DR.

SHAMIM RIMA
MBBS,DMU,FCGP
M.PHIL
RADIOLOGY & IMAGING
BSMMU.
 US Beam

Figure :  Diagram of an ultrasound beam. The main ultrasound beam narrows as it

approaches the focal zone and then diverges. Grating lobes and side lobes are
forms of off-axis energy
 ARTIFACTS

An image artifact is any image attribute, which is not present in the original imaged object. An
image artifact is sometime the result of an improper operation of the imager, and in other
times a consequence of natural processes or properties of the human body. 

Artifacts in diagnostic ultrasound are a reflection   or an echo, which appears on the
display and represents the real anatomical structure not correctly.
An artifact can be a false, multiple or misleading information introduced by the imaging
system or by interaction of ultrasound with the adjacent tissue.
 Artifacts in ultrasound can be classified as to their source like e.g.:

Physiologic (motion, different sound velocities, acoustical impedances of tissue);

Hardware (dimension of the ultrasound beam and the transducer array);

Imaging technique (B-mode, Spectral Doppler , color-Doppler,  3D ultrasound).

Image artifacts can occur in each medical ultrasound. Then an interpretation of the image
is complicated and can eliminate the structural information of objects looking for.
 Technique-dependent artifacts:  Noise
An undesirable background interference or disturbance that affects image quality.
The noise is commonly characterized by the standard deviation of signal intensity in the
image of a uniform object (phantom) in the absence of  artifacts.

Overall increase in echogenicity.

Noise caused by excess gain

Resolving noise caused by excess gain
- Decrease overall gain
 Low signal

Low signal caused by inappropriate transducer selection or low gain settings

Resolving low gain artifacts:

- Increase overall gain 
- Increase far gain
- Apply more acoustic coupling gel
ARTIFACTS ASSOCIATED WITH ATTENUATION ERRORS

 Shadowing
Increased through transmission

 Shadowing
 Shadowing

Caused by sound striking a strong reflective interface example;

areas behind ribs or gall stones

Shadowing
Shadowingcorrective
correctivetechnique:
technique:
- -Scan
Scanaround
aroundobject
objectcausing
causingshadowing
shadowing
Shadowing.(a) Diagram shows the ultrasound beam encountering a strongly attenuating
material. The echoes received from points distal to this material are significantly lower in
intensity than echoes received from a similar depth. (b)Longitudinal US image of the
gallbladder shows shadowing (arrow) posterior to echogenic gallstones.
 Enhancement

Caused by sound travelling through fluid-filled structures without attenuation (example: area behind
cysts, area behind gallbladder)

Enhancement corrective technique:

- Reduce overall gain
- Decrease far gain
 Enhancement artifacts

Enhancement artifacts occur
Enhancement artifacts occur if if decreasing
decreasing ofof the echo
the echo amplitude is
amplitude is not
not equal
equal
with penetration
with penetration depth caused
depth causedbybyinhomogeneous
inhomogeneoustissue
tissuelayers
layersand
andfluids
fluidslike
likecysts
cystsoror
air-filled
air-filledregions.
regions.

The
The enhanement
enhanement artifacts appears
artifacts appears asas aa hyperintense
hyperintense (hyperechoic)
(hyperechoic) signal.
signal. The
The
attenuation
attenuation of ofthe ultrasound wave
the ultrasound waveininfluids
fluidsisismuch
muchlower
lowerasasthe attenuation
the attenuationininother
other
tissues,
tissues,therefore
thereforetissues
tissuesdistal
distaltotofluid
fluidare
areenhanced.
enhanced.Artificial enhancement may
Artificial enhancement mayalso
also
bebefound
founddistal
distaltotoaahomogeneous
homogeneoussolid
solidtumor
tumorsurrounded
surroundedbybyadipose
adiposetissue,
tissue,due
duetotothe
the
comparatively
comparativelyhigh attenuation
high attenuationininfatfat
Figure:  Increased
Figure:  Increasedthrough
throughtransmission. (a)Diagram
transmission. (a)Diagramshows
showsthe
theultrasound
ultrasoundbeam beamencountering
encounteringaafocal
focal
weakly
weaklyattenuating
attenuatingmaterial.
material.The
Theechoes
echoesreceived
receivedfrom
frompoints
pointsdistal
distaltotothis
thismaterial
materialare
arehigher
higherinin
intensity
intensitythan
thanechoes
echoesreceived
receivedfrom
fromaasimilar
similardepth
depthininthe
theimaging
imagingplane. (b)Transverse
plane. (b)TransverseUS
USimage
imageofofthethe
liver
livershows
showshypoechoic
hypoechoicand
andweakly
weaklyattenuating
attenuatinghepatic
hepaticcysts.
cysts.The
Thehepatic
hepaticparenchyma
parenchymadistal
distaltotothe
the
cysts
cystsisisfalsely
falselydisplayed
displayedasasincreased
increasedininintensity
intensity(arrow)
(arrow)secondary
secondarytotoincreased
increasedthrough-transmission
through-transmission
artifact.
artifact.
  Reverberation

