Ultrasound waves are reflected when there is a change in acoustic impedance. The larger the change, the more ultrasound is reflected. Microbubbles have an enormous difference in acoustic impedance as compared to surrounding fluid due to the large differences in density, elasticity and compressibility.
At low acoustic power (mechanical index less than 0.1), the mechanism of ultrasound reflection is that of Rayleigh scattering and the microbubbles may be regarded as point scatterers. The scattering strength of a point scatterer is proportional to the sixth power of the particle radius and to the fourth power of the ultrasound frequency;; the echogenicity of such contrast agent is therefore highly dependent upon particle size and transmit frequency. The backscattered intensity of a group of point scatterers is furthermore directly proportional to the total number of scatterers in the insonified volume. The concentration of the contrast medium is of importance.

See also Backscatter Energy, Cross-section Scattering.

Cross-section scattering is a measure of the scattering strength of a point scatterer. The scattering strength is dependent on the size of the scatterer, the density and compressibility of the scatterer and the surrounding medium, and the ultrasound wavelength.
If a transducer emits ultrasound with a total acoustic power of P, and the power is assumed to be uniform distributed over the US beam cross-sectional area, then the ultrasound intensity at a certain range, is defined by:
I = P/A
where I is the intensity, and A is the cross-sectional beam area at that range.
A point scatterer located in the ultrasound beam at this range, will scatter the ultrasound with a total acoustic power of Ps, defined by:
Ps = I s
where s is the scattering cross-section of the point scatterer.

A cycle is the combination of one rarefaction and one compression equals one cycle.

B-scan comined with D-scan (D=Depth) is used to avoid image inhomogeneity. Different transmitter signals for each depth are applied and prefiltered pseudoinversely according to the transfer properties of the covering tissue. Pulse compression techniques with nonlinearly frequency modulated signals are used to gain the required energy for inverse filtering.
D-scan is a modified C-scan used in nondestructive testing with the display of amplitudes. In the 2D graphical presentation, time of flight values are displayed in the top view on a test surface.

See also A-Scan, B-Scan and C-Scan.

Echocardiography is the ultrasound examination of the heart. Depending on the used ultrasound system, echocardiograms can be two-dimensional slices or 3D real-time images of the heart. Based on the ultrasound principles the direction and speed of blood flow can be utilized e.g., to diagnose a leaking or stenosed valve or to identify intracardiac shunts.

Different types of echocardiography:
The transthoracic echocardiogram (images are taken through the chest wall) is a non-invasive, highly accurate and quick assessment of the overall health of the heart.
A more invasive method is to insert a specialized scope containing an echocardiography transducer (TEE probe) into the esophagus, and record images from there. The advantages are clearer images, since the transducer is closer to the heart.
Contrast echocardiogram (CE) is already a valuable tool to delineate endocardial borders, direct invasive procedures, detect intracardiac shunts, assess myocardial perfusion and viability, and quantify coronary flow reserve and blood volumes (see also hemoglobin). The mechanism of microbubble CE is based on the physical principles of rarefaction and compression, leading to volume pulsations of microbubbles, and it is this change that results in CE signal.
Stress echocardiograms are echocardiography exams used for detection of coronary artery disease.

See also Diastole, Bicycle Stress Echocardiography, Resistive Index, and M-Mode Echocardiography.