Scanning Technique - Machine Settings

Machine Settings
Optimizing Image Quality
Visualization of nerves with ultrasound depends on the operator's ability to properly:
locate the nerve (see Nerve Localization)
handle the transducer (see Transducer Movement)
maximize the ultrasound machine capability (e.g., the choice of transducer frequency,
proper adjustment of depth, focus and gain and the use of compound imaging)
The Impact of DEPTH Setting on Image Quality
The figures above illustrate how the image of the median nerve in the forearm (arrowhead)
gets smaller and smaller as the depth is increased from 2-6 cm. It is important to select
the appropriate depth setting (e.g. 2 cm in this case) according to the target nerve location.
The Impact of GAIN Setting on Image Quality
The GAIN function compensates for attenuation (a reduction in sound amplitude) as sound travels
deep into the body. The intensity of the returning signals can be amplified by the receiver upon arrival
so that the displayed image is brighter and more visible on the screen. Gain can be adjusted for the
near field, far field or the entire field (overall gain). Excessive increase in GAIN will add "noise" to the
An Illustration of Different Gain Settings
Figure A shows a proper gain settings.
Figure B shows under gain thus the overall
image is very dark. The muscle layers are not
well visualized.
Figure C shows excessive gain thus the overal
image is very bright.
The Impact of FOCUS Setting on Image Quality
Image quality and beam focus is best at the focal zone. Most modern electronically steered
transducers provide electronic focusing adjustable for depth. It is important to place the FOCUS at or
slightly below the level of the target structure of interest.
Infraclavicular Region (8-12 MHz Range)
Figure A shows inappropriate focus setting at a
superficial level (< 2 cm) resulting in a dark
image. The target structures (AA = axillary
vessels and Arrowheads = cords) are 5-6 cm
deep to the skin.
Figure B shows appropriate focus setting at 5-6
cm. The target structures (AA = axillary vessels
and Arrowheads = cords) are 5-6 cm deep to
the skin.
The Impact of COMPOUND IMAGING on Image Quality
COMPOUND IMAGING is a broad bandwidth technology that combines multiple coplanar images
captured from different beam angles and from multiple ultrasound frequency spectra to form a single
image in real time. Spatial compounding reduces speckle artifacts and improves contrast resolution.
No Compound Imaging
Compound Imaging
Median Nerve in the Forearm (12 MHz Transducer, 3 cm Depth)
No Compound Imaging
Compound Imaging
Supraclavicular Region (10 MHz Transducer, 3 cm Depth)
No Cross Beam (No Compound Imaging)
Cross Beam (Compound Imaging)
Color Doppler
Color Doppler is an instrument to characterize blood flow. The Doppler effect occurs when there is a
moving source (blood flow of red blood cells, RBC) and a stationary listener (ultrasound transducer).
There is an apparent change in the returning echoes due to the relative motion between the sound
source and the receiver. If the source (RBC) is moving towards the receiver (transducer), the
perceived frequency is HIGHER (display in RED) and when the source (RBC) is moving away from the
receiver, the perceived frequency is LOWER than the actual (display in BLUE)
It is important to note that Color Doppler detection of flow and flow direction is worst when the
transducer is perpendicular (90 degrees) to the vessel and best when the transducer is parallel (0
degrees) to the blood flow.
r to radial
artery (no
flow is
aiming away
from artery
(flow in
artery (flow
in RED)
For ultrasound guided regional anesthesia, Color Power Doppler (CPD) is useful for differentiating
vascular from non vascular structures. CPD is more sensitive than Color Doppler in flow detection but
does not indicate flow direction.
r to radial
artery (weak
flow is
towards or
away from
(strong flow
is detected)
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