Вы находитесь на странице: 1из 10

3204jum_online.

qxp:Layout 1 3/18/13 12:11 PM Page 573

SPECIAL COMMUNICATION

Ultrasound Transducer Selection in


Clinical Imaging Practice
Thomas L. Szabo, PhD, Peter A. Lewin, MSc, PhD

Invited paper Many types of medical ultrasound transducers are used in clinical practice. They operate
at different center frequencies, have different physical dimensions, footprints, and shapes,
Article includes CME test
and provide different image formats. However, little information is available about which
transducers are most appropriate for a given application, and the purpose of this article
is to address this deficiency. Specifically, the relationship between the transducer, imag-
ing format, and clinical applications is discussed, and systematic selection criteria that
allow matching of transducers to specific clinical needs are presented. These criteria
include access to and coverage of the region of interest, maximum scan depth, and cov-
erage of essential diagnostic modes required to optimize a patients diagnosis. Three
comprehensive figures organize and summarize the imaging planes, scanning modes,
and types of diagnostic transducers to facilitate their selection in clinical diagnosis.
Key Wordsultrasound imaging; ultrasound transducer arrays; ultrasound transducers

Received July 11, 2012, from the Department of


Biomedical Engineering, Boston University, Boston,
Massachusetts USA (T.L.S.); and School of
Biomedical Engineering, Science, and Health
Systems, Drexel University, Philadelphia,
F or more than 50 years, many kinds of transducers have
evolved for medical ultrasound imaging. Transducers oper-
ate at different center frequencies, have different physical
dimensions, footprints, and shapes, and provide different image
Pennsylvania USA (P.A.L.). Revision requested formats. For example, the phased array has a small (typically 20
July 30, 2012. Revised manuscript accepted for 15 mm) footprint (or contact area) to fit between the ribs and has
publication August 17, 2012. the capability to produce sector images with wide coverage and
We thank GE Healthcare (Milwaukee, depth at high (>100 frames/s) frame rates. However, little infor-
WI), Philips Healthcare (Bothell, WA), and
Boston Scientific (Natick, MA) for the use of their
mation is available about why certain transducers are most appro-
images to illustrate general transducer types. These priate for a given clinical application,1 and the purpose of this article
images are not intended to endorse any manufac- is to address this deficiency. Specifically, the relationship between
turer. We also thank Kai E. Thomenius, PhD (GE the transducer, imaging format, and clinical applications is discussed.
Global Research, Niskayuna, NY), for collabora- Systematic selection criteria that allow matching of transducers to
tion and Sverre Holm, MSc, PhD (Department of
Informatics, University of Oslo, Oslo, Norway), specific clinical needs are presented in a new framework that both
for permission to use Figure 2. explains why certain types of transducers are used in specific clinical
Address correspondence to Thomas L. Szabo, applications and also provides a basis for selecting transducers for
PhD, Department of Biomedical Engineering, new applications. The criteria include access to and coverage of the
Boston University, 44 Cummington St, Boston, region of interest, maximum scan depth and image extent, and cov-
MA 02215 USA. erage of essential diagnostic modes required to optimize a patients
E- mail: tlszabo@bu.edu diagnosis. For completeness, single-element transducers, primarily
Abbreviations
used in intraluminal or catheter applications, are also included in the
4D, 4-dimensional; FOV, field of view; 1D, considerations presented below. Whenever appropriate, a historical
1-dimensional; 3D, 3-dimensional; 2D, 2- perspective for transducer selection is pointed out, but, in general,
dimensional new trends are emphasized.

2013 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2013; 32:573582 | 0278-4297 | www.aium.org
3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 574

