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Welcome to

The Basics of
Doppler Ultrasound

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The Doppler Effect

stated that any
directional motion
between a light source
and an observer would
produce a detectable
frequency shift or color
change (twinkling of
stars)
Dopplers theory is
applicable to both light
and sound

About the Colorlightning of the Dopplerstars 1842 Johann Christian Doppler

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Doppler Effect
In ultrasound Imaging, echoes received from most tissues will be at the same
frequency as the transmitted beam. However, if echoes received are from
tissues or blood cells that are moving, the transmitted and received frequencies
will not be the same. This shifted frequency can be used to determine the
relative velocity and the direction of this moving tissues. This effect is known as
the Doppler Principle. Essentially, the greater the frequency shift, the higher
the velocity of the moving object. Additionally, movement toward the transducer
results in a higher received frequency, and movement away in a lower received
frequency.

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Index of Slides:
The Dopper Effect Applied to Sound
Doppler Ultrasound Modes
Duplex/Triplex

11-17

18

Pulse Repetition Frequency

Aliasing

4-10

19

20-23

Adjusting the Doppler Spectrum

24,25

Automatic Spectrum Optimization

26

CFM Adjustments
Artifacts

27

28

Hemodynamics

29

Spectral Doppler Waveforms

Doppler Calculations

34

Auto Doppler Calcs.

35

Hints and Tips

36-37

30-33

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The Doppler Effect applied to sound

The sound frequency from an approaching

source is higher than from one receding
The difference is the Doppler shift frequency - fD

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The Doppler Equation

fD : 2f x Vx cos/c
f:

the insonating frequency, in MHz

V:

the velocity of the blood flow

the insonating angle (angle of observation)

c:

the speed of sound through soft tissue

(ca. 1540m/sec.)
fD is kHz, which is within the audible range

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Angle of Observation

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Angle of Incidence
When the motion of the object and the transmitted
beam are not parallel, it is necessary to correct for
the angular difference. Motion that occurs at an
angle to the beam axis will result in a decrease
in the magnitude of the frequency shift and a lower
calculated velocity. Therefore, the transmitted beam
needs to be parallel to the flow for the most accurate
velocity. An equation is used to correct for the angle
offset. The transducer receives only the component
parallel to the beam Vcos .

Ultrasound Beam

Blood Flow
V

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The smaller the angle between the insonated vessel and the probe, the
higher is the Doppler shift.

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The Insonating Frequency, f

B- mode frequency-

Doppler frequecies

In combined modes the probe sends two different sets of frequencies:

one for B-mode, one for Doppler mode(s)
According to the Doppler equation f should be as high as possible.
But as the reflectors, the red blood cells, are very small, their echoes are
rather weak.
Because low frequencies travel farther than high ones a reatively low f
is used for Doppler modes.

The LOGIQ systems have for CFM og PDI two different D-frequencies in all probes,
and are programmed to use the lower one

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Doppler modes

PW: Pulsed Wave Doppler (Spectral Doppler)

CFM: Color Flow Mapping (Color Doppler)
PDI: Power Doppler Imaging (Power Doppler)

CW: Continuous Wave Doppler (Spectral Doppler)

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Clinical use of the Doppler Effect

Presence of flow, vascular or cystic

CFM, PWD, PDI

The direction of flow in respect to the probe

CFM , PWD, CW

Quantification of flow velocities and indices

PWD, CW

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Spectral Doppler
Spectral Doppler, of high value in ultrasound diagnosis, can be used for
evaluation of blood flow, includes three kinds:
- Pulse Doppler(PW)
- High Pulse Repetition Frequency
Pulse Doppler (HPRF)
- Continuous Wave Doppler (CW).

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Pulse Ultrasound
For practical use, most modern ultrasound systems are designed based on the
principle of pulse-echo technique, which means that transducer emits only a
few cycles of pulses at a time into the human body. When encountering tissues
interfaces, reflection and scattering will occur and produce pulse echoes, By
detecting these echoes, tissue positioning and identification as well as diagnosis
can be made.

