Medical Imaging Modalities

Ultrasound imaging
Gizeaddis Lamesgin (MSc.)

Jimma University
Jimma Institute of Technology
Biomedical Engineering Department
 What is Sound?
Sound is propagated through a mechanical movement of a
particle through compression and rarefaction that is
propagated through the neighbor particles depending on the
density and elasticity of the material in the medium.
 What is Sound?
Sound waves propagate mechanical energy causing periodic
vibration of particles in a continuous, elastic medium.
 What is Ultrasound?
Ultrasound is the term that describes sound waves of
frequencies exceeding the range of human hearing and their
propagation in a medium.

The upper limit of hearing : about 20[kHz]

Over the upper limit = Ultrasound ?
Application to diagnosis
Frequency : 2MHz 10MHz
 Ultrasound imaging
Ultrasound or ultrasonography is a medical
imaging technique that uses high frequency
sound waves and their echoes.

Known as a pulse echo technique

The technique is similar to the echolocation used

by bats, whales and dolphins, as well as SONAR
used by submarines etc.
 Ultrasound imaging
In ultrasound, the following events happen:
1. The ultrasound machine transmits high-frequency (1 to 12
megahertz) sound pulses into the body using a probe.
2. The sound waves travel into the body and hit a boundary
between tissues (e.g. between fluid and soft tissue, soft tissue
and bone).
3. Some of the sound waves reflect back to the probe, while
some travel on further until they reach another boundary and
then reflect back to the probe .
4. The reflected waves are detected by the probe and relayed to
the machine.
 Ultrasound imaging
5. The machine calculates the distance from the probe to the
tissue or organ (boundaries) using the speed of sound in
tissue and the time of the each echo's return (usually on the
order of millionths of a second).

6. The machine displays the distances and intensities of the

echoes on the screen, forming a two dimensional image.
 Ultrasound imaging

The fundamental equation of ultrasound is:

ct
d
2
where: d = distance of the reflecting object
from the source/detector of ultrasound;
c = speed of the ultrasound;
t = round-trip time of the pulse, from
emission to reception.
 Physics of ultrasound
Important concepts in production of an U/S image:

Propagation velocity

Acoustic impedance

Reflection

Refraction

Attenuation
 Propagation Velocity
Sound is energy transmitted through a medium-
Each medium has a constant
velocity of sound (c)
Product of frequency (f) and wavelength ()
c=f
Frequency and Wavelength therefore are directly
proportional- if the frequency increases the
wavelength must decrease.
 Propagation Velocity
Ultrasound wavelength is determined by the
frequency and the speed of sound in the propagation
medium.

Ultrasound wavelength
determines the spatial
resolution achievable
along the direction of
the beam.
 Propagation Velocity
A high-frequency ultrasound beam provides superior
resolution and image detail
However, the depth of beam penetration is reduced at higher frequency.
Lower frequency ultrasound has less resolution, but a
greater penetration depth.
Ultrasound frequencies selected for imaging are
determined by the imaging application.
For thick body parts (e.g., abdominal imaging), a lower
frequency ultrasound wave is used (3.5 to 5 MHz) to image
structures at significant depths,
for small body parts or organs close to the skin surface (e.g.,
thyroid, breast), a higher frequency is employed (7.5 to 10
MHz).
 Propagation Velocity
Propagation velocity is dependent
Tissues resistance to compression (density or stiffness)

The speed (c) of the ultrasound wave through tissue is

determined by the tissue density (p) and compressibility
(k) values:

the more rigid the tissue and or/less dense the tissue,
the higher the ultrasound propagation velocity
 Propagation Velocity
Acoustic properties of biological tissues

The average speed of sound in human tissue is 1540 metres/second.

Example
For example, if an echo is detected from a reflector in human
soft tissue in 0.065 ms (0.000065 sec). How far is the reflector
from the transducer.

