of this
intensity reaching the film. The time taken by the operator to carry out the
complete scan and the rate of swing of the beam through each part of the
tissues sets the other part of the film exposure-the duration of the exposure.
Since there are so many controls it is essential to obtain an image for
inspection as soon as possible and before proceeding to obtain the next
cross-sectional image. Instant photography is thus essential in this technique.
Photography of the display on the TV monitor from the intermediate image
stored in the scan converter, rests on many of the basic principles described
in section 9.9. Some additional ideas should be borne in mind however. The
TV display is repetitively built up in the raster scanning fashion, and it takes
1/25th of a second for a complete picture. Exposure times less than this
yield an incomplete image. Exposure times integral numbers of times 1/25 (s),
produce even integration of the exposure over the image and may allow the
use of reduced .f~number. Other values of exposure time yield uneven in-
tegration of the image and therefore some parts of it brighter than other
parts.
In a darkened room the TV monitor display has a brightness dynamic
range of some 24 dB. An analogue scan converter has a dynamic range of
about 18 dB and so the monitor contrast setting control must be used to
reduce the display contrast in order to match the data from the scan con-
verter. Some digital scan converters have a wider dynamic range and are
more closely compatible with the monitor. Transparency film can encompass
the monitor output dynamic range but prints such as those from instant
techniques such as Polaroid can not. In this latter case some compromise
may often have to be made resulting in the neglect of some echo variations
either at the low end or at the high end. This compromise can be made with
the TV monitor controls but may not be visually the most pleasing image.
It becomes a problem in scanning, when a satisfactory visual image is ob-
tained on the screen but then it must be modified before the photographic
step. The best solution is to have a separate dedicated monitor for pho-
tography. This can be chosen to have the appropriate phosphor for the film
of choice and can have a smaller screen to suit the available cameras.
Since the range of luminances in a TV display can vary from one scan to
the next, it may be necessary to modify the aperture and/or the shutter
speed, repeatedly during an examination. Some machines have automatic
light meters in the cameras which measure the light coming towards the
film at a number of spots and which use this information to electronically set
the shutter opening duration. A more dependable photography can be
achieved in this way.
In the diagnostic examination of ultrasound images some clinicians prefer
a negative image (black echo data on white background) while others prefer
a positive image (white echo information on a black background). A positive
or negative transparency can be prepared, or a positive or negative print can
be made along the lines previously described. But many TV systems allow
the signals to be reversed electronically, as shown in figure I.3(b). The
picture part of the video signal for each line is inverted electronically to
produce the negative from the positive or vice versa. Another ready possi-
bility is currently available from some instant Polaroid films, and this is that
both the positive and negative images emerge in a form that can be retained
and stored.
The third main way of obtaining printed pictures of the ultrasound images-
so-called hard copies-is shown schematically in figure 9.15. The basic
display device is a specialised cathode-ray tube such as is shown in more
detail in figure 9.16. It has a very narrow horizontal display screen and no
vertical deflection plates. It displays one line of video at a time. The light
output from the face of the screen is conducted along a linear array of fibre
optics and directed on to the emulsion of a rapid development photographic
paper. The paper is moved past the tip of the fibre optic array in a stepped
manner and at each step the specific line of the raster is repeated often enough
to accumulate an adequate exposure of the photographic paper. The line
synchronisation pulses in the composite video signal control the stepping
motion of the paper and the frame synchronisation signals control the
further carriage of paper into the rapid development process. In most cases a
single line of the video provides enough luminance input for exposure of the
emulsion and so the whole exposure and development process can take less
than 30 seconds.
The print output from this technique can, depending on the video signal
input, be either a positive or negative image. The overall contrast- the range
COMPOSITE
VIDEO SIGNAL
CONTROL
ELECTRON ICS
DEVELOP
&'PRINT
VIDEO
STEPPING
MOTOR
C. R. T.
'-----//
LINEAR ARRAY
FIBRE OPTIC
LIGHT GUIDE
Figure 9.15 A line printer system for producing a paper print of an electronic image,
TV raster line by TV raster line
SIDE FRONT
Figure 9.16 A special-purpose single line display oscilloscope for line-by-Iine photogra-
phy
of grey shades from black to white-is less than that achieved with trans-
parencies and less than are apparent on the TV monitor. But the speed and
ease of operation are major advantages.
An imaging technique very similar to the above is also commonly used for
recording M-mode studies of the heart and related structures as discussed in
chapter 5. In that case the linear display in the specialised CRT screen at each
instant is the B-mode representation of the echo train from the structures
along the axis of the ultrasound beam at that instant. The photographic
paper is moved along at a steady rate and the M-mode display from the
moving structures are imprinted on the paper. Two main types of paper are
used in this application. A rapidly developed paper with a range of grey
tones as described above can be used and the images stored on it convey the
motion information and very useful information about the echo-producing
texture of the structures. This latter is an expanding area of interest in
cardiac ultrasound. The second paper type is one which is capable of photo-
development. After the initial exposure as described above the paper is
passed under an ultraviolet light which activates the development process in
the emulsion already on the paper. The development proceeds to completion
and the resulting image has limited contrast, usually on a yellow or buff
background. The whole process is dry and very fast. Subsequent exposure to
daylight and normal artificial lighting results in very little image fading.
9.11 ELECTRONIC IMAGE STORAGE DEVICES
The following electronic image storage systems are coming into increasing
availability and use: video tape recorders, magnetic disc memory and com-
puter memory devices. These devices require the image to be supplied to
them in an electrical form, either analogue or digital, and usually in a
rastered sampled fashion just like the video signal which drives a TV monitor.
The image is first converted into a set of lines each yielding a time-varying
video voltage, each video line following the previous one. On the 625-line
standard the total image takes 1/25 s and is segmented into 625 time sections.
In the digital case this 1/25 s of signal is sampled and digitised, for instance
106 times, at equal intervals throughout, and so the picture then consists of
106 separate numbers in known orderly sequence (see Appendix K).
The video tape recorder (VTR) is capable of storing an image in either of
these forms, analogue or digital. The storage medium is a layer of ferro-
magnetic material such as a metal oxide which is spread on a polymer base
(see figure 9.17). In the recording or storing mode this tape is moved at a
steady speed past the air gap of the electromagnet. This is energised by a
current varying as the video signal to be recorded. Thus the particles of the
magnetic material are magnetised to a degree dependent on the signal
energising the recording head electromagnet. The degree of magnetisation
of the particles along the tape thus carries the signal to be stored. In the
VIDEO
SIGNAL
MAGNETIC OXIDE
.z::zLoor:~~m~~:zCOATI NG
________ Q--POLYMER BASE
TAPE MOTION
Figure 9.17 Simplified diagram of the process for magnetic recording of electronic
signals
reproduce or play-back mode, the tape carrying the analogue magnetic

signal is moved at a steady speed past another electromagnet. In this case the
varying degrees of magnetisation of the tape induce varying magnetic flux
in this magnet which in turn induces proportionally varying currents in the
electrical coil encircling the magnet. This latter electrical signal is then taken
and amplified and used to provide the line video signals for a TV monitor.
Such a tape recorder can equally record pulses coded to represent the
digitised samples of a video signal in a digital system. Upon subsequent
reproduction the output train of coded pulses must be decoded into an
analogue video signal before being used to drive the TV monitor display.
Clearly very many such images can be stored on magnetic tape and can
be reproduced at will as many times as desired. They can be recorded and
viewed as sequences-a cine presentation-or individual images can be
viewed in freeze-frame mode. Video tape recorders offer considerable
promise as temporary buffers for holding all the images from a session's
ultrasound examinations. The clinician then could view the images re-
produced from the VTR and photograph a limited selection of the output
from each examination, for permanent placement in the patient's case notes.
In the magnetic disc recorder the recording medium is again a ferro-
magnetic layer of metal oxide spread over a more rigid polymer disc. The
recording is done along circumferential tracks at various radial distances
and may be of analogue or digital data. The recording and reproducing
heads can move in short increments along radii while the disc is driven in
circular motion about its centre. In such a disc recorder it is possible to
record a full field or frame of a TV picture along a single circumference.
Therefore in the play-back mode, if the reproduce head is held at a fixed
radial distance, one can hold or freeze-frame, i.e. the same frame or image is
repeated for leisurely and detailed viewing. This is especially useful in
dynamic or real-time imaging. It allows for ready photography of particular
images obtained during the examination.
Another temporary memory device which can serve as a buffer to hold a
set of images is a computer solid-state memory. In this case the stored data
must be in digital form, the picture must be sub-divided into pixels, each
pixel with an address or post-box in the memory, and the brightness of each
pixel is coded into a binary number. If the digitisation is in 4-bit binary
numbers the number representing the brightness or luminance can be from
o to 16 (24) (12 dB maximum contrast), if 6-bit from 0 to 64 (2 6 ) (18 dB
maximum contrast) and if 8-bit from 0 to 256 (2 8 ) (24 dB maximum con-
trast). A random access memory (RAM) chip of 16 k-byte memory could
accommodate 8-bit picture information from 16 thousand (16 k) such
pixels. Depending therefore on the total number of pixels in the picture and
on the detail of the digitisation a large number of such RAM's would be
needed to contain the full image. Because so many RAM's would be needed
to store a battery of images this technique is only of economic value in
freeze-framing of individual dynamic scans for detailed examination or for
photography. It is also of great potential value in computer manipulation of

the images-for length, area and volume measurement, for edge and bound-
ary enhancement, for texture analysis and for image improvement and
tissue characterisation (see Appendix L).
9.12 CHART RECORDING
The permanent records of some ultrasound examinations such as M-mode

and some Doppler examinations are in the form of paper chart records. The
type of recorder used for M-mode work was described in chapter 5 and
reviewed in figure 9.15.
A chart recorder suitable for continuously recording the peak Doppler
signal from the output of a zero-cross detector would have certain features
in common with that of figure 9.15. The paper is drawn from the storage roll
by the drive motor at a steady speed. This paper speed can be varied within
a range from 1 mm/s to 50 mm/s. The paper motion carries it over a platen
or roller under a writing pen. The pen can be felt-tipped or fed by capillary
action from an ink well. The pen is deflected in a fashion similar to the
needle deflection in a voltmeter, by the voltage from the detector. An ampli-
fier may be needed to magnify that voltage enough to yield appreciable pen
deflections.
Before use therefore, an amplification setting is chosen to ensure that the
maximum voltage does not deflect the pen beyond the limited span of the
paper width. A paper speed is chosen to ensure that all the variations of the
Doppler signal during a heart period may be clearly distinguished while not
consuming excessive lengths of chart paper.
Some chart recorders have special heat-sensitive paper--a sandwich of
paper, carbon layer and whitened wax on the top. Heating the wax layer
exposes the carbon layer thus producing recording on the paper. In this
instrument the deflecting pen is a heated stylus.
9.13 RECORDING OF AUDITORY SIGNALS
Occasionally it is valuable to tape record the audible signals emerging from

the FM discriminator of Doppler units. In this case the audio voltage
signals may be stored on magnetic tape in a manner identical with that
discussed for video signals in section 9.11. The electronic requirements in an
audio tape recorder are much less stringent than in video recorders and so
they can be much cheaper than the latter.
Such recording of a Doppler examination allows later auditory review or

later detailed analysis with a spectrum analyser or computer.
9.14 BIBLIOGRAPHY
Andrews, H. C. et al.. Computer Techniques in Image Processing. Academic Press,

New York. 1970
Dainty. J. C. and Shaw. R .. Image Science. Academic Press. London, 1974
Li Evans. A .. The Eraluation of Medical Images. Adam Hilger Ltd, BristoL 1981
James. A. E. Jr. (Ed.). Radiological Clinics oj North America, Vol. 18-1: Symposium on
Advances in Ultrasonography. W. B. Saunders Co .. Philadelphia. 1980
Lunt. R. M .. Handhook of Ultrasonic B-Scanning in Medicine, Cambridge University
Press. Cambridge, 1978
John Wiley. New York. 1981
McGinty. G. P .. Videocassette Recorders: Theory and Servicing. McGraw-Hill. New
York. 1979
McLean. T. P. and Schagen. P .. Electronic Imaging. Academic Press. London. 1979
Metreweli. C. Practical Ahdominal Ultrasound. Heinemann. London. 1978
Neblette. C B .. Handbook of Photography and Reprography (Ed. J. M. Sturge), Van
Nostrand Reinhold Co .. New York. 1977
Robinson, J. F. (revised by S. Lowe). Videotape Recording: Theory and Practice. 3rd
edn, Focal Press. London. 1982
Rosenfeld, A. and Kak, A. C. Digital Picture Processing. Academic Press. New York.
1976
Sherr. S .. Electronic Displays. John Wiley. New York. 1979
10 Special Instruments and New
Topics
There are many developments in the general area of diagnostic ultrasound

which have not yet found wide application, but which are of considerable
interest nevertheless. Some of these apply only in limited regions of the body
or in limited areas of medicine. Some are still at the research stage and must
yet be developed into clinical tools and procedures - if indeed the ideas prove
worthwhile.
In this chapter it is proposed to discuss the main minority and develop-
mental strands in diagnostic ultrasound.
(a) describe the principles and applications of PPI-mode scanning;
(b) show the principles of C-mode scanning;
(c) outline the basic techniques for achieving ultrasound transmission
tomography using computerised reconstruction approaches;
(d) suggest the special needs of small-organ scanners;
(e) describe the main approaches used in machines dedicated to breast
scanning;
(f) discuss the features of various special-purpose transducer probes;
(g) describe the factors involved in automatic scanners;
(h) outline the concepts and approaches used in dual-purpose or duplex
scanners;
(i) discuss some of the approaches to ultrasound tissue characterisation;
G) describe ways of constructing tissue-equivalent phantoms;
(k) discuss the need for instrument standardisation.
10.2 PPI-MODE SCANNING INSTRUMENTS
A PPI-mode, plan-position-indicator-mode display is in reality a B-mode

