Doppler Ultrasound Principles and Artifacts

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Questions and Answers

What adjustment should be made to capture slow flow with color Doppler?

  • Increase the pulse repetition frequency and decrease the wall filter
  • Increase the Nyquist limit to 60 cm/s and wall filter to 8 cm/s
  • Reduce the velocity scale or Nyquist limit to 40 cm/s and set the wall filter to 4 cm/s (correct)
  • Maintain the current velocity scale and only adjust the color gain

Which of the following is a possible cause of mirror imaging artifact in Doppler ultrasound?

  • Insufficient color gain leading to signal dropout
  • Doppler angle being too close to 90 degrees with increased gain (correct)
  • Use of a high wall filter eliminating low-velocity signals
  • Spectral broadening due to a small sample volume

What is the recommended action to correct for spectral signals overlapping due to beam width artifacts?

  • Increase the pulse repetition frequency (PRF)
  • Decrease the color gain
  • Adjust the focal zone and gain (correct)
  • Increase the wall filter setting

What is the typical cause of color overgain artifact, and how can it be resolved?

<p>Excessive color gain; reduce color gain (A)</p> Signup and view all the answers

How can aliasing, that exceeds the Nyquist limit, be resolved when using Doppler ultrasound?

<p>Switch to continuous-wave (CW) Doppler to change the velocity scale and frequency. (D)</p> Signup and view all the answers

What does the Bernoulli equation, $4V^2$, primarily calculate?

<p>The pressure gradient at the narrowing of a vessel. (A)</p> Signup and view all the answers

What artifact results from strong reflectors or regurgitation displaying color signals on the side?

<p>Side lobe artifact with color (B)</p> Signup and view all the answers

Which of the following best describes the Flow Convergence region?

<p>A dome-shaped region with high velocities indicated by color aliasing. (D)</p> Signup and view all the answers

Normally, the Lateral Annulus should not exceed which value?

<p>$&gt;10$ (A)</p> Signup and view all the answers

What is the primary indicator of RV volume overload when assessing LV geometry?

<p>LV D-shaped only in diastole (A)</p> Signup and view all the answers

What is indicated by an LV wall that has a thinned out Anteroseptal wall?

<p>Old MI affecting LV systolic function (A)</p> Signup and view all the answers

Which of the following is considered a precursor to thrombus formation?

<p>Spontaneous contrast (B)</p> Signup and view all the answers

How is Cardiac Output calculated?

<p>SV x HR (A)</p> Signup and view all the answers

What adjustment can be made to PISA Radius to clear flow convergence?

<p>Shifting the baseline in the direction of the jet. (B)</p> Signup and view all the answers

In flow convergence, when does the flow exceed the Nyquist limit?

<p>When blue (lower velocity) transitions to red (higher velocity). (A)</p> Signup and view all the answers

Which of the following is the correct relationship between frequency and penetration of ultrasound waves?

<p>Frequency and penetration are inversely related; as frequency increases, penetration decreases. (C)</p> Signup and view all the answers

What type of wave is an ultrasound wave?

<p>Longitudinal and mechanical (C)</p> Signup and view all the answers

Which acoustic parameter CANNOT be adjusted by the sonographer?

<p>Propagation speed (D)</p> Signup and view all the answers

If the frequency of an ultrasound wave is $5 \text{ MHz}$, what is its period?

<p>$0.2 \text{ microseconds}$ (A)</p> Signup and view all the answers

Which of the following best describes rarefactions in sound waves?

<p>Regions of lower particle density and pressure. (A)</p> Signup and view all the answers

What is the relationship between Pulse Repetition Period (PRP) and Pulse Repetition Frequency (PRF)?

<p>PRP and PRF are inversely proportional. (B)</p> Signup and view all the answers

What determines axial resolution?

<p>Spatial Pulse Length (SPL) (D)</p> Signup and view all the answers

Which of the following is NOT a component of attenuation?

<p>Refraction (A)</p> Signup and view all the answers

Which of the following is a characteristic of Dyskinesia?

<p>Bulging in systole with outward movement. (D)</p> Signup and view all the answers

What is the primary effect of the Valsalva maneuver on atrial pressure?

