Teaching Course

Basics of cardiac ultrasound I

Echocardiography essentials:
physics and instrumentation

Carmen Beladan, MD
University of Medicine and Pharmacy “Carol
Carol Davila”
Bucharest, Romania
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 What is Ultrasound?
• Sound is a mechanical wave transmitted through an
elastic medium by local displacement of particles within
the medium from the equilibrium position.

Ultrasound is a high frequency sound, exceeding the

upper limit of human hearing (over 20,000 Hz)

Feigenbaum’s Echocardiography, 6th Edition

Humphrey VF. Progress in Biophysics and Molecular Biology, 2007:93;195–211
 Basic Ultrasound Physics
• The displacement of the particles from their equilibrium
positions produces changes in the medium density
from the equilibrium density (compression/rarefaction)

Propagation
prressure
e

depth

Rarefaction Compression
 Properties of Sound Waves

The magnitude of the pressure changes along the wave

ssure

Amplitude
pres

Frequency 1 cycle Wavelength Velocity

Thenumber
The
Th speed
b with Thwhich
The athsound
l length
l per
off cycles diwave
off a single
second travels
l offthrough
l cycle the lt a given
th ultrasound medium
d wave
 Wavelength and frequency
• Wavelength and frequency are inversely related
• The unit of frequency is Hertz (Hz) = 1 cycle in one second

Cardiac US imaging frequency range

2‐3 MHz 3.5‐7 MHz 10‐40 MHz

TTE TEE IVUS
 Velocity
• Average
g speed
p of US in the human body y is 1540 m/sec
• Directly related to stiffness of the media
• Inversely related to density of the media
Medium Velocity (m/s)
Air 330
Fat 1450
Water 1480 c =λ x f
Soft tissue 1540
Blood 1570 λ = c/f
Muscle 1580
Bone 4080
Feigenbaum’s Echocardiography, 6th Edition
 Amplitude

• Amplitude (dB) is the magnitude of the pressure

changes along the sound wave (“loudness”)

• Power (Watts) is the rate at which energy is transferred

from a sound beam and is proportional to the amplitude
squared

• Intensity (Watts/cm2) is the concentration of energy in a

sound beam (power divided by its cross-sectional area).
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
Interactions between ultrasound and tissue

• Reflection
• Refraction
• Scattering
• Attenuation
reflected
refracted

θ1’ θ2
θ1

1 2
1 incident 2
 Reflection
Fraction of the reflected intensity depends on acoustic
impedances of the two media

medium 1 medium 2

Acoustic Impedance = Density X Speed of Sound

 IRC Equation

reflected intensity z 2 - z1 2
IRC = ------------------------ = ----------
incident intensity z 2 + z1

Acoustic
Impedance (rayls)
Air 400
Reflected fraction: 0.9995
Soft Tissue 1,630,000
 Reflection
• A specular reflection is produced by smooth reflectors
that are large relative to the transmitted wavelength

• A relatively greater proportion of the ultrasound energy is

reflected in an angle-
angle
g -dependent
p fashion
 Scattering
• Scatteringg is caused by y interaction with a very
y small
reflector or a very rough interface

• A small portion of the soundwave returns to the

transducer
Basis for Doppler Visualization of Visualization of the
imaging surfaces parallel to the texture of gray-scale
US beam images
g
 Attenuation

• The amplitude/strength of the wave decreases with

increasing depth
• Depends
D d on acoustic
ti impedance
i d

Attenuation is frequency
q y dependent
p such that lower US
frequencies penetrate deeper into the body.
Key points

• Higher frequency US allows smaller objects to be

visualized but the depth of penetration decreases
(i
(increased
d scattering)
i )

• The degree of penetration decreases with less

homogeneous
g media
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 Ultrasound imaging
• The reflected pulse gives information on: the amplitude
of the reflected signal and the time it takes returning

Ti
Time (T)

Distance= c x T/2
 Transducers
TRANSDUCER = a device which is capable of converting
one form of energy into another