SPECIAL INSTRUMENTS AND NEW TOPICS 165
display for the situation where the ultrasound beam is rotated or sector
scanned about a fixed point of rotation through an angle up to 360". Figure
10.1 shows the type of image obtained from such a technique.
The image can be built up in a static fashion on a storage oscilloscope or
on a scan converter by a single wide angle sectoring motion of the probe .
Clearly the construction of the transducer must be adapted from the pulse
echo probe described in chapter 3 into a form such as is shown in figure
10.2(a). The front face of the transducer must look out radially from the
probe axis. In some commercial constructions the actual probe is mounted
inside an oil bath in a fixed outer plastic sheath as shown. Coupling must be
ensured between the sheath and the tissues by using a gel or oil.
Figure 10.1 A PPI-mode image of the prostate (top) , obtained with probe in the anal
passage
Alternatively the image can be a dynamic or real-time image produced by

rapid rotation of the probe inside the stationary sheath and by rapid acquisi-
tion of the image on a scan converter. Another type of dynamic imaging may
be achieved with a circumferentially ranged array of radially directed trans-
ducers as in figure 1O.2(b), which are activated in sequence just like the
linear array discussed in chapter 7.
In either of these methods the orientation of the active transducer must be
measured in order to control the positioning of the writing vector on the
----+-------') 35J~BE
(a)
______________-__ ~UTER
SHEATH
(b)
Figure 10.2 Transducer probes used in PPI-mode scanning: (a) A single transducer
rotating within a fixed sheath. (b) An array laid out along the circumference of the probe
image storage or display. In this case a single parameter, the angle, is suffi-
cient to describe the beam orientation at any location.
The main application of PPI-mode scanners is transrectal examination of
the prostate, bladder and contiguous structures. Some applications have
been reported in the examination of cardiac structures from a vantage point
in the oesophagus or in the trachea. With the development of miniaturised
probes and improvements in scanned array technology it is likely that such
applications will increase in the future.
10.3 C-MODE TECHNIQUES
The C-mode scan is also based on the pulse echo principle. The C-mode
image is an acoustic image of a cross-section through the tissues, at right
angles to the conventional B-mode sections. Thus, a C-mode cross-section
would be normal to the ultrasound beam axis.
To build up such an image three novel steps must be taken thus:
(a) In the signal processing stage, the echo train is range-gated, to allow
through only the echo signals from a fixed depth or fixed distance from the
transducer face. This brief gated echo signal is then used to generate a
bright-up signal in a scan converter.
(b) The probe is held in fixed orientation and is moved in a ziz-zag
motion on the skin over the tissue region of interest. This is illustrated in
figure 10.3. Since the plane in which the motion of the probe occurs must be
held fixed to ensure that the image is of a flat plane defined by the depth of
the range gate, it is desirable to use a water bath over the skin and to move
the probe in the open surface of the water. The zig-zag motion of the probe
CONSTANT
DEPTH
CROSS -
SECTION
Figure 10.3 The build-up of a C-mode or constant depth-mode scan involves the
zig-zag painting motion of the probe over the skin surface
is to ensure that all parts of the tissue section of interest are interrogated at
least once by the beam.
(c) Both the X and Y spatial dimension of each feature of the image are
set by the X and Y positions of the probe. Registration involves the genera-
tion of electrical signals proportional to the two Cartesian co-ordinates of
the probe, and the use of these voltages to produce X and Y deflections in
the display devices. The image can be either bistable or grey scaled depending
on the imaging modality available - bistable in a storage oscilloscope, grey
scaled in a scan converter/TV monitor system.
If the region to be imaged is large it can take a long time to 'paint' the full
picture. If the probe motion is done manually, parts can be missed. But if a
water bath is used the scanning action can be readily automated in contrast
to conventional contact B-mode imaging.
The image acquired is of a single cut at a fixed depth. To obtain images of
sections at other depths the range gate must be reset and the zig-zag scanning
motion repeated.
The possibility of automating such scanning, promises a growing number
of applications for this technique. This possibility is heightened by the intro-
duction of linear arrays with dynamic focussing capability. In such an
instrument, one movement only of the linear array probe would be needed
to complete a scan, and the dynamic focus could be set to the sample depth.
Indeed much sharper focussing than is tolerable in B-mode imaging would
then be possible. Furthermore, the introduction of computer techniques
with intermediate storage of images in a magnetic disc buffer and rapid
flick-through viewing of a set of C-mode images of different depth sections

could greatly extend the diagnostic usefulness of this form of imaging.
C-mode imaging does not offer new information, just an alternative way
of displaying what is now conventionally displayed by the B-mode technique.
Up to the present time C-mode methods have not had wide acceptance
or usage.
10.4 THROUGH-TRANSMISSION COMPUTERISED

RECONSTRUCTION TOMOGRAPHY
Through-transmission tomography is an alternative method of constructing

cross-sectional images of tissues. Ultrasound attenuation tomography and
time-of-flight tomography are being investigated. Both of these techniques
have similarities to X-ray tomography, except that the type of radiation is
different.
Tomography requires a computer to construct the image from the meas-
ured tissue data. The plane cross-section to be imaged is divided into pixels
and each pixel has an assigned memory location. A transmission transducer
and separate receiver transducer are required, and they must be carefully
aligned as shown in figure 10.4. The tissue to be imaged is positioned be-
tween the two transducers in the ultrasound beam. The ultrasound beam
path through the tissues is mapped on to a specific vector or set of pixels
across the image plane, and hence is correlated with a particular set of
memory locations.
In attenuation tomography the attenuation of the ultrasound when the
tissue path is interposed in it, is measured in comparison with a reference
water path. This measured attenuation is then assigned to all the pixels
(memory locations) in the corresponding vector in figure 10.4. The aligned
transducer pair are then moved laterally or rotated to a new path through the
tissue, to obtain another attenuation value which is loaded into the pixels
appropriate to that vector. When two of these vectors intersect, the attenua-
tion score in that pixel is the sum of the two relevant line or vector scores. By
thus moving and rotating the transducer pair in the plane of the section to
be imaged, attenuation values are accumulated in all the pixels. Many pixels
receive more than one contribution and at the end of the scan the score in
each pixel memory location is divided by the number of contributions it has
received, to yield an average attenuation score. In this way a cross-sectional
image is generated which is conditioned by the tissue ultrasound attenuation
at the various locations in the section. Thus highly attenuating regions
would possibly be assigned lighter shades of grey than the less attenuating
tissues which would be depicted as dark to black regions.
In this technique it should be noted that the overall attenuation in a path
~C TOR 0)CTOR
\2)' , 2r
, ,
, ,
,
,,
, , , TISS E
,, ,
,
!J
, ,
'~ I
,,
1MAGE PLANE'
(a) (b)
Figure 10.4 The formation of a computer-reconstructed tomogram with ultrasound

involves (a) the interrogation of the tissues by the ultrasound beam along a large
number of paths and (b) the assignment of the tissue-conditioned data (attenuation or
time of flight) to pixels in the image plane
through the tissues is due to both the attenuation coefficient of the tissue
types and the length of the path through those tissues as shown in figure
10.5. Thus the total attenuation AT' in the path is given by (equation 10.1):
A T =/11 Ll +/12 L 2 +/13 L3 ...
(10.1)
m
the sum of all the constituent attenuations. If one of the tissue types in a
vector is highly attenuating then all of the pixels in that vector will receive
a high attenuation score. But when any slightly attenuating tissues are
approached from other angles these pixel memory locations receive only
small contributions. Equally when the highly attenuating tissue is ap-
proached from other angles its pixels continue to receive large contributions.
Then when the final averaging is done the pixels mapped on to highly
attenuating tissues still retain high values and the reverse holds for the
pixels on to which are mapped the low attenuation tissues.
2 3 4 5
c,
Figure 10.5 A transmission through an inhomogeneous tissue is characterised by an

overall attenuation and by a total time of flight, both dependent on the transmission
parameters of the individual tissues in the path and on the thicknesses of those tissues.
The angulation of tissue boundaries to the beam would also be of importance
In this type of tomography a pulsed ultrasound beam is used in order to

avoid setting up standing waves in the tissues. Access must be available to
the front and back of the tissue to be examined and since good acoustic
coupling must be maintained with the tissue surface at all times, an im-
mersion water bath is indicated. The limbs, the neck and the breasts might
be readily examined under such conditions but in other parts of the body the
presence of bone and/or gas would cause such severe attenuation as to
render the method too difficult. The technique has not been widely in-
vestigated up to the present but since it is based on the attenuation inter-
actions between ultrasound and the tissues, as compared with the
conventional ultrasound imaging techniques which are based on reflection
at acoustic boundaries between and within tissues, it does offer different,
complementary and potentially valuable insights into the tissues.
In time-ofjlight tomography a set-up very similar to that described above
is used, but the measured index at each location of the transducer pair is not
the overall attenuation but the time taken for the ultrasound pulse to travel
from transmitter to receiver - the time of flight. With reference to figure
10.5 this time of flight, Tp is a function of the individual speeds of propaga-
tion of ultrasound in the tissues in the path, of the lengths of the beam path
in these tissues and of course of the total number of such tissues (equation
10.2),
(10.2)
The tomogram is constructed in a fashion exactly the same as before.

This type of tomography has been investigated in relation to breast
examinations but is not yet widely used. Again since it is complementary
to pulse echo imaging and also to attenuation tomography it can offer
useful diagnostic insights into tissues and organs.
10.5 SMALL ORGAN SCANNING INSTRUMENTS
Where clinical interest is confined to small superficial structures and organs,

such as the eyes, a range of specialised A- and B-mode instruments have
been developed. In some such situations the physical dimensions of the
probe and mounting can be considerably smaller (about x 0.1) than con-
ventional whole body devices.
But the major ultrasound feature that distinguishes these instruments
from the larger devices is the frequency range used. Since the tissue depths
are small, much higher frequencies can be used. For work on the eyes,
frequencies of 10 MHz, 15 MHz and even 20 MHz are commonly used.
This results in smaller diameter probes and more importantly in much
improved lateral and axial resolutions.
For eye examinations the intensity of the ultrasound beam transmitted
must be kept as low as possible because the threshold energy for damage to
the eyes by ultrasound, is lower than for most other tissues in the body. Also
there is very little attenuation of ultrasound as it traverses the aqueous
humour within the eye, so that damage to the retina can readily occur.
10.6 BREAST SCANNING UNITS
There has been considerable interest in applying ultrasound to the examina-

tion of the breast, with a view to detecting carcinoma as early as possible.
Because the breast is so readily deformed by surface pressure, contact
scanning does not yield reproducible results unless the breast is held in some
fixed position. Even in this situation the geometrical information obtained
from the image can bear little relation to the internal tissue geometry of the
unrestrained breast. Water bath techniques have therefore been more widely
used in breast scanning than for most other organs.
One scheme is to have the patient lie prone with her breasts pendant into
the water bath as shown in figure 1O.6(a). The pulse echo transducer is
mounted underwater directed upwards towards the breasts. In another
scheme (figure 10.6(b», the patient lies supine and the breasts protrude
through close-fitting holes in the bottom of a water bath. The buoyancy of
the breast tissue ensures that they are largely undistorted and help to seal the
bottom of the bath. The transducer in this case is directed downwards
through the surface of the water bath.
In either case the depth of the water must, as explained in chapter 4, be
greater than the maximum depth of tissues to be examined. In consequence
PROBE
IjPROBE
(a) (b)
Figure 10.6 Two alternative water-bath immersion techniques used for breast scanning
the focal region of the beam must be further from the transducer face than
in contact scanning in order to fall within the breast tissues. For correct
electronic registration, the water bath must have a speed of propagation
equal to the average speed of propagation in the breast tissue. This speed
may not be quite 1540 m/s as is used for general soft tissues, but whatever
the value that is optimum, it can be set for the bath by making this an
aqueous sodium chloride solution or an ethyl alcohol/water solution as
described in section 10.11. The bath temperature should be set for patient
comfort and for correct propagation speed. In the signal processing it is
important to initiate the time gain compensation (TGC) slope at the skin
surface echo at each position of the beam. This is critical in that in general
the skin line is at various distances from the probe at different stages of a
scan and unless the TGC is set as mentioned, echoes from the same depth
into the tissues will be amplified or compensated to different extents. A
quite erroneous texture would appear in the final image.
Another problem arises in breast scanning when the situation of figure
10.7 occurs -severe refraction at the sides of the breast. This can result in
failure to be able to interrogate the tissue in the outer perimeter of the breast,
giving an incomplete image. It can also result in artifactual registration of
structures in the breast. Therefore it is important to be able to achieve ex-
tensive compounding of the motion of the probe during the scan. However,
because the refraction artifacts can give valuable clues as to whether a
structure within the tissues is cystic or not, linear scanning is also necessary
and helpful.
A technique similar to that of figure 10.6(b) is commonly used also for
scanning the thyroid, except that in this case the water bath is usually a thin
polythene bag which can readily adapt to the shape of the neck when filled
with water.
Figure 10.7 Refraction can occur in water bath scanning of the breast
10.7 SPECIAL TRANSDUCERS
Ultrasound has proven a valuable aid in guiding needles for aspirating

cysts, for sampling the amniotic fluid in pregnant women and for obtaining
biopsy specimens for histological assessment of tissues. One of the most

common techniques of guiding the needle to the liquid or tissue in question
is by use of a specially constructed transducer with a hole in the centre,
through which the needle is inserted. As shown in figure 10.8 the probe must
be off-set from the normal probe holder in order to allow the insertion of the
needle. The procedure is to scan the region first, using the off-set probe.
From the B-mode image the depth and extent of the tissue or liquid to be
sampled can be measured. A sterilised needle of requisite gauge and length
is then selected. With the probe over the region of interest and the A-mode
and B-mode display of that path through the tissues on the viewing screens,
the needle is inserted through the locally anaesthetised tissues to the ap-
propriate depth. The depth of the needle tip can be monitored on the screen
because the needle tip produces a characteristic echo signal. In this way the
tip can be set to the appropriate depth and the sample taken.
H PROBE
HOLDER
, :
,
-:-, ~, - ,
" PROBE
Figure 10.8 A transducer probe with a hole through the axis designed for needle
biopsy work
Specially adapted linear array transducers have also been made for needle
guidance. A needle hole through some of the crystals or just beside the array
serves to perform the task.
Another adaptation of transducer array technology, the concentric array
transducer. promises to allow a wide range of degrees of focussing as well as
ranges of focussing in a cylindrical beam. The face of such a transducer is
shown in figure 10.9. By activating the set of transducers in different phased
sequences, the distance to the focal zone can be controlled as can the degree
of focus. Refer to multi-element linear array beam focussing in chapter 3.
Among the most recent developments of array technology and the related
instrumentation is the two-dimensional matrix such as is shown in figure
10.10. In such a rectangular matrix. any row or column of crystals can be
activated at any stage to define a scan plane. Switching between different
sets of crystals is done electronically. Sets of images from a series of parallel
planes can be quickly acquired. Indeed real-time or dynamic flick-through
viewing of a set of neighbouring static images can be a feature. The same
procedure can be carried out in planes perpendicular to those previously
Figure 10.9 A four-element annular array or zone plate transducer. The elements
have equal front surface areas
DDDDD
DDDDD
DDDDD
DDDDD
DDDDD
Figure 10.10 A possible two-dimensional array of transducer elements
done to yield C-mode images. Flick-through viewing of successively deeper

