SPECIAL ISSUE PAPER 127

A tutorial on ultrasonic physics and imaging techniques

M Halliwell
Medical Physics and Bioengineering, Bristol General Hospital, Bristol, UK

The manuscript was received on 7 May 2009 and was accepted after revision for publication on 5 October 2009.

DOI: 10.1243/09544119JEIM656

Abstract: Ultrasound is a widely used modality for both therapy and diagnosis in medicine
and biology. Currently, in the field of medical diagnosis, ultrasound is responsible for about
one in five of all diagnostic images. The physical characteristics of medical ultrasound, along
with its behaviour as it interacts with biological tissues, are described in this tutorial. The role of
ultrasound in therapeutic and diagnostic applications is briefly described. In view of the
importance of ultrasound as a medical imaging modality, the basic technological building
blocks utilized in diagnostic ultrasound scanners are also described. Many of these topics are
the subjects of other papers in this special issue where they are dealt with in more detail.

Keywords: acoustic oscillation

1 INTRODUCTION ‘infra-sound’ has a frequency less than 20 Hz, the

The purpose of this medical ultrasound tutorial is to
introduce in a fairly uncomplicated manner: the
basic physics of ultrasound; the generation and
detection of high-frequency mechanical waves: the
interactions of ultrasound with biological tissues,
and some of the more frequently used techniques for
medical imaging. Specific consideration of the use of
ultrasound in therapeutic and diagnostic roles is
described elsewhere in this special issue; many of
the more complex details will be found there.
2 ULTRASOUND
Ultrasound is an example of an ‘acoustic oscillation’.
Acoustic oscillation is defined as: movement of
particles in an elastic medium about an equilibrium
position. Other instances of acoustic oscillation are
sound and infra sound. The only difference between
these is in the frequency of oscillation. For the
acoustic oscillation to be called ‘ultrasound’, its
frequency must be greater than 20 kHz, approxi-
mately the upper limit of human hearing. Similarly,
*Corresponding author: Medical Physics and Bioengineering,
Bristol General Hospital, Guinea Street, Bristol BS1 6SY, UK.
email: mike.halliwell@bris.ac.uk
lower limit of human hearing. Unsurprisingly,
‘sound’ occupies the in-between frequency range
(from 20 Hz to 20 kHz). The frequencies commonly
used in biological and imaging applications range
from about 500 kHz to more than 50 MHz.
3 PROPAGATION
A useful simple model of tissues shows them as a
three-dimensional (3D) matrix of balls connected to
their neighbours by springs (Fig. 1). In this model, a
movement of any one of the balls is transmitted to
its neighbours by the altered tensions in the
compressed or expanded springs.
Propagation of ultrasound, the oscillatory move-
ment of particles about a mean position, occurs by
the action of intra-particle forces (springs) on each
particle (ball) in the elastic medium (human tissue).
The way in which displacements propagate through
the medium is described by the wave equation. In its
simplest form, the wave equation for a one-dimen-
sional (1D) wave describes the time change of
pressure in terms of its change with distance as
L2 DP L2 DP
~c2 ð1Þ
Lt 2 Lx2

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Fig. 1 Simple ‘balls on springs’ model of matter. The
balls represent the particles of the material and
the springs represent the forces between each
particle and all its neighbours. The movement
of a single particle will change each force; this is
represented by a compression or expansion of
each spring
In three dimensions, the wave equation becomes

2 
L2 DP 2 L DP L2 DP L2 DP
~c z z
Lt 2 Lx2 Ly 2 Lz2
where DP is the change in local pressure in the
medium and c, the speed of the wave, is given by


k
c~H
r
where k is the bulk modulus of the tissue and r is the
density.
The bulk modulus (k) of a substance describes
behaviour under uniform compression. It is defined
as the pressure increase needed to cause a given
relative decrease in volume. The units are Pa.
The density (r) of a material is its mass per unit
volume. The units are kg per cubic metre.
It is worth noting that, generally, the bulk modulus
will be a function of DP, and in turn DP is a function
of x, y, z, and t. Consequently, in real tissues, the
speed of sound will not be absolutely constant
during the passage of the ultrasound wave.
3.1 Period, frequency, and wavelength
A simple depiction of medical ultrasound is as a
sinusoidal variation of pressure with time. This is
represented graphically in Fig. 2.
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M Halliwell
Fig. 2 Propagation of acoustic oscillations is achieved
through movement and changes in the relative
spacing of particles in response to high and low
pressure parts of the acoustic wave. (a) The
upper graph represents the pressure fluctuation
with distance at an instant in time. The distance
occupied by one cycle of pressure is the
wavelength (it is the distance travelled by the
wave in one period, T). (b) The bottom graph of
the acoustic wave indicates the changing
pressure with time at a fixed position in front
of the transducer. T is the period of a single
oscillation. The frequency is 1/T
ð2Þ
In Fig. 2, the period, T, of the wave is the time
interval between sequential occurrences of the same
phase and amplitude of the varying pressure. The
frequency of the wave, f, is the reciprocal of the
period
ð3Þ
f ~1=T ð4Þ
For a wave travelling at speed c, the wavelength, l, is
given by
l~c=f ð5Þ
The relationship can be expressed as
c~lf ð6Þ
Note that c, the speed of sound, is dependent on the
mechanical characteristics of the material (Fig. 3).
For low-amplitude waves, the speed of sound is
constant for a particular material, with a small
dependence on temperature and frequency. How-
ever, the mechanical characteristics of the material
also depend on the local pressure; consequently,
high-amplitude waves can cause local changes in
sound speed leading to non-linear propagation. This
phenomenon is described later.
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 A tutorial on ultrasonic physics and imaging techniques
Fig. 3 Speed of sound differences in different material
types, using the balls and springs model. (a)
Light balls (low density) and stiff springs (high
bulk modulus) gives a high speed of sound. The
low-mass ball reaches its final particle displa-
cement in a short time as the stiff spring rapidly
transmits enough force to accelerate the light
particle. (b) Heavy balls (high density) and
weak springs (low bulk modulus) give low
speed of sound. A result of the combination of
reduced force and greater mass is that the more
massive ball takes a longer time to reach the
final particle displacement
3.2 Non-linear propagation
3.2.1 Speed of sound dependent on frequency
For most materials, the propagation speed depends
on the frequency. In a more realistic form of the
wave equation the speed, c, must be replaced by the
phase velocity.
The phase velocity (or phase speed), vp, of a wave
is the rate at which the phase of the wave propagates
in space. This is the speed at which the phase of any
one frequency component of the wave travels. For
such a component, any given phase of the wave (for
example, the crest) will appear to travel at the phase
velocity. The phase speed is given in terms of the
wavelength l (lambda) and period T
vp ~l=T
This phenomenon is ‘dispersion’. In soft tissues the
effect is small and the speed of sound is essentially
constant for the range of frequencies normally used
for medical ultrasound. Frequency has a much more
significant effect in relation to the dependence of
attenuation with frequency.
3.2.2 Speed of sound dependent on pressure
In most materials, propagation speed depends on
the amplitude of the wave. The non-linear wave
equation is