Distance = 1540 metres/sec x 0.000065 sec

Distance = 0.1 metres
= 10 cm
If the sound has travelled 10 cm from the transducer to the
reflector and back again, then the reflector is 5cm below the
transducer.
 Acoustic Impedance
Acoustic impedance (z) of a material is the product of its
density and propagation velocity
Z= pc

Differences in acoustic impedance create reflective interfaces

that echo the u/s waves back at the probe
Impedance mismatch = Z
 Acoustic Impedance
Homogeneous mediums reflect no sound
acoustic interfaces create visual boundaries between different
tissues.
Bone/tissue or air/tissue interfaces with large z values
reflect almost all the sound
Muscle/fat interfaces with smaller z values reflect only part
of the energy
Exercise

Solution
 Reflection
The production of echoes at reflecting interfaces
between tissues of differing physical properties.

Specular - large smooth surfaces

Diffuse small interfaces or nooks and crannies
 Reflection coefficients
When an incident plane wave,
with amplitude pi, travelling
through a medium with acoustic
impedance Z1 hits a boundary
with a second material of
impedance Z2 there is in general
both a reflected wave pr and a
transmitted wave pt:
 Reflection coefficients
The strongest reflected signal is received if the angle
between the incident wave and the boundary is 90 degrees

The reflection coefficient Pr/Pi and transmission

coefficient Pt/Pi:
Z 2 Z1 2Z 2
pr pi ; pt pi
Z 2 Z1 Z 2 Z1
 Significance of reflection coefficients

Too little reflection is bad. pr / pi 0

Useful images occur only where there is a difference in
acoustic impedance.
Tissues with strikingly different properties in other respects
may have similar acoustic impedances hence the two tissues
will not be delineated from each other.

Too much reflection is bad. pr / pi 1

If difference in acoustic impedance is too high, then
virtually all the incident ultrasound will be reflected. This
means that the boundary is opaque to ultrasound.
The organ in question will show up very brightly, but there
is an inability to see through it to find out what is
underneath
 Implications
No ultrasound images of brain in vivo;

skull reflects ultrasound.

Images of the heart have to be taken round the ribs, which

are also opaque.

Finding the right window into the body is important.

The ultrasound transducer must be coupled to the body

using a special gel. Before an ultrasound scan, a thin layer
of gel is smeared onto the skin. Why?
 Answer

The material from which transducers are made has a very

different acoustic impedance Ztransducer to that of the body
Ztissue and more importantly that of air Zair.

These large mis-matches between Ztransducer and Ztissue and

between Ztransducer and Zair mean that the reflection coefficients
at these interfaces are close to -1.

Little of the signal gets through at a transducer-tissue

boundary (pr/pi -0.86) and virtually none at a transducer-
air boundary (pt/pi - 0.9997).
 By applying the coupling gel, we exclude all air from region
between probe and body and the worst case scenario of
reflection from a transducer-air boundary is avoided.

The reflection coefficient is still high (0.86), but imaging is

possible.

Some manufacturers use impedance matching to increase

amount of transmitted radiation through transducer-tissue
interface.
(a) (b) Matching gel

Transducer Soft Tissue Transducer Soft Tissue

pi pi
pt
pt
pr pr

|pt| << |pr| |pt| >> |pr|

Fig (a) A large degree of reflection occurs at the interface

between the ultrasound transducer and soft tissue.
(b) If the correct thickness of an appropriate material is
built into the probe, much improved transmission can be
obtained.
 Attenuation
The intensity of sound waves diminish as they travel
through a medium
In real systems some waves are scattered and others
are absorbed, or reflected
Some of the energy is transferred to the tissue in
the form of heat.
In diagnostic ultrasound, this heat transfer is not high
enough to be considered deleterious
 Attenuation

This decrease in intensity (loss of amplitude) is called

attenuation

Attenuation is characterized by an exponential decrease in

both the pressure and intensity of the ultrasound beam as
a function of its propagation distance, z, through tissue

Attenuation causes low resolution of echo image.

