2F 2014 Utah Basic Physics Knobology Hamlin PDF

!
WINFOCUS’ BASIC ECHO (WBE)
Basic Ultrasound Physics

and Knobology
Mark P. Hamlin, MD, MS 
Associate Professor of Anesthesiology and Surgery

University of Vermont College of Medicine
Co-Director of Surgical Critical Care
Medical Director of Respiratory Care Services
Fletcher Allen Health Care
Burlington, Vermont
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!
Outline
• A basic overview of sound
• Understanding types of transducers, and

basic modes
• Understanding common controls across

platforms
• Optimizing images
!
Types of Waves
• Transverse
• Longitudinal
Sound is a Longitudinal mechanical wave

Compressions an rarefac@ons of molecules in gas, liquid, or solid
!
Types of Waves
• Transverse
• Longitudinal
Sound is a Longitudinal mechanical wave

Compressions an rarefac@ons of molecules in gas, liquid, or solid
!
Sound Waves
• Audible sound 20 Hz to 20 KHz
• Ultrasound > 20 KHz
• Diagnostic Ultrasound 1 MHz to 20 MHz

!
Frequency and Penetration
• High Frequency (MHZ) gives better

resolution, but limited tissue depth of
view
• Low Frequency gives better tissue

penetration

Ultrasound Wave !
Interaction With Tissues
Tissue 1
Tissue 2
Refraction
Scattering Attenuation
• Specular=mirror reflectors-‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

(Image demonstrates apparent gaps in vessel wall on sides due to lack of reflec@on)
• ScaOer=diffuse, irregulari@es in surface are larger than wavelength of wound wave
Ultrasound Wave !
Interaction With Tissues
Tissue 1
Tissue 2
Refraction
Scattering Attenuation
• Specular=mirror reflectors-‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

(Image demonstrates apparent gaps in vessel wall on sides due to lack of reflec@on)
• ScaOer=diffuse, irregulari@es in surface are larger than wavelength of wound wave
Speed and Time !
Characteristics of Sound Waves

• Period
• Frequency
• Wavelength
• Propagation speed
• 1540m/s in soft
tissue, vs. 330 in
air
Period-‐Dura@on of one cycle 0.1-‐0.5 microsecs for US

Wavelength =Velocity (1540 m/s) X Frequency (in mHZ)
Bigness Characteristics !
of Sound
• Amplitude
• Power
• Intensity

!
Power/Intensity
• Power-Amount of
energy transferred
to tissues total
• Intensity-
Concentration
!
of
energy
Bioeffects on @ssues regulate limits of power output by medical US imaging devices.
!
Power/Intensity
• Power-Amount of
energy transferred
to tissues total
• Intensity-
Concentration
!
of
energy
Bioeffects on @ssues regulate limits of power output by medical US imaging devices.
!
Transducer Design
Uncouples internal components

from case
Absorbs unnecessary sound
Piezoelectric crystal
• Piezo Electric crystals create sound when electricity applied!

Energy created varies based on how fast and how strong electrical impulses are sent to crystals
!
Transducer Types
• Traditional-One sending/one receiving, or

stepwise (L to R)
• Phased array-smaller footprint, but

triangular image to see wide area
Non-phased array- shape of beam matches shape of probe end!

Phased, by timing the energy releases the combined wavefronts can be shaped
!
Creating an image
• Sound enters tissue
• Transducer sends sound and

receives reflection, machine
measures time, and since velocity
known (1540) it plots distance
• Brightness=amount of reflection,
acoustic characteristics of tissues
!
Display Modes
• A-mode
• (history)
• B-mode
• “2D”
• M-mode

!
Knobology Rules
• “Platform vary, but basics don’t”

• Button location will vary based on manufacturer design,
so don’t worry if you cannot find them right away
• More important to know basic approach
• “Continue to learn ‘knobs’ as you scan”
• Understand basic knobology before scanning.
• Acceptable to review knobology as you are scanning

!
Knobology Rules
• Platform manipulation and probe handling

are key to:
• Achieving technical know-how
• Achieving interpretation expertise

!
device footprinting evolving...
so know ‘pros’ & ‘cons’

!
Portability

!
Portability
Power /
Capability

!
Preparing to scan

!
Preparing to scan
Turn power on

!
Ensure Proper Connections

!

