Duplex ultrasonography (duplex scan) consists of two ultrasound modalities to study blood flow and the perivascular tissue. This includes B-mode / gray scale imaging used in combination with spectral Doppler / pulsed-wave Doppler.
The real-time visualization of the vessels and tissue by the B-mode component improves the PW Doppler positioning and the direction of blood flow can be inferred. The angle between the direction of the PW Doppler signal and the estimated direction of blood flow can be measured.
Duplex techniques are available on phased array, linear array, and mechanical scanners. A phased array probe is able to create nearly simultaneous images and flow information. A linear array transducer can also do this if the Doppler probe is attached separately to one end of the scanhead. A mechanical transducer freeze the image; the crystals must be static to produce a Doppler image. The first two transducers are therefore the best choice for Duplex.

See also Compound B-Mode, and Duplex Scanner.

Duplex systems often combine a pulsed Doppler with a spectral display and a real time imaging system. A duplex scanner has usually an imaging transducer or a separate transducer used to collect continuous wave or pulsed Doppler signals, either simultaneously with imaging or sequentially.

Doppler ultrasound is a medical imaging technique for calculating the relative velocity between two points by measuring the frequency shift of a sound wave transmitted from one point to the other, based on the Doppler effect. Continuous or pulsed Doppler is frequently used to examine cardiovascular blood flow. The combination of routine 2D-mode and Doppler ultrasound allows a complete evaluation of the heart's anatomy and function (including the fetal heart). See also Doppler Fluximetry in Pregnancy.
Doppler ultrasound depends on the fact that if a moving object reflects the ultrasound waves, the echo frequencies are changed. A higher frequency is created if the object is moving toward the probe//transducer and a lower frequency if it is moving away from it. How much the frequency is changed depends upon how fast the object is moving. Doppler ultrasound shows the different rates of blood flow in different colors on a monitor in real time.
The major Doppler parameters are the peak systolic velocity and the end-diastolic velocity. The peak systolic velocity ratio compensates the variability between different patients and instrumentations.

Different Doppler and duplex techniques:

The earliest introduction of vascular ultrasound contrast agents (USCA) was by Gramiak and Shah in 1968, when they injected agitated saline into the ascending aorta and cardiac chambers during echocardiographic to opacify the left heart chamber. Strong echoes were produced within the heart, due to the acoustic mismatch between free air microbubbles in the saline and the surrounding blood.

(CD) Color Doppler is an ultrasound imaging mode, which visualizes the presence, direction and velocity of flowing blood in a wide range of flow conditions. It provides an estimate of the mean velocity of flow within a vessel by color coding the flow and displaying it superimposed on the 2D gray scale image. The flow direction is arbitrarily assigned the color red or blue, indicating flow toward or away from the transducer.
Color (colour, Brit.) Doppler ultrasound is capable of evaluating a wider area than other Doppler modes than for example Duplex or power Doppler, and therefore makes it less likely to miss flow abnormalities. It is also easier to interpret. Color flow is not as precise as conventional Doppler and is best used to scan a larger area and then use conventional Doppler for detailed analysis at a site of potential flow abnormality.

Adjustments for color Doppler in case of too much color:
Adjustments for color Doppler in case of not enough color:
See also Color Power Doppler, Autocorrelation, Color Priority, Triplex Exam and Color Saturation.