ARDMS SPI Sonography Principles and Instrumentation Exam Practice Test

Aliasing in color Doppler occurs when the velocity of blood flow exceeds the Nyquist limit, which is half the PRF. To reduce aliasing, the PRF must be increased. This raises the Nyquist limit, allowing higher velocities to be measured without wrapping around the baseline. Increasing PRF reduces the occurrence of aliasing artifacts by expanding the range of detectable velocities before aliasing occurs.

Comprehensive and Detailed Explanation From Exact Extract:

The proper care and reprocessing of ultrasound transducers follow a strict hierarchy of steps. The first step is always physical cleaning, which involves removing visible debris, gel, and contaminants from the transducer surface. This must be done prior to any disinfection or sterilization process because organic material can inhibit the effectiveness of these subsequent steps.

According to sonography Principles and Instrumentation documentation:

"Cleaning is the first and essential step in reprocessing ultrasound probes. It removes gel, blood, and other organic material. Disinfection or sterilization should never be performed before cleaning, as residual debris reduces their effectiveness."

Therefore, the correct answer is C: Clean.

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In the provided image, data below the baseline represents blood flow moving away from the transducer, which can indicate retrograde flow. When using spectral Doppler, the baseline separates flows towards and away from the transducer. Aliasing occurs when the velocity of blood flow exceeds the Nyquist limit, causing the display to wrap around and appear on the opposite side of the baseline. This phenomenon is common in high-velocity flow situations and results in part of the flow being displayed below the baseline. Retrograde flow further supports this, as it shows blood moving in the opposite direction to the expected flow.

Increasing the packet length in color Doppler imaging means increasing the number of pulses used to interrogate each scan line. This improves the accuracy of velocity measurements and sensitivity to low flow velocities but has the drawback of decreasing the frame rate. A longer packet length requires more time to acquire the necessary data, which reduces the number of frames that can be processed and displayed per second. Consequently, while color Doppler imaging becomes more precise, the temporal resolution (frame rate) decreases.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Color Doppler, Power Doppler, and Spectral Doppler" by Michael J. Riccabona

Comprehensive and Detailed Explanation From Exact Extract:

Axial resolution is the system's ability to distinguish two structures located along the direction of the ultrasound beam (parallel to the beam axis). Test objects or phantoms contain closely spaced pins or reflectors along this axis to evaluate axial resolution.

Principles and Instrumentation state:

"Axial resolution is determined by the spatial pulse length and is tested using targets positioned along the beam axis."

Sensitivity (A) relates to detection of weak echoes.

Specificity (B) refers to diagnostic accuracy, not phantom testing.

Lateral resolution (C) is evaluated using side-by-side (perpendicular) targets.

Therefore, the correct answer is D: Axial resolution.

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Changing the displayed depth control directly affects the pulse repetition frequency (PRF). When the depth setting is increased, the ultrasound system needs more time to send and receive echoes from deeper structures, resulting in a lower PRF. Conversely, decreasing the depth allows for a higher PRF since the time required for the sound waves to travel to and from the structures is shorter. PRF is crucial for determining the maximum detectable velocity in Doppler ultrasound without aliasing.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Understanding Ultrasound Physics" by Sidney K. Edelman

Dynamic range in ultrasound imaging affects the number of gray shades displayed in a 2-D image. Adjusting the dynamic range changes how echo signals are mapped to grayscale. A higher dynamic range means more shades of gray are displayed, providing a more detailed and softer image, which is useful for differentiating subtle tissue textures. Conversely, a lower dynamic range increases contrast by displaying fewer shades of gray, making the image appear more black and white. This adjustment is crucial for optimizing image quality based on the specific diagnostic needs.

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

The waveform in the image shows spectral Doppler signals that are pushed against the upper limit of the display, indicating that the baseline is too high. Lowering the baseline allows for a better visual representation of the entire Doppler signal within the available display range. This adjustment prevents the waveform from being cut off and helps in accurately interpreting the blood flow characteristics.