2  into surf. In soft tissues the shock wave does
L2 DP 2 L DP L2 DP L2 DP
~c ðP Þ z z
Lt 2 Lx2 Ly 2 Lz2
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129
A practical consequence of non-linear propagation is
the generation of harmonic frequencies during wave
propagation. The high-pressure portions of the wave
travel at higher speed than the low-pressure ones,
leading to the initial sinusoidal wave shape becom-
ing a more saw-tooth shape (Fig. 4).
Mathematically, the pressure front will become a
shock wave with a zero rise time. In reality the high-
frequency components are sufficiently attenuated
that a fully developed shock does not occur in soft
tissues at diagnostic power levels. However, the
higher harmonics are sufficient in amplitude for
them to be used to advantage in diagnostic imaging
systems. Under the appellation ‘tissue harmonic
imaging’, the harmonic frequency components are
processed and contribute to diagnostic images. Two
practical examples of the clinical advantages of
tissue harmonic imaging are that deep structures
can be visualized at higher resolution and that some
reverberation artefacts can be reduced.
4 WAVES
Acoustic waves in general are described as propagat-
ing energy in 3D space, as described by the 3D wave
equation. For purposes of analysis, this propagation
ð7Þ
Fig. 4 Progression of a sinusoidal pressure wave to a
saw-tooth wave in a material where the speed
of sound increases with pressure. The high-
pressure parts of the wave travel more quickly
than the low-pressure parts. After a sufficient
travel time, the high-pressure parts will catch
up with the low-pressure parts to form a ‘shock’
wave. In soft tissue it is not possible for the
peak to overtake the trough, but in water waves
this phenomenon leads to the waves breaking
not travel, as the very high frequencies asso-
ð8Þ
ciated with it are massively attenuated
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130
is categorized into two fundamental modes: long-
itudinal and transverse.
1. Longitudinal waves: the direction of particle
displacement is the same as the direction of
energy flow.
2. Transverse waves: the direction of particle dis-
placement is perpendicular to that of energy flow.
These waves are also called shear waves.
4.1 Waves in biological tissues
The anisotropic nature of the forces between
particles in human tissues determines the supported
wave types.
N Bone: in bony structures vibrations in all three
directions are supported and both longitudinal
and transverse (shear) waves propagate.
N Soft tissue: in soft tissues, and liquid components
of the body, the coupling forces between particles
in the direction of energy flow are large and
longitudinal waves with velocities of thousands of
metres per second are supported. The coupling
forces perpendicular to this direction are weak;
consequently transverse particle movements are
rapidly attenuated. Shear waves are also sup-
ported in soft tissues. However, they have a
relatively low velocity, in the order of hundreds
of metres per second and high attenuation
coefficients, which render them unsuitable for
imaging purposes. Recent developments in elas-
tography make use of shear-wave propagation.
N Mode conversion: in the situation of a longitudinal
wave incident at a non-normal angle to a
boundary, some of the energy of longitudinal
particle movement can cause particle movement
in the transverse direction. This process is known
as mode conversion.
4.2 Reflection
At a discontinuity of the mechanical characteristics
in the path of the ultrasound wave, reflection of
energy occurs. In the simple example illustrated in
Fig. 5, this discontinuity is represented by a change
in the mass of the particles along the path and a
change in intra-particular forces. For a wave incident
from the left, say, reflection can be thought of in
purely mechanical terms as the smaller particle
‘bouncing off’ the more massive particle – in much
the same way that a ping-pong ball would bounce if
run against a snooker ball.
Acoustic impedance is used to describe the me-
chanical properties of tissues relevant to such
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M Halliwell
Fig. 5 Reflection of acoustic waves at a mismatch
between acoustic impedances in the medium.
For a wave incident from the left, the small balls
would bounce off the large ones; for a wave
incident from the right, the large balls would
overshoot the small ones and the extra energy
in the increased extension of the spring is
reflected towards the right
reflections. Whenever a change in acoustic impe-
dance occurs, reflection will take place. Acoustic
impedance, Z, is of two types: specific or character-
istic acoustic impedance and acoustic impedance.
The difference is that specific (characteristic) im-
pedance refers to the impedance at a point whereas
acoustic impedance refers to impedance at a surface.
Specific acoustic impedance is the complex ratio of
the effective sound pressure at a point to the
effective particle velocity at that point. Impedance
can be expressed in either its constituent units
(pressure per velocity per area) or in rayls. The rayl
equals 1 pascal-second per metre (Pa s/m), or
equivalently, 1 Newton-second per cubic metre
(N s/m3). In SI base units, that is kg/s m2
 
