Transducers used for the real-time mode are different than for the A-mode, B-, or M-modes. A linear array transducer with multiple piezoelectric crystal elements that are different arranged and fired, transmits the needed larger sound beam.
A subgroup of x adjacent elements (8-16; or more in wide-aperture designs) is pulsed simultaneously; the inner elements pulse delayed with respect to the outer elements. The interference of the x small divergent wavelets generates a focused beam. The delay time determining the focus depth of a real-time transducer can be changed during imaging.
Similar delay factors applied during the receiving phase, result in a dynamic focusing effect on the return. This forms a single scan line in the real-time image. To produce the following scan line, another group of x elements is selected by shifting one element position along the transducer array from the previous group. This pattern is then repeated for the groups along the array, in a sequential and repetitive way.

From Siemens Medical Systems;
'This extremely flexible system supports targeted applications for OB/GYN, Radiology, Internal Medicine, Urology, and Prostate Brachytherapy. The large transducer selection, most with high-frequency capabilities, provides the right tool for general imaging, radiology, and internal medicine applications.'

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.

Transducers can be divided in:
1.) Transducers where the sound wave is transmitted and received by different elements.
2.) Transducers where multiple elements part of the time transmit and part of the time receive sound energy.
The first type of ultrasound transducer is used in detection of blood flow (also called nonimaging transducers). For example, the continuous wave transducer (Pedoff transducer) has two separate elements, where one element is always transmitting while the other element is always receiving.
Probes of the second type are used to image cardiac structures and have the capability to use various Doppler techniques to detect blood flow (also called imaging transducers). For example, continuous wave, pulsed wave, high pulse repetition frequency, color flow, M-mode, and 2D-mode are the various modes that this type of transducer can perform.

Transducers can also be divided in mechanical and electronic or phased scan types.
Mechanical transducers use a combination of single element oscillation, multiple element rotation, or a single element and set of acoustic mirrors to generate the sweeping beam for 2D mode. Caused by the vibration (created as the mirrors rotate or oscillate inside the cover) is this type sometimes called the 'wobbler'. Mechanical transducers are cheaper than electronic transducers.
Different types of electronic or phased array probes can create a linear or rectangular shaped scan plane as well as a sector or pie shaped scan plane. Sector scanners are most useful for cardiac ultrasound examinations where the beam is directed between the ribs to image the heart. A linear array transducer is more useful in abdominal, OB/GYN, and small parts examinations. Electronic transducers are more expensive but they provide dynamic focusing and smaller probe.

See also Rectangular Array Transducer.

(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.