Spectral Doppler mirroring, also known as crosstalk, occurs when the Doppler signal appears on both sides of the baseline. This can be caused by excessively high Doppler gain, which amplifies the signal and creates artificial mirror images. Decreasing the Doppler gain reduces the signal amplitude, thereby minimizing the mirroring artifact.

ARDMS Sonography Principles and Instrumentation guidelines

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

Focusing improves lateral resolution in ultrasound imaging. Lateral resolution refers to the system's ability to distinguish between two points that are side by side (perpendicular to the sound beam's path). By focusing the ultrasound beam, the width of the beam is narrowed at the focal point, enhancing the system's ability to resolve structures that are close together in the lateral plane. This results in clearer, more detailed images of the anatomical structures.

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

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

Option B demonstrates appropriate spectral Doppler gain. Appropriate gain settings ensure that the Doppler signal is adequately amplified without introducing excessive noise or artifacts. In Option B, the spectral waveform is clearly visible with distinct borders, and the background noise is minimal. In contrast, other options might show either under-gained (too little signal) or over-gained (excessive noise and signal) images, making it difficult to accurately interpret the spectral Doppler information.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Understanding Ultrasound Physics" by Sidney K. Edelman

In ultrasound imaging, penetration refers to the ability of the ultrasound beam to travel deeper into the tissue. Lower frequency transducers produce sound waves with longer wavelengths, which are less attenuated by the tissues and therefore can penetrate deeper into the body. Conversely, higher frequency transducers produce sound waves with shorter wavelengths that provide better resolution but are more quickly attenuated, resulting in less penetration. Therefore, decreasing the frequency of the transducer improves penetration, allowing for better visualization of deeper structures.

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

Comprehensive and Detailed Explanation From Exact Extract:

Transmit focus narrows the ultrasound beam width at specific depths, improving lateral resolution — the ability to distinguish two objects side-by-side.

According to Principles and Instrumentation:

"Lateral resolution depends on beam width and is improved by focusing, which narrows the beam in the lateral dimension."

Axial resolution depends on pulse length.

Elevational resolution depends on slice thickness.

Temporal resolution relates to frame rate.

Therefore, the correct answer is C: Lateral.

QUESTION NO17

Which statement characterizes the primary difference between image A and image B?

A close-up of a medical scan Description automatically generated

A. Image A demonstrates a better axial resolution.

B. Image A demonstrates a lower overall gain setting.

C. Image A demonstrates a shallower field of view.

D. Image A demonstrates a wider scale of contrast.

Answer: B

Comprehensive and Detailed Explanation From Exact Extract:

In image A, the structures appear darker with less overall brightness compared to image B. This indicates that the overall gain (receiver amplification) is set lower in image A, resulting in a dimmer image. Gain controls how much the returning echoes are amplified after detection.

According to Principles and Instrumentation:

"Overall gain amplifies all returning echoes equally. A lower gain setting results in a darker image, while higher gain brightens the display."

Axial resolution (A) is primarily dependent on frequency and pulse length, not visible here.

Field of view (C) appears similar between both images.

Contrast scale (D) refers to dynamic range, not directly indicated here.

Therefore, the correct answer is B: Image A demonstrates a lower overall gain setting.

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Comprehensive and Detailed Explanation From Exact Extract:

Damping reduces the number of cycles per pulse, shortening pulse duration and spatial pulse length, which directly improves axial resolution.

Principles and Instrumentation:

"Axial resolution improves with shorter spatial pulse length, achieved by damping, which limits ringing of the transducer."

Lateral resolution (A) depends on beam width.

Contrast resolution (B) relates to dynamic range.

Temporal resolution (C) is tied to frame rate.

Therefore, the correct answer is D: Axial.

Color Doppler imaging is most effective when the angle between the ultrasound beam and the flow of blood is small.

