Figure 3-6. The shape of the ultras

Figure 3-6. The shape of the ultrasound beam is simulated in this drawing (purple). The focal zone (A) is located to produce the best lateral resolution of the medial renal cortex. The location of the focal zone is designated by the caret (B). The location of the focal zone can be adjusted by the operator.Figure 3-7. The relationship between velocity, frequency, and wave length of sound waves in tissue. Wavelength and frequency vary in an inverse relationship.Figure 3-8. A, In this sagittal view of the right kidney, the paucity of perinephric fat and thesmall impedance difference make it difficult to distinguish the interface between the kidney and the liver (arrows). B, The large impedance difference at the interface between urine and a bladder stone (arrow) results in significant reflection and attenuation of the sound wave. An acoustic shadow is seen distal to the stone (arrowhead).TABLE 3-1 Density and Impedance of Tissues Encountered During Urologic UltrasonographyDENSITY IMPEDANCEAir and other gases 1.2 0.0004Fat tissue 952 1.38Water and other clear liquids 1000 1.48Kidney (average of soft tissue) 1060 1.63Liver 1060 1.64Muscle 1080 1.70Bone and other calcified objects 1912 7.8Mechanisms of AttenuationAs sound waves transit tissues, energy is lost or attenuated. Mecha nisms of attenuation include reflection, scattering, interference,and absorption. Reflection is the key physical phenomenon that allows for information to return to the transducer as mechanical energy. Reflection occurs when ultrasound waves strike an object, a surface, or a boundary (called an interface) between unlike tissues.The shape and size of the object and the angle at which the advancing wave strikes the object are critical determinants of the amount of energy reflected. The amount of energy reflected from an interface is also influenced by the impedance of the two tissues at the inter face. Impedance is a property that is influenced by tissue stiffness and density. The difference in impedance allows an appreciation of interfaces between different types of tissue (Table 3-1).The impedance difference between perinephric fat and the kidney allows a sharp visual distinction at the interface. If the impedance difference between tissues is small (e.g., between liver and kidney), the interface between the tissues is more difficult to see (Fig. 3-8A). If impedance differences are large, there issignificant reflection of the sound wave producing an acousticalshadow distal to the interface (Fig. 3-8B).Scattering occurs when sound waves strike a small or irregular object. The resulting spherical wave overlaps waves of surrounding scattering objects (Fig. 3-9).When interacting sound waves are in phase or out of phase, their amplitude is enhanced or diminished. This pattern of interference is partially responsible for the echo architecture or texture of organs.One pattern of interference, commonly called “speckling” (Fig.3-10), is seen in organs with fine, internal histology (i.e., reflectors such as the testis).Absorption occurs when the mechanical energy of the ultrasound waves is converted to heat. Absorption is directly proportional to frequency. The higher the frequency of the incident wave,the greater the absorption of energy, and more tissue heating results.It follows that higher frequency waves are more rapidly attenuatedand have a limited depth of penetration (Fig. 3-11).ArtifactsThe interaction of ultrasound waves with tissues may produceimages that do not reflect the true underlying anatomy. These misrepresentations are called “artifacts.” Artifacts may be misleadingbut, if recognized, may also assist diagnosis. Acoustical shadowing occurs when there is ignificant attenuation or reflection of sound waves at a tissue interface. Echo information posterior to the interface may be obscured or lost. An anechoic or hypoechoic “shadow”is produced. Under these conditions, three-dimensional (3D) objects such as stones may appear as crescentic objects, making it difficult to obtain accurate measurements (Fig. 3-12). Importantpathology posterior to such an interface may be missed. This problem may often be overcome or mitigated by changing the angle of insonation, changing the frequency of the transducer, or chang-ing the focal zone of the transducer.

