(MI) The mechanical index is an estimate of the maximum amplitude of the pressure pulse in tissue. It is an indicator of the likelihood of mechanical bioeffects (streaming and cavitation). The mechanical index of the ultrasound beam is the amount of negative acoustic pressure within a ultrasonic field and is used to modulate the output signature of US contrast agents and to incite different microbubble responses.
The mechanical index is defined as the peak rarefactional pressure (negative pressure) divided by the square root of the ultrasound frequency.
The FDA ultrasound regulations allow a mechanical index of up to 1.9 to be used for all applications except ophthalmic (maximum 0.23). The used range varies from 0.05 to 1.9.
At low acoustic power, the acoustic response is considered as linear. At a low MI (less than 0.2), the microbubbles undergo oscillation with compression and rarefaction that are equal in amplitude and no special contrast enhanced signal is created. Microbubbles act as strong scattering objects due to the difference in impedance between air and liquid, and the acoustic response is optimized at the resonant frequency of a microbubble.
At higher acoustic power (MI between 0.2-0.5), nonlinear oscillation occurs preferentially with the bubbles undergoing rarefaction that is greater than compression. Ultrasound waves are created at harmonics of the delivered frequency. The harmonic response frequencies are different from that of the incident wave (fundamental frequency) with subharmonics (half of the fundamental frequency), harmonics (including the second harmonic response at twice the fundamental frequency), and ultra-harmonics obtained at 1.5 or 2.5 times the fundamental frequency. These contrast enhanced ultrasound signals are microbubble-specific.
At high acoustic power (MI greater than 0.5), microbubble destruction begins with emission of high intensity transient signals very rich in nonlinear components. Intermittent imaging becomes needed to allow the capillaries to be refilled with fresh microbubbles. Microbubble destruction occurs to some degree at all mechanical indices. A mechanical index from 0.8 to 1.9 creates high microbubble destruction. The output signal is unique to the contrast agent.

Piezo means pressure, so piezoelectric means that pressure is generated when electrical energy is applied to a quartz crystal. When electrical energy is applied to the face of the crystal, the shape of the crystal changes as a function of the polarity of the applied electrical energy. As the crystal expands and contracts it produces compressions and rarefactions, and creates sound waves. When this material is struck by sound waves it creates electrical currents.
Thus, a piezoelectric crystal can produce a pulse of mechanical energy (pressure pulse) by electrically exciting the crystal (transmitter), and they can produce a pulse of electrical energy by mechanically exciting the crystal (receiver). This ultrasound physics principle is called the piezoelectric effect (pressure electricity), which was discovered by Pierre and Jacques Curie in 1880, and is used to generate ultrasound waves. Instead of quartz crystals, piezoelectric ceramics such as barium titanate or lead zirconate titanate are also used, which are crystalline materials with similar piezoelectric properties.

See also Temporal Peak Intensity.

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.

The traveling ultrasonic wave causes a low-level ultrasound radiation force when this energy is absorbed in tissues (absorbed dose). This force produces a pressure in the direction of the beam and away from the transducer. It should not be confused with the oscillatory pressure of the ultrasound wave itself. The pressure that results and the pressure gradient across the beam are very low, even for intensities at the higher end of the range of diagnostic ultrasound. Mechanical effects like radiation forces lead to stress at tissue interfaces. The effect of the force is manifest in volumes of fluid where streaming can occur with motion within the fluid. The fluid velocities which result are low and are unlikely to cause damage.
The effects of ultrasound radiation force (also called Bjerknes Forces) were first reported in 1906 by C. A. and V. F. K. Bjerknes, when they observed the attraction and repulsion of air bubbles in a sound field.
While incompressible objects do experience radiation forces, compressible objects driven at their resonant frequency experience far larger forces and can be observably displaced by low-amplitude ultrasound waves. A microbubble driven near its resonance frequency experiences a large net radiation force in the direction of ultrasound wave propagation. Ultrasound pulses of many cycles can deflect resonant microbubbles over distances on the order of millimeters.
In addition to primary radiation force, which acts in the direction of acoustic wave propagation, a secondary radiation force for which each individual bubble is a source and receptor causes the microspheres to attract or repel each other. The result of this secondary force is that a much larger concentration of microbubbles collects along a vessel wall than might otherwise occur.

See also Acoustically Active Lipospheres.

Cavitation is any activity of highly compressible transient or stable microbubbles of gas and/or vapour, generated by ultrasonic power in the propagation medium. Cavitation can be described as inertial or non-inertial. Inertial cavitation has the most potential to damage tissue and occurs when a gas-filled cavity grows, during pressure rarefaction of the ultrasound pulse, and contracts, during the compression phase. Collapses of bubbles can generate local high temperatures and pressures. Transient cavitation can cause tissue damage.
The threshold for cavitation is high and does not occur at current levels of diagnostic ultrasound. The introduction of contrast agents leads to the formation of microbubbles that potentially provide gas nuclei for cavitation. The use of contrast agents can lower the threshold at which cavitation occurs.

Types of cavitation: