Triplex exam means the use of three ultrasound modalities in a single examination to study blood flow with gray scale imaging, color Doppler and spectral Doppler.

Ultrasound physics is based on the fact that periodic motion emitted of a vibrating object causes pressure waves. Ultrasonic waves are made of high pressure and low pressure (rarefactional pressure) pulses traveling through a medium.

Properties of sound waves:

The speed of ultrasound depends on the mass and spacing of the tissue molecules and the attracting force between the particles of the medium. Ultrasonic waves travels faster in dense materials and slower in compressible materials. Ultrasound is reflected at interfaces between tissues of different acoustic impedance e.g., soft tissue - air, bone - air, or soft tissue - bone.
The sound waves are produced and received by the piezoelectric crystal of the transducer. The fast Fourier transformation converts the signal into a gray scale ultrasound picture.

The ultrasonic transmission and absorption is dependend on:
See also Sonographic Features, Doppler Effect and Thermal Effect.

Unlike regular sound, ultrasound can be directed into a single direction. The echoes received by a stationary probe will result in a single dimensional signal showing peaks for every major material change.
To generate a 2D picture, the probe is swiveled, either mechanically or through a phased array of ultrasound transducers. The data is analyzed by computer and used to construct the image. In a similar way, 3D pictures can be generated by computer using a specialized probe. In this way, a photo of an unborn baby may be made.
Some ultrasonography machines can produce color pictures, of sorts. Doppler ultrasonography is color coded onto a gray scale picture. From the amount of energy in each echo, the difference in acoustic impedance can be calculated and a color is then assigned accordingly.

See also Densitometry and 3D Ultrasound.

Urologic ultrasound includes the examination of the kidneys, renal vessels, urinary tract, bladder, prostate, and scrotum.
Usual gray scale ultrasound equipment and standard probes are sufficient to examine the kidney parenchyma and renal pelvis, the urinary tract and bladder. Doppler ultrasound is a useful adjunct to kidney ultrasound. High ultrasound system performance is desirable to show the arterial system, because advanced power Doppler is significantly more sensitive to blood flow than standard color Doppler.
Transurethral sonography may be used to examine the bladder and urethra. Transrectal sonography is used to scan and treat the prostate e.g., with brachytherapy or high intensity focused ultrasound. Very small probes are used for these applications. Reflux sonography is especially used in pediatric ultrasound.

See also Ultrasound Imaging Procedures, Ultrasound Picture, Ultrasound Imaging Modes, Lithotripsy, Thermotherapy, Brachytherapy and Ultrasound Therapy.