The question confused me is how can we measure the velocity of sound in

the tissues. Whether the ultrasound technology is harmful to human

beings or it have some side effects?
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Hi!
Speed of sound
Thanks for your questions. As you may know from the tutorials, the speed of
sound in tissue is determined by its density and stiffness. Low density and high
stiffness lead to high speed of sound whereas high density and low stiffness lead
to low speed of sound. Mathematically you can calculate the speed of sound by
knowing the physical values of the tissue and solving:

Sound speed

Tissue stiffness
Tissue density

However, ultrasound systems are designed to assume an average speed of

sound in soft tissues of 1540m s-1 . In reality true soft tissue velocities vary
slightly by approximately 5%. This might create certain image distortion artifacts
if the average speed of an organ is not 1540m s -1 . However, as long as the
referential velocity is the same in all other patients there will be no error of
interpretation between patients.
Safety
First of all it is important to know that among all imaging techniques ultrasound
(US) has a privileged record for safety. Hence this imaging modality has been
used widely for almost four decades in health centres all around the world.
Numerous studies have been published investigating the possible association
between ultrasound exposure and the occurrence of disease in human
populations. These studies have been particularly dedicated to determine
whether the use ultrasound is safe in susceptible population. (e.g. in utero,
newborn and during childhood development).
The findings revealed that:
1. There is no evidence to suggest an association between exposure to
ultrasound and birth weight.
2. No association with childhood malignancy has been found in any study
after US exposure.
3. A vast number of neurological function have been clinically assessed and
so far NO association between US exposure in utero and subsequent
visual, hearing, behavioural or cognitive impairment has been found.
To sum up, there is no verified evidence to suggest that US exposure in utero
has caused an alteration of growth and natural development (1)(2).
You also mentioned the question whether the use of US has side effects or not. It
is worth knowing that every time that an ultrasound examination is carried out a

part of the patient is exposed to the influence of the beam of mechanical waves.
As these waves travel through the patients body they interact with the tissue
giving rise to two type of biological effects: thermal and non-thermal effects
1. Thermal effects:
a. As the mechanical waves travel through the tissue, some of the
ultrasound energy is absorbed by the tissue and is converted to heat
causing a local rise of the temperature. This increase of temperature
depends on the region of the body that is scanned and the parameters
used to perform the ultrasound. If we perform an ultrasound with the
transducer in a fixed position (e.g. pulsed Doppler study) the increase
of temperature will be fastest at the focus of the field of view. However,
as time passes the regions where the increase was highest will start to
lose some of the absorbed energy. This thermal energy will be
dissipated to adjacent cooler regions by thermal conduction. Among all
tissues, bones have shown a strong ultrasound waves absorption at all
frequencies. This leads to a focal rapid increase of the temperature to
its final value since the US energy is almost completely absorbed.
b. A second consequence related with thermal effect is that the
transducer itself begins to heat up as it generates the mechanical
waves. This rise of temperature will be perceived at the contact surface
between the transducer and the patients skin.
Does the rise of temperature matters?
Studies have shown that after been exposed to Doppler
examination it appeared to be unlikely that a temperature rise of more
than 1.5C would occur in soft tissue. While for bone tissue the evidence
showed a temperature rise between 1.5 and 4C. However, it is important
to consider that the human body is quite capable to recover from this local
increase of temperature (3).
Besides from the fact that temperature rise is localized and
normally well-tolerated by patients safety, for more than 20 years all
ultrasound manufacturers have been following the FDA regulation that
limits the energy output of the equipment. The regulation also introduced
the output display standard which are biophysical indicators (thermal
index (TI) and mechanical index (MI)) for real-time display of safety
information during scanning.
2. Non-thermal effects
a. Mechanical waves might create cavitation effect in micro bubbles
within the tissue. Theoretically, bubbles with a diameter of 2m can
resonate with typical diagnostic frequencies giving rise to a rapid
collapse of the bubble, high localized increase of pressure and
temperature. However, this theoretical local destructive outcome have
never been evidenced in the clinical settings.

(1) Hoskins, P., Kevin, M., Abigail, T., 2010. Diagnostic Ultrasound: Physics and
Equipment, 2 ed.

(2) Salvesen, K. ., and C. Lees. "Ultrasound is not unsound, but safety is an

issue." Ultrasound in Obstetrics & Gynecology 33.5 (2009): 502-505.
(3) Shaw, A., N. M. Pay, and R. C. Preston. Assessment of the likely thermal
index values for pulsed Doppler ultrasonic equipment-Stages II and III:
experimental assessment of scanner/transducer combinations. National
Physical Laboratory. Great Britain, Centre for Mechanical and Acoustical
Metrology, 1998.