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Pulse Doppler
In Pulse Doppler, a single ultrasound line
is repeatedly fired. Echoes reflected from
moving structure, including blood cells,
experience a Doppler shift in frequency.
Using the Doppler equation, the echo
information obtained within the Sample
Volume is analyzed for shifted frequency
content and amplitude, rather than transmit
frequency amplitude. From this, the blood
velocity can be determined.

Transducer
Sample
Volume

Pulsed Doppler Line

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Pulse Doppler
In order to obtain enough data to
calculate the frequency components
of the sampled volume, many
ultrasound lines must be fired.
The frequency data is converted to
velocity, and displayed in a scrolling
strip format on the monitor.

Time

The highest detectable velocity is

limited by one half of the rate at
which the ultrasound lines are fired,
known as *Nyquist Limit .
Velocity

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Pulsed Doppler (Spectral Doppler, PW)

Is a graphic representation of velocity and profile of the flow inside the Sample
Volume, SV as a function of time
Flow toward the probe is seen above the Baseline
Flow away from the probe below the Baseline

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Pulse Repetition Frequency

T

Pulse Repetition
Period
* Pulse Repetition Frequency (PRF) is the number of times per second that
transducer transmits a pulse.
* Pulse Repetition Frequency is dependent on transmit depth and
propagation velocity. ( 1540 m/s )

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Pulse Repetition Frequency (PRF)

CFM PRF

PWD PRF

PRF is the frequency of pulses transmitted by the probe.

The higher the flow velocity, the higher the PRF settings must be
PRF=2x fD is optimal
PRF can be shown as kHz or cm/sec.

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Pulsed Doppler (PW)

For Pulsed Doppler the
probe uses only one
crystal, which acts as
both transmitter and
receiver.

Delay

Transmitt

Receive
Time gate

Signal processing
Time

A timing switch activates

a window in the region of
interest - the Sample
Volume (SV)

Time

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Frequency Spectrum-Analysis
For each received signal a Doppler shift is
calculated.
The frequencies/velocities are displayed as
bright dots

Each frequency/velocity is translated into a

seperate Doppler curve, all curves together
are combined to form the DOPPLER
SPECTRUM where the
frequencies/velocities are assigned
different dot brightness or color.

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Continuous Wave Doppler

Continuous Wave Doppler, or CW Doppler, is a similar modality to Pulse Doppler in that frequency
data is gathered to determine blood velocity along the ultrasound line. With CW Doppler, the transmit
and receive functions happen simultaneously. This overcomes the maximum velocity limit, but the
exact point along the ultrasound line from which the velocity data originated can not be determined.
(No range resolution).
CW Doppler is used primarily in diagnosing abnormalities in which range resolution is not important
or when the sonographer is interested in the quantification of high velocity jets.

CW

PW

Range Resolution

None

Determined by
Sample Volume

Maximum Velocity

Virtually Unlimited

Limited by 1/2 PRF

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Continuous Wave Doppler

Monitor
Transducer

Velocity

Time

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Continuous Wave Doppler: (Unidirectional)

The result of the

Doppler shift will
increase or decrease,
depending of the
blood flow direction
Vessel

Skin

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Color Flow Mapping

Color Flow Mapping (CFM) combines B-mode image format and Pulsed Doppler to
provide a two dimensional representation of blood flow in Real Time.
The Doppler ultrasound lines, like B-mode lines, are sequentially scanned through the
frame. Multiple range gates are taken along the Doppler lines. The calculated velocity
data is assigned a color to represent a certain velocity and direction, and then displayed
combining with the B-mode image at the original location.

Blood
Flow

2-D

CFM

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MTI (Moving Target Indicator)

First
Blood Cell

Ultrasound Line

Second
Blood Cell

Subduction

Blood Cell Signal

Ultrasound Line

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Limitations of CFM
- Only give the average of the velocity across the beam,
can not get the maximum velocity.
- Sensitivity, a compromise to be made among the depth,
velocity range, and PRF
- Frame Rate, influenced by FOV , scan angle and control
system of transmit and receive.