C-mode images can be readily achieved. Development of the control and
display electronics can allow projection of any cross-sectional view desired.
The three principal planes are as shown in figure IO.II(a) while a more
general cross-section such as that in figure 1O.11(b) would also be possible,
simply by electronic means.
To be able to achieve so much flexibility without having to manually scan
the patient would clearly be a major leap forward in ultrasound imaging. It
is a fairly safe prediction that developments along these lines will mark a
major line of progress for diag!lostic ultrasound in the future.
10.8 AUTOMA TIC SCANNING
Various degrees of automation, minimising the involvement of the operator,

have been achieved in ultrasound scanning. For instance, the dynamic
B,
(a) (b)
Figure 10.11 In the build-up of an image of any general cross-section (b) through the
tissues, by computer, the images of all the parallel slices in the three principal directions
(a) must first be acquired
scanners, both rotating/oscillating transducers and multi-transducer array

types, produce the image without manual scanning by the operator. The
operator must in these instruments set the signal processing (time gain com-
pensation (TGC), output intensity, display parameters such as contrast and
brightness) parameters. Some efforts have been made to automate the setting
of the TGC by such methods as electronically comparing the average
luminance at different depths across the image and varying the TGC electron-
ically and automatically in a feedback fashion, to maintain the average
lumimince as steady as possible. Such a scheme is unfortunately insensitive
to the fact that some regions of tissue are naturally more strongly echoing
than others and should have greater average brightness than other regions.
At present the best opportunities for automation reside in water bath
techniques and probably the most automated scanner on the market is the
'Octoson' machine which has eight transducers with large diameters and
long focal lengths, mounted in a circumferential array as shown in figure
10.12. This array is under water and the patient lies on a thick plastic sheet
stretched on the surface of the water. Acoustic coupling between patient and
I
I
~ ~~ / BJH
Figure 10.12 The circumferential array of transducers within a water bath, of the
'Octo son ' scanner
plastic is achieved with gel or oil. The array of transducers can be made to
automatically execute a number of motions thus: the whole gantry can move
linearly up and down the water bath lengthwise along the patient (per-
pendicular to the paper in figure 10.12); the whole gantry can swing about
the diameter of the circle, thereby interrogating different angular sections
through the body; the array can be rotated about the centre of the circle of
the array, thereby allowing the scanning action of the array, in any section,
to be compound in that the approach of the active beam to any structure in
the body varies during the scan and so perpendicular incidence can more
likely be approximated. The control of the motorised transducer array must
be computerised and also the measurement of the active beam orientation
for the image reconstruction is complex and is also computer processed. A
scan consists of the sequential activation of the transducers coupled with
their rotation.
Clearly, the main automatic element in this scanner is in the transducer
motion. Also the range of motions of the transducer array shown in figure
10.13, allows a wide number of angles of approach to any tissue in the part
of the body to be examined. Most tissues are therefore accessible to the
instrument. Furthermore since the patient lies on the water bath and the
access into the patient is from the underside, the problem of gas in the bowels
is greatly reduced since this gas has a tendency to rise when it is free to do so.
PATIENT
Figure 10.13 The range of motions of the circumferential array in the scanner of
figure 10. 12
10.9 DUPLEX SCANNERS
Duplex scanners are devices that have a dual capability, usually B-mode
imaging and a Doppler blood flow detector in the same unit. The basic idea
is to first obtain a B-mode image (usually a real-time image) of a blood
vessel, for example a longitudinal view, and to use this image to position
and orient the Doppler probe. A line representing the path of the beam from
the Doppler unit can be inscribed on the B-mode image, so that the angle
of incidence of this beam relative to the flowing blood cells can be measured
directly. The diameter of the vessel can also be measured from the image
and hence the data needed for quantitative blood flow measurements are
available.
If the Doppler instrument is a pulsed unit, it is possible to use the same
transducer for both B-mode and Doppler applications.
10.10 TISSUE CHARACTERISATION
Efforts to develop objective methods and criteria for classifying tissues by

means of ultrasound, have constituted an important area of research in
diagnostic ultrasound over the recent decade. The aim is to be able to
specify the histology and pathology of regions of soft tissues from an an-
alysis of the fine details of the echo signals returned from and through the
target tissues. This would ultimately improve diagnosis of tissue damage or
malfunction and would also improve the determination of the boundaries
between different tissues and organs.
Most of the approaches in this work rest on the idea that the echoes re-
ceived from within tissues, consist of interference patterns of small back-
scattered wave pulses (see figure 10.14). Such back-scattering arises at the
level of the first order organisation of the cells and membranes of the tissues,
such as the lobules of the liver and the fibres of muscles, etc., which act as
back-scatterers. Each tissue has a different such organisation. When analysed
in the conventional way and displayed on a grey-scale display this back-
scattering produces the speckled patterns of the tissue interiors.
The eye and brain are very good tools for analysing such patterns but
experience and training are required before reliable analyses can be made.
To remove the subjective element, various techniques of computer-aided
pattern recognition can be used for objective pattern recognition. Take for
instance the pattern in figure 10.15, and consider any region in particular.
2 3
0
0 0
0
0
0
0
Figure 10.14 A crude representation of different tissues as assemblies of back scatterers

Figure 10.15 A speckled pattern of greys such as might be found in the image of the
parenchymal tissue of an organ
Within such a region of interest one can measure the distribution of optical
densities (transmission or reflection) and obtain a histogram of this distribu-
tion as shown in figure 10.16. The histogram plots the number of occurrences
of each density (or luminance in the TV display) in the region. Another
possibility is to continuously measure the optical density along various lines
across the region of interest. Such a plot. as shown in figure 10. I7 . indicates
the range of densities encountered but also the lengths of the features of the
pattern. The latter would indicate the graininess of the image . Comparison
between such area histograms or optical density functions along lines of
interest related to different tissues . might be expected to reveal clear points
NUMBER
OF
CASES
1 2 3 4 5 6 7
8 109
WHITE BLACK
OPTICAL DENSITY
Figure 10.16 A possible histogram of the optical densities within a region of an image
BLACK--
OPTICAL
DENSITY
WHITE- _L...-_ _ _ _ _ _ _ _ _ __
DISTANCE ALONG LINE
Figure 10.17 A possible variation of the optical density along a line of interest across
an image
of differentiation and indices for unambiguous characterisation of tissue

types.
Some of the digital scan converters coupled to computing capability,
allow these types of analyses to be carried out with the echo strength or the
display luminance data in the scan converter memory. This is at a stage
ahead of the hard copy or photographic imaging stage and any image
degradation that might be involved there.
Because of the loss of dynamic range at various stages in the signal pro-
cessing before the display, it is likely that there is some degradation and loss
of tissue-specific information along the way. Therefore much effort is being
put into detailed analysis of the received echo signals after their first ampli-
fication stage, when still in the rf state. Most of the efforts involve trying to
extract and analyse the features of these echo signals - the frequencies and
amplitudes present, and the distributions of these parameters throughout the
tissue regions of interest. Such regions of interest are usually specified from
the B-mode display.
10.11 TISSUE-EQUIVALENT PHANTOMS
In the training of machine operators as well as in the testing of the per-

formance of machines, it is highly desirable to have available phantoms
which mimic the ultrasound properties of tissues. In learning the operation
of machines, long hours must be spent becoming familiar with the machine
controls and simultaneously performing scans on patients or volunteers. It
would be better if such preliminary experience could be gained on an inert
phantom since this would save time and inconvenience. In the testing of
machine performance it is necessary to assess them under conditions as close
as possible to actual service conditions.
In this latter effort, one of the first prerequisites in a test propagation

medium is that the speed of propagation in the medium be 1540 mis, the
assumed average speed of propagation in tissues. As may be found from
figure 10.18, an aqueous NaCl (4 g/l00 ml) solution or an ethyl alcoholj
water (7%) solution or an n-propanoljwater (10%) solution has this propa-
gation speed near 20°e. These solutions have been widely used in test
1650
c (m/s)
160
150
20't:
(a) 5 10 15
%NaCi
1650
c (m/s)
1600
1550
145c~--------~----------~-
(b) 10 20
% ETHYL ALCOHOL
(c) %n-10 PROPANOL20

Figure 10.18 The dependence of speed of propagation, c, on the concentration of
various aqueous solutions (a) of NaCI, (b) of ethyl alcohol and (c) ofn-propanol. In all
cases propagation speeds close to the values in soft tissues are found
arrangements to assess registration, beam patterns, iso-echo contours, and
lateral resolution and other parameters.
These solutions do not necessarily have values of acoustic impedance
such as might be encountered in tissues and they have attenuation values
very much less than tissues, less even than blood or lymph. Formulations
of materials with properties much closer to those of tissues have been
suggested. One such material is a 3% gel of agar in water/n-propanol solution
into which different concentrations of powdered graphite are mixed.
The concentration of n-propanol in the water is the main determinant of
the speed of propagation while the concentration of agar controls the density
and produces a gel at room temperature. Figure 10.19 shows how the speed
of propagation rises linearly in a 3% agar preparation as a function of
n-propanol concentration in the water.
Further addition of powdered graphite (particles of about 7 11m) allows
the attenuation coefficient 11, to be set predictably as shown in figure 10.19.
Even the frequency dependence of the attenuation coefficient can be made
a good match to that encountered in tissues. Efforts are underway to con-
struct phantoms of these materials with attenuation coefficient values, shapes
and reflection coefficients, similar to those found in the body in vivo. Such
phantoms can have great value in training and also in establishing objective
comparison measures between different machines.
180 (kg/ml)
1.
.8
.6
.4
.2
o r . . . . , I
2 3 4 5 6 7
f (MHz)
Figure 10.19 The logarithmic attenuation coefficient in 3% agar/water gel, doped
with different concentrations of carbon powder as shown, at diagnostic ultrasound
frequencies. The curves are similar to those for soft tissues as shown in figure 2.16 and
by choosing the concentration of carbon powder specific attenuation levels may be
designed into the medium
10.12 INSTRUMENT STANDARDISATION
Unfortunately, there is very little uniformity or even comparable specifica-

tions amongst the many diagnostic ultrasound scanners on the market. The
same remark applies to the Doppler instrumentation available. Con-
sequently, there is little objective basis for comparisons among the different
units. They differ in the details of the transducers used, in the pulse genera-
tion method used to drive the transducers, in the signal processing applied to
the received echoes, in the scan converters, in the displays and in the pho-
tography used. The machines differ in the way the transducer probe is
mounted and also in their general convenience and ease of use.
This relative chao; is due mainly to the fact that the field is rapidly de-
veloping and changing. New and better techniques and instruments are
emerging and being produced often before the full potential of previous
generation machines has been realised. The need for objective machine per-
formance indices is therefore great. Not only imaging performance but
criteria such as minimising patient exposure, ease of learning, ease of opera-
tion, capital cost, running cost, standards of servicing, portability or mobil-
ity, ease of up-dating, etc., can have an important bearing on the acceptability
of a particular machine.
This is an area that has received considerably less attention than it needs.
10.13 BIBLIOGRAPHY
Brascho, D. J. and Shawker, T. H., Abdominal Ultrasound in the Cancer Patient, John
Wiley, New York, 1980
Evans, K. T. and Gravelle, I. H., Mammography, Thermography and Ultrasonography
in Breast Disease, Butterworths, London, 1973
1977
Estates, Ca, 1975
Hazzard, D. G. and Litz, M. L., Biological Effects and Characterizations oj Ultrasound
Hildebrand, B. P. and Brenden, B. B., An Introduction to Acoustical Holography,
Plenum Press, New York, 1972
Hill, C. R. and Alvisi, C. (Eds), Investigative Ultrasonology. 1: Technical Advances,
Pitman Medical, Tunbridge Wells, Kent, 1980
Holm, H. H. and Kristensen, P., Ultrasonically Guided Puncture Technique, W. B.
Saunders Co., Philadelphia, 1981
James, A. E. Jr. (Ed.), Radiological Clinics ojNorth America, Vol. 18-1: Symposium on
Advances in Ultrasonology, W. B. Saunders Co., Philadelphia, 1980
Millner, R. (Ed.), Ultrasound Interaction in Biology and Medicine, Plenum Press, New
York, 1983
Preston, K. et al. (Eds), Medical Imaging Techniques: a Comparison, Plenum Press,
New York, 1979
Rhyne, T. L., Acoustic Instrumentation and Characterisation of Lung Tissue, Research
New York, 1979
1979
Optical Applications, Plenum Press, New York, 1974
Thijssen, J. M. (Ed.), Ultrasonic Tissue Characterization: Clinical Achievements and
Technological Potentials, Stafleu's Scientific Publishing Co., Brussels, 1980
1978
Wade, G. (Ed.), Acoustic Imaging: Cameras, Microscopes, Phased Arrays and Holo-
graphic Systems, Plenum Press, New York, 1976
Wells, P. N. T. and Woodcock, J. P., Computers in Ultrasonic Diagnostics, Research
Wells, P. N. T. and Ziskin, M., New Techniques and Instrumentation in Ultrasono-
graphy, Churchill Livingstone, Edinburgh, 1980
Annual Reviews
ards, Washington, annually from 1976
White, D. N. (Ed.), Recent Advances in Ultrasound in Biomedicine, Research Studies
Press, Forest Grove, Or, annually from 1977
White, D. N. (Ed.), Ultrasound in Medicine, Plenum Press, New York, annually from
1976
Various Editors, Acoustical Imaging, Plenum Press, New York, annually from 1969
11 Safety of Diagnostic Ultrasound
One of the main advantages of ultrasound as a diagnostic tool is the absence

of any observed undesirable side effects. But clinical users of ultrasound
instrumentation should have a critical appreciation of this statement. What
side effects can be caused by ultrasound? Under what conditions can such
effects be produced? What risk is there of such effects arising from present
or possible future diagnostic applications of ultrasound? Are there any
possible abuses or mis-uses of diagnostic ultrasound which could accentuate
these risks? How do these risks weigh in the balance with the benefits of
diagnostic ultrasound procedures? Where are the gaps in our knowledge of
this area? What basic precautions should the machine operator take to im-
prove the protection of the patient against any possible risks from ultra-
sound radiation?
(a) outline the range of physical effects which ultrasound can have on
tissues and which can result in irreversible ill effects;
(b) enumerate the main bioeffects of ultrasound as reported in the litera-
ture and indicate the threshold parameters of the ultrasound beam
needed to produce these effects;
(c) describe the role of epidemiology in the effort to discover any subtle
effects of diagnostic ultrasound;
(d) discuss the principal features of the diagnostic ultrasound beam that
enter into consideration of bioeffects ;
(e) outline the types of measures taken in clinical practice to minimise
the possibility of causing any ill effects by diagnostic ultrasound.
11.2 GENERAL PHYSICAL EFFECTS OF ULTRASOUND ON