Z~p=v~I v2 ~p2 I ð9Þ
where p is the sound pressure (N/m2 or Pa), v is the
particle velocity (m/s), and I is the sound intensity
(W/m2).
Acoustic impedance is the total reaction of a
medium to acoustic transmission through it, repre-
sented by the complex ratio of the pressure to the
effective flux, that is particle velocity multiplied by
surface area, through the medium. In other words,
the sound pressure p divided by the particle velocity
v and the surface area S, through which the acoustic
wave propagates. For example, in plane, single-
frequency travelling waves the acoustic impedance
is equal to the specific (characteristic) impedance
divided by the surface area, S
Z~p=vS ð10Þ
Sometimes vS is referred to as the volume velocity.
For practical purposes, acoustic impedance, Z, for
any medium is calculated as the square root of the
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 A tutorial on ultrasonic physics and imaging techniques 131

product of the density, r, and the bulk modulus, k
pffiffiffiffiffiffi
Z~ rk
In the simple tissue model, the density relates
approximately to the mass of the particles and the
bulk modulus to the forces between them.
N small masses, weak springs 5 low acoustic im-
pedance;
N large masses, strong springs 5 high acoustic im-
pedance.
pffiffiffiffiffiffiffiffi
Using equation (3) (c 5 k=r), the computation
most often used to calculate Z is the product of the
density and the speed of sound
Z~rc
Typical acoustic impedances for biological materi-
als, in rayls, are:
The practical significance of these reflectivities in
diagnosis is that ultrasound is limited to use
ð11Þ primarily in the assessment of soft tissues. Bone
presents a significant barrier and air is essentially
impenetrable.
Coupling/Matching layer: the acoustic impedance
of transducer material is significantly greater than
that of soft tissue. To reduce reflection, and conse-
quently improve transmission, at the probe/skin
boundary, matching layers of solid materials of
intermediate acoustic impedance are incorporated
over the face of the transducer. This is an issue for
equipment manufacturers. A related impedance
issue for the end users is the presence of air between
the probe face and the patient’s skin. The acoustic
impedance mismatch here is overcome by the use of
ð12Þ a coupling gel with an impedance very close to that
of skin. A by-product of using gel as a coupling agent
is that the gel also acts as a lubricant. This facilitates
easy manipulation of the probe over the skin surface.

Air 0.0004 6106

Lung 0.18 6106 4.2.2 Real reflections
Fat 1.34 6106
Water 1.48 6106 In real systems, boundaries between media are not
Blood 1.65 6106 flat and infinite. In the body, reflection processes
Muscle 1.71 6106 depend critically on the actual physical dimensions
Skull Bone 7.80 6106 in relation to the wavelength of the ultrasound being
used. Real reflections are considered to be some
combination of the two extreme types of interaction:
4.2.1 Reflection coefficients
non-specular (or scattering) and specular reflection.
In specific geometrical situations, reflection can be Scattering is the reflection of ultrasonic waves by
quantified. The amplitude reflection coefficient, R, is discontinuities or surface irregularities, small, rela-
given by the equation tive to the wavelength of the waves.
Pr ðZ2 {Z1 Þ For objects in tissue which have a maximum
R~ ~ ð13Þ dimension less than about a tenth of the wavelength
Pi ðZ2 zZ1 Þ
of the ultrasound energy, the vibrating object then
acts as a point radiator creating a spherical field, so
where Pr and Pi are the reflected and incident
the energy is re-radiated or scattered equally in all
pressure amplitudes, Z1 and Z2 are the acoustic
directions. Real objects, with dimensions closer in
impedance coefficients for the two media.
size to the wavelength, re-radiate ultrasound in a
The intensity reflection coefficient is
non-uniform manner, with a directivity pattern
  depending on the size–wavelength relationship and
Ir ðZ2 {Z1 Þ 2
~ ð14Þ the surface morphology. As the object dimensions
Ii ðZ2 zZ1 Þ increase to the limiting situation of a large flat
surface, the directivity pattern is identical to that of a
These equations hold for a plane-wave incident on
an infinite plane boundary at normal incidence. specular reflection (see Fig. 6)
Making that assumption, and using values from Specular reflection is the perfect, mirror-like re-
the table of acoustic impedances, it is possible to flection of ultrasound from a surface. Ultrasound
show that at a blood fat boundary approximately 10 from a single incident direction is reflected into a
per cent of the incident pulse amplitude is reflected. single reflected direction. The law of reflection, states
For soft tissue to bone, the value is 66 per cent, and that the angle of incidence equals the angle of
for soft tissue to air (lung), it is 99 per cent. reflection.