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

Scanning for Images that can be controlled in groups or clusters to create pulse
echo lines.2 For a linear array, groups of in-line elements
It is well known that piezoelectric transducers can, when are incrementally switched on and off, effectively sliding
placed on or in the body, transmit ultrasound pulses and an active group of elements laterally by x at a time to cre-
receive echoes from within the tissue and organs. To produce ate the individual pulse echo lines that compose the image
clinically useful images, an additional ingredient is needed, plane. Pulse echo lines are interpolated to form the result-
namely, scanning.1 Usually the acoustic beam generated ing rectangular image format and corresponding transducer
by an individual transducer is moved in a prescribed direc-
tion either electronically or mechanically to produce a Figure 1. A, Cartesian reference system for linear scanning in the xz
series of pulse echo lines that define an image plane. For plane from acoustic line a to line b by increment x. B, Coordinate sys-
orientation, Figure 1A shows a reference system useful for tem for sector scans in the xz plane where an acoustic line c is moved to
explaining linear scanning in the xz plane. For 2-dimen- position d by an angular increment . C, Coordinate system for a
curved linear or convex array for sector scans in the xz plane where an
sional (2D) scanning, the image plane is the xz plane. acoustic line e is moved to position f by an angular increment .
A simple scanning method is to move the acoustic beam
incrementally, a little bit (defined as x) at a time, along A
the x-axis. At each position, a pulse echo line is created, and
the set of lines is interpolated to produce a rectangularly
shaped image in which lateral translation is depicted from
line a to line b. An alternative approach to translation
is to shift the angle of the acoustic beam in an arc, in small
angles, , at a time, to define an image in the xz plane, as
illustrated by Figure 1B. Here the rotation from line c is
shown to line d. Note that each line represents an
acoustic beam, as illustrated more graphically in Figure 2A.
As before, after a complete set of lines is acquired, it is inter-
polated into a sector-shaped image. A variant of linear shift-
ing is the curved geometry shown in Figure 1C. In this case, B
the array is situated on a curve formed by a radius of cur-
vature (R), and the line increment, s, is along the curved
surface rather than a straight line. What is interesting about
this geometry is that this increment along a curve going
from line e to line f is the equivalent of an angular shift
through the relation s = R . As a consequence of this
type of scanning along an arc, the lines fan out radially.
Similarly, scanning can be defined for the yz plane.
In this case, the translation scanning is along the y-axis in
increments of y, and angular scanning is done in incre-
ments of in the yz plane. To achieve 3-dimensional
(3D) scanning, or scanning anywhere in the positive half C
space defined by the positive x- , y-, and z-axes, scanning in
both xz and yz planes can be combined to form a pyramidal-
shaped volume scan, as illustrated by Figure 2B.

Imaging Formats

Even though early (single-element) transducers were


mechanically scanned in 2D planes for ultrasound imaging,
by the early 1980s, transducer arrays were routinely used
for scanning.2 An ultrasound array consists of an ensem-
ble of arranged individual single transducers, or elements

574 J Ultrasound Med 2013; 32:573582


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 575

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

shape, which are shown in format 1 of Figure 3 and the asso- To somewhat alleviate the fixed focus limitation, some
ciated linear array transducer of Figure 4A, respectively. imaging system manufacturers offer arrays with multiple rows
Focusing can be accomplished either mechanically or in the elevation direction. However, fully controlled focusing
electronically. For the linear format of Figure 4A, electronic in the elevation plane requires 2D array transducers, which
focusing is achieved for each scanned image line by con- are capable of providing not only improved elevation focus-
trolling the delay time at which voltage excitation of the ing but also 3D and 4-dimensional (4D) images. In Figure
individual elements is delivered to a group of active ele- 2B, simultaneous electronic focusing of a 2D array is depicted
ments. In the elevation or yz plane (ie, the plane perpen- for both the elevation and azimuth planes, xz and yz.
dicular to the image plane, often referred to as the slice To facilitate matching an image format with a spe-
thickness), fixed focusing, using a mechanical lens, is cific ultrasound transducer, Figures 3 and 4 can be used.
achieved. For example, formats 1 and 4 of Figure 3 are associated
with the linear array transducer type A of Figure 4. For
an example of sector scanning or angular scanning, the
image format is in the shape of a pie slice, as depicted by
Figure 2. A, Sketch of a focused acoustic beam corresponding to an
acoustic line for a 2D image from a 1D array. B, Sketch of an acoustic format 2 of Figure 3 and the corresponding phased array
beam corresponding to an acoustic line electronically focused to a point transducer, shown in Figure 4B.
in the xz and yz planes in a 3D image from a 2D or matrix array (courtesy
of Sverre Holm, MSc, PhD). Typecasting Transducers
A With the help of Figures 3 and 4, it is possible to create a
systematic way of organizing imaging formats and relating
them to transducer types with the realization that scanning
types, modes, and planes need to be taken into account.
To categorize formats and transducers, abbreviations can
be combined to describe specific image-transducer rela-
tionships. Specifically, to denote the scanning type, M
signifies mechanical scanning; E, electronic scanning;
and F, (fixed), no scanning. The scanning direction is
either linear (L) along the x-axis or angular (<), or curved
(C), or a combination (a more detailed description of these
is given below). The scanning plane can also be specified.
For 2D imaging, the xz plane is used.

Figure 3. Types of image formats: 1, 2D rectangular; 2, 2D sector;


3, 2D convex or curved where the maximum angular extent is the FOV;
4, 2D trapezoidal; 5, 3D parallelepiped; 6, 3D fan or broom shape;
B 7, 3D truncated prism; 8, 2D donut; and 9, 3D tube.

