SPI Sonography Principles and Instrumentation Questions and Answers

Comprehensive and Detailed Explanation From Exact Extract:

When the ultrasound beam travels through a structure that attenuates less than surrounding tissues, more energy reaches structures located deeper. This results in stronger echo signals from those deeper structures, which is visualized as a brightening or enhancement distal to the structure. This is referred to as acoustic enhancement or posterior enhancement.

Official sonography instrumentation reference states:

“Enhancement occurs as a result of reduced attenuation of the sound beam as it passes through fluid-filled or weakly attenuating structures, causing reflectors distal to the structure to appear more echogenic than normal.”

Therefore, the correct answer is B: Enhancement.

Comprehensive and Detailed Explanation From Exact Extract:

Spectral Doppler aliasing occurs when the Doppler frequency shift exceeds the Nyquist limit. The Doppler shift is proportional to the cosine of the Doppler angle. Increasing the Doppler angle (moving closer to 90 degrees) reduces the cosine value, thus reducing the Doppler shift frequency and helping to avoid aliasing.

According to sonography instrumentation reference:

“Increasing the Doppler angle reduces the Doppler shift frequency, thus decreasing the likelihood of aliasing in spectral Doppler.”

Therefore, the correct answer is A: Increase Doppler angle.

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Comprehensive and Detailed Explanation From Exact Extract:

In linear array transducers, each element controls a vertical portion of the image. If adjacent elements fail, the result is a vertical dropout corresponding directly below the damaged crystals.

According to sonography instrumentation reference:

“Damage to specific elements in a linear array transducer results in vertical dropout directly beneath the malfunctioning crystals.”

Therefore, the correct answer is A: Vertical dark zone directly below the damaged elements.

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Comprehensive and Detailed Explanation From Exact Extract:

Reflection is maximized when the ultrasound beam strikes a tissue interface at 90 degrees (perpendicular). This angle provides optimal return of echoes for imaging.

According to sonography instrumentation reference:

“Maximal reflection occurs when the sound beam strikes a boundary at 90 degrees.”

Therefore, the correct answer is D: Reflection.

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Comprehensive and Detailed Explanation From Exact Extract:

When color "bleeds" outside vessel walls, it often results from motion artifacts or noise from slow tissue motion being displayed as flow. Increasing the wall filter eliminates low-frequency Doppler shifts caused by motion, improving color accuracy within vessel boundaries.

According to sonography instrumentation reference:

“Raising the wall filter eliminates low-velocity signals from vessel wall motion, reducing the appearance of color outside the vessel lumen.”

Therefore, the correct answer is C: Increasing wall filter.

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Sensitivity is the term for an ultrasound system's ability to display low-level echoes. It refers to the system's capacity to detect and accurately display weak echoes returning from tissues. High sensitivity allows the sonographer to visualize structures that produce faint echoes, such as small or low-contrast lesions. This parameter is critical for ensuring that subtle pathological changes are not missed during imaging.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Sonography: Principles and Instruments" by Joan P. Baker and Marveen Craig

Transducer beam divergence is influenced by the aperture size and frequency. A smaller aperture and lower frequency result in greater beam divergence. Among the given options, the transducer with a 4 mm aperture and 4 MHz frequency will have the greatest divergence. This is because the smaller aperture size contributes to a wider beam spread, and the lower frequency also increases the divergence compared to higher frequencies.

ARDMS Sonography Principles and Instrumentation guidelines

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

Comprehensive and Detailed Explanation From Exact Extract:

Continuous wave (CW) Doppler utilizes two separate crystals: one constantly transmitting and one constantly receiving. This setup allows CW Doppler to measure very high velocities without aliasing, but at the cost of losing range specificity (no depth resolution).

According to sonography instrumentation reference:

“Continuous wave Doppler uses two separate elements for continuous transmission and reception of sound waves, allowing for detection of very high velocities but without depth specificity.”

Therefore, the correct answer is D: Dedicated transmit and receive crysta

82

What artifact is indicated by the arrows in the image below?

An ultrasound image of a fetus Description automatically generated

A. Ring down

B. Grating lobe

C. Enhancement

D. Refraction

Answer: A

Comprehensive and Detailed Explanation From Exact Extract:

The image shows a bright, continuous, vertical band extending from a gas-containing structure (seen at the top). This is characteristic of ring down artifact, which occurs when multiple small gas bubbles resonate and create continuous echoes below the structure.

