Diagnostic

Ultrasound

Sutiporn Khampunnip, M.D.

 Definition of Ultrasound
• Ultrasound is simply sound waves, like audible sound.

• High-frequency sound and refers to mechanical

vibrations above 20 kHz.

• Human ears can hear sounds with frequencies between

20 Hz and 20 kHz.
• Ultrasound frequencies commonly used for
medical diagnosis are between 2 MHz and 15
MHz.
 Generation of ultrasound pulse
• Ultrasound transducers (or probes) contain
multiple piezoelectric crystals which are
interconnected electronically and vibrate in
response to an applied electric current.
 Imaging by ultrasound
• Ultrasound imaging is performed by emitting a pulse,
which is partly reflected from a boundary between two
tissue structures, and partly transmitted

• The reflection depends on the difference in impedance of

the two tissues.

• Different structures will reflect different amount of the

emitted energy, and thus the reflected signal from
different depths will have different amplitudes as shown
below. The time before a new pulse is sent out, is
dependent of the maximum desired depth that is desired
to image.
 Ultrasound wave length and
frequency
• Proper selection of transducer frequency is an
important concept for providing optimal image
resolution in diagnostic and procedural US.

• High-frequency ultrasound waves (short wavelength)

generate images of high axial resolution.

• Low-frequency waves (long wavelength) offer images

of lower resolution but can penetrate to deeper
structures due to a lower degree of attenuation
 Ultrasound Instruments
• Ultrasound machines convert the echoes received by
the transducer into visible dots, which form the
anatomic image on ultrasound screen

• A linear transducer can produce parallel scan lines

and rectangular display, called a linear scan

• Curved transducer yields a curvilinear scan and arc-

shaped image
 Bioeffect and Safety
• Ultrasound application could produce a
biologic effect can be characterized into two
aspects: heating and mechanical.
• The generation of heat increases as
ultrasound intensity or frequency is increased.
Curved transducer
linear transducer
Transvaginal transducer
• 4

4 D transducer
 Ultrasound mode
• A mode is the oldest ultrasound modality
• Simple one-dimensional ultrasound image is
generated
• B mode
• Two-dimensional image of the area
• B mode can provide a cross sectional image through
the area of interest
• Doppler mode
• Produces a color-coded map of Doppler shifts
superimposed onto a B-mode ultrasound image
• Blood flow direction depends on whether the motion
is toward or away from the transducer. Selected by
convention, red and blue colors provide information
about the direction and velocity of the blood flow.
• Power Doppler mode
• Up to five times more sensitive in detecting blood
flow than color Doppler and it is less dependent on
the scanning angle.
• Not provide any information on the direction and
speed of blood flow
• M mode
• A single beam in an ultrasound scan can be used to
produce a picture with a motion signal
• Movement of a structure such as a heart valve can
be depicted in a wave-like manner.
 Liver abscess
• Liver abscesses are typically poorly demarcated with a variable
appearance, ranging from predominantly hypoechoic (still with some
internal echoes however) to hyperechoic.
• Gas bubbles may also be seen.
• Doppler will demonstrate absence of central perfusion.
Cirrhosis
Acute cholecystitis
Pancreatitis
Renal calculi and hydronephrosis
Appendicitis
Torsion testis VS orchitis
Urinary bladder lesion
Other bowel lesion