Obstetric ultrasound

By Gebremaryam Temesgen(MSc in CMW)

Introduction to the Physics
of Ultrasound
 introduction
 “Ultra” means beyond, ultrasound is sound with a frequency
beyond that of human perception (i.e. >20 kHz), and has the
same physical properties as “audio” sound.

 Ultrasonic energy travels through a medium in the form of a

wave.

 The wave travels by compressing and rarefacting matter

 Depending on the matter- the wave will travel at different

velocities or directions

 U/S probes emit and receive the energy as waves to form pictures
 Cont...
 Sound is a mechanical, longitudinal wave that travels in a
straight line
 Sound requires a medium through which to travel (e.g. air)
 Ultrasound is a mechanical, longitudinal wave with a
frequency exceeding the upper limit of human hearing,
which is 20,000 Hz or 20 kHz.
 Most clinical diagnostic applications of ultrasound employ
frequencies in the range 1 - 30MHz.
Ultrasound uses sound waves.
Audible 20Hz and 20 000Hz.
Infra sound Below 20Hz
Ultrasound Above 20 000H
Ultrasound imaging > 2MHz (1000kHz)
 When and why is it used?
 •There are many occasions when ultrasound is a
favorable method of viewing inside the body
 •An obstetrician can use ultrasound to check the
development of an unborn baby
 •Doppler ultrasound can be use to view blood flow
through the heart and diagnose circulation problems
 •Ultrasound is a „non-invasive‟ imaging method with
instant results, relatively inexpensive, with little or no
health risks
 •Recent advances, including 4D with surface rendering
have increased the resolution and detail of ultrasound
Physical Principles
Basic Ultrasound

Amplitude

oscillations/sec = frequency - expressed in Hertz (Hz)

 I. Frequency

 # of cycles per second

 Measured in Hertz (Hz)
-Human Hearing 20 - 20,000 Hz
-Ultrasound > 20,000 Hz
-Diagnostic Ultrasound 2.5 to 10 MHz
(this is what we use!)
 Frequency vs. Resolution
 The frequency also affects the QUALITY of the
ultrasound image
› The HIGHER the frequency, the BETTER the
resolution
 The LOWER the frequency, the LESS the resolution
 A 12 MHz transducer has very good resolution, but
cannot penetrate very deep into the body
 A 3 MHz transducer can penetrate deep into the body,
but the resolution is not as good as the 12 MHz

High Frequency
Low Frequency
12 MHz
3 MHz
 High Frequency
 High frequency (5-10 MHz)
greater resolution
less penetration
 Shallow structures
vascular, abscess, t/v gyn,
testicular
 Low Frequency

 Low frequency (2-3.5 MHz)

greater penetration
less resolution
 Deep structures
Aorta, t/a gyn, card, gb, renal
 II. Wavelength
 The length of one complete
cycle
 A measurable distance
 distance between any point
on one wave and the
corresponding point on the
next wave
Student Activity- Problem
 An ultrasonic pulse has a speed of 1500 ms-1 in a
sample of soft tissue. If the frequency is 10 MHz,
find its wavelength using...
speed = frequency × wavelength
 v=fl
III. Amplitude

Amplitude
 IV. Velocity(v)
 Sound is energy transmitted through a medium-
 Each medium has a constant
velocity of sound (c)
 Tissue’s resistance to compression
› density or stiffness
 Product of frequency (f) and wavelength (λ)
c=fλ
 Frequency and Wavelength therefore are
inversely proportional- if the frequency increases
the wavelength must decrease.
 Propagation velocity
Increased by increasing stiffness
Reduced by increasing density
 Bone: 4,080 m/sec
 Air: 330 m/sec
 Soft Tissue Average: 1,540 m/sec
Cont…
 Producing an image
 Probe emits a sound wave pulse-measures the time
from emission to return of the echo
 Wave travels by displacing matter, expanding and
compressing adjacent tissues
 It generates an ultrasonic wave that is propagated,
impeded, reflected, refracted, or attenuated by the
tissues it encounters
 ULTRASOUND – How is it produced?
Produced by passing an electrical current through a
piezoelectrical (material that expands and contracts with
current) crystal
 Ultrasound Production
Transducer produces ultrasound pulses (transmit 1% of the
time)
These elements convert electrical energy into a mechanical
ultrasound wave

Reflected echoes return to the scan head which converts the

ultrasound wave into an electrical signal
The probe
Piezoelectric quartz
 AC

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 The patient must remove
clothing around the area to be
examined.
 A gel is applied to the area-
this removes any air which
would affect the signal.
 The probe or transducer is
placed on the skin.
 A computer monitor
displays the image which can
be stored or printed
 Image Formation
Electrical signal produces ‘dots’ on the screen
 Brightness of the dots is proportional to the
strength of the returning echoes
 Location of the dots is determined by travel
time. The velocity in tissue is assumed
constant at 1540m/sec
Distance = Velocity
Time
 Impedance

