Current Directions in Biomedical Engineering 2018; 4(1): 49 – 53

Ramona De Luca*, Tommaso Dattoma*, Leonardo Forzoni, Jeffrey Bamber, Paolo

Palchetti, Alessandro Gubbini
Diagnostic ultrasound probes: a typology and
overview of technologies

Abstract: The routine clinical use of diagnostic ultrasound elastography [1]. Diagnostic US imaging is used for many
(US) has spread considerably worldwide in recent decades. parts of the body [3], on fetal, neonatal, pediatric, adult, human
This is due in large part to the availability of US probes that and animal patients, and by users who may be for example
enable a wide range of clinical applications as well as provide sonographers, physicians, radiologists, surgeons,
performance benefits arising from technological anaesthetists, midwives, paramedics or veterinarians. US
improvements. This paper describes the current commercially imaging systems undergo rapid technology advancements and
available US probe types, lists some of their clinical this results in a quick rotation of products available on the
applications and briefly explains the technologies that are Market and change of price-performance ratio. Within this
responsible for recent enhancements in image quality and complex context, US probes play a crucial role in terms of both
ergonomics. Our intention is to summarize information that image quality and ergonomics. US probes are specialized to
will allow healthcare professionals to select the appropriate each clinical application and are becoming more and more
probe for the intended use and the desired performance-price sophisticated due to important technology improvements
ratio. leading to more significant and consistent diagnostic
information, faster and easier scanning and increased
Keywords: Medical imaging, ultrasound probes, typology,
reliability. This paper presents an overview of US probes
technologies
available nowadays on the Market, giving insights into
different types and latest inner technologies. This analysis
https://doi.org/10.1515/cdbme-2018-0013
should help users and other stakeholders with purchasing and
maintenance commitments to select the appropriate probe
according to their clinical and economical needs. The
1 Introduction description of both current categories and advanced
performance arising from latest innovations allows an
Being free of ionizing radiation, sufficiently hazardless, understanding of what contributes to different prices, features,
portable, compact, cost-effective and real time, diagnostic quality level and breadth of applications.
ultrasound (US) is the most widely used cross-sectional
imaging modality worldwide [1]. In addition to its ability to
provide images of internal body anatomy, detect the dynamic
movement of organs and reveal details of blood flow in real
2 US probes technologies
time [2], it offers a variety of imaging approaches, each
providing a different type of clinically relevant information. The US probe is responsible for conveying acoustic energy
These techniques include contrast enhanced ultrasound and from the US system into the body. The choices for design,
materials and manufacturing technologies play a key role in
achieving high image quality. Traditionally, the probe consists
______ in an acoustic stack composed of a backing block, a
*Corresponding authors: Ramona De Luca, Tommaso piezoelectric ceramic layer, acoustic matching layers and a
Dattoma: Esaote S.p.A., via di Caciolle 15, Florence 50127, Italy, lens [2]. The piezoelectric layer is a critical component
e-mail: [email protected], because it is the active material that converts the electrical
[email protected]
signal to an US wave and vice versa [4]. In the last decades,
Leonardo Forzoni, Paolo Palchetti, Alessandro Gubbini:
Esaote S.p.A., via di Caciolle 15, Florence 50127, Italy
lead zirconate titanate (PZT) ceramic was the predominant
Jeffrey Bamber: Institute of Cancer Research and Royal solution due to its excellent piezoelectric properties, chemical
Marsden NHS Foundation Trust, 15 Costwold Road, Sutton, inertness, physical strength, and easy and inexpensive
London, SM2 5NG, United Kingdom

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50  —  R. De Luca et al.: Diagnostic ultrasound probes: a typology and overview of technologies

