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Medical ultrasound includes
diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
techniques (mainly imaging techniques) using
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles, joints, blood vessels, and internal organs, to measure some characteristics (e.g. distances and velocities) or to generate an informative audible sound. Its aim is usually to find a source of disease or to exclude
pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...
. The usage of ultrasound to produce visual images for medicine is called medical ultrasonography or simply sonography. The practice of examining pregnant women using ultrasound is called obstetric ultrasonography, and was an early development of clinical ultrasonography. Ultrasound is composed of sound waves with frequencies which are significantly higher than the range of human hearing (>20,000 Hz). Ultrasonic images, also known as sonograms, are created by sending pulses of ultrasound into tissue using a probe. The ultrasound pulses echo off tissues with different reflection properties and are returned to the probe which records and displays them as an image. Many different types of images can be formed. The most common is a B-mode image (Brightness), which displays the acoustic impedance of a two-dimensional cross-section of tissue. Other types display blood flow, motion of tissue over time, the location of blood, the presence of specific molecules, the stiffness of tissue, or the anatomy of a three-dimensional region. Compared to other medical imaging modalities, ultrasound has several advantages. It provides images in real-time, is
portable Portable may refer to: General * Portable building, a manufactured structure that is built off site and moved in upon completion of site and utility work * Portable classroom, a temporary building installed on the grounds of a school to provide ...
, and can consequently be brought to the bedside. It is substantially lower in cost than other imaging strategies and does not use harmful ionizing radiation. Drawbacks include various limits on its field of view, the need for patient cooperation, dependence on patient physique, difficulty imaging structures obscured by
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
, air or gases,It is for this reason that the person subjected to ultrasound of organs that can contain quantities of air or gas, such as the stomach, intestine and bladder, must follow a food preparation designed to reduce their quantity: specific diet and supplements for the intestine and intake of non-carbonated water to fill the bladder; sometimes, during the examination, it may be required to fill the stomach with non-carbonated water. and the necessity of a skilled operator, usually with professional training. Owing to these drawbacks, novel wearable ultrasound implementations are gaining popularity. These miniature devices continuously monitor vitals and alert at the emergence of early signs of abnormality. Sonography (ultrasonography) is widely used in
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
. It is possible to perform both
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
and therapeutic procedures, using
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
to guide interventional procedures such as
biopsies A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a disea ...
or to drain collections of fluid, which can be both diagnostic and therapeutic. Sonographers are medical professionals who perform scans which are traditionally interpreted by radiologists, physicians who specialize in the application and interpretation of medical imaging modalities, or by cardiologists in the case of cardiac ultrasonography ( echocardiography). Increasingly, physicians and other healthcare professionals who provide direct patient care are using ultrasound in office and hospital practice (
point-of-care ultrasound Emergency ultrasound employing point-of-care ultrasound (POCUS) is the application of ultrasound at the point of care to make immediate patient-care decisions. It is performed by the health care professional caring for the injured or ill persons. ...
). Sonography is effective for imaging soft tissues of the body. Superficial structures such as muscle, tendon, testis,
breast The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and sec ...
,
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The ...
and parathyroid glands, and the neonatal brain are imaged at higher frequencies (7–18 MHz), which provide better linear (axial) and horizontal (lateral) resolution. Deeper structures such as liver and kidney are imaged at lower frequencies (1–6 MHz) with lower axial and lateral resolution as a price of deeper tissue penetration. A general-purpose ultrasound transducer may be used for most imaging purposes but some situations may require the use of a specialized transducer. Most ultrasound examination is done using a transducer on the surface of the body, but improved visualization is often possible if a transducer can be placed inside the body. For this purpose, special-use transducers, including transvaginal, endorectal, and transesophageal transducers are commonly employed. At the extreme, very small transducers can be mounted on small diameter catheters and placed within blood vessels to image the walls and disease of those vessels.


Types

Several modes of ultrasound are used in medical imaging. These are: * A-mode: A-mode (amplitude mode) is the simplest. A single transducer scans a line through the body with the echoes plotted on screen as a function of depth.
Therapeutic ultrasound Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. Physiotherapeutic ultrasound was introduced into clinical practice in the 1950s, with lithotripsy introduced in the 1980s. ...
aimed at a specific tumor or calculus is A-mode, to allow for pinpoint accurate focus of the destructive wave energy. * B-mode or 2D mode: In B-mode (brightness mode), a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. More commonly known as 2D mode now. :*B-flow is a mode that digitally highlights moving reflectors (mainly
red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "hol ...
s) while suppressing the signals from the surrounding stationary tissue. It can visualize flowing blood and surrounding stationary tissues simultaneously. It is thus an alternative or complement to
Doppler ultrasonography Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe. By calculating the frequency shift of a ...
in visualizing blood flow. * C-mode: A C-mode image is formed in a plane normal to a B-mode image. A gate that selects data from a specific depth from an A-mode line is used; then the transducer is moved in the 2D plane to sample the entire region at this fixed depth. When the transducer traverses the area in a spiral, an area of 100 cm2 can be scanned in around 10 seconds. * M-mode: In M-mode (motion mode), pulses are emitted in quick succession – each time, either an A-mode or B-mode image is taken. Over time, this is analogous to recording a
video Video is an electronic medium for the recording, copying, playback, broadcasting, and display of moving visual media. Video was first developed for mechanical television systems, which were quickly replaced by cathode-ray tube (CRT) sy ...
in ultrasound. As the organ boundaries that produce reflections move relative to the probe, this can be used to determine the velocity of specific organ structures. * Doppler mode: This mode makes use of the Doppler effect in measuring and visualizing blood flow ** Color Doppler: Velocity information is presented as a color-coded overlay on top of a B-mode image ** Continuous wave (CW) Doppler: Doppler information is sampled along a line through the body, and all velocities detected at each time point are presented (on a time line) ** Pulsed wave (PW) Doppler: Doppler information is sampled from only a small sample volume (defined in 2D image), and presented on a timeline ** Duplex: The term refers to the fact that 2 modes of ultrasounds are used simultaneously, these are generally simultaneous presentation of 2D (B-mode) and PW Doppler/Color doppler information. ** Triplex: When 2D image (B-mode) and color doppler are combined with Spectral doppler it becomes a Triplex Ultrasound. In the triplex image putting a cursor on any point gives the spectral reading of the point below the image. * Pulse inversion mode: Two successive pulses with opposite sign are emitted and then subtracted from each other. This implies that any linearly responding constituent will disappear while gases with non-linear compressibility stand out. Pulse inversion may also be used in a similar manner as in Harmonic mode; see below: * Harmonic mode: A transducer emits fundamental ultrasound pulses into the body and a central, narrow beam of harmonic overtone is reflected back after passing through the bodily tissues. When the harmonic mode is turned on, only this narrow beam of pulses is detected. The fundamental ultrasound pulses and scattered pulses are removed. Thus, lateral and contrast resolutions are improved with this mode.


Uses


Anesthesiology

In
anesthesiology Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
, ultrasound is commonly used to guide the placement of needles when injecting local anesthetic solutions in the proximity of nerves identified within the ultrasound image (nerve block). It is also used for vascular access such as cannulation of large central veins and for difficult arterial cannulation.
Transcranial Doppler Transcranial Doppler (TCD) and transcranial color Doppler (TCCD) are types of Doppler ultrasonography that measure the velocity of blood flow through the brain's blood vessels by measuring the echoes of ultrasound waves moving transcranially ...
is frequently used by neuro-anesthesiologists for obtaining information about flow-velocity in the basal cerebral vessels.


