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Figure 1-1: Diagram illustrating a longitudinal wave using a coiled spring (slinky) attached to a wall, shown in two panels demonstrating both the static structure and the dynamic motion of a longitudinal wave. The top panel shows a black coiled spring anchored to a black wall bracket on the left, with a gray illustrated hand on the right gripping the end of the spring, depicting how the wave is generated by pushing and pulling the spring. Two regions of the spring are labeled: “Compression,” indicating a section where the coils are pressed tightly together, and “Refraction” (labeled beneath a section where the coils are spread further apart). In the bottom panel the same spring setup is shown again, with additional labels and arrows illustrating the wave’s motion dynamics. On the right side near the hand, a label reads “Coils Vibrate Left and Right” with a double-headed blue arrow indicating the side-to-side oscillation of the spring’s coils. Above the wall end on the left, a label reads “Source Moves Left and Right” with a similar double-headed blue arrow, indicating that the wave source itself oscillates back and forth. Below the spring, a large pink/salmon arrow labeled “Direction of Wave” points to the left, indicating the overall direction of wave propagation, which is parallel to (along the same axis as) the back-and-forth coil vibrations.

Figure 1-2: At the top, a horizontal grayscale gradient bar alternates between dark (black) and light (white) bands, representing regions of compression (dark, high pressure/density) and rarefaction (light, low pressure/density) in the physical medium. Labels beneath this bar read “Rarefaction” and “Compression,” and an arrow above labeled “Propagation” points to the left, indicating the direction the wave is traveling. Below the grayscale bar, a black sinusoidal (sine) wave curve is drawn, representing the pressure variation of the sound wave plotted against position, oscillating above and below a horizontal blue dashed line labeled “Zero” (representing average/ambient pressure). The wave completes approximately four full oscillation cycles across the diagram. Key labeled features on the sine wave include: Wavelength: A bracket spanning from one wave crest to the next, indicating the distance of one complete cycle. Pressure Maximum: An arrow pointing to a wave crest (peak), corresponding to a dark compression band above, where the medium experiences the highest pressure/density. Pressure Minimum: An arrow pointing to a wave trough, corresponding to a light rarefaction band above, where the medium experiences the lowest pressure/density. 1 Cycle: A bracket beneath one full oscillation (crest to trough to the next equivalent point), indicating one complete wave cycle. Amplitude: On the right side of the diagram, a vertical double-headed arrow between the zero line and the peak height, labeled “Amplitude,” indicating the maximum displacement of the wave from its equilibrium (zero) position.

Figure 1-3: A two-part diagram illustrating transverse wave terminology. The top diagram, “Amplitude of Transverse Wave” has a horizontal line labeled “Mean Position of the Particles” that runs through a sine-like wave with two crests above and two troughs below the line. Dashed vertical arrows extend from the mean position line to each crest (pointing up) and each trough (pointing down), with a horizontal arrow labeled “Amplitude” pointing to one of these vertical dashed lines, indicating that amplitude is the distance from the mean position to the peak of a crest or the bottom of a trough. The bottom diagram, “Crests and Troughs of a Transverse Wave” is the same wave shape is shown over a dotted background representing particles, with the horizontal mean position line again labeled “Mean Position of the Particles.” Two peaks are labeled “Crest A” and “Crest C,” with three upward arrows beneath Crest A showing particle displacement above the mean position. Two valleys are labeled “Trough B” and “Trough D,” with three downward arrows above Trough B showing particle displacement below the mean position. Text beneath the diagram states: “Shown: A and C Are Crests, B and D Are Troughs.”

Figure 1-4: Diagram illustrating the inverse square law for light or wave intensity from a point source. A circular inset in the upper left labeled “Sphere Area 4πr²” presents the formula for intensity at the surface of a sphere: P / 4πr² = I, where P is “Source Power.” The main diagram shows a point source labeled “Source Power P” at the bottom left, from which light radiates outward in a cone shape, expanding to three increasingly distant grid planes representing cross-sections of the spreading energy at distances r, 2r, and 3r from the source. At distance r, a single grid square represents intensity I. At distance 2r, the area has expanded to a 2 by 2 grid of four squares (covering 4 times the area), with the intensity labeled I over 4. At distance 3r, the area has expanded further to a 3 by 3 grid of nine squares (covering 9 times the area), with the intensity labeled I over 9. Caption text below the diagram reads: “The energy that is twice as far from the source is spread over four times the area, which equates to one-fourth of the intensity.”

