(ESWL) Extracorporeal shock wave lithotripsy is a special use of kidney ultrasound, where high intensity focused ultrasound pulses are used to break up calcified stones in the kidney, bladder, or urethra. Pulses of sonic waves pulverize dense renal stones, which are then more easily passed through the ureter and out of the body in the urine. The ultrasound energy at high acoustic power levels is focused to a point exactly on the stone requiring an ultrasound scanning gel for maximum acoustic transmission.
Air bubbles in the ultrasound couplant, regardless of their size, degrade the performance of Lithotripsy and have the following effect:
Air bubbles smaller that 1/4 wavelength cause scattering of the sound waves as omni directional scatterers and less acoustic energy reaches the focal point. The result is less acoustic power at the focal point to disintegrate the kidney stone.
Air bubbles larger than 1/4 wavelength act as reflectors and deflects the acoustic energy off in a different direction. These results in less acoustic energy at the focal point.
Microbubbles dispersed throughout the ultrasound couplant layer change the average acoustic impedance of the gel layer (which reduces the total transmitted energy) and, due to refraction, change the focal point.

The M-mode (Motion-mode) ultrasound is used for analyzing moving body parts (also called time-motion or TM-mode) commonly in cardiac and fetal cardiac imaging. The application of B-mode and a strip chart recorder allows visualization of the structures as a function of depth and time. The M-mode ultrasound transducer beam is stationary while the echoes from a moving reflector are received at varying times.
A single beam in an ultrasound scan is used to produce the one-dimensional M-mode picture, where movement of a structure such as a heart valve can be depicted in a wave-like manner. The high sampling frequency (up to 1000 pulses per second) is useful in assessing rates and motion, particularly in cardiac structures such as the various valves and the chamber walls.

Microbubbles filled with air or inert gases are used as contrast agents in ultrasound imaging. Compression and rarefaction created by an ultrasound wave insonating a gas-filled microbubble along with the mechanical index of the ultrasonic beam lead to volume pulsations of the bubbles, and it is this change that results in the signal enhancement.
Microbubbles have diameters from 1 μm to 10 μm and a thin flexible or rigid shell composed of albumin, lipid, or polymer confining a gas such as nitrogen, or a perfluorocarbon. These microbubbles can cross the pulmonary capillaries and have a serum half-life of a few minutes. Microbubbles in the 1-10 μm range have their resonance at the frequencies used in diagnostic ultrasound (1−15MHz). Smaller bubbles resonate at higher frequencies. Caused by this coincidence, they are such effective reflectors.
The intrinsic compressibility of microbubbles is approximately 17,000 times more than water, and they are very strong scatterers of ultrasound. Under acoustic pressure the vibrating bubble radius may have a conventional linear response or a harmonic non-linear response. Microbubbles usually increase the Doppler signal amplitude by up to 30 dB.

A point scatterer is a reflector with a diameter much smaller than the ultrasound wavelength. The reflection from blood is a typical example of point scattering. Red blood cells are with 7μm versus 0.44 mm wavelength at 3.5 MHz, smaller than any US wavelength. The individual cells are not only the point scatterers, ultrasound is scattered whenever there is a change in acoustic impedance, and in blood such changes are caused by variable cell concentration. These local fluctuations in cell concentration have a spatial extent that is also much smaller than the ultrasound wavelength, and they therefore act as point scatterers.
A point scatterer gives rise to spherical wavelets spreading out in all directions with the scatterer itself at the center of the sphere. The spherical wavelets from one single point scatterer are much too weak to be detected by the transducer, but constructive interference between numerous wavelets will produce backscattering of higher amplitude echoes with parallel wavefronts, also in the direction of the ultrasound transducer.

See also Rayleigh Scattering.

The range resolution is the ability to determine the depth of reflectors.