Angiology (vascular)

In angiology or vascular medicine, duplex ultrasound (B Mode imaging combined with Doppler flow measurement) is used to diagnose arterial and venous disease. This is particularly important in potential neurologic problems, where carotid ultrasound is commonly used for assessing blood flow and potential or suspected stenosis in the carotid arteries, while
transcranial Doppler Transcranial Doppler (TCD) and transcranial color Doppler (TCCD) are types of Doppler ultrasonography that measure the velocity of blood flow through the brain's blood vessels by measuring the echoes of ultrasound waves moving transcranially ...
is used for imaging flow in the intracerebral arteries.
Intravascular ultrasound Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the cathe ...
(''IVUS'') uses a specially designed catheter with a miniaturized
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
probe attached to its distal end, which is then threaded inside a blood vessel. The proximal end of the catheter is attached to computerized
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
equipment and allows the application of
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
technology, such as a piezoelectric transducer or
capacitive micromachined ultrasonic transducer A capacitive micromachined ultrasonic transducer (CMUT) is a relatively new concept in the field of ultrasonic transducers. Most of the commercial ultrasonic transducers today are based on piezoelectricity. CMUTs are the transducers where the e ...
, to visualize the
endothelium The endothelium is a single layer of squamous endothelial cells that line the interior surface of blood vessels and lymphatic vessels. The endothelium forms an interface between circulating blood or lymph in the lumen and the rest of the ve ...
of
blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...
s in living individuals. In the case of the common and potentially, serious problem of blood clots in the deep veins of the leg,
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
plays a key diagnostic role, while ultrasonography of chronic venous insufficiency of the legs focuses on more
superficial vein Superficial veins are veins that are close to the surface of the body, as opposed to deep veins, which are far from the surface. Superficial veins are not paired with an artery, unlike the deep veins, which are typically associated with an art ...
s to assist with planning of suitable interventions to relieve symptoms or improve cosmetics.


Cardiology (heart)

Echocardiography is an essential tool in
cardiology Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular h ...
, assisting in evaluation of heart valve function, such as stenosis or insufficiency, strength of
cardiac muscle Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle ...
contraction, and hypertrophy or dilatation of the main chambers. ( ventricle and atrium)


Emergency medicine

Point of care Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care. Clinical documentation Clinical documentation is a record of the critical thinking and judgment of a heal ...
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
has many applications in emergency medicine. These include differentiating cardiac from pulmonary causes of acute breathlessness, and the Focused Assessment with Sonography for Trauma (FAST) exam, extended to include assessment for significant hemoperitoneum or
pericardial tamponade Cardiac tamponade, also known as pericardial tamponade (), is the buildup of fluid in the pericardium (the sac around the heart), resulting in compression of the heart. Onset may be rapid or gradual. Symptoms typically include those of obstructi ...
after
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
(
EFAST Focused assessment with sonography in trauma (commonly abbreviated as FAST) is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart (pericardial effusio ...
). Other uses include assisting with differentiating causes of abdominal pain such as gallstones and kidney stones. Emergency Medicine Residency Programs have a substantial history of promoting the use of bedside ultrasound during physician training.


Gastroenterology/Colorectal surgery

Both
abdominal The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...
and endoanal ultrasound are frequently used in
gastroenterology Gastroenterology (from the Greek gastḗr- “belly”, -énteron “intestine”, and -logía "study of") is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract ...
and colorectal surgery. In abdominal sonography, the major organs of the abdomen such as the
pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an ...
, aorta, inferior vena cava,
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...
, gall bladder,
bile duct A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. ...
s,
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
s, and
spleen The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes .
may be imaged. However, sound waves may be blocked by gas in the bowel and attenuated to differing degrees by fat, sometimes limiting diagnostic capabilities. The
appendix Appendix, or its plural form appendices, may refer to: __NOTOC__ In documents * Addendum, an addition made to a document by its author after its initial printing or publication * Bibliography, a systematic list of books and other works * Index (pu ...
can sometimes be seen when inflamed (e.g.:
appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...
) and ultrasound is the initial imaging choice, avoiding radiation if possible, although it frequently needs to be followed by other imaging methods such as CT. Endoanal ultrasound is used particularly in the investigation of anorectal symptoms such as fecal incontinence or obstructed defecation. It images the immediate
perianal The anus ( Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, ...
anatomy and is able to detect occult defects such as tearing of the anal sphincter. Ultrasonography of liver tumors allows for both detection and characterization.


Gynecology and obstetrics

Gynecologic ultrasonography examines female pelvic organs (specifically the
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
,
ovaries The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...
, and
Fallopian tubes The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...
) as well as the
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine en ...
, adnexa, and Pouch of Douglas. It uses transducers designed for approaches through the lower abdominal wall, curvilinear and sector, and specialty transducers such as Transvaginal ultrasound. Obstetrical sonography was originally developed in the late 1950s and 1960s by Sir
Ian Donald Ian Donald (27 December 1910 – 19 June 1987) was an English physician who pioneered the diagnostic use of ultrasound in obstetrics, enabling the visual discovery of abnormalities during pregnancy. Donald was born in Cornwall, England, to a ...
and is commonly used during
pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...
to check the development and presentation of the
fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal dev ...
. It can be used to identify many conditions that could be potentially harmful to the mother and/or baby possibly remaining undiagnosed or with delayed diagnosis in the absence of sonography. It is currently believed that the risk of delayed diagnosis is greater than the small risk, if any, associated with undergoing an ultrasound scan. However, its use for non-medical purposes such as fetal "keepsake" videos and photos is discouraged. Obstetric ultrasound is primarily used to: * Date the pregnancy ( gestational age) * Confirm fetal viability * Determine location of
fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal dev ...
, intrauterine vs ectopic * Check the location of the placenta in relation to the cervix * Check for the number of fetuses ( multiple pregnancy) * Check for major physical abnormalities. * Assess fetal growth (for evidence of
intrauterine growth restriction Intrauterine growth restriction (IUGR), or fetal growth restriction, refers to poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...
( IUGR)) * Check for fetal movement and heartbeat. * Determine the sex of the baby According to the European Committee of Medical Ultrasound Safety (ECMUS) Nonetheless, care should be taken to use low power settings and avoid pulsed wave scanning of the fetal brain unless specifically indicated in high risk pregnancies. Figures released for the period 2005–2006 by the UK Government (Department of Health) show that non-obstetric ultrasound examinations constituted more than 65% of the total number of ultrasound scans conducted.


Hemodynamics (blood circulation)

Blood velocity can be measured in various blood vessels, such as middle cerebral artery or descending aorta, by relatively inexpensive and low risk ultrasound Doppler probes attached to portable monitors. These provide non-invasive or transcutaneous (non-piercing) minimal invasive blood flow assessment. Common examples are,
Transcranial Doppler Transcranial Doppler (TCD) and transcranial color Doppler (TCCD) are types of Doppler ultrasonography that measure the velocity of blood flow through the brain's blood vessels by measuring the echoes of ultrasound waves moving transcranially ...
, Esophageal Doppler and Suprasternal Doppler.


Otolaryngology (head and neck)

Most structures of the neck, including the
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The ...
and parathyroid glands,
lymph nodes A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
, and salivary glands, are well-visualized by high-frequency ultrasound with exceptional anatomic detail. Ultrasound is the preferred imaging modality for thyroid tumors and lesions, and its use is important in the evaluation, preoperative planning, and postoperative surveillance of patients with thyroid cancer. Many other benign and malignant conditions in the head and neck can be differentiated, evaluated, and managed with the help of diagnostic ultrasound and ultrasound-guided procedures.


Neonatology

In neonatology,
transcranial Doppler Transcranial Doppler (TCD) and transcranial color Doppler (TCCD) are types of Doppler ultrasonography that measure the velocity of blood flow through the brain's blood vessels by measuring the echoes of ultrasound waves moving transcranially ...
can be used for basic assessment of intracerebral structural abnormalities, suspected hemorrhage, ventriculomegaly or
hydrocephalus Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary i ...
and anoxic insults (
Periventricular leukomalacia Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis (more often coagulation) of white matter near the lateral ventricles. It can affect newborns and (less commonly) fetuses; premature infant ...
). It can be performed through the soft spots in the skull of a newborn infant ( Fontanelle) until these completely close at about 1 year of age by which time they have formed a virtually impenetrable acoustic barrier to ultrasound. The most common site for cranial ultrasound is the anterior fontanelle. The smaller the fontanelle, the more the image is compromised.