LIVING TISSUES
The nature of the disturbance of the medium during the propagation of an

ultrasound wave, as described in chapter 2, involves vibratory motion of the
SAFETY OF DIAGNOSTIC ULTRASOUND 185
particles of the medium, oscillatory fluctuations of the pressure in the
medium, oscillatory changes in the density of the medium and also oscilla-
tory fluctuations in the temperature of the medium. All of the changes
disappear when the wave propagation stops. They are all reversible changes
in the medium. The medium passively and elastically recovers, just as a
spring returns to its original length when a deforming force is removed. This
type of reversibility in relation to ultrasound propagation through tissues,
would mean that the tissues would return to their undisturbed healthy state
suffering no side effects, after the wave stops. The assumption inherent in
diagnostic ultrasound is that any departures from such reversibility occur-
ring with conventional diagnostic modes of ultrasound, are negligibly small.
The presence of absorption mechanisms in tissues means that strictly
speaking, reversibility is not achieved. The variety of absorption mechanisms
such as viscosity and the many relaxation mechanisms, result in the extrac-
tion of mechanical energy from the ultrasound wave and its conversion into
heat. This heat raises the temperature of the medium (see Appendix D). The
rate of heat production depends on the intensity of the ultrasound wave and
on the absorption coefficient of the medium. The resulting temperature rise
of the medium depends on the specific heat capacity of the medium and on the
rate at which heat is taken away or lost from the medium. In the case of
living tissues the circulating blood plays a major role in temperature control
and can be mobilised to take away large amounts of heat over relatively
short periods of time. The circulation therefore acts to ensure within limits,
the reversibility of any temperature rise in the tissues. During the propaga-
tion of the wave, the circulation acts to keep the temperature from rising too
high, while after the wave has passed, the circulation quickly brings the
temperature down to the normal body temperature. The higher the vascular-
ity ofa particular tissue the more effective is this process. Thus if the tempera-
ture rise which occurs is insufficient to cause tissue damage, the circulation
serves to ensure medium-term reversibility in a dynamic, self-correcting
fashion. A dynamic, biological reversibility then holds.
If however, the ultrasound intensity is high or if the absorption coefficient
is large, the heat loss mechanism, including any enhanced circulation, may
not be capable of keeping the temperature lower than levels which could
cause damage to the tissues. Such overheating of body tissues can be very
hazardous.
As the intensity of the wave is increased, the range of observable and
measurable irreversible effects increases.
The presence of an intensity drop across a reflecting boundary results in a
unidirectional force, the so-called radiation force, on the boundary. This
force is directly proportional to the intensity drop across the boundary and
is therefore related to the intensity in the wave as well as the reflection co-
efficient at the boundary. If this force is great enough it can result in fracture
or tearing of the tissues at the boundary. This radiation force is the basis for
the radiation balance, described in chapter 3-a method of measuring
ultrasound intensity.
A gradient of intensity along the direction of propagation through a

medium similarly results in a unidirectional radiation force acting on each
successive layer of the medium perpendicular to the beam. If the medium is
fluid such as blood, this radiation force can produce micro streaming or
microcurrents in the fluid.
Other unidirectional forces can arise when at higher intensities the re-
sponse of the medium to the pressure wave, i.e. the change in density, is
non-linear or is not proportionally greater at higher intensities than at
lower intensities. The non-linearity of the medium can, for instance, result
in a greater net force on a particle in the medium during the compression
phase of the wave than during the rarefaction phase. The particle then
experiences an average net force in one direction called the Oseen force.
Particles in a liquid medium like blood or aqueous humour, can ex-
perience a unidirectional force called the Stokes force, due to the non-
linearity of the viscosity of the liquid medium at higher intensities. The
viscosity may be different in the compression phase from that in the rarefac-
tion phase, and therefore there can be different force patterns on the particles
during the two parts of the ultrasound cycle. Consequently over a full cycle
the particles experience a net unidirectional force.
Two large particles located side-by-side in a liquid medium and presenting
to the high intensity beam so that the gap between the particles is along or
parallel to the beam axis, can experience forces drawing them together.
These so-called Bernoulli forces arise from the flow of the liquid through the
constriction between the particles and the consequent net pressure reduction
at that location.
Disruption due to fatigue can also occur at high intensity. The mechanism
offatigue appears to be the gradual spread of flaws or cracks in the medium,
during each successive cycle of the pressure. Eventually after the crack has
spread widely enough, the acoustic pressure in the ultrasound wave is
sufficient to complete the fracture.
As the intensity rises higher still, more drastic rupturing of the medium
can happen through the complex phenomenon of cavitation. At high in-
tensity, very large pressure fluctuations are imposed on the medium. During
rarefaction, bubbles form and expand, filled with gas and vapour. Then
during the compression phase the bubbles are reduced in size. If the in-
tensity is not too high, this growth and disappearance of bubbles can happen
during each cycle of the wave, and the process is called stable cavitation. But
if the intensity is very great the bubbles are unable to diminish rapidly
enough during the compression phase, and they eventually implode near the
peak of the pressure cycle. Associated with this bubble collapse are high
localised stresses and temperatures which produce considerable disruption
and tearing of the medium. This is so-called transient cavitation and is a
severely destructive phenomenon.
In an aqueous medium, at the frequencies used in diagnostic ultrasound,
ca vitation only occurs at intensities over 10 6 W 1m 2 • The more structure is
present in the medium the higher the intensity needed to cause cavitation.
The various unidirectional forces become measurable at around 103 W/m2
in a liquid medium and are also inhibited in more structured media. Because
in biological soft tissues the medium is more viscous and has more internal
structured organisation than in water, the levels of intensity needed to pro-
duce these disruptive effects to observable extents in such tissues, would be
greater than for liquid aqueous media.
11.3 BIOEFFECTS AND THRESHOLDS
There have been many experimental studies on different biological systems

to determine what ill effects high intensity ultrasound can have on them and
at what intensities such ill effects occur.
Probably the simplest system studied has been aqueous solutions of
biological macromolecules such as proteins and deoxyribonucleic acid
(DNA). Fragmentation of DNA molecules has been observed at frequencies
near 1 MHz when ultrasound intensities of 2 x 10 3 W/m2 act continuously
on the solution for periods in excess of 15 min. Ultrasound of intensity
5 x 104 W/m2 acting for over 10 min fragments the DNA molecules com-
pletely. This degradation occurs in the absence of cavitation and seems to be
due to shearing forces acting on the large molecules, breaking them mainly
at their mid-points. Intensity levels which do produce cavitation, even of the
stable kind, are still more effective at fragmenting these long polymers.
Aqueous suspensions of white and red blood cells as well as of other
types of cultured cells, have also been used as test systems for ultrasound
treatments. Continuous ultrasound at 1 MHz and about 2 x 103 W/m2,
acting for some 5 min causes disruption of platelets in aqueous suspension.
Red blood cell suspensions similarly exposed to intensities up to 3 X 104
W/m2 suffer some changes to the membranes such as to increase membrane
permeability, but without membrane disruption. Cavitation however does
cause destruction of the cells. In studies on cell cultures, cavitation causes
more disruption during mitosis than at other phases of the cell cycle. Chromo-
somal damage is produced in plant cells in aqueous suspension, by ultra-
sound of intensities between 104 and 10 5 W/m2, at frequencies of 1 MHz or
lower.
The arrest of blood flow in chick embryo can be produced by a standing
ultrasound wave of 3 MHz at 5 x 103 W/m 2. The red blood cells clump at
half-wavelength intervals along the direction of propagation of the ultra-
sound wave.
Of the range of soft tissues in the body, the skin, liver, nerve tissue and
brain tissue among others have been widely studied as target tissues for
ultrasound irradiation in the search for bioeffects. These tissues in mice,
rats, cats and humans have been studied. Tissue damage, or the production
of lesions, in which the primary mechanism is heating depends on the in-

tensity of the ultrasound and on the duration of the irradiation in a manner
similar to that in figure 11.1. This figure refers to brain tissue in mammals.
Broadly speaking, the higher the intensity the shorter the duration needed to
cause the lesion. Also in general, the higher the frequency the greater the
intensity of the burst of ultrasound required to produce the damage.
1d
INTENSITY
(W/m2)
10'
10 1d 10'
DURATION (5)
Figure 11.1 The threshold conditions of ultrasound intensity and irradiation duration
to cause damage to mammalian brain tissue
Inhibition of the action potentials of muscle tissue in vitro has been found
to result from exposure to ultrasound intensity levels near 1.5 x 104 W/m2
at 1 MHz for 5 min. Similar intensity levels at 3 MHz have been shown to
change the calcium transport properties of muscle cell membranes. Other
alterations in membrane permeability have also been noted to result from
intensity levels of about 6 x 103 W/m2.
Damage to the foetus in utero, caused by ultrasound, has been investigated
in a number of animals including mice and rats. In one such study, rat
embryos were subjected to 2.25 MHz ultrasound of intensities in the range
10-2 x 10 3 W/m2 through an incision in the maternal skin and abdominal
wall. Five minute treatment durations were applied on the 3rd, 5th, 6th and
15th days of gestation. The foetuses treated early in pregnancy weighed less
than control cases and the abortion rate was also greater in the treated cases.
However no abnormalities in the neonatal rats which had been thus treated,
were found when these latter were compared with untreated controls. Studies
on pregnant mice, using 1 MHz ultrasound at 5 x 10 3 W/m2 for 3-min
treatment periods, resulted in significant decrease in the rates of survival of
the foetuses in comparison with untreated controls .
Figure 11.2 summarises the conditions of intensity and duration which
have been observed to cause ill effects in mammalian tissues. Below 10 3
W/m2 no ill effects have been found regardless of the duration. Furthermore
if the product of intensity and duration of exposure to ultrasound is less
than 5 x 10 5 J/m2 , no undesirable side effects have been demonstrated.
10'
IN TE NSI TY
( W / m l)
\
\
ld
\
. r;:'!" J~9J~~l,-[::.R..L.I!'1 I.T. } .. _. _~ y . . _. ~ 5. _
\
\
10
10' 10' 10 ' 10 10' 0' 10'

DURA TION (5)
Figure 11.2 The minimum levels of intensity and duration of ultrasound , at which
effects in mammalian tissues have been observed or postulated . The effects cited are
(\) paralysis, (2) foetal weight reduction , (3) postpartum mortality, (4) altered mitotic
rates and (5) suspected foetal abnormalities. The 5 x 10 5 11m2 exposure line is shown
as is also the 10 3 W1m2 maximum reported intensity of a cw Doppler beam (after Hill)
In consequence, the American Institute for Ultrasound in Medicine has

issued guidelines on the biological effects of ultrasound energy on living
mammals thus:
'In the low megahertz frequency range there have been no demonstrated
significant biological effects of ultrasound in mammalian tissues exposed
in vivo to intensities below 100 mW/cm 2 (i .e. 10 3 W/m2) . Furthermore, for
ultrasonic exposure times less than 500 seconds and greater than 1 second ,
such effects have not been demonstrated even at higher intensities, where
the product of intensity and exposure time is less than 50 J/cm 2 (i.e.
5 x 10 5 J/m2).'
11.4 EPIDEMIOLOGY
Apart from the more macroscopic ill effects discussed above, the possibility
exists that more subtle effects may result from exposure to ultrasound. Such
effects might remain latent only to become manifest months or years after
the original exposure. This type of possibility raises worries especially in
relation to the many uses of ultrasound during pregnancy to study the
foetus. At the present time many millions of pregnant women are examined
with ultrasound at least once during pregnancy, each year. At least half of
these are examined more than once in the pregnancy. Furthermore the
availability of pulse-echo and Doppler devices is increasing rapidly from
one year to the next and so the numbers of pregnant women being examined
is also rapidly growing. In addition the number of clinical situations in
which ultrasound is the indicated investigative modality is also growing. The
possible existence of a sub-group of the population sensitive to ultrasound
should also be borne in mind.
The requisite large-scale epidemiological search for any such subtle effects
of diagnostic ultrasound has not yet been carried out. Such a study would
be of great value in quantifying the risks and safety of diagnostic ultrasound
as used in clinical situations.
In an early limited study carried out in New York, Glasgow and Lund
(Sweden), abnormalities in the off-spring of some 1048 pregnancies which
had been examined ultrasonically, were studied. Table 11.1 summarises the
results of the study. An overall abnormality rate of2.7% was observed. This
rate compares favourably with the average abnormality rate of some 4.8%
Table 11.1 The Numbers of Abnormalities Observed in Human Foetuses, in Relation

to the Time after Gestation at which the First Ultrasound Examination
Took Place
Week of gestation No. examined No. of abnormalities %abnormal

10 146 2 1.4
10-19 102 3 1.9
20-29 154 5 3.25
30-39 467 13 2.8
40 150 6 4.0
Totals 29 2.7
found in another survey of some 63000 single births in the United States.
The conclusion of that study was that diagnostic ultrasound did not appear
to present a hazard to the foetus.
11.5 DIAGNOSTIC ULTRASOUND DOSIMETRY
One of the main questions in relation to the safety of diagnostic ultrasound

is whether or not the intensity values produced by conventional instrumenta-
tion are likely to approach the AlUM guideline levels for known biological
effects. In general the answer is not clear-cut. There are wide differences be-
tween the pulse-echo units and the Doppler instruments. There are even
wide differences between the many pulse-echo instruments.
The average intensity produced by Doppler instruments of the con-
tinuous wave type at frequencies from 2 to 10 MHz, ranges up to about 10 3
W1m 2 . Allowing for the fact that the actual intensity varies across the face
of the transducer in a fashion indicated in figure 3.20, peak intensity in any
section through the beam could reach 104 W/m2.
In pulsed instruments the shape of the pulse affects the intensity at any
moment. In such instruments average intensities up to 70 W/m2 have been
measured. So-called spatial peak values of intensity, at a focus of the beam
and averaged over the duration of the pulse, up to 10 3 W/m2 have been
measured. Without the averaging over the pulse duration, brief instantaneous
levels at the focal plane of some 10 7 W/m2 have been detected. These high
levels pertain for less than 10-7 s.
Some of these intensity levels can exceed the threshold values at which
some bioeffects have been observed. But the extreme brevity of the pulse in
pulse-echo applications brings the total energy dose in 11m2 along the beam
well below the guideline threshold of 5 x 10 5 11m 2.
11.6 PROTECTION AGAINST ILL EFFECTS OF ULTRASOUND
In most clinical procedures using ultrasound, the beam is fairly constantly

moved in order to scan or interrogate the different regions of interest in the
body. This action means that a specific target tissue is not in the beam and
being irradiated by the ultrasound energy except for short intervals. This
factor introduces an important safety factor.
One situation where this safety factor does not pertain is in the use of
Doppler ultrasound systems for foetal monitoring during labour. In some
such applications the orientation of the beam is fixed, to flood the foetal
heart with ultrasound for up to some hours during labour. Such long-term
monitoring could conceivably elevate the energy concentration in the beam
to the vicinity of 5 x 10 5 11m 2 . Some care is needed in this application.
The attenuation of the ultrasound wave as it traverses the tissues also
introduces a safety factor. If a specific target tissue or organ is some 5 cm
deep below the skin, the beam is attenuated by 5 dB or more before it en-
counters the organ of interest. For example 6 dB corresponds to a reduction
of intensity by a factor of 4. The greater the attenuation coefficient of the
intervening tissues, the greater the reduction of the ultrasound energy
dosage to the target tissue.
Other 'good house-keeping' measures should also be adopted in practice
in order to minimise the dose to the tissues. The lowest output ultrasound
power, commensurate with obtaining a good image of the required flow
information from Doppler studies, should always be used. Many instruments
allow the output or transmitted power to be reduced electronically. Un-
necessary scans should be avoided and repeat scanning minimised. The
development of tissue-equivalent phantoms for use in the process of learning
how to scan, can also minimise unnecessary scanning of humans. When not
scanning and building up the images, the transducer should be lifted away
from contact with the patient's skin. If the pulse repetition frequency (prf)
of a pulse-echo instrument can be varied, then it should be set to the lowest
value needed for adequate imaging. The overall duration of the ultrasound
examination should be kept as short as possible, and training and experience
help in this respect. When ultrasound is used in the vicinity of the eyes, where
there is very little attenuation in the tissue path before the sensitive retina,
care should be taken to avoid intense or focussed beams and to minimise the
duration of the examination.
11.7 BIBLIOGRAPHY
Dunn, F. and O'Brien, W. D. Jr. (Eds), Ultrasonic Biophysics, Dowden, Hutchinson &
Ross Inc., Stroudsburg, Pa, 1976
Hazzard, D. G. and Litz, M. L., Biological Effects and Characterization of Ultrasound
Hill, C. R., Chapter on Ultrasound in Manual on Health Aspects of Exposure to Non-
ionizing Radiation, World Health Organization, Geneva, 1977
Hussey, M., Diagnostic Ultrasound: an Introduction to the Interactions between Ultra-
sound and Biological Tissues, Blackie & Son, Glasgow, 1975
ards, Washington (annual volume)
Rose, J. L. and Goldberg, B. B., Basic Physics in Diagnostic Ultrasound. John Wiley,
New York, 1979
1978
Appendix A
EXPONENTIAL DECAY
Figure A.1 illustrates the exponential decay of the dependent variable y,

from an initial value Yo, as the independent variable x increases. Exponential
decay is characterised by the fact that in each given x interval, y always de-
clines by the same factor. In particular, it declines by a factor of 0.7 in the
characteristic interval, xc' Thus, a large value of Xc would indicate a gradual
decay while a small value of Xc would indicate an abrupt decay.
The exponential decay may also be written algebraically thus
(A.I)
where e (=2.7183 ... ) is the base of natural logarithms, a constant.
'. -- -- - - - --
:,7"
, Jo
,
:·7(·71.
, 0
)
x
Figure A.I The exponential decay of the dependent variable y as the independent
variable x increases. In each characteristic increase in x, xc' y falls by a factor of about
0.7
Appendix B
LOGARITHMS
The logarithm x of a number A to the base lOis written thus:

x=logloA (B.l )
and is defined through equation (B.2),
A= lOX (B.2)
Logarithms to base e, where e (=2.718 ... ) is the base of natural logar-
ithms, are also widely used. Tables of values of logarithms to the base 10
and to the base e are available.
The usefulness of logarithms may be illustrated as follows. Consider
logarithms to the base 10 of the two numbers Al and Al as shown in equa-
tions (B.3) and (B.4).
Xl =10g lo A I , Al = lOx) (B.3)
Xl =loglOA 1 , Az = lOxz (B.4)