Ensure properly
connected probe
adapter.

!

Ensure properly Connect ECG cable, either
connected probe via patient monitor or
adapter. applied 3-lead ECG.

!
Select Your Transducer
Select ‘Cardiac’
transducer

!
Common Transducers
‘Cardiac’
‘Deep penetration
probe’
‘Curved’
‘moderate penetration
probe’
‘Linear’
‘superficial penetration
probe’
Different vendors have different probes. It is important to know your vendor’s probes, their usages, limitations, etc.
!
Common Transducers
‘Cardiac’
5-1MHz, phased array
35cm scan depth
‘Linear’
13-6MHz, 25-mm
broadband
6cm scan depth
‘Small curved’
8-5MHz, curved array
10cm scan depth

!
Common Transducers
‘Cardiac’
5-1MHz, phased array
35cm scan depth
‘Linear’
13-6MHz, 25-mm
broadband
6cm scan depth
‘Small curved’
8-5MHz, curved array
10cm scan depth
Remember: !
• ↓ Frequency = ↑ penetration = ↓ resolution.!
• ↑ Frequency = ↓ penetration = ↑ resolution.

!
Enter patient data
Pa#ent
Preferable
to enter
pa@ent info
before
image
storage.

!
Patient data entry and storage
Create patient
•Use keyboard
•HT, WT, BP to
obtain indexed
values.
Enter name, dob, etc.!

Ht, weight to obtain indexed values. Such as cardiac index!
Same page typically accessed to export images
!
Before you scan... review platform
options
keyboard gain
2D
Doppler Image manipulation/
M-mode calculations

!
Before you scan... review platform
options
keyboard
gain
2D
Doppler
M-mode Image
manipulation/
calculations

!
Be aware of options
Op@ons may change with mode selec@on.
options

!
Adjust sweep speed

!
Adjust sweep speed
S l o w e r
AV interrogation
via M-mode
!
Adjust sweep speed
Faster
S l o w e r
AV interrogation
via M-mode IVC collapsibility
!
Gain
• This is a receiving function

• Does not impact how much energy is
transmitted to patient (i.e. power)

Adjust gain & time gain compensation !
(TGC)
• Near field!
• Strong reflected
signals
• Far field!
• Weak reflected
signals
TGC allows compensation for Attenuation of signal due to absortion

(TGC)
• Near field!
• Strong reflected Time Gain Compensation
signals (TGC)!
• Corrects varying depths of
intensities in imaging field
• Adjust TGC to:

1.Decrease in the near field
2. Increase in the far field
• Far field!
• Weak reflected
signals

(TGC)
• Near field!
• Strong reflected Time Gain Compensation
signals (TGC)!
• Corrects varying depths of
intensities in imaging field
• Adjust TGC to:

1.Decrease in the near field
2. Increase in the far field
Gain!
• Far field! • OVERALL amplification of
returning ultrasound
• Weak reflected signal received from ALL
signals
depths

!
Extremes in tgc & gain
Too bright Too dark
high amplitude low amplitude

!
Extremes in tgc & gain
Too bright Too dark
high amplitude low amplitude
If gain too high, noise

amplified, so
differentiation lost
!
graded tgc.....
Gradual near-to-far field adjustment

!
graded tgc.....
Gradual near-to-far field adjustment

!
gain affects image interpretation
Optimal gain
!
Optimal gain
!

Signal “blooming” vs. Signal “dropout”
↑ (‘over’) gain ↓ (‘under’) gain

!

!
Extent of left pleural effusion?