J Ultrasound Med 2013; 32:573582 575


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 576

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

According to the above description, each transducer can This format, similar in shape to a sector or pie slice with a
be associated with scanning types and planes. For example, bite taken out of its top, often is described by a field of view
the linear array, L from Figure 4A is associated with elec- (FOV) angle specifying its lateral angular extent. This
tronic linear scanning, E in the xz plane and fixed focusing, example employs electronic linear scanning, E, in the xz
and F in the yz plane; therefore, the resulting designations plane and fixed focusing, F, in the yz plane; therefore, the
are abbreviated as ELxz and Fyz, and the associated resulting designations are abbreviated as ECxz and Fyz,
formats are 1 and 4 from Figure 3. The combined rep- and the associated format is 3, as illustrated by Figure 4B.
resentation is the first example shown as Figure 4A. The As the importance of 3D imaging is steadily growing,
trapezoidal format, denoted as 4 in Figure 2, can be it is appropriate to discuss it in more detail. For 3D imag-
thought of as a rectangular format with two partial sectors ing, a volume is scanned instead of a plane, as demon-
on each end, for the linear array of Figure 4A. Similarly, the strated by the outer volume depicted in Figure 2B. For a
phased array of Figure 4B is linked with sector format 2 of 2D or matrix array (Figure 4F), scanning can be electronic
Figure 3 and the same planes as the previous examples. and typically angular in both directions so that the scanned
Other transducers and formats are also summarized volume is pyramidal in shape (denoted as format 7 of Fig-
in Figures 3 and 4. A diverse sampling of transducer types ure 3). In this case, electronic focusing is achieved in both
is shown in Figure 5. planes with angular scanning so the appropriate designa-
The curved or convex array (Figure 4C) is similar to tions and format are E<xz, E<yz, and format 7, as rep-
a linear array except that the elements are on a curved resented by Figure 4E.
rather than a flat surface, as described by the scanning Alternatively, to achieve cost-effective 3D imaging,
method C of Figure 1C, resulting in format 3 of Figure 3. linear or convex arrays can be scanned mechanically

Figure 4. Transducer types and associated scanning and image formats: A, linear array; B, phased array; C, convex or curved array; D, endo array;
E, 2D or matrix array; F, mechanically scanned linear array; G, mechanically scanned convex array; and H, intravascular ultrasound transducer (courtesy
of Boston Scientific, GE Healthcare, and Philips Healthcare).

576 J Ultrasound Med 2013; 32:573582


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 577

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

around the x-axis in the yz plane. In these cases, the arrays priate to note that there is also an array version of this
are moved in fluid-filled acoustically transparent chambers. intravascular ultrasound device. If this mechanical trans-
For example, a linear array (usually type A) is rotated about ducer is rotated and translated along the y-axis, a cylindri-
the z-axis to produce a series of image planes (usually format cal volume image, format 9 of Figure 3, results.
1 or 4) so that the result is a mechanically scanned trans- In conclusion, the transducer types, depicted in Figure
ducer of the type F of Figure 4 and the scanned volume 4, can be associated with the image formats of Figure 3
format 5 of Figure 3. Similarly, a curved or convex array through the use of format and scan designations given
(usually type C) is rotated about the axis to produce a below the transducer shapes in Figure 4.
series of image planes (usually format 3) so that the
result is a mechanically scanned transducer of the type G Transducer Characteristics for Imaging
of Figure 4 and the scanned volume format 6 of Figure 3.
In addition to electronically controlled movement, This section discusses the criteria for linking which prop-
these 1-dimensional (1D) arrays (array type A, B, or C) erties of ultrasound imaging transducers and their formats
can also be moved mechanically by hand, in freehand 3D need to be identified for various clinical applications.3
imaging, in which the acquired images are organized usu- What follows is primarily applicable to clinically used
ally into 3D volumes. Here it is worth noting that image imaging transducers that operate in the frequency range of
reconstruction for freehand 3D imaging involves either 1 to 20 MHz. Transducers operating above this frequency
assumptions of regular spacing or additional spatial infor- are used for special applications such as intravascular
mation for each spatial imaging plane, which may be imaging (see Figure 4, F and G) or preclinical imaging
achieved by use of position sensors. of small animals but are also included in the discussion
Finally, for completeness, the images produced by wherever possible.
single-element transducers, primarily used in intralumi-
nal or catheter applications (such as intravascular ultra- Acoustic Windows
sound or intracardiac echo) are also shown in formats 8 How well is the type of transducer suited to the acoustic
and 9 of Figure 3. A single transducer, shown in Figure 4H, window or location where it makes contact with the body
can be scanned mechanically to produce 2D or 3D images, to visualize the organs or tissues of interest? Standard
as represented by formats 8 and 9. For format 8, a single acoustic windows provide an unobstructed view of an
transducer (Figure 4H) is swept in an angle circumferen- organ or region; many, by convention, have specific names,
tially to produce a donut-shaped image. Here it is appro- such as transabdominal or parasternal long-axis, so
that images can be compared and described consistently.3
Figure 5. Family of transducers. Top left quadrant: top three are trans- Typical windows are located in or on the following general
esophageal probes; bottom two are endovaginal arrays. Top right regions of the body: head, chest, abdomen, pelvis, limbs,
quadrant: a microconvex array in the middle with two phased arrays on vessels, and various orifices of the body. Transducers can
each side. Bottom right quadrant, left to right: convex array, three linear be associated with certain regions through Latin prefixes:
arrays, a curved linear array, and a phased array. Bottom left quadrant, left
to right: two surgical probes and two intraoperative probes (courtesy of trans, through or across; intra, into or inside; and
Philips Healthcare). endo, within, etc. An example is transthoracic, a category
that includes transducers that image through the chest.
Transcranial describes a transducer that images the head
through the skull.
As already mentioned, for the transthoracic window,
the phased array would be the most appropriate if the
imaging task requires the transducer to be placed between
the ribs; it is designed to fit into intercostal spaces and max-
imize the scanned area (format 2 of Figure 3). For most
contact surfaces that are relatively flat and/or slightly
deformable (eg, ones used for small parts or vascular imag-
ing), the most general and frequently used transducer type
is the linear array designed to make contact with flat sur-
faces, with the footprint decreasing in size with increasing
frequency. Here rectangular and trapezoidal formats