Figure 1-6: Diagram comparing specular and diffuse reflection across three panels. Left panel, titled “Specular: One Direction” shows a single arrow that strikes a flat horizontal surface at an angle and reflects away as a single arrow in one defined direction, illustrating that specular reflection sends light in a single, predictable direction. The middle panel, titled “Diffuse: Multiple Directions, Low Amplitude (Scattering)” shows an arrow that strikes a flat horizontal surface and scatters into several smaller arrows pointing in multiple different directions, illustrating that diffuse reflection scatters light across many directions with reduced intensity. The right panel shows a single bold downward arrow that strikes a central point, from which eight small arrows radiate outward in all directions, further illustrating the concept of scattering from a single point of contact.

Figure 1-7: Diagram titled “Transducer” illustrating wave behavior at an impedance boundary, shown in two panels. Panel a) shows a blue downward arrow labeled “Incident Wave” striking a horizontal boundary line separating “Impedance Z₁” (above) from “Impedance Z₂” (below). At the boundary, a portion of the wave reflects back upward as a smaller blue arrow labeled “Reflected Wave,” while another portion continues downward through the boundary as a larger blue arrow labeled “Transmitted Wave,” illustrating partial reflection and transmission at an impedance mismatch. Panel b) shows a blue downward arrow labeled “Incident Wave” striking a horizontal boundary with small black triangular bumps (representing a rough or textured surface). At this boundary, the wave scatters into multiple small arrows pointing in different upward/outward directions, while a portion still transmits straight through as a downward arrow below the line.

Figure 1-8: Two-panel diagram illustrating refraction, shown through a physics schematic and an ultrasound imaging analogy. The left panel is a diagram showing the boundary between a gray “Glass” medium (lower left) and “Air” (upper right), separated by a horizontal dashed blue line labeled “Boundary,” with a vertical dashed line labeled “Perpendicular Line” at the point of incidence. An “Incident Ray” travels diagonally downward through the air and strikes the boundary at angle θᵢ, measured from the perpendicular line. Upon crossing into the glass, the ray bends and continues as a “Refracted Ray” traveling downward and to the left at a different angle, illustrating how light changes direction when passing between media of different optical densities. The right panel is an illustration of an ultrasound transducer (depicted as a handheld probe with a cord) emitting a cone-shaped ultrasound beam (shown in light blue) downward into a cross-section of tissue (shown in pink with small oval shapes representing cellular structures). The beam bends slightly within the tissue, with an angle θ marked at the point of bending, and dotted arrows indicate the beam’s path of travel through the tissue layer. This panel draws a parallel between optical refraction and the refraction of ultrasound waves as they pass through biological tissue.

Figure 1-9: Two-panel image illustrating a mirror artifact in ultrasound imaging, shown through a schematic diagram and an actual clinical scan. The left panel, a schematic diagram shows two pink, curved muscle shapes labeled “Muscle” at the top, with three solid black lines converging downward from the muscle regions to a central purple heart-like shape, labeled “True Aorta” via a line pointing to the central path. Two dashed lines diverge from the muscle regions outward to two gray circles on either side, labeled “False Images.” The right panel is a clinical color Doppler ultrasound image with a fan-shaped scanning field. At the top, an orange and yellow curved structure represents the transducer footprint or near-field tissue. A white-outlined rectangular region of interest labeled “LLL” contains the color Doppler overlay: a blue-colored structure labeled “IVC” (inferior vena cava) on the left and two orange/red/yellow colored structures both labeled “A” (representing the aorta and its mirror artifact) on the right, illustrating a real vessel alongside a duplicated artifactual image, similar to the false images described in the schematic. Technical parameters in the upper left read “TIS: 0.7” and “TIB: 0.7,” with “5fps” and “13cm” labeled at the bottom right indicating frame rate and depth.