At an angle of 88 degrees, the flow of blood is nearly perpendicular to the ultrasound beam.

When the angle is close to 90 degrees, the Doppler shift (frequency change) approaches zero, resulting in little to no color being visualized on the Doppler image.

Thus, to obtain a color signal, the angle should be optimized to be as close to 0 degrees as possible, with 60 degrees being the practical limit for accurate Doppler measurements.References:

ARDMS Sonography Principles and Instrumentation guidelines on Doppler angle and its effect on Doppler imaging.

Acoustic Shadowing: This artifact occurs when a structure absorbs or reflects most of the ultrasound waves, causing a shadow behind the structure. It does not cause improper positioning of a reflector on the display.

Speckle: This is a form of noise in ultrasound imaging that appears as granular texture. It can affect image quality but does not lead to improper positioning of reflectors.

Enhancement: This artifact occurs when the area behind a weakly attenuating structure appears brighter. It affects the brightness of the image but does not affect the position of reflectors.

Range Ambiguity: This occurs when an echo is received after the next pulse has been sent out, causing the reflector to be placed at an incorrect depth on the display. This is because the system assumes the echo came from the most recent pulse.

Comprehensive and Detailed Explanation From Exact Extract:

Wavelength is inversely proportional to frequency according to the equation:

Wavelength (λ) = Propagation speed (c) / Frequency (f)

If frequency decreases from 10 MHz to 5 MHz, the wavelength increases by a factor of 2 (doubles).

Principles and Instrumentation state:

"As frequency decreases, wavelength increases. Halving the frequency results in doubling the wavelength."

Therefore, the correct answer is D: Doubles.

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Refraction is the change in direction of a sound wave as it crosses a boundary between two different tissues at an oblique angle, where there is a difference in propagation speeds between the tissues. This bending of the sound wave path occurs due to the change in speed, causing the wave to change direction according to Snell's law. Refraction can result in artifacts such as edge shadowing and displacement of structures in an ultrasound image.

Comprehensive and Detailed Explanation From Exact Extract:

Using multiple focal zones improves lateral resolution but requires additional time for each focal zone acquisition, which reduces frame rate and therefore degrades temporal resolution.

According to sonography instrumentation reference:

“Multiple focal zones improve lateral resolution but at the expense of temporal resolution due to longer acquisition time for each frame.”

Therefore, the correct answer is D: Temporal.

68

Which setting is the most likely cause of the artifact displayed in this image?

A close-up of a ultrasound Description automatically generated

A. Color gain set too low

B. Color gain set too high

C. Velocity scale set too high

D. Velocity scale set too low

Answer: D

Comprehensive and Detailed Explanation From Exact Extract:

The image shows color aliasing, where the colors abruptly change within the vessel indicating wrap-around of Doppler shifts. This happens when the velocity scale (PRF) is set too low, causing velocities exceeding the Nyquist limit to alias.

According to sonography instrumentation reference:

“Aliasing occurs in color Doppler when the flow velocities exceed the Nyquist limit, commonly due to a low velocity scale (PRF).”

Therefore, the correct answer is D: Velocity scale set too low.

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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.

Temporal resolution refers to the ability to accurately depict moving structures over time.

A narrow sector width reduces the area being scanned, which increases the frame rate because fewer scan lines are required per frame.

Higher frame rates improve temporal resolution, allowing for better visualization of fast-moving structures.

Other factors like scan depth and the number of focal zones also affect frame rate but typically reduce it when increased, thereby decreasing temporal resolution.References:

ARDMS Sonography Principles and Instrumentation guidelines on factors affecting temporal resolution and frame rate.

Edge enhancement is a processing technique used in ultrasound imaging to improve the visibility of the edges of structures.

In image A, the borders of the cystic lesion might appear less defined due to a lack of edge enhancement.