Summary of interactions of ultrasound at boundaries
of materials
Example
a 1-MHz ultrasound beam traverses a block of tissue
consisting of 2 cm fat, 3 cm muscle (ultrasound
propagated parallel to the fibers), and 4 cm liver. What
will be the total energy loss after the ultrasound returns.
Solution
 Instrumentation of ultrasound
Anatomy of a scanner:
Transmitter

Transducer

Receiver

Processor

Display

Storage
Instrumentation of ultrasound

A schematic diagram of a conventional ultrasound imaging system

 Transducer
A transducer is any device that converts one form of
energy into another.

An ultrasound transducer converts electrical energy into

ultrasound energy and vice versa.

Transducers for ultrasound imaging consist of one or

more piezoelectric crystals or elements.

The piezoelectric effect is an exhibited by certain crystals

that, in response to applied pressure, develop a voltage
across opposite surfaces.
 Transducer
On both sides of the piezoelectric element electrodes are
affixed and a voltage is applied.
 Transducer
The temperature above which a crystals piezoelectric
properties disappear is known as the Curie point of the crystal.

For an ultrasound transducer efficiency is described as the

electromechanical coupling coefficient kc
 Transducer
Essentially all diagnostic ultrasound units use
piezoelectric crystals for the generation and detection of
ultrasound.

A number of piezoelectric crystals occur in nature

 Transducer design
A crystal exhibits its greatest response at the resonance
frequency.

The resonance frequency is determined by the thickness of

the crystal

Thickness is selected to be one-half of the wavelength of

ultrasound in the crystal

The crystal has a natural resonant frequency (f0)

corresponding to its thickness (t)
 Transducer design
Ultrasound transducer consists of the following

Linear probe transducer

 Transducer design
Multi array Ultrasound transducer
 Transducer design
The acoustic lens is a gray colored part looking like rubber
attached to the tip of the probe.

Ultrasonic waves transmitted from the probe would spread and

travel like light.

The acoustic lens prevents

the ultrasonic waves from
spreading and focuses them
in the slice direction to
improve the resolution
 Transducer design
Matching layer
A PZT-based transducer has a Z value of
Skin/Tissue Z is

Without some modifications,

large amount of energy will be
reflected from the patients skin

a matching layer is added to the

external face of the crystal to
improve this.
 Transducer design
The backing material/damping block
absorbs the backward directed ultrasound energy and
attenuates stray ultrasound signals from the housing.

This component also dampens the

transducer vibration to create an
ultrasound pulse with a short
spatial pulse length, which is
necessary to preserve detail along
the beam axis (axial resolution).
 Transducer design
The backing Reducing excessive vibration will cause the
element to generate ultrasonic waves with a shorter pulse
length, improving axial resolution in images
 Transducer Arrays
The majority of ultrasound systems employ transducers with many
individual rectangular piezoelectric elements arranged in linear or
curvilinear arrays.
Typically, 128 to 512 individual rectangular elements compose the
transducer assembly.
Beam Former
responsible for generating the electronic delays for individual
transducer elements in an array to achieve transmit and receive
focusing and, in phased array beam steering

Pulser
also known as the transmitter provides the electrical voltage for
exciting the piezoelectric transducer elements, and controls the
output transmit power by adjustment of the applied voltage.
Preamplification
Each transducer element produces a small voltage proportional to the
pressure amplitude of the returning echoes.
An initial Preamplification increases the detected voltages to useful
signal levels

