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Artifacts in Echo
Dr Dilzith
Contents
• Artifacts
• In 2D Echo
• In Doppler
• In Colour flow
• In TEE
Artifacts  in echocardiography
Artifacts
1. Extraneous US signal that results in appearance of structures that
are not actually present
2. Failure to visualize structures that are present
3. An image of a structure that differs in size or shape or both from its
actual appearance
2-D Echo
Artifacts  in echocardiography
Suboptimal Imaging
• Cause is poor ultrasound tissue penetration
• Body habitus with interposition of high attenuation tissue. (Lung,
Bone)
• Increased distance ( Adipose tissue)
• THI can improve the image quality
• TEE may be required
Artifacts  in echocardiography
Acoustic Shadowing
• Reflection of entire US signal by a
strong specular reflector
• Ex:
• prosthetic valves.
• Heavily calcified Native structures
• Contrast containing blood also
produces shadowing.
• Try alternate acoustic window or
different transthoracic view
• TEE may be required
Reverberations
• Multiple linear high amplitude
echo signals originating from two
strong specular reflectors
• Results in back and forth reflection
• Typically, a reverberation artifact
that originates from a fixed
reflector will not move with the
motion of the heart.
Beam Width
• Superimposition of structures within the beam profile (Including side
lobes) into a single tomographic image
• Can be due to strong reflectors at the edge of a larger beam will be
superimposed on structures in central zone.
• Can be due to consequences of varying lateral resolution
Range Ambiguity
• Echo from previous pulse reaches transducer on next cycle.
• Results in appearance of deep structures closer to the transducer than their actual
location
• Second type of range ambiguity is a double image on the vertical axis
• Echoes being re-reflected by a structure close to the transducer (ex. Rib)
• Results in signal received twice normal and can form double image.
• Range ambiguity can be eliminated by decreasing depth or adjusting the transducer
position
Refraction
• Deviation of US signal from a
straight path along the scan line.
• Appearance of side-by-side
double image
• Commonly seen in parasternal
short axis view
Near Field clutter
• Also called as “Ringdown artefact”
• Arises from high amplitude oscillations
of the piezoelectric elements.
• The artifact is troublesome when trying
to identify structures that are
particularly close to the transducer
• Greatly reduced in modern day systems
Doppler Artifacts
Artifacts  in echocardiography
Velocity Underestimation
• Due to non-parallel intercept angle between the US beam and
direction of blood flow
Signal Aliasing
• Inability to measure maximum
velocity
• Can be due to non-laminar
disturbed flow and high velocity
laminar flow
• Can be controlled by using low-
frequency, change Nyquist limit
and use of CW doppler
Beam width
• Superimposition of Doppler signals from adjacent
flows
• Beam width artifacts in Doppler imaging can be
clinically useful.
• beam width artifact often has less desirable effects.
Ex: a large sample volume may hinder
one's ability to distinguish aortic stenosis from mitral
regurgitation.
Range ambiguity
• It’s a speed of sound artefact
• Doppler signals from more than one depth along the US
beam are recorded.
1.misregistration of targets
2.distortion of interfaces
3.errors in size and
4.defocusing of the ultrasound beam.
• It can be reduced by decreasing the depth or width to the
minimum required
Mirror Imaging
• Also called as “Cross Talk”
• Such mirror images are usually less
intense but similar in most other
features to the actual signal.
• can be reduced by decreasing the
power output or gain and optimizing
the alignment of the Doppler beam
with the flow direction.
Transit Time Effect
• Change in the velocity of the US wave as it passes through a moving
medium results in overestimation of Doppler shifts
• Results in broadening of the velocity range at a given time point.
(Blurring on the vertical axis)
Colour Doppler
Artifacts  in echocardiography
Shadowing and Ghosting
Shadowing:-
• may occur, masking color flow information beyond strong reflectors.
Ghosting:-
• is a phenomenon in which brief patterns of color are painted over
large regions of the image.
• Ghosts are usually a solid color (either red or blue) and bleed into the
tissue area of the image.
• These are produced by the motion of strong reflectors such as
prosthetic valves.
Background Noise
• Also called as Gain setting artifacts
• Too much gain can create a mosaic distribution of color signals
throughout the image.
• Too little gain eliminates all but the strongest Doppler signals and
may lead to significant underestimation.
• Gain level just below the random background noise can optimize the
flow signal
Other artifacts..
• Intercept angle: Change in
colour (or absence at 90
degrees) due to angle between
flowstream and US beam
• Aliasing: On colour flow results
in “wraparound” of the velocity
signal.
• Electronic interference:
Instrument dependent
In TEE
Artifacts  in echocardiography
Multiple reflections
Misplaced reflections
Thank You!!

