Piezo means pressure, so piezoelectric means that pressure is generated when electrical energy is applied to a quartz crystal. When electrical energy is applied to the face of the crystal, the shape of the crystal changes as a function of the polarity of the applied electrical energy. As the crystal expands and contracts it produces compressions and rarefactions, and creates sound waves. When this material is struck by sound waves it creates electrical currents.
Thus, a piezoelectric crystal can produce a pulse of mechanical energy (pressure pulse) by electrically exciting the crystal (transmitter), and they can produce a pulse of electrical energy by mechanically exciting the crystal (receiver). This ultrasound physics principle is called the piezoelectric effect (pressure electricity), which was discovered by Pierre and Jacques Curie in 1880, and is used to generate ultrasound waves. Instead of quartz crystals, piezoelectric ceramics such as barium titanate or lead zirconate titanate are also used, which are crystalline materials with similar piezoelectric properties.

See also Temporal Peak Intensity.

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.

A transducer is a device, usually electrical or electronic, that converts one type of energy to another. Most transducers are either sensors or actuators. A transducer (also called probe) is a main part of the ultrasound machine. The transducer sends ultrasound waves into the body and receives the echoes produced by the waves when it is placed on or over the body part being imaged.
Ultrasound transducers are made from crystals with piezoelectric properties. This material vibrates at a resonant frequency, when an alternating electric current is applied. The vibration is transmitted into the tissue in short bursts. The speed of transmission within most soft tissues is 1540 m/s, producing a transit time of 6.5 ms/cm. Because the velocity of ultrasound waves is constant, the time taken for the wave to return to the transducer can be used to determine the depth of the object causing the reflection.
The waves will be reflected when they encounter a boundary between two tissues of different density (e.g. soft tissue and bone) and return to the transducer. Conversely, the crystals emit electrical currents when sound or pressure waves hit them (piezoelectric effect). The same crystals can be used to send and receive sound waves; the probe then acts as a receiver, converting mechanical energy back into an electric signal which is used to display an image. A sound absorbing substance eliminates back reflections from the probe itself, and an acoustic lens focuses the emitted sound waves. Then, the received signal gets processed by software to an image which is displayed at a monitor.
Transducer heads may contain one or more crystal elements. In multi-element probes, each crystal has its own circuit. The advantage is that the ultrasound beam can be controlled by changing the timing in which each element gets pulsed. Especially for cardiac ultrasound it is important to steer the beam.
Usually, several different transducer types are available to select the appropriate one for optimal imaging. Probes are formed in many shapes and sizes. The shape of the probe determines its field of view.
Transducers are described in megahertz (MHz) indicating their sound wave frequency. The frequency of emitted sound waves determines how deep the sound beam penetrates and the resolution of the image. Most transducers are only able to emit one frequency because the piezoelectric ceramic or crystals within it have a certain inherent frequency, but multi-frequency probes are also available.
See also Blanking Distance, Damping, Maximum Response Axis, Omnidirectional, and Huygens Principle.

Transducers used for the real-time mode are different than for the A-mode, B-, or M-modes. A linear array transducer with multiple piezoelectric crystal elements that are different arranged and fired, transmits the needed larger sound beam.
A subgroup of x adjacent elements (8-16; or more in wide-aperture designs) is pulsed simultaneously; the inner elements pulse delayed with respect to the outer elements. The interference of the x small divergent wavelets generates a focused beam. The delay time determining the focus depth of a real-time transducer can be changed during imaging.
Similar delay factors applied during the receiving phase, result in a dynamic focusing effect on the return. This forms a single scan line in the real-time image. To produce the following scan line, another group of x elements is selected by shifting one element position along the transducer array from the previous group. This pattern is then repeated for the groups along the array, in a sequential and repetitive way.

Ultrasound physics is based on the fact that periodic motion emitted of a vibrating object causes pressure waves. Ultrasonic waves are made of high pressure and low pressure (rarefactional pressure) pulses traveling through a medium.

Properties of sound waves:

The speed of ultrasound depends on the mass and spacing of the tissue molecules and the attracting force between the particles of the medium. Ultrasonic waves travels faster in dense materials and slower in compressible materials. Ultrasound is reflected at interfaces between tissues of different acoustic impedance e.g., soft tissue - air, bone - air, or soft tissue - bone.
The sound waves are produced and received by the piezoelectric crystal of the transducer. The fast Fourier transformation converts the signal into a gray scale ultrasound picture.

The ultrasonic transmission and absorption is dependend on:
See also Sonographic Features, Doppler Effect and Thermal Effect.