<p>Causes a drop in atrial pressure by reducing venous return. (A)</p> Signup and view all the answers

A patient with Diastolic Dysfunction has a fused E/A wave on Doppler. Which maneuver is most appropriate to resolve this issue and separate the waveforms?

<p>Applying a carotid massage. (C)</p> Signup and view all the answers

What is the normal value for Flow propagation when using Color Doppler M mode as a marker of impaired relaxation?

<blockquote> <p>45 cm/s (D)</p> </blockquote> Signup and view all the answers

Which finding during a diastolic stress test would be considered abnormal and indicative of pulmonary hypertension?

<p>RVSP &gt; 70 mmHg and TR velocity &gt; 2.8 m/s (C)</p> Signup and view all the answers

What is the recommended method to accurately measure the Ejection Fraction of the Right Ventricle?

<p>3D Echocardiography (B)</p> Signup and view all the answers

In the context of Ischemic Heart Disease, what does Speckle Tracking assess, and what color indicates unhealthy cardiac tissue on the Bull's Eye chart?

<p>Assesses myocardial strain; Blue indicates unhealthy tissue. (C)</p> Signup and view all the answers

Which coronary artery is most likely associated with SERP (Systolic Early Regional Pre-ejection) observed in the apical and mid-septum during a stress echo?

<p>Left Anterior Descending Artery (LAD) (A)</p> Signup and view all the answers

Which statement best describes the M-mode characteristics seen with RV volume overload pattern?

<p>Enlarged RV, Flattened Septum, paradoxical motion of septum in SYSTOLE. (B)</p> Signup and view all the answers

What is the hemodynamic definition of the Vena Contracta?

<p>The narrowest diameter with maximum velocity. (D)</p> Signup and view all the answers

A patient presents with classic indications of Aortic Stenosis, increased LV pressure, and LVH. How will the LV End-Diastolic Pressure be affected?

<p>Decreased (A)</p> Signup and view all the answers

What M-mode finding is most consistent with Calcific Aortic Stenosis (Degenerative)?

<p>Parallel and thickened aortic leaflets with reverberation lines at valve closure. (D)</p> Signup and view all the answers

What is the effect on End Systolic Volume, during an Ischemic Response to Dobutamine?

<p>End Systolic Volume Decreases. (A)</p> Signup and view all the answers

What blood pressure value(s) indicates a Hypertensive Response to Exercise?

<p>Systolic BP &gt; 220 mmHg (men) or &gt; 190 mmHg (women) and Diastolic BP &gt; 90 mmHg. (B)</p> Signup and view all the answers

What value is needed to calculate RVSP?

<p>RAP (C)</p> Signup and view all the answers

What is the primary purpose of the matching layer in ultrasound transducers?

<p>To increase ultrasound transmission between the active element and skin. (A)</p> Signup and view all the answers

In the context of ultrasound, what is axial resolution?

<p>The ability to distinguish two structures that are parallel to the main beam's axis. (C)</p> Signup and view all the answers

What adjustment should be made to mitigate the side lobe artifact in an ultrasound image?

<p>Turn on harmonic imaging. (A)</p> Signup and view all the answers

If the imaging depth is doubled, what happens to the frame rate (FR) in real-time imaging?

<p>The FR is halved. (A)</p> Signup and view all the answers

What is the term for the bending of the ultrasound beam as it passes from one medium to another?

<p>Refraction (A)</p> Signup and view all the answers

What is the relationship between frequency and divergence in the far field for smaller diameter crystals?

<p>Lower frequency, more divergence. (A)</p> Signup and view all the answers

What information is provided by spectral analysis of Pulsed Wave (PW) Doppler signals?

<p>Mean velocities using Autocorrelation. (A)</p> Signup and view all the answers

Which of the following actions could cause aliasing in Pulsed Wave (PW) Doppler measurements?

<p>Having velocities exceed the Nyquist limit. (B)</p> Signup and view all the answers

What does 'Time of Flight' refer to in the range equation, within the context of soft tissue?

<p>The time it takes for ultrasound to travel to a reflector and back to the transducer. (B)</p> Signup and view all the answers

What is the function of the demodulator in Doppler ultrasound?

<p>To extract the Doppler frequency shift. (C)</p> Signup and view all the answers

Regarding ultrasound artifacts, what causes mirror imaging?