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Fig. 6 Scatter of ultrasound at boundaries smaller
than the wavelength. The targets can be
considered as very small re-radiators of the
ultrasound. If such sources of ultrasound are
much smaller than a wavelength, the energy is
radiated uniformly in all directions. An extreme
example would be oscillations of a single ball in
the ‘balls on springs’ tissue model. All of its
springs would be equally disturbed and the
displacements would propagate equally in all
directions. Real boundaries are larger than this
and show some directivity
Specular reflection can be considered to be a
special case of scattering. For specular reflection to
occur, the interface between tissues must be rela-
tively large (more than 10 wavelengths in diameter)
and relatively flat (less than one wavelength-high
irregularities). The boundary between liver and
kidney is an example of this kind of boundary for
ultrasound with a wavelength of less than 1 mm
(frequency more than 3 MHz). Pulses are reflected,
as replicas of themselves, at an angle of reflection
equal to the angle of incidence. This kind of
reflection is often called ‘mirror-like reflection’ as it
is entirely analogous to optical reflection in flat glass
surfaces (Fig. 7).
Speckle is another special case of scattering. A
speckle pattern is formed by the constructive and
destructive interference of ultrasound re-radiated
uniformly from randomly positioned closely packed
small objects (less than a tenth of the wavelength) in
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M Halliwell
Fig. 7 Specular (mirror-like) reflection. At boundaries
large and flat relative to the wavelength, the
ultrasound beam is reflected without any
change in its characteristics (beam width,
convergence, or divergence) and in a direction
from the surface which is at an angle equal to
that of the incident beam. The angle of the
beam is measured with respect to a line which
is perpendicular to the surface (the ‘normal’).
For specular reflection, the angle of incidence is
equal to the angle of reflection. Tissue bound-
aries and blood vessel walls are targets which
exhibit specular reflection and are best seen
when the ultrasound beams fall perpendicu-
larly on them
tissue. The speckle pattern is entirely artefactual and
is characteristic of the imaging system.
Interference occurs when the spatial separation of
the individual scatterers is less than the wavelength.
This results in areas of alternating high- and low-
level echoes. Speckle patterns are strongly wave-
length and therefore frequency dependent. They also
change as the angle of insonation of the scattering
region is altered. Changing this angle alters the
relative separation in the beam direction and hence
the pattern of interference. For randomly distributed
targets the speckle pattern is random noise and
entirely artefactual. In real tissues the targets are not
purely randomly distributed. The underlying tissue
components impose a structure upon which the
random speckle pattern is superimposed. The
textural pattern of the ultrasound images from tissue
combines a random, fine echo texture, component
with structural information at a coarser dimension.
This is the reason that the textural pattern from the
liver is different from that from the kidney.
In spite of the fact that the echo patterns are
largely artefacts, many end users confuse the fine
echo texture of the speckle component with true
resolution (Fig. 8).
Speckle reduction. Speckle can be reduced in
images by techniques such as spatial and frequency
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 A tutorial on ultrasonic physics and imaging techniques 133

with differing speeds of sound. Refraction is de-

scribed by Snell’s Law

sin hi c1
~ ð15Þ
sin ht c2

where hi and ht are the angles of incidence and

transmission respectively, and c1 and c2 are the
speeds of sound in the two media (Fig. 9).
For angles of incidence other than 90u, the
direction of the main axis of the ultrasound beam
will be deviated across boundaries between tissues
with different sound speeds. For example, a beam
travelling from muscle to fat at an incidence angle of
60u will be deviated by 8u. This effect is significant in
imaging applications and causes considerable image
degradation in many patients. Real targets are
incorrectly located on the image leading to blurring
and loss of resolution.
Fig. 8 Speckle resulting from constructive and de-
structive interference of waves scattered from
clusters of small targets. Each small target re- 4.4 Attenuation
radiates the ultrasound as in scattering, but
because there are several scatterers in close As ultrasound propagates, energy is lost either by
proximity, the ultrasound wave can either absorption (as heat) or by reflection. Both specular
reinforce or cancel out in the tissues around reflection and scattering contribute to this loss of
the scatterers. If the waves happen to be in step energy from the beam. The intensity reduces
(pressure peaks in line) they reinforce (con-
exponentially with distance
structive interference). If waves are out of step
so that the pressure peak of one corresponds
with the pressure trough of another, then in Ix ~I0 expð{axÞ ð16Þ
that direction the waves cancel; in other words,
the interference between waves is destructive.
The pattern of the textural pattern is both
direction and frequency dependent. This allows
speckle reduction to be implemented in two
ways: by using multiple angles of view (steering
the beam–spatial compounding) and by trans-
mitting pulses with differing centre frequencies
(frequency compounding)

compounding. These take advantage of the spatial

and frequency dependence of speckle patterns.
Multiple images of the same region are created with
beams progressively steered so as to insonate at a
variety of different angles with pulses at a series of
different centre frequencies. Real targets are un-
affected by changes in beam angle or frequency. The
speckle patterns will be affected by these changes.
Following frame-averaging, speckle in the displayed
image will blur to a mid-grey background, leaving Fig. 9 Refraction due to the speed of sound difference
real targets conspicuous against it. across an inclined boundary. The ultrasound
image is constructed with an assumption that
4.3 Refraction the beam travels in a straight line; a deviation of
the beam away from this direction can lead to
As with all wave phenomena, ultrasound suffers misregistration and subsequent blurring of the
refraction as it passes a boundary between materials targets in the images