J Ultrasound Med 2013; 32:573582 577


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 578

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

(1 and 4 of Figure 3) provide appropriate viewing areas. cient, which includes additional losses due to scattering
With abdominal imaging, to increase the viewing area with and diffusion and hence is always greater than the absorp-
minimal increases of the contact area, convex arrays tion coefficient. The attenuation coefficient is highly
(Figure 4C) produce format 3 (shown in Figure 3) and are patient and acoustic path dependent.
designed to make surface contact in deformable soft areas To optimize image resolution, users and manufactur-
of the body. ers have worked on increasing the imaging frequencies for
the various examination types. For example, some 30 years
Specialized Transducers ago, people might have imaged the abdomen with a fre-
Specialized transducers are designed to operate inside the quency of 2.25 MHz, whereas today the number is more
body. These include transesophageal probes that are often 3.5 MHz with some obstetric and gynecologic imag-
phased arrays suitable for manual manipulation within the ing reaching up to 5 MHz.5 Similarly, the last decade has
esophagus, format 2 and transducer type B in Figure 4. seen a steady increase in breast imaging reaching the low
A number of other specialty probes have also been devel- teens in megahertz.
oped for interventional or surgical use such as laparoscopic
arrays and intracardiac arrays. These probes can be either Transducer Properties and Imaging
linear or phased arrays, depending on the application and Other criteria to be included in the above-discussed selection
access windows. Several endo probes: such as endovaginal, process are the transducer efficiency,2 transducer-system
endorectal, and endocavity (type D shapes), are function- design, system signal-to-noise ratio, and, as already noted,
ally like end-fire phased arrays (format 2 and Figure 4B) absorption of the tissues being imaged. A major factor is
or convex arrays (format 3 and Figure 4C) at the end of a absorption, the compositions and relative positions of
small-diameter cylindrically shaped handle to fit in ori- different tissue types in the acoustic path. For example, a
fices and yet maximize the FOVs. Another example is the thick layer of adipose tissue will reduce penetration due to
intravascular ultrasound transducer (Figure 4H), which refractive or aberration errors in the acoustic path to the
is inserted in veins to produce an image plane, format 8 or site of interest. Similarly increased amounts of amniotic
scanned volume, format 9. fluid with fetal imaging enhance penetration and may per-
mit the use of frequencies higher than those ordinarily used
Resolution and Penetration at the given scanning site.
The selected scan depth allows viewing over the range of The frequency range, or bandwidth,1,2,6 of the trans-
interest. Factors involved in imaging capability include the ducer will determine whether it can support B-mode imag-
size of the active aperture (occult to the user, but typically a ing at different center frequencies and also operate in
low F number [F#; focal depth/active aperture width] value Doppler, harmonic, and color flow modes. With Doppler-
of 12 is used), the transmit focal depth, and time-gain con- based imaging modes, we often need to operate with lower
trol settings available. Penetration is the minimum scan frequencies than the B-mode frequency to minimize alias-
depth at which electronic noise is visible, despite optimiza- ing. With harmonic imaging, by definition, one uses a
tion of available controls (usually at the deepest transmit receive frequency that is a multiple (usually 2) of the trans-
focal setting and maximum gain), and electronic noise stays mitted frequency; hence the need for the wide bandwidth.
at a fixed depth even when the array is moved laterally. Pen- The bandwidth and focusing properties will also influence
etration is primarily determined by the center frequency of image resolution. In clinical practice, it is essential to ensure
the transducer: the higher the frequency, the shallower the that the image obtained can discern the smallest possible
penetration because the absorption of the ultrasound wave dimensions in both the lateral and axial directions.
traveling through tissue increases with frequency. Finally, the number of individual transducer elements
A useful first approximation for estimating a depth of is of interest because the number of active elements (with
penetration (dp) for a given frequency is dp = 60/f cm- the exception of phased arrays or angularly scanned 2D
MHz, where f is given in megahertz. Thus, one might arrays) determines the lateral extent or width of the image.
expect a 6-cm penetration from a 10-MHz center fre- For phased arrays, an increasing number of elements is
quency transducer. As noted earlier, the absorption coeffi- associated with improved resolution and penetration
cient (acoustic power loss per unit depth) is a function of depth. For 2D arrays (usually symmetric), the number of
frequency and varies from tissue to tissue (values for soft elements along the x and y directions determines the extent
tissues range from 0.6 to 1.0 dB/cm-MHz4). A more gen- of the volume for linearly scanned arrays. For a 2D phased
eral term describing acoustic loss is the attenuation coeffi- array, resolution and penetration increase with a greater

