Medical Ultrasound Imaging
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Ultrasound Biomicroscopy
Ultrasound biomicroscopy utilizes high frequency (10 - 50 MHz) diagnostic ultrasound to examine living tissue at a microscopic level and allows to image the skin with extremely high resolution to a depth of 2-3 centimeters. Ultrasound biomicroscopy images provide detailed anatomical information that can lead to better and more accurate treatments and avoid a biopsy.
Ultrasound biomicroscopy improves also the spatial resolution of US images of the anterior segment of the eye. US biomicroscopy of the eye operates in the 50 MHz range with a possible axial resolution on the order of 30 μm. In this frequency range, tissue penetration of only approximately 5 mm is attainable. Both continuous wave Doppler and high-frequency pulsed Doppler can be used.

See also Ultrasound Imaging Procedures, A-Scan, B-Scan and C-Scan.
Ultrasound Machine
Ultrasound machines, widely used in medical imaging, are essential tools in the field of diagnostic ultrasound. These devices utilize high-frequency sound waves to create real-time images of internal body structures. Ultrasound machines consist of several key components that work together to generate diagnostic images. These include:
The transducer is a handheld device that emits and receives sound waves. It converts electrical energy into sound waves and captures the returning echoes to create images.
The control panel houses the interface where the sonographer adjusts imaging parameters such as depth, frequency, and gain. It allows for customization of imaging settings based on the clinical requirements. The transducer pulse controls change the amplitude, frequency and duration of the pulses emitted from the transducer probe.
The central processing unit (CPU) serves as the brain of the ultrasound machine, processing the acquired data and transforming it into images. It handles complex calculations, image optimization, data storage and contains the electrical power supplies for itself and the transducer probe.
The display monitor (oscilloscope, tablet, computer monitor, etc.) showcases the real-time ultrasound images produced by the machine. It provides visual feedback to the sonographer, aiding in the interpretation and analysis of anatomical structures. Handheld ultrasound devices and mobile ultrasound probes can be connected wirelessly to a smartphone or tablet via Bluetooth or WiFi. These end device serves then as the ultrasound monitor.
Data input and measurements are done with the keyboard cursor (trackball). Ultrasound devices used for handheld point of care ultrasound (HPOCUS) are operated via the touch screen of the control panel.
Images are captured, reviewed, stored and transmitted digitally, using a standard format for digital imaging and communications in medicine (DICOM). Disk storage devices (FDD, HDD, CD, DVD) are outdated, but may be used in older machines to store the acquired images if no picture archiving and communication system (PACS) connection is possible.
The displayed ultrasound pictures are usually digitally stored in a PACS. The images from portable ultrasound machines can be stored and conveniently managed on the end device itself, the inserted memory card or in the cloud. With a QR scanner, the images can be accessed via the Internet in the cloud. Often there is also the possibility to get a picture of a baby sonography as a printout.

B-mode machines represent the vast majority of machines used in echocardiology, obstetrical scans, abdominal scans, gynecological scans, etc. B-mode ultrasound machines usually produce the sector (or pie segment-shaped) scans. These ultrasound scans require either a mechanical scanner transducer (the transducer moves to produce the sector scan), or a linear array transducer operated as a phased array.


Ultrasound machines come in different types, each catering to specific clinical needs. The two primary types are stationary and portable ultrasound machines:

Stationary units are typically larger in size and are installed in dedicated imaging rooms. These machines offer advanced imaging capabilities and a wide range of specialized features. They are commonly found in hospitals, clinics, and university medical centers where comprehensive imaging services are provided.
Portable units (see Portable Ultrasound Machine), as the name suggests, are compact and lightweight, designed for on-the-go imaging. These machines are highly versatile and offer excellent mobility, allowing healthcare professionals to bring the ultrasound system directly to the patient's bedside. Portable ultrasound machines are particularly useful in emergency settings, rural healthcare facilities, and point-of-care applications.

See also Handheld Ultrasound, Ultrasound System Performance, Equipment Preparation, Coaxial Cable, and Microbubble Scanner Modification, Environmental Protection and Ultrasound Accessories and Supplies.
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.
Vascular Ultrasound Contrast Agents
Vascular ultrasound contrast agents are gas microbubbles with a diameter less than 10 μm (2 to 5 μm on average for most of the newer agents) to pass through the lung capillaries and enter into the systemic circulation. Air bubbles in that size persist in solution for only a short time; too short for systemic vascular use in medical ultrasound imaging. So the gas bubbles have to be stabilized to persist long enough and survive pressure changes in the heart.
Most vascular contrast media are stabilized against dissolution and coalescence by the presence of additional materials at the gas-liquid interface. In some cases, this material is an elastic solid shell that enhances stability by supporting a strain to counter the effect of surface tension. In other cases, the material is a surfactant, or a combination of two or more surfactants.
Typically the effective duration of vascular enhancement is a few minutes, after which the microbubbles dissipate. This rather short duration of vascular enhancement makes it easy to perform repeated dynamic studies. Intravenous vascular contrast agents will be used in imaging malignant tumors in the liver, kidney, ovary, pancreas, prostate, and breast. Tumor neovascularization can be a marker for angiogenesis, and Doppler signals from small tumor vessels may be detectable after contrast injection. Contrast agents are useful for evaluating vessels in a variety of organs, including those involved in renal, hepatic, and pancreatic transplants. If an area of ischemia or a stenosis is detected after contrast administration, the use of other more expensive imaging modalities, including CT and MRI, can often be avoided.

See also Acoustically Active Lipospheres.
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