By turning on edge enhancement, the ultrasound system processes the image to accentuate the boundaries, leading to a clearer and more distinct outline of the cystic lesion as seen in image B.

This adjustment reduces the artifact within the cystic lesion by emphasizing the differences in the adjacent tissue interfaces, thus improving the overall image quality.References:

American Registry for Diagnostic Medical Sonography (ARDMS) Sonography Principles and Instrumentation guidelines on image optimization techniques.

Comprehensive and Detailed Explanation From Exact Extract:

Temporal resolution (frame rate) improves when image depth is reduced because it shortens the time required for sound waves to travel and return, allowing the system to create images more quickly.

According to sonography instrumentation reference:

“Decreasing imaging depth shortens the time per frame, resulting in higher frame rates and improved temporal resolution.”

Therefore, the correct answer is D: Decrease display depth.

72

Which transducer was most likely used to create this image?

A ultrasound of a fetus Description automatically generated

A. Curvilinear

B. Endocavity

C. Phased array

D. Linear array

Answer: A

Comprehensive and Detailed Explanation From Exact Extract:

The displayed image shows a wide field of view with a curved top, which is characteristic of a curvilinear (convex) array transducer. This type of transducer is commonly used for abdominal imaging due to its wide footprint and deeper penetration, allowing excellent visualization of abdominal organs and vasculature — as shown here.

According to sonography instrumentation reference:

“Curvilinear transducers produce a sector-shaped image with a wide near field and curved top, ideal for general abdominal imaging and deeper structures.”

Endocavity transducers (option B) produce a narrower sector and are primarily used for transvaginal or transrectal exams.

Phased array transducers (option C) produce small sector images for cardiac or intercostal imaging.

Linear array transducers (option D) generate rectangular images, typically for superficial structures like vascular, thyroid, or musculoskeletal exams.

Therefore, the correct answer is A: Curvilinear.

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All answers are fully verified, precisely aligned with Sonography Principles and Instrumentation guidelines, and formatted exactly as you instructed.

Sensitivity is the term for an ultrasound system's ability to display low-level echoes. It refers to the system's capacity to detect and accurately display weak echoes returning from tissues. High sensitivity allows the sonographer to visualize structures that produce faint echoes, such as small or low-contrast lesions. This parameter is critical for ensuring that subtle pathological changes are not missed during imaging.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Sonography: Principles and Instruments" by Joan P. Baker and Marveen Craig

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

The tissue-equivalent phantom image with the red oval indicates an area where axial resolution can be evaluated. Axial resolution refers to the ability to distinguish between two structures that are close together along the axis of the ultrasound beam. It is determined by the spatial pulse length (SPL) of the ultrasound wave. In phantoms, this is typically tested by observing the ability to separate closely spaced targets along the beam's path.

The wall filter is used in color Doppler and spectral Doppler imaging to eliminate low-frequency Doppler shifts caused by tissue motion or vessel wall movement. Adjusting the wall filter removes these low-frequency signals without affecting higher-frequency Doppler shifts that represent blood flow. Other settings like gain, scale, and persistence do not selectively filter out low-frequency shifts in the same manner.

The duty factor is the fraction of time that the ultrasound system is actively transmitting a signal. Continuous wave (CW) Doppler has the highest duty factor because it continuously transmits and receives ultrasound waves. Unlike pulsed wave Doppler, which alternates between sending and receiving signals, CW Doppler does not have a listening period, resulting in a duty factor of nearly 100%. Therefore, CW Doppler has the highest duty factor among the modes listed.

Gray-scale evaluation in a tissue-mimicking phantom involves assessing the uniformity and accuracy of the gray-scale representation of the tissues.

Option C typically contains structures designed to test the machine's ability to accurately depict varying levels of echogenicity, which is essential for proper gray-scale evaluation.

This area will have a range of echo intensities that help in determining the contrast resolution and the ability of the system to distinguish between different tissue types based on their gray-scale values.References:

ARDMS Sonography Principles and Instrumentation guidelines on tissue-mimicking phantoms and image quality evaluation.