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where I is the intensity, x is the distance, and a is the
attenuation coefficient.
The description of attenuation is simplified with
the introduction of a logarithmic representation of
the intensity variation. Taking logarithms of equa-
tion (16)
logðIx =I0 Þ~{ax
The logarithm of the ratio of intensities is called the
Bel. In view of the magnitudes involved in medical
applications, the more frequent notation is the
decibel (dB). The usage is the term ‘intensity level’
where
intensity level~10 log10 I1 =I0 dB
For example, in a situation where the intensity at the
location of interest (I1) is 100 times less, than the
initial intensity I0, the intensity level would be
described as being ‘minus 20 dB’.
The attenuation coefficient, a, is frequency de-
pendent and in the order of 0.5 to 0.7 dB per
centimetre per MHz. The loss of signal strength
due to attenuation is a limiting factor for diagnostic
purposes and typically restricts the depth of imaging
to about 15 cm at 5 MHz.
4.5 Wave production and detection
Acoustic oscillations can be generated in many ways.
Simple sound-wave generators include plucked
guitar strings and beaten drum skins. In both of
these examples, the mechanical vibrations of the
surfaces cause the air molecules with which they are
in contact to vibrate in sympathy. As it is a higher
frequency, ultrasound is usually generated using
mechanical vibrations which result from the elec-
trical excitation of a transducer.
These devices convert or ‘transduce’ the electrical
exciting signal into a mechanical movement via a
variety of mechanisms. The inverse piezoelectric
effect is the most frequently employed but capacitive
and solid-state devices also exist.
Ultrasound detection is often undertaken by the
same transducer, now operated in the inverse mode
(for example, utilizing the direct piezoelectric effect).
Changes in local pressure around the transducer (the
mechanical disturbance) are converted to electrical
signals.
The thickness of the transducer governs its
resonant frequency. This is the frequency of max-
imum efficiency and sensitivity. Usually, transducers
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M Halliwell
are operated at their resonance; consequently, their
thickness is determined. For fundamental reso-
nance, the thickness must equal one half-wave-
length, remembering that it is the wavelength in the
transducer material. In a commonly used piezo-
electric material, lead zirconate titanate (PZT), the
speed of sound is approximately 3300 m/s. The wave-
ð17Þ length of sound in PZT at a frequency of 5 MHz is
approximately 0.7 mm. Consequently, 5 MHz reso-
nant elements would have to be 0.35 mm thick. The
other dimensions, height, width, and shape, depend
upon the application. Typically, they can be single flat
or bowl-shaped elements of circular or rectangular
shape up to 100 wavelengths in dimension or they can
be in the form of rectangular arrays of side-by-side
ð18Þ elements about 0.2 wavelengths wide and 5–10
wavelengths long, with either flat or convex front
faces. Whatever its particular construction, the trans-
ducer arrangement and its housing is usually referred
to as the ‘probe’.
4.6 Continuous wave ultrasound
A continuous wave is an acoustic wave of constant
amplitude and frequency and, strictly speaking, of
infinite duration. In practice, ultrasound is consid-
ered to be a continuous wave if is transmitted without
interruption while the equipment is functioning. Its
duration is never infinite but is long enough for its
amplitude and frequency to be considered constant.
Continuous wave ultrasound propagating in a
medium of low attenuation between parallel reflect-
ing surfaces can create a standing wave field. The
standing wave field is one in which there are
stationary regions of high and low pressure. Stand-
ing wave fields have been shown to cause blood flow
stasis in chick embryos in vivo. They are also used as
a tool for contactless separation, concentration and
manipulation of microparticles and biological cells.
The basis is the acoustic radiation force, a non-linear
effect which causes particles to be attracted to either
the nodes or antinodes of the standing wave. In
therapy, continuous wave ultrasound is used in
applications such as physiotherapy and surgery.
Diagnostically, continuous wave ultrasound is used
solely in Doppler applications.
4.7 Pulsed ultrasound
A pulse wave is a non-sinusoidal waveform. The
shape of the wave is determined by the character-
istics of the exciting electrical pulse and the proper-
ties of the transducer. Typically, pulsed ultrasound is
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 A tutorial on ultrasonic physics and imaging techniques 135

generated as a sequence of regularly occurring Manufacturers make use of the increased sensi-
pulses. The pulse duration and the time interval tivity and bandwidth of transducers by labelling
between pulses depend on the application. them as having a range of usable frequencies equal
In the frequency domain, the primary character- to the upper and lower limits of the bandwidth; for
istics of an ultrasound pulse are its centre frequency example, a typical diagnostic probe for abdominal
and its bandwidth. For typical excitation with a use may be labelled as a ‘3 to 7 MHz probe’. This
short, high-amplitude voltage spike, the centre means that the ultrasound pulse has a centre
frequency of the pulse is the mechanical resonant frequency of 5 MHz but a bandwidth sufficient for
frequency of the transducer elements. The resonant images to be created at filtered, received frequencies
frequency depends on the thickness of the elements from 3 to 7 MHz.
and cannot be altered for a particular transducer.
Changing the centre frequency of the pulse requires
4.7.1 Beam shape
changing the thickness of the elements; in other
words, it requires the probe to be changed. Typical beam shapes and characteristics of ultra-
The bandwidth of the pulse is a measure of the sound emitted from the transducers used in medical
range of frequencies it contains. Usually, the width is and biological systems are detailed in Fig. 11.
measured between the 23 dB points and is referred
to as the full-width, half maximum (FWHM) value
(Fig. 10).
The upper and lower frequencies are taken as the
usable limits of the pulse. Above and below these
frequencies, the signal amplitude is less than half of
its maximum value and is considered to be insuffi-
cient for most purposes. Similar considerations
apply to the overall sensitivity characteristic of the
transducer. Its response is taken to be the square of
that of the pulse it launches.

