The gain is a linear factor that is used in a device as a multiplier after calibration. The gain is the ratio of input to output in an amplifier. The sensitivity of a probe is adjusted by changing the gain.

See also Compress, and Reject.

Gray scale [also grayscale, grey scale = brit.] produces basically black and white images with series of shades of gray. Solid areas appear white and fluid areas appear black, varying from black at the weakest intensity to white at the strongest. Gray scale resolves artifacts as small as 1 mm. The display is made by transmitting bursts of energy and analyzing the returning signal. Gray scale pictures are limited to the gray scale tones; color pictures display more information because the color is added to the gray scale.
Most ultrasound contrast agents also improve gray scale visualization of the flowing blood to such a degree that the tissue echogenicity increases. Gray scale enhancement of flow in an organ promises to improve lesion detection, along with the ability to differentiate between normal and abnormal areas, using many of the criteria already routinely used in CT and MRI.

See also Compress, Densitometry, Triplex Exam and QB-Mode.

Handheld ultrasound systems are portable devices for smartphone or tablet and are increasingly common in emergency, intensive care and veterinary medicine, but also in the pocket of the stationary doctor. This type of ultrasound machine enables immediate diagnoses directly on site (handheld point-of-care-ultrasound / HPOCUS) and quickly provide information regarding the patient's further care. Handheld ultrasound machines fit into a single-use plastic cover and can be easily disinfected, making them particularly useful in infectious environments.
The most striking advantage of handheld POCUS devices is the small footprint. The design is very compact, lightweight (approx. 200 g/0,44 lbs. - 500 g/1,1 lbs) and flexible. Due to this compactness and the necessary technical compression, the quality of the imaging is still limited compared to 'high-end devices', but sufficient to the extent that handheld ultrasound devices are already successfully used in many medical disciplines.
Depending on the model, handheld ultrasound systems run on Android, iOS, Windows or proprietary operating systems. They are connected to the end device via USB cable or wirelessly via Bluetooth or WiFi. The respective end device is used as an ultrasound monitor to display the ultrasound images. The associated app is operated via touchscreen, although some devices have a few buttons, e.g. for recording ultrasound images or freeze images. The images can be stored and managed on the end device itself, the inserted memory card or in the cloud. Theoretically, also a private smartphone can be connected, but this can lead to complications with reimbursement.
See also Portable Ultrasound Machine, Ultrasound Technology, Environmental Protection, Ultrasound Accessories and Supplies and Sonographer.

Standard scanners allow visualizing microbubbles on conventional gray scale imaging in large vascular spaces. In the periphery, more sensitive techniques such as Doppler or non-linear gray scale modes must be used because of the dilution of the microbubbles in the blood pool. Harmonic power Doppler (HPD) is one of the most sensitive techniques for detecting ultrasound contrast agents.
Commonly microbubbles are encapsulated or otherwise stabilized to prolong their lifetime after injection. These bubbles can be altered by exposure to ultrasound pulses. Depending on the contrast agent and the insonating pulse, the changes include deformation or breakage of the encapsulating or stabilizing material, generation of free gas bubbles, reshaping or resizing of gas volumes.
High acoustic pressure amplitudes and long pulses increase the changes. However, safety considerations limit the pressure amplitude and long pulses decrease spatial resolution. In addition, lowering the pulse frequency increases destruction of contrast bubbles. However, at low insonation power levels, contrast agent particles resist insonation without detectable changes. Newer agents are more reflective and will usually allow gray scale imaging to be used with the advantages of better spatial resolution, fewer artifacts and faster frame rates.

Feasible imaging methods with advantages in specific acoustic microbubble properties:
Resonating microbubbles emit harmonic signals at double their resonance frequency. If a scanner is modified to select only these harmonic signals, this non-linear mode produces a clear image or trace. The effect depends on the fact that it is easier to expand a bubble than to compress it so that it responds asymmetrically to a symmetrical ultrasound wave. A special array design allows to perform third or fourth harmonic imaging. This probe type is called a dual frequency phased array transducer.

See also Bubble Specific Imaging.

The propagation of high amplitude ultrasound waves is inadequate described by a linear wave equation. Non-linear propagation is to expect if the power levels are high enough to make non-linear effects significant. A non-linear propagation results in the distortion of the transmitted waveforms, resulting in the generation of harmonics of the initial frequency components transmitted by the transducer.
In the near field of ultrasound probes, the occurring diffraction and focusing effects make this process complex. The distortion of a wavefront propagating in a medium in which the compressional phase moves slightly faster than the rarefactional phase, results is the conversion of some wave energy into higher harmonics of the fundamental frequency. The effect increases strongly with increasing wave amplitude.