The product of Al and Az ' B, is then
B=Al x A z
=lOxlxlOx2 (B.5)
= 10(x1+xZ)
The logarithm to the base of 10 of this product:

loglo B=x l +x 2
=loglo Al +loglo A z (B.6)
The logarithm of the product is equal to the sum of the logarithms of the
two quantities which are multiplied together. So, in converting to logarithms
the product operation becomes addition.
When the two quantities, Al and A z , are divided one into the other thus
C=AdA z
= lOxl/IOX 2 (B.7)
= 10(xl-x2)
196 APPENDIX B: LOGARITHMS
The logarithm of the quotient C is given by

logio C=X I - X l
=loglO Al -iogio Al (B.8)
The logarithm of A I divided by A 1 is equal to the difference between the
logarithm of A I and the logarithm of A l. Thus, in converting to logarithms
the division operation is transformed into subtraction.
Appendix C
MECHANICAL ENERGY AND VIBRATIONS
Mechanical energy occurs in two distinguishable forms, kinetic and potential.

If an object of mass M kg has a velocity of v mis, it possesses an amount of
kinetic energy E k , given by the following equation:
Ek =~ M 1,2 (C.l)
The unit of energy is the joule (J).
A mass can possess gravitational potential energy if it is held at some
height, h m above the ground. The amount of such potential energy E p ' is
given by the following equation,
(C.2)
in which M kg is the mass and g is a constant, the acceleration due to gravity.
A spring may also possess potential energy E ps ' when it is either compressed
or extended. As shown in figure C.1, the force required to stretch a spring
F(N)
Figure C.I The force F on a spring is directly proportional to the extension x of the
spring. The slope of the graph, C, is called the spring constant. The area under the
graph up to a given extension, shown cross-hatched, is the work done in stretching the
spring and also the energy stored in the spring
depends on the amount of the extension x (increase in length) of the spring

and on the spring constant C thus:
F=Cx (C.3)
This is Hooke's Law for a spring. The potential energy stored in the spring
is equal to the area (cross-hatched in the figure) under the graph. This is
given by equation (C.4):
Eps =~ Fx
=~CX2 (C.4)
Mechanical work is done when a force is moved through a distance. An
example of this is when a weight is lifted up from the ground. In fact, in this
case the work done equals the weight of the object multiplied by the height
through which it had been lifted. Energy is ability, or capacity, to do work.
Thus the potential energy that the mass possesses when it is lifted through
height h m, is in fact equal to the amount of work that had to be done to
raise the object. Likewise, when a spring is being stretched, work has to be
done, and the amount of work is equal to the amount of energy stored in the
spring. Work, therefore, has the same unit as energy, the joule (1).
It takes time to do work. For instance, it takes time to lift a weight to
some height. The rate at which the work is done or the rate at which the
energy is being stored (the amount of energy being stored every second) is
called the power and is measured in watts (W), which are joules/second
or l/s.
Consider a mass resting on a surface as shown in figure C.2. If one tries to
move this mass along the surface, it is necessary to apply an amount of force
to first get the object into motion. This is because between the mass and the
surface there occurs a force called the frictional force, Fp which tends to
prevent the relative movement. At one level, this frictional force may be
Figure C.2 A mass M, acted upon by a force F horizontally along the table, is pre-
vented from being accelerated by an oppositely-directed frictional force, Ff
considered to arise from molecular attraction and simple mechanical inter-

locking between the top surface of the table and the bottom surface of the
object and these effects tend to prevent the relative movement. Once the
object has acquired some velocity the friction tends to reduce this velocity.
Friction therefore tends to reduce the kinetic energy of the object. In fact,
friction transforms the kinetic energy into a different and non-mechanical
form of energy, namely heat.
APPENDIX C: MECHANICAL ENERGY AND VIBRATIONS 199
Consider the simple mechanical system shown in figure C.3(a), which

consists of a mass resting on a flat table attached to one end of a spring
whose other end is attached to a fixed vertical support. If the mass is set in
motion, it will oscillate back and forth and one can graphically display its
movement as shown in figure C.3(b). At the furthest limit of the movement
of the mass (R), it possesses no velocity and hence no kinetic energy, but the
spring is maximally extended and so does have potential energy. At the mid-
point of the movement of the object (Q), the mass has its maximum velocity
and hence its maximum kinetic energy. But, at that point the spring is
neither extended nor compressed and, therefore, possesses no potential
energy. Then, when the object is at its furthest excursion to the left (P), it
again possesses no velocity and no kinetic energy. But, then the spring is
maximally compressed and has the maximum potential energy. Thus, the
energy picture is such that it is constantly being changed between kinetic and
potential forms during the vibration of the object.
The result of the intrusion of friction into this system is to gradually
reduce the amplitude of movement of the object as shown in figure C.3(c).
(a)
(b)
(c)
Figure C.3 A mechanical system consisting initially of a mass M and a spring of

constant C, as shown at (a), which when disturbed executes simple harmonic motion
as in (b). If the viscous dashpot be connected, the motion of the mass after being
disturbed is a damped simple harmonic motion as in (c)
In fact, what friction does is to gradually convert the mechanical energy of

the system into heat. This latter damped type of vibration is of much wider
occurrence in real systems than the undamped vibration described above. If
the damping is very severe, with much friction, a very small number of
oscillations of the object will happen before the movement decays appreci-
ably to zero.
Appendix D
HEAT
When heat energy is given to an object, it causes the temperature of the

object to rise. The magnitude of the resulting temperature rise AT, depends
on the amount of heat donated. H J, but also on the mass of the object. M.
and an intrinsic property of the material of the object called the specific heat
capacity, c. The relationship is shown in the following equation:
H=Mc(A1) (D.I)
Heat can be obtained in a number of ways, most commonly by combustion,
but also from electrical heaters, and through friction from mechanical
energy.
Appendix E
ELECTRICITY
Electricity is another form of energy, from which mechanical energy (by

means of a motor), heat (by means of heating elements) and light may be
derived. Electricity is commonly used in one of two forms, (a) direct current
(D.C.), and (b) alternating current (A.C.).
(a) D.C.
A simple D.C. circuit is shown in figure E.l. On the left is a source of electrical
current and on the right is a resistor which tends to reduce the current flow.
The current flowing consists of electrons, tiny negatively-charged particles,
Figure E.1 A simple D.C. circuit consisting of a battery source of electromotive

force (electrical potential difference) and a single resistor. A current I A flows around
the circuit
moving through the wires of the circuit. The current flowing is the amount of
electrical charge flowing in each second, arid is measured in units of amperes
(A). The source of current, which might be a battery, is characterised by the
electrical pressure, called the potential difference, E, which it develops. For
a particular potential difference, E, and a given circuit resistor of resistance,
R, the amount of current, I, which flows is determined by Ohm's law shown
in equation (E.l)
I=E/R (E.1)
Potential difference is measured in volts (V), while resistance is measured in
Ohms (Q).
APPENDIX E: ELECTRICITY 203
Every electrical appliance has a value of resistance. A lamp or fire element,
a motor or cooker, each a characteristic value of resistance.
The current flowing constantly carries energy to the resistive load. The
amount of energy carried each second is the power delivered to the re-
sistor. The power, P, in watts (W) is given by equation (E.2):
P=EI
=R PeW) (E.2)
If the current flows for some length of time, t, then the amount of energy,
EE' in joules delivered to the load is the product of power and the time taken,
indicated by equation (E.3):
EE=Pt
=Elt (E.3)
=RPt
The flow of current in a wire is also associated with magnetism. F or instance,
a coil of wire caIled a solenoid, as shown in figure E.2, carrying current, has
a magnetic field which is equivalent to that of a bar magnet. The strength of
the magnetic field is proportional to the current I. The polarity of the field,
which end of the equivalent magnet is north and which is south, depends on
the direction of flow of the current.
N s
Figure E.2 A solenoid carrying an electrical current acts like a bar magnet
Certain materials which are ferromagnetic, such as soft iron, if placed in

the solenoid, strengthen the magnetic field and also become magnetised
themselves.
(b) A.C.
In an A.C. circuit the source of potential difference, the electrical pressure

causing the current flow, is not constant but is alternating with time as shown
in figure E.3. This alternating potential difference or alternating voltage, (e),
may be described by equation (E.4):
e = E m • x sinwt (E.4)
In every so-caIled period, T s, where
T=2n/w (E.5)
e(V) E:f!1?X.
(a)
. p'
I(A)~.q(s)
T(5) ,
(b)
p(W)F~T\~
(c)
t(s)
Figure E.3 (a) The sinusoidal variation of voltage with time in an A.C. voltage source.
(b) The A.C. current which flows in a resistive circuit when the voltage in (a) is applied
across it. (c) The instantaneous power delivered to the resistor in this A.C. circuit
the pattern of the potential difference change is repeated. The number of

such periods repeated each second is called the frequency, f~ where
f= liT
=wl2n (E.6)
Frequency is measured in hertz (Hz).
As the voltage varies, so also does the current according to Ohm's Law as
shown in equations (E.7) and (E.8):
i=elR
= (Emaxl R) sin wt (E.7)
= I max sin wt
where
(E.8)
As shown in figure E.3(b), the current varies in step with the voltage.
Therefore, for half of the time the current is moving in one direction in the
circuit while for the other half of the time it is moving in the opposite direction.
Nevertheless, power, p, is delivered to the resistive load as indicated by the
following equation:
p=ei
(E.9)
APPENDIX E: ELECTRICITY 205
As shown in figure E.3(a), the power, the rate at which energy is being
delivered to the resistor, is constantly changing. The average power, P AV' a
constant power which would deliver the same amount of energy as the A.C.
power, is given by equation (E.IO):
P _ Emax Imax
AV- 2
Emax Imax
(E.lO)
where the so-called root mean square (rms) values are:
(E.II)
Some materials, such as metals, are good conductors of electricity. Such

materials present low values of resistance, thereby allowing large currents
to flow according to Ohm's Law. Other materials. such as plastics and
ceramics tend to be poor conductors. They offer very high resistance values
and are commonly referred to as insulators.
If an A.C. current flows through the solenoid of figure E.2, the associated
magnetic field is also alternating. Such local fluctuating electromagnetism
can initiate an electromagnetic wave which propagates at the speed of light.
This is the basis of radiotelemetry.
Appendix F
ELECTRONICS
Electronics is a sub-section of electricity in which the concern is to manipu-

late and control the flow of current, usually low values of current, in various
desired ways. The central elements used in electronic circuits are semi-
conductors. In their electrical conducting properties, semiconductors lie
between insulators and conductors. It is possible at the manufacturing stage
to impart, by appropriate added impurities, various desirable properties to
the semiconductor material. These materials are usually based on either
silicon or germanium.
A simple such device is the semiconductor diode which allows current to
flow in one direction but not in the opposite direction. If such a device is
included in an A.C. circuit as shown in figure F.1(a) the current flowing
through the resistance is as shown in figure F.l(c). It flows only half of
the time.
Another important semiconductor device is the transistor, depicted sym-
bolically in figure F.2(a). Transistors have found many and varied applica-
tions, but one of the most important is as amplifiers. A simple transistor
amplifier is shown in figure F.2(b). Note that the transistor is a three-terminal
device. One small voltage, the so-called input signal, ein , is connected be-
tween the base terminal and the emitter terminal. The output voltage, eout' is
developed across the load resistance R or between the collector and the earth
of the circuit. The basic point about the amplifier is that the ratio of the
output voltage to the input voltage can be greater than unity. This ratio is
known as the gain or the amplification factor (A) of the amplifier. Thus
(F.1)
An amplifier may be schematically represented as in figure F.2(c).
Transistors also act as key components in many other circuits such as
electronic switches, filters, oscillators and other wave/pulse shaping circuits,
voltage level detectors and comparators, analogue-to-digital as well as
digital-to-analogue converters, counters, demodulators, etc.
With the development of micro-miniat uris at ion, it has become possible to
drastically reduce the size of these semiconductor devices and to incorporate
APPENDIX F: ELECTRONICS 207
(a)
(b)
(c) i~
t
Figure F.l The rectifying action of a diode in an A.C. circuit. (a) The resistive circuit
with the diode in series with the resistor. (b) The sinusoidal A.C. supply voltage. (c) The
current flows only during the positive or forward phases of the A.C. voltage. Zero
current flows during the negative phases
(a)
~
base
Ollector
eml.tt er
eout
(b)
(c)
~OU\
Figure F.2 (a) The usual symbolic representation for a transistor. (b) A simple circuit
for a common-emitter transistor amplifier. ein is the input signal voltage and eOU ! is the
output voltage. (c) A schematic or functional representation of the amplifier as a four-
terminal device. ein is the input voltage, eOU ! is the output voltage and A, the ratio of
these two voltages, is the gain or amplification factor of the amplifier
many of them in an interconnected fashion into a single small module or