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Artifacts in echocardiography

  • 2. Contents • Artifacts • In 2D Echo • In Doppler • In Colour flow • In TEE
  • 4. Artifacts 1. Extraneous US signal that results in appearance of structures that are not actually present 2. Failure to visualize structures that are present 3. An image of a structure that differs in size or shape or both from its actual appearance
  • 7. Suboptimal Imaging • Cause is poor ultrasound tissue penetration • Body habitus with interposition of high attenuation tissue. (Lung, Bone) • Increased distance ( Adipose tissue) • THI can improve the image quality • TEE may be required
  • 9. Acoustic Shadowing • Reflection of entire US signal by a strong specular reflector • Ex: • prosthetic valves. • Heavily calcified Native structures • Contrast containing blood also produces shadowing. • Try alternate acoustic window or different transthoracic view • TEE may be required
  • 10. Reverberations • Multiple linear high amplitude echo signals originating from two strong specular reflectors • Results in back and forth reflection • Typically, a reverberation artifact that originates from a fixed reflector will not move with the motion of the heart.
  • 11. Beam Width • Superimposition of structures within the beam profile (Including side lobes) into a single tomographic image • Can be due to strong reflectors at the edge of a larger beam will be superimposed on structures in central zone. • Can be due to consequences of varying lateral resolution
  • 12. Range Ambiguity • Echo from previous pulse reaches transducer on next cycle. • Results in appearance of deep structures closer to the transducer than their actual location • Second type of range ambiguity is a double image on the vertical axis • Echoes being re-reflected by a structure close to the transducer (ex. Rib) • Results in signal received twice normal and can form double image. • Range ambiguity can be eliminated by decreasing depth or adjusting the transducer position
  • 13. Refraction • Deviation of US signal from a straight path along the scan line. • Appearance of side-by-side double image • Commonly seen in parasternal short axis view
  • 14. Near Field clutter • Also called as “Ringdown artefact” • Arises from high amplitude oscillations of the piezoelectric elements. • The artifact is troublesome when trying to identify structures that are particularly close to the transducer • Greatly reduced in modern day systems
  • 17. Velocity Underestimation • Due to non-parallel intercept angle between the US beam and direction of blood flow
  • 18. Signal Aliasing • Inability to measure maximum velocity • Can be due to non-laminar disturbed flow and high velocity laminar flow • Can be controlled by using low- frequency, change Nyquist limit and use of CW doppler
  • 19. Beam width • Superimposition of Doppler signals from adjacent flows • Beam width artifacts in Doppler imaging can be clinically useful. • beam width artifact often has less desirable effects. Ex: a large sample volume may hinder one's ability to distinguish aortic stenosis from mitral regurgitation.
  • 20. Range ambiguity • It’s a speed of sound artefact • Doppler signals from more than one depth along the US beam are recorded. 1.misregistration of targets 2.distortion of interfaces 3.errors in size and 4.defocusing of the ultrasound beam. • It can be reduced by decreasing the depth or width to the minimum required
  • 21. Mirror Imaging • Also called as “Cross Talk” • Such mirror images are usually less intense but similar in most other features to the actual signal. • can be reduced by decreasing the power output or gain and optimizing the alignment of the Doppler beam with the flow direction.
  • 22. Transit Time Effect • Change in the velocity of the US wave as it passes through a moving medium results in overestimation of Doppler shifts • Results in broadening of the velocity range at a given time point. (Blurring on the vertical axis)
  • 25. Shadowing and Ghosting Shadowing:- • may occur, masking color flow information beyond strong reflectors. Ghosting:- • is a phenomenon in which brief patterns of color are painted over large regions of the image. • Ghosts are usually a solid color (either red or blue) and bleed into the tissue area of the image. • These are produced by the motion of strong reflectors such as prosthetic valves.
  • 26. Background Noise • Also called as Gain setting artifacts • Too much gain can create a mosaic distribution of color signals throughout the image. • Too little gain eliminates all but the strongest Doppler signals and may lead to significant underestimation. • Gain level just below the random background noise can optimize the flow signal
  • 27. Other artifacts.. • Intercept angle: Change in colour (or absence at 90 degrees) due to angle between flowstream and US beam • Aliasing: On colour flow results in “wraparound” of the velocity signal. • Electronic interference: Instrument dependent

Editor's Notes

  1. A: A St. Jude mitral prosthesis (MV) is present. The echo-free space beyond the sewing ring (*) represents shadowing behind the strong echo-reflecting sewing ring. The cascade of echoes directly beyond the prosthetic valve itself that extend into the left ventricle (LV) represent reverberations. B: A shotgun pellet within the heart (arrow) casts a series of reverberations into the left ventricle. Ao, aorta; LA, left atrium.
  2. A: The source of the artifact is the posterior pericardium, which is a very strong reflector. In this case, the second line of echoes is twice the distance from the transducer as the actual pericardial echoes. B: A second lumen appears just distal to the descending aorta (DA) in this subcostal view.
  3. A: The strong echoes produced by the posterior mitral anulus and atrioventricular groove produce a side lobe artifact that appears as a mass within the left atrium. B: Bright echoes within the pericardium produce a linear artifact that appears within the descending aorta and left atrium.