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CFM Display

Monitor

Transducer

Color Box

Doppler Ultrasound Line

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CFM, Color Doppler

Color coded Doppler signals from numerous small sample volumes inside
the Region Of Interest (ROI)
Color coding is assingned according to flow direction in respect to the
probe, and mean velocities
Flow toward the probe is coded RED
Flow away from probe is coded BLUE
High velocities have bright hues, low velocities dark hues

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CFM, Color Doppler

No frequency spectrum is displayed, color information is superimposed on the 2D image.

The wider the Region of Interest (ROI,color box)>the higher number of color lines>the
more time needed to create each image frame>the lower the Frame Rate

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PDI, Power Doppler

Color coded signals from numerous small Sample Volumes inside the
Region Of Interest (ROI, color box)
Color coding is assigned according to flow intensities, (power), not
direction.
Is used to detect flow in very small, or low flow vessels

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Duplex / Triplex

Duplex: B mode og Doppler spectrum

Is the fastest to generate

Triplex: B mode, CFM and Doppler spectrum

Simultaneous Triplex: B, CFM and PW live at the same time

takes longer time to generate
Alternating Triplex: B/CFM mode and Doppler spectrum live in turns - switch
between them by pressing B-Pause

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Nyquist Limit
The maximum Doppler shift velocity measurable in Pulse Doppler is limited to one
half the sampling rate defined by the PRF, which is mainly determined by the sampling
depth. For a given transducer and depth, this maximum measurable velocity, which is
known as the Nyquist Limit, can be calculated using the following equation:
PRF
Nyquist Limit =
2

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Aliasing
If the maximum velocity for that transducer and depth exceeds the Nyquist limit, a
phenomenon known as Aliasing occurs. Aliasing results in the display of erroneous
velocity information.(Showing a wraparound effect.)

2
Velocity 0
-2
Spectral Display Showing Aliasing

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Aliasing

The moving wheel is filmed every

quarter turn: no aliasing

Aliasing occurs because the wheel is

only filmed every three quarter turn: it
appears to move slowly backwards

The aliasing phenomenon is seen in old movies, where wagon wheels

appear to rotate slowly backwards instead of fast forwards.
The true velocity and correct direction of the wheel is only seen if the
movie frame rate is frequent enough to detect the position of the wheel at
each quarter turn.

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Aliasing

Doppler Aliasing is a result of too low PRF settings

Can also be called undersampling: The flow velocity is higher than the
PRF, the probe reads part of the flow as negative flow

Aliasing is compensated by:

1.
Increasing PRF
2.
Lowering the Baseline

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Spectral Aliasing

On the frequency spectrum display the aliasing effect is represented by a

curve where the top is transposed to the negative range

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HPRF Doppler
Transducer

The Nyquist limit will decrease with

depth of the sample volume. As this
limit reaches 1/2 PRF, the system
automatically increases the sample
rate by increasing the PRF and the
number of samples. This results in
more than one wavefront propagating
through the body simultaneously.
Therefore, information obtained may
be from more than one location.

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Color Aliasing

A mix of red and blue color signals is seen.

Red changes to Blue through White: a classical sign of CFM
aliasing

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Adjusting the Spectrum

Angle of insonation: adjust Angle Steer
or
slightly angle the probe
Angle Correct: align crosshair inside
SV in parallel
to the vessel walls/blood flow
PRF: adjust according to flow velocity
Baseline: the whole spectrum should be
shown above or below the Baseline

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Adjusting the Spectrum

Sample Volume: keep SV size inside the
vessel lumen

Gain: is set correctly when background noise is

only just discernable

Wall Filter: adjustment is rarely needed, WF is

linked to PRF

Sweep Speed: low Sweep Speed to show many

cycles in timeline
fast Sweep Speed for better detail of cycle(s)

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SmartScan:
One-Touch Auto Spectral Optimization (ASO)
ASO adjustments:
PRF (up to 3 iterations)
Baseline Shift
Angle correct (optional)
Invert (optional)