Figure 3-6. The shape of the ultrasound beam is simulated in this drawing (purple). The focal zone (A) is located to produce the best lateral resolution of the medial renal cortex. The location of the focal zone is designated by the caret (B). The location of the focal zone can be adjusted by the operator.Figure 3-7. The relationship between velocity, frequency, and wave length of sound waves in tissue. Wavelength and frequency vary in an inverse relationship.Figure 3-8. A, In this sagittal view of the right kidney, the paucity of perinephric fat and thesmall impedance difference make it difficult to distinguish the interface between the kidney and the liver (arrows). B, The large impedance difference at the interface between urine and a bladder stone (arrow) results in significant reflection and attenuation of the sound wave. An acoustic shadow is seen distal to the stone (arrowhead).TABLE 3-1 Density and Impedance of Tissues Encountered During Urologic UltrasonographyDENSITY IMPEDANCEAir and other gases 1.2 0.0004Fat tissue 952 1.38Water and other clear liquids 1000 1.48Kidney (average of soft tissue) 1060 1.63Liver 1060 1.64Muscle 1080 1.70Bone and other calcified objects 1912 7.8Mechanisms of AttenuationAs sound waves transit tissues, energy is lost or attenuated. Mecha nisms of attenuation include reflection, scattering, interference,and absorption. Reflection is the key physical phenomenon that allows for information to return to the transducer as mechanical energy. Reflection occurs when ultrasound waves strike an object, a surface, or a boundary (called an interface) between unlike tissues.The shape and size of the object and the angle at which the advancing wave strikes the object are critical determinants of the amount of energy reflected. The amount of energy reflected from an interface is also influenced by the impedance of the two tissues at the inter face. Impedance is a property that is influenced by tissue stiffness and density. The difference in impedance allows an appreciation of interfaces between different types of tissue (Table 3-1).The impedance difference between perinephric fat and the kidney allows a sharp visual distinction at the interface. If the impedance difference between tissues is small (e.g., between liver and kidney), the interface between the tissues is more difficult to see (Fig. 3-8A). If impedance differences are large, there issignificant reflection of the sound wave producing an acousticalshadow distal to the interface (Fig. 3-8B).Scattering occurs when sound waves strike a small or irregular object. The resulting spherical wave overlaps waves of surrounding scattering objects (Fig. 3-9).When interacting sound waves are in phase or out of phase, their amplitude is enhanced or diminished. This pattern of interference is partially responsible for the echo architecture or texture of organs.One pattern of interference, commonly called “speckling” (Fig.3-10), is seen in organs with fine, internal histology (i.e., reflectors such as the testis).Absorption occurs when the mechanical energy of the ultrasound waves is converted to heat. Absorption is directly proportional to frequency. The higher the frequency of the incident wave,the greater the absorption of energy, and more tissue heating results.It follows that higher frequency waves are more rapidly attenuatedand have a limited depth of penetration (Fig. 3-11).ArtifactsThe interaction of ultrasound waves with tissues may produceimages that do not reflect the true underlying anatomy. These misrepresentations are called “artifacts.” Artifacts may be misleadingbut, if recognized, may also assist diagnosis. Acoustical shadowing occurs when there is ignificant attenuation or reflection of sound waves at a tissue interface. Echo information posterior to the interface may be obscured or lost. An anechoic or hypoechoic “shadow”is produced. Under these conditions, three-dimensional (3D) objects such as stones may appear as crescentic objects, making it difficult to obtain accurate measurements (Fig. 3-12). Importantpathology posterior to such an interface may be missed. This problem may often be overcome or mitigated by changing the angle of insonation, changing the frequency of the transducer, or chang-ing the focal zone of the transducer.