!
start scanning
2D
•Two-dimensional imaging
•Most systems default to 2D
at startup
Freeze
•Regulates between
active and still
image

!
2D-live vs. 2D-freeze
2D ‘frozen’ or
‘still’ image
2D ‘live’ image

!
2D-live vs. 2D-freeze
2D ‘frozen’ or
‘still’ image
2D ‘live’ image

!
M-mode
M-mode
Temporal
measurement
of object(s)
movement
away and
toward
transducer

!
M-mode
Distance
IVC via 2D time
IVC collapsibility via M-Mode

!
M-mode
Distance
IVC via 2D time
IVC collapsibility via M-Mode

!
Doppler modes: pulse wave (PW),
color flow (CF), continuous wave (CW)
CW
• transducer emits & receives
continuously
• High velocity
• Velocity depth indeterminate
PW CF (CFM)
• transducer emits • Type of PW,
ultrasound in transducer emits
pulses pulses
• Lower velocity • Flow direction/
• Velocity depth dynamics color
measurable coded

!
Doppler modes: pulse wave (PW),
color flow (CF), continuous wave (CW)
PW CF (CFM)
• transducer emits • Type of PW,
ultrasound in transducer emits
pulses pulses
• Lower velocity • Flow direction/
• Velocity depth dynamics color
measurable coded
CW
• transducer emits & receives
continuously
• High velocity
• Velocity depth indeterminate
Anatomy of Pulsed !
Ultrasound Beam
Receive Time
Listening Pulse repetition period
Time Pulse repetition frequency
Off Time
Transmit Pulse Duration

Time Pulse Length
Talking Time
On Time Pulse Duration
Duty Factor=
Pulse repetition
period
!
Pulse Wave Doppler

!
Pulse Wave Doppler

!
Pulse Wave Doppler

Place your
‘sample volume
box’ over area of
interest.

!
Pulse Wave Doppler

!
Pulse Wave Doppler

Trace LVOT
VTI + adjust
HR using
trackball.

!
Color Flow Doppler
!
By convention, Blue is Away from transducer-watch for “invert”
!
Color Flow Doppler
!
!
Color Flow Doppler
!
!
Color Flow Doppler

Adjust ‘Region of
interest’ for color
display
!
!
Color Flow Doppler
small region + shallow

depth = temporal
resolution
!
!
Color Flow Doppler
!
!
Color Flow Doppler
Adjust ‘Color
gain’ amplifies
signal
!
!
Color Flow Doppler

!
Color Flow Doppler

!
Color Flow Doppler

Adjust ‘Color scale’:
range of velocities
displayed

!
Color Flow Doppler
Detecting low
velocities requires
lower color scale

!
Continuous Wave Doppler

!

!

!

!
Move cursor using
‘trackball,’ mark with ‘Set’
button

!
V = 4.20m/s
P =( 4v2) ~ 70.67mmHg

!
Adjust depth, sector size, zoom...
Trackball & Set

•Ball controls cursor Depth
movement, sector size, Controls the
window rotation. maximal imaging
•Set locks & unlocks. display distance.
Zoom
Live image
amplification of
defined area.

!
Effects of Imaging Depth
• Image size
• Depth change affects reduction/enlargement of
displayed structures ➙ affects evaluation
• Frame rate
• Time per second an image is updated
• ↑ Depth of structure = ↑ US penetration needed =
↑wait-time between pulses = ↓ frame rate

!

• Temporal resolution
• Ability to evaluate rapidly moving structures
• Directly related to frame rate
• For optimal temporal resolution keep
imaging depth just beyond region of
interest
•Lateral resolution
•Ability to evaluate structures perpendicular
to US beam
•↑ Depth of structure = ↓ lateral resolution
!
• Sector size
• Usually starts with ‘wide & deep’ sector for broad
view
• Wide sector size = ↓ frame rate & ↓ temporal
resolution
• If fast moving structure, narrow your sector or
consider M-mode
• Zoom
• Magnification without change in resolution
!
Real-Time Imaging
‣ Frame rate
‣ Temporal resolution
- line density
- sector size
• Absolute amount of info returning slows procession

• Depth of viewing determines frame rate
• USE THE NARROWEST AND SHORTEST WINDOW YOU CAN
!
Sector Width

!
Sector Width

!
Sector Width

!
Calculations
Measure
•Brings up cardiac calculations folders.
•Some devices, use ‘trackball,’ ‘cursor,’ and
Worksheet ‘set’ to access.
•Compiles data & calculations.
•May edit, delete, save.

