Medical Ultrasound Imaging
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Ultrasound Imaging Modes
Ultrasound imaging is excellent for diagnosing cysts and other fluids in soft tissue. For ultrasound imaging or ultrasonography, different modes are used to examine the arterial/venous system, heart, pancreas, urinary system, ovaries, spinal cord, joints and more.
Power levels, frequencies used, amplification, and beamforming determine the clarity of the image. These things are controlled by the sonographer, interacting with the properties of the ultrasound machine.

Various imaging modes:
Interventional Ultrasound
Interventional ultrasound, also known as ultrasonography, encompasses a range of invasive or surgical procedures guided by ultrasound imaging. While its widest application lies in intravascular ultrasound imaging for measuring atherosclerotic plaque, it has proven valuable in various medical fields.
In urology, ultrasound-guided interventions are employed for treatments like high intensity focused ultrasound (HIFU) in prostate conditions. The precise imaging provided by ultrasound aids in targeting the affected area and delivering therapeutic energy effectively.
In intraabdominal conditions, endoscopic ultrasound is frequently utilized. This technique combines ultrasound imaging with an endoscope to visualize and evaluate structures within the gastrointestinal tract, allowing for precise diagnoses and targeted interventions.
Ultrasound-guided procedures play a significant role in several medical specialties, including liver sonography, obstetric and gynecologic ultrasound, and thyroid ultrasound. These procedures involve interventions such as RF thermal ablation or biopsies, which are guided by real-time ultrasound imaging.
For instance, in liver sonography, ultrasound guidance is crucial for performing biopsies or RF thermal ablation, a technique used to treat liver tumors by delivering localized heat to destroy the abnormal tissue. The real-time imaging allows for precise needle placement and monitoring during the procedure.
In obstetric and gynecologic ultrasound, ultrasound-guided procedures, such as biopsies, can be performed to obtain tissue samples for diagnostic purposes. Additionally, ultrasound guidance is valuable during interventions like amniocentesis or fetal blood sampling, enabling accurate and safe procedures.
Thyroid ultrasound procedures often involve ultrasound-guided fine-needle aspiration biopsy (FNAB), which allows for the sampling of thyroid nodules for cytological examination. The ultrasound image helps guide the needle into the targeted area, ensuring accurate sampling and minimizing potential complications.
Overall, ultrasound-guided interventions provide minimally invasive and precise approaches to diagnosis and treatment. The real-time imaging capabilities of ultrasound contribute to enhanced accuracy, safety, and patient outcomes in procedures like biopsies, injections, and drainage.

See also Transurethral Sonography, Endocavitary Echography, and B-Mode Acquisition and Targeting.
Ultrasound Contrast Agents
(UCA / USCA) Ultrasonography is the most commonly performed diagnostic imaging procedure. The introduction of sonographic contrast media into routine practice modifies the use of ultrasound in a variety of clinical applications. USCAs consist of microbubbles filled with air or gases and can be classified according to their pharmacokinetics. Among the blood pool agents, transpulmonary ultrasound contrast agents offer higher diagnostic potential compared to agents that cannot pass the pulmonary capillary bed after a peripheral intravenous injection. In addition to their vascular phase, some USCAs can exhibit a tissue- or organ-specific phase.
The sonogram image quality is improved either by decreasing the reflectivity of the undesired interfaces or by increasing the backscattered echoes from the desired regions.

Different types of ultrasound contrast agents:
Ultrasound contrast agents act as echo-enhancers, because of the high different acoustic impedance at the interface between gas and blood. The enhanced echo intensity is proportional to the change in acoustical impedance as the sound beam crosses from the blood to the gas in the bubbles.

The ideal qualities of an ultrasound contrast agent:
high echogenicity;
low blood solubility;
low diffusivity;
ability to pass through the pulmonary capillary bed;
lack of biological effects with repeat doses.

A typical ultrasound contrast agent consists of a thin flexible or rigid shell composed of albumin, lipid, or polymer confining a gas such as nitrogen, or a perfluorocarbon. The choice of the microbubble shell and gas has an important influence on the properties of the agent.
Current generations of microbubbles have a diameter from 1 μm to 5 μm. The success of these agents is mostly dependent on the small size and on the stability of their shell, which allows passage of the microbubbles through the pulmonary circulation. Microbubbles must be made smaller than the diameter of capillaries or they would embolize and be ineffective and perhaps even dangerous.
The reflectivity of these microbubbles is proportional to the fourth power of a particle diameter but also directly proportional to the concentration of the contrast agent particles themselves.
Ultrasound contrast agents produce unique acoustic signatures that allow to separate their signal from tissue echoes and to depict whether they are moving or stationary. This enables the detection of capillary flow and of targeted microbubbles that are retained in tissues such as normal liver.
The new generation of contrast media is characterized by prolonged persistence in the vascular bed which provides consistent enhancement of the arterial Doppler signal. Contrast agents make it also possible to perform dynamic and perfusion studies. Targeted contrast imaging agents are for example taken up by the phagocytic cell systems and thus have liver/spleen specific effects.

