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The Doppler shift is highest when the angle between the ultrasound beam and the direction of blood flow is 0 degrees. This is because the cosine of 0 degrees is 1, maximizing the Doppler frequency shift. As the angle increases towards 90 degrees, the cosine value decreases, reducing the Doppler shift.

ARDMS Sonography Principles and Instrumentation guidelines

Hoskins, P. R., Thrush, A., Martin, K., & Whittingham, T. A. (2010). Diagnostic Ultrasound: Physics and Equipment.

Autoclaving involves high-pressure steam at high temperatures, which can damage the delicate piezoelectric crystals within the ultrasound transducer. These crystals are responsible for converting electrical energy into sound waves and vice versa. Exposure to the extreme conditions of an autoclave can cause thermal and mechanical damage to the crystals, rendering the transducer ineffective.

ARDMS Sonography Principles and Instrumentation guidelines

Zagzebski, J. A. (1996). Essentials of Ultrasound Physics.

Comprehensive and Detailed Explanation From Exact Extract:

Persistence is a post-processing technique that averages multiple consecutive frames to reduce random noise and smooth the displayed image. It helps enhance image quality by stabilizing slow-moving or stationary structures while sacrificing some temporal resolution.

As per official sonography Principles and Instrumentation guidelines:

"Persistence is a frame averaging technique that reduces speckle and temporal noise, improving image smoothness by combining data from successive frames."

Elastography measures tissue stiffness.

Panoramic imaging extends the field of view.

Fusion imaging combines ultrasound with other imaging modalities.

Therefore, the correct answer is C: Persistence.

QUESTION NO10

Which change would allow low velocities to be displayed in this spectral Doppler image?

A close-up of a ultrasound Description automatically generated

A. Decrease compression

B. Increase sample volume size

C. Increase transmitted frequency

D. Decrease wall filter

Answer: D

Comprehensive and Detailed Explanation From Exact Extract:

In the spectral Doppler display shown, the wall filter setting determines the lower limit of velocity signals that are displayed. A high wall filter removes low-velocity signals (such as end-diastolic flow or slow venous flow), while a lower wall filter allows both high and low velocities to be visualized.

According to the official Principles and Instrumentation documents:

"The wall filter eliminates low-frequency Doppler shifts, which correspond to low-velocity blood flow or motion artifacts. Decreasing the wall filter allows display of low-velocity flow components that may otherwise be filtered out."

Decreasing compression (A) adjusts dynamic range but does not influence velocity detection.

Increasing sample volume size (B) affects spatial resolution and signal amplitude but not velocity thresholds.

Increasing transmitted frequency (C) may improve sensitivity but does not directly control the display of low velocities.

Therefore, the correct answer is D: Decrease wall filter.

The artifact demonstrated in the image is mirroring. This occurs when the ultrasound beam encounters a strong reflector, such as a diaphragm or pleura, and is reflected back and forth between the object and the transducer. This results in a duplicate image appearing on the other side of the strong reflector, creating a mirror image artifact. It is crucial for sonographers to recognize and differentiate this artifact from actual anatomical structures to avoid misinterpretation.

American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation study materials.

Diagnostic Ultrasound: Principles and Instruments by Kremkau, F. W. (latest edition).

Attenuation refers to the reduction in the intensity of the ultrasound beam as it travels through tissue. Higher frequency ultrasound beams experience more attenuation because they are absorbed and scattered more than lower frequency beams. This is due to the fact that higher frequency waves have shorter wavelengths and interact more with the small particles in tissues, causing greater energy loss.

Lateral resolution describes the ability of an ultrasound system to distinguish between two structures that are side by side (perpendicular to the path of the ultrasound beam). This type of resolution depends on the beam width; narrower beams provide better lateral resolution. As the ultrasound beam travels deeper into the tissue, it generally widens, which can reduce lateral resolution. Techniques such as focusing the beam can help improve lateral resolution at specific depths by narrowing the beam width.

American Registry for Diagnostic Medical Sonography (ARDMS). Sonography Principles and Instrumentation (SPI) Examination Review Guide.

Comprehensive and Detailed Explanation From Exact Extract:

Each additional focal zone requires extra transmissions per scan line, which slows down frame acquisition, thereby reducing the frame rate.

Principles and Instrumentation state:

"Increasing the number of focal zones lowers frame rate because multiple pulses are needed per scan line for each focal depth."

Increasing PRF (B) allows faster data acquisition.

Decreasing depth (C) shortens round-trip time, increasing frame rate.

Decreasing sector width (D) reduces scan lines, increasing frame rate.

Comprehensive and Detailed Explanation From Exact Extract:

A larger sample volume collects Doppler signals from a wider region, which can include multiple velocities and noise. This leads to a broader spectrum (spectral broadening) and may introduce additional noise into the signal.

According to sonography instrumentation reference:

“Increasing the sample volume size increases the likelihood of including multiple velocity components and noise, resulting in spectral broadening and reduced spectral clarity.”

Therefore, the correct answer is B: Increased noise.

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Overall gain in ultrasound refers to the amplification of all the received echo signals. Increasing the overall gain amplifies the signals, making the entire image brighter. Conversely, decreasing the overall gain reduces the signal amplification, resulting in a darker image. Overall gain adjustment affects the entire image uniformly, unlike time gain compensation (TGC), which adjusts the gain at different depths independently.

References

ARDMS Sonography Principles and Instrumentation (SPI) Exam Study Guide

"Diagnostic Ultrasound: Principles and Instruments" by Frederick W. Kremkau

Comprehensive and Detailed Explanation From Exact Extract:

Axial resolution is determined by the spatial pulse length (SPL). A longer SPL means that structures closer together along the beam axis are more likely to overlap in the returning echoes, degrading axial resolution.

According to sonography instrumentation reference:

“Axial resolution is inversely related to spatial pulse length. Increasing SPL worsens the ability to distinguish closely spaced structures along the beam axis.”

Therefore, the correct answer is B: Degraded axial resolution.

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Based on the table in this image, what is the sensitivity?

A white square with black numbers and a white square with black numbers Description automatically generated

A. 32/33

B. 32/35

C. 45/46

D. 45/48

Answer: B

Comprehensive and Detailed Explanation From Exact Extract:

Sensitivity measures the test's ability to correctly identify true positives. It is calculated using the formula:

Sensitivity = True Positives / (True Positives + False Negatives)

From the table:

True Positives (TP) = 32 (Noninvasive test positive & Gold Standard positive)

False Negatives (FN) = 3 (Noninvasive test negative but Gold Standard positive)

Thus:

Sensitivity = 32 / (32 + 3)

Sensitivity = 32 / 35

According to sonography instrumentation reference:

“Sensitivity represents the proportion of actual positive cases correctly identified by the test.”

Therefore, the correct answer is B: 32/35.

At what Doppler angle to flow is the maximum Doppler shift frequency acquired?

A. 90 degrees

B. 60 degrees

C. 30 degrees

D. 0 degrees

Answer: D

Comprehensive and Detailed Explanation From Exact Extract:

The Doppler equation shows that the frequency shift is proportional to the cosine of the Doppler angle. The maximum value of cosine (cos 0° = 1) occurs at 0 degrees — meaning the beam is parallel to flow. At this angle, the full velocity component is measured.

According to sonography instrumentation reference:

“The maximum Doppler shift is obtained when the ultrasound beam is parallel (0 degrees) to blood flow.”

Therefore, the correct answer is D: 0 degrees.

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