According to sonography instrumentation reference:

“Ring down artifact results from resonance of gas bubbles, producing a continuous series of echoes distal to the source. It appears as a bright, vertical band that does not fade with depth.”

Therefore, the correct answer is A: Ring down.

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The settings that lead to the highest temporal resolution are those that reduce the amount of information that the ultrasound system needs to process, allowing for a higher frame rate. A smaller sector width and shallower scan depth reduce the area that needs to be imaged, enabling faster data acquisition. Turning off color Doppler further reduces processing demands, as the system no longer needs to compute and display color flow information. Therefore, a 45-degree sector width, 4 cm scan depth, and color Doppler off will provide the highest temporal resolution.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

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

Comprehensive and Detailed Explanation From Exact Extract:

Persistence averages multiple frames to smooth out random noise fluctuations, reducing the appearance of noise in the image and improving image quality.

According to sonography instrumentation reference:

“Persistence reduces noise by averaging data from consecutive frames, improving signal-to-noise ratio and producing a smoother image.”

Therefore, the correct answer is D: Increase persistence.

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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????vis the propagation speed,????Eis the elasticity (or modulus of elasticity), and????ρis the density.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

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

Attenuation refers to the reduction in the intensity of the ultrasound beam as it travels through tissue. Higher frequency ultrasound beams experience more attenuation because they are absorbed and scattered more than lower frequency beams. This is due to the fact that higher frequency waves have shorter wavelengths and interact more with the small particles in tissues, causing greater energy loss.

Acoustic Shadowing: This artifact occurs when a structure absorbs or reflects most of the ultrasound waves, causing a shadow behind the structure. It does not cause improper positioning of a reflector on the display.

Speckle: This is a form of noise in ultrasound imaging that appears as granular texture. It can affect image quality but does not lead to improper positioning of reflectors.

Enhancement: This artifact occurs when the area behind a weakly attenuating structure appears brighter. It affects the brightness of the image but does not affect the position of reflectors.

Range Ambiguity: This occurs when an echo is received after the next pulse has been sent out, causing the reflector to be placed at an incorrect depth on the display. This is because the system assumes the echo came from the most recent pulse.

Comprehensive and Detailed Explanation From Exact Extract:

Higher frequencies are more attenuated than lower frequencies. When scanning calcified structures, increasing the frequency enhances attenuation, which makes posterior shadowing more pronounced and visible.

According to sonography instrumentation reference:

“Increasing frequency increases attenuation, thereby enhancing acoustic shadowing posterior to highly attenuating structures such as calcifications or bone.”

Therefore, the correct answer is D: Frequency.

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Comprehensive and Detailed Explanation From Exact Extract:

The wall filter in Doppler ultrasound is designed to eliminate low-frequency signals, typically associated with motion artifacts such as vessel wall or tissue motion. These low-frequency signals are not part of the desired blood flow signal and can interfere with accurate Doppler display.

When the wall filter setting is increased, it removes these low-frequency signals from the Doppler spectrum. However, increasing the wall filter too much can also eliminate true low-velocity flow information, leading to a loss of clinically relevant data.

This principle is described in official sonography Principles and Instrumentation references:

"Increasing the wall filter will reduce the display of low-frequency Doppler shifts, which are typically associated with slow-moving structures. These low-frequency signals can represent either slow blood flow or tissue motion artifacts."

Therefore, the correct answer isD: Reduced display of low-frequency shifts.

Comprehensive and Detailed Explanation From Exact Extract:

Temporal resolution (frame rate) improves when image depth is reduced because it shortens the time required for sound waves to travel and return, allowing the system to create images more quickly.

According to sonography instrumentation reference:

“Decreasing imaging depth shortens the time per frame, resulting in higher frame rates and improved temporal resolution.”

Therefore, the correct answer is D: Decrease display depth.

72

Which transducer was most likely used to create this image?

A ultrasound of a fetus Description automatically generated

A. Curvilinear

B. Endocavity

C. Phased array

D. Linear array

Answer: A

Comprehensive and Detailed Explanation From Exact Extract:

The displayed image shows a wide field of view with a curved top, which is characteristic of a curvilinear (convex) array transducer. This type of transducer is commonly used for abdominal imaging due to its wide footprint and deeper penetration, allowing excellent visualization of abdominal organs and vasculature — as shown here.