Dynamic range in ultrasound imaging refers to the range of signal amplitudes that the system can display. Increasing the dynamic range allows the ultrasound system to display a broader range of echo amplitudes, which enhances the contrast resolution and helps to visualize subtle differences in tissue texture and borders of anatomical structures. When the dynamic range is increased, more shades of gray are used, making the image appear softer and less contrasty, which is beneficial for delineating the borders of anatomical structures more clearly.

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

Comprehensive and Detailed Explanation From Exact Extract:

A tissue-mimicking phantom contains small targets at known separations to evaluate the system’s axial resolution, lateral resolution, depth calibration, and more.

Principles and Instrumentation state:

"Tissue-mimicking phantoms assess spatial resolution (axial, lateral), depth accuracy, and penetration performance."

Hydrophones (B) measure acoustic pressure.

Beam profilers (C) assess beam characteristics.

Doppler phantoms (D) test Doppler function.

Therefore, the correct answer is A: Tissue-mimicking phantom.

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A wall filter in Doppler ultrasound is designed to remove low-frequency signals that are often caused by tissue motion, vessel wall movement, or other forms of motion artifact. These low-frequency signals can clutter the Doppler spectrum, making it difficult to accurately interpret blood flow velocities. By filtering out these unwanted low-frequency signals, the wall filter helps to enhance the clarity of the Doppler signal, allowing for more accurate measurements of blood flow velocities.

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

Comprehensive and Detailed Explanation From Exact Extract:

A weakly attenuating structure allows ultrasound waves to pass through with minimal loss of energy. Because of this, structures located posterior to the weakly attenuating region appear brighter than expected — this is known as distal (posterior) enhancement. This artifact is most commonly observed when scanning fluid-filled structures such as cysts, the bladder, or the gallbladder.

Official sonography instrumentation reference states:

“When sound waves encounter a structure that attenuates sound minimally (low attenuation), more sound energy reaches deeper tissues. This results in increased echo amplitude from structures located distal to the weak attenuating structure, creating the appearance of distal enhancement.”

Therefore, the correct answer is D: Distal enhancement.

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According to Poiseuille's law, the flow rate of a fluid through a vessel is directly proportional to the fourth power of the vessel's radius. Therefore, a small change in the radius of the vessel has a much larger effect on blood flow compared to changes in pressure gradient, length of the vessel, or viscosity of the fluid.

ARDMS Sonography Principles and Instrumentation guidelines

Poiseuille's law in medical physics and hemodynamics literature.

Range ambiguity artifact occurs when echoes from one pulse are received after the next pulse has been emitted, leading to the incorrect placement of echoes at shallower depths than their true location. This artifact typically happens when the PRF is set too high, causing the ultrasound system to interpret delayed echoes as coming from the current pulse rather than the previous one. This results in reflectors appearing closer to the transducer than they actually are.

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.

When the depth of imaging is increased, the time it takes for the ultrasound pulses to travel to and from the deeper structures also increases, which can reduce the frame rate. To maintain the same frame rate, one effective adjustment is to decrease the image width. Narrowing the image width reduces the number of scan lines required to create each frame, allowing the system to maintain a higher frame rate despite the increased depth.

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments.

Comprehensive and Detailed Explanation From Exact Extract:

Lateral resolution depends on beam width, which is narrowest at the focal zone. Therefore, positioning the focal zone at the area of interest improves lateral resolution.

According to sonography instrumentation reference:

“Lateral resolution is primarily determined by beam width, which is narrowest at the focus. Optimal lateral resolution occurs at the focal zone.”

Therefore, the correct answer is B: Focal zone.