chip, of dimensions of the order 0.5 cm. These small modules, called in-
tegrated circuits, may incorporate a wide variety of different interconnections
between the basic semiconductor devices. Many electronic functions may be
included in one very small device. Then, a number of these integrated circuits
may be used to implement the many desired functions in an overall instru-
ment such as a television set or an ultrasound scanner.
Appendix G
CATHODE-RAY OSCILLOSCOPE
A very useful device for visually displaying time-varying voltage waveforms

is the cathode-ray oscilloscope. At the heart of the cathode-ray oscilloscope
is the cathode-ray tube shown schematically in figure G.1.
The tube is generally an evacuated glass bottle. The inner face of the right
hand rectangular end of the bottle is coated with a fluorescent phosphor
which when it is struck by a beam of electrons, emits light which can be seen
through the glass. This is the front face or screen of the tube where the
voltage waveforms are displayed. The light emitted is not persistent. When
electrons are not impinging on the phosphor, no light is emitted and when
the electrons stop striking the phosphor the light emitted quickly decays.
SCREEN
.. -
Figure G.t A schematic diagram of a cathode-ray tube, comprising an evacuated

glass vessel, an electron gun which has a control grid to control the intensity of the
electron beam, the two deflection plates and the screen with a coating oflight-emitting
phosphor
The beam of electrons used to essentially write on the screen is formed in