Figure 1-10: The top panel shows a pale yellow tissue block containing a single dark red vertical structure (representing a strong reflector, such as a vessel wall or fascial layer). An ultrasound transducer on the right emits an orange beam that travels left through the tissue, reflects off the red structure, and returns to the transducer (shown as a double-headed orange arrow). A red horizontal arrow points rightward from the structure toward the transducer, indicating the direction of the returning echo. Below the tissue block, a single red triangle marks the resulting position of this single reflector as it would appear on the ultrasound display. The bottom panel shows the same tissue block now containing three dark red vertical structures with alternating orange and yellow bands between them, representing multiple reflective layers. The transducer’s beam interacts with all three structures, each sending an echo back (shown by three red rightward arrows of increasing length matching depth). Below the tissue block, three red triangles of increasing size are shown, illustrating that each reflective boundary produces its own artifact or echo signal on the display, with deeper or stronger reflectors producing larger triangular markers.

Figure 2-5: Block flow diagram illustrating the internal signal processing pathway of an ultrasound machine. At the top, “Microprocessor” connects with arrows in three directions: to the right toward “Transmitter,” downward to “Beam Former,” and to the left/down to “Scan Converter.” The “Transmitter” sends a signal down to the “Transducer” (depicted as a probe icon with a coiled cable), which emits a beam (shown as a triangular shaded region) toward a heart-shaped outline, representing the imaged anatomical target. The returning echo signal travels back up through a triangular shape labeled “TCG” (Time Gain Compensation), then into the “Beam Former.” From “Beam Former,” the signal flows down to “Signal Processor,” then left to “Analog to Digital Converter,” then up to “Scan Converter,” and then left to “Post-Processing,” which flows down to “Cathode Ray Tube” (depicted with a small heart icon representing the final displayed image.) Additional arrows show “Analog to Digital Converter” connecting upward to “Scan Converter,” and a vertical line connecting “Cathode Ray Tube” back up to “Scan Converter,” indicating a feedback or shared connection between these stages.

Figure 2-6: Two-part diagram illustrating ultrasound pulse-echo timing and depth calculation. The top graph shows a voltage-versus-time plot showing two distinct pulse groups. The first pulse, near the start of the time axis, is a single tall sharp peak with a small secondary bump, representing the initial transmitted pulse. After a gap labeled “t = 2d/c” (marked with arrows spanning the interval between the two pulse groups), a second cluster of smaller, irregular peaks appears, representing returning echoes from tissue interfaces at varying depths. The bottom illustration is a side-view schematic shows a transducer probe (black icon with coiled cable) positioned to the left, separated by a gap labeled “d” representing the distance through “Water” to the “Skin Surface” (marked by a vertical wavy black line). Beyond the skin surface lies a textured tissue region filled with small oval shapes (representing cells or tissue structures), within which a shaded, irregularly contoured shape labeled “Organ” is embedded, illustrating the structure being imaged.

Figure 2-7: Annotated grayscale ultrasound image of the gallbladder, fan-shaped on a black background, with labeled anatomical structures and pathological findings. At the top, “Abdominal wall” is labeled with a double-headed vertical arrow marking its thickness, with “Liver” labeled in the upper right showing the surrounding hyperechoic liver tissue. Below this, “Pericholecystic fat” points to a bright rim around the gallbladder, and “Gallbladder wall” points to the thin echogenic boundary of the gallbladder. The large dark central oval structure is labeled “Bile,” representing the anechoic (black) fluid-filled lumen of the gallbladder. Within the lower portion of the gallbladder, “Sludge” points to a layered, low-level echogenic material settled at the bottom of the bile, and “Gallstones” points to bright, hyperechoic foci within the sludge layer, representing calculi. Below the gallstones, “Acoustic shadowing” points to a dark, shadowed region beneath the stones, caused by sound wave attenuation as it passes through the dense calculi.