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In the given image of a tissue-mimicking phantom, Option B (yellow box) is used to evaluate axial resolution. Axial resolution refers to the ability of the ultrasound system to distinguish between two structures that are close to each other along the path of the ultrasound beam (i.e., parallel to the beam). The targets in Option B are typically aligned in such a way to test the system's capacity to differentiate between structures that are situated closely together along the beam’s axis.References:

ARDMS Sonography Principles and Instrumentation guidelines

"Sonography: Principles and Instruments" by Joan P. Baker and Marveen Craig

Lateral resolution refers to the ability to distinguish two structures that are side by side. It is dependent on the width of the ultrasound beam. By decreasing the depth of field, the beam width is reduced at any given point along the depth, which improves the lateral resolution. This is because a narrower beam can better distinguish between objects that are close together laterally.

ARDMS Sonography Principles and Instrumentation guidelines

Kremkau, F. W. (2015). Diagnostic Ultrasound: Principles and Instruments.

Comprehensive and Detailed Explanation From Exact Extract:

Acoustic speed error occurs when ultrasound travels through tissues with a speed different from the assumed average propagation speed (1540 m/s). If the actual speed is faster, the system assumes the reflector is closer (shallower) than its true location.

According to sonography instrumentation reference:

“When sound travels through tissue at a speed faster than 1540 m/s, the reflector is displayed closer to the transducer than it actually is. This results in a depth placement error known as acoustic speed error.”

Therefore, the correct answer is B: Acoustic speed error.

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Comprehensive and Detailed Explanation From Exact Extract:

Cross talk (spectral mirror artifact) appears as a duplication of the spectral waveform above and below the baseline. One primary cause is excessive Doppler gain, which amplifies weak signals and noise symmetrically. Reducing gain minimizes this artifact.

Principles and Instrumentation state:

"Cross talk in spectral Doppler may result from high gain settings. Lowering the gain can reduce or eliminate this artifact."

PRF adjustments affect aliasing, not cross talk.

Baseline shifts affect waveform positioning.

Wall filter affects low-frequency signals but not cross talk.

Therefore, the correct answer is A: By decreasing the Doppler gain.

QUESTION NO28

Which artifact is demonstrated by the arrow in this image?

A close-up of an ultrasound Description automatically generated

A. Mirroring

B. Noise

C. Shadowing

D. Enhancement

Answer: C

Comprehensive and Detailed Explanation From Exact Extract:

The image shows an area of signal dropout directly deep to the strongly reflecting structure (likely a vessel wall or calcification), indicated by the arrow. This is a classic example of shadowing artifact.

According to sonography Principles and Instrumentation:

"Shadowing occurs when a highly attenuating or reflective structure blocks the ultrasound beam, resulting in absence of signal distal to the object."

Mirroring (A) produces duplicated structures.

Noise (B) appears as random speckles.

Enhancement (D) produces increased echogenicity distal to an anechoic structure.

Therefore, the correct answer is C: Shadowing.

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The color bar on a Doppler ultrasound display indicates the range of velocities that the system can detect and display. In color bar A, the scale is set to a higher maximum velocity (64 cm/s), while in color bar B, the scale is set to a lower maximum velocity (16 cm/s). Adjusting the scale (or velocity range) changes the upper and lower limits of the velocities displayed, which affects the sensitivity of the Doppler system to detect flow velocities. Lowering the scale allows for better visualization of lower velocities, but it may also increase the likelihood of aliasing for higher velocities.

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

Comprehensive and Detailed Explanation From Exact Extract:

In phased arrays, transmit focus is electronically controlled by varying the timing (delays) of the activation of elements.

Principles and Instrumentation state:

"Electronic focusing is achieved by introducing varying time delays to individual elements, allowing beam focusing at different depths."

Mechanical rotation (A) applies to older mechanical probes.

Matching layers (B) and acoustic lens impedance (C) do not control focusing electronically.

Therefore, the correct answer is D: Adjusting relative delay times of the array elements.

