Doppler Ultrasound - The angle between the direction of blood flow and the

- based on the shift of frequency in an ultrasound wave direction of the sound is called the Doppler angle
caused by a moving reflector, such as blood cells in the
vasculature
- By comparing the incident ultrasound frequency with the - generalized Doppler shift equation:
reflected ultrasound frequency from the blood cells, it is - The preferred Doppler angle ranges from 30 to 60
possible to discern the velocity of the blood. Not only can degrees.
blood velocity (and indirectly blood flow) be measured, - At too large an angle (greater than 60 degrees), the
but the information provided by the Doppler techniques apparent Doppler shift is small, and minor errors in angle
can also be used to create color blood flow maps of the accuracy can result in large errors in velocity (Table 14-
vasculature. 7). At too small an angle (e.g., less than 20 degrees),
Doppler Frequency Shift refraction and critical angle interactions can cause
- difference between the incident frequency and reflected problems, as can aliasing of the signal in pulsed Doppler
frequency studies.
Continuous Doppler Operation
- Two transducers are required, with one transmitting the
incident ultrasound and the other detecting the resultant
- continuous echoes. An oscillator produces a resonant
- Doppler ultrasound exploits changes in frequency from frequency to drive the transmit transducer and provides
interaction with moving objects. Sound waves reflected the same frequency signal to the demodulator, which
from a moving object are compressed (higher frequency) compares the returning frequency to the incident
when moving toward the transducer and expanded (lower frequency. The receiver amplifies the returning signal and
frequency) when moving away from the transducer extracts the residual information containing the Doppler
compared to the incident sound wave frequency. shift frequency by using a “low-pass” filter, which removes
- The maximum Doppler shift occurs at an angle 0. For a the superimposed high-frequency oscillations.
larger Doppler angle, the measured Doppler shift is less - suffers from depth selectivity with accuracy affected by
by a factor of cos(), and velocity estimates are object motion within the beam path
compensated by 1/cos (theta).
 - Advantages: high accuracy of the Doppler shift - Maximum Doppler shift:
measurement because a narrow frequency bandwidth is
used and no aliasing when high velocities are measured
Quadrature Detection
- phase sensitive and can indicate the direction of flow
either toward or away from the transducers.
-
Pulsed Doppler Operation
- combines the velocity determination of continuous wave
Doppler systems and the range discrimination of pulse-
echo imaging.
- Depth selection is achieved with an electronic time gate
circuit to reject all echo signals except those falling within
the gate window, as determined by the operator.
- Isolation of a selected area is achieved by gating the time
of echo return and analyzing only those echoes that fall
within the time window of the gate. In the pulsed mode,
the Doppler signal is discretely sampled in time to
- maximum blood velocity that is accurately determined is
estimate the frequency shifts occurring in the Doppler
increased with larger PRF, lower operating frequency,
gate. Because axial resolution isn’t as important as
and larger angle
narrow bandwidths to better estimate the Doppler shift, a
- PRF cant be arbitrarily increased to high values, because
long spatial pulse width (high Q factor) is employed.
of echo transit time and possible echo ambiguity.
- sampling theory: a signal can be reconstructed
- larger angle between the ultrasound beam direction and
unambiguously as long as the true frequency (e.g., the
the blood flow direction (e.g., 60 degrees) reduces the
Doppler shift) is less than half the sampling rate. Thus,
Doppler shift.
the PRF must be at least twice the maximal Doppler
Duplex Scanning
frequency shift encountered in the measurement.
refers to the combination of 2D B-mode imaging and pulsed Doppler
data acquisition.
 - A duplex scanner operates in the imaging mode and - Phase-shift autocorrelation is a technique to measure the
creates a real-time image. The Doppler gate is positioned similarity of one scan line measurement to another when
over the vessel of interest with size (length and width) the maximum correlation (overlap) occurs. The
appropriate for evaluation of blood velocity, and at an autocorrelation processor compares the entire echo pulse
orientation (angle with respect to the interrogating US of one A-line with that of a previous echo pulse separated
beam) that represents the Doppler angle. by a time equal to the PRP. The output correlation varies
- The duplex system allows estimation of the blood velocity proportionately with the phase change, which in turn
directly from the Doppler shift frequency, since the varies proportionately with the velocity at the point along
velocity of sound and the transducer frequency are the echo pulse trace.
known, while the Doppler angle can be estimated from
the B-mode image and input into the scanner computer
for calculation
- Source of errors: vessel axis might not lie totally within the
scanned plane, the vessel might be curved, or flow might
be altered from the perceived direction. The beam-vessel
angle (Doppler angle) could be in error. The Doppler gate
(sample area) could be mispositioned or of inappropriate
size. Noncircular cross-sections will cause errors in the -
area estimate, and therefore errors in the flow volume. - FOV determines the processing time necessary to
- Multigate pulsed Doppler systems operate with several evaluate the color flow data. A smaller FOV delivers a
parallel channels closely spaced across the lumen of a faster frame rate but, of course, sacrifices the area
single large vessel. evaluated for flow.