Caused by sound interfacing with two structures of markedly differing acoustic properties;
example: inadequate amount of gel, obstructing bowel gas

Reverberation
Reverberationcorrective
correctivetechnique:
technique:
- -Change angle of transducer
Change angle of transducer
- -Apply
Applymore
moregel
gel
- -Rotate
Rotatepatient
patient
 Reverberation

Reverberation occurs when sound encounters two highly reflective layers. The sound is
bounced back and forth between the two layers before traveling back. The probe will detect
a prolonged traveling time and assume a longer traveling distance and display additional
‘reverberated’ images in a deeper tissue layer
Figure.  Reverberation artifact. (a) Diagram shows ultrasound echoes being
repeatedly reflected between two highly reflective interfaces. (b) The
display shows multiple equally spaced signals extending into the deep
field. 
Transverse
TransverseUS USimage
imageobtained
obtainedover
overaapalpable
palpablemass
massininaaneonate
neonateshows
showsreverberation
reverberation
artifact
artifact(arrow). 
(arrow). 
 Longitudinal
 Longitudinal US
US image
image ofof the
the gallbladder
gallbladder shows
shows comet
comet tail
tail artifact
artifact (arrow)
(arrow) caused
caused byby
cholesterol
cholesterol crystals
crystals inin Rokitansky-Aschoff
Rokitansky-Aschoff sinuses.
sinuses. This
This finding
finding isis diagnostic
diagnostic ofof
adenomyomatosis.
adenomyomatosis.Shadowing
Shadowinggallstones
gallstonesare
arealso
alsoidentified.
identified.
 Mirror Image Artifacts

If a structure is located close to a highly reflective interface (such as the diaphragm), it is

detected and displayed in its normal position. However, the strong reflector causes
additional sound waves to bend towards the neighboring anatomy, from where they are
bounced back towards the strong reflector and return to the transducer. These sound waves
have a longer travel time and are perceived as an additional anatomic structure. The image
is duplicated on the other side of the strong reflector .
Figure
Figure.  Mirror
.  Mirrorimage
imageartifact. (a) In
artifact. (a) Inthis
thisdiagram,
diagram,the thegray
grayarrows
arrowsrepresent
representthe
theexpected
expectedreflective
reflectivepathpath
ofofthe ultrasound beam. These echoes are displayed properly. The black arrows show
the ultrasound beam. These echoes are displayed properly. The black arrows show an alternative path an alternative path
ofofthetheprimary
primaryultrasound
ultrasoundbeam.beam.InInthis thispath,
path,the
theprimary
primaryultrasound
ultrasoundbeambeamencounters
encountersthe thedeeper
deeper
reflective
reflective interface first. (b) The echoes from the deeper reflective interface take longer to return tothe
interface first. (b) The echoes from the deeper reflective interface take longer to return to the
transducer
transducerand andarearemisplaced
misplacedononthe thedisplay. (c) Longitudinal
display. (c) LongitudinalUS USimage
imageobtained
obtainedatatthe thelevel
levelofofthe
theright
right
hepatic lobe shows an echogenic lesion in the right hepatic lobe (cursors) and
hepatic lobe shows an echogenic lesion in the right hepatic lobe (cursors) and a duplicated echogenic a duplicated echogenic
lesion
lesion(arrow)
(arrow)equidistant
equidistantfrom
fromthe
thediaphragm
diaphragmoverlying
overlyingthe
theexpected
expectedlocation
locationofoflung
lungparenchyma.
parenchyma.
Mirror Image Artifacts
 Comet Tail artifacts

A comet tail artifact is similar to reverberation. It is produced by the front and back of a very strong
reflector (air bubble, BB gun pellet, suture) , createsa dense echogenic line extending through the
image.

