Ultrasound imaging

Modern ultrasonic transducers mainly employ lead zirconate titanate (PZT) but vinylidene fluoride trifluoroethylene copolymer (P (VDF-TrPE)) is becoming more competitive. The static scanner is now largely replaced by mechanical or electronically controlled array real time systems; the speed of scanning is limited by the speed of sound and the resolution depends on the wavelength and so, ultimately, on the attenuation in tissue. Tissue inhomogeneities degrade the resolution. Intraoperative and intracavitary scanners have advantages in some anatomical situations and ultrasonic imaging can guide extracorporeal shock wave lithotripsy. Inexpensive battery powered scanners will soon become available. Duplex scanners are used to localize the acquisition of Doppler signals; blood flow volume rate can be estimated from measurements of blood velocity and vessel cross-sectional area, or by the attenuation-compensated technique which avoids the main sources of error. Colour flow mapping combines real time imaging with Doppler information, but has limited scanning speed. Computed tomography and acoustical microscopy are feasible. Speckle arises from the coherent nature of ultrasound and can be suppressed by summing uncorrelated images or by filtering. Image manipulation and display techniques are being developed to cope with three dimensional scan data and the approach is compatible with picture archiving and communication systems (PACS). Tissue characterization based on the measurement of properties has been disappointing but blood flow analysis and contrast agents are promising. Quality assurance programmes are crucial; ultrasonic diagnosis appears to be free from hazard and prudent use is determined by cost-benefit considerations.