manufacturing [5]. However, PZT has some serious phase, forwards. This reuse of acoustic energy that would
drawbacks as the very high acoustic impedance (20 times otherwise be dispersed makes for less heat dissipation. This is
higher than human tissue) and power loss from low conversion a crucial point since the heat dissipated in the transducer often
efficient [6], that have motivated the investigation of a new degrades the performance of the device, especially sensitivity
generation of piezoelectric materials, such as single crystal and penetration.
lead magnesium niobate-lead titanate (PMN-PT) and lead zinc Several options are available to implement the thermal
niobate-lead titanate (PZN-PT). Grown in a monocrystalline management. An example of an efficient cooling system is that
form with an increased efficiency of poling, single crystals based on a heat transfer device made of a graphene-based
exhibit an electromechanical coupling factor (k33) and a material, either pure graphene or a graphene-loaded resin,
piezoelectric coefficient (d33) up to 90% and three times higher which is placed on the front of the transducer assembly to work
than PZT, respectively. Compared with PZT, this technology also as part of the matching layer into the body [14].
allows the development of US transducers with larger Alternatively, a cooling system embedded at the rear of the
bandwidth, enhanced sensitivity and lower losses. As a result, transducer between the backing block and the acoustic
penetration and image resolution are improved, providing amplifier is also achievable. It is composed of a heat spreader,
more detailed diagnostic information even for difficult-to- which transfers heat away from the heat source, and a heat
image patients [4]. A further increase in efficiency of signal sink, which dissipates the heat [15].
transmission is obtained using multi-layered crystal Conventional 1D transducer arrays have good lateral and
technology, an advanced architecture developed to accomplish axial resolution, but elevation resolution is limited by the
an enhanced image quality. The core of this technology is a fixed-focus lens determining the image slice profile. Multi-
piezoelectric chip composed of several layers [7], which are row (typically 3-8 rows) transducer arrays can provide a thin
mounted in the acoustic stack to improve electrical matching image slice over an extended depth of field, providing
with the cable and reduce the energy and sensitivity loss due improved spatial and contrast resolution. There are two
to the typical mismatch between the output impedance of implementation strategies [16]: i) 1.5D arrays that have
transducer and load impedance of cable. electronic beamforming in both azimuth and elevation,
Micromachined ultrasound transducers (MUTs), namely allowing dynamic control of the elevation aperture and focus,
capacitive MUTs (cMUTs) and piezoelectric MUTs (pMUTs), and ii) 1.25D arrays that have the elevation rows connected
are practical substitutes of piezoelectric bulk ceramics for the together by switches allowing static elevation focusing
design of transducers. cMUTs consists of micromachined determined by a mechanical lens with a fixed focus (or foci).
surface membranes on silicon substrates [8], which exploit the 2D matrix arrays, consisting of many thousands of transducer
electrostatic transduction to transmit and receive acoustic elements, enable full electronic elevation apodization,
energy [9], [10], whereas pMUTs work by taking advantage of focusing and steering, and providing volumetric imaging in
the flexural motion of a thin membrane driven by a thin real time. 1.25D, 1.5D and 2D transducers are in commercial
piezoelectric film [11], [12]. Of the two technologies, cMUTs production, optimized for different clinical applications.
are already integrated in commercial products, providing high
spatial resolution from wide bandwidth (excess of 100%) and
narrow beam width due to easier manufacturability of multiple
3 US probes typology
rows of elements [10].
Innovation on piezoelectric materials alone is not enough
US probes are available in a wide range of sizes, shapes,
for augmenting image quality. A significant contribution to the
frequencies, with each probe optimized to specific clinical
performance of modern probes derives from the application of
imaging applications and resulting image formats. Proper
multiple adaptive matching layers (MAMLs) [6] and the
choice of probe before scanning is crucial and depends on
acoustic amplifier (AA) [13]. Both methods can be thought of
several factors such as exam type, scan depth and patient
as working by tuning the acoustic impedance of the
characteristics. Probes may be classified in two main
transducing element, transmitting a more faithful replica of the
categories: conventional probes (linear, phased and convex
intended pulse, attaining an even wider bandwidth and higher
arrays) and speciality probes that are dedicated to specific
sensitivity. MAMLs, mounted between the element and the
clinical applications (for instance, intraoperative and trans-
body, consist of a thin multi-layer with a tapered acoustic
esophageal probes).
impedance across the layers [6], whereas AAs, sandwiched
between the backing block and the element, detect the energy
transmitted backwards by the element and retransmit it in-

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R. De Luca et al.: Diagnostic ultrasound probes: a typology and overview of technologies  —  51