The reverberations are spaced very narrowly and blend into a small band.
 Ring Down Artifacts

The artifact is caused by a resonance phenomenon from a collection of gas bubbles. A continuous
emission of sound occurs from the ‘resonating’ structure causing a long and uninterrupted echo. It
appears very similar to the comet tail artifact

Diagram shows the main ultrasound beam encountering a ring of bubbles with fluid trapped
centrally.  Vibrations from the pocket of fluid cause a continuous source of sound energy that is
transmitted back to the transducer for detection. The display shows a bright reflector with an echogenic
line extending posteriorly.  Left lateral decubitus US image of the gallbladder shows air and fluid in the
duodenum causing ring-down artifact (arrow).
Figure :  Ring-down artifact. (a) Diagram shows the main ultrasound beam encountering a
ring of bubbles with fluid trapped centrally. (b) Vibrations from the pocket of fluid cause a
continuous source of sound energy that is transmitted back to the transducer for
detection. (c) The display shows a bright reflector with an echogenic line extending
posteriorly.
 Side Lobe Artifacts

This artifact is caused by low energy ‘side lobes’ of the main ultrasound beam. When an echo
from such a side lobe beam becomes strong enough and returns to the receiver, it is ‘assigned’ to
the main beam and displayed at a false location. Side-lobe artifacts are usually seen in
hypoechoic or echo-free structures and appear as bright 
 Lobe Artifacts

Side lobes and grating lobes are sound waves that are created peripheral to the
main beam

Are lower energy, so generally are lost to attenuation

Provide distracting echoes when misinterpreted as being from the main beam
 Side lobes

Side lobes are multiple beams of low-amplitude ultrasound energy that project radially from the main

beam axis .

Side lobe energy is generated from the radial expansion of piezoelectric crystals and is seen primarily

in linear-array transducers

Strong reflectors present in the path of these low-energy, off-axis beams may create echoes detectable

by the transducer.

These echoes will be displayed as having originated from within the main beam in the side lobe artifact .

As with beam width artifact, this phenomenon is most likely to be recognized as extraneous echoes

present within an expected anechoic structure such as the bladder

  Refraction Artifact.
A change in velocity of the ultrasound beam as it travels through two adjacent tissues with
different density and elastic properties may produce a refraction artifact.

In refraction, nonperpendicular incident ultrasound energy encounters an interface between two

materials with different speeds of sound. When this occurs, the incident ultrasound beam
changes direction.

The degree of this change in direction is dependent

 Refraction on both the angle of the incident ultrasound
artifact.
beam and the difference in velocity between the two media. 
The ultrasound display assumes that the beam travels in a straight line and thus misplaces the
returning echoes to the side of their true location .

In clinical imaging, this artifact may be recognized in pelvic structures deep to the junction of the
rectus muscles and midline fat.

Refraction artifact may cause structures to appear wider than they actually are or may cause an
apparent duplication of structures 
Figure:  Refraction
Figure:  Refractionartifact. (a) Diagram
artifact. (a) Diagramshows showsthe
therefraction
refractionororchange
changeinindirection
directionofofthe
theobliquely
obliquely
angled
angledincident
incidentultrasound
ultrasoundbeam beamasasit ittravels
travelsbetween
betweentwo twoadjacent
adjacenttissues
tissueswith
withdifferent
differentsound
sound
propagation velocities(C1
propagationvelocities and C2
(C1and  C2).).The
Theincident
incidentultrasound
ultrasoundbeambeamwithwithrefraction
refractionencounters
encounterstwo
two
structures. (b)The
structures. (b)Theobject
objectininthe
thepath
pathofofthe
therefracted
refractedportion
portionofofthe
thebeam
beamisismisplaced
misplacedbecause
becausethe
the
processor
processorassumes
assumesaastraight
straightpath
pathofofthe
thebeam.
beam.
Figure:  Refraction
Figure:  Refractionartifact
artifact
 Edge Shadowing

The lateral edge shadow is a thin acoustic shadow that appears behind edges of

cystic structures. Sound waves encountering a cystic wall or a curved surface at a

tangential angle are scattered and refracted, leading to energy loss and the

formation of a shadow.
Figure .  Side lobe artifact. (a) Diagram shows multiple beams of off-axis side lobe ultrasound energy

encountering an object (black circle). (b) The display assumes that the echoes returning from this off-

axis object came from the main beam and misplaces and duplicates the structure.
ARTIFACTS ASSOCIATED WITH VELOCITY ERRORS

Speed Displacement Artifact

Refraction Artifact.
 Speed Displacement Artifact

When sound travels through material with a velocity significantly slower than the
assumed 1540 m/sec, the returning echo will take longer to return to the transducer.

The image processor assumes that the length of time for a single round trip of an echo is
related only to the distance traveled by the echo.