- Velocity profile
Color Flow Imaging
- provides a 2D visual display of moving blood in the
vasculature, superimposed upon the conventional gray-
scale image
 have a smaller, faster range of velocities. A Doppler gate
positioned near a stenosis in the turbulent flow pattern will
measure the largest range of velocities.
- With the pulsatile nature of blood flow, the spectral
characteristics vary with time. Interpretation of the
frequency shifts and direction of blood flow is
accomplished with the fast Fourier transform, which
mathematically analyzes the detected signals and
generates amplitude versus frequency distribution profile
- known as the Doppler spectrum.
- Time domain correlation uses a short SPL and an echo
- Interpretation of the spectral display provides the ability to
“template” to determine positional change of moving
determine the presence of flow, the direction of flow, and
reflectors from subsequent echoes. The template scans
characteristics of the flow. It is more difficult to determine
the echo train to find maximum correlation in each A-line;
a lack of flow, since it is also necessary to ensure that the
the displacement between the maximum correlations of
lack of signal is not due to other acoustical or electrical
each A-line divided by the PRP is the measured velocity.
system parameters or problems. The direction of flow
Doppler Spectral Interpretation
(positive or negative Doppler shift) is best determined with
- The Doppler signal is typically represented by a spectrum
a small Doppler angle (about 30 degrees).
of frequencies resulting from a range of velocities
contained within the sampling gate at a specific point in
time.
- Fast, laminar flow exists in the center of large, smooth
wall vessels, while slower blood flow occurs near the
vessel walls, due to frictional forces. Turbulent flow
occurs at disruptions in the vessel wall caused by plaque
buildup and stenosis. A large Doppler gate that is
positioned to encompass the entire lumen of the vessel
will contain a large range of blood velocities, while a
smaller gate positioned in the center of the vessel will
 - - Eliminate: adjust the velocity scale to a wider range, as
- The spectral most instruments have the PRF of the Doppler unit linked
Doppler display is a plot to the scale setting (a wide range delivers a high PRF).
of the Doppler shift - If the scale is already at the maximum PRF, the spectral
frequency spectrum baseline, which represents 0 velocity (0 Doppler shift),
displayed vertically, can be readjusted to allocate a greater sampling
versus time, displayed (frequency range) for reflectors moving toward the
horizontally. The transducer
amplitude of the shift
frequency is encoded as
gray-scale or color
intensity variations. Bottom graph: Two Doppler spectra
are shown from the spectral display at two discrete points
in time, with amplitude (gray-scale variations) plotted
versus frequency (velocity). A broad spectrum
(bandwidth) represents turbulent flow, while a narrow -
- Left. Aliasing of the spectral Doppler display is
spectrum represents laminar flow within the Doppler gate
characterized by “wrap-around” of the highest velocities to
Velocity Aliasing
the opposite direction when the sampling (PRF) is
- Aliasing, as described earlier, is an error caused by an
inadequate. Right. Without changing the overall velocity
insufficient sampling rate (PRF) relative to the high-
range, the spectral baseline is shifted to incorporate
frequency Doppler signals generated by fast-moving
higher forward velocity and less reverse velocity to avoid
blood. A minimum of two samples per cycle of Doppler
aliasing. The maximum, average, and minimum spectral
shift frequency is required to unambiguously determine
Doppler display values allow quantitative determination of
the corresponding velocity.
clinically relevant information such as pulsatility index and
- In a spectral Doppler display, the aliased signals wrap
resistive index.
around to negative amplitude, masquerading as reversed
- the minimum to the maximum Doppler shift still cannot
flow
exceed +/PRF/2.
 - Enhanced sensitivity of the power Doppler acquisition,
particularly in areas perpendicular to the beam direction,
where the signal is lost in the color Doppler image.
Power Doppler
- Doppler analysis places a constraint on the sensitivity to
motion, because the signals generated by motion must be
extracted to determine velocity and direction from the
Doppler and phase shifts in the returning echoes within
each gated region Power Doppler is a signal processing
method that relies on the total strength of the Doppler
signal (amplitude) and ignores directional (phase)
information.
- dependent on the amplitude of all Doppler signals,
regardless of the frequency shift which improves the
sensitivity to motion
- Aliasing is not a problem as only the strength of the
frequency shifted signals are analyzed, and not the
phase. Greater sensitivity allows detection and
interpretation of very subtle and slow blood flow
- frame rates tend to be slower for the power Doppler
imaging mode, and a significant amount of “flash artifacts”
occur, which are related to color signals arising from
moving tissues, patient motion, or transducer motion
- No increased in transmit power