Gray scale [also grayscale, grey scale = brit.] produces basically black and white images with series of shades of gray. Solid areas appear white and fluid areas appear black, varying from black at the weakest intensity to white at the strongest. Gray scale resolves artifacts as small as 1 mm. The display is made by transmitting bursts of energy and analyzing the returning signal. Gray scale pictures are limited to the gray scale tones; color pictures display more information because the color is added to the gray scale.
Most ultrasound contrast agents also improve gray scale visualization of the flowing blood to such a degree that the tissue echogenicity increases. Gray scale enhancement of flow in an organ promises to improve lesion detection, along with the ability to differentiate between normal and abnormal areas, using many of the criteria already routinely used in CT and MRI.

See also Compress, Densitometry, Triplex Exam and QB-Mode.

Standard scanners allow visualizing microbubbles on conventional gray scale imaging in large vascular spaces. In the periphery, more sensitive techniques such as Doppler or non-linear gray scale modes must be used because of the dilution of the microbubbles in the blood pool. Harmonic power Doppler (HPD) is one of the most sensitive techniques for detecting ultrasound contrast agents.
Commonly microbubbles are encapsulated or otherwise stabilized to prolong their lifetime after injection. These bubbles can be altered by exposure to ultrasound pulses. Depending on the contrast agent and the insonating pulse, the changes include deformation or breakage of the encapsulating or stabilizing material, generation of free gas bubbles, reshaping or resizing of gas volumes.
High acoustic pressure amplitudes and long pulses increase the changes. However, safety considerations limit the pressure amplitude and long pulses decrease spatial resolution. In addition, lowering the pulse frequency increases destruction of contrast bubbles. However, at low insonation power levels, contrast agent particles resist insonation without detectable changes. Newer agents are more reflective and will usually allow gray scale imaging to be used with the advantages of better spatial resolution, fewer artifacts and faster frame rates.

Feasible imaging methods with advantages in specific acoustic microbubble properties:
Resonating microbubbles emit harmonic signals at double their resonance frequency. If a scanner is modified to select only these harmonic signals, this non-linear mode produces a clear image or trace. The effect depends on the fact that it is easier to expand a bubble than to compress it so that it responds asymmetrically to a symmetrical ultrasound wave. A special array design allows to perform third or fourth harmonic imaging. This probe type is called a dual frequency phased array transducer.

See also Bubble Specific Imaging.

Ultrasound machines, with their various components and types, have revolutionized the field of medical imaging. These devices enable healthcare professionals to visualize internal structures, assess conditions, and guide interventions with real-time imaging capabilities. Today, medical ultrasound systems are complex signal processing machines. Assessing the performance of an ultrasound system requires understanding the relationships between the characteristics of the system, such as the point spread function, temporal resolution, and the quality of images. Image quality aspects include the detail resolution, contrast resolution and penetration. Systems with microbubble scanner modification are particularly suitable for contrast enhanced ultrasound.


In summary, ultrasound machines have diverse performance levels and corresponding price ranges, catering to various medical imaging needs. From low-performance systems with basic imaging capabilities to high-performance and premium systems with advanced features, ultrasound technology continues to advance healthcare imaging capabilities.
See also Ultrasound Physics, Handheld Ultrasound, Environmental Protection, Equipment Preparation.

Also called B-mode echography, B-mode sonography, 2D-mode, and sonogram.
B-mode ultrasound (Brightness-mode) is the display of a 2D-map of B-mode data, currently the most common form of ultrasound imaging.
The development from A-mode to B-mode is that the ultrasound signal is used to produce various points whose brightness depends on the amplitude instead of the spiking vertical movements in the A-mode. Sweeping a narrow ultrasound beam through the area being examined while transmitting pulses and detecting echoes along closely spaced scan lines produces B-scan images. The vertical position of each bright dot is determined by the time delay from pulse transmission to return of the echo, and the horizontal position by the location of the receiving transducer element.
To generate a rapid series of individual 2D images that show motion, the ultrasound beam is swept repeatedly. The returning sound pulses in B-mode have different shades of darkness depending on their intensities. The varying shades of gray reflect variations in the texture of internal organs. This form of display (solid areas appear white and fluid areas appear black) is also called gray scale.

Different types of displayed B-mode images are:
The probe movement can be performed manual (compound and static B-scanner) or automatic (real-time scanner).
The image reconstruction can be parallel or sector type.

See also B-Scan, 4B-Mode, and Harmonic B-Mode Imaging.

The 2D-mode (2-Dimensional-mode) is a spatially oriented B-mode (brightness) ultrasound. The imaged structures are displayed 2 dimensional as a function of depth and width. The brightness level is based on the echo signal amplitude.
Most of the ultrasound devices in medical imaging are 2D real-time scanner. The image is created by a rapidly back and forth swept sound beam over the region of interest.

See also Gray Scale.