<p>A strong reflector and longer goal return time. (D)</p> Signup and view all the answers

What characteristics are associated with the Near Field Clutter artifact in ultrasound imaging, and how is it reduced?

<p>Appears as a cloud at the apex of the image; reduced by Tissue Harmonic Imaging (THI). (B)</p> Signup and view all the answers

How is contrast resolution affected by decreasing the dynamic range?

<p>Decreasing the dynamic range decreases the number of shades of gray, increasing contrast. (B)</p> Signup and view all the answers

In the context of Color Doppler, what does the aliasing pattern typically look like within a vessel?

<p>Red → Light Blue → Dark Blue in the center. (A)</p> Signup and view all the answers

Which of the following is true regarding refraction artifacts in ultrasound imaging?

<p>They can be easily eliminated by alternating the transducer's angle and position. (B)</p> Signup and view all the answers

Flashcards

Sound

A creation due to vibration of a moving structure.

Sound Waves

Composed of compressions and rarefactions.

Compressions

Regions of higher pressure in density within sound waves.

Rarefactions

Regions of lower pressure in density within sound waves.

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Frequency

Number of cycles occurring in a given time.

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Attenuation

Decreases power, intensity, and amplitude of sound waves.

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Pulse Duration

Time from the start to the end of a single pulse.

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Duty Factor

Percentage of time the system transmits a pulse.

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Sweep Speed

Change the number of cardiac cycles, typically set to 100 mm/s for clarity.

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Wall Filter (WF)

Adjusting the Wall Filter to a lower setting helps in recording correct frequencies.

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Tissue Doppler Imaging (TDI)

Records tissue movement; its signal strength shows amplitude and brightness.

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Aliasing Resolution

Use Continuous Wave (CW) Doppler to resolve aliasing issues, increasing the velocity scale.

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Color Aliasing

Occurs with turbulent flow; often indicates stenosis in vessels.

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Color Mirror Image

Artifact seen in IVC or subcostal views where colors reflect incorrectly.

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Bernoulli Principle

Energy conservation law demonstrated in stenotic lesions affecting flow.

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Mean Velocity Calculation

Mean velocity is calculated by tracing the velocity time integral (VTI) over time.

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PISA Radius

Radius used to analyze flow convergence and calculate effective regurgitant orifice area (EROA).

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Cardiac Output Formula

Cardiac output is calculated by multiplying stroke volume (SV) by heart rate (HR).

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Continuity Equation

Mass conservation principle stating flow in one area must equal flow in a second area without shunts.

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D-Shaped LV

Shape indicating right ventricular pressure overload during systole or diastole.

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True Aneurysm

A bulge at the apex of the heart where the myocardium wall is dead.

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Pseudoaneurysm

A bulge with a narrow neck, high risk of rupture and thrombus formation.

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Supernormal Filling

Condition where LV vigorously draws blood from LA, making E wave double that of A wave.

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Sound Reflection

The change in direction of a sound wave when it strikes a boundary.

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Incident Intensity

Intensity of a sound wave before it strikes the boundary.

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Transmitted Intensity

The intensity of a sound wave that continues after hitting a boundary.

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Axial Resolution

Ability to distinguish two structures parallel to the main beam's axis.

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Focal Depth

Distance from the transducer to the focal point.

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Doppler Shift

Change in frequency of sound waves due to relative motion.

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Aliasing

Occurs in PW Doppler when the frequency measured exceeds the Nyquist limit.

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Matching Layer

Layer that increases the transmission of ultrasound between the active element and skin.

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Harmonics

Reflected sound waves that are double the fundamental frequency.

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Temporal Resolution

Ability to capture events in time, affecting motion perception.

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Color Flow Doppler

Doppler shifts are represented as colors to indicate blood flow and velocity.

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Beam Divergence

The spread of the sound beam across the far zone.

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Refractive Artifact

A partially duplicated structure caused by differing ultrasound speeds.

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Wall Drop Artifact

Poor specular reflection at 90 degrees leading to loss of lateral structures.

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Contrast Resolution

The detail in differentiating shades of gray in an image.

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Impaired Relaxation

A condition where the LV cannot relax due to stiffness, reducing blood intake from the LA.

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E/A Ratio

The ratio of early to late diastolic flow velocities, used to assess diastolic function.