!
Calculations & Measurements
Cardiac calculation
•Open folder
•Using ‘cursor,’ select specific
measure or calculation.

!
Calculations & Measurements
Cardiac calculation
•Open folder
•Using ‘cursor,’ select specific
measure or calculation.

!
LVOT Measurement
D = 1.43 cm
Measurements parallel to beam are most accurate, try to orient imaging to obtain this,
example measure LVOT from PSLAX not Apical view.
!
LV 2D Measurements

!
Options: image optimizing techniques
options

!
Options: image optimizing techniques
• Frequency (freq)
• ↑ freq = ↓ penetration = ↑ resolution of
proximal structures
• If deep structures, will need ↓ freq.
• If superficial structures, will need ↑ freq.
• For example, obese patient may need ↓ freq.
Higher Frequency=greater attenuation in tissues

!
Frequency
Freq Freq
3.6 MHz 1.5 MHz
↑ freq = ↓ penetration ↓ freq = ↑ penetration

!
Frequency
Freq Freq
3.6 MHz 1.5 MHz
↑ freq = ↓ penetration ↓ freq = ↑ penetration

!
B-color
Grey color scale

!
B-color
Grey color scale

!
B-color
Blue color scale Orange color scale

!
Summary
• Remember how to choose an appropriate

ultrasound transducer
• Apply the basics of an ultrasound platform to any

echocardiography device
• Practice basic image optimizing techniques

!
Take home messages

• Ultrasound beam reflection is the basis for
the image
• High frequency=high resolution but low
penetration depth
• Image quality and temporal resolution are
at odds
• Optimizing gain and imaging settings is
essential for interpretation
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY 60

!
Questions?

2F 2014 Utah Basic Physics Knobology Hamlin PDF

Uploaded by

Copyright:

Available Formats

2F 2014 Utah Basic Physics Knobology Hamlin PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2F 2014 Utah Basic Physics Knobology Hamlin PDF

Uploaded by

Copyright:

Available Formats

!

WINFOCUS’ BASIC ECHO (WBE)

Basic Ultrasound Physics

Associate Professor of Anesthesiology and Surgery

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• A basic overview of sound

• Understanding types of transducers, and

• Understanding common controls across

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Sound is a Longitudinal mechanical wave

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Sound is a Longitudinal mechanical wave

• Audible sound 20 Hz to 20 KHz

• Ultrasound > 20 KHz

• Diagnostic Ultrasound 1 MHz to 20 MHz

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• High Frequency (MHZ) gives better

• Low Frequency gives better tissue

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Interaction With Tissues

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• Specular=mirror reﬂectors-­‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

Interaction With Tissues

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• Specular=mirror reﬂectors-­‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

Characteristics of Sound Waves

Period-­‐Dura@on of one cycle 0.1-­‐0.5 microsecs for US

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Uncouples internal components

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• Piezo Electric crystals create sound when electricity applied!

• Traditional-One sending/one receiving, or

• Phased array-smaller footprint, but

Non-phased array- shape of beam matches shape of probe end!

• Sound enters tissue

• Transducer sends sound and

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• “Platform vary, but basics don’t”

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

• Platform manipulation and probe handling

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Ensure Proper Connections

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Ensure Proper Connections

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Ensure Proper Connections

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

Enter patient data

• Specular=mirror reﬂectors-‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

• Specular=mirror reﬂectors-‐ANGLE is CRITICAL FOR SPECULAR REFLECTORS

Period-‐Dura@on of one cycle 0.1-‐0.5 microsecs for US