Lesson 43: Ultrasound Scanning

24. Medical Physics

24.1 Production and use of ultrasound

Learning outcomes
understand that a piezo-electric crystal changes shape when a p.d. is applied
1 across it and that the crystal generates an e.m.f. when its shape changes

understand how ultrasound waves are generated and detected by a piezoelectric

2 transducer

understand how the reflection of pulses of ultrasound at boundaries between

3 tissues can be used to obtain diagnostic information about internal structures

define the specific acoustic impedance of a medium as Z = ρc,

4 where c is the speed of sound in the medium
𝐼𝐼𝑟𝑟 𝑍𝑍2 −𝑍𝑍1 2
use = for the intensity reflection coefficient of a boundary between
5 𝐼𝐼0 𝑍𝑍2 +𝑍𝑍1
two media
6 recall and use I = I0e^–αx for the attenuation of ultrasound in matter
Transducers: Piezo-electric effect

• A transducer is a device which

contains piezo-electric crystals
such as quartz. Once these
crystals are put under stress &
strain, you can make electricity
flow through them. The reverse is
usually true as well: if you pass
electricity through the same
crystals, they "squeeze
themselves" by vibrating back and
forth. It is this alternating emf
across the crystal, which produces
the ultrasound waves. The
frequency of this vibration is also
the same as the ultrasonic waves
it produces (above 20kHz).
 Cross-section through an ultrasound

Outer case:

Damping material:

Acoustic window
 Echo sounding

The principle of an ultrasound is to direct

ultrasound waves into the body. These pass
through various tissues and are partially
reflected at each boundary where the wave
speed changes. These reflected waves are
detected by the transducer and used to
construct an internal image.

The beam is also partially refracted as can be

seen.

For ultrasound, we are interested in the

fraction of the incident intensity of
ultrasound that is reflected at the boundary.
This depends on the acoustic impedance Z
Acoustic impedance (Z)
is a physical property of tissue. It describes how much resistance an
ultrasound beam encounters as it passes through a tissue. Acoustic
impedance depends on:
• the density of the tissue (d, in kg/m3)
• the speed of the sound wave in that material (c, in m/s)

𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂 𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊 = 𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅 𝒙𝒙 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒐𝒐𝒐𝒐 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔

𝐙𝐙 = 𝝆𝝆 𝒙𝒙 𝒄𝒄
Factors affecting ultrasound
The fraction of light that is reflected depends on acoustic impedance of
the tissue on each side of the interface – this depends on the density of
the medium.
 A much bigger reflection occurs at a tissue-bone boundary than a tissue-
muscle boundary
The amplitude depends on how much is scattered or absorbed within the
body, known as attenuation.

The size of peaks on an oscilloscope is increased by the transition to a

more-dense medium, and the attenuation can reduce the peak size,
unless accounted for (e.g. by the distance travelled).
 Calculating reflected intensities
When an ultrasound beam reaches the boundary between 2 materials, the
greater the difference in acoustic impedances, the greater the reflected
fraction of the ultrasound waves.
z1 z2
𝐼𝐼𝑟𝑟 (𝑍𝑍2 − 𝑍𝑍1 )2
=
𝐼𝐼0 (𝑍𝑍2 + 𝑍𝑍1 )2

2
𝐼𝐼𝑟𝑟 𝑍𝑍2 − 𝑍𝑍1
=
𝐼𝐼0 𝑍𝑍2 + 𝑍𝑍1

Where 𝐼𝐼0 is incident intensity

𝐼𝐼𝑟𝑟 is reflected intensity

Thus, for air-tissue boundary there will be a very large fraction reflected. Roughly 95%
will not go through.
 Attenuation of ultrasound

• The amplitude and intensity of ultrasound waves decrease as they

travel through tissue, a phenomenon known as attenuation

Absorption. This is the main factor causing attenuation of the ultrasound beam. The
higher the frequency of the sound wave, the greater the amount of absorption that
will occur. However, attenuation is not too much a problem in ultrasound as it relies
on the reflection of ultrasound at the boundaries.

I = I0e-αx

Where:
• α is the absorption coefficient
• x is the distance travelled through the material
 Why do we use Gel on the patient?

• Air is the enemy of ultrasound. Ultrasound waves tend to reflect strongly

wherever air meets biological tissue. If there is even a small bubble between the
probe and the patients skin, the ultrasound waves will be reflected away instead
of penetrating the skin. Without the waves going into the patient, you will not
be able to get a decent image. Therefore, it is absolutely vital to make sure that
there are no air bubbles between the probe and the skin of the patient. This is
why we ‘couple’ the transducer to the skin with gel.