Ophthalmology ()

In
ophthalmology Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a me ...
and optometry, there are two major forms of eye exam using ultrasound: *
A-scan ultrasound biometry A-scan ultrasound biometry, commonly referred to as an A-scan (short for Amplitude scan), is a routine type of diagnostic test used in optometry or ophthalmology. The A-scan provides data on the length of the eye, which is a major determinant in ...
, is commonly referred to as an ''A-scan'' (''Amplitude scan''). A-mode provides data on the length of the eye, which is a major determinant in common sight disorders, especially for determining the power of an intraocular lens after cataract extraction. * ''B-scan ultrasonography'', or ''B-scan'', is a B-mode scan that produces a cross-sectional view of the eye and the
orbit In celestial mechanics, an orbit is the curved trajectory of an object such as the trajectory of a planet around a star, or of a natural satellite around a planet, or of an artificial satellite around an object or position in space such as ...
. Its use in the emergency department for the timely diagnosis of conditions such as retinal or vitreous detachment, retinal and vitreous hemorrhages, and intra-ocular foreign bodies is common and important.


Pulmonology (lungs)

Ultrasound is used to assess the lungs in a variety of settings including critical care, emergency medicine, trauma surgery, as well as general medicine. This imaging modality is used at the bedside or examination table to evaluate a number of different lung abnormalities as well as to guide procedures such as thoracentesis, (drainage of pleural fluid (effusion)), needle aspiration biopsy, and catheter placement. Although air present in the lungs does not allow good penetration of ultrasound waves, interpretation of specific artifacts created on the lung surface can be used to detect abnormalities.


Lung ultrasound basics

* The Normal Lung Surface: The lung surface is composed of visceral and parietal
pleura The pulmonary pleurae (''sing.'' pleura) are the two opposing layers of serous membrane overlying the lungs and the inside of the surrounding chest walls. The inner pleura, called the visceral pleura, covers the surface of each lung and dips b ...
. These two surfaces are typically pushed together and make up the pleural line, which is the basis of lung (or pleural) ultrasound. This line is visible less than a centimeter below the rib line in most adults. On ultrasound, it is visualized as a
hyperechoic Echogenicity (misspelled sometimes as echogenecity) or echogeneity is the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, echogenicity is higher when the surface bouncing the sound echo reflects increa ...
(bright white) horizontal line if the ultrasound probe is applied perpendicularly to the skin. * Artifacts: Lung ultrasound relies on artifacts, which would otherwise be considered a hindrance in imaging. Air blocks the ultrasound beam and thus visualizing healthy lung tissue itself with this mode of imaging is not practical. Consequently, physicians and sonographers have learned to recognize patterns that ultrasound beams create when imaging healthy versus diseased lung tissue. Three commonly seen and utilized artifacts in lung ultrasound include lung sliding, A-lines, and B-lines. ** §  Lung Sliding: The presence of lung sliding, which indicates the shimmering of the pleural line that occurs with movement of the visceral and parietal pleura against one another with respiration (sometimes described as 'ants marching'), is the most important finding in normal aerated lung. Lung sliding indicates both that the lung is present at the chest wall and that the lung is functioning. ** §  A-lines: When the ultrasound beam makes contact with the pleural line, it is reflected back creating a bright white horizontal line. The subsequent reverberation artifacts that appear as equally spaced horizontal lines deep to the pleura are A-lines. Ultimately, A-lines are a reflection of the ultrasound beam from the pleura with the space between A-lines corresponding to the distance between the parietal pleura and the skin surface. A-lines indicate the presence of air, which means that these artifacts can be present in normal healthy lung (and also in patients with pneumothorax). ** §  B-lines: B-lines are also reverberation artifacts. They are visualized as
hyperechoic Echogenicity (misspelled sometimes as echogenecity) or echogeneity is the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, echogenicity is higher when the surface bouncing the sound echo reflects increa ...
vertical lines extending from the pleura to the edge of the ultrasound screen. These lines are sharply defined and laser-like and typically do not fade as they progress down the screen. A few B-lines that move along with the sliding pleura can be seen in normal lung due to acoustic impedance differences between water and air. However, excessive B-lines (three or more) are abnormal and are typically indicative of underlying lung pathology.


Lung pathology assessed with ultrasound

*
Pulmonary edema Pulmonary edema, also known as pulmonary congestion, is excessive liquid accumulation in the tissue and air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia and respiratory failure. It is due ...
: Lung ultrasound has been shown to be very sensitive for the detection of pulmonary edema. It allows for improvement in diagnosis and management of critically ill patients, particularly when used in combination with echocardiography. The sonographic feature that is present in pulmonary edema is multiple B-lines. B-lines can occur in a healthy lung; however, the presence of 3 or more in the anterior or lateral lung regions is always abnormal. In pulmonary edema, B-lines indicate an increase in the amount of water contained in the lungs outside of the pulmonary vasculature. B-lines can also be present in a number of other conditions including pneumonia, pulmonary contusion, and lung infarction. Additionally, it is important to note that there are multiple types of interactions between the pleural surface and the ultrasound wave that can generate artifacts with some similarity to B-lines but which do not have pathologic significance. * Pneumothorax: In clinical settings when pneumothorax is suspected, lung ultrasound can aid in diagnosis. In pneumothorax, air is present between the two layers of the pleura and lung sliding on ultrasound is therefore absent. The negative predictive value for lung sliding on ultrasound is reported as 99.2–100% - briefly, if lung sliding is present, a pneumothorax is effectively ruled out. The absence of lung sliding, however, is not necessarily specific for pneumothorax as there are other conditions that also cause this finding including acute respiratory distress syndrome, lung consolidations, pleural adhesions, and pulmonary fibrosis. * Pleural effusion: Lung ultrasound is a cost-effective, safe, and non-invasive imaging method that can aid in the prompt visualization and diagnosis of pleural effusions. Effusions can be diagnosed by a combination of physical exam, percussion, and auscultation of the chest. However, these exam techniques can be complicated by a variety of factors including the presence of
mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...
, obesity, or patient positioning, all of which reduce the sensitivity of the physical exam. Consequently, lung ultrasound can be an additional tool to augment plain chest Xray and chest CT. Pleural effusions on ultrasound appear as structural images within the thorax rather than an artifact. They will typically have four distinct borders including the pleural line, two rib shadows, and a deep border. In critically ill patients with pleural effusion, ultrasound may guide procedures including needle insertion, thoracentesis, and chest-tube insertion. *
Lung cancer Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, mali ...
staging: In pulmonology, endobronchial ultrasound (EBUS) probes are applied to standard flexible endoscopic probes and used by pulmonologists to allow for direct visualization of endobronchial lesions and lymph nodes prior to transbronchial needle aspiration. Among its many uses, EBUS aids in lung cancer staging by allowing for lymph node sampling without the need for major surgery. *
COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...
: Lung ultrasound has proved useful in the diagnosis of COVID-19 especially in cases where other investigations are not available.


Urinary tract

Ultrasound is routinely used in urology to determine the amount of fluid retained in a patient's bladder. In a pelvic sonogram, images include the
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
and
ovaries The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...
or urinary bladder in females. In males, a sonogram will provide information about the bladder, prostate, or
testicles A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testosteron ...
(for example to urgently distinguish epididymitis from testicular torsion). In young males, it is used to distinguish more benign testicular masses ( varicocele or hydrocele) from
testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include a ...
, which is curable but must be treated to preserve health and fertility. There are two methods of performing pelvic sonography – externally or internally. The internal pelvic sonogram is performed either trans vaginally (in a woman) or transrectally (in a man). Sonographic imaging of the pelvic floor can produce important diagnostic information regarding the precise relationship of abnormal structures with other pelvic organs and it represents a useful hint to treat patients with symptoms related to pelvic prolapse, double incontinence and obstructed defecation. It is also used to diagnose and, at higher frequencies, to treat (break up) kidney stones or kidney crystals ( nephrolithiasis).