Connector Matching Layer

Electrodes

Piezoelectric elements
Insulation

Backing Material

Crystal acts as speaker and microphone

 Piezoelectric Elements
• Wh
When an electric
l t i currentt is
i applied
li d the
th crystals
t l vibrate
ib t
resulting in the generation and transmission of
ultrasound energy

• The crystal will change shape in response to its

interaction with reflected energy and produce an
electrical impulse
p (piezoelectric effect))
(p
 Ultrasound beam
r2
l=
λ

Frequency, size, and focusing affect image quality in the

near and
d far
f fields
fi ld
Feigenbaum’s Echocardiography, 6th Edition
 Ultrasound beam
Li
Linear array Ph
Phased
d array

Beam stearing Beam focusing

 TOE probes – multiplane devices
• Square or circular configuration of US crystals

• Phased-array
y technologygy to steer the US examining
g
plane through a 180° arc

• 360
360° panoramic view of the cardiac structures

• Multiple frequencies: 3.5 - 7.0 MHz

• The knobs on the handle allow lateral flexion in both

directions and anteflexion and retroflexion of the probe

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 3D probes
V l
Volumetric
t i 3D echocardiography
h di h

• Full matrix phase-array transducer consisting of

approximately 3000 elements, arranged in a 2D grid, that
g of the US beam in both the elevation and
offers steering
the azimuth plane

Active US element

Shiota T. 3D Echocardiography, 2007.

EUROECHO CONGRESS - COPENHAGEN -

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 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 Resolution

Resolution is the ability to distinguish between

two objects in close proximity

• spatial resolution

• contrast resolution

• temporal resolution
 Spatial resolution
• A
Axial
i l Resolution
R l ti
– The smallest distance between 2 points that
allows the points to be distinguished as separate
– frequency, pulse length or duration affects axial
resolution

The higher the frequency the better the resolution

 Spatial resolution

• Lateral Resolution
– the ability to resolve two adjacent objects that are
perpendicular
di l to t the
th beam
b axis
i as separate
t objects
bj t
– Beam width, depth, gain affects lateral resolution
 Spatial resolution

Visualization of the interatrial septum

Lateral Resolution Axial Resolution

 Contrast resolution
Contrast Resolution
– the ability to distinguish and to display different
shades of gray within the image
 Temporal resolution
Temporal Resolution
– the ability of the system to accurately track moving
targets over time (also known as frame rate)
– depth of field affects temporal resolution
Profile of processing of raw data

1. Signal amplification
2 Time – gain compensation
2.
3. Filtering (to reduce noise)
4. Compression
5. Rectification
 Display options

A mode = Amplitude

B mode = Brightness

M mode = Motion
 M mode
M-mode
• A single crystal rapidly alternates between transmission
and receiver modes with rapid updating (>1000 Hz)
• Only
y one scan line

Very high temporal resolution: sampling rates > 1800 /sec

 2D mode
2D-mode
• As a pulse is sent out, the transducer has to wait for the
returning echoes, before a new pulse can be sent out,
generating the next line in the image

Tradeoff between line density and frame rate

 Tradeoffs in image creation

Depth PRF

Line density Sweep angle

Frame
rate
t
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 Doppler echocardiography

Doppler echo 2D echo

• p
provides information on • p
provides information on
function structure
• The primary target is the • The primary targets are
red blood cells the myocardium and
• Rely on a parallel cardiac valves
alignment
li t between
b t th
the • Functions
F ti optimally
ti ll
beam and the flow of when the beam and the
blood target are at right angles
Principles of Doppler Ultrasound
The apparent
pp pitch
p of sound is affected by
y motion
either toward or away from the listener
Principles of Doppler Ultrasound

fo
fr
Ɵ

Parallel to flow : Cos 0° = 1

2 f0 v 20°
f= cos Ɵ
c Perpendicular to flow: Cos 90° = 0
 Continuous wave Doppler
• Transducer continuously
y transmits and receives the
ultrasound data