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Valsalva Maneuver

A method that reduces venous return to the atrium, helping diagnose elevated pressures.

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Diastolic Dysfunction

Impairment in the ability of the heart to relax and fill effectively.

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Wall Motion Abnormality

An abnormal contraction pattern of the heart wall, often due to ischemic heart disease.

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Dyskinesia

Abnormal bulging movement of the heart wall during systole.

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Speckle Tracking

A technique to measure the strain and function of the LV during contraction.

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Cardiac Remodeling

Changes in size and shape of the heart after damage, typically due to a heart attack.

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Effective Orifice Area

The maximum pressure gradient between the left ventricle and the aortic valve opening.

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Aortic Stenosis

Narrowing of the aortic valve that restricts blood flow from the heart.

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Bicuspid Aortic Valve

A congenital abnormality with two cusps instead of three on the aortic valve.

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Akinesia

Absence of motion of the heart wall during contraction.

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Tardokinesia

Delayed contraction of the heart wall seen during stress tests.

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Cherry on Top of the Bull’s Eye

Refers to amyloidosis affecting specific segments of the heart.

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RV Volume Overload

Condition marked by a D-shaped right ventricle due to excess volume.

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Study Notes

Sound

  • Sound is created by vibrations of a moving structure
  • Sound waves consist of compressions and rarefactions
  • Compressions are higher pressure areas
  • Rarefactions are lower pressure areas
  • Sound waves are longitudinal and mechanical waves

Wave Types

  • Transverse waves have particles moving perpendicular to the wave direction.
  • Longitudinal waves have particles moving parallel to the wave direction.

Time and Frequency

  • Period is the time required to complete one cycle.
  • Frequency is the number of cycles per unit time.
  • Frequency is measured in MHz.

Ultrasound Frequency

  • Ultrasound frequency ranges from 2 to 10 MHz.
  • Higher frequency improves image quality.
  • Frequency is inversely related to penetration.

Amplitude and Power

  • Amplitude is the average between the maximum and average values.
  • Sonographers can adjust amplitude.
  • Power is the rate at which work or energy is transferred.
  • Sonographers can adjust power.

Intensity

  • Intensity is the concentration of energy in a sound beam.
  • Sonographers can adjust intensity to control biological effects and safety.

Propagation Speed

  • Propagation speed is the rate of sound traveling through a medium.
  • The speed in soft tissue is 1.54 mm/microsecond.

Wavelength

  • Wavelength is the length of a single cycle.
  • The formula for calculating wavelength is 1.54/Frequency (MHz).

Pulse Duration

  • Pulse duration is the time from the start to the end of a single pulse.
  • Pulse duration is comprised of 2-4 cycles.

Repetition Frequency (PRF)

  • PRF is the number of pulses that occur in 1 second.
  • Sonographers can adjust PRF.

Pulse Repetition Period (PRP)

  • PRP is the time from the start of one pulse to the start of the next pulse.
  • Sonographers can adjust PRP.
  • PRP x PRF = 1

Duty Factor

  • Duty factor is the percentage of time the system transmits a pulse.
  • Sonographers can adjust duty factor.

Spatial Pulse Length (SPL)

  • SPL is the length or distance the pulse occupies in space.
  • SPL determines axial resolution.

Attenuation

  • Attenuation decreases the power, intensity, and amplitude of a sound wave.
  • Attenuation is directly related to distance traveled and frequency.

Types of Attenuation

  • Absorption: converts energy to heat
  • Scattering: reflects energy to diffuse (backscatter) or specular ways
  • Reflection: specular from smooth reflectors and diffuse from rough ones.
  • Rayleigh Scattering: sound scattering uniformly in all directions when the reflector is smaller than the wavelength.

Other Key Concepts

  • Range equation: describes the time of flight in soft tissue.
  • Axial Resolution: ability to separate two structures parallel to the main beam.
  • Lateral Resolution: ability to separate two structures side-by-side; improves in the near field.
  • Contrast Resolution: ability to distinguish different shades of gray/shades of colors in an image.
  • Dynamic Range: range of grayscale from black to white.
  • Unfocused CW Transducer: beam diameter is equal to the transducer diameter at the end of the NZL.
  • Focal Depth: distance from the transducer to the focal point.
  • Phased Array: electric focusing and steering.

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