The echoes are thus displayed deeper on the image than they really are . This is referred
to as the speed displacement artifact; in clinical imaging, it is often recognized when the
ultrasound beam encounters an area of focal fat.
Figure.  Speed displacement artifact. (a)In this diagram, the gray arrows represent the expected reflected path of
the ultrasound beam. The echoes returning from the posterior wall of the depicted structure will be displayed
properly. The black arrows represent the path of an ultrasound beam that encounters an area of focal fat. The
dashed lines indicate that the sound beam travels slower in the focal fat than in the surrounding
tissue. (b) Because the round trip of this echo is longer than expected, the posterior wall is displaced deeper on
the display. (c, d) Transverse US image of the liver (c) and close-up detail image (d) show that the interface
between the liver and the diaphragm (arrow in c) is discontinuous and focally displaced (arrows in d). This
appearance may be explained by areas of focal fat within the liver.
 Slice Thickness

Remember that the image is a two dimension representation of a volume of tissue, not a true

two dimensional plane

Results in false echoes, especially in anechoic structures

Thick slices result in an inability to see objects substantially smaller than beam
Thickness
This is also referred to as elevational resolution

Generally not controllable by the user

Generally the poorest resolution in the system.
 Slice Thickness Artifacts

When the interface between a fluid-filled & soft tissue is acutely angled, the beam, which is
relatively wide (2-3mm), may strike both tissue & fluid simultaneously.
Low-level artifactual echoes will be displayed within the fluid.
 TGC Banding

Occurs when the user has not appropriately adjusted the TGC curve
 Aliasing
Occurs only in Doppler imaging
If the pulse repetition frequency is set at too fast a speed, signals return to
transducer after the transmission of next signal.
With color flow, this artifact induces specks of color at the opposite end of the
color spectrum from the rest of the color related to high-velocity areas.
If the velocity exceeds the range, it will be depicted as going the other direction
 Aliasing

Aliasing of color doppler imaging and

artefacts of color. Color image shows Reduce color gain and increase pulse
regions of aliased flow (yellow arrows).
repetition frequency.
Figure (a,b): Example of aliasing and correction of the aliasing. (a) Waveforms with aliasing,
with abrupt termination of the peak systolic and display this peaks bellow the
baseleineSonogram clear without aliasing. (b) Correction: increased the pulse repetition
frequency and adjust baseline (move down)
 Aliasing

Can
Cancontrol
controlaliasing
aliasingbybyincreasing
increasingPRF
PRFororchanging
changingbaseline
baseline
It’s
It’simportant
importanttotocorrect
correctininpulse
pulseDoppler
Dopplersosoaccurate
accuratemeasurements
measurementscan
canbebemade
made
It’s
It’simportant
importanttotocorrect
correctinincolor
colorDoppler
Dopplerbecause
becauseit itisiseasily
easilymistaken
mistakenforforturbulence
turbulence
 Poor Angle For Color

As with pulsed Doppler, the best visualization of a vessel is a with the transducer at an
angle of less than 600 to the vessel.
If a 900 angle is used. Flow within vessels will be poorly seen.
Figure : Effect of high vessel/beam angles. (a) and (b) A scan of fetal aortic flow is undertaken at a high
beam/vessel angle. Beam/flow angles should be kept to to 60° or less. A hudge discrepancy is observed when
use unapropiate angles > 60°. If absolute velocities are to be measured, beam/flow angles should be kept to 60°
or less.
 ADVERSE BIOLOGICAL EFFECTS OF ULTRASOUND ON BODY TISSUES

There are several known effects of ultrasound on tissues, but at the low doses used in diagnostic
imaging these are not thought to create any adverse effect. At higher therapeutic doses the effects
are used to influence tissues.

The various effects of ultrasound can be categorised into three main types :

Mechanical - no adverse effect on cell structure or chromosomes have been reported

Vibration of tissues 
Forms small cavities in fluids during "suction" phase which disperse during the
"pressure" phase
This phenomenon is called cavitation in gas-free fluids, and pseudocavitation in
fluids containing gas
Vibration associated with high intensities of ultrasound result in heat production
ADVERSE BIOLOGICAL EFFECTS OF ULTRASOUND ON BODY TISSUES

Heat   
At usual frequencies and intensities the heat produced by ultrasound is dispersed by
the local blood circulation
High intensity ultrasound is used to induce local hyperthermia for therapeutic purposes

Chemical 

Depolymerisation - experimentally ultrasound can breakdown polysaccharides and

polypeptides including DNA. These effects have not been reported to occur in vivo
following diagnostic ultrasound procedures.
Oxidation
Reduction
ADVERSE BIOLOGICAL EFFECTS OF ULTRASOUND ON BODY TISSUES

High intensity, high frequency ultrasound has been shown to result in adverse effects
including :

Tissue necrosis
Chromosomal damage
Genetic mutations
Teratogenic changes

So far these adverse effects have not been reported following diagnostic
ultrasonography but safety limits to minimise potential risks have been set as follows

Intensities over 100mW/cm2 (spatial peak/temporal average) should only be applied

for a few seconds/minutes.
For human use 10 mW/cm2 is approved for commercial 2-D ultrasound.