Dr. med. Dirk Manski

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Principles of Ultrasound Imaging

Ultrasound Waves


Ultrasound waves are longitudinal pressure waves with a frequency above 20,000 Hz. For diagnostic ultrasound frequencies between 2–10 MHz (Megahertz) are used (Singer et al, 2006).

Creation of ultrasound waves:

The ultrasound waves are generated using the piezoelectric effect: a voltage change on a quartz crystal leads to the deformation of the crystal. Ultrasonic waves can be generated with alternating current from a high-frequency generator applied to a series of crystals in the transducer.

Detection of the ultrasound echo:

The reflected ultrasonic waves (echo) generate a low voltage by deforming the piezoelectric crystal. The electric signal is amplified and computed: the time shift between generation and dection enables to assign the signal to a tissue depth.

Pulse echo principle:

The high frequency generator generates a short wave series (e.g. 2 periods, approximately 0.3–0.6 μ duration). Thereafter, the piezoelectric crystal in the transducer serves as a detector for the reflected sound waves. The next pulse-echo cycle can only be started after receiving the echo from the selected maximum depth.


The axial imaging resolution (in direction the wave) depends on the frequency (e.g. 0.2–0.3 mm at 7.5 MHz). The higher the frequency, the better the resolution. The lateral imaging resolution depends on the geometry of the transducer and is highest in the focal zone. In a 7.5 MHz linear transducer, the lateral imaging resolution is 0.5–0.7 mm.

Interaction of Ultrasound Waves with Tissue

Sound waves propagate through tissue at a speed of about 1540 m/s. The ultrasonic waves are attenuated by various mechanisms (reflection, scattering, interference and absorption). The lower the frequency of the ultrasound, the less the waves are attenuated by the tissue and the better the ability to study deep regions.


At the interface of tissues with different density, there is a partial or complete reflection of the ultrasound wave. The returning wave is the crucial component in diagnostic ultrasound, which provides the information about the tissue structure.


If the ultrasound wave hits a small object, a circular reflection wave is created. The interference of the scattered sound waves produces a grainy echo of actually homogeneous tissues (speckle-noise).


If the ultrasound wave hits nonperpendicular an interface of tissues with different density, the advancing non-reflected wave is deflected in its direction of propagation.


Loss of ultrasound wave energy due to friction, heat is generated.

Ultrasound Artefacts

The interaction of ulrasound waves with tissues can lead to disturbances of the image structure, which do not correspond to the tissue anatomy. Knowledge of artifacts is helpful in diagnostics.


The interference of scattered sound waves produces a grainy echo of actually homogeneous tissues (speckle noise). Another form of noise is multiple small reflexes in echo-free structures close to the transducer (bladder or liver cysts).

Acoustic shadow:

Dorsal echo free area behind strongly reflecting or absorbing interfaces (stone, bone, air) [fig. kidney stone].

figure Acoustic shadow of a kidney stone

Acoustic shadow of a kidney stone. With kind permission by Dr. H. Kempter, Augsburg.

Acoustic enhancement:

Reduced ultrasound wave attenuation (increased through-transmission) in echo-poor tissues (cysts) leads to an enhancement of the posterior echo signal [fig. testicular cyst].

figure Testicular cyst with acoustic enhancement

Testicular cyst with acoustic enhancement, with kind permission by Prof. Dr. R. Harzmann, Augsburg.

Edging artefact:

Narrow shadow dorsal to the lateral boundary of a circular structure. The ultrasound wave is strongly attenuated by a combination of refraction and scattering caused by tangential hit of the lateral boundary [fig. testicular cyst with edging artefact].

figure Edging artefact due to an testicular cyst

Testicular cyst with edging artefact. With kind permission by Dr. M. Fretschner, Augsburg.


Ultrasound waves can be reflected several times between two parallel interfaces, these additional reflection waves are computed according to the additional time to a greater depth.

Mirrow image:

Strong reflecting interfaces may cause a specular reflection of the ultrasound wave leading to mirrow image.

Comet tail:

Strong repetitive echoes can disturb the image behind strongly reflective interfaces (reverberation artifact).

Side lobe artefact:

Arcuate reflections of highly reflective interfaces, which are only visible in hypoechoic structures. The side lobe artefact is caused by echo reflections from the side lobe beam of the transducer.

Imaging Modes

The reflected echo can be displayed in different modes:


Amplitude modulation, display of the echo in a diagram, the x-axis represents the depth and the y-axis the echo intensity. The A-mode is not used any more in modern ultrasound imaging.


Brightness modulation, the echo intensity is converted into brightness. Modern ultrasound (gray value).

2D real time:

A linear array of transducers simultaneously scans a plane through the body. The echo is computed into a two-dimensional sectional image of the examined region. The frame rate of the image depends on the probe frequency and imaging depth and varies from a few to over 100 frames per second. 2D real time mode is the most commonly used in urology, it can be combined with Doppler sonography.


Motion mode. The amplitude of the echo along a chosen line is shown on the y-axis, the x-axis represents the time. The M-mode has a high frame rate and is used to display fast motion sequences of moving organs (e.g. heart valve or ventricular wall).


Doppler mode. The Doppler effect is used to visualize the blood flow, see next section Doppler ultrasound.

Ultrasound Transducers

Linear transducer:

The linear arrangement of the piezoelectric crystals produces a rectangular beam shape. Linear transducers offer a high near-field resolution and use frequencies around 7,5 MHz.

Convex transducers:

Convex transducers or curved array transducer. Curved linear arrangement of the piezoelectric crystals reduces the footprint of the probe and produces a wide convex beam with an acceptable near-field resolution. Convex transducers are useful for imaging the abdominal cavity and use frequencies of 2,5–5 MHz.

Sector array transducers:

The arrangement of the piezoelectric crystals produces a triangular beam (slice-of-pie shape with a field of view near 90 degrees. The near-field resolution is poor, sector array transducers have the smallest footprint and are used to for imaging deep structures. Sector array transducers are used for cardiac and abdominal imaging.

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Singer u.a. 2006 SINGER, Eric A. ; GOLIJANIN, Dragan J. ; DAVIS, Robert S. ; DOGRA, Vikram:
What’s new in urologic ultrasound?
In: Urol Clin North Am
33 (2006), Aug, Nr. 3, S. 279–286

  Deutsche Version: Grundlagen der Ultraschall Untersuchung (Sonographie)