Fig. 10 An ultrasound pulse typically contains four or

five cycles. The number of cycles determines
the length and frequency content of the pulse.
The fewer the cycles, the shorter the pulse and
the smaller (better) the resolution along the
beam (axial). The frequency content of the
pulse is described by its bandwidth. A wide
bandwidth comes from a pulse with few
cycles. Very long pulses are narrow band-
width, the limit is an infinitely long pulse (a
continuous wave) which has a single fre-
quency component
Fig. 11 Beam from a plane transducer is fairly well
collimated but diverges after the near-field/
far-field boundary. Focusing the beam is
important and is frequently achieved by
curving the emitted wavefront, either with a
lens for a single-element transducer, or by
timing delays for the pulses exciting an array
transducer. The curved wave front converges
to the focal point and diverges beyond it

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136
4.7.2 Therapy ultrasound
Pulsed ultrasound is used for some physiotherapy
applications. The rationale is that the time interval
between pulses enables induced tissue heating to
dissipate, allowing non-thermal effects of ultrasound
to predominate in the patient’s treatment.
Surgical and high-intensity focused ultrasound
(HIFU) applications also use pulses. The reason here
is to enable delivery of a specified dose of energy to
heat and to destroy the target volume. Energy
deposition is determined by a combination of
acoustic power, pulse number, and pulse duration.
4.7.3 Diagnostic ultrasound
The majority of diagnostic imaging techniques also
use pulsed ultrasound. Pulse duration and ampli-
tude control the characteristics of equipment per-
formance and are tailored for specific applications.
High-resolution imaging requires pulses to be as
short as possible; these pulses are created by exciting
the transducer with a single voltage pulse of less
than a half-period duration. Imaging of blood flow
uses longer pulses; these may be generated by
excitation with a gated sinusoidal voltage.
4.8 The pulse echo technique
Similar to its application as the echo location
method used by bats and dolphins, this method
forms the basis of the majority of diagnostic systems.
Ultrasound is launched in the form of pulses;
reflections of those pulses at tissue boundaries
return to the probe as echoes (Fig. 12).
Imaging relies on those reflections to yield
information concerning the range and direction of
interfaces. The range is deduced from the time
interval between launching the ultrasound pulse and
receiving its echo. This time is converted into a
measure of target range by making an assumption
about the speed of propagation of the pulse in the
body tissues. The directional location of the reflect-
ing target is assumed to be identical with the
direction in which the ultrasound pulse was initially
launched from the face of the probe.
5 DISPLAY AND IMAGING TECHNOLOGIES
5.1 A-mode
A display method in which echo amplitude is plotted
along the y-axis versus time on the x-axis. The
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M Halliwell
Fig. 12 Pulse echo technique. A pulse launched
towards the target is partially reflected at the
target, causing an echo to return to the
transducer. The time elapsed, t (measured at
the transducer), is equal to twice the time
taken for the pulse to travel to the target. The
range of the target is computed assuming a
value, c, for the speed of sound in the medium.
Range, d 5 K t6c
horizontal distance between two echoes represents
the time interval between them. The vertical excur-
sion, in a linear system, is directly proportional to
the amplitude of the signal. In many practical
systems the vertical excursion is logarithmically
proportional to the received echo amplitude. This
takes account of the significance of the low-level
scattered echoes from tissues.
5.1.1 Radiofrequency display
In their raw, unprocessed form, echo data are
radiofrequency (RF) electrical signals. The display
of these RF signals incorporates more than simply
information about the amplitude of the signals and
their time of arrival back at the probe face. There is
also detail concerning the phase changes that have
occurred during the reflection and interference
processes (Fig. 13(a)). Historically, this additional
information has been largely unused. Development
of high-speed, wide dynamic range analogue-to-
digital conversion hardware and increases in the
processing power of computers has enabled the
construction of scanners which take advantage of
this information. Colour Doppler imaging, synthetic
aperture, and tissue characterization techniques are
available in some commercial equipment and
developments of these processes are to be expected.
5.1.2 Unipolar, filtered display
A more frequently used display involves processing
the RF signals, usually by full wave rectification and
filtering, to produce a unipolar display. Target
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 A tutorial on ultrasonic physics and imaging techniques
Fig. 13 (a) Upper trace is the radio frequency (RF)
scan, the raw ultrasound echo train detected
and amplified. The ultrasound echo train is a
series of pressure fluctuations at a frequency
approximately the same as that of the trans-
ducer. The transducer converts the pressure
changes to an electrical signal. This voltage
trace is very similar to the signals used in radio
transmitters and receivers and so was given
the name ‘radio frequency signal’ in the early
days of ultrasound development. (b) Lower
trace is the A-scan, the result of rectifying and
envelope-detecting the RF trace. The radio
frequency fluctuations are too rapid and
irregular for easy discrimination by eye.
Changing the echo train to a lower frequency
representation (the A scan) makes it easier to
appreciate the size and presence of targets
along the beam
boundaries are displayed as short, fast rise time,
spikes positioned along the display at locations
proportional to their time of arrival.
The initial use of such displays was for flaw
detection in metal constructions, typically in the
shipbuilding and aircraft industries. For medical
purposes, the 1D A-mode displays were used in the
differentiation of solid and cystic lesions and in the
measurement of structures such as the fetal head.
Medically, the displays have very largely been super-
seded by the two-dimensional (2D) images produced
by B-mode scanners. An example of a clinical use
which still utilizes the A-scan is the accurate
determination of tissue thickness. For example, prior
to surgical eye correction procedures, the thickness of
the cornea is measured using A-mode ultrasound to
an accuracy of about 100 microns.
5.2 B-mode
B-mode (‘brightness modulation’) scanning is a
major component of by far the most frequently used
technique in diagnostic ultrasound imaging. The
principle is that echoes are displayed as bright dots
along a time-base line.
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137
Fig. 14 B-scan is formed by changing the amplitude
fluctuations of the A-scan to a brightness
modulated time-base line. The peaks on the
A-scan corresponding to individual targets are
now shown as bright dots on the B-scan. The
brightness depends on the amplitude of the A
scan peak
The brightness of the dot is related to the
amplitude of that particular received echo; the
position of the dot along the time-base line is
proportional to the time of arrival of the echo at
the probe face. The position of the time-base line on
the screen is linked to the spatial location of the
ultrasound beam. The direction is governed by the
direction at which the ultrasound pulse is launched
from the probe face (Fig. 15).
Frequently, the display shows a representation of
the face of the probe, either a horizontal straight line,
for a linear array flat faced probe, or a curved line,
when the probe used has a curved face (a curvilinear
probe). Time-base lines are then drawn as though
emanating from this face in the direction deter-
mined by the scanner.
Fig. 15 Sequential pulses from the face of the trans-
ducer are depicted as vertical time-base lines
on the display screen. The horizontal starting
point of each vertical scan line corresponds
with the site on the probe face from which the
corresponding ultrasound beam emerges.
Echoes are drawn at the appropriate depth
on each line. The final scan shows the cross-
sectional view of targets beneath the transdu-
cer
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5.3 C-scan: constant depth scanning