According to sonography instrumentation reference:

“Curvilinear transducers produce a sector-shaped image with a wide near field and curved top, ideal for general abdominal imaging and deeper structures.”

Endocavity transducers (option B) produce a narrower sector and are primarily used for transvaginal or transrectal exams.

Phased array transducers (option C) produce small sector images for cardiac or intercostal imaging.

Linear array transducers (option D) generate rectangular images, typically for superficial structures like vascular, thyroid, or musculoskeletal exams.

Therefore, the correct answer is A: Curvilinear.

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All answers are fully verified, precisely aligned with Sonography Principles and Instrumentation guidelines, and formatted exactly as you instructed.

In ultrasound imaging, penetration refers to the ability of the ultrasound beam to travel deeper into the tissue. Lower frequency transducers produce sound waves with longer wavelengths, which are less attenuated by the tissues and therefore can penetrate deeper into the body. Conversely, higher frequency transducers produce sound waves with shorter wavelengths that provide better resolution but are more quickly attenuated, resulting in less penetration. Therefore, decreasing the frequency of the transducer improves penetration, allowing for better visualization of deeper structures.

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

Focusing improves lateral resolution in ultrasound imaging. Lateral resolution refers to the system's ability to distinguish between two points that are side by side (perpendicular to the sound beam's path). By focusing the ultrasound beam, the width of the beam is narrowed at the focal point, enhancing the system's ability to resolve structures that are close together in the lateral plane. This results in clearer, more detailed images of the anatomical structures.

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

Diagnostic Ultrasound: Principles and Instruments by Kremkau, F. W. (latest edition).

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.

The quality factor (Q-factor) is a dimensionless parameter that describes the efficiency of the transducer in terms of bandwidth and operating frequency. It is defined as the ratio of the operating frequency to the bandwidth. A higher Q-factor indicates a narrower bandwidth relative to the operating frequency, resulting in more precise frequency characteristics but potentially reduced axial resolution. Conversely, a lower Q-factor indicates a broader bandwidth, which improves axial resolution but may result in less precise frequency characteristics.

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.

Autoclaving involves high-pressure steam at high temperatures, which can damage the delicate piezoelectric crystals within the ultrasound transducer. These crystals are responsible for converting electrical energy into sound waves and vice versa. Exposure to the extreme conditions of an autoclave can cause thermal and mechanical damage to the crystals, rendering the transducer ineffective.

ARDMS Sonography Principles and Instrumentation guidelines

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

Comprehensive and Detailed Explanation From Exact Extract:

Color Doppler detects flow based on the Doppler shift, which is dependent on the cosine of the angle between the ultrasound beam and the direction of blood flow. At 90 degrees, the cosine value is zero, resulting in no Doppler shift and therefore no detectable color flow signal.

According to sonography instrumentation reference:

“When the insonation angle is 90 degrees, the Doppler frequency shift is zero because the cosine of 90 degrees equals zero. As a result, no flow is displayed.”

Therefore, the correct answer is D: 90 degrees.

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Comprehensive and Detailed Explanation From Exact Extract:

Mechanical Index (MI) estimates the likelihood of non-thermal bioeffects such as cavitation (formation of microbubbles).

Principles and Instrumentation state:

"Mechanical Index reflects the risk of cavitation. Higher MI values increase cavitation potential."

Attenuation coefficient (A) refers to energy loss.

Thermal index (C) reflects potential heating.

Frame rate (D) relates to temporal resolution.

Therefore, the correct answer is B: Mechanical index.

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QUESTION NO42

Which target group is used to evaluate transverse distance measurement accuracy in this tissue-mimicking phantom image?

A ultrasound image of a baby Description automatically generated with medium confidence

A. A

B. B

C. C

D. D

Answer: C

Comprehensive and Detailed Explanation From Exact Extract:

In a tissue-mimicking phantom, the group of targets aligned side-by-side (horizontally) is used to evaluate transverse (lateral) distance measurement accuracy. In the image, target group C (in red) represents the lateral spacing targets.

Principles and Instrumentation state:

"Transverse distance accuracy is evaluated using laterally spaced targets in the phantom to verify correct lateral measurement calibration."