578 J Ultrasound Med 2013; 32:573582


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 579

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

number of elements along the x and y directions, but the Matching Transducers to Clinical Applications
angular shape or FOV remains the same, independent of
the number of active elements used. The focusing in a fixed Now that transducer types and properties have been
direction can indirectly affect imaging because focusing is related to imaging and acoustic windows, they can con-
positioned at only one depth and is poorer elsewhere. For tribute to the selection of transducers for specific clinical
3D imaging, mechanically scanned 2D arrays suffer from applications.3 The appropriateness of certain transducers
the same fixed elevation focal depth limitation encoun- to specific applications evolved historically and through
tered in 2D imaging. In contrast, all the elements of fully specific tailored designs. The primary considerations are
populated 3D imaging or matrix arrays focus electronically the target region of interest and its extent and the available
at one point in both azimuth and elevation planes to pro- acoustic windows needed for access.
vide far better resolution.
At the deepest depths, it is the maximum number of Abdominal Imaging
available active channels in the system that determines the When transducer arrays were initially introduced com-
resolution (along with strength of focusing and system mercially for abdominal imaging (including obstetrics and
noise). Spatial resolution is generally poorer (typically by gynecology) in the 1970s, they were of the linear array type
a factor of 2) than the temporal resolution along scan lines; (type A in Figure 4 with image format 1 of Figure 3). In most
in the discussion presented here, resolution refers to spatial cases, the contact area with the patient was not a critical
resolution, unless noted otherwise. For phased arrays, the issue, and some of these linear arrays were quite long (eg,
number of channels usually corresponds to the maximum 8 cm) to cover, say, the third-trimester fetal head.3,5 How-
number of elements. As a general rule of thumb, because ever, it was soon realized that one could achieve sufficiently
elements are typically on half-wavelength spacing, the large coverage by the use of curved or convex arrays (type
more elements, the better the spatial resolution, which is C in Figure 4) without incurring the penalty of having to
inversely proportional to the active aperture in wave- manipulate the rather unwieldy linear array transducers.
lengths. For example, a 64-element array, 32-wavelength The convex arrays (Figure 4C) are the tools of choice
aperture will have maximum spatial resolution 2-fold lower for most general 2D imaging applications involving the
(wider beam) than that of a 128-element, 64-wavelength abdomen. The general form factor, related to ergonomic
array. In the case of a linear array, which may have several factors and the suitability of the transducer shape and FOV
hundred elements, the number of elements determines the to the application, for abdominal 3D imaging is still evolving.
lateral extent of the image, but it is the number of active Three key descriptors for these arrays are the footprint
channels that governs the resolution. For these 1D arrays, (overall aperture size), FOV, and radius of curvature
the resolution out of the imaging plane (also known as slice (Figure 1C). The footprint describes the contact area usu-
thickness) is poor except near the fixed elevation focal ally in the form of a rectangle, circle or ellipse. Even though
length. For 2D arrays, the spatial resolution is inversely pro- for abdominal imaging, access is not usually a concern,
portional to the active apertures that form the sides of the when these types of transducers are considered for new
2D array. Two-dimensional arrays have superior resolution applications, window access is of primary importance. The
compared to 1D array focusing with fixed elevation focus- radius of curvature and FOV (expressed in degrees of max-
ing because true-point focusing can be achieved simulta- imum angular coverage) are related to image extent and
neously in azimuth and elevation for 3D imaging. coverage. Advanced signal processing has been added to
Another way of looking at resolution is F#. The smaller some systems to increase penetration; however, this feature
the F#, the better the resolution.1 A simple estimate of the is usually only available on certain probes.
full (beam) width in millimeters, a common measure of For the mechanical 3D probes, the currently preferred
resolution, neglecting absorption, is approximately F# , form factor is a mechanically swept convex array (Figure 4G
where is wavelength (1.5 mm/s/f [MHz]). For exam- and format 6 in Figure 3); however, fully electronic con-
ple, resolution would be 0.3 mm at 5 MHz for an F# = 1. vex 2D arrays are now becoming available. For these cases,
Focal depths are also active aperture dependent. For exam- two FOVs are given for the orthogonal scan directions.
ple, for a 128-element 64-wavelength array, the deepest Alternatively, phased arrays, because of their small foot-
focal depth achieved at maximum aperture and an F# = 1 print and wide sector image format, are also used for
is F = F# L = 64 wavelengths. The actual penetration or abdominal imaging. Finally, 2D or matrix arrays are becom-
useable scan depth would, of course, be deeper than the ing increasingly prevalent for these applications because of
maximum focal depth. their superior image quality, resolution, and ease of use.