The C-scan yields a 2D plan view of the object. Early
systems involved mechanical movement of the
transducer over the surface in an x–y raster. The
display was a single dot whose position was linked
to that of the transducer. The brightness of the dot
was modulated by the echo strength at each x–y
location and from a depth along the z-axis deter-
mined by a range-gated receiver. The constant
depth scans were time-consuming to acquire and
found limited use in medical applications. Devel-
opments of 3D scanning have revitalized the C-
scan, which can now be created by resampling in
planes orthogonal to the original 2D slices within
the data volume [1]. Fig. 16 M-mode trace takes echoes from a single
direction within the scan plane and traces
out the movement of targets with time.
Stationary targets, such as the chest wall, will
5.4 M-mode
appear as parallel horizontal lines. Moving
The motion mode display is a variant of the single targets, such as the leaflets of a heart valve,
line B-mode scan. The vertical time-base line will trace their movement over time. From the
trace, values such as total excursion and rate
contains the echoes deep to the stationary trans-
of movement can be measured. The M-mode
ducer and along one of the ultrasound beams. The is used most frequently in examining the
horizontal time-base is a constant speed shift of motion of cardiac structures
those echoes. Stationary echoes are displayed as
horizontal lines. Echoes from moving structures, 5.5.2 Beamformer
such as heart valves, draw out distance–time
Each of these pulses is channelled via the beamfor-
graphs of their movements. From these traces,
mer to transducer array. The beam former deter-
the displacement, speed and acceleration of mov-
mines which group of elements in the array are
ing structures may be computed. Those character-
excited. An ultrasound pulse is launched from that
istics are of clinical significance in cardiac dis-
group, propagates through the patient, and echoes
orders (Fig. 16).
from boundaries along the path return to the probe
face to be converted to electrical signals. The
number of elements in the transmission group is
5.5 Real-time ultrasound B-mode scanner
usually between 10 and 15. On reception, the
The simplified construction layout and sequence of number of elements in the receive group may well
events in a basic scanner is illustrated in Fig. 17. be increased as deeper and deeper echoes return.
The reason for this is to optimize the focusing and
sensitivity performance for distant targets. Essen-
5.5.1 Pulser tially, this process increases the aperture and focal
The pulser generates a repetitive sequence of depth of the receiver with time.
voltage pulses. The rate of pulsing depends on the
type of scan and, in particular, the maximum depth
5.5.3 Receiver
of display required. The time interval between
pulses is usually sufficiently long to allow echoes This amplifies the raw electrical signals. Echoes from
from the deepest targets to reach the probe face close targets produce signal voltages in the order of
before the next pulse is launched. In soft tissue with millivolts. However, pulse and echo attenuation
a speed of sound of 1540 m/s (1.54 mm/ms) the time introduced by soft-tissue interactions during propa-
interval for a depth of 15 cm (a typical liver gation dictates that mean signal levels fall exponen-
dimension) will be 200 ms (100 ms for the pulse to tially with time of arrival (target range). The fall in
reach the deepest part and 100 ms for the echo to signal strength is compensated by an increase in the
return). receiver gain with time, logarithmically. Such com-

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 A tutorial on ultrasonic physics and imaging techniques 139

Fig. 17 Block diagram of a typical real-time scanner. The pulser or clock creates a regular
sequence of electrical signals which are processed by the beamformer to be sent to the
appropriate group of elements in the probe. The pulse created by the electrical pulse
travels into the patient and a train of echoes returns. These echoes are converted to an
electrical signal in the probe. The receiver amplifies these to make them large enough to
process. The processing black box cleans up the echoes and conditions them before they
are stored in the computer memory. The display of the memory is the ultrasound image,
which is annotated with details of machine settings, patient details, and date. Image
storage is usually digital and often in a picture archiving and communications system
(PACS) system

pensation is termed depth compensation, time gain

compensation or swept gain compensation. It is
implemented at the receiver by user operated
controls (Fig. 18).

