SPI Sample Questions Answers

Refraction is the change in direction of a sound wave as it crosses a boundary between two different tissues at an oblique angle, where there is a difference in propagation speeds between the tissues. This bending of the sound wave path occurs due to the change in speed, causing the wave to change direction according to Snell's law. Refraction can result in artifacts such as edge shadowing and displacement of structures in an ultrasound image.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Hedrick WR, Hykes DL, Starchman DE. Ultrasound Physics and Instrumentation. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005.

Narrowing the field of view reduces the number of scan lines that need to be processed per frame. This allows the ultrasound system to maintain or even increase the frame rate without compromising temporal resolution. Temporal resolution, which refers to the system's ability to depict motion accurately, is directly related to the frame rate. Reducing the field of view ensures fewer lines are needed to create each image, thus preserving the frame rate and temporal resolution.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments.

Color Doppler imaging is most effective when the angle between the ultrasound beam and the flow of blood is small.

At an angle of 88 degrees, the flow of blood is nearly perpendicular to the ultrasound beam.

When the angle is close to 90 degrees, the Doppler shift (frequency change) approaches zero, resulting in little to no color being visualized on the Doppler image.

Thus, to obtain a color signal, the angle should be optimized to be as close to 0 degrees as possible, with 60 degrees being the practical limit for accurate Doppler measurements. References:

ARDMS Sonography Principles and Instrumentation guidelines on Doppler angle and its effect on Doppler imaging.

Continuous wave Doppler uses two crystals – one for transmitting and one for receiving ultrasound waves continuously. This allows for the measurement of high velocities without aliasing, a common limitation in pulsed wave Doppler. However, continuous wave Doppler does not have range specificity, meaning it cannot precisely determine the depth from which the Doppler signal is returning.References: ARDMS Sonography Principles and Instrumentation, Chapter on Doppler Ultrasound.

The propagation speed of sound in a medium is determined by the medium's elasticity and density. Elasticity refers to the ability of the medium to return to its original shape after deformation, while density is the mass per unit volume of the medium. The speed of sound increases with higher elasticity and decreases with higher density. This relationship is described by the equation ????=????????v=ρE​​, where ????v is the propagation speed, ????E is the elasticity (or modulus of elasticity), and ????ρ is the density.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau

The Doppler shift is highest when the angle between the ultrasound beam and the direction of blood flow is 0 degrees. This is because the cosine of 0 degrees is 1, maximizing the Doppler frequency shift. As the angle increases towards 90 degrees, the cosine value decreases, reducing the Doppler shift.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Hoskins, P. R., Thrush, A., Martin, K., & Whittingham, T. A. (2010). Diagnostic Ultrasound: Physics and Equipment.

The placement of an echo on an ultrasound image is dependent on the assumption that the speed of sound in soft tissue is 1540 m/s. If the speed of sound in the medium is less than this assumed speed, the ultrasound system will interpret the returning echo as taking longer to return than it actually does. This causes the system to place the echo deeper in the image than its actual position. Therefore, the echo will be displayed "too deep" in the image.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.

When the depth of imaging is increased, the time it takes for the ultrasound pulses to travel to and from the deeper structures also increases, which can reduce the frame rate. To maintain the same frame rate, one effective adjustment is to decrease the image width. Narrowing the image width reduces the number of scan lines required to create each frame, allowing the system to maintain a higher frame rate despite the increased depth.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments.

Increased Transmit Frequency: This would generally improve the resolution of the image but does not directly correlate to the changes seen in the provided image link.

Increased Scale: Adjusting the scale changes the velocity range displayed but does not directly affect the speckle or noise reduction.

Decreased Color Gain: Reducing the color gain can decrease the amount of color noise, making the blood flow regions more defined, which aligns with the change observed from image A to image B.

Decreased Acoustic Power: This reduces the overall intensity of the ultrasound beam, affecting penetration depth and overall brightness but is less likely to result in the specific improvements seen.

References:

"Understanding Ultrasound Physics" by Sidney K. Edelman

ARDMS Sonography Principles and Instrumentation study materials

The wall filter is used in color Doppler and spectral Doppler imaging to eliminate low-frequency Doppler shifts caused by tissue motion or vessel wall movement. Adjusting the wall filter removes these low-frequency signals without affecting higher-frequency Doppler shifts that represent blood flow. Other settings like gain, scale, and persistence do not selectively filter out low-frequency shifts in the same manner.References:

American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation guidelines.

Doppler Scale Too High: This would prevent aliasing but could result in loss of low-velocity signals.