Penis and scrotum

Scrotal ultrasonography Scrotal (or transscrotal) ultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses. Indications Although the development of new imaging modalities such as c ...
is used in the evaluation of
testicular pain Testicular pain, also known as scrotal pain, occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration. Causes range from non serious musc ...
, and can help identify solid masses. Ultrasound is an excellent method for the study of the
penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...
, such as indicated in trauma, priapism, erectile dysfunction or suspected Peyronie's disease.Originally copied from:

CC-BY license


Musculoskeletal

Musculoskeletal ultrasound is used to examine tendons, muscles, nerves, ligaments, soft tissue masses, and bone surfaces. It is helpful in diagnosing ligament sprains, muscles strains and joint pathology. It is an alternative or supplement to x-ray imaging in detecting fractures of the wrist, elbow and shoulder for patients up to 12 years ( Fracture sonography). Quantitative ultrasound is an adjunct musculoskeletal test for myopathic disease in children; estimates of lean body mass in adults; proxy measures of muscle quality (i.e., tissue composition) in older adults with sarcopenia Ultrasound can also be used for needle guidance in muscle or joint injections, as in ultrasound-guided hip joint injection.


Kidneys

In nephrology, ultrasonography of the kidneys is essential in the diagnosis and management of kidney-related diseases. The kidneys are easily examined, and most pathological changes are distinguishable with ultrasound. It is an accessible, versatile, relatively economic, and fast aid for decision-making in patients with renal symptoms and for guidance in renal intervention.Content initially copied from:
(CC-BY 4.0)
/ref> Using B-mode imaging, assessment of renal anatomy is easily performed, and US is often used as image guidance for renal interventions. Furthermore, novel applications in renal US have been introduced with contrast-enhanced ultrasound (CEUS), elastography and fusion imaging. However, renal US has certain limitations, and other modalities, such as CT (CECT) and MRI, should be considered for supplementary imaging in assessing renal disease.


Venous Access

Intravenous access, for the collection of blood samples to assist in diagnosis or laboratory investigation including blood culture, or for administration of intravenous fluids for fluid maintenance of replacement or blood transfusion in sicker patients, is a common medical procedure. The need for intravenous access occurs in the outpatient laboratory, in the inpatient hospital units, and most critically in the Emergency Room and Intensive Care Unit. In many situations, intravenous access may be required repeatedly or over a significant time period. In these latter circumstances, a needle with an overlying catheter is introduced into the vein and the catheter is then inserted securely into the vein while the needle is withdrawn. The chosen veins are most frequently selected from the arm, but in challenging situations, a deeper vein from the neck ( external jugular vein) or upper arm (
subclavian vein The subclavian vein is a paired large vein, one on either side of the body, that is responsible for draining blood from the upper extremities, allowing this blood to return to the heart. The left subclavian vein plays a key role in the absorptio ...
) may need to be used. There are many reasons why the selection of a suitable vein may be problematic. These include, but are not limited to, obesity, previous injury to veins from inflammatory reaction to previous 'blood draws', previous injury to veins from recreational drug use. In these challenging situations, the insertion of a catheter into a vein has been greatly assisted by the use of ultrasound. The ultrasound unit may be 'cart-based' or 'handheld' using a linear transducer with a frequency of 10 to 15 megahertz. In most circumstances, choice of vein will be limited by the requirement that the vein is within 1.5 cms. from the skin surface. The transducer may be placed longitudinally or transversely over the chosen vein. Ultrasound training for intravenous cannulation is offered in most ultrasound training programs.


Mechanism

The creation of an image from sound has three steps – transmitting a sound wave, receiving
echoes Echoes may refer to: * Echo (phenomenon) Film and television * ''Echoes'' (2014 film), an American supernatural horror film * ''Echoes'' (miniseries), a 2022 Netflix original drama series * "Echoes" (''Fear Itself''), an episode of ''Fear Itse ...
, and interpreting those echoes.


Producing a sound wave

A sound wave is typically produced by a piezoelectric transducer encased in a plastic housing. Strong, short electrical pulses from the ultrasound machine drive the transducer at the desired frequency. The frequencies can vary between 1 and 18 MHz, though frequencies up to 50–100 megahertz have been used experimentally in a technique known as biomicroscopy in special regions, such as the anterior chamber of the eye. Older technology transducers focused their beam with physical lenses. Contemporary technology transducers use digital antenna array techniques (piezoelectric elements in the transducer produce echoes at different times) to enable the ultrasound machine to change the direction and depth of focus. Near the transducer, the width of the ultrasound beam almost equals to the width of the transducer, after reaching a distance from the transducer (near zone length or Fresnel zone), the beam width narrows to half of the transducer width, and after that the width increases (far zone length or Fraunhofer's zone), where the lateral resolution decreases. Therefore, the wider the transducer width and the higher the frequency of ultrasound, the longer the Fresnel zone, and the lateral resolution can be maintained at a greater depth from the transducer. Ultrasound waves travel in pulses. Therefore, a shorter pulse length requires higher bandwidth (greater number of frequencies) to constitute the ultrasound pulse. As stated, the sound is focused either by the shape of the transducer, a lens in front of the transducer, or a complex set of control pulses from the ultrasound scanner, in the beamforming or spatial filtering technique. This focusing produces an arc-shaped sound wave from the face of the transducer. The wave travels into the body and comes into focus at a desired depth. Materials on the face of the transducer enable the sound to be transmitted efficiently into the body (often a rubbery coating, a form of impedance matching). In addition, a water-based gel is placed between the patient's skin and the probe to facilitate ultrasound transmission into the body. This is because air causes total reflection of ultrasound; impeding the transmission of ultrasound into the body. The sound wave is partially reflected from the layers between different tissues or scattered from smaller structures. Specifically, sound is reflected anywhere where there are acoustic impedance changes in the body: e.g.
blood cell A blood cell, also called a hematopoietic cell, hemocyte, or hematocyte, is a cell produced through hematopoiesis and found mainly in the blood. Major types of blood cells include red blood cells (erythrocytes), white blood cells (leukocytes) ...
s in
blood plasma Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but contains proteins and other constituents of whole blood in suspension. It makes up about 55% of the body's total blood volume. It is the int ...
, small structures in organs, etc. Some of the reflections return to the transducer.


Receiving the echoes

The return of the sound wave to the transducer results in the same process as sending the sound wave, in reverse. The returned sound wave vibrates the transducer and the transducer turns the vibrations into electrical pulses that travel to the ultrasonic scanner where they are processed and transformed into a digital image.


Forming the image

To make an image, the ultrasound scanner must determine two characteristics from each received echo: # How long it took the echo to be received from when the sound was transmitted. (Time and distance are equivalent.) # How strong the echo was. Once the ultrasonic scanner determines these two, it can locate which pixel in the image to illuminate and with what intensity. Transforming the received signal into a digital image may be explained by using a blank spreadsheet as an analogy. First picture a long, flat transducer at the top of the sheet. Send pulses down the 'columns' of the spreadsheet (A, B, C, etc.). Listen at each column for any return echoes. When an echo is heard, note how long it took for the echo to return. The longer the wait, the deeper the row (1,2,3, etc.). The strength of the echo determines the brightness setting for that cell (white for a strong echo, black for a weak echo, and varying shades of grey for everything in between.) When all the echoes are recorded on the sheet, a greyscale image has been accomplished.


Displaying the image

Images from the ultrasound scanner are transferred and displayed using the DICOM standard. Normally, very little post processing is applied.


