The various gas microbubble contrast media are generally safe with low toxicity in humans. The tolerance of these agents is much higher than that of most x-ray agents, a reflection perhaps of the higher expectation of safety and convenience for ultrasound.
Extensive preclinical and clinical trials have demonstrated an excellent ultrasound contrast agent safety profile, the main side effect being a mild and transient local discomfort at the injection site which results from the high osmolality of these agents. Each contrast agent has its own profile of adverse effects, but all have been trivial thus far.

See also Ultrasonic Contrast Agents.

(THI) Tissue harmonic imaging (also called native harmonic imaging) is a signal processing technique which addresses ultrasound limitations like penetration and resolution. Tissue harmonic imaging reduces noise and clutter by improving signal to noise ratio and resolution. The signal penetration in soft tissue increases as the transmit frequency is decreased, by simultaneous decreased image resolution. As an ultrasound wave propagates through the target media a change occurs in the shape and frequency of the transmitted signal. The change is due to the normal resistance of tissue to propagate sound energy. This resistance and the resulting signal change is called a harmonic oscillation.
For harmonic imaging the input frequency doubles the output frequency, for example a transmit frequency of 3.0 MHz. which would provide maximum penetration will return a harmonic frequency of 6.0 MHz. The returning higher frequency signal has to only travel one direction to the probe. The advantages of high frequency imaging and the one-way travel effect are decreased reverberation, beam aberration, and side lobes, as well as increased resolution and cystic clearing.

(MI) The mechanical index is an estimate of the maximum amplitude of the pressure pulse in tissue. It is an indicator of the likelihood of mechanical bioeffects (streaming and cavitation). The mechanical index of the ultrasound beam is the amount of negative acoustic pressure within a ultrasonic field and is used to modulate the output signature of US contrast agents and to incite different microbubble responses.
The mechanical index is defined as the peak rarefactional pressure (negative pressure) divided by the square root of the ultrasound frequency.
The FDA ultrasound regulations allow a mechanical index of up to 1.9 to be used for all applications except ophthalmic (maximum 0.23). The used range varies from 0.05 to 1.9.
At low acoustic power, the acoustic response is considered as linear. At a low MI (less than 0.2), the microbubbles undergo oscillation with compression and rarefaction that are equal in amplitude and no special contrast enhanced signal is created. Microbubbles act as strong scattering objects due to the difference in impedance between air and liquid, and the acoustic response is optimized at the resonant frequency of a microbubble.
At higher acoustic power (MI between 0.2-0.5), nonlinear oscillation occurs preferentially with the bubbles undergoing rarefaction that is greater than compression. Ultrasound waves are created at harmonics of the delivered frequency. The harmonic response frequencies are different from that of the incident wave (fundamental frequency) with subharmonics (half of the fundamental frequency), harmonics (including the second harmonic response at twice the fundamental frequency), and ultra-harmonics obtained at 1.5 or 2.5 times the fundamental frequency. These contrast enhanced ultrasound signals are microbubble-specific.
At high acoustic power (MI greater than 0.5), microbubble destruction begins with emission of high intensity transient signals very rich in nonlinear components. Intermittent imaging becomes needed to allow the capillaries to be refilled with fresh microbubbles. Microbubble destruction occurs to some degree at all mechanical indices. A mechanical index from 0.8 to 1.9 creates high microbubble destruction. The output signal is unique to the contrast agent.

(US) Also called echography, sonography, ultrasonography, echotomography, ultrasonic tomography.
Diagnostic imaging plays a vital role in modern healthcare, allowing medical professionals to visualize internal structures of the body and assist in the diagnosis and treatment of various conditions. Two terms that are commonly used interchangeably but possess distinct meanings in the field of medical imaging are 'ultrasound' and 'sonography.'
Ultrasound is the imaging technique that utilizes sound waves to create real-time images, while sonography encompasses the entire process of performing ultrasound examinations and interpreting the obtained images. Ultrasonography is a synonymous term for sonography, emphasizing the use of ultrasound technology in diagnostic imaging. A sonogram, on the other hand, refers to the resulting image produced during an ultrasound examination.
Ultrasonic waves, generated by a quartz crystal, cause mechanical perturbation of an elastic medium, resulting in rarefaction and compression of the medium particles. These waves are reflected at the interfaces between different tissues due to differences in their mechanical properties. The transmission and reflection of these high-frequency waves are displayed with different types of ultrasound modes.
By utilizing the speed of wave propagation in tissues, the time of reflection information can be converted into distance of reflection information. The use of higher frequencies in medical ultrasound imaging yields better image resolution. However, higher frequencies also lead to increased absorption of the sound beam by the medium, limiting its penetration depth. For instance, higher frequencies (e.g., 7.5 MHz) are employed to provide detailed imaging of superficial organs like the thyroid gland and breast, while lower frequencies (e.g., 3.5 MHz) are used for abdominal examinations.

Ultrasound in medical imaging offers several advantages including:

Diagnostic ultrasound imaging is generally considered safe, with no adverse effects. As medical ultrasound is extensively used in pregnancy and pediatric imaging, it is crucial for practitioners to ensure its safe usage. Ultrasound can cause mechanical and thermal effects in tissue, which are amplified with increased output power. Consequently, guidelines for the safe use of ultrasound have been issued to address the growing use of color flow imaging, pulsed spectral Doppler, and higher demands on B-mode imaging. Furthermore, recent ultrasound safety regulations have shifted more responsibility to the operator to ensure the safe use of ultrasound.

See also Skinline, Pregnancy Ultrasound, Obstetric and Gynecologic Ultrasound, Musculoskeletal and Joint Ultrasound, Ultrasound Elastography and Prostate Ultrasound.

Fetal ultrasound is a safe and non-invasive imaging technique used to visualize and monitor the development of a fetus during pregnancy. It employs high-frequency sound waves to create detailed images of the baby, the placenta, and the uterus. Fetal ultrasound provides valuable information about the baby's growth, organ development, and overall well-being. It is commonly used to determine gestational age, assess fetal anatomy, detect abnormalities, and monitor fetal movements and heart rate. This essential tool enables healthcare professionals to ensure the optimal health of both the mother and the baby throughout the pregnancy.
The FDA (Food and Drug Administration) has established regulations governing ultrasound usage, including specific guidelines for fetal ultrasound examinations. These regulations permit an eight-fold increase in ultrasound intensity for fetal scans. They place considerably responsibility on the user to understand the output measurements, the mechanical index (MI), the thermal index (TI) and to use them in their scanning. The primary safety concern in prenatal diagnostic imaging is temperature rise. It is known that hyperthermia is teratogenic. The efforts of investigators have concentrated on defining the temperature increases and exposure times which may give rise to biological effects and on determining the ultrasound levels which might, in turn, lead to those temperature rises.
In fetal ultrasound, the highest temperature increase would be expected to occur at bone and the thermal index with bone at/near the focus (TIB) would give the 'worst case' conditions. The mechanical index and thermal index must be displayed if the ultrasound system is capable of exceeding an index of 1. The displayed indices are based on the manufacturer's experimental and modeled data. However, an independent study has demonstrated significant discrepancies over declared spatial peak time averaged intensity (I-SPTA) output of up to 400%.

See also ALARA Principle, Pregnancy Ultrasound and Doppler Fluximetry in Pregnancy.