the electron gun portion of the tube. The electron gun consists of a cathode,
heated with an electrical element, and an anode, or set of anodes, which are
arranged to be at a higher D.C. voltage than the cathode. The difference in
voltage between cathode and anode can be hundreds of volts.
Located between the cathode and this first anode is a metallic screen with
multiple perforations, the so-called control grid. Varying the fairly small
voltage of this grid relative to the cathode varies the flow of electrons to the
anode and in turn controls the brightness of the light produced at the screen.
Normally there is an external connection or input to this grid which is called
the 'Brightness Modulation' or Z input of the osciIIoscope.
The first anode in the electron gun has a perforation in its centre. The
electrons are drawn from the cathode at a high speed towards the anode.
Some of these electrons manage to pass through the hole in the centre of the
anode of the gun. They continue to be accelerated towards the screen by a
final anode which is evaporated on to the inside of the phosphor of the
screen. This anode is at a stiII higher voltage relative to the cathode. Thus, the
electron gun focusses the electrons into a sharp collimated beam which is
then drawn to the screen.
Between the electron gun and the screen, there are located two sets of
electron-beam deflection plates, one set arranged horizontally and the other
set arranged vertically with the electron beam passing between the two pairs
of plates. When a voltage is impressed between the two horizontal plates,
with the upper plate positive and lower plate negative, the beam of electrons
is repelled from the lower plate and attracted towards the upper plate. Con-
sequently, the beam arrives at the screen at a higher vertical position than
previously (see figure G.2). The greater the voltage between the plates, the
greater the vertical deflection of the bright spot on the screen. If the polarity
of the voltage between the plates is reversed, the deflection of the light spot
is vertically downwards, i.e. reversed. The two horizontal plates, are there-
fore used to produce vertical deflection of the bright spot on the screen, i.e.
deflection in the Y direction. Similarly, the pair of vertically-arranged plates
may be used to produce deflection of the bright spot along the horizontal or
X direction on the screen. Because the beam of electrons has so very little
mass, it may be caused to move around the screen very rapidly by appropriate
rapidly changing voltages between the pairs of deflection plates .
...
~~~C.I~N___ : __ ........
BEAM -
VERTICAL
DEFLECTION
PLATES
SCREEN
Figure G.2 The deflecting action of the charged deflection plates on the beam of
negative electrons
APPENDIX G: CATHODE-RAY OSCILLOSCOPE 211
In most oscilloscopes, the voltages applied to the horizontal deflection

plates are internally generated (i.e. within the oscilloscope electronics) saw-
tooth voltages, often referred to as the time-base voltages. These voltages
would vary as shown in figure G.3. Each consists of a linearly increasing
voltage, drawing the bright spot across the screen at a steady rate, followed
by a very abrupt drop in voltage drawing the bright spot back rapidly to the
left-hand side of the screen. Usually, also, the brightness of the spot is
diminished during the fly-back period so that it is not visible during fly-back.
The rate at which the bright spot travels from left to right may be varied by
varying the slope of the saw-tooth voltage as shown in the figure. If an
external time-varying voltage is simultaneously applied to the vertical de-
flection plates, the bright spot experiences vertical deflections as well as the
steady time-base horizontal deflection. The motion of the bright spot on the
screen is then an image of the voltage versus time graph of the time-varying
voltage to be monitored.
Depending upon the setting of the time-base, i.e. the rate of rise of the
ramp of the saw-tooth voltage, the time taken for the bright spot to travel
from left to right on the screen can be controlled and consequently the
duration of the display of the time-varying voltage can also be varied.
The main controls on a cathode-ray oscilloscope are the following:
(a) The time-base setting as described above.
(a)
(b)
(c)
Figure G.3 Saw-tooth voltage variations with time, which are used to sweep the
electron beam horizontally across the viewing screen at different steady speeds. The
horizontal scale is then a time base with from (a) through (c) a decreasing time for the
sweep across the screen width
(b) The sensitivity of the vertical deflection. This setting controls the
amount of amplification applied to the time-varying voltage of interest before
it is applied to the vertical deflection plates.
(c) The brightness or luminance of the bright-spot display. This controls
the steady voltage of the control grid and thereby controls the amount of
electrons in the beam reaching the screen.
(d) The focus-control varies the voltages on the electrodes in the electron
gun and thereby helps to collimate the electron beam and to ensure that a
narrow beam reaches the screen.
(e) The triggering of the time-base. Sometimes, it is adequate for the
time-base voltages to be a free-running saw-tooth. But, often it is desirable
for the sweep of the saw-tooth of the time-base to start simultaneously with
portion of the voltage being examined. In such cases, instead of the saw-
tooth being free-running, it can be triggered to start when desired, i.e. when
the voltage of interest reaches a particular level or else by some other ex-
ternally-applied trigger signals.
Appendix H
STORAGE OSCILLOSCOPE
In the conventional oscilloscope, the phosphor chosen for coating the screen
usually has a short persistence. This means that the light from the phosphor
continues to be emitted for only a short period of time after the electrons
have stopped impinging on the phosphor. Longer persistence phosphors are
available and the effect with these phosphors is for the light to much more
gradually fade away, i.e. they possess a certain amount of short-term
memory. This memory can be greatly extended by use of storage oscillo-
scope tubes. Such a tube is shown schematically in figure H.!.
This oscilloscope tube differs from the conventional tube in two main
ways. First of aIL it possesses a coating of a dielectric or insulating material
inside the phosphor coating on the screen. When the electron beam is made
to move over the screen, the rapidly-moving high energy electrons in the
beam knock electrons off the insulator, leaving a pattern, or latent image,
of positively-charged regions on the insulator layer.
The second point of difference between the conventional and the storage
tube is the fact that the latter possesses extra electron guns. One of these
guns, when activated. is made to flood the full screen with medium energy
electrons. This means that it does not produce a collimated beam but rather
= DO
STORAGE MESH
Figure H.l The main elements in a storage oscilloscope tube, showing, in addition to
the features of a simple CRT, the storage and collector meshes or grids and the addi-
tional electron guns, the read flood gun and the erase flood gun
a divergent beam which covers the whole screen. These medium-energy

electrons can only reach the phosphor and produce light by passing through
the positively-charged regions on the insulator layer. They are not energetic
enough to punch through the insulator alone. In this way, light is emitted
from the screen only where the original high-energy electron beam originally
travelled over the screen. As long as this medium energy supply of electrons
falls on the screen, the originally-stored pattern can be viewed on the screen.
The latent image or pattern on the screen can be erased by using the
second extra electron gun which produces very low-energy electrons to flood
the screen. These electrons have just enough energy to replace those origin-
ally knocked off the insulator layer and thereby erase the pattern on the
screen.
Thus the 'Write' mode of this tube consists of the high-energy electron
gun imprinting a pattern on the insulator layer. The 'Read' mode consists of
the medium-energy electron gun constantly flooding the screen with elec-
trons. The 'Erase' mode consists of the low-energy electron gun flooding the
screen and replacing the charges originally displaced by the high energy
electron beam.
The image displayed on the storage oscilloscope screen is bi-stable. This
means that the trace is visible at a constant brightness or else is not visible
at all. If the writing voltage signal is less than a fixed level, then the electron
beam is not energetic enough to write on the insulating layer in the tube. If
the signal is greater than this set writing level, it will punch a conducting hole
in the dielectric layer. Thus in the 'Read' mode, the brightness of the trace is
not related to the strength of the original writing signal.
A storage oscilloscope can also be used in a variable persistence mode by
having the writing and erasing processes occurring simultaneously. By vary-
ing the balance between 'Write' and 'Erase', a variable persistence can be
achieved.
In some variable persistence tubes, the layer of dielectric insulator is
separate from the phosphor layer and the greater the number of electrons in
the writing beam, the greater the number of electrons knocked off the in-
sulating layer. Consequently, in the 'Read' mode, more electrons can pass
through the insulator and therefore write a brighter trace on the phosphor.
Thus, the brightness of the display can be made proportional to the strength
of the original writing voltage signal. In this device, an image containing a
scale of greys is possible.
Appendix I
TV MONITOR
The central component in a TV monitor is the picture or display tube. This

is illustrated in figure 1.1. It is basically a specially shaped cathode-ray tube
in which the face or screen is as large as possible. The wide part of the tube
is called the bowl while the narrow part is the neck. The deflection angle or
angle of divergence of the bowl in a normal 'full performance' tube is 110°.
The electron beam is formed and focussed in the electron gun and is
accelerated to the phosphor screen by the second, and final, anodes at high
positive voltages, 16--20 kV with respect to the cathode. The phosphor is
chosen to have a short time constant and a spectral or colour range output
to suit the viewing or photography use of the display.
NECK
ELECTRON
GUN
Figure 1.1 The basic construction of a television viewing tube
The magnitude of the electron current which determines the brightness of

the spot written on the screen, is set by relatively slight variations of voltage
of a control grid within the electron gun.
The deflection of the electron beam within TV monitors is usually by
electromagnetic coils-not by electrostatic plates as in many oscilloscopes.
There is a Y - or vertical- deflection coil and an X - or horizontal- de-
flection coil. These coils are mounted outside the tube, where the neck joins
the bowl.
The orderly sequence of the electron beam deflection, the so-cal1ed raster
scanning action , is illustrated in figure 1.2. The point of impact of the
electron beam with the screen, the bright spot, starts at the top left-hand
corner (as viewed from the front). As the spot is slowly deflected vertical1y
downwards by means of a slowly rising ramp current drive to the Y-coil, it
is simultaneously deflected horizontal1y to the right , by means of a more
rapidly-rising ramp current drive to the X-coil. As the spot thus describes a
line across the screen, the Z - or brightness - modulation signal increases or
decreases the luminance of the writing spot, in keeping with the image
information for that slice of the picture.
When the spot reaches the right-hand side of the picture the horizontal
deflection current abruptly drops to zero, the spot quickly flicks back to the
left-hand side of the picture to resume its smooth progress from left to right
along a second line. During the line fly-back shown in dotted lines in figure
I.2, the brightness is reduced below the visible so that no writing then occurs.
Continuing with this raster scanning action down to the bottom of the
picture or frame, there is produced on the screen a pattern of almost hori-
zontal writing lines and the brightness of the spot registered at each location
in the two dimensions is determined by the image information. In the normal
use of television, this image information comes from a camera but in ultra-
sound displays it comes from a scan converter.
~ -.-.:;....... -
-.: . . . - 3- ( -
.. - - --
----:3_ _...:._
- - - ',,-- -- -.......... . -. ..
...
,
... ~ "',
(a) (b)
Figure 1.2 The raster scanning action of the electron beam in a TV viewing tube . (a)
A simple sequential raster scan. (b) An interlaced raster scan
The image information signal which controls the brightness or luminance

of the display at each point along each line is cal1ed the video signal and
consists of a voltage which varies during the period of each line as indicated
in figure I.3(a). The signal information is contained between the 30% and
100% levels of the overall video signal , with the maximum or 100% level
producing the maximum brightness (white) on the screen, and the 30% level
producing the minimum brightness (black) level on the screen. Just before
this picture information there is a brief pulse which is called the line syn-
chronisation pulse which acts to trigger the line ramp current drive . Levels
of video signal between the 30% and the 100% levels produce the various
shades of grey.
When the bright spot reaches the bottom right-hand corner of the screen
APPENDIX G: CATHODE-RAY OSCILLOSCOPE 217
E E
······WHITE·········
~) (W
t t
Figure 1.3 The video voltage signal for one line of a raster scan in (a) a white-on-black
display and (b) a black-on-white display
it must be returned to the top left-hand corner, i.e. there must be a frame
fly-back at that juncture. During this fly-back also, writing must be sup-
pressed.
In practical high-resolution systems an interleaved, or interlaced, raster
scanning system is used as shown in figure I.2(b). In this type of scan an
initial frame is written with the lines more widely spaced and then during the
second half of the frame write period, the lines in between the first set are
written.
In most European countries each single partial pass through the field, or
frame, is repeated fifty times each second and, so, the complete interlaced
scan is repeated 25 times each second. In the European standard the inter-
laced scan has 625 lines. From this it can be seen that each second some
15625 lines are written or, as shown in figure 1.3, each line takes 64 flS. In
American systems, interlaced frames of 525 lines are repeated 30 times each
second.
When the bright-up pulse reaches the bottom right-hand corner of the
screen, the vertical deflection current drive drops to zero. The video signal
possesses coded frame synchronisation pulses which signal to the vertical or
frame drive to initiate a new frame from the top. Normally, the synchronisa-
tion signals are generated in the television camera electronics and the video,
or picture information, is generated by having the scene to be imaged pro-
duce a pattern of brightnesses in the light-sensitive surface in the camera. In
the ultrasound system all of these signals are generated in the scan converter,
the synchronisation pulses in the electronics and the video or picture signal
from the ultrasound image pattern stored in the memory.
The video signal of figure I.3(a) produces a white/grey image on a black
background. The inverted version of the same image consisting of black/grey
on a white background may be produced with an 'inverted video' signal such
as that of figure I.3(b). Inversion of the video signal may be readily achieved
electronically, for instance by using an inverting amplifier.
Appendix J
ANALOGUE SCAN CONVERTERS
An analogue scan converter is a device which stores the B-mode ultrasound

picture in the form of a two-dimensional array of continuously variable
levels of electrical voltage or charge . The device accepts the picture data in a
manner similar to the storage oscilloscope , while the beam from the trans-
ducer is swept through the tissues (see figure 1.1). It is capable of retaining
the amplitude variation information (destined to determine the luminance)
in the form of an analogue or continuously variable signal such as the amount
of electrical charge stored in each location of the two-dimensional storage or
memory surface . The stored image can be electronically read and presented
in a raster format to a TV monitor, as indicated in figure 1.1.
Broadly, there are two classes of such devices, the single-ended types in
which the reading/ picture-presentation mode cannot be done simultaneously
with the writing/ storage mode , and the double-gun types which allow reading
and writing to be done simultaneously.
Both of these types are basically non-viewing cathode-ray tubes with
many of the features of the tubes described in Appendixes G and H.
~ - ... . . - ~ . - . -
PUT OUTPUT
Figure J.t The data build-up on the scan converter storage screen (INPUT) occurs in
the fairly random fashion in which they are acquired during the scanning action of the
ultrasound probe. The read-out of the data (OUTPUT) is achieved in an orderly
raster pattern
APPENDIX J: ANALOGUE SCAN CONVERTERS 219
(a) Single-ended Scan Converter
Figure J .2 is a schematic diagram of a single-ended scan converter tube. It

is an evacuated vessel with an electron gun and deflection plates . What is
novel about it is the storage assembly. There is no phosphor screen for direct
viewing , only a final anode which is at high positive voltage relative to the
cathode. Interposed between the anode and the rest of the tube is the target
storage surface and the so-called collector electrode.
lSTORAGE SCREEN
0 :
b :
Do
b :
0 :
b :
b :
b :
b :
b :
b :
~b :\:~
0 :
"-
COLLECTOR GRI D
Figure J.2 The main features of a non-viewing analogue scan converter
There are a number of types of storage surface, and a commonly used one
is the barrier grid . This consists of a thin metal backing electrode coated
with a thin layer, in the form of a mosaic of small capacitor elements, of a
dielectric material. This is illustrated in figure J.3 . There can be up to 1000
by 1000 of these elements in the complete storage screen . Finally, there is a
metal grid interposed between the screen and the electron gun , the so-called
collector grid.
When the electron beam strikes the target , secondary electrons are knocked
0: DODD
tJ t DODD
O[ DODD
oi DO
(a)
0: (b)
o
~\ (.10kV)
TA~GET (.5V)
COLLECTOR (.120V)
Figure J.3 The details of the region near the storage screen of an analogue scan con-
verter, showing the final anode, the target or storage screen and the collector grid. The
actual storage screen is a two-dimensional array of elemental capacitors as in (b)
off the target. The voltage on the collector grid controls this secondary
emission as indicated in figure J.4. At low values of this voltage fewer
electrons are emitted than strike the target and so this becomes negatively
charged. At the critical voltage, there is no net storage of charge. At still
higher collector voltages, there are more electrons emitted than are incident
and so the target becomes positively charged. Furthermore over a range of
collector grid voltages, the amount of charge is approximately proportional
to the change in the grid voltage above Ec.
COLLECTOR
VOLTAGE
Figure J.4 The effect of the collector grid voltage on the production of secondary
electrons. R, the vertical ordinate, is the ratio of the number of electrons emitted by the
target to the number of electrons incident upon it
Initially, the electron beam is raster scanned over the target with the
screen voltage held below the critical voltage value. An even distribution of
charge is spread on all of the little capacitors making up the storage target.
For writing/storage, the screen voltage is raised above the critical voltage
so that when the electron beam strikes the surface, there is net emission. As
the writing electron beam moves over the surface, depending upon the
collector grid voltage (controlled now by the echo signal voltage), more or
less secondary emission happens and more or less positive charge is stored
on the elemental capacitors. The orientation of the writing line or vector on
the storage surface is controlled by the orientation of the probe which pro-
duces X and Y deflection signals for the scan converter. Consequently, the
pattern of stored charge is an analogue representation of the pattern of strong
and weak echoes produced as the ultrasound beam scans through the cross-
section of the tissues.
For reading/presenting the stored pattern for viewing on the TV monitor
the grid voltage is reduced to the critical value. The electron beam is raster
scanned over the storage target, and depending upon the charge stored on
the different elemental capacitors, more or less secondary electrons are
emitted to form the current through to the collector grid. Therefore, the
collector current depends directly on the charge stored on the screen and so
constitutes a video signal which can be used to produce the image on the TV
monitor.
APPENDIX J: ANALOGUE SCAN CONVERTERS 221
The single-ended scan converter can be used in one mode at a time and is
therefore suitable only for static B-mode scans. Even for these, it is not
totally satisfactory in that it takes some seconds to acquire a scan, and it is
desirable and necessary to view the scan as it is being acquired. But this scan
converter is not capable of performing in this way. Usually, a compromise
is used. What is done is to electronically switch between writing and reading
for equal intervals some ten times each frame. What results is a venetian
blind effect which allows a rough viewing of the image as it is being con-
structed. Thus, when the operator is doing the scanning, the scan converter
operates in this dual mode. When the operator is not moving the transducer
it operates in the read/view mode only.
There is one further mode of operation in the scan converter, the erase
mode, in which an even distribution of charge is established on all the
elemental capacitors. Erasing is achieved by setting the grid voltage below
the critical voltage and allowing the electron beam to raster scan over the
screen. Under these conditions the secondary emission of electrons is less
than the number of incident electrons and the capacitors charge up to a
steady voltage. The target is then essentially a tablet ready to receive another
array of charges, the analogues of the luminance pattern of the image.
(b) Double-ended Scan Converter
Figure J.5 is an illustration of a double-ended scan converter tube. It is very

much like two of the tubes of figure J.2 butt-joined together. However, in
this tube there is only one storage target, one of the tubes acts in the read
mode only while the second side acts in the write/store mode only. The
storage screen can be a barrier grid as described previously or any of a
number of other modes of charge storage. The important point about this
type of tube however, is that the reading and writing can occur simultane-
ously. Such a scan converter tube is suitable for static B-mode imaging and
even more importantly, for dynamic (real-time) scanning. There is no
venetian blind effect.
Erasing can be done with the writing electron gun in exactly the same
c:: 0== ==D~

READ GUN WRITE GUN
& DEFlEClDRS & DEFLECTORS
READ
COLLECTOR COLLECTOR
