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.

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.

Echoes of deep lying structures within the body do not always come from the latest emitted sound pulse and can produce an aliasing artifact. Aliasing lowers the frequency components when the pulse repetition frequency is less than 2 times the highest frequency of a Doppler signal. This artifact can be problematical at Spectral or Color Doppler examinations.
Aliasing of the data displayed in pulsed wave technology is utilized as a benefit in determining transitions from laminar to turbulent flow.

See also Ultrasound Imaging Modes.

Spectral Doppler refers to the combination of either continuous wave Doppler or pulsed Doppler with a spectral display. Spectral Doppler provides a quantitative analysis of the velocity and direction of blood flow.
The Fourier spectrum analyzer performs a fast Fourier transformation on the Doppler signal. The amplitudes of the resulting spectra are encoded as brightness. In the 2D spectral display, the frequency shift is depicted in the vertical and the time in the horizontal axis. The range of blood velocities in the volume produces a corresponding range of frequency shifts.

See also Acceleration Index and Triplex Exam.

Transducers can be divided in:
1.) Transducers where the sound wave is transmitted and received by different elements.
2.) Transducers where multiple elements part of the time transmit and part of the time receive sound energy.
The first type of ultrasound transducer is used in detection of blood flow (also called nonimaging transducers). For example, the continuous wave transducer (Pedoff transducer) has two separate elements, where one element is always transmitting while the other element is always receiving.
Probes of the second type are used to image cardiac structures and have the capability to use various Doppler techniques to detect blood flow (also called imaging transducers). For example, continuous wave, pulsed wave, high pulse repetition frequency, color flow, M-mode, and 2D-mode are the various modes that this type of transducer can perform.

Transducers can also be divided in mechanical and electronic or phased scan types.
Mechanical transducers use a combination of single element oscillation, multiple element rotation, or a single element and set of acoustic mirrors to generate the sweeping beam for 2D mode. Caused by the vibration (created as the mirrors rotate or oscillate inside the cover) is this type sometimes called the 'wobbler'. Mechanical transducers are cheaper than electronic transducers.
Different types of electronic or phased array probes can create a linear or rectangular shaped scan plane as well as a sector or pie shaped scan plane. Sector scanners are most useful for cardiac ultrasound examinations where the beam is directed between the ribs to image the heart. A linear array transducer is more useful in abdominal, OB/GYN, and small parts examinations. Electronic transducers are more expensive but they provide dynamic focusing and smaller probe.

See also Rectangular Array Transducer.