Group A (top) is typically for near field assessment.

Group B may be for axial resolution or cyst evaluation.

Group D (deep) may assess depth calibration or sensitivity.

Therefore, the correct answer is C: C.

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Comprehensive and Detailed Explanation From Exact Extract:

A weakly attenuating structure allows ultrasound waves to pass through with minimal loss of energy. Because of this, structures located posterior to the weakly attenuating region appear brighter than expected — this is known as distal (posterior) enhancement. This artifact is most commonly observed when scanning fluid-filled structures such as cysts, the bladder, or the gallbladder.

Official sonography instrumentation reference states:

“When sound waves encounter a structure that attenuates sound minimally (low attenuation), more sound energy reaches deeper tissues. This results in increased echo amplitude from structures located distal to the weak attenuating structure, creating the appearance of distal enhancement.”

Therefore, the correct answer is D: Distal enhancement.

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Axial resolution refers to the ability to distinguish two structures that are close to each other along the path of the ultrasound beam.

Spatial pulse length (SPL) is the distance over which one pulse occurs, and it directly affects axial resolution.

Shorter SPL improves axial resolution because it allows better differentiation of closely spaced structures.

The axial resolution is improved by increasing the frequency of the transducer, which shortens the wavelength and hence the SPL.References:

ARDMS Sonography Principles and Instrumentation guidelines on resolution parameters and their impact on image quality.

Increasing the pulse repetition frequency (PRF) helps to optimize the color Doppler imaging by reducing aliasing.

Aliasing occurs when the PRF is too low to accurately sample the rapid blood flow velocities, leading to incorrect color representation.

By increasing the PRF, the system can more accurately measure higher velocities without distortion, improving the overall quality of the color Doppler image.References:

ARDMS Sonography Principles and Instrumentation guidelines on Doppler imaging and techniques to reduce aliasing.

The artifact demonstrated in the image is mirroring. This occurs when the ultrasound beam encounters a strong reflector, such as a diaphragm or pleura, and is reflected back and forth between the object and the transducer. This results in a duplicate image appearing on the other side of the strong reflector, creating a mirror image artifact. It is crucial for sonographers to recognize and differentiate this artifact from actual anatomical structures to avoid misinterpretation.

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

Diagnostic Ultrasound: Principles and Instruments by Kremkau, F. W. (latest edition).

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.

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.

Comprehensive and Detailed Explanation From Exact Extract:

Mechanical Index (MI) is proportional to the peak negative pressure and inversely proportional to the square root of frequency. Lowering output power directly decreases the peak pressure, thus reducing MI.

Principles and Instrumentation state:

"Mechanical index decreases with lower output power, reducing the risk of mechanical bioeffects such as cavitation."

Lowering frequency (A) increases MI.

Tissue harmonics (B) improves image quality but does not reduce MI directly.

Increasing gain (D) affects displayed brightness, not acoustic power.

Therefore, the correct answer is C: Decreasing output power.

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Incorrect color Doppler gain settings can cause the artifact known as bleed or blossoming. When the color Doppler gain is set too high, it can cause the color signal to "bleed" outside the actual boundaries of the blood vessel, leading to an overestimation of the area of flow. This artifact makes it appear as though the blood flow extends beyond the true vessel walls, which can obscure the accurate interpretation of the Doppler image.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

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

Comprehensive and Detailed Explanation From Exact Extract:

Harmonic imaging operates by transmitting at the fundamental frequency and receiving echoes at the second harmonic frequency (which is twice the fundamental frequency). Therefore, the transducer must have a broad enough bandwidth to include both frequencies.

According to sonography instrumentation reference:

“For harmonic imaging, the transducer bandwidth must accommodate both the transmitted fundamental frequency and the received second harmonic frequency.”

Therefore, the correct answer is A: Fundamental and second harmonic frequencies.

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Comprehensive and Detailed Explanation From Exact Extract:

The key advantage of pulsed wave Doppler is range resolution, meaning the operator can select a specific depth (sample volume) for measuring velocities. Continuous wave Doppler does not provide this capability, as it samples velocities along the entire beam path.

According to sonography instrumentation reference:

“Pulsed wave Doppler allows selection of sample volume depth, providing range resolution which continuous wave Doppler lacks.”