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图3-6。超声波束的形状进行模拟该图（紫色）英寸聚焦区（A）位于以产生内侧肾皮质的最佳横向分辨率。聚焦区的位置是由插入符号（B）表示。聚焦区的位置可以由运营商来进行调整。 图3-7。速度，频率，和在组织声波的波长之间的关系。波长和频率在相反的关系变化。 图3-8。A，在右肾这个矢状来看，肾周脂肪垫和贫乏 小的阻抗差使得难以肾脏和肝脏（箭头）之间的界面区分开。B，在尿和膀胱结石（箭头）导致的声波的反射显著和衰减之间的界面上大的阻抗差。一个声影看到远端的石头（箭头）。 表3-1密度和组织过程中遇到的泌尿系统超声检查的阻抗 密度阻抗 空气和其他气体1.2 0.0004 脂肪组织952 1.38 水，其他清澈的液体1000 1.48 肾（平均软组织）1060 1.63 肝脏1.64 1060 肌肉1080 1.70 骨等钙化对象1912年7.8 衰减机制 作为声波中转组织，能量损失或衰减。衰减的机甲nisms包括反射，散射，干涉，和吸收。反思是关键物理现象，它允许信息返回到传感器为机械能。当超声波撞击物体，表面，或不同的组织之间的边界（称为接口）时发生的反射。 的形状和物体的尺寸和在该前进波撞击物体的角度是能量的反射的光量的关键性决定因素。能量从一个界面反射的光量也由两个组织中的帧间面的阻抗的影响。阻抗是受组织硬度和密度的影响的性质。的阻抗差允许不同类型的组织（表3-1）之间的界面的评价。 肾周围脂肪和肾之间的阻抗差异允许在界面处的尖锐视觉区别。如果组织之间的阻抗差变小（例如，肝脏和肾脏之间）时，组织之间的界面更加难以看到（图3-8A）。如果阻抗差异是大的，在那里的声波产生的声的issignificant反射 阴影远离接口（图3-8B）。 当声波撞击一个小的或不规则的物体发生散射。（图3-9）周围散射体的所得球面波的重叠波。 当交互声波同相或异相，其幅度被提高或降低。干扰的这种模式是回声结构或纹理器官的部分原因。 干扰的一种模式，通常被称为“斑点”（图3-10），被认为是在与精细，内部组织学器官（即反射如睾丸）。 当超声波的机械能转换为热能发生吸收。吸收正比于频率。入射波的频率越高， 加热results.It越大能量的吸收，更组织遵循较高频率波是更迅速attenuatedand具有的穿透深度有限（图3-11）。 文物 超声波与组织的相互作用可能produceimages不反映真实基础解剖。这些误传被称为“神器”。文物可能会误导 但是，如果认可，也可协助诊断。当存在在组织界面ignificant衰减或声波的反射发生声学遮蔽。回波信息后到该接口可以被遮蔽或丢失。消声或低回声“阴影” 被产生。在这些条件下，三维（3D）物体，如石块可能会出现新月体的物体，因此很难获得准确的测量（图3-12）。重要 病理后到这样的接口可以被错过。这个问题通常可以克服或通过改变声波作用的角度，改变换能器的频率，或者 改变换能器的聚焦区。

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图 3-6。此图（紫色）模拟了超声波束的形状。焦点区（A）位于产生中肾皮层的最佳横向分辨率。焦点区域的位置由护套（B）指定。操作员可以调整焦点区域的位置。 图 3-7。组织中声波的速度、频率和波长度之间的关系。波长和频率成反比。 图 3-8。A，在这个右肾的下垂视图，肾脂肪的缺乏和 小阻抗差使得很难区分肾脏和肝脏（箭头）之间的界面。B，尿液和膀胱结石（箭头）界面处的巨大阻抗差导致声波的显著反射和衰减。声音阴影被看到远至石头（箭头）。 表 3-1 在泌尿超声学过程中遇到的组织的密度和阻抗 密度阻抗 空气和其他气体 1.2 0.0004 脂肪组织 952 1.38 水和其他透明液体 1000 1.48 肾脏（软组织平均值） 1060 1.63 肝脏 1060 1.64 肌肉 1080 1.70 骨骼和其他钙化物体 1912 7.8 衰减机制 当声波传递组织时，能量会丢失或衰减。衰减的美查nis包括反射、散射、干扰和吸收。反射是关键的物理现象，它允许信息作为机械能返回到传感器。当超声波撞击物体、表面或边界（称为接口）时，就会发生反射。 物体的形状和大小以及前进波撞击物体的角度是反射能量量的关键决定因素。从界面反射的能量量也受两个组织在面间的阻抗的影响。阻抗是受组织刚度和密度影响的特性。