n ultrasonography, a signal generator is combined with a transducer.

Piezoelectric crystals in the

signal generator convert electricity into high-frequency sound waves, which are sent into tissues.
The tissues scatter, reflect, and absorb the sound waves to various degrees. The sound waves that
are reflected back (echoes) are converted into electric signals. A computer analyzes the signals
and displays an anatomic image on a screen.
Ultrasonography is portable, widely available, relatively inexpensive, and safe. No radiation is
used.

Uses of Ultrasonography
Ultrasonography can identify superficial growths and foreign bodies (eg, in the thyroid gland,
breasts, testes, limbs, and some lymph nodes). With deeper structures, other tissues and densities
(eg, bone, gas) can interfere with images.
Ultrasonography is commonly used to evaluate the following:

Heart (echocardiography): For example, to detect valvular and chamber size

abnormalities and to estimate ejection fraction and myocardial strain (see
Echocardiography)

Gallbladder and biliary tract: For example, to detect gallstones and biliary tract
obstruction (see Ultrasonography)

Urinary tract: For example, to distinguish cysts (usually benign) from solid masses
(often malignant) in the kidneys or to detect obstruction such as calculi or other structural
abnormalities in the kidneys, ureters, or bladder (see Genitourinary Imaging Tests :
Ultrasonography)

Female reproductive organs: For example, to detect tumors and inflammation in the
ovaries, fallopian tubes, or uterus (see Approach to the Gynecologic Patient:Imaging
tests)

Pregnancy: For example, to evaluate the growth and development of the fetus and to
detect abnormalities of the placenta (eg, placenta previasee Ultrasonography).

Musculoskeletal: To evaluate muscles, tendons, and nerves.

Ultrasonography can also be used to guide biopsy sampling.

Ultrasonography is sometimes done internally, using a small transducer on the tip of an
endoscope or vascular catheter.

Variations of Ultrasonography
Ultrasound information can be displayed in several ways.

A-mode
This display mode is the simplest; signals are recorded as spikes on a graph. The vertical (Y) axis
of the display shows the echo amplitude, and the horizontal (X) axis shows depth or distance into
the patient.
This type of ultrasonography is used for ophthalmologic scanning.

B-mode (gray-scale)
This mode is most often used in diagnostic imaging; signals are displayed as a 2-dimensional
anatomic image.
B-mode is commonly used to evaluate the developing fetus and to evaluate organs, including the
liver, spleen, kidneys, thyroid gland, testes, breasts, uterus, ovaries, and prostate gland.
B-mode ultrasonography is fast enough to show real-time motion, such as the motion of the
beating heart or pulsating blood vessels. Real-time imaging provides anatomic and functional
information.

M-mode
This mode is used to image moving structures; signals reflected by the moving structures are
converted into waves that are displayed continuously across a vertical axis.
M-mode is used primarily for assessment of fetal heartbeat and, in cardiac imaging, most notably
to evaluate valvular disorders.

Doppler
This type of ultrasonography is used to assess blood flow. Doppler ultrasonography uses the
Doppler effect (alteration of sound frequency by reflection off a moving object). The moving
objects are RBCs in blood.
Direction and velocity of blood flow can be determined by analyzing changes in the frequency of
sound waves:

If a reflected sound wave is lower in frequency than the transmitted sound wave, blood
flow is away from the transducer.

If a reflected sound wave is higher in frequency than the transmitted sound wave, blood
flow is toward the transducer.

The magnitude of the change in frequency is proportional to blood flow velocity.

Changes in frequency of the reflected sound waves are converted into images showing blood
flow direction and velocity.