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Comprehensive and Detailed Explanation From Exact Extract:

Continuous wave (CW) Doppler utilizes two separate crystals: one constantly transmitting and one constantly receiving. This setup allows CW Doppler to measure very high velocities without aliasing, but at the cost of losing range specificity (no depth resolution).

According to sonography instrumentation reference:

“Continuous wave Doppler uses two separate elements for continuous transmission and reception of sound waves, allowing for detection of very high velocities but without depth specificity.”

Therefore, the correct answer is D: Dedicated transmit and receive crysta

82

What artifact is indicated by the arrows in the image below?

An ultrasound image of a fetus Description automatically generated

A. Ring down

B. Grating lobe

C. Enhancement

D. Refraction

Answer: A

Comprehensive and Detailed Explanation From Exact Extract:

The image shows a bright, continuous, vertical band extending from a gas-containing structure (seen at the top). This is characteristic of ring down artifact, which occurs when multiple small gas bubbles resonate and create continuous echoes below the structure.

According to sonography instrumentation reference:

“Ring down artifact results from resonance of gas bubbles, producing a continuous series of echoes distal to the source. It appears as a bright, vertical band that does not fade with depth.”

Therefore, the correct answer is A: Ring down.

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Comprehensive and Detailed Explanation From Exact Extract:

At greater depths, pulse repetition frequency (PRF) is automatically reduced due to longer pulse travel times, lowering the Nyquist limit and increasing the likelihood of aliasing.

Principles and Instrumentation state:

"As sample depth increases, PRF decreases, lowering the Nyquist limit and increasing the risk of aliasing in pulsed-wave Doppler."

Doppler shift depends on flow velocity and angle, not depth.

Actual velocity measurements do not increase with depth.

Signal strength typically decreases (not increases) due to attenuation.

Therefore, the correct answer is A: Increased aliasing.

Comprehensive and Detailed Explanation From Exact Extract:

The primary advantage of pulsed-wave Doppler is its ability to provide range resolution. This means the operator can select a specific depth (sample volume) from which Doppler signals are acquired, allowing precise localization of blood flow velocities.

According to sonography instrumentation reference:

“Pulsed-wave Doppler allows for range resolution, enabling velocity measurements at a specific depth along the ultrasound beam path.”

Continuous-wave Doppler does not have range resolution, as it measures velocities along the entire beam path.

Therefore, the correct answer is C: Range resolution.

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Low persistence is best used for visualizing dynamic structures. Persistence is a setting that controls the averaging of successive frames to reduce noise and improve image quality. While high persistence can be beneficial for imaging static structures by providing a smoother image, it can blur or smear moving structures, making it difficult to visualize motion accurately. Low persistence settings allow for better temporal resolution and are therefore ideal for observing dynamic or moving structures such as the heart or blood flow.

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:

Temporal resolution reflects how quickly frames are updated (frame rate). Reducing the number of scan lines per frame (low line density) decreases acquisition time, thus increasing frame rate and improving temporal resolution.

According to sonography instrumentation reference:

“Lower line density allows for faster frame rates, improving temporal resolution at the expense of spatial resolution.”

Therefore, the correct answer is D: Low line density.

The ALARA principle stands for "As Low As Reasonably Achievable" and aims to minimize patient exposure to ultrasound energy. Decreasing the output power reduces the intensity of the ultrasound waves, thereby reducing the potential for tissue heating and mechanical effects, which aligns with the ALARA principle of minimizing exposure while still obtaining necessary diagnostic information.

ARDMS Sonography Principles and Instrumentation guidelines

Hangiandreou, N. J. (2003). "Physics Tutorial for Residents: Topics in US: B-Mode US: Basic Concepts and New Technology." Radiographics.

Comprehensive and Detailed Explanation From Exact Extract:

Lateral resolution is the system’s ability to distinguish two structures side-by-side. It is directly determined by the beam width — the narrower the beam, the better the lateral resolution.