J Ultrasound Med 2013; 32:573582 579


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 580

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

Intercostal Imaging Superficial and Breast Imaging


The primary applications of this imaging grouping are car- This category refers to superficial imaging of carotids, leg
diac scanning and examination of the liver from between veins, breasts, thyroids, testicles, etc and includes the cate-
the ribs. Simply because of the restrictive anatomy and the gories of small parts, musculoskeletal, and peripheral vas-
limited acoustic windows caused by the ribs and the often cular imaging. It is the last bastion of the application of linear
encroaching lungs, the transducer choice here is limited arrays (type A), which formed the starting design type for
to phased arrays (Figure 4B). Even in this area, initial the applications discussed earlier. In this clinical category,
attempts were made to use linear arrays; however, these access is usually not an issue, and the sizes of the probes
were rapidly dropped due to the rib shadowing and the themselves can be small (because of the use of high 7- to
superiority of phased array transducer format 2. For car- 15-MHz frequencies and the resultant small element sizes).
diac applications, the probes tend to have array dimen- Musculoskeletal applications for imaging muscles, liga-
sions on the order of 20 14 mm depending on the ments, and tendons also use arrays of this type. In the last 10
manufacturer. The patient contact area will be slightly years, breast imaging has gone to very high frequencies
larger. These numbers have evolved over the last 40 years (eg, 14 MHz), while imaging of the peripheral vasculature
and depend on a number of things, such as the general size has remained at lower (about 311 MHz) values due to the
of the patient population. Age is another consideration; need to include deeper leg veins and successful Doppler
rib spacing and the depth penetration needed vary as chil- performance. Usually the capability of the array to add
dren mature into adults. trapezoidal imaging (format 4) is a considerable advantage.
For noncardiac intercostal applications, the dimen- As in abdominal imaging, 3D imaging with mechanically
sions of the arrays are somewhat larger. As noted earlier, swept probes or electronic 2D arrays is now available for
the existence of these anatomic limitations creates an upper superficial and breast applications, greatly improving the
performance limit for spatial resolution since resolution coverage available and image quality. For applications
performance is inversely related to the size of the aperture, involving imaging vasculature, some probes have advan-
as explained above. In both cardiac and general intercostal tages of including modes that enhance flow visualization.
imaging applications, the imaging depth is deep (depend-
ing on the patient size, it may be as deep as 24 cm), forcing Obstetrics and Gynecology
the use of lower (13.5 MHz) frequencies and resulting in At the present time, mechanically scanned convex or linear
some further loss of imaging performance. arrays (types G and F) are used widely to provide 3D and
There is an interesting aspect of cardiac imaging 4D imaging of fetuses in vivo (formats 57). Matrix or fully
that has had a profound effect on the nature of the probes. populated 2D arrays (type E) are also available for this
Due to the presence of the ribs and other acoustically application (typically format 7).
hostile tissue in the ray path, echocardiography suffers For gynecology, specialized endo-array probe shapes
from imaging artifacts due to reverberant noise. The intro- are used (type D). Typically, the arrays are at the end of
duction of harmonic imaging has proven to be highly suc- the probe (end-fire arrays) and are convex or curved arrays
cessful in reducing this noise. As a consequence, the with wide FOVs (format 3); however, phased arrays in an
importance of transducer bandwidth has become criti- endo-array package (type D) can also be used (format 2).
cal in cardiac transducer design. Today, most cardiac Frequencies used are typically 5 MHz and higher. As in
systems transmit at frequencies between 1.5 and 2.0 other applications, 2D arrays have been designed for 3D
MHz and, of course, receive signals at frequencies twice imaging of these cases.
that range.
A major development in cardiac imaging was the Neonatal and Pediatric
implementation of fully populated 2D or matrix arrays Pediatric transducers tend to have smaller footprints than
(type E) containing thousands (typically 50 50 or so) transducers used for adults, applications AC, and operate
of elements. These make possible real-time (4D) depic- at higher-frequency varieties (7 MHz) of those that are
tion of pyramidal volumes (format 7, Figure 3), visuali- used for adults. Depending on the body region, types of
zation of arbitrary cut planes, and 4D cardiac imaging and transducers similar to those for adults are applicable. Phased
color flow imaging. In addition, true electronic focusing arrays (type B) and 3D transducers (types E and G) are
in both the xz and yz planes provides superior resolution appropriate for cardiac imaging. Other arrays that are also
in comparison with all other 1D array transducers. useful for these clinical needs include static (2D) and, for
3D, mechanically swept linear arrays and convex arrays.