Sound in the body

Ultrasonography ( sonography) uses a probe containing multiple acoustic transducers to send pulses of sound into a material. Whenever a sound wave encounters a material with a different density (acoustical impedance), some of the sound wave is scattered but part is reflected back to the probe and is detected as an echo. The time it takes for the echo to travel back to the probe is measured and used to calculate the depth of the tissue interface causing the echo. The greater the difference between acoustic impedances, the larger the echo is. If the pulse hits gases or solids, the density difference is so great that most of the acoustic energy is reflected and it becomes impossible to progress further. The frequencies used for medical imaging are generally in the range of 1 to 18 MHz Higher frequencies have a correspondingly smaller wavelength, and can be used to make more detailed sonograms. However, the attenuation of the sound wave is increased at higher frequencies, so penetration of deeper tissues necessitates a lower frequency (3–5 MHz). Penetrating deep into the body with sonography is difficult. Some acoustic energy is lost each time an echo is formed, but most of it (approximately \textstyle 0.5 \frac) is lost from acoustic absorption. (See Acoustic attenuation for further details on modeling of acoustic attenuation and absorption.) The speed of sound varies as it travels through different materials, and is dependent on the acoustical impedance of the material. However, the sonographic instrument assumes that the acoustic velocity is constant at 1540 m/s. An effect of this assumption is that in a real body with non-uniform tissues, the beam becomes somewhat de-focused and image resolution is reduced. To generate a 2-D image, the ultrasonic beam is swept. A transducer may be swept mechanically by rotating or swinging or a 1-D phased array transducer may be used to sweep the beam electronically. The received data is processed and used to construct the image. The image is then a 2-D representation of the slice into the body. 3-D images can be generated by acquiring a series of adjacent 2-D images. Commonly a specialized probe that mechanically scans a conventional 2-D image transducer is used. However, since the mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2-D phased array transducers that can sweep the beam in 3-D have been developed. These can image faster and can even be used to make live 3-D images of a beating heart. Doppler ultrasonography is used to study blood flow and muscle motion. The different detected speeds are represented in color for ease of interpretation, for example leaky heart valves: the leak shows up as a flash of unique color. Colors may alternatively be used to represent the amplitudes of the received echoes.


Expansions

An additional expansion of ultrasound is bi-planar ultrasound, in which the probe has two 2D planes perpendicular to each other, providing more efficient localization and detection. Furthermore, an omniplane probe can rotate 180° to obtain multiple images.Page 161 (part II > Two-dimensional Echocardiography) in: In
3D ultrasound 3D ultrasound is a medical ultrasound technique, often used in fetal, cardiac, trans-rectal and intra-vascular applications. 3D ultrasound refers specifically to the volume rendering of ultrasound data. When involving a series of 3D volumes collec ...
, many 2D planes are digitally added together to create a 3-dimensional image of the object.


Doppler ultrasonography

Doppler ultrasonography Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe. By calculating the frequency shift of a ...
employs the Doppler effect to assess whether structures (usually blood) are moving towards or away from the probe, and their relative velocity. By calculating the frequency shift of a particular sample volume, flow in an artery or a jet of blood flow over a heart valve, its speed and direction can be determined and visualized, as an example. ''Color Doppler'' is the measurement of velocity by color scale. Color Doppler images are generally combined with gray scale ( B-mode) images to display ''duplex ultrasonography'' images. Uses include: *
Doppler echocardiography Doppler echocardiography is a procedure that uses Doppler ultrasonography to examine the heart. An echocardiogram uses high frequency sound waves to create an image of the heart while the use of Doppler technology allows determination of the spee ...
is the use of Doppler ultrasonography to examine the
heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...
. An echocardiogram can, within certain limits, produce accurate assessment of the direction of blood flow and the
velocity Velocity is the directional speed of an object in motion as an indication of its rate of change in position as observed from a particular frame of reference and as measured by a particular standard of time (e.g. northbound). Velocity i ...
of blood and cardiac tissue at any arbitrary point using the Doppler effect. Velocity measurements allow assessment of cardiac valve areas and function, abnormal communications between the left and right side of the heart, leaking of blood through the valves (
valvular regurgitation Regurgitation is blood flow in the opposite direction from normal, as the backward flowing of blood into the heart or between heart chambers. It is the circulatory equivalent of backflow in engineered systems. It is sometimes called reflux. Regur ...
), and calculation of the cardiac output and
E/A ratio The E/A ratio is a marker of the function of the left ventricle of the heart. It represents the ratio of peak velocity blood flow from left ventricular relaxation in early diastole (the E wave) to peak velocity flow in late diastole caused by atria ...

Abdul Latif Mohamed, Jun Yong, Jamil Masiyati, Lee Lim, Sze Chec Tee. ''The Prevalence Of Diastolic Dysfunction In Patients With Hypertension Referred For Echocardiographic Assessment of Left Ventricular Function.'' Malaysian Journal of Medical Sciences, Vol. 11, No. 1, January 2004, pp. 66-74
(a measure of
diastolic dysfunction Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the l ...
). Contrast-enhanced ultrasound using gas-filled microbubble contrast media can be used to improve velocity or other flow-related measurements of interest. *
Transcranial Doppler Transcranial Doppler (TCD) and transcranial color Doppler (TCCD) are types of Doppler ultrasonography that measure the velocity of blood flow through the brain's blood vessels by measuring the echoes of ultrasound waves moving transcranially ...
(TCD) and transcranial color Doppler (TCCD), measure the velocity of blood flow through the
brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...
's
blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...
s through the cranium. They are useful in the diagnosis of
emboli An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule ( fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid ( amn ...
, stenosis, vasospasm from a subarachnoid
hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...
(bleeding from a ruptured
aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus ( ...
), and other problems. * Doppler fetal monitors use the Doppler effect to detect the fetal heartbeat during prenatal care. These are hand-held, and some models also display the heart rate in beats per minute (BPM). Use of this monitor is sometimes known as ''Doppler auscultation''. The Doppler fetal monitor is commonly referred to simply as a ''Doppler'' or ''fetal Doppler'' and provides information similar to that provided by a fetal stethoscope.


Contrast ultrasonography (ultrasound contrast imaging)

A
contrast medium A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radio ...
for medical ultrasonography is a formulation of encapsulated gaseous microbubbles to increase echogenicity of blood, discovered by Dr. Raymond Gramiak in 1968 and named
contrast-enhanced ultrasound Contrast-enhanced ultrasound (CEUS) is the application of ultrasound contrast medium to traditional medical sonography. Ultrasound contrast agents rely on the different ways in which sound waves are reflected from interfaces between substances. T ...
. This contrast medical imaging modality is used throughout the world, for echocardiography in particular in the United States and for
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
in
Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
and
Asia Asia (, ) is one of the world's most notable geographical regions, which is either considered a continent in its own right or a subcontinent of Eurasia, which shares the continental landmass of Afro-Eurasia with Africa. Asia covers an are ...
. Microbubbles-based contrast media is administrated intravenously into the
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...
blood stream during the ultrasonography examination. Due to their size, the microbubbles remain confined in blood vessels without extravasating towards the interstitial fluid. An
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
contrast media is therefore purely intravascular, making it an ideal agent to image
organ Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...
microvasculature for
diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
purposes. A typical clinical use of contrast ultrasonography is detection of a hypervascular metastatic
tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
, which exhibits a contrast uptake (kinetics of microbubbles concentration in blood circulation) faster than healthy biological tissue surrounding the tumor. Other clinical applications using contrast exist, as in echocardiography to improve delineation of left ventricle for visualizing contractibility of
heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...
muscle after a
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...
. Finally, applications in quantitative perfusion (relative measurement of blood flow) have emerged for identifying early patient response to anti-cancerous drug treatment (methodology and clinical study by Dr. Nathalie Lassau in 2011), enabling the best
oncological Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''ó ...
therapeutic options to be determined. In oncological practice of medical contrast ultrasonography, clinicians use 'parametric imaging of vascular signatures' invented by Dr. Nicolas Rognin in 2010. This method is conceived as a
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
aided diagnostic tool, facilitating characterization of a suspicious
tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
( malignant versus benign) in an organ. This method is based on medical computational science to analyze a time sequence of ultrasound contrast images, a digital video recorded in real-time during patient examination. Two consecutive
signal processing Signal processing is an electrical engineering subfield that focuses on analyzing, modifying and synthesizing '' signals'', such as sound, images, and scientific measurements. Signal processing techniques are used to optimize transmissions, ...
steps are applied to each
pixel In digital imaging, a pixel (abbreviated px), pel, or picture element is the smallest addressable element in a raster image, or the smallest point in an all points addressable display device. In most digital display devices, pixels are the ...
of the tumor: # calculation of a vascular signature (contrast uptake difference with respect to healthy tissue surrounding the tumor); # automatic classification of the vascular signature into a unique
parameter A parameter (), generally, is any characteristic that can help in defining or classifying a particular system (meaning an event, project, object, situation, etc.). That is, a parameter is an element of a system that is useful, or critical, when ...
, the latter coded in one of the four following
color Color (American English) or colour (British English) is the visual perceptual property deriving from the spectrum of light interacting with the photoreceptor cells of the eyes. Color categories and physical specifications of color are associ ...
s: #*
green Green is the color between cyan and yellow on the visible spectrum. It is evoked by light which has a dominant wavelength of roughly 495570 nm. In subtractive color systems, used in painting and color printing, it is created by a combin ...
for continuous hyper-enhancement (contrast uptake higher than healthy tissue one), #*
blue Blue is one of the three primary colours in the RYB colour model (traditional colour theory), as well as in the RGB (additive) colour model. It lies between violet and cyan on the spectrum of visible light. The eye perceives blue when ...
for continuous hypo-enhancement (contrast uptake lower than healthy tissue one), #* red for fast hyper-enhancement (contrast uptake before healthy tissue one) or #*
yellow Yellow is the color between green and orange on the spectrum of light. It is evoked by light with a dominant wavelength of roughly 575585 nm. It is a primary color in subtractive color systems, used in painting or color printing. In th ...
for fast hypo-enhancement (contrast uptake after healthy tissue one). Once
signal processing Signal processing is an electrical engineering subfield that focuses on analyzing, modifying and synthesizing '' signals'', such as sound, images, and scientific measurements. Signal processing techniques are used to optimize transmissions, ...
in each pixel is completed, a color spatial map of the parameter is displayed on a computer monitor, summarizing all vascular information of the tumor in a single image called a parametric image (see last figure of press article as clinical examples). This parametric image is interpreted by clinicians based on predominant colorization of the tumor: red indicates a suspicion of malignancy (risk of cancer), green or yellow – a high probability of benignity. In the first case (suspicion of malignant tumor), the clinician typically prescribes a biopsy to confirm the diagnostic or a CT scan examination as a second opinion. In the second case (quasi-certain of
benign tumor A benign tumor is a mass of cells ( tumor) that does not invade neighboring tissue or metastasize (spread throughout the body). Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have r ...
), only a follow-up is needed with a contrast ultrasonography examination a few months later. The main clinical benefits are to avoid a systemic biopsy (with inherent risks of invasive procedures) of benign tumors or a CT scan examination exposing the patient to
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
radiation. The parametric imaging of vascular signatures method proved to be effective in humans for characterization of tumors in the liver. In a cancer screening context, this method might be potentially applicable to other organs such as
breast The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and sec ...
or prostate.