Analog to Digital Converter

ADCs digitize the signals directly from the Preamplification stage.
In some systems digitization of the signal occurs after analog beam
formation and summing,
 phased array transducer
produces a pulsed beam that
is focused at a
programmable depth, and
receives echoes
Timed electronic delays
phase align the echoes, with
the output summed to form
the ultrasound echo train
along a specific beam
direction.
Receiver
The receiver accepts data
from the beam former
during the pulse repetition
period, which represents
echo information as a
function of time (depth).
Subsequent signal
processing occurs in the
following sequence
Receiver
Time gain Compensation (TGC)
Ultrasound is attenuated as it passes through tissue. Even for the same
type of reflector, the signal is less for deeper objects.
The solution is to Amplify the later-arriving signals (i.e. the ones from
deeper in the tissue) more than those from superficial reflections
This is achieved by making the gain of the amplifier dependent on a
control voltage.
Specifically, the input voltage is changed by the TGC unit.
Because of the logarithmic nature of the decrease in signal, the TGC
should increase the gain a certain number of dB.
Receiver
Time gain compensation (TGC) is a user-adjustable
amplification of the returning echo signals as a function of time,
to further compensate for beam attenuation.

TGC (also known as time

varied gain, depth gain
compensation, and variable
swept gain) can be changed
to meet the needs of a
specific imaging application.
 Receiver
Logarithmic compression
reduces the range of the
signals (minimum to
maximum) after time gain
compensation to enable the
full range of gray-scale values
to be displayed on the monitor.
output signal proportional to
the logarithm of the input
signal.
 Receiver
Rectification inverts the negative amplitude signals of the echo
to positive values.
Demodulation and envelope detection change a signal
oscillating at a high frequency to a lower frequency.

Converts the rectified

amplitudes of the echo into a
smoothed, single pulse
 Receiver

Rejection sets the

threshold of signal
amplitudes allowed to pass
to the digitization and
display subsystems.
This removes undesirable
low-level noise generated
from scattered sound or by
the electronics.
 Receiver

Processed A-line
data with
appropriate TGC
demonstrates that
equally reflective
interfaces have
equal amplitude.
 Ultrasound Scanning Modes
A-Mode scan:
Records the amplitude of returning echoes from the tissue
boundaries with respect to time (one dimensional).
the echo time represents the acoustic impedance of the
medium and depth of the reflecting boundary of the tissue,
A-mode currently used in ophthalmology applications for
precise distance measurements of the eye..
 Ultrasound Scanning Modes
M-Mode Scan
Provides information about the variations in signal
amplitude due to object motion.
A fixed position of the transducer, in a sweep cycle, provides a
line of data that is acquired through A-mode.
In a series of sweep cycles, each sequential A-line data is
positioned horizontally.
As the object moves, the changes in the brightness levels
representing the deflection of corresponding pixels in the
subsequent sequential lines indicate the movement of the
tissue boundaries.
M-mode scanning is used most commonly in cardiac imaging
 Ultrasound Scanning Modes
M-Mode Scan
The x-axis represents the time while the y-axis indicates
the distance of the echo from the transducer.

M-Mode display of mitral valve leaflet of a beating heart

 Ultrasound Scanning Modes
B-Mode Scan
Provides two-dimensional images representing the
changes in acoustic impedance of the tissue.

The brightness of the B-Mode image shows the strength of

the echo from the tissue structure.

To obtain a 2-D image of the tissue structure, the transducer

is pivoted at a point about an axis and is used to obtain a V-
shape imaging region.
Alternately, the transducer can be moved to scan the imaging region.
 Ultrasound Scanning Modes
B-Mode Scan

B-mode image
of a fetus.
The dark region
is the uterus,
which is filled
with fluid
 2-Dimensional imaging
Fire beam vertically, wait for echoes, store information &
then fire new line from neighbouring transducer etc in a
sequence of B-mode lines.

In linear crystal array, phased array shoots parallel beams,

with field as wide as probe length. 0
50
100
150

Reflecting
200

Surfaces
50
100
150
200

Ultrasound
beam

Other orientations
Image Formed
Boundaries giving
of ultrasound beam
rise to echoes
 The Co-ordinate Generator
This device is often also called the scan converter.