• The impedance of the gel matches that of the skin. This is so the majority of
the ultrasound is not reflected back at the patients skin, but rather goes
straight through . This is called impedance matching
 A- Scan

Each partial reflection of the

ultrasound is detected and
appears as a spike on the screen.

Thickness Distance travelled

of bone = 2

∴ Thickness = c ∆t
2

Where c is speed of ultrasound

in bone

Ultrasound waves are gradually attenuated as they pass through

the body. The echoes from tissues deeper in the body are weaker .
 B-scan
a wave of ultrasound is sent out in a
pencil like narrow path. The horizontal
line represents the time since the wave
was released

The probe is placed on one end. When

the wave meets the first wall, a part of
the wave is reflected back into the probe.
The strength of the returning wave is
recorded by a bright dot. The brightness
of the dot represents the strength of the
returning wave. The brighter the dot, the
stronger is the returning wave.
The letter “B” of “B scan” represents
Brightness.
Part of the wave continues through
until it reaches the other wall. Again,
part of it is reflected into the probe.
This returning wave, like the
returning wave from the previous
wall, is represented as a bright dot
on the screen. The brightness is
determined by the intensity of the
reflection

However, if a B scan is done at

different levels of the object,
you will get a two dimensional
image on the screen as shown
on the right . First a B scan is
done at the top of the structure
chosen, e.g. the eye.
Real B-scans of the eye

A healthy eye

These are a few examples of the

pathologies that can be imaged
using B-scan ultrasonography.

1. Posterior vitreous detachment with

macular traction.

2. Choroidal melanoma with

overlying retinal detachment.

3. Cilary body tumor.

4. Optic nerve drusen.

Textbook questions (Q10-15 , p624-627)
Exam-style questions (Q5,6,12 on p634-5)
November 2013 (v1) QP - Paper 4 CIE Physics A-level
Lesson 44:
Production and
use of X-rays
 24. Medical physics
24.2 Production and use of X-rays

Learning outcomes
explain that X-rays are produced by electron bombardment of a metal
1 target and calculate the minimum wavelength of X-rays produced from
the accelerating p.d.
understand the use of X-rays in imaging internal body structures, including an
2 understanding of the term contrast in X-ray imaging

3 recall and use I = Ioe–μx for the attenuation of X-rays in matter

Nature of X-rays

• X-rays are a form of EM radiation. They belong to the short-wavelength,

high frequency end of the EM spectrum beyond UV. They have
wavelengths in the range 10-13 to 10-8 .
Frequency
 X-ray Production

Rotating anode

As electrons hit the metal target, they rapidly

Vacuum
decelerate. The energy E gained by the electron as it
is accelerated through a p.d. of V (between cathode
and anode) is Emax=eV

This energy is converted into X-ray photons

𝒆𝒆𝒆𝒆
∴ 𝑬𝑬𝒎𝒎𝒎𝒎𝒎𝒎 = 𝒉𝒉𝒇𝒇𝒎𝒎𝒎𝒎𝒎𝒎 𝒆𝒆𝒆𝒆 = 𝒉𝒉𝒇𝒇𝒎𝒎𝒎𝒎𝒎𝒎 or 𝒇𝒇𝒎𝒎𝒎𝒎𝒎𝒎 =
𝒉𝒉
 Minimum wavelength of x-rays produced

• As there is a max frequency an x-ray can have to find the wavelength,

we can just substitute fmax into the wave-speed equation

𝒇𝒇𝒎𝒎𝒎𝒎𝒎𝒎 =
𝒆𝒆𝒆𝒆
𝒄𝒄 = 𝒇𝒇𝝀𝝀
𝒉𝒉𝒉𝒉
𝒉𝒉 𝝀𝝀 =
𝒆𝒆𝒆𝒆
Question 2: (p616)
Attenuation of X-rays
Attenuation is a general term that refers to any reduction in the strength of a
signal. As X-rays pass through matter, the intensity will decrease.

Original Intensity, I0

Organ being
Thickness , x
penetrated μ

New Intensity, I
• To calculate the attenuation, we can use the following equation:

I = I0e-μx
Half thickness
This is the thickness of a material that will reduce the transmitted intensity
of an x-ray by half.
 IA

Step 1: find I 1

Step 2: find I 2 Step 3: find ratio I 1 / I 2

 Image quality
There are many factors/ filters that could be improve on the quality of photos,
such as brightness, colour, sharpness, contrast and so on. We will look at how
we can improve the contrast of an X-ray.

Contrast: the difference in brightness between the

brightest and dark areas.
Contrast
Ideally, we would like a good high contrast between the white and black parts.