Ad
Advantages:
t

-very high velocities can be accurately

resolved

Disadvantages:

- Lack
L k off selectivity
l ti it or depth
d th discrimination
di i i ti
 Pulsed wave Doppler
• Transducer alternatively
y transmits and receive the
ultrasound data to a sample volume
Advantages:

- Returning signals from one specific distance

from the transducer can be selectively
received and analyzed - range resolution

Disadvantages:

- Ambiguous information obtained when flow

velocity is high - aliasing
 Pulsed wave Doppler
• The number of pulses transmitted from a Doppler transducer
each second is called the Pulse Repetition Frequency (PRF)
• Sampling rate is an important determinant of how accurately
the system resolves frequency information

Nyquist limit = PRF/2

Aliasing
g will occur if low p
pulse repetition
p frequencies
q or
velocity scales are used and high velocities are
encountered
 High PRF Doppler
• Combines features of both PW and CW Doppler
pp imaging
g g

• Velocity information from the primary sample volume as

well as integer multiples of that depth during a single
listening event

• If the sample volume is placed at one-half of the actual

depth of interest, velocity information from both sites
can be recorded over two consecutive pulses.
 Color Flow Imaging
• A form of pulsed wave Doppler imaging that uses
multiple sample volumes along multiple raster lines to
record the Doppler shift

• Each pixel represents a region of interest in which the

flow characteristics must be measured

• Only mean frequencies and frequency spreads

(variance) are calculated

• By using a color reject threshold,

threshold only flow above a
given velocity level is displayed as color

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 Tissue harmonic imaging
• Integer multiples of the original frequency are referred to
as harmonics
h i

• By suppressing or eliminating the fundamental

component, an image is created primarily from the harmonic
energy
gy

• The strength of the harmonic frequency actually increases

as the
th wave penetrates
t t the
th body
b d

• Avoids many of the near field artifacts that affect

fundamental imaging
 Tissue harmonic imaging
Fundamental frequency imaging Tissue harmonic imaging

• The signal to noise ratio is improved and image quality is

enhanced in patients with poor fundamental frequency
images
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 Imaging Artifacts

Artifacts occur when the assumptions used in

the creation of the echocardiographic image are
not true.
 Artifacts

Acoustic shadowing Reverberations

Artifacts - reverberations
 Artifacts

Mirror imaging Ghosts

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 Artifacts

F
Frame rate
t artifact
tif t

EUROECHO CONGRESS - COPENHAGEN -

TEACHING COURSE 2010
 Agenda

• The
Th physics
h i off ultrasound
lt d
• Interactions between ultrasound and tissue
• Generation of ultrasound waves
• Ultrasound imaging
• Doppler principles
• Artifacts
• Biological effects of ultrasound
 Biological effects of US

The biological effect of an ultrasound signal is

proportional to:

• energy across the area of interest

• the spatial pattern of energy of the US beam
• the time duration of exposure to the tissue
• the US frequency
• the "sensitivity" of the tissue to US

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 Biological effects of US
• US heating:g The acoustic energygy removed from the
wave by absorption is deposited in the medium as
heat
• Cavitation: creation, oscillation, growth and
collapse of bubbles within a medium
• Oscillatory, sheer, radiation, pressure, and
microstreaming

Despite considerable study, virtually no clinically important

biologic
g effects attributable to ultrasound at diagnostic
g power
p
levels have been demonstrated

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 Therapeutic applications of ultrasound
• Physiotherapy
• Bone
B h
healing
li
• Ultrasonic enhancement of drug uptake:
9Sonophoresis
9Sonoporation and sonodynamic therapy
9Gene therapypy
9Sonothrombolysis
• High intensity focused ultrasound
9T t l HIFU
9Trans-rectal
9Extra-corporeal HIFU
9Haemostasis and vascular occlusion
Gail ter Haar. Progress in Biophysics and Molecular Biology 2007;93:111–129

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