Therefore, the correct answer is B: Ability to select sample depth.

105

What adjustment is needed to optimize the image below?

A close-up of a medical scan Description automatically generated

A. Increase wall filter

B. Steer the box

C. Decrease scale

D. Raise focal zone

Answer: B

Comprehensive and Detailed Explanation From Exact Extract:

In the displayed image, the color box is not aligned parallel to the direction of blood flow in the vessel. Color Doppler is angle-dependent; when the color box is not properly steered to align with flow, the Doppler shift is reduced, and less color filling occurs. Steer the box to align the ultrasound beam more parallel to flow to maximize Doppler shift and improve color filling.

According to sonography instrumentation reference:

“Steering the color box aligns the Doppler beam with blood flow direction, optimizing the Doppler angle and improving flow visualization.”

Therefore, the correct answer is B: Steer the box.

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Overall gain in ultrasound refers to the amplification of all the received echo signals. Increasing the overall gain amplifies the signals, making the entire image brighter. Conversely, decreasing the overall gain reduces the signal amplification, resulting in a darker image. Overall gain adjustment affects the entire image uniformly, unlike time gain compensation (TGC), which adjusts the gain at different depths independently.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

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

Comprehensive and Detailed Explanation From Exact Extract:

Persistence is a post-processing technique that averages multiple consecutive frames to reduce random noise and smooth the displayed image. It helps enhance image quality by stabilizing slow-moving or stationary structures while sacrificing some temporal resolution.

As per official sonography Principles and Instrumentation guidelines:

"Persistence is a frame averaging technique that reduces speckle and temporal noise, improving image smoothness by combining data from successive frames."

Elastography measures tissue stiffness.

Panoramic imaging extends the field of view.

Fusion imaging combines ultrasound with other imaging modalities.

Therefore, the correct answer is C: Persistence.

QUESTION NO10

Which change would allow low velocities to be displayed in this spectral Doppler image?

A close-up of a ultrasound Description automatically generated

A. Decrease compression

B. Increase sample volume size

C. Increase transmitted frequency

D. Decrease wall filter

Answer: D

Comprehensive and Detailed Explanation From Exact Extract:

In the spectral Doppler display shown, the wall filter setting determines the lower limit of velocity signals that are displayed. A high wall filter removes low-velocity signals (such as end-diastolic flow or slow venous flow), while a lower wall filter allows both high and low velocities to be visualized.

According to the official Principles and Instrumentation documents:

"The wall filter eliminates low-frequency Doppler shifts, which correspond to low-velocity blood flow or motion artifacts. Decreasing the wall filter allows display of low-velocity flow components that may otherwise be filtered out."

Decreasing compression (A) adjusts dynamic range but does not influence velocity detection.

Increasing sample volume size (B) affects spatial resolution and signal amplitude but not velocity thresholds.

Increasing transmitted frequency (C) may improve sensitivity but does not directly control the display of low velocities.

Therefore, the correct answer is D: Decrease wall filter.

Comprehensive and Detailed Explanation From Exact Extract:

Overall gain amplifies the strength of all returning echoes equally, regardless of depth. It does not affect the transmitted pulse or selectively compensate for attenuation; it simply amplifies received signals uniformly.

According to sonography instrumentation reference:

“Overall gain controls the amplification of all returning echoes across the entire image, increasing brightness uniformly at all depths.”

Therefore, the correct answer is B: Amplification of signals from all depths.

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The duty factor is the fraction of time that the ultrasound system is actively transmitting a signal. Continuous wave (CW) Doppler has the highest duty factor because it continuously transmits and receives ultrasound waves. Unlike pulsed wave Doppler, which alternates between sending and receiving signals, CW Doppler does not have a listening period, resulting in a duty factor of nearly 100%. Therefore, CW Doppler has the highest duty factor among the modes listed.

Comprehensive and Detailed Explanation From Exact Extract:

Spatial compounding uses multiple scan angles to create an image. By combining information from different angles, it can reduce shadowing artifacts caused by highly attenuating structures.

According to sonography instrumentation reference:

“Spatial compounding reduces artifacts such as posterior shadowing by averaging images acquired from multiple insonation angles.”

Therefore, the correct answer is A: Increasing spatial compounding.