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CFM Adjustments
PRF
low PRF for slow flows/small vessels - if PRF is too high,
low flows are not detected
high PRF for high flow velocities to avoid color
overwriting of tissue/ vessel walls and aliasing
Gain
Gain and PRF should be adjusted together
higher Gain for small vessels
decrease Gain to avoid overwriting of tissue/vessel walls
Angle Steer (linear probes)
ROI should be angled toward the flow direction

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Artifacts

Ultrasound

Ghost-artifact of the Doppler

spectrum, appears when the
angle of insonation is close to
90 degrees

Angle artifact in CFM, appears

when the angle of insonation is
close to 90 degrees.
Appearance is different from
alaising: Red and Blue are
separated by Black

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Hemodynamics

Plug flow

Laminar
flow
Plug flow: most of the reflectors
travel at the same
(parabolic)

Turbulent flow - speed

velocity >narrow spectral waveform

Laminar flow: the reflectors in mid-stream travel at

higher velocities, especially duing diastole >broader
spectral waveform

Turbulent flow at a
Turbulent flow: the reflectors travel at different velocities stenosis
>spectral broadening
At a stenosis: spectral broadening proximal to the stenosis
high velocities at the narrowest point,
complete spectral broadening and flow on both sides of the Baseline caused by eddy currents and
vortices distal to the stenosis

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Spectral Doppler waveforms

Doppler arterial waveforms are affected by:

Cardiac contractility

The resistance in the receiving bed

Compliance of the vessel walls

Turbulence

Viscosity of the blood

and vary in accordance with the cardiac cycle

Doppler waveforms are used for:

1.

Measuring velocities- for exmple to quantify stenoses

These measurements are angle depentant for accuracy: the insonating
angle must not exeed 60 degrees

2.

Indices- for example PI or RI,

which do not depend on the angle for accuracy of measurement, but the
Doppler Equation must be kept in mind

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High/Low Resistance Arterial Waveforms

There are two major arterial waveforms:

High peak systolic flow,

low, absent or negative
flow in diastole

High resistance waveform is mostly seen in arteries supplying

muscles and skin,
which in resting phase have high resistance to the blood flow.

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High/Low Resistance Arterial Waveforms

Flow above the baseline

troughout the carciac cycle,
the lower the resistance in the
receiving bed, the higher the
diastolic flow

Low resistance waveform is typical for arteries supplying blood hungry

organs such as kidneys and brain. The vessels act like slack funnels
supplying the receiving bed with rich perfusion.

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The arterail waveforms change according to

the peripheral resistance.

Radial artery in rest phase:

high peak systolic flow, low or
negative diastolic flow

After moving the fingers the

waveform changes according to the
altered peripheral resistance

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Doppler calculations
Frequently used
measurements/ indices:
PsV
EdV
ACCel (Acceleration
Index)
RI (Resistance
Index):
PsV-EdV/PsV
PI (Pulsatility
Index):
PsV-EdV/TAMAX

Peak
systolic
Velocity

End
diastolic
Velocity

Time Average
MAX curve

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Auto Doppler Calcs.

Measurements of velocities and calculation of indices can be performed
manually or automatically on the spectrum live or frozen.

Six Sigma for Healthcare

Project, July 2003:
Auto calcs. and ASO for
third trimester flow exams
and measurement of PI in
the umbilical artery reduce
average Doppler exam
time by 45%.

Auto calcs. save examination time and are operator independent .

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Hints and Tips

Angle Correct
Adjust Gain

Change Sweep Speed

Shift Baseline

TrueAccess:
In the frozen or stored image you can adjust several parameters

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Hints and Tips L3

If simultaneous triplex is too slow:
1. Zoom the image around the SV
2. Switch to Alternating Triplex, (Sub menu, Pg.2, / Dupelx/Triplex OFF)
3. Switch to Duplex

For PI and TAMAX, if the Auto TAMAX curve is inaccurate:

Switch to Manual Trace (Top Menu) click the calc.of choice from the
Measurement menu, i.e. PI, place the cursor at the Start Systolic point of a
cycle, manually trace the spectrum to the End Diastolic point, press SET.

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Thank you...

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