阻抗的差异允许欣赏不同类型的组织之间的接口（表3-1）。 肾脂肪和肾脏之间的阻抗差允许在界面上实现明显的视觉区别。如果组织之间的阻抗差小（例如，肝脏和肾脏之间），则组织之间的界面更难看到（图3-8A）。如果阻抗差异较大，则产生声波的显著反射 与接口的阴影远端（图 3-8B）。 当声波撞击小物体或不规则物体时，就会发生散射。产生的球形波与周围散射对象的波重叠（图3-9）。 当相互作用的声波处于相位或出相时，其振幅增强或减小。这种干扰模式部分负责器官的回声结构或纹理。 一种干扰模式，通常称为"斑点"（图3-10），在具有精细的内部组织学（即反射器，如睾体）的器官中可见。 当超声波的机械能转化为热时，就会发生吸收。吸收与频率成正比。事件波的频率越高， 能量吸收越大，组织加热效果越多。因此，高频率波的衰减速度更快，穿透深度有限（图3-11）。 工件 超声波与组织的相互作用可能产生不能反映真实底层解剖的图像。这些虚假陈述称为"伪影"。工件可能具有误导性 但是，如果被识别，也可以协助诊断。当组织界面上出现声波衰减或反射时，就会发生声影。接口的回声信息可能被遮挡或丢失。消声或低声"阴影" 生产。在这些条件下，三维（3D）物体（如石头）可能显示为新月物体，因此很难获得精确的测量（图3-12）。重要 病理学后，这样的接口可能会错过。此问题通常可以通过改变射音角度、改变传感器的频率或 传感器的焦区。

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图3-6。超声束的形状在这张图中模拟（紫色）。病灶区（A）位于肾内侧皮质产生最佳横向分辨率的位置。焦点区域的位置由插入符号（B）指定。焦距区域的位置可以由操作员调整。 图3-7。组织中声波的速度、频率和波长之间的关系。波长和频率成反比关系。 图3-8。A、在右肾的矢状视图中，肾周脂肪的缺乏和 阻抗差异小，很难区分肾和肝之间的界面（箭头）。B、尿液和膀胱结石（箭头）之间的界面阻抗差异较大，导致声波的反射和衰减。在石头（箭头）的远端可见声影。 表3-1超声检查中组织的密度和阻抗 密度阻抗 空气和其他气体1.2 0.0004 脂肪组织9521.38 水和其他透明液体1000 1.48 肾（软组织平均）10601.63 肝脏1060 1.64 肌肉10801.70 骨和其他钙化物1912 7.8 衰减机制 当声波通过组织时，能量会损失或衰减。衰减机制包括反射、散射、干扰和吸收。反射是一种关键的物理现象，它允许信息以机械能的形式返回传感器。当超声波击中不同组织之间的物体、表面或边界（称为界面）时，就会发生反射。 物体的形状和大小以及前进的波浪撞击物体的角度是反射能量的关键决定因素。界面反射的能量也受界面处两组织阻抗的影响。阻抗是一种受组织刚度和密度影响的特性。阻抗的差异允许对不同类型组织之间的界面进行评估（表3-1）。 肾周脂肪和肾脏之间的阻抗差异允许在界面上有明显的视觉区别。如果组织之间的阻抗差很小（例如肝和肾之间），则组织之间的界面更难看到（图3-8A）。如果阻抗差异较大，则会产生声波的反射非常小 界面远端阴影（图3-8B）。 当声波击中一个小的或不规则的物体时，就会发生散射。由此产生的球面波与周围散射物体的波重叠（图3-9）。 当相互作用的声波同相或异相时，其振幅会增强或减小。这种干扰模式部分地与器官的回声结构或结构有关。 一种干扰模式，通常被称为“斑点”（图3-10），见于组织学良好的内部器官（即睾丸等反射器）。 当超声波的机械能转化为热能时，就会发生吸收。吸收与频率成正比。入射波的频率越高， 能量吸收越大，组织加热的结果就越多，因此高频波衰减越快，穿透深度有限（图3-11）。 人工产品 超声波与组织的相互作用可能产生的图像不能反映真正的基础解剖。这些虚假陈述被称为“人工制品”。人工制品可能具有误导性 但是，如果被发现，也可能有助于诊断。当声波在组织界面上有显著的衰减或反射时，就会产生声阴影。界面后面的回声信息可能被遮挡或丢失。无回声或低回声的“阴影” 是生产出来的。在这些条件下，三维物体（如石头）可能会显示为新月体，因此很难获得精确的测量值（图3-12）。重要的 这种界面后的病理学可能被忽略。这个问题通常可以通过改变内方位角、改变换能器的频率或改变- 传感器的焦点区域。

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