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.
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