5.6 Image processing

Just as the RF signals were processed to make an
easily intelligible A-mode display, so the echo signals
need processing for the B-mode image. The main
difference is that the signal amplitude is used to
modulate the brightness of the time-base line and
the appreciation of image detail now relies much
more on the physiology of human perception. A
large range of processing techniques is employed to Fig. 18 Exponentially increasing amplification is ap-
achieve optimum image performance. They will be plied to the received echoes to compensate for
used in a variety of ways which will depend on the attenuation within tissues. This is called
clinical context. For example, liver scanning requires variously, depth gain, swept gain, or time gain
display characteristics which emphasize low signal compensation. The aim is to ensure that
similar targets appear with similar brightness,
discrimination to allow the visualization of liver
irrespective of their depth. The limit to
metastases. However, cardiac applications need amplification, subject to the electronic noise
characteristics which suppress low-level artefactual levels in the receiver, is reached at a particular
echoes and noise to enable the cardiac chambers to depth, after which the echo brightness reduces
be delineated clearly. and structural detail is lost

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140 M Halliwell

The different mixtures of processing techniques

are under operator control, but more usually, they
are stored in the machine as application-specific
presets which the operator selects prior to each
investigation.

5.6.1 Display
The display is invariably a computer monitor which
shows the image accumulating in the computer
memory. Each time-base line is digitized and echo
signals are written into the appropriate location for
subsequent display. In normal operation, memory
locations are refreshed as new echo information is
received and processed. Typically, complete scans of
100 ultrasound lines can be performed at a rate of
about 25/s.

5.7 Resolution
5.7.1 Spatial resolution
The spatial resolution (Fig. 19) of any imaging
system relates to the physical dimensions of the
energy pulse travelling/propagating through the
tissue and is critically dependent on the wavelength.
In microscopy, for example, electron microscopes
have significantly greater resolution than optical
microscopes in direct proportion to the ratio of the
relative wavelengths associated with electrons and
light photons. Similarly, in diagnostic ultrasound,
frequencies of 10 MHz have about twice the resolu-
tion of 5 MHz systems, the relative wavelengths in
soft tissue are 0.15 mm and 0.3 mm. The spatial
resolution of a pulse-echo ultrasound imager is
frequently assessed by linear measurement of the
Fig. 19 Spatial resolution is defined in terms of how
dimensions of the image produced by scanning a well the system can visualize small targets.
‘point’ target. The image is essentially the point- The three directions in which it is usually
spread function of the system – the point-spread determined are axial (along the beam direc-
function relates to the physical dimensions of the tion), lateral (across the beam in the scan
ultrasound pulse and thus to the ‘clarity’ or spatial plane), and slice thickness or elevation (across
resolution of the system. This measure of resolution the beam perpendicular to the scan plane).
is difficult to relate to the clinical situation; for The measurements are made by scanning a
phantom that contains wire targets embedded
example, the length of the point-spread function of a in a tissue-like substance and measuring the
nylon wire target in a gel is not directly applicable to width and length of the resulting bright dots
the accuracy of measurement of the diameter of an
intra-hepatic vessel in vivo. pulses are generated at a rate which is limited by the
requirement that the returning echoes can be
processed unambiguously and do not overlap with
5.7.2 Temporal resolution
echoes from a preceding pulse. The time interval
During the observation of moving targets, the rate at between pulses, for M-mode and Doppler, or
which new images are made, the sample rate, between frames, for imaging, is a measure of
determines the fidelity of measurement. Ultrasound temporal resolution.

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 A tutorial on ultrasonic physics and imaging techniques
Fig. 20 Contrast resolution is the ability to display
regions which have small differences in echo
size. As well as machine signal-processing
aspects, the physical size of the beam is a
limiting factor. Beams which are wider than
the target will override the true echoes from
the target with echoes from surrounding
tissue. In this example, the cyst becomes
invisible when the beam is too wide
5.7.3 Contrast resolution
Contrast resolution is the ability to depict the
difference between regions of differing reflectivity.
A clinical example is the display of metastatic cancer
deposits against the background of the liver par-
enchyma. This ability depends on several factors to
do with signal processing but also with the physical
dimensions of the beam. Narrow beams are more
likely to return signals which relate to the echogeni-
city of the lesion; wide beams will add echoes from
tissues surrounding the lesion and will reduce its
visibility. In Fig. 20 the extreme situation of a cyst
(which should return no echoes) is demonstrated for
two beam sizes. Contrast resolution is difficult to
measure but is one of the major performance
differences between scanners.
6 CONCLUSIONS
Ultrasound is a very widely used modality both in
therapy and diagnosis and it is estimated that
approximately 20 per cent of all medical images are
made with ultrasound. There is no sign that its use is
diminishing and new applications and new technol-
ogies are regularly introduced. This paper has
illustrated the basic physical properties of ultrasound.
For more depth on the topics touched on here, the
other articles in this special issue may be consulted.
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141
ACKNOWLEDGEMENTS
I thank numerous colleagues in the Department of
Medical Physics at University Hospital Bristol NHS
Trust for their help and encouragement. In particu-
lar, thanks go to Ms T. Robinson, Dr S. Curtis and Dr
H. Liang. I must also thank Professor P. N. T. Wells.
for the kind invitation to participate in this special
issue.
F Author 2010
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