Molecular ultrasonography (ultrasound molecular imaging)

The current future of contrast ultrasonography is in molecular imaging with potential clinical applications expected in cancer screening to detect malignant tumors at their earliest stage of appearance. Molecular ultrasonography (or ultrasound molecular imaging) uses targeted microbubbles originally designed by Dr Alexander Klibanov in 1997; such targeted microbubbles specifically bind or adhere to tumoral microvessels by targeting biomolecular cancer expression (overexpression of certain biomolecules that occurs during neo-angiogenesis or
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
in malignant tumors). As a result, a few minutes after their injection in blood circulation, the targeted microbubbles accumulate in the malignant tumor; facilitating its localization in a unique ultrasound contrast image. In 2013, the very first exploratory
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
in humans for prostate cancer was completed at
Amsterdam Amsterdam ( , , , lit. ''The Dam on the River Amstel'') is the capital and most populous city of the Netherlands, with The Hague being the seat of government. It has a population of 907,976 within the city proper, 1,558,755 in the urban ar ...
in the
Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...
by Dr. Hessel Wijkstra. In molecular ultrasonography, the technique of acoustic radiation force (also used for shear wave
elastography Elastography is any of a class of medical imaging modalities that map the elastic properties and stiffness of soft tissue.Sarvazyan A, Hall TJ, Urban MW, Fatemi M, Aglyamov SR, Garra BSOverview of elastography–an emerging branch of medical im ...
) is applied in order to literally push the targeted microbubbles towards microvessels wall; first demonstrated by Dr. Paul Dayton in 1999. This allows maximization of binding to the malignant tumor; the targeted microbubbles being in more direct contact with cancerous biomolecules expressed at the inner surface of tumoral microvessels. At the stage of scientific preclinical research, the technique of acoustic radiation force was implemented as a prototype in clinical ultrasound systems and validated ''
in vivo Studies that are ''in vivo'' (Latin for "within the living"; often not italicized in English) are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and p ...
'' in 2D and 3D imaging modes.


Elastography (ultrasound elasticity imaging)

Ultrasound is also used for elastography, which is a relatively new imaging modality that maps the elastic properties of soft tissue. This modality emerged in the last two decades. Elastography is useful in medical diagnoses as it can discern healthy from unhealthy tissue for specific organs/growths. For example, cancerous tumors will often be harder than the surrounding tissue, and diseased livers are stiffer than healthy ones. There are many ultrasound elastography techniques.


Interventional ultrasonography

Interventional ultrasonography involves
biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
, emptying fluids, intrauterine
Blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...
( Hemolytic disease of the newborn). * Thyroid cysts: High frequency thyroid
ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
(HFUS) can be used to treat several gland conditions. The recurrent thyroid cyst that was usually treated in the past with surgery, can be treated effectively by a new procedure called percutaneous ethanol injection, or PEI. With ultrasound guided placement of a 25 gauge needle within the cyst, and after evacuation of the cyst fluid, about 50% of the cyst volume is injected back into the cavity, under strict operator visualization of the needle tip. The procedure is 80% successful in reducing the cyst to minute size. * Metastatic thyroid cancer neck lymph nodes: HFUS may also be used to treat metastatic thyroid cancer neck lymph nodes that occur in patients who either refuse, or are no longer candidates, for surgery. Small amounts of ethanol are injected under ultrasound guided needle placement. A power doppler blood flow study is done prior to injection. The blood flow can be destroyed and the node rendered inactive. Power doppler visualized blood flow can be eradicated, and there may be a drop in the cancer blood marker test, thyroglobulin, TG, as the node become non-functional. Another interventional use for HFUS is to mark a cancer node prior to surgery to help locate the node cluster at the surgery. A minute amount of methylene dye is injected, under careful ultrasound guided placement of the needle on the anterior surface, but not in the node. The dye will be evident to the thyroid surgeon when opening the neck. A similar localization procedure with methylene blue, can be done to locate parathyroid adenomas. * Joint injections can be guided by medical ultrasound, such as in ultrasound-guided hip joint injections.


Compression ultrasonography

Compression ultrasonography is when the probe is pressed against the skin. This can bring the target structure closer to the probe, increasing spatial resolution of it. Comparison of the shape of the target structure before and after compression can aid in diagnosis. It is used in ultrasonography of deep venous thrombosis, wherein absence of vein compressibility is a strong indicator of thrombosis. Compression ultrasonography has both high
sensitivity and specificity ''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are ...
for detecting proximal deep vein thrombosis in symptomatic patients. Results are not reliable when the patient is asymptomatic, for example in high risk postoperative orthopedic patients. File:Ultrasonography of a normal appendix without and with compression.jpg, A normal
appendix Appendix, or its plural form appendices, may refer to: __NOTOC__ In documents * Addendum, an addition made to a document by its author after its initial printing or publication * Bibliography, a systematic list of books and other works * Index (pu ...
without and with compression. Absence of compressibility indicates
appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...
. File:Ultrasonographic measurement of aortic diameter at the navel.svg, Compression is used in this ultrasonograph to get closer to the abdominal aorta, making the
superior mesenteric vein In human anatomy, the superior mesenteric vein (SMV) is a blood vessel that drains blood from the small intestine (jejunum and ileum). Behind the neck of the pancreas, the superior mesenteric vein combines with the splenic vein to form the hepa ...
and the inferior vena cava look rather flat.


Panoramic ultrasonography

Panoramic ultrasonography is the digital stitching of multiple ultrasound images into a broader one. April 2010 It can display an entire abnormality and show its relationship to nearby structures on a single image.


