Reflux sonography, as an alternative to micturating cystography (MCU), evaluates vesico-ureteral reflux (VUR), a common problem in children. Contrast enhanced pulse-inversion imaging shows best results. During the instillation of an ultrasound contrast agent into the bladder, (as for a conventional MCU) the lower ureters and renal pelves are scanned transabdominally as the bladder is filled to stimulate micturition.
Advantages for reflux sonography are a high sensitivity and the avoidance of X-rays. A disadvantage is the poorer depiction of the posterior urethra. However, for girls and for all follow-up studies, the ultrasound MCU has become standard in many pediatric ultrasound departments.

See also Urologic Ultrasound, Kidney Ultrasound, Ultrasound Safety, Ultrasound Imaging Modes.

As the sound travels through a relatively homogeneous medium it propagates in essentially a straight line. When the sound reaches an interface a part of the incident beam is reflected, and a part is refracted (transmitted). Snells law governs the direction of the transmitted beam when refraction occurs:
sin qt = (c2/c1) x sin qi (qt is the transmit and qi is the incident angle)
The amount of sound that is reflected depends on the degree of difference between the two media; the greater the acoustic mismatch, the greater the amount of sound reflected. In addition, the amount of ultrasound reflected or refracted depends on the angle at which the sound beam hits the interface between the different media. As the angle of incidence approaches 90°, a higher percentage of the ultrasound is reflected.

See also Sonographic Features.

The thermal effect of ultrasound is caused by absorption of the ultrasound beam energy. As the ultrasound waves are absorbed, their energy is converted into heat. The higher the frequency, the greater the absorbed dose, converted to heat according the equation: f = 1/T where T is the period as in simple harmonic motion. Ultrasound is a mechanical energy in which a pressure wave travels through tissue. Heat is produced at the transducer surface and also tissue in the depth can be heated as ultrasound is absorbed.
The thermal effect is highest in tissue with a high absorption coefficient, particularly in bone, and is low where there is little absorption. The temperature rise is also dependent on the thermal characteristics of the tissue (conduction of heat and perfusion), the ultrasound intensity and the length of examination time. The intensity is also dependent on the power output and the position of the tissue in the beam profile. The intensity at a particular point can be changed by many of the operator controls, for example power output, mode (B-mode, color flow, spectral Doppler), scan depth, focus, zoom and area of color flow imaging. The transducer face and tissue in contact with the transducer can be heated.

See also Thermal Units Per Hour and Ultrasound Radiation Force.

Attenuation is the reduction of power, for example due to the passage through a medium or electrical component. In ultrasound imaging, attenuation means the decrease in amplitude and intensity as a sound wave travels through a medium. In ultrasound attenuation is often characterized as the half-value layer, or the half-power distance. These terms refer to the distance that ultrasound will travel in a particular tissue before its energy is attenuated to half its original value.

Attenuation originates through:
A thick muscled chest wall will offer a significant obstacle to the transmission of ultrasound. Non-muscle tissue such as fat does not attenuate acoustic energy as much. The half-value layer for bone is still less than muscle, that's why bone is such a barrier to ultrasound.

See also Attenuation Coefficient, and Derated Quantity.

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.