580 J Ultrasound Med 2013; 32:573582


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 581

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

Intracavity Probes greater than 20 MHz and dedicated imaging systems,


Intracavity probes constitute a large group of specialty although there are also tiny (about 2-mm-diameter) arrays
transducers that are designed to image inside the body cavity. designed for this purpose.
Transesophageal transducers are used to enable imaging
of internal organs, especially the heart, from inside the Head Probes
esophagus (see Figure 5). They use higher frequencies Transcranial imaging of the brain and its vasculature is con-
(5 MHz) and are implemented as phased arrays with ducted through limited acoustic windows through the skull
manipulators and motors to adjust the orientation of the such as the temples or eyes. Transorbital arrays are high-
transducer. Miniature transesophageal 2D arrays offer elec- frequency (typically >20 MHz) ophthalmologic trans-
tronic scanning for 3D and 4D imaging. ducers and are used to image the eye or use the eye as an
Transducers can be highly specialized for viewing usu- acoustic window. Transcranial probes are usually lower-
ally within body openings or vessels. Intracardiac phased frequency (14 MHz) phased arrays used to image blood
arrays are inserted through a vessel to gain access to the vessels within the skull through the temples as windows.
inner chambers of the heart. Surgical specialty probes
include laparoscopic arrays inserted through small inci- Conclusions
sions to image and aid in laparoscopic surgery (similar to
endo probes); these are remarkable for their FOV despite Many ultrasound imaging transducers are designed to
small diameters. Intraoperative arrays are specially shaped operate in certain regions of the body for specific applica-
to be placed on vessels, organs, and regions made accessi- tions. A primary objective of this article is to provide a sys-
ble during open surgery (see Figure 5). Others in this class tematic approach that would aid in matching a transducer
are surgical and interventional probes with unique shapes to a clinical application, starting with the acoustic window
(see Figure 5). and the region and depth to be imaged. To this end, a
As already noted, the probes that are inserted into the checklist for selecting a transducer is given in Table 1.
body are designed to fit through small openings and have As indicated earlier, the first consideration for imaging
a wide FOV (90150). These probes include transrectal a target region or organs is the access: the intended acoustic
(or endorectal) for imaging of the pelvic region using the window. The transducer type must provide access through
anus for access and the already described endovaginal (also the selected acoustic window. The transducer type is linked
called transvaginal) for imaging the female pelvis and with the image format, and common selections previously
reproductive organs using the vagina as entry for gyne- discussed include the linear, phased, convex, and 2D arrays.
cologic and obstetric applications. These endo probes, The size or transducer footprint must fit within the win-
described earlier, are cylindrical to fit into small orifices and dow, and in extreme cases in which the transducer window
have convex arrays (typically 39 MHz) at their ends with is an orifice, the transducer shape must conform to the
large fields of view, biplanes, or mechanically swept con- available opening. As noted above, in some applications,
vex arrays. Probes for urologic applications include the specialty probes, such as endorectal transducers, are needed
biplane type. that are small enough in diameter (size) and have the elon-
A unique transducer is the biplane probe, which con- gated shape suitable for entering a body orifice.
sists of two orthogonal arrays producing images in planes Second, the size or FOV and image format are
xz and yz. Typically the arrays are small (812 mm) and of selected to obtain the desired coverage over the region of
the convex type. Each format and transducer would corre- interest. Here both the scan depth and image width or FOV
spond to those of a singleimaging plane transducer such are important. For linear arrays, the availability of trape-
as format 3 of Figure 3 and the convex array of Figure 4C.
However, sector or linear array formats are also possible,
Table 1. Transducer Selection Checklist
depending on the transducer construction, so that several
combinations can be used in practice. Alternatively, a sub- 1. Access to region of interest Acoustic window, footprint,
set of the imaging capability of a 2D array is the simulta- appropriate transducer shape
2. Coverage of region of interest Scan depth, image width, FOV,
neous presentation of two orthogonal 2D images. scan volume, slice thickness
Intravascular transducers are inserted into blood ves- 3. Maximum scan depth Frequency, absorption,
sels to image the vessel walls for various pathologic condi- resolution, signal processing
tions (type H and formats 8 and 9). They are most often 4. Coverage of essential Bandwidth, modes supported
mechanically rotated single transducers with frequencies diagnostic modes

