Acoustic mismatch arise at the boundary between two different media where reflection and refraction occur.

See also Snells Law.

The earliest introduction of vascular ultrasound contrast agents (USCA) was by Gramiak and Shah in 1968, when they injected agitated saline into the ascending aorta and cardiac chambers during echocardiographic to opacify the left heart chamber. Strong echoes were produced within the heart, due to the acoustic mismatch between free air microbubbles in the saline and the surrounding blood.

The earliest introduction of vascular ultrasound contrast agents (USCA) was by Gramiak and Shah in 1968, when they injected agitated saline into the ascending aorta and cardiac chambers during echocardiographic to opacify the left heart chamber. Strong echoes were produced within the heart, due to the acoustic mismatch between free air microbubbles in the saline and the surrounding blood.
The disadvantage of this microbubbles produced by agitation, was that the air quickly leak from the thin bubble shell into the blood, where it dissolved. In addition, the small bubbles that were capable of traversing the capillary bed did not survive long enough for imaging because the air quickly dissipated into the blood. Aside from agitated saline, also hydrogen peroxide, indocyanine green dye, and iodinated contrast has been tested. The commercial development of contrast agents began in the 1980s with greatest effort to the stabilization of small microbubbles.

The development generations by now:
To pass through the lung capillaries and enter into the systemic circulation, microspheres should be less than 10 μm in diameter. Air bubbles in that size range persist in solution for only a short time; too short for systemic vascular use.
The first developed agent was Echovist (1982), which enabled the enhancement of the right heart. The second generation of echogenic agents, sonicated 5% human albumin-containing air bubbles (Albunex), were capable of transpulmonary passage but often failed to produce adequate imaging of the left heart. Both Albunex and Levovist utilize air as the gas component of the microbubble.
In the 1990s newer developed agents with fluorocarbon gases and albumin, surfactant, lipid, or polymer shells have an increased persistence of the microspheres. This smaller, more stable microbubble agents, and improvements in ultrasound technology, have resulted in a wider range of application including myocardial perfusion.

See also First Generation USCA, Second Generation USCA, and Third Generation USCA.

The refraction is the change of the sound direction on passing from one medium to another. In ultrasound, refraction is due to sound velocity mismatches combined with oblique angles of incidence, most commonly with convex scanheads. When the ultrasound wave crosses at an oblique angle the interface of two materials, through which the waves propagate at different velocities, refraction occurs, caused by bending of the wave beam.

See also Refraction Artifact, Acoustic Shadowing, Acoustic Mismatch, and Duplication Artifact.

As the sound travels through a relatively homogeneous medium it propagates in essentially a straight line. When the sound reaches an interface a part of the incident beam is reflected, and a part is refracted (transmitted). Snells law governs the direction of the transmitted beam when refraction occurs:
sin qt = (c2/c1) x sin qi (qt is the transmit and qi is the incident angle)
The amount of sound that is reflected depends on the degree of difference between the two media; the greater the acoustic mismatch, the greater the amount of sound reflected. In addition, the amount of ultrasound reflected or refracted depends on the angle at which the sound beam hits the interface between the different media. As the angle of incidence approaches 90°, a higher percentage of the ultrasound is reflected.

See also Sonographic Features.