 Acoustic impedance (z) of a material is the product

of its density and propagation velocity
Z= pc, where p is the density of the
material and c propagation velocity.
 Differences in acoustic impedance create reflective
interfaces that echo the u/s waves back at the probe
 Impedance mismatch = ΔZ
 Acoustic Impedance

 Homogeneous mediums reflect no sound

 acoustic interfaces create visual boundaries between
different tissues.
 Bone/tissue or air/tissue interfaces with large Δz
values reflect almost all the sound
 Muscle/fat interfaces with smaller Δz values reflect
only part of the energy
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99.5% of ultrasound pulse is

transmitted in to the body.
 Example:-

a. What is the acoustic impedance of human bone of density

1800 kg/ m3 if ultrasound travels through it at a speed of
3700 m/ s?
b. Calculate the speed of ultrasound in air, given that its density
is 1.3 kg/ m3 and its acoustic impedance is 400 kg/ m2 s.
c. Blood has an acoustic impedance of 1.6 x 106 kg/ m2 s and
ultrasound travels through it at a speed of 1600 m/ s.
Calculate the density of blood.
 Interactions of Ultrasound with Tissue

 Acoustic impedance (AI) is dependent on the density of

the material in which sound is propagated
› the greater the impedance the denser the material.
 Reflections comes from the interface of different AI’s
• greater  of the AI = more signal reflected
• works both ways (send and receive directions)
 Interaction of Ultrasound with Tissue

 Greater the AI, greater the returned signal

• largest difference is solid-gas interface
• we don’t like gas or air
• we don’t like bone for the same reason
GEL!!
 Sound is attenuated as it goes deeper into the body
Interactions of Ultrasound with Tissue

 Important concepts in production of an U/S

image:-
 Propagation velocity
 Acoustic impedance
 Reflection
 Refraction
 Transmission
 Attenuation
Interactions of Ultrasound with Tissue
Interactions of Ultrasound with Tissue
Interactions of Ultrasound with Tissue
Interactions of Ultrasound with Tissue
 Image properties
 Echogenicity- amount of energy reflected back
from tissue interface

› Hyperechoic - greatest intensity - white

› Anechoic - no signal - black
› Hypoechoic – Intermediate - shades of gray
Reflected Echo’s
Strong Reflections = White dots
Diaphragm, tendons, bone
‘Hyperechoic’
 Reflected Echo’s

Weaker Reflections =
Grey dots

Most solid organs,

thick fluid – ‘isoechoic’
Reflected Echo’s

No Reflections = Black dots

Fluid within a cyst, urine, blood
‘Hypo-echoic’ or echo-free
When an ultrasound wave passes through tissues
Attenuation: Reduction in amplitude and intensity of
wave
Reflection: Back to the transducer
Scattering- Refraction: Change in direction & velocity
of wave
 What determines how far ultrasound
waves can travel?

 The FREQUENCY of the transducer

› The HIGHER the frequency, the LESS it can
penetrate
› The LOWER the frequency, the DEEPER it can
penetrate
› Attenuation is directly related to frequency
 Ultrasound Beam Profile

 Beam comes out as a slice

 Beam Profile
› Approx. 1 mm thick
› Depth displayed – user controlled
 Image produced is “2D”
› tomographic slice
› assumes no thickness
 You control the aim
 Accomplishing this goal depends upon...

 Resolving capability of the system

› axial/lateral resolution
› spatial resolution
› contrast resolution
› temporal resolution
 Processing Power
› ability to capture, preserve and display the
information
 Types of Resolution

 Temporal Resolution
› the ability to accurately locate the position of
moving structures at particular instants in time
› also known as frame rate
 Types of Resolution

 Contrast Resolution
› the ability to resolve two adjacent objects of
similar intensity/reflective properties as
separate objects - dependent on the dynamic
range
 Ultrasound Applications

 Visualisation Tool:
 Nerves, soft tissue masses
 Vessels - assessment of position, size, patency
 Ultrasound Guided Procedures in real time –
dynamic imaging; central venous access, nerve
blocks
 Imaging

 Know your anatomy – Skin, muscle, tendons,

nerves and vessels
 Recognise normal appearances – compare sides!
Skin, subcutaneous tissue
 Summary