Color Doppler Ultrasonography

Doppler ultrasonography is also used

To evaluate vascularity of tumors and organs

To evaluate heart function (eg, as for echocardiography)

To detect occlusion and stenosis of blood vessels

To detect blood clots in blood vessels (eg, in deep venous thrombosis)

Spectral Doppler ultrasonography displays blood flow information as a graph with velocity on
the vertical axis and time on the horizontal axis. Specific velocities can be measured if the
Doppler angle (the angle between the direction of the ultrasound beam and the direction of blood
flow) can be determined. Velocity measurements and the appearance of the spectral Doppler
tracing can indicate the severity of vascular stenoses.
Duplex Doppler ultrasonography combines the graphic display of spectral ultrasonography
with the images of B-mode.
Color Doppler ultrasonography converts the Doppler blood flow information into a color
image with blood flow in color; it is displayed on a gray-scale anatomic ultrasound image.
Direction of blood flow is indicated by the shade of color (eg, red for blood flow toward the
transducer, blue for blood flow away from the transducer). Average blood flow velocity is
indicated by the brightness of the color (eg, bright red indicates high-velocity flow toward the
transducer; dark blue indicates low-velocity flow away from the transducer).

Disadvantages of Ultrasonography
Quality of images depends on the skills of the operator.
Obtaining clear images of the target structures can be technically difficult in overweight patients.
Ultrasonography cannot be used to image through bone or gas, so certain images may be difficult
to obtain.
when 2D and 3D or 2D and 4D are used in collaboration with one another, much information can
be obtained.
There are several types of ultrasound, or sonogram, procedures, but what they have in common is
that all use high-frequency sound waves that scan and bounce off of the abdomen and pelvic
cavity, resulting in an image of the fetus and surrounding placenta.
2d ultrasound gives a black and white image of the fetus while it is in the mother's womb. the
picture usually shows the form of the fetus and can show its development but not in detail
3d ultrasound shows the structure of the fetus and several features such as the face of the fetus
etc.. The main benefit of 3d ultrasound is that it allows the parent the visualise the fetus and
observe if the fetus may have defects or anything abnormal.
4d ultrasound is similar to 3d ultrasound but instead it shows the images in motion as a real time

live action video. 4D is incredible in that it can offer a view of the unborn baby moving around,
yawning, sucking his or her thumb and even appearing to wave a hand

Producing a sound wave

Medical ultrasound scanner

A sound wave is typically produced by a piezoelectric transducer encased in a plastic housing.

Strong, short electrical pulses from the ultrasound machine drive the transducer at the desired
frequency. The frequencies can be anywhere between 1 and 18 MHz. Older technology
transducers focused their beam with physical lenses. Newer technology transducers use phased
array techniques to enable the ultrasound machine to change the direction and depth of focus.
The sound is focused either by the shape of the transducer, a lens in front of the transducer, or a
complex set of control pulses from the ultrasound scanner (Beamforming). This focusing
produces an arc-shaped sound wave from the face of the transducer. The wave travels into the
body and comes into focus at a desired depth.
Materials on the face of the transducer enable the sound to be transmitted efficiently into the
body (often a rubbery coating, a form of impedance matching). In addition, a water-based gel is
placed between the patient's skin and the probe.
The sound wave is partially reflected from the layers between different tissues or scattered from
smaller structures. Specifically, sound is reflected anywhere there are acoustic impedance
changes in the body: e.g. blood cells in blood plasma, small structures in organs, etc. Some of the
reflections return to the transducer.
Receiving the echoes

The return of the sound wave to the transducer results in the same process that it took to send the
sound wave, except in reverse. The return sound wave vibrates the transducer, the transducer
turns the vibrations into electrical pulses that travel to the ultrasonic scanner where they are
processed and transformed into a digital image.
Forming the image

To make an image, the ultrasound scanner must determine two things from each received echo:

1. How long it took the echo to be received from when the sound was
transmitted.
2. How strong the echo was.

Once the ultrasonic scanner determines these two things, it can locate which pixel in the image to
light up and to what intensity.
Transforming the received signal into a digital image may be explained by using a blank
spreadsheet as an analogy. First picture a long, flat transducer at the top of the sheet. Send pulses
down the 'columns' of the spreadsheet (A, B, C, etc.). Listen at each column for any return
echoes. When an echo is heard, note how long it took for the echo to return. The longer the wait,
the deeper the row (1,2,3, etc.). The strength of the echo determines the brightness setting for that
cell (white for a strong echo, black for a weak echo, and varying shades of grey for everything in
between.) When all the echoes are recorded on the sheet, we have a greyscale image.