Stress echocardiograms are used for detection of coronary artery disease, or to determine the cardiac performance. Stress echocardiograms are less performed to evaluate pulmonary artery pressures, pulmonary hypertension or the significance of valvular heart disease.
Stress increases the degree to which the heart contracts. After a myocardial infarction there will be a region of the heart muscle that contracts abnormal at rest. This area may worsen with stress. A coronary artery blockage most often do not impairs the function of the heart at rest. With stress, a region of the heart does not receive enough blood to work effectively and wall motion abnormalities occur. The echocardiographer compares rest and exercise and can determine the presence and severity of a coronary artery blockage.

Stress echocardiograms involve:
A bicycle stress echocardiogram involves transthoracic echocardiography performed at the rest baseline and after or during different stages of physical exercise.
A dobutamine stress echocardiography uses the drug dobutamine instead physical exercise.
Transthoracic echocardiograms are routinely performed during stress and rest.
Cardiovascular stress represents a minimal risk to the patient.

See also Transesophageal Echocardiography, Echocardiography, M-Mode, Curved Transducer, Doppler Ultrasound, History of Ultrasound and History of Ultrasound Contrast Agents.

(TCD) Transcranial color Doppler sonography allows to evaluate the presence and flow direction of vessels as well as their relationships to surrounding structures.
A disadvantage of cerebrovascular ultrasonography is the attenuation of the ultrasound signal by the skull. The loss of power through the skull is considerable, the signal to noise ratio is poor and so contrast enhanced Doppler imaging is advantageous. The use of ultrasound contrast agents provides a diagnostic window of sufficient duration and imaging quality to improve an evaluation of the cerebral vessels. Contrast TCD also results in visualization of small arteries and veins and greater length of these vessels.

See also A-Mode, Cranial Bone Thermal Index, Transcranial Color Coded Sonography and Transcranial Window.

(TEE) Transesophageal echocardiography provides a superior view of cardiac anatomy compared with transthoracic echocardiography. TEE is performed by the introduction of a probe attached to a fiberoptic endoscope into the esophagus. Caused by the position close to the heart e.g., clot finding and the view of the mitral valve are improved.

Indications:
The piezoelectric crystal creating the acoustic power is mounted on the gastroscope that must be swallowed by the patient. This endoscopic transducer is miniaturized to approximately the size of a fingernail. Usually the probe is in place for an average of 15 minutes, to numb the surface a topical anesthetic is sprayed into the throat, in addition a conscious sedation is recommended.

See also Myocardial Contrast Echocardiography, Stress Echocardiogram, M-Mode Echocardiography, Contrast Enhanced Ultrasound and Vascular Ultrasound Contrast Agents.

The main advantage of ultrasound is that certain structures can be observed without using radiation. However, ultrasound is energy and there are ultrasound safety regulations, because two bioeffects of ultrasound are heat and cavitation. Ultrasound is a mechanical energy in which a pressure wave travels through tissue. Reflection and scattering back to the transducer are used to form the image. As sound energy is transmitted through the tissue, some energy is reflected and some power is absorbed.
Possible physical effects with ultrasound:
The ultrasound safety is based on two indices, the mechanical index (MI) and the thermal index (TI). The WFUMB guidelines state that ultrasound that produces temperature rises of less than 1.5°C may be used without reservation. They also state that ultrasonic exposure causing temperature rises of greater than 4°C for over 5 min should be considered potentially hazardous. This leaves a wide range of temperature increases which are within the capability of diagnostic ultrasound equipment to produce and for which no time limits are recommended. However, it has not been determined that medical ultrasound causes any adverse reaction or deleterious effect.
The American Institute of Ultrasound in Medicine states that as of 1982, no independently confirmed significant biologic effects had been observed in mammalian tissue below (medical usage) 100mW/cm2.

See also Ultrasound Regulations and Ultrasound Radiation Force.

Ultrasound technology with its advancements is vital for delivering high-quality patient care. Innovations including high-frequency ultrasound, 3D//4D imaging, contrast enhanced ultrasound, elastography, and point-of-care ultrasound, have expanded the capabilities of ultrasound imaging and improved diagnostic accuracy.
B-Mode imaging, also known as brightness mode, is the fundamental technique in ultrasound imaging. It produces two-dimensional images based on the echoes received from tissues and organs. Understanding the principles of B-Mode imaging, such as gain adjustment, depth control, and image optimization, is crucial for obtaining diagnostically valuable images. M-Mode imaging, on the other hand, allows for the visualization of motion over time, enabling assessment of cardiac structures and function, as well as fetal heart rate.
High-frequency ultrasound refers to the use of ultrasound waves with frequencies greater than 10 MHz. This technology enables improved resolution, allowing for detailed imaging of superficial structures like skin, tendons, and small organs. High-frequency ultrasound has found applications in dermatology, ophthalmology, and musculoskeletal imaging.
Traditional 2D ultrasound has been augmented by the advent of 3D ultrasound technology. By acquiring multiple 2D images from different angles, this technique construct a volumetric representation of the imaged area. The addition of 4D ultrasound in real-time motion adds further value by capturing dynamic processes.
Doppler imaging employs the Doppler effect to evaluate blood flow within vessels and assess hemodynamics. Color Doppler assigns color to different blood flow velocities, providing a visual representation of blood flow direction and speed. Spectral Doppler displays blood flow velocities as a waveform, allowing for detailed analysis of flow patterns, resistance, and stenosis.
Contrast enhanced ultrasound employs microbubble contrast agents to enhance the visualization of blood flow and tissue perfusion. By injecting these agents intravenously, sonographers can differentiate between vascular structures and lesions. Elastography is a technique that measures tissue elasticity or stiffness. It assists in differentiating between normal and abnormal tissues, aiding in the diagnosis of various conditions such as liver fibrosis, breast lesions, and thyroid nodules.
Fusion imaging combines ultrasound with other imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). By overlaying or merging ultrasound images with those obtained from other modalities, the user can precisely locate and characterize abnormalities, guide interventions, and improve diagnostic accuracy. Fusion imaging has proven particularly useful in areas such as interventional radiology, oncology, and urology.
See also Equipment Preparation, Environmental Protection, Handheld Ultrasound, Portable Ultrasound and Ultrasound Accessories and Supplies.