Regulations governing the output of diagnostic ultrasound have been largely set by the USA's Food and Drug Administration (FDA), although the International Electrotechnical Commission (IEC) is currently in the process of setting internationally agreed standards.
The relevant national societies for ultrasound users (e.g. American Institute of Ultrasound in Medicine (AIUM), British Medical Ultrasound Society (BMUS)) usually have safety committees who offer advice on the safe use of ultrasound. In 1992, the AIUM, in conjunction with the National Electrical Manufacturers Association (NEMA) developed the Output Display Standard (ODS), including the thermal index and mechanical index which have been incorporated in the FDA's new regulations.
Within Europe, the Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) also addresses safety and has produced safety guidelines (through the European Committee for Ultrasound Radiation Safety). The World Federation (WFUMB) held safety symposia in 1991 (on thermal issues) and 1996 (thermal and non-thermal issues), at which recommendations were proffered.
The FDA ultrasound safety regulations from 1993 combine an overall limit of spatial peak time averaged intensity (I-SPTA) of 720 mW/cm2 for all equipment. A system of output displays allows users to employ effective and judicious levels of ultrasound appropriate to the examination. The output display is based on two indices, the mechanical index (MI) and the thermal index (TI).

See also ALARA Principle, and Radiological Society of North America.

In physics, the absorbed dose is the ultrasonic power absorbed per unit of mass of an object, and is measured in watts per kilogram (W/kg). The absorption increases with ultrasound intensity and frequency.
The thermal index describes the potential for heating of the patient's tissue due to the application of energy.

See also Thermal Effect, Ultrasound Safety, Ultrasound Regulations.

Diagnostic ultrasound imaging has no known risks or long-term side effects. Discomfort to the patient is very rare if the sonogram is accurately performed by using appropriate frequencies and intensity ranges. However, the application of the ALARA principle is always recommended.
There are reports of low birth weight of babies after applying more than the recommended ultrasound examinations during pregnancy. Women who think they might be pregnant should raise this issue with the doctor before undergoing an abdominal ultrasound, to avoid any harm to the fetus in the early stages of development.
Since ultrasound is energy, sensitive tissues like the reproductive organs could possibly sustain damage if vibrated to a high degree by too intense ultrasound waves. In diagnostic ultrasonic procedures, such damage would only result from improper use of the equipment.

Possible ultrasound bioeffects:
The thermal effect is controlled by the displayed thermal index and the mechanical index indicates the risk of cavitation.
An ultrasound gel is applied to obtain better contact between the transducer and the skin. This has the consistency of thick mineral oil and is not associated with skin irritation or allergy.
Specific conditions for which ultrasound may be selected as a treatment may be attached with higher risks.

See also Ultrasound Imaging Procedures, Fetal Ultrasound and Obstetric and Gynecologic Ultrasound.

(TCCS) Transcranial color coded sonography is a combination of B-mode and pulsed wave Doppler. TCCS is used to study morphological and functional assessment of the circle of Willis, intracranial hemodynamics caused by extracranial artery stenosis, collateral flow and the vascular supply of intracranial lesion. Color imaging of the intracranial vessels allows placing the spectral Doppler volume correctly. This modality has encouraged the widespread use.
Contrast enhanced TCCS analysis of cerebral arteriovenous transit time (cTT) is used as a measure of cerebral microcirculation.
The windows that are used for transcranial Doppler examinations include regions where the skull bones are relatively thin or where naturally occurring gaps allow proper penetration of the sound beam.

See also A-Mode, Cranial Bone Thermal Index, Transcranial Doppler and Transcranial Window.

(TCD) Transcranial color Doppler sonography allows to evaluate the presence and flow direction of vessels as well as their relationships to surrounding structures.
A disadvantage of cerebrovascular ultrasonography is the attenuation of the ultrasound signal by the skull. The loss of power through the skull is considerable, the signal to noise ratio is poor and so contrast enhanced Doppler imaging is advantageous. The use of ultrasound contrast agents provides a diagnostic window of sufficient duration and imaging quality to improve an evaluation of the cerebral vessels. Contrast TCD also results in visualization of small arteries and veins and greater length of these vessels.

See also A-Mode, Cranial Bone Thermal Index, Transcranial Color Coded Sonography and Transcranial Window.