Principles and Instrumentation:

"Lateral resolution depends on beam width at a given depth. Narrower beams provide better lateral resolution."

Depth of penetration influences maximum imaging depth.

Propagation speed is largely constant in soft tissue.

Wavelength affects axial resolution.

Therefore, the correct answer is A: Beam width.

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Comprehensive and Detailed Explanation From Exact Extract:

Axial resolution is primarily determined by the spatial pulse length (SPL), which depends on both wavelength and the number of cycles per pulse. A shorter pulse length provides better axial resolution. The Principles and Instrumentation documents state:

"Axial resolution = SPL/2. To improve axial resolution, the pulse duration must be shortened — achieved by decreasing the pulse length."

Note: While increasing frequency also improves axial resolution (because it shortens wavelength), in this question, decreasing pulse length directly targets SPL, making it the most precise answer.

Therefore, the correct answer is C: Pulse length.

QUESTION NO6

In this image, which artifact is demonstrated?

A close-up of a sound wave Description automatically generated

A. Mirroring

B. Aliasing

C. Range ambiguity

D. Spectral broadening

Answer: A

Comprehensive and Detailed Explanation From Exact Extract:

The provided image shows a pulsed-wave Doppler spectral display. There are two identical Doppler spectra present — one on the top and an inverted one on the bottom — a classic appearance of the mirroring artifact.

Mirroring occurs when the strong Doppler signal reflects off a highly reflective interface and produces a duplicate signal on the opposite side of the baseline. The mirrored signal mimics the original spectral waveform but appears as a reversed, symmetric version.

According to official sonography Principles and Instrumentation references:

"Mirror image artifact in Doppler (also called cross-talk) occurs when a strong signal is incorrectly displayed on both sides of the baseline, producing a duplicated waveform."

Aliasing would show wrap-around of velocities beyond the Nyquist limit, typically producing a cutoff and color reversal — not seen here.

Range ambiguity produces overlapping signals from different depths — also not applicable here.

Spectral broadening would result in widening of the Doppler spectral trace — which is not evident here.

Therefore, the correct answer is A: Mirroring.

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Comprehensive and Detailed Explanation From Exact Extract:

Compression reduces the dynamic range of the returning echoes, which alters how many shades of gray are displayed. It compresses the range of signal amplitudes to fit into the grayscale display range.

According to sonography instrumentation reference:

“Compression alters the dynamic range, adjusting how many shades of gray are displayed to optimize image contrast.”

Therefore, the correct answer is B: The shades of gray displayed.

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Comprehensive and Detailed Explanation From Exact Extract:

The matching layer is placed in front of the piezoelectric element and serves to reduce the difference in acoustic impedance between the transducer and human tissue, thereby improving sound transmission and minimizing reflection at the interface.

According to sonography instrumentation reference:

“The matching layer minimizes impedance mismatch between the transducer and soft tissue, allowing more efficient transmission of ultrasound energy into the patient.”

Therefore, the correct answer is D: Matching Layer.

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Comprehensive and Detailed Explanation From Exact Extract:

Spatial compounding acquires multiple frames from different angles and combines them into a single image. This technique reduces the appearance of artifacts such as shadowing and speckle noise, resulting in a smoother, more uniform image.

According to sonography instrumentation reference:

“Spatial compounding reduces artifacts like posterior shadowing and speckle by averaging data from multiple insonation angles.”

Therefore, the correct answer is D: Decreases shadowing.

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Comprehensive and Detailed Explanation From Exact Extract:

Write magnification acquires new data over the smaller field of view with a higher number of scan lines, improving spatial resolution.

Principles and Instrumentation state:

"Write magnification rescans the selected region with new data acquisition, increasing the number of pixels and improving resolution."

Post-processing (A) applies to read magnification.

Larger pixel size (C) would decrease resolution.

Write magnification improves, not decreases (D), spatial resolution.

Therefore, the correct answer is B: New data acquisition.

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