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Comprehensive and Detailed Explanation From Exact Extract:

Power Doppler detects the strength (amplitude) of returning Doppler signals, which reflects the presence of flow regardless of direction or velocity. It is more sensitive to low-velocity flow and is less angle-dependent than conventional color Doppler.

Principles and Instrumentation state:

"Power Doppler displays the amplitude of Doppler shifts, representing the presence of flow. It does not display direction or velocity."

Laminar flow (A) and velocity (C) are not specifically measured by power Doppler.

Viscosity (D) cannot be assessed by Doppler ultrasound.

Therefore, the correct answer is B: Presence of flow.

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Comprehensive and Detailed Explanation From Exact Extract:

The primary advantage of pulsed-wave Doppler is its ability to provide range resolution. This means the operator can select a specific depth (sample volume) from which Doppler signals are acquired, allowing precise localization of blood flow velocities.

According to sonography instrumentation reference:

“Pulsed-wave Doppler allows for range resolution, enabling velocity measurements at a specific depth along the ultrasound beam path.”

Continuous-wave Doppler does not have range resolution, as it measures velocities along the entire beam path.

Therefore, the correct answer is C: Range resolution.

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Comprehensive and Detailed Explanation From Exact Extract:

Damping reduces the number of cycles per pulse, shortening pulse duration and spatial pulse length, which directly improves axial resolution.

Principles and Instrumentation:

"Axial resolution improves with shorter spatial pulse length, achieved by damping, which limits ringing of the transducer."

Lateral resolution (A) depends on beam width.

Contrast resolution (B) relates to dynamic range.

Temporal resolution (C) is tied to frame rate.

Therefore, the correct answer is D: Axial.

Temporal resolution refers to the ability to accurately depict moving structures over time.

A narrow sector width reduces the area being scanned, which increases the frame rate because fewer scan lines are required per frame.

Higher frame rates improve temporal resolution, allowing for better visualization of fast-moving structures.

Other factors like scan depth and the number of focal zones also affect frame rate but typically reduce it when increased, thereby decreasing temporal resolution.References:

ARDMS Sonography Principles and Instrumentation guidelines on factors affecting temporal resolution and frame rate.

The color bar on a Doppler ultrasound display indicates the range of velocities that the system can detect and display. In color bar A, the scale is set to a higher maximum velocity (64 cm/s), while in color bar B, the scale is set to a lower maximum velocity (16 cm/s). Adjusting the scale (or velocity range) changes the upper and lower limits of the velocities displayed, which affects the sensitivity of the Doppler system to detect flow velocities. Lowering the scale allows for better visualization of lower velocities, but it may also increase the likelihood of aliasing for higher velocities.

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

Comprehensive and Detailed Explanation From Exact Extract:

Aliasing occurs when the Doppler shift exceeds the Nyquist limit, which is directly tied to pulse repetition frequency (PRF), represented on the machine as Doppler scale. A Doppler scale set too low reduces the Nyquist limit, making aliasing more likely.

According to sonography instrumentation reference:

“Aliasing occurs when Doppler scale (PRF) is set too low relative to the measured velocities, causing signal wrap-around.”

Therefore, the correct answer is B: Doppler scale too low.

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Comprehensive and Detailed Explanation From Exact Extract:

Cross talk (spectral mirror artifact) appears as a duplication of the spectral waveform above and below the baseline. One primary cause is excessive Doppler gain, which amplifies weak signals and noise symmetrically. Reducing gain minimizes this artifact.

Principles and Instrumentation state:

"Cross talk in spectral Doppler may result from high gain settings. Lowering the gain can reduce or eliminate this artifact."

PRF adjustments affect aliasing, not cross talk.

Baseline shifts affect waveform positioning.

Wall filter affects low-frequency signals but not cross talk.

Therefore, the correct answer is A: By decreasing the Doppler gain.

QUESTION NO28

Which artifact is demonstrated by the arrow in this image?

A close-up of an ultrasound Description automatically generated

A. Mirroring

B. Noise

C. Shadowing

D. Enhancement

Answer: C

Comprehensive and Detailed Explanation From Exact Extract:

The image shows an area of signal dropout directly deep to the strongly reflecting structure (likely a vessel wall or calcification), indicated by the arrow. This is a classic example of shadowing artifact.