See also Ultrasound Contrast Agent Safety, Adverse Reaction, Tissue-Specific Ultrasound Contrast Agent, and Bubble Specific Imaging.
Ultrasound Radiation Force
The traveling ultrasonic wave causes a low-level ultrasound radiation force when this energy is absorbed in tissues (absorbed dose). This force produces a pressure in the direction of the beam and away from the transducer. It should not be confused with the oscillatory pressure of the ultrasound wave itself. The pressure that results and the pressure gradient across the beam are very low, even for intensities at the higher end of the range of diagnostic ultrasound. Mechanical effects like radiation forces lead to stress at tissue interfaces. The effect of the force is manifest in volumes of fluid where streaming can occur with motion within the fluid. The fluid velocities which result are low and are unlikely to cause damage.
The effects of ultrasound radiation force (also called Bjerknes Forces) were first reported in 1906 by C. A. and V. F. K. Bjerknes, when they observed the attraction and repulsion of air bubbles in a sound field.
While incompressible objects do experience radiation forces, compressible objects driven at their resonant frequency experience far larger forces and can be observably displaced by low-amplitude ultrasound waves. A microbubble driven near its resonance frequency experiences a large net radiation force in the direction of ultrasound wave propagation. Ultrasound pulses of many cycles can deflect resonant microbubbles over distances on the order of millimeters.
In addition to primary radiation force, which acts in the direction of acoustic wave propagation, a secondary radiation force for which each individual bubble is a source and receptor causes the microspheres to attract or repel each other. The result of this secondary force is that a much larger concentration of microbubbles collects along a vessel wall than might otherwise occur.

See also Acoustically Active Lipospheres.
Portable Ultrasound Machine
Ultrasound technology has evolved significantly, providing sonographers with a wide range of ultrasound machines. As technology has advanced, portable ultrasound equipment, including handheld ultrasound systems, have emerged in the field of medical imaging. However, these devices may have limited imaging capabilities and reduced image quality compared to larger systems.
Types of ultrasound systems compiled according to their portability:
Handheld Ultrasound Devices:
Handheld ultrasound devices are compact, lightweight, and easily maneuverable. They offer convenience and point-of-care imaging capabilities, making them ideal for emergency medicine, primary care, and remote settings. Pros include portability, rapid assessments, and ease of use. However, these devices may have limited imaging capabilities and reduced image quality compared to larger systems.
Laptop-Based Ultrasound Scanner:
Laptop-based ultrasound machines combine portability with a larger display and enhanced imaging capabilities. They are versatile and suitable for various applications, including primary care, obstetrics, and musculoskeletal imaging. These machines provide good image quality, a user-friendly interface, and improved storage capacity. However, they may still be bulkier and less portable than handheld devices.
Console-Based Ultrasound Systems: Console-based ultrasound machines are larger, stationary systems commonly found in hospitals and specialized imaging centers. They offer comprehensive imaging capabilities, advanced features, and excellent image quality. These machines are suitable for a wide range of specialties and can perform complex examinations. Pros include high image resolution, advanced imaging modes, and comprehensive data management. However, they lack the portability and immediate accessibility of handheld or laptop-based devices.
Cart-Based Ultrasound Machines:
Cart-based ultrasound machines strike a balance between portability and advanced imaging capabilities. They consist of a console unit mounted on a mobile cart. These machines are commonly used in hospitals, clinics, and larger healthcare facilities. They provide excellent image quality, a wide range of imaging options, and ergonomic considerations. While less portable than handheld or laptop-based devices, cart-based machines offer enhanced functionality and versatility.


In summary, pros and cons of portable ultrasound machines:
Pros:
Compact portable ultrasound machines eliminate transfers and reduce wait times, improving patient comfort. Scans at the bedside minimize discomfort and anxiety while optimizing workflow efficiency. Sonographers can quickly assess patients and detect abnormalities. Real-time examinations provide immediate visualization, procedural guidance, and support for critical decision-making especially in emergency, critical care, and resource-limited settings.
Cons:
Portable ultrasound machines may have restricted features and imaging modes compared to larger systems, potentially affecting diagnostic quality and detail. The compact size can lead to compromises in image resolution and overall quality due to factors like lower power output and smaller transducers.The small displays and simplified controls of portable systems may pose challenges for sonographers, potentially impacting workflow efficiency and user fatigue. Portable ultrasound machines often come with a higher price tag, requiring careful evaluation of cost versus expected benefits and specific practice needs.

See also Ultrasound Accessories and Supplies, Environmental Protection, Sonographer, Ultrasound Technology and Equipment Preparation.
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