 Imaging tool – Must have the knowledge to understand how

the image is formed

 Dynamic technique

 Acquisition and interpretation dependant upon the skills of

the operator.
 Acoustic Impedance

 The velocity of sound in a tissue and tissue density

= determine acoustic impedance
 Most soft tissues = 1400-1600m/sec
 Bone = 4080, Air = 330
› Sound will not penetrate – gets reflected or absorbed

 Travel time – dot depth

 Attenuation

 Absorption = energy is captured by the tissue then

converted to heat
 Reflection = occurs at interfaces between tissues of
different acoustic properties
 Scattering = beam hits irregular interface – beam
gets scattered
 Ultrasound Terminology

 Never use dense, opaque, lucent

 Anechoic
› No returning echoes= black (acellular fluid)
 Echogenic
› Regarding fluid--some shade of grey d/t returning echoes
 Relative terms
› Comparison to normal echogenicity of the same organ or
other structure
› Hypoechoic, isoechoic, hyperechoic
 Spleen should be hyperechoic to liver
When an ultrasound wave passes through tissues
Attenuation: Reduction in amplitude and intensity of wave
Reflection: Back to the transducer
Scattering- Refraction: Change in direction & velocity of wave
 Modes of Ultrasound

 A-mode :Amplitude
 B-mode: Brightness
 M-mode: Motion
 Doppler
 Color Doppler
 Spectral Doppler
 Power Doppler
 Doppler Ultrasound
 •As the ultrasound reflects off the flowing blood there
is a Doppler Shift.
 •This can be used to analyse the flow of blood in an
artery or through the heart.
 •A Doppler ultrasound, also known as a
echocardiogram ,can be used to diagnose coronary
heart disease (artery blockages) and other heart
problems with the valves or the hearts rhythm
 Ultrasound flow in a spleen. Colour is added to the image; red
is flow away from the probe and blue is flow towards the
probe.
 3D Ultrasound
 3D Ultrasound
 Recent advances in electronics and computing power
have led to the development of 3D scanning which
shows greater detail such as perspective
 4D Ultrasound
 If many images are recorded in the scan and
merged together a movement can be seen and so
a movie can be made
 Computers can also add „ a skin effect‟ this is
called surface rendering picture for 4D scan of
twins in the womb
 Research from Ultrasound

 Recent advances in imaging have lead to new

discoveries about the behaviour of the unborn. It
is now known that the unborn baby opens its
eyes, cries, yawns and even scratches!
 Student Activity

 Ultrasound scans have always been able to determine the

sex of the baby.
 Some parents do not wish to know the gender of their baby
 What do you think?
 It is also now possible to diagnose many more foetal
abnormalities
 Could this lead to increased numbers of terminations?
 -this is a complex medical ethics issue
 What are your opinions?
 Maybe you would like to do further research,
 write an essay or debate the issue?
 Ultrasound Treatments
 Ultrasound is the best form of heat treatment for soft tissue
injuries. It is used to treat joint and muscle sprains, and
tendonitis.
 Ultrasound treatment is used to:

•relieve pain and inflammation

•speed healing
•reduce muscle spasms
•increase range of motion
 Ultrasound uses high frequency sound waves. The sound waves
vibrate tissues deep inside the injured area. This creates heat that
draws more blood into the tissues. The tissues then respond to
healing nutrients brought in by the blood and the repair process
begins.
 Lithotripsy

 LITHO = Stone , TRIP = To Break

 Lithotripsy (also called ESWL- Extra-Corporeal Shock
Wave Lithotripsy) is a method is breaking up kidney
stones in the kidneys or tract ,using ultasound shock
waves.

A kidney stone(2cm diameter)

formed from build up of calcium A Lithotripter machine
 Some Other Ultrasound Treatments

 Treating benign and malignant tumors and other

disorders, via a process known as Focused Ultrasound
Surgery (FUS)
 Ultrasound sources may be used to clean teeth in dental
hygiene
 Focused ultrasound sources may be used for cataract
treatment
 Low intensity pulsed ultrasound is used for
therapeutic tooth and bone regeneration.
 As a guidance tool for „key hole surgery‟
 Detecting prostate cancer early
 Possible Dangers of Ultrasound
 There have been many concerns about the safety of ultrasound.
Because ultrasound is energy there may be some side effects,
particularly due to high doses or many scans.
 There have been some reports of low birthweight babies being born
to mothers who had frequent ultrasound examinations during
pregnancy
 The two problems with ultrasound are : The development of heat -
tissues or water absorb the ultrasound energy which increases their
temperature locally The formation of bubbles when dissolved gases
within the body come out of solution due to local heat caused by
ultrasound.
 However, there have been no substantiated ill-effects of ultrasound
documented in studies in either humans or animals.
 This being said, ultrasound should still be used only when necessary
Thank you!!!