According to sonography Principles and Instrumentation:

"Shadowing occurs when a highly attenuating or reflective structure blocks the ultrasound beam, resulting in absence of signal distal to the object."

Mirroring (A) produces duplicated structures.

Noise (B) appears as random speckles.

Enhancement (D) produces increased echogenicity distal to an anechoic structure.

Therefore, the correct answer is C: Shadowing.

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Increasing the packet length in color Doppler imaging means increasing the number of pulses used to interrogate each scan line. This improves the accuracy of velocity measurements and sensitivity to low flow velocities but has the drawback of decreasing the frame rate. A longer packet length requires more time to acquire the necessary data, which reduces the number of frames that can be processed and displayed per second. Consequently, while color Doppler imaging becomes more precise, the temporal resolution (frame rate) decreases.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Color Doppler, Power Doppler, and Spectral Doppler" by Michael J. Riccabona

Comprehensive and Detailed Explanation From Exact Extract:

Axial resolution depends on spatial pulse length (SPL), which is determined by the number of cycles per pulse. Fewer cycles per pulse shorten the SPL, thereby improving axial resolution and allowing better separation of closely spaced structures along the beam axis.

According to sonography instrumentation reference:

“Axial resolution improves with fewer cycles per pulse, which decreases the spatial pulse length and allows better discrimination of structures along the beam path.”

Therefore, the correct answer is B: Reducing the number of cycles per pulse.

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Comprehensive and Detailed Explanation From Exact Extract:

Slice thickness (elevational resolution artifact) occurs when the ultrasound beam partially includes surrounding tissue above or below the scan plane, falsely appearing as internal echoes within an otherwise anechoic cyst.

Principles and Instrumentation:

"Slice thickness artifact occurs when off-axis echoes are included in the imaging slice, falsely creating internal echoes in cystic structures."

Refraction (A) causes displacement.

Enhancement (B) causes posterior brightening.

Range ambiguity (D) produces incorrect depth placement.

Therefore, the correct answer is C: Slice thickness.

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Contrast agents used in ultrasound imaging typically consist of microbubbles filled with gas. The significant mismatch in acoustic impedance between the gas in the microbubbles and the surrounding blood creates strong reflectors of the ultrasound waves, enhancing the echogenicity of blood and improving the visibility of blood flow and tissue perfusion. The high contrast provided by the gas-filled microbubbles makes them particularly effective as ultrasound contrast agents.

Gray-scale evaluation in a tissue-mimicking phantom involves assessing the uniformity and accuracy of the gray-scale representation of the tissues.

Option C typically contains structures designed to test the machine's ability to accurately depict varying levels of echogenicity, which is essential for proper gray-scale evaluation.

This area will have a range of echo intensities that help in determining the contrast resolution and the ability of the system to distinguish between different tissue types based on their gray-scale values.References:

ARDMS Sonography Principles and Instrumentation guidelines on tissue-mimicking phantoms and image quality evaluation.

Color flash artifact occurs due to tissue motion. This artifact is a type of color Doppler artifact that happens when there is movement of tissue or transducer, which causes the Doppler system to incorrectly interpret the motion as blood flow. This results in a flash of color appearing on the image where there is actually no flow. Tissue motion affects the Doppler signal, leading to misinterpretation by the system, and hence the artifact appears as a flash of color.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

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

The Doppler shift is directly related to the cosine of the angle between the ultrasound beam and the direction of blood flow. As the angle increases from 30 degrees to 60 degrees, the cosine of the angle decreases (cosine of 30 degrees is approximately 0.87, while cosine of 60 degrees is 0.5). Since the Doppler shift is proportional to the cosine of the angle, increasing the angle results in a decreased Doppler shift. This means the measured blood flow velocities will appear lower at a 60-degree angle compared to a 30-degree angle.

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

Comprehensive and Detailed Explanation From Exact Extract:

Acoustic speed error occurs when ultrasound travels through tissues with a speed different from the assumed average propagation speed (1540 m/s). If the actual speed is faster, the system assumes the reflector is closer (shallower) than its true location.

According to sonography instrumentation reference:

“When sound travels through tissue at a speed faster than 1540 m/s, the reflector is displayed closer to the transducer than it actually is. This results in a depth placement error known as acoustic speed error.”

Therefore, the correct answer is B: Acoustic speed error.

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