Bone is a good absorber of X-rays. To view bones,

hard X-rays are used. However, to view tissues (e.g.
of the breast), which are generally poor absorbers
of X-rays, a soft X-ray is used which requires a much
longer exposure.

Bone is readily distinguished from a soft tissue, such

as muscle because it is a good absorber of X-rays.
However, sometimes it is desirable to show up
different tissues that absorb X-rays equally.

A contrast medium such as iodine or barium, is

swallowed by the patient. These are good
absorbers of X-rays and thus, used to show the
edges more clearly.
Lesson 45: Computerised Axial Tomography
(CAT or CT scan)
 24. Medical physics
24.2 Production and use of X-rays

Learning outcomes
understand that computed tomography (CT) scanning produces a 3D
image of an internal structure by first combining multiple X-ray images
4 taken in the same section from different angles to obtain a 2D image of
the section, then repeating this process along an axis and combining 2D
images of multiple sections
What is CAT scan?

Computerized Axial Tomography

(CAT) scan combines data from
several X-rays to produce a
detailed image of structures
inside the body.

CT scans produce 2-dimensional

images of a “slice” or section of
the body, but the data can also
be used to construct 3-
dimensional images.

A CT scan can be compared to

looking at one slice of bread
within a whole loaf.
Purpose of CAT scans
As useful as X-rays are, they still have limitations. X-rays are unable to give
you important information such as depth.
It is difficult to distinguish the bones of the
front and back of the ribcage.

Advantages of CT scan over the standard X-

ray image:
1) Image gives depth
2) 3D image formed
3) final image can be rotated viewed from
any angle
4)Can distinguish between tissues with
similar densities (attenuation coefficients)

Disadvantages of CT scan over the standard X-ray image:

1) Greater exposure to X-ray radiation /higher health risks
2) More expensive
3) Person must remain stationary
• This can be overcome by taking several images at different
angles.
Lesson 46: PET scanning
 24. Medical physics
24.3 PET Scanning
Learning outcomes
understand that a tracer is a substance containing radioactive nuclei that can be
1 introduced into the body and is then absorbed by the tissue being studied

recall that a tracer that decays by β+ decay is used in positron emission

2 tomography (PET scanning)
understand that annihilation occurs when a particle interacts with its antiparticle
3 and that mass-energy and momentum are conserved in the process
explain that, in PET scanning, positrons emitted by the decay of the tracer
4 annihilate when they interact with electrons in the tissue, producing a pair of
gamma-ray photons travelling in opposite directions
calculate the energy of the gamma-ray photons emitted during the annihilation
5 of an electron-positron pair

understand that the gamma-ray photons from an annihilation event travel outside
6 the body and can be detected, and an image of the tracer concentration in the
tissue can be created by processing the arrival times of the gamma-ray photons
Positron Emission Tomography (PET)
The principle of a PET scan is different from CT and ultrasound scanning.
In PET scans a small amount of tracer, sometimes referred to as a
radiotracer, is injected into a vein, travels round the body and is absorbed
by organs and tissues. It is this radiation from this that is used to produce
an image.

PET scanners require an isotope that

decays by β+ emissions (ie. Positron)

When this positron meets its anti-

particle (electron), they will both
annihilate and their mass becomes
pure energy in the form of 2 gamma
rays. Both gamma rays move apart
in opposite directions
 Gamma ray energy
In the annihilation process, as in all collisions, both mass-energy and
momentum is conserved. The initial KE of the positron is small-negligible
compared to their rest mass-energy- hence, the gamma ray photons have
a specific energy and a specific frequency that are determined, solely, by
the mass-energy of the positron-electron pair.

𝑬𝑬𝑬𝑬𝑬𝑬𝑬𝑬𝑬𝑬𝑬𝑬 𝒐𝒐𝒐𝒐 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 = 𝒉𝒉𝒉𝒉

𝑬𝑬
Momentum (p) 𝒐𝒐𝒐𝒐 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 = 𝒄𝒄

Where c is the speed of light

Gamma-Ray Burst With Highest Energy Ever Seen

– A Trillion Times More Powerful Than Visible Light
Detecting gamma rays
During a PET scan, the detectors
of γ-ray photons consist of 2 parts.
• A crystal that scintillates: When
high energy γ-ray photon is
incident on the crystal, an
electron is excited into a very
high state. As the electron
travels through the crystal, it
loses energy and excites more
electrons; these electrons then
decay back to their original
state , emitting visible light
photons.
• A photomultiplier: converts
these visible light photons into
electrical signals, and is fed into
a computer that can plot back
where the photon pair was
originally produced
Producing radioisotopes