It takes information about the instantaneous orientation of

the beam and turns it into the co-ordinates of a line on the
display monitor (image matrix).

the co-ordinate generator gives the memory location in

which signal information is stored.
The data is then displayed on a monitor by a computer program.
 Image quality

Ultrasound Image quality depends on amount of

energy reflected back from tissue interface

Echogenicity:
Hyperechoic - greatest intensity - white

Anechoic - no signal - black

Hypoechoic Intermediate - shades of gray

Hyperechoic Anechoic

Hypoechoic
 Image quality

Image quality is also dependent on

Axial Resolution

Lateral Resolution

Focal Zone

Probe Selection

Frequency Selection

Recognition of Artifacts
 Axial Resolution

Ability to differentiate two objects along the long

axis of the ultrasound beam

Determined by the pulse length

Product of wavelength and # of cycles in pulse

Pulse length Decreases as frequency f increases

Higher frequencies produce better resolution

 Axial Resolution

5 MHz transducer 10 MHz transducer

Wavelength 0.308mm Wavelength 0.15mm

Pulse of 3 cycles Pulse of 3 cycles

Pulse length Pulse length

approximately 1mm approximately 0.5mm

Maximum resolution Maximum resolution

distance of two objects = distance of two objects =
1 mm 0.5mm
Example
What is the maximum resolution attainable for a 7MHz
ultrasound beam applied with pulse of 5 cycles?

Pulse length (max resolution) = No. of pulse cycles x wavelength

= C/f

= 1540m/s/6 x10^-6 /s = 0.22mm

Pulse length (max resolution) = 0.22 x 5

= 1.1mm
 Axial Resolution

screen

body
 Lateral Resolution

The ultrasound beam is made up of multiple individual beams

The individual beams are fused to appear as one beam

The distances between the single beams determines the lateral

resolution

Ability to differentiate objects along an axis perpendicular to the

ultrasound beam

Dependent on the width of the ultrasound beam, which can be

controlled by focusing the beam
 Lateral Resolution

screen

body
 Ultrasound Artifacts
Acoustic shadowing
Acoustic enhancement
Lateral cystic shadowing (edge artifact)
Contact artifact
Wide beam artifact
Side lobe artifact
Reverberation artifact
Gain artifact
 Acoustic Shadowing

Occurs distal to any highly reflective or highly attenuating

surface

Important diagnostic clue seen in a large number of medical

conditions

Biliary stones

Renal stones

Tissue calcifications
 Acoustic Shadowing

Shadowing is a
hypointense signal
area distal to an
object or interface,
and is caused by
objects with high
attenuation or
reflection of the
incident beam.
 Acoustic Enhancement

Opposite of acoustic shadowing

Better ultrasound transmission allows enhancement of the

ultrasound signal distal to that region
 Lateral Cystic Shadowing
A type of refraction artifact

Can be falsely interpreted as an acoustic shadow (similar to

gallstone)
 Contact artifact

Caused by poor probe-patient

interface

Artifacts video
Doppler Ultrasound
 Doppler Effect

Shift in perceived frequency when either source

or listener are moving relative to one another

Familiar occurrence in audible sounds

Also occurs in medical ultrasound

Doppler Effect in ultrasound
 Doppler shift

Doppler shift is the

difference between the
transmitted and received
frequencies.
Transmitted and received
frequencies are in the MHz
range
Doppler shift frequencies
often in audible range
 Doppler shift

~MHz

~MHz

Difference
(audible)

It is both customary and convenient to convert these

frequency shifts into an audible signal through a
loudspeaker that can be heard by the sonographer to aid in
positioning and to assist in diagnosis.
 Doppler shift
The received frequency and Doppler shift depends on:
Frequency of incident pulse (Fo)
Velocity of the reflector (V) and incident pulse velocity(C)
angle between incident pulse and reflector flow direction ()