3.1 Conventional probes - Adult and pediatric trans-esophageal (TEE): imaging of

the heart made from within the esophagus.
The most prevalent US probe types are linear, phased and - TEE for continuous patient monitoring: hemodynamic US
convex arrays (Figure 1). Linear Arrays (LAs) are flat and for use in the intensive care unit (ICU).
provide rectangular or trapezoidal image format with a field of - Transnasal micro-multiplane TEE.
view that is roughly equal to the probe length [16]. They - Intraoperative: imaging during a surgical procedure.
operate over many frequency ranges, the choice of which - Intraoperative bi-plane: simultaneous biplane imaging
depends on the tissue depth of interest (the higher the with two orthogonal planes for needle guidance.
frequency, the better the resolution, but the poorer the depth of - Interventional CA and LA with biopsy guidance: imaging
tissue penetration). Typical frequency ranges for available with direct biopsy access within the array width.
probes are: medium (3-11 MHz) for vascular and small parts - Hockey stick: mainly dedicated to musculoskeletal
[16], high (4-18 MHz) for vascular and musculoskeletal, and imaging.
very high (8-24 MHz) for superficial anatomy (e.g., - Hockey stick with motorized tip for intraoperative
dermatology, rheumatology, superficial musculoskeletal). procedures.
Ultra-high frequency (30-70 MHz) linear arrays also exist for - Laparoscopic: imaging to guide and evaluate laparoscopic
dermatology and pre-clinical research. Phased arrays (PAs) surgery.
are also flat, but have smaller footprint to fit between ribs, - LA array manoeuvred by robotic surgery arm.
being primarily used for cardiac imaging. To achieve a field of - Electro-mechanical 3D (LA, CA, EC, MC, LA with
view sufficient to image the entire heart, they operate at parallel acquisition) for 4D real-time Imaging.
different frequencies depending on patient: 4-12 MHz for - Intravascular (IVUS): imaging of the interior of arteries
neonatal, 2-12 MHz for pediatric, 1-5 MHz for adult [16]. from catheter-tip transducers inserted in them.
Convex arrays (CAs) (1-9 MHz) are curved, with a radius of - Intracardiac: imaging from within the heart.
curvature (ROC) in the range 40-60 mm, and are used for - 3D matrix (LA, CA, PA, TEE).
abdominal and obstetrics applications [16]. - 3D Electro-mechanical transrectal: anorectal 3D Imaging
with 360° image field.
- Prostate triplane: images in three planes (transverse,
sagittal, end-fire), plus 3D image reconstruction.
Figure 1: Example of conventional probes: from left to right, LA, CA - Dual-headed probe integrating both LA and PA that is
and PA and the relative image format. typically used at point of care (POC).
CAs with smaller ROC (13-20 mm), namely micro-
- Oral probe: intra-oral imaging.
convex (MC) arrays, typically operate in the frequency range
- Trans-urethral probe.
3-11 MHz and are for pediatrics, vascular and veterinary uses.
- Endoscopic US probe: a small transducer is installed on
MCs specially designed for interventional use, mainly liver
the tip of an endoscope with a camera. It is used to image
biopsy, have lower frequency (2-7 MHz). Endo-cavity (EC)
the digestive tract and the surrounding organs.
probes are also curved (in general, ROC is 10 mm) and are
designed to access specific acoustic windows in the body (as - PA, LA and CA with USB connection
in obstetrics and gynecology). More complex, are bi-plane - PA, LA, CA wireless probes.
transrectal probes that have dual arrays: linear + convex (4-13 - Pencil Doppler: non-imaging CW and PW Doppler.
MHz/3-13 MHz) or convex + convex (2-12 MHz/2-12 MHz). - Photoacoustic probes: allowing tissue-illumination for US
(Figure 2) generation by optical-tissue interactions.
- Automated breast ultrasound volume scanner (ABVS)
with linear automatic scanning array.
- 3D whole breast US tomography system incorporating a
Figure 2: From left to right, examples of MC, EC and bi-plane circular US transducer immersed in water for prone patient
transrectal probes acquisition.
Figure 3 shows some examples of speciality probes.

3.2 Speciality probes

A list of speciality US probes available on the Market, with a
3.3 Additional features
description of some their peculiarities, is provided [2], [3]: The user interface ergonomics of the US systems and probes
is of primary importance due to the increased use of US

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52  —  R. De Luca et al.: Diagnostic ultrasound probes: a typology and overview of technologies

systems in the everyday clinical practice especially for choosing a product that has the most appropriate technical-
problems as work-related musculoskeletal disorders clinical performance/price ratio.
(WRMSD) for sonographers [3]. The percentage of
sonographers reporting consequences of pain and discomfort Acknowledgments
is close to 80% within the first five years of entering the We thank Guillaume Gauthier, Valentina Iorio and Marco
profession. A new probe design concept has been developed Maglione (Esaote S.p.A.) for their insights and expertise that
in recent years in order to reduce scanning fatigue and related greatly assisted the large market data collection summarized
WRMSD. Transducers with a dual-possibility hand grip in this paper. JB acknowledges support from the EPSRC and
(appleprobe™ design) are available (pinch grip and palmar Cancer Research UK.
grip) in order to provide a neutral wrist position, reduced
fatigue and making probes easier to handle [17]. An important Author Statement
aspect of probe typology and ergonomics is represented by Research funding: The authors state no funding involved. Con-
biopsy kits which are available for different uses and body flict of interest: Authors state no conflict of interest. Informed
areas, and for guidance of fine needle aspiration (FNA), consent: Informed consent is not applicable. Ethical approval:
percutaneous interventions and core biopsies. Another The conducted research is not related to either human or ani-
accessory that can be attached to an US probe is support for mals use.
navigation systems (usually electromagnetic or optical) for
real-time fusion imaging. A single electromagnetic or optical References
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