Multiparametric ultrasonography

Multiparametric ultrasonography (mpUSS) combines multiple ultrasound techniques to produce a composite result. For example, one study combined B-mode, colour Doppler, real-time elastography, and contrast-enhanced ultrasound, achieving an accuracy similar to that of multiparametric MRI.


Speed-of-Sound Imaging

Speed-of-sound (SoS) imaging aims to find the spatial distribution of the SoS within the tissue. The idea is to find relative delay measurements for different transmission events and solve the limited-angle tomographic reconstruction problem using delay measurements and transmission geometry. Compared to shear-wave elastography, SoS imaging has better ex-vivo tissue differentiation for benign and malignant tumors.


Attributes

As with all imaging modalities, ultrasonography has positive and negative attributes.


Strengths

* muscle, soft tissue, and bone surfaces are imaged very well including the delineation of interfaces between solid and fluid-filled spaces. * "Live" images can be dynamically selected, permitting diagnosis and documentation often rapidly. Live images also permit ultrasound-guided biopsies or injections, which can be cumbersome with other imaging modalities. * Organ structure can be demonstrated. * There are no known long-term side effects when used according to guidelines, and discomfort is minimal. * Ability to image local variations in the mechanical properties of soft tissue. * Equipment is widely available and comparatively flexible. * Small, easily carried scanners are available which permit bedside examinations. * Transducers have become relatively inexpensive compared to other modes of investigation, such as computed X-ray tomography,
DEXA Dual-energy X-ray absorptiometry (DXA, or DEXA) is a means of measuring bone mineral density (BMD) using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtracted ...
or magnetic resonance imaging. * Spatial resolution is better in high frequency ultrasound transducers than most other imaging modalities. * Use of an ultrasound research interface can offer a relatively inexpensive, real-time, and flexible method for capturing data required for specific research purposes of tissue characterization and development of new image processing techniques.


Weaknesses

* Sonographic devices have trouble penetrating
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
. For example, sonography of the adult brain is currently very limited. * Sonography performs very poorly when there is gas between the transducer and the organ of interest, due to the extreme differences in acoustic impedance. For example, overlying gas in the gastrointestinal tract often makes ultrasound scanning of the
pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an ...
difficult. Lung imaging however can be useful in demarcating pleural effusions, detecting
heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
and pneumonia. * Even in the absence of bone or air, the depth penetration of ultrasound may be limited depending on the frequency of imaging. Consequently, there might be difficulties imaging structures deep in the body, especially in obese patients. * Image quality and accuracy of diagnosis is limited with obese patients and overlying subcutaneous fat attenuates the sound beam. A lower frequency transducer is required with subsequent lower resolution. * The method is operator-dependent. Skill and experience is needed to acquire good-quality images and make accurate diagnoses. * There is no scout image as there is with CT and MRI. Once an image has been acquired there is no exact way to tell which part of the body was imaged. * 80% of sonographers experience Repetitive Strain Injuries (RSI) or so-called Work-Related Musculoskeletal Disorders (WMSD) because of bad ergonomic positions.


Risks and side-effects

Ultrasonography is generally considered safe imaging, with the World Health Organizations stating: :"Diagnostic ultrasound is recognized as a safe, effective, and highly flexible imaging modality capable of providing clinically relevant information about most parts of the body in a rapid and cost-effective fashion". Diagnostic ultrasound studies of the fetus are generally considered to be safe during pregnancy. However, this diagnostic procedure should be performed only when there is a valid medical indication, and the lowest possible ultrasonic exposure setting should be used to gain the necessary diagnostic information under the "as low as reasonably practicable" or ALARP principle. Although there is no evidence that ultrasound could be harmful to the fetus, medical authorities typically strongly discourage the promotion, selling, or leasing of ultrasound equipment for making "keepsake fetal videos".


Studies on the safety of ultrasound

* A meta-analysis of several ultrasonography studies published in 2000 found no statistically significant harmful effects from ultrasonography. It was noted that there is a lack of data on long-term substantive outcomes such as neurodevelopment. * A study at the Yale School of Medicine published in 2006 found a small but significant correlation between prolonged and frequent use of ultrasound and abnormal neuronal migration in mice. * A study performed in Sweden in 2001 has shown that subtle effects of neurological damage linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker for brain problems when not hereditary) and speech delays. ** The above findings, however, were not confirmed in a follow-up study. ** A later study, however, performed on a larger sample of 8865 children, has established a statistically significant, albeit weak association of ultrasonography exposure and being non-right handed later in life.


Regulation

Diagnostic and
therapeutic ultrasound Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. Physiotherapeutic ultrasound was introduced into clinical practice in the 1950s, with lithotripsy introduced in the 1980s. ...
equipment is regulated in the US by the
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
, and worldwide by other national regulatory agencies. The FDA limits acoustic output using several metrics; generally, other agencies accept the FDA-established guidelines. Currently,
New Mexico ) , population_demonym = New Mexican ( es, Neomexicano, Neomejicano, Nuevo Mexicano) , seat = Santa Fe, New Mexico, Santa Fe , LargestCity = Albuquerque, New Mexico, Albuquerque , LargestMetro = Albuquerque metropolitan area, Tiguex , Offi ...
,
Oregon Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...
, and
North Dakota North Dakota () is a U.S. state in the Upper Midwest, named after the indigenous Dakota Sioux. North Dakota is bordered by the Canadian provinces of Saskatchewan and Manitoba to the north and by the U.S. states of Minnesota to the east, ...
are the only US states that regulate diagnostic medical sonographers. Certification examinations for sonographers are available in the US from three organizations: the American Registry for Diagnostic Medical Sonography, Cardiovascular Credentialing International and the
American Registry of Radiologic Technologists American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the "United States" or "America" ** Americans, citizens and nationals of the United States of America ** American ancestry, pe ...
. The primary regulated metrics are Mechanical Index (MI), a metric associated with the cavitation bio-effect, and Thermal Index (TI) a metric associated with the tissue heating bio-effect. The FDA requires that the machine not exceed established limits, which are reasonably conservative in an effort to maintain diagnostic ultrasound as a safe imaging modality. This requires
self-regulation Self-regulation may refer to: *Emotional self-regulation *Self-control, in sociology/psychology *Self-regulated learning, in educational psychology *Self-regulation theory (SRT), a system of conscious personal management *Industry self-regulation, ...
on the part of the manufacturer in terms of machine calibration. Ultrasound-based pre-natal care and sex screening technologies were launched in India in the 1980s. With concerns about its misuse for sex-selective abortion, the Government of India passed the Pre-natal Diagnostic Techniques Act (PNDT) in 1994 to distinguish and regulate legal and illegal uses of ultrasound equipment. The law was further amended as the Pre-Conception and Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) (PCPNDT) Act in 2004 to deter and punish prenatal sex screening and sex selective abortion. It is currently illegal and a punishable crime in India to determine or disclose the sex of a fetus using ultrasound equipment.


History

After the French physicist
Pierre Curie Pierre Curie ( , ; 15 May 1859 – 19 April 1906) was a French physicist, a pioneer in crystallography, magnetism, piezoelectricity, and radioactivity. In 1903, he received the Nobel Prize in Physics with his wife, Marie Curie, and Henri Becq ...
's discovery of
piezoelectricity Piezoelectricity (, ) is the electric charge that accumulates in certain solid materials—such as crystals, certain ceramics, and biological matter such as bone, DNA, and various proteins—in response to applied mechanical stress. The word ' ...
in 1880, ultrasonic waves could be deliberately generated for industry. In 1940, the American acoustical physicist
Floyd Firestone Floyd Alburn Firestone (1898–1986) was an acoustical physicist, who in 1940 while a professor at the University of Michigan invented the first practical ultrasonic testing method and apparatus.Beyer, R.T. (1999). ''Sounds of our times: 200 years o ...
devised the first ultrasonic echo imaging device, the Supersonic Reflectoscope, to detect internal flaws in metal castings. In 1941, Austrian neurologist Karl Theo Dussik, in collaboration with his brother, Friedrich, a physicist, was likely the first person to image the human body ultrasonically, outlining the ventricles of a human brain. Ultrasonic energy was first applied to the human body for medical purposes by Dr  George Ludwig at the Naval Medical Research Institute,
Bethesda, Maryland Bethesda () is an unincorporated, census-designated place in southern Montgomery County, Maryland. It is located just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House (1820, rebuilt 1849), which ...
, in the late 1940s. English-born physicist
John Wild John Wild may refer to: *Jack Wild (1952–2006), English actor * John Benton Wild (1806–1857), Australian politician * John Caspar Wild (1804–1846), American painter *John Daniel Wild (1902–1972), American philosopher *John J. Wild (1914–2 ...
(1914–2009) first used ultrasound to assess the thickness of bowel tissue as early as 1949; he has been described as the "father of medical ultrasound". Subsequent advances took place concurrently in several countries but was not until 1961 when David Robinson and George Kossoff's work at the Australian Department of Health resulted in the first commercially practical water bath ultrasonic scanner. In 1963 Meyerdirk & Wright launched production of the first commercial, hand-held, articulated arm, compound contact B-mode scanner, which made ultrasound generally available for medical use.