2f o v cos
FD
c
and
FDc
V
2f o v cos
 Doppler shift
The only quantity that is measured directly by a typical
Doppler ultrasound unit is Doppler shift.
Determination of the velocity of blood in units such as
centimeters per second requires an estimate of the sonation
angle.
Errors in the estimate of this angle (using on-screen cursors)
limit the accuracy of velocity estimates.
This error is more significant at larger angles (near 90 degrees)
than at smaller angles
 Example
A 10-MHz ultrasound probe detects a 1.4-kHz Doppler shift at
a sonation angle estimated as 45 degrees. Find the estimated
velocity of blood flow and the percent error in the estimate if
the angle of sonation is incorrect by as much as 3 degrees:
Solution
FDc
V
2f o v cos
 Continuous Wave (CW) Doppler
Ultrasound transmitted continuously rather than in pulses

Some units have two-element transducers, one transmitting,

the other receiving.

The incident and returning frequencies are compared, filtered

and amplified to audible sound level.

Continuous-wave Doppler suffers from depth selectivity with

accuracy affected by object motion within the beam path
 Continuous Wave (CW) Doppler
An oscillator produces
a resonant frequency
to drive the transmit
transducer and
provides the same
frequency signal to the
demodulator, which
compares the
returning frequency to
the incident frequency
 Continuous Wave (CW) Doppler

CW Doppler
spectrogram
showing the
velocity
profile of the
blood flow through
a heart valve
 Pulsed Wave (PW) Doppler
Pulsed Doppler ultrasound combines the velocity
determination of continuous-wave Doppler systems and the
range discrimination of pulse echo imaging.

A transducer tuned for pulsed Doppler operation is used in a

pulse echo format, similar to imaging.
Pulsed Wave (PW) Doppler
 Pulsed Wave (PW) Doppler
Each Doppler pulse does not contain enough information to
completely determine the Doppler shift, but only a sample of the
shifted frequencies measured as a phase change.
The phases of the returning echoes from a stationary object, relative to
the phase of the transmitted sound, does not change with time.
However, the phases of the returning echoes from moving objects do vary
with time.

Repeated echoes from the active gate are analyzed in the

sample/hold circuit, and a Doppler signal is gradually built up
Pulsed Wave (PW) Doppler
Pulsed wave Doppler uses the M-mode
acquisition scheme
Pulsed Wave (PW) Doppler
 Pulsed Wave (PW) Doppler
The discrete measurements acquired at the pulse repetition
frequency (PRF) produce the synthesized signal.
According to sampling theory, a signal can be reconstructed
unambiguously as long as the true frequency is less than half
the sampling rate.
Thus the rate of pulsing [the pulse repetition frequency
(PRF)] of pulsed Doppler must be at least twice the Doppler-
shift frequency produced by flow.
 Pulsed Wave (PW) Doppler
The maximum Doppler shift that is unambiguously
determined in the pulsed Doppler acquisition follows directly
from the Doppler equation:
 Example
A stenosis produces a high-speed jet in a vessel. The
maximum velocity of RBCs in the stenosis is 80 cm/sec. Find
the minimum PRF that must be used to avoid aliasing for
pulsed Doppler at 7.5 MHz. Assume that the angle of
sonation is 0 degrees.
 Solution
The Doppler shift is

The minimum PRF required to prevent aliasing is twice the

Doppler-shift frequency, or 15.6 kHz
 Color flow imaging
Color flow imaging provides a 2D visual display of moving
blood in the vasculature, superimposed upon the conventional
gray-scale image.
gray-scale B-mode image must be acquired at the same time, the
flow information must be interleaved with the image
information.
 Color flow imaging
The motion data is mapped with a color scale (e.g., red for
blood moving toward the transducer, and shades of blue for
blood moving away from the transducer)and superimposed on
the gray-scale image.
Color flow imaging
102
1. What is Reverberation artifact in ultrasound? (2pt)
2. Discuss the four signal processing procedures in the receiver
section of ultrasound. (4pts.)
3. The maximum velocity of RBCs in a vessel is 80 cm/sec. if the
maximum PRT that must be used to avoid aliasing is 62.5 sec,
What should be Doppler incident frequency. Assume that the
angle of sonation is 0 degrees.(4pts)