J Ultrasound Med 2013; 32:573582 581


3204jum_online.qxp:Layout 1 3/18/13 12:11 PM Page 582

Szabo and LewinUltrasound Transducer Selection in Clinical Imaging Practice

zoidal imaging may be necessary for adequate coverage. For 3. Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound.
3D or volumetric imaging, the extent of the image may 4th ed. Maryland Heights, MO: Mosby; 2011.
be given as a set of maximum scan angles in orthogonal 4. Duck FA. Physical Properties of Tissue. New York, NY: Academic Press;
directions or a FOV and an angle. A somewhat more 1990.
hidden parameter for 2D imaging for determining cov- 5. Woo J. Obstetric Ultrasound website; 19982002. http://www.ob-
erage for the region of interest is the elevation focal ultrasound.net/.
depth that describes the region with the thinnest slice 6. Szabo TL, Lewin PA. Piezoelectric materials for imaging. J Ultrasound Med
thickness. 2007; 26:283288.
Third, the maximum scan depth selected determines
the highest achievable frequency through the penetration
relation given in the Resolution and Penetration section
above. For example, if the scan depth is 10 cm, then, as
already discussed in the Resolution and Penetration sec-
tion, the frequency from the penetration depth d is equal
to 60/d = 60/10 = 6 MHz. This frequency provides an
estimate of the best lateral resolution of about 1 wave-
length for an F# = 1, or , for this example, the resolution is
= c/f = 0.25 mm (from the Transducer Properties and
Imaging section). Exceptions to this rule are systems that
use advanced signal processing to enhance sensitivity and
increase penetration. In addition, the use of piezoelectric
materials such as piezo composites or domain-engineered
single crystals can increase sensitivity or, correspondingly,
penetration depth.6
Fourth, the coverage of essential diagnostic imaging
modes can be determined. From the manufacturer-
provided data, the effective bandwidth needed to support
different modes of interest may be extracted, or for the
system considered, the actual modes of interest may be
listed, such as pulsed wave Doppler, multiple imaging fre-
quencies available, or elastographic mode. Transducers
with piezoelectric materials such as piezo composites or
domain-engineered single crystals can increase bandwidth
substantially.6
In conclusion, transducers and image formats have
evolved to better suit specific clinical applications. The clas-
sification and organization given in this article provide the
background for the selection of a transducer for a particu-
lar purpose. In addition, the understanding provided can
aid in determining transducer characteristics needed for
new cases, thereby extending the range of transducer use.

References

1. Szabo TL. Diagnostic Ultrasound Imaging: Inside Out. Burlington, MA:


Elsevier; 2004.
2. Reid JM, Lewin PA, Ultrasound imaging transducers. In: Encyclopedia of
Electrical and Electronics Engineering. Vol 22. New York, NY: John Wiley &
Sons; 1999:664672.

582 J Ultrasound Med 2013; 32:573582