Doppler Scale Too Low: When the scale is set too low, velocities exceed the Nyquist limit, resulting in aliasing where the Doppler signal wraps around the baseline.

Doppler Gain Too High: High gain may result in noise and overamplified signals but does not directly cause aliasing.

Doppler Gain Too Low: Low gain results in weak signal detection but does not cause aliasing.

References:

"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau

ARDMS Sonography Principles and Instrumentation study materials

When a reflector (such as red blood cells) is moving toward the sound source, the frequency of the reflected sound waves increases. This phenomenon is known as the Doppler effect. The frequency shift occurs because the motion of the reflector compresses the sound waves, leading to a higher frequency than the emitted frequency. This increased frequency is what the Doppler ultrasound system detects and uses to calculate the velocity of the moving reflector.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Hoskins, P. R., Thrush, A., Martin, K., & Whittingham, T. A. (2010). Diagnostic Ultrasound: Physics and Equipment.

Color flow Doppler imaging displays the mean Doppler frequency shift, which represents the average velocity of blood flow within a sample volume. The ultrasound system uses autocorrelation to process Doppler signals and compute the mean frequency shift. This provides a color-coded map of blood flow velocities, allowing for visualization of flow direction and speed. The mean Doppler frequency is displayed as different colors, with each color representing a range of velocities.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.

To avoid exceeding the Nyquist limit and prevent aliasing in Doppler ultrasound, the pulse repetition frequency (PRF) should be increased. The Nyquist limit is half of the PRF, so by increasing the PRF, the Nyquist limit is raised, allowing the system to accurately measure higher velocities without encountering aliasing artifacts.References:

ARDMS Sonography Principles and Instrumentation guidelines

Zwiebel, W. J., & Pellerito, J. S. (2017). Introduction to Vascular Ultrasonography. Elsevier.

Overall gain controls the amplification of all the received ultrasound signals uniformly. This adjustment affects the brightness of the entire image by increasing or decreasing the amplification of the echoes returning from all depths. It is a primary control for adjusting image brightness. The overall gain should be set to an appropriate level to ensure that the ultrasound image is neither too bright (over-gained) nor too dark (under-gained), allowing for optimal visualization of the anatomical structures.

References:

American Registry for Diagnostic Medical Sonography (ARDMS). Sonography Principles and Instrumentation (SPI) Examination Review Guide.

Enhancement artifact occurs when an anechoic (or low-attenuation) structure, such as a cyst or fluid-filled structure, allows the ultrasound beam to pass through it with minimal attenuation. As a result, the tissues located distal to this anechoic structure appear brighter (increased echo amplitude) on the ultrasound image because the sound waves are less attenuated by the anechoic structure, leading to higher intensity echoes returning from the distal tissue. This increased brightness beyond the anechoic area is known as enhancement.References:

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments. Elsevier.

Lateral resolution refers to the ability to distinguish two structures that are side by side. It is dependent on the width of the ultrasound beam. By decreasing the depth of field, the beam width is reduced at any given point along the depth, which improves the lateral resolution. This is because a narrower beam can better distinguish between objects that are close together laterally.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments.

When sound waves encounter a smooth, flat surface, the primary interaction is reflection. This means the sound waves bounce back towards the transducer, producing echoes that are used to create the ultrasound image. Reflection is most effective when the surface is smooth and perpendicular to the sound beam, allowing for the maximum return of sound waves to the transducer.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Zagzebski, J. A. (1996). Essentials of Ultrasound Physics.

During 3-D volume acquisition in ultrasound, the quality of the images is most dependent on the number of slices acquired. This is because the more slices (or planes) that are captured, the more detailed and accurate the reconstruction of the 3-D volume will be. This allows for better spatial resolution and more precise visualization of anatomical structures. Other factors, such as power output, rendering methods, and speed of post-processing, also affect image quality but are secondary to the number of slices in terms of fundamental image acquisition quality.References: ARDMS Sonography Principles and Instrumentation (SPI) Review, 3-D Ultrasound Imaging section.

Frame rate in color flow Doppler is influenced by several factors, including the imaging depth. Decreasing the depth reduces the time it takes for sound waves to travel to the imaging area and back to the transducer. This allows for more frames to be captured per second, thereby increasing the frame rate. Higher frame rates improve temporal resolution, making it easier to visualize moving structures.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Hagen-Ansert SL. Textbook of Diagnostic Ultrasonography. 8th ed. St. Louis, MO: Mosby; 2017.