Figure J.S The basic structure of a double-ended analogue scan converter
fashion as for the single-ended device. The position of the writing vector is
controlled by the beam orientation. The locations where charges must be
stored are set by the pulse echo information while the amplitudes of the
echo signals determine the amounts of charge stored. The reading electron
beam is raster scanned over the target to generate the video signals for the
TV monitor.
Appendix K
DIGITAL COMPUTERS
A digital computer is an electronic device which has the general schematic

arrangement shown in figure K.1. The computer is capable of performing a
number of elementary arithmetical tasks on numbers--addition, subtrac-
tion, multiplication, division, comparison. It can do these operations very
rapidly. But it will only do them as instructed by the operator, who controls
the sequence of operations of the computer and the kinds of operations, by
means of a programme.
The computer is also capable of storing or memorising large series of
numbers, letters and words. and of recalling any of these on command. It
CONTROL
UNIT
INPUT !-------.,t>I
OUTPUT
DEVICE DEVICE
ARITHMETIC
UNIT
Figure K.l The basic organisational and functional blocks of a digital computer
showing the interconnections between them
does this task by pigeon-holing the numbers/letters in specific addressed

locations in its memory. The contents of any address can be examined or
added to or replaced any time the operator requires.
As well as the computer being programmable by the operator, and the
programme is usually first installed in the memory of the control unit of the
computer, the computer also has permanently in this memory many in-
ternal rules or control instructions which help to expedite the operation of

any programme.
To communicate with the computer there must be some input device(s)-
a teletypewriter, a paper tape reader, a punch card reader, a magnetic tape
or disc reader, an analogue-digital converter, etc. By means of such devices
the programme is inserted into the computer and the data or numbers on
which the programme is to operate are also inserted. There must also be an
output device with which the computer communicates its results with the
outside world. Many of the same types of devices that act as input devices
also act as output units. Oscilloscopes and TV monitors act as visual display
units (VDU) for this task. If the output is needed in analogue or continuous
form a digital-analogue converter is needed. With such an output device an
oscilloscope or paper chart recorder may be the final stage in the output.
Digital computers do not work in decimal arithmetic based on 10, but in
binary numbers, i.e. numbers to the base 2. Table K.1 shows the correspond-
ence between some of the decimal numbers and binary numbers.
In the binary scale only O's and 1's are used. The larger the decimal number
the more binary digits or bits are needed to represent it. Indeed at every
decimal number 2n , the number of binary digits rises by one to n + 1. When
numbers are inserted into the computer they must be coded into binary and
then at the output they must be decoded back into decimal numbers.
The process of analogue to digital conversion is of particular interest. In
this process an analogue or continuous signal, such as a time-varying voltage,
is sampled at regular intervals and the amplitude at the end of each interval
is measured and expressed as a number or quantised. Figure K.2 illustrates
the process. Sampling is a major step in this conversion. It is necessary that
the sampling be done often enough to obtain good representation of the
analogue signal. After conversion, the analogue signal is changed into a
sequence of numbers, binary numbers, stored in the memory of the computer.
The wider the range of signal amplitudes to be quantised, the more binary
digits or bits are needed to completely cover the range. Also, since the
binary numbers only increment in whole number units, the quantisation can
only be to the nearest whole number so that there results a possible quantisa-
tion error of ± half of one binary digit value.
Digital to analogue conversion consists of the electronic generation of the
envelope of the amplitudes of the sampled numbers strung out in orderly
sequence and separated from each other by the sampling interval. This
process is shown in figure K.3.
The memory devices in computers which can store data and from which
the data from specific memory locations or pigeon-holes can be readily
and rapidly recalled are commonly called random access memories (RAM).
The other form of memory device which is used to store computer rules and
permanent programming elements are called recall only memories (ROM).
The portions of programmes stored in ROM's cannot be altered after they
have been installed in them.
APPENDIX K: DIGITAL COMPUTERS 225
Table K.l Corresponding Representations of Numbers in Decimal and Binary
Decimal Binary
o o
1 1
2 10
3 11
4 100
5 101
6 110
7 111
8 1000
9 1001
10 1010
11 1011
12 1100
13 1101
14 1110
15 1111
16 10000
17 10001
18 10010
19 10011
20 10100
21 10101
22 10110
23 10111
24 11000
25 11001
26 11010
27 11011
28 11100
29 11101
30 11110
31 11111
32 100000
33 100001
t l Least significant bit

Most significant bit
(a)
(b) III I III III IIII IIIIII

t
E
t
(c)
(d) 0.12,25,35,22,30,35,18,-17, -20, -9, -7, -10,0,

12,15,3, -6, -5, -1
Figure K.2 (a) A time-varying analogue voltage signal. (b) The sampling intervals of
the analogue-to-digital (A-D) converter. (c) The sampled and quantised version of the
analogue signal in (a). (d) The digitised version of the signals in (c) and (a), as produced
by the A-D converter
Figure K.3 Comparison of the analogue and quantised digital versions of a voltage
signal
Appendix L
DIGITAL SCAN CONVERTER
The central component in a digital scan converter is a digital memory which

stores the picture data. The cross-section through the body defined by the
ultrasound beam scan is to be mapped on to the image plane shown in
figure L.l through the intermediate stage of the memory. To facilitate this
mapping, the picture is divided into picture elements-pixels-with a typical
frame consisting of 512 x 512 such pixels. Each of these pixels is alloted a
MAPPING
~:
y X
xx .XIX x~
IXIX
X
X
IX
IX
XIX IX IX ,IX IX
iXiX
CROSS-SECTION IMAGE PLANE

OF BODY
Figure L.t The process of mapping data about a cross-section of the tissues into pixel
addresses in an image memory plane
unique address in the memory into which a number representing the ampli-
tude of the echo from the corresponding tissue location can be stored. This
number will also determine the luminance of the corresponding pixel in the
image. The more binary bits can be fitted into the address the wider the
dynamic range of the converter. Thus, 2 bits would accommodate 6 dB, 3
bits 9 dB, 4 bits 12 dB, 5 bits 15 dB, 6 bits 18 dB, 7 bits 21 dB, 8 bits 24 dB,
9 bits 27 dB and 10 bits 30 dB.
The scan converter must also be equipped with means of getting the
appropriate data into the correct addresses and of reading the data out and
converting them into analogue video signals for viewing on a TV monitor.
Figure L.2 is an overall scheme for achieving these tasks.
On the input or storing side, the A-mode echoes from a given beam orienta-
tion are sampled, digitised and held temporarily in a buffer memory. Simul-
taneously the set of memory addresses for that beam orientation must be
PROBE
COORDINATE
SIGNALS
TX
MASTER
CLOCK
TV
Figure L.2 The main functional elements in a digital scan converter
worked out from the transducer position and orientation measurement

devices. Then the sequence of binary numbers representing that A-mode
echo train are stored, as indicated in figure L.3 (a) and (b), in the set or so-
called vector of memory locations.
On the output or reading side of the scan converter, the binary numbers
in the memory are read non-destructively, row by row, with each row being
temporarily held in a buffer before passing into a digital to analogue con-
verter. This latter component generates line video signals to drive the TV
monitor. The order of sampling the rows, the generation of the line syn-
chronisation pulses and frame synchronisation pulses is controlled by a
master clock electronic timer.
APPENDIX L: DIGITAL SCAN CONVERTER 229
11 1,2 1,3 1,4 1,5 If: ~

2 t 121 12.3 21 ~
31 32 3YJ
41 .:t
~
lJ.\i
I~
1/
(a)
(b)
1,6 2,6 3,5 ',5 5,5 6,' 7,' t (or U
Figure L.3 The assignment of quantised and digitised data from the echo train in an
A-mode scan, to memory locations appropriate to the probe vector and hence to pixels
in the image plane
The processes of reading and writing in the memory are not interactive
and can be done simultaneously. This scan converter is suitable therefore
for dynamic as well as static B-mode scanning.
However , to achieve a dynamic range even comparable to an analogue
scan converter - 6 bits and 512 x 512 pixels ~ .. requires some 1.6 million bits or
locations of memory, a large memory , and can consequently be expensive.
Among the special advantages of the digital scan converter are the possi-
bilities of digital processing of the signals either before the memory (pre-
processing) or after the memory and before display (post-processing). These
are capabilities that have not been much exploited as yet but some of the
potential processing steps are listed in figure LA. Among the pre-processing
steps possible are some now done in instruments by analogue methods -
setting suppressor and limiter levels, setting the time gain compensation
_. and some not now done such as corrections for the different sensitivities
of transducer with different focussing, or compensation for the possible
non-linear amplifier gain. Many of these processes could be done auto-
matically as determined by the operator through computer programmes.
Altl1Jth
(a)
Aldl DJJ
z
(b)
z
(C)
Ah n I!hTGC
llltr1--I--l1
ALt-LhJ1h
z
Ahi1Jtb
(d)
z
(e)
z
Figure L.4 A simplified representation of the preprocessing steps possible in a digital
scan converter. The quantised A-mode signal is shown in (a). The application of
suppression ofiow amplitude signals and ofiimiting or peak clipping of high amplitude
signals is indicated in (b). Implementing a given TGC is shown in (c). Modification of
the sensitivity to COrrect for beam focussing might result in the quantised signal of (d).
Removal of the effects of analogue TGC and correction for the different sensitivities
along the beam may result in the true amplitudes shown in (e)
Post-processing refers to the mUltiplicity of analyses and image modifica-

tions which can be implemented on the digitally swred image information in
the computer.
A keyboard allows access to the computer to insert programme instructions
and to cause alphanumeric inscriptions such as patient data and details of
the examination, to be written on the display. A so-called 'light pen' allows
the operator to mark landmark points and even lines or boundaries on the
displayed image. The computer can readily compute distances between
pairs of such marked points, lengths of curved marked lines and areas en-
closed by marked boundaries.
Programmes can also be written to modify the display. Multiplication of
each stored number in the memory by a constant can expand or contract the
APPENDIX L: DIGITAL SCAN CONVERTER 231
grey scale. Thus, the effective gamma of the display can be chosen to match
the photographic film or to match the human vision.
Various spatial operations can also be implemented on the displayed
image by numerical manipulations on the data on the memory. Zooming--
magnifying or minifying a portion of the picture can be achieved by
assigning numbers to larger or smaller groups of pixel addresses in the
output buffer memory. Picture inversion from black on white to white on
black requires a subtraction operation on all pixel data. Any pixels which
may be empty due to an artifact while all surrounding pixels contain picture
information, may be filled with a number which is the average of the numbers
in the surrounding pixels.
Abrupt increases in image luminance can be smoothed out by averaging
the numbers stored in the adjacent pixel addresses. Likewise, increases or
decreases in luminances, stored as increasingly greater or smaller numbers in
the relevant memory locations, can be detected and enhanced. In this way
boundaries may be detected and highlighted. Furthermore the length of
such boundaries and the areas included within them may be computed.
Many of the procedures suggested in section 10.10 for tissue characterisa-
tion may also be implemented on the digital intermediate or stored image.
Index
abdomen I, 5, 105 cage, Faraday 33

absorption 12, 23, 25, 185 caliper 51,63,71
adaptation camera 97,139,145,146
dark 141,155 carcinoma 171
light 155 cardiology I, 79, 80
amplifiers cavitation 186, 187
receiver (rf) 55, 56, 61, 76, 85, 112, cells, red blood 187
113, 123, 124, 129, 133 characterisation, tissue 177, 231
summing (mixing) 114, 116 circuit, integrated 208
analyser, frequency 123, 125, 127, 134 clipping, peak- see limiter
aneurysm 131 coefficient, attenuation 25~28, 56, 181
aorta 118 compensation, time gain see TGC
arrays compressibility 15, 16
concentric 173, 174 compression 14, 15
multi-element 29, 43, 44, 108, computer 163, 223~225, 228~231
IIO~113, 116, 118, 165~167, 173, contours, iso-echo 49, 70, 71
175 contrast 97,140,141,157,161,175
phased 115, 117 converters
artifacts analogue to digital 206, 226, 228
incomplete trace 79 digital to analogue 206, 226, 228
multiple path 66, 99 co-ordinates
patient movement 101, 106 Cartesian 87, 88
refraction 66, 67, 99, In polar 87,88
reverberation see reverberation probe 84,85,93,118,167
transmission 54, 58 coupling, acoustic 68,69, 104, 105, 135,
aspiration 105, In, 173 175
attenuation 12, 24-26, 168, 169 crystals
attenuator, transmitter 59, 64, 102 liquid 29, 46, 47
piezoelectric 30, 39, 40, 43--45, 48,
balance, radiation 29,46,47,49,185 55,61,97,98
bats 53 current 41, 202~205
beam 29, 35, 191 curve, characteristic 150, 151, 153, 156
guidance 113~ 116 cycle 15
bioeffects 187
biopsy 105
bladder 166 damping 29,34,35,41,43,45,63, 123,
gall 105, 118 133,200
blood flow 1,2,5, 129, 131, 137, 177, decay, exponential 25, 26, 194
187 decibel (dB) 12, 18, 26, 59, 60, 92, 145,
breast I, 4, 104, 164, 170-171 157, 161
brightness see brilliance delay 57, 60, 133, 136
brilliance 63, 97, 175 demodulator 55, 57, 62, 75, 76, 85, 93,
see also luminance 112, 113, 133,206
234 INDEX
density 15, 16, 185 forces

optical 149,152,178, 179 Bernoulli 186
detectors 29-31, 44 Oseen 186
quadrature-phase 128 radiation 46, 185, 186
zero-cross 125-127, 131, 134, 135, Stokes 186
162 frame, freeze- 110, 117, 161
developing 147-149, 151-153 frequency 27, 28, 34-38, 41, 102, 121,
diode 206 122,204
discriminator 123-125, 129, 133, 162 pulse repetition 40, 55, 59-61, 112,
DNA 187 133, 192
dolphins 53 resonant 32
dosimetry 191 spatial 143, 144
friction 24, 198-201
function, modulation transfer 139, 142,
144
earphone 125, 130, 134
echoencephalography 69
echo location 53 gain, swept see TGC
echo-ranging 51, 52, 56 see also factors, amplification
effects gamma 150, 151,231
Doppler 120--122 gate 41, 133
ill 184, 190, 191 range 132-134
piezoelectric 29, 30 generator, pulse 56, 76, 93, 113
electrocardiogram (ECG) 77, 78, 81 grid, barrier 219
emulsion 147 gynaecology 1
energy
kinetic 197-199
mechanical 13, 17, 197 heart I, 69, 74, 79, 80, 118, 130, 138,
potential 197-199 192
enhancement, image or echo 99 heat 24, 198-201
epidemiology 184, 190 housing, probe 33, 43, 47
exposure 146, 156, 158 hydrophone 48
eye 140, 170, 171, 192
image, bistable 83,90--92, 156,214

factors image labelling 83, 88, 89
amplification 56, 206, 207 imaging, incomplete 101
scale 97,111,142 impedance, acoustic 12, 16, 19,20, 34,
fatigue 186 141
fields incidence, angle of 20, 21, 121, 122
far 29, 37, 43, 98, 117 index, pulsatility 131
near 29, 37,42,43,98, 112 intensity 12, 17, 18, 29, 45, 48, 49, 59,
film 109, 117, 139, 141, 145, 147, 149, 171,175,185,186,188-191
151, 157 intensity level 18, 26 (see also decibel)
filter 128, 206 iodine blue 46
fixing 149 isolator 43
f-number 146, 156, 157
focussing 22,29, 38, 39,44,47,98,99 kidney 5, 91, 95, 105, 118
102, 108, 113, 114, 116, 117, 167
173
internal 39, 44 latitude, exposure 150, 151
foetus 5,69, 118, 130, 188, 190, 191 laws
fog, basic 150, 151 Ohm's 202, 204, 205
fogging, post- 156 Snell's 21
INDEX 235
lens 38 phantom 164, 179, 192
light 140 phonocardiogram (peG) 79, 81
ultraviolet 78, 140, 160 photography, time-exposure 92
limiter 60,61,65, 102,229,230 piezoelectricity 30
line, delay 114-116 see also effects, piezoelectric
liver 3, 5,91, 100, 105, 118, 187 pixel 95,96, 168, 169,227-229,231
lobes planes
main 38 coronal 90
side 37,38 longitudinal (sagittal) 89
see also fields, far scan 95
loop, phase-locked 127 transverse 89
loudspeaker 123, 125, 130, 134 platelet 187
luminance 63, 140, 143, 146, 148, 149, Polaroid 69, 78, 153-155, 158
152, 155, 158, 175, 178, 212, 214, power 17, 198,203-205
216,217,231 pressure, acoustic 15, 16,45, 185
print, positive 139, 151
matching, quarter-wavelength 34, 45, probe, transducer 33,45,47,52,55,61,
47, 123 76,84,85,87,88,93, 102, 110, 123,
129, 133, 135, 165-167, 173, 176,
materials
ferroelectric 31, 39 182
process, xiphoid 89
piezoelectric 31
processing
memory 95, 102, 160, 161, 223, 224,
227-229 post- 229, 230
pre- 229, 230
random access (RAM) 161, 224
profile, beam 48, 49
read only (ROM) 224
meter, frequency 129, 130 prostate 166
pulse duration (width) 29, 41, 42, 63,
microstreaming 186
191
monitor, TV 93, 96, 108, 112, 113, 117,
139, 141, 145, 157, 158, 161,
215-218 radionuclide 1, 2
muscle 188 range, dynamic 60, 61, 70, 118, 145,
150,153,154,157,179,227,229
rarefaction 14, 15
neck 170 raster 157,216-218,222
neurology rays, gamma 140
notch, sternal 89 record
paper chart 140, 162
obstetrics 1 photographic 69, 83, 101, 102, 117
ophthalmology 1, 69 recorders
optics, fibre 78, 158, 159 magnetic disc 160, 161
oscillator 123, 124, 129, 133 video tape 117,160,161
oscilloscopes reflection 12, 19,24, 25, 46, 52,90, 185
cathode-ray 54, 63, 69, 75, 78, 84, 90, angle 20,21
92, 96, 108, 113, 117, 139, 140, coefficient 19,20,90
145, 154-159,209-214 refraction 12, 19,20,66,67, 172
storage 78,88, 165,213,214,218 angle 21
output, spectral 154 registration, electronic 101, 102, 104,
118
reject
paper, photographic 77, 151-154 see suppressor
parenchyma 90, 178 relaxation 24, 185
pattern recognition 177 resolution
pen, light 230 axial 51,63,64, 72, 83, 118
period 13, 203 lateral 65,83,97-99,102,117,118
236 INDEX
resonance 32, 35, 45 TGC (time gain compensation) 55-57

half-wavelength 29, 33 59, 60, 68, 70, 71, 76, 85, 93, 96:
response, spectral 154 ISS 100-102, 104, 112, 113, 124, 172,
retina 140,171,192 ' 175, 229, 230
reverberation 65, 71, 99, 100, 104 thermistor 45
reversibility 185 thermocouple 45
thermometer 29
thickness, half-value 25
threshold 187
scale, grey 77,92,93,95, 128, 140 157
177 ' , thyroid 1. 4, 104, i72
time, transit 132
scan converters
tomography
analogue 83,92,93,216,218-222
attenuation 168, 169
digital 83,95,96,112,113,117,136,
time-of-flight 168-170
142, 145, 157, 179, 182,227-231
transmission 164, 168-170
scanner, duplex 164, 176, 177
transceiver 52, 55, 110
scanning transducer 29,32-35,38,43--45,47--49,
automatic 167, 174-176 109, 110, 121, 123, 124, 164, 172,
compound 83, 85-87, 172
173, 175, 182
contact 68, 83, 104 transfer, diffusion 153
linear 83, 85, 86, 172
transform, fast Fourier 128
sector 83, 85, 86, 108, 115, 116, 165
transistor 206, 207
water-path 104, 105 transmission angle 21
scattering 12, 23-25, 177, 178 transmission coefficient 20
semiconductor 206
sensitivity 44, 45, 49, 51, 65, 71, 90, 118
shadowing 67,99, 100 ultrasound 15, 17
shift, Doppler 121, 122, 124-127 134
135 ' , umbilicus 89
sidelobe see lobes, side
signal processing 75, 76, 125, 126, 128,
vibration 199, 200
166, 175, 182 vibrator, electromagnetic 79, 80
signal video 158-161, 217, 220, 228 viscosity 185, 186
solenoid 203 voltage 30-35, 40--42, 44, 45, 125,
sound 12, 122 202-207, 209-214, 219, 220
speed
offilm 151,154
of propagation 12,15-17,20,51-53,
water bath 104,105,171,172,175
66,67, 172, 180
waves 12,45, 185
average 53, 54, 62
longitudinal 14
spleen 118
transverse 14
starch 46 wavelength 15-17,45,121,122
stenosis 131 work 198
suppressor 60,61,65,90,102,229,230
symphysis pubis 89
x-rays 1,2,4, 140, 142, 149
tape recorder 125, 128, 162

tape recording, video 102, 108, 117, 160 zones
technique, open-shutter 157 Fraunhofer 36
temperature 46, 185,201 see also fields, far
Curie 33 Fresnel 36
test object, AlUM 71, 103 see also fields, near
testing, non-destructive 53 zoom 321

Basic Physics of Ultrasound

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BASIC PHYSICS AND TECHNOLOGY OF

MEDICAL DIAGNOSTIC ULTRASOUND

MATTHEW HUSSEY, PhD, FInstP

All rights reserved. No part of this publication

First published 1985 by

British Library Cataloguing in Publication Data

Filmset in Monophoto Times New Roman by

1 The Scope of Medical Diagnostic Ultrasound 1

1.1 Introduction and Objectives 1

2 Basic Features of Ultrasound Propagation 12

2.1 Introduction and Objectives 12

3 Generating and Detecting Ultrasound 29

3.1 Introduction and Objectives 29

3.5 Circular Ultrasound Beam 35

4 A-Mode Scanning Instruments 51

4.1 Introduction and Objectives 51

5 Motion (M-) Mode Scanning Instruments 74

5.1 Introduction and Objectives 74

6.1 Introduction and Objectives 83

7 Dynamic (Real-Time) B-Mode Scanning 108

7.1 Introduction and Objectives 108

8 Doppler Instrumentation 120

8.1 Introduction and Objectives 120

8.10 Performance Checks for Pulsed Doppler Instruments 137

9 Permanent Records of Ultrasound Examinations 139

9.1 Introduction and Objectives 139

10 Special Instruments and New Topics 164

10.1 Introduction and Objectives 164

11 Safety of Diagnostic Ultrasound 184

11.1 Introduction and Objectives 184

11.2 General Physical Effects of Ultrasound on Living Tissues 184

A: Exponential Decay 194

The applications of medical diagnostic ultrasound grow year by year. New

Dublin, 1984 M.H.

Ms Gerardine Keating, who typed the manuscript.

1.1 INTRODUCTION AND OBJECTIVES

Ultrasound now ranks as a major diagnostic tool in medicine. Its applications

1.2 BASIC FEATURES OF ULTRASOUND

The main reasons why ultrasound is becoming so popular in medical diag-

Studies may therefore be repeated as often as desired. Patients may be

1.3 RANGE OF USES OF DIAGNOSTIC ULTRASOUND

As mentioned previously ultrasound techniques have been applied through-

1.4 WHY ULTRASOUND METHODS ARE BEING

The major advantages of ultrasound diagnostic methods over alternative

1.5 AIMS AND STANDARDS OF THIS BOOK

1.6 QUANTITIES AND THEIR UNITS

Quantity Symbol Units Abbreviation

Basic Physics and Instrumentation

General Ultrasound Imaging

Carter. B. L. et aI., Cross-sectional Anatomy: Computed Tomography and Ultrasound

Fleischer, A. C. and James, A. E., Introduction to Diagnostic Sonography, John Wiley,

Applications in Obstetrics and Gynaecology

Uses in Brain Disorders

Mostafawy, A. (with Nagle, J. B.), Pediatric Sonoencephalography, Springer Verlag,

Barnett, E. and Morley, P., Abdominal Echography, Butterworths, London, 1974

Reneman, R. S. (Ed.), Cardiovascular Applications of Ultrasound, North-Holland,

Uses of Doppler Ultrasound

2.1 INTRODUCTION AND OBJECTIVES

2.2 SOUND WAVES

Sound is a mechanical disturbance in the air which is initiated by the vibra-

DIRECTION OF SOUND PROPAGATION (z)

<1-0-1> <1-0-1> <1-0-1> <1-0-1> <1-0-1>

to the beginning of the next compression. In reality, there is a smooth

Sound or ultrasound travels through a medium at a constant speed, the