(TI) The definition of the thermal index is the ratio of the total acoustic power to that required raising a maximum temperature increase of 1 °C under defined assumptions. A thermal index of 1 indicates the acoustic power achieving a temperature increase of 1 °C. A thermal index of 2 has the doubled power but would not necessarily indicate a peak temperature rise of 2 °C. The temperature rise is dependent on tissue type and is particularly dependent on the presence of bone.
Classifications of thermal indices:
For fetal ultrasound, the highest temperature increase would be expected occurring at bone. Therefore, TIB gives the worst-case conditions. If the ultrasound system can exceed an index of 1, the mechanical index and thermal index must be displayed. The displayed indices are based on the manufacturer's data.

See also Cranial Bone Thermal Index, Bone Thermal Index, Soft Tissue Thermal Index.

(TIB) The bone thermal index is an exposure model for the case that the ultrasound beam passes through soft tissue and a focal region is in the immediate vicinity of bone.
The longitudinal waves of ultrasound are reflected and transformed into transverse waves, creating a heating effect. Muscle and bone absorb more energy at interfaces with other heterogeneous tissues.

See also Sheer Wave.

(TIS) The bone thermal index is an exposure model for the case that the ultrasound beam heats primarily soft tissue.

(TIC) The cranial bone thermal index is an exposure model for the case that the ultrasound beam passes through bone near the beam entrance into the body.

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.