Spatial compounding involves acquiring multiple frames from different angles and averaging them. This technique reduces speckle noise, which is a granular interference pattern, and enhances the visualization of specular reflectors (smooth surfaces that reflect sound in a single direction) and attenuated structures (structures that reduce the intensity of the sound beam). By averaging frames from different angles, spatial compounding improves image quality and contrast resolution.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Hedrick, W. R., Hykes, D. L., & Starchman, D. E. (2005). Ultrasound Physics and Instrumentation.

In the provided image, data below the baseline represents blood flow moving away from the transducer, which can indicate retrograde flow. When using spectral Doppler, the baseline separates flows towards and away from the transducer. Aliasing occurs when the velocity of blood flow exceeds the Nyquist limit, causing the display to wrap around and appear on the opposite side of the baseline. This phenomenon is common in high-velocity flow situations and results in part of the flow being displayed below the baseline. Retrograde flow further supports this, as it shows blood moving in the opposite direction to the expected flow.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.

A string phantom is designed to evaluate the accuracy of Doppler ultrasound systems, specifically in measuring flow velocity. It consists of a moving string or filament that mimics blood flow within a vessel. By using this phantom, sonographers can assess how accurately the ultrasound system can detect and measure the speed of the moving target. This helps in calibrating and verifying the performance of Doppler systems, ensuring they provide accurate flow velocity readings in clinical practice.References:

American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation study materials.

Textbook of Diagnostic Sonography by Hagen-Ansert, S. L. (latest edition).

Temporal resolution refers to the ability of an ultrasound system to distinguish between events occurring closely in time. It is primarily affected by the frame rate, which is the number of frames displayed per second. One of the main factors that influence the frame rate is the display depth. The deeper the imaging depth, the longer it takes for the ultrasound pulses to travel to the target and back, thus reducing the frame rate and temporal resolution. Shallower imaging depths allow for higher frame rates and better temporal resolution.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau

Range ambiguity artifact occurs when echoes from one pulse are received after the next pulse has been emitted, leading to the incorrect placement of echoes at shallower depths than their true location. This artifact typically happens when the PRF is set too high, causing the ultrasound system to interpret delayed echoes as coming from the current pulse rather than the previous one. This results in reflectors appearing closer to the transducer than they actually are.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Kremkau FW. Sonography Principles and Instruments. 9th ed. Philadelphia, PA: Elsevier; 2016.

Axial resolution refers to the ability of an ultrasound system to distinguish between two structures that are close to each other along the path of the ultrasound beam. It is primarily determined by the spatial pulse length, which is the product of the wavelength and the number of cycles in a pulse. Shorter wavelengths result in shorter spatial pulse lengths, thereby improving axial resolution. This is because shorter wavelengths (which correspond to higher frequencies) allow for better differentiation between closely spaced structures along the beam's axis.

References:

American Registry for Diagnostic Medical Sonography (ARDMS). Sonography Principles and Instrumentation (SPI) Examination Review Guide.

Noise in the Doppler waveform can often be attributed to excessive gain settings. Decreasing the Doppler gain reduces the amplification of both the signal and the noise, thus providing a clearer and more accurate Doppler waveform. Excessive gain can cause speckling and clutter, which obscure the true Doppler signals. By reducing the gain, the noise level is minimized, resulting in a cleaner Doppler signal representation.

References:

ARDMS Sonography Principles & Instrumentation Guidelines

Hagen-Ansert SL. Textbook of Diagnostic Ultrasonography. 8th ed. St. Louis, MO: Mosby; 2017.

The ALARA principle stands for "As Low As Reasonably Achievable" and aims to minimize patient exposure to ultrasound energy. Decreasing the output power reduces the intensity of the ultrasound waves, thereby reducing the potential for tissue heating and mechanical effects, which aligns with the ALARA principle of minimizing exposure while still obtaining necessary diagnostic information.

References:

ARDMS Sonography Principles and Instrumentation guidelines

Hangiandreou, N. J. (2003). "Physics Tutorial for Residents: Topics in US: B-Mode US: Basic Concepts and New Technology." Radiographics.

The backing material, also known as damping material, in an ultrasound transducer serves to dampen the vibrations of the piezoelectric crystal.

This damping reduces the number of cycles in each pulse, leading to a shorter spatial pulse length (SPL).

Shorter SPL improves axial resolution by allowing the system to better distinguish between two closely spaced structures along the axis of the ultrasound beam.

Improved axial resolution is crucial for producing clearer, more detailed images. References:

ARDMS Sonography Principles and Instrumentation guidelines on transducer design and the role of backing material in image quality.