France

Léandre Pourcelot, a researcher and teacher at INSA (Institut National des Sciences Appliquées), Lyon, co-published a report in 1965 at the Académie des sciences, "Effet Doppler et mesure du débit sanguin" ("Doppler effect and measure of the blood flow"), the basis of his design of a Doppler flow meter in 1967.


Scotland

Parallel developments in
Glasgow Glasgow ( ; sco, Glesca or ; gd, Glaschu ) is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated popu ...
, Scotland by Professor
Ian Donald Ian Donald (27 December 1910 – 19 June 1987) was an English physician who pioneered the diagnostic use of ultrasound in obstetrics, enabling the visual discovery of abnormalities during pregnancy. Donald was born in Cornwall, England, to a ...
and colleagues at the Glasgow Royal Maternity Hospital (GRMH) led to the first diagnostic applications of the technique. Donald was an obstetrician with a self-confessed "childish interest in machines, electronic and otherwise", who, having treated the wife of one of the company's directors, was invited to visit the Research Department of boilermakers Babcock & Wilcox at Renfrew. He adapted their industrial ultrasound equipment to conduct experiments on various morbid anatomical specimens and assess their ultrasonic characteristics. Together with the medical physicist . and fellow obstetrician Dr. John MacVicar, Donald refined the equipment to enable differentiation of pathology in live volunteer patients. These findings were reported in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles ...
'' on 7 June 1958 as "Investigation of Abdominal Masses by Pulsed Ultrasound" – possibly one of the most important papers published in the field of diagnostic medical imaging. At GRMH, Professor Donald and Dr. James Willocks then refined their techniques to obstetric applications including fetal head measurement to assess the size and growth of the fetus. With the opening of the new Queen Mother's Hospital in Yorkhill in 1964, it became possible to improve these methods even further. Dr. Stuart Campbell's pioneering work on fetal cephalometry led to it acquiring long-term status as the definitive method of study of foetal growth. As the technical quality of the scans was further developed, it soon became possible to study pregnancy from start to finish and diagnose its many complications such as multiple pregnancy, fetal abnormality and '' placenta praevia''. Diagnostic ultrasound has since been imported into practically every other area of medicine.


Sweden

Medical ultrasonography was used in 1953 at
Lund University , motto = Ad utrumque , mottoeng = Prepared for both , established = , type = Public research university , budget = SEK 9 billion cardiologist Inge Edler and Gustav Ludwig Hertz's son Carl Hellmuth Hertz, who was then a graduate student at the university's department of
nuclear physics Nuclear physics is the field of physics that studies atomic nuclei and their constituents and interactions, in addition to the study of other forms of nuclear matter. Nuclear physics should not be confused with atomic physics, which studies t ...
. Edler had asked Hertz if it was possible to use
radar Radar is a detection system that uses radio waves to determine the distance (''ranging''), angle, and radial velocity of objects relative to the site. It can be used to detect aircraft, Marine radar, ships, spacecraft, guided missiles, motor v ...
to look into the body, but Hertz said this was impossible. However, he said, it might be possible to use ultrasonography. Hertz was familiar with using ultrasonic reflectoscopes of the American acoustical physicist
Floyd Firestone Floyd Alburn Firestone (1898–1986) was an acoustical physicist, who in 1940 while a professor at the University of Michigan invented the first practical ultrasonic testing method and apparatus.Beyer, R.T. (1999). ''Sounds of our times: 200 years o ...
's invention for nondestructive materials testing, and together Edler and Hertz developed the idea of applying this methodology in medicine. The first successful measurement of heart activity was made on October 29, 1953, using a device borrowed from the ship construction company Kockums in
Malmö Malmö (, ; da, Malmø ) is the largest city in the Swedish county (län) of Scania (Skåne). It is the third-largest city in Sweden, after Stockholm and Gothenburg, and the sixth-largest city in the Nordic region, with a municipal popul ...
. On December 16 the same year, the method was applied to generate an echo-encephalogram (ultrasonic probe of the
brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...
). Edler and Hertz published their findings in 1954.


United States

In 1962, after about two years of work, Joseph Holmes, William Wright, and Ralph Meyerdirk developed the first compound contact B-mode scanner. Their work had been supported by U.S. Public Health Services and the University of Colorado. Wright and Meyerdirk left the university to form Physionic Engineering Inc., which launched the first commercial hand-held articulated arm compound contact B-mode scanner in 1963. This was the start of the most popular design in the history of ultrasound scanners. In the late 1960s Dr Gene Strandness and the bio-engineering group at the
University of Washington The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington. Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seatt ...
conducted research on Doppler ultrasound as a diagnostic tool for vascular disease. Eventually, they developed technologies to use duplex imaging, or Doppler in conjunction with B-mode scanning, to view vascular structures in real time while also providing hemodynamic information. The first demonstration of color Doppler was by Geoff Stevenson, who was involved in the early developments and medical use of Doppler shifted ultrasonic energy.


Manufacturers

Major manufacturers of Medical Ultrasound Devices and Equipment are: *
Canon Medical Systems Corporation Canon Medical Systems Corporation is a medical equipment company based in Ōtawara, Tochigi, Japan. Formerly known as Toshiba Medical, a subsidiary of Toshiba, the company was an early pioneer on X-ray tubes in 1914 in Japan. Canon Medical Sys ...
* Esaote *
GE Healthcare GE HealthCare is a subsidiary of American multinational conglomerate General Electric incorporated in New York and headquartered in Chicago, Illinois. As of 2017, it is a manufacturer and distributor of diagnostic imaging agents and radiopharma ...
* Hitachi Ltd. * Mindray Medical International Limited * Koninklijke Philips N.V. * Samsung Medison * Siemens Healthineers


See also

*
3D ultrasound 3D ultrasound is a medical ultrasound technique, often used in fetal, cardiac, trans-rectal and intra-vascular applications. 3D ultrasound refers specifically to the volume rendering of ultrasound data. When involving a series of 3D volumes collec ...
* Doppler fetal monitor *
Elastography Elastography is any of a class of medical imaging modalities that map the elastic properties and stiffness of soft tissue.Sarvazyan A, Hall TJ, Urban MW, Fatemi M, Aglyamov SR, Garra BSOverview of elastography–an emerging branch of medical im ...
* Polybiography *
Radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of pathology. Rad ...
*
Ultrasound computer tomography Ultrasound computer tomography (USCT), sometimes also ''Ultrasound computed tomography'', ''Ultrasound computerized tomography'' or just ''Ultrasound tomography'', is a form of medical ultrasound tomography utilizing ultrasound waves as physical p ...
*
Ultrasound transmission tomography Ultrasound transmission tomography (UTT) is a form of tomography involving ultrasound. Like X-ray tomography, the attenuation of the ultrasound as it passes through the object can be measured, but since the speed of sound is so much lower than th ...
* Voluson 730


Explanatory notes


References


External links


About the discovery of medical ultrasonography
on ob-ultrasound.net

on ob-ultrasound.net {{DEFAULTSORT:Medical Ultrasonography Medical imaging Acoustics Medical equipment Physical therapy