Real-time mode has been developed to present motion like a movie of the body's inner workings, showing this information at a high rate. The special real-time transducer uses a larger sound beam than for A, B or M-modes. A linear array transducer with multiple crystal elements displays real-time compound B-mode images with up to 100 images per second.
At each scan line, one sound pulse is transmitted and all echoes from the surface to the deepest range are received. Then the ultrasound beam moves on to the next scan line position where pulse transmission and echo recording are repeated.

See also Compound B-Mode, Pulse Inversion Doppler, and Frame Averaging.

(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.

Harmonic B-mode imaging takes advantage of the non-linear oscillation of microbubbles. During harmonic imaging, the sound signal is transmitted at a frequency of around 1.5 to 2.0 MHz and received at twice this frequency. The microbubbles also reflect waves with wavelengths different from the transmitted one, the detectors can be set to receive only the latter ones and create only images of the contrast agent.
Using bandpass filters the transmitted frequency is separated from the received signal to get improved visualization of vessels containing ultrasound contrast agents (USCAs). The signal to noise ratio during the presence of microbubbles in tissue is four- to fivefold higher at the harmonic compared with the basic frequency.
Using harmonic B-mode imaging, harmonic frequencies produced by the ultrasound propagation through tissue have to be taken into account. The tissue reflection produces only a small amount harmonic energy compared to USCAs, but has to be removed by background subtraction for quantitative evaluation of myocardial perfusion.

See also Non-linear Propagation.

The 2D-mode (2-Dimensional-mode) is a spatially oriented B-mode (brightness) ultrasound. The imaged structures are displayed 2 dimensional as a function of depth and width. The brightness level is based on the echo signal amplitude.
Most of the ultrasound devices in medical imaging are 2D real-time scanner. The image is created by a rapidly back and forth swept sound beam over the region of interest.

See also Gray Scale.

In 3D ultrasound (US) several 2D images are acquired by moving the probe across the body surface or rotating inserted probes. 3D-mode uses the same basic concept of a 2D ultrasound but rather than take the image from a single angle, the sonographer takes a volume image. The volume image that is displayed on the screen is a software rendering of all of the detected soft-tissue combined by specialized computer software to form three-dimensional images.
The 3D volume rendering technique (VR) does not rely on segmentation (segmentation techniques are difficult to apply to ultrasound pictures) and makes it possible to obtain clear 3D ultrasound images for clinical diagnosis. A 3D ultrasound produces a still image. Diagnostic US systems with 3D display functions and linear array probes are mainly used for obstetric and abdominal applications. The combination of contrast agents, harmonic imaging and power Doppler greatly improves 3D US reconstructions.

3D imaging shows a better look at the organ being examined and is used for:

Fusion 3D imaging methods for generating compound images from two sets of ultrasound images (B-mode and Doppler images) enable the observation of the structural relationships between lesions and their associated blood vessels in three dimensions (maximum intensity projection).

As far as ultrasound is concerned, 4D ultrasound (also referred to as live 3D ultrasound or 4B-mode) is the latest ultrasound technology - the fourth dimension means length, width, and depth over time. 4D Ultrasound takes 3D ultrasound images and adds the element of time to the progress so that a moving three-dimensional image is seen on the monitor. A 4D scan takes the same amounts of time as a 2D or 3D scan; the difference is the ultrasound equipment being used. One advantage of a 4D fetal ultrasound to a 2D-mode is that parents can see how their baby will generally look like. However, there are different opinions over the medical advantages.
To scan a 3D ultrasound image, the probe is swept over the maternal abdomen. A computer takes multiple images and renders the 3D picture. With 4D imaging, the computer takes the images as multiple pictures while the probe is hold still and a 3D image is simultaneously rendered in real time on a monitor.
In most cases, the standard 2D ultrasound is taken, and then the 3D/4D scan capability is added if an abnormality is detected or suspected. The 3D/4D sonogram is then focused on a specific area, to provide the details needed to assess and diagnose a suspected problem. A quick 4D scan of the face of the fetus may be performed at the end of a routine exam, providing the parents with a photo.