Figure 2-8: Two-panel image illustrating a mirror image artifact in ultrasound. The left panel is a grayscale fan-shaped ultrasound image showing a curved, bright reflective line arcing across the lower portion of the scan, with a region of tissue containing scattered small hypoechoic and hyperechoic foci above it. A small body-position icon in the bottom right corner indicates the probe placement, with depth marked as 16 cm. The right panel (schematic diagram) is a fan-shaped scan sector outline illustrates how the artifact forms. A blue arrow labeled “Mirror” travels diagonally upward toward a blue diagonal line representing a strong reflective surface (such as the diaphragm). From this mirror line, a black arrow points left to a gray star labeled “Real,” representing the true structure’s actual position. A dashed line extends from the mirror point to a second gray star labeled “Artifact,” positioned deeper and to the right, representing the falsely duplicated mirror-image structure that appears on the far side of the reflective interface.

Figure 2-9a: Diagram illustrating acoustic shadowing in ultrasound imaging. A purple bar at the top labeled “Transducer” sits above a hatched line representing the transducer face, from which vertical lines extend downward through a gray rectangular region labeled “Scanning Field,” representing the parallel ultrasound beams. An oval shape with stippled texture, labeled “Shadowing Object,” is positioned near the top of the scanning field, representing a dense or highly attenuating structure (such as a stone or bone) that blocks sound transmission. Below this object, a white vertical column extends down through the rest of the scanning field, labeled “Shadow,” representing the area where sound has been blocked, resulting in an absence of returning echoes and a corresponding dark, signal-free region directly beneath the shadowing object.

Figure 2-14: Six-panel diagram and ultrasound comparison illustrating the effect of beam width artifact, arranged in two columns. Left column (a, b, e) are panels that show a transducer probe emitting a beam toward a small square target positioned within the beam, with a black circle positioned just outside the beam’s edge. Panel b shows the resulting fan-shaped scan output, in which a gray circular shape overlaps the white square target, illustrating that the off-axis circle is incorrectly captured by the wider portion of the beam and appears superimposed on the true square target. Panel e shows a corresponding real grayscale ultrasound image labeled “BLADDER LONG,” with a white arrow pointing to debris or artifact within the dark, fluid-filled bladder lumen, illustrating this beam-width artifact in clinical practice. Right column (c, d, f): Panel c shows the same setup, but with the square target positioned at the narrower part of the beam (closer to the focal zone) and the circle further outside the beam’s edge. Panel d shows the resulting scan output as a clean white square with no overlapping artifact, since the narrower beam at this depth does not capture the off-axis circle. Panel f shows a corresponding clean grayscale ultrasound image of the bladder without the artifact/debris seen in panel e, illustrating that proper focusing reduces beam-width artifacts.

Figure 2-15: Annotated grayscale ultrasound image of the abdominal midline, displayed in a wide rectangular format with yellow text labels and arrows identifying anatomical structures and an imaging artifact. At the top, “Skin” points with a yellow arrow to the superficial echogenic layer at the top of the image. To its right, “Reverberation Artifact” points with an arrow toward a vertical bright streak running down the image, representing a common imaging artifact caused by repeated reflections between the transducer and a strong reflector. “Subcutaneous Tissue” labels the layer just beneath the skin. In the middle of the image, two green crosshair markers (calipers) are placed for measurement reference. “Visceral Fat” labels a hypoechoic region near the center, and “Linea Alba” points with an arrow to a bright vertical line representing the fibrous midline structure separating the rectus muscles. “Right Rectus Muscle” labels the muscular tissue on the left side of the image, and “Left Rectus Muscle” labels the corresponding muscle on the right side. At the bottom right, “Intestine” labels a deeper hypoechoic structure, representing bowel visualized beneath the abdominal wall muscles. Overall, the image documents the layered anatomy of the anterior abdominal wall in cross-section, from skin through subcutaneous fat, midline linea alba, paired rectus muscles, and underlying intestine.

Figure 2-17: Three-panel 3D wireframe diagram comparing different ultrasound transducer array geometries and their resulting scanning field shapes. Each panel includes a small axis indicator labeled “Elevation” (vertical double-headed arrow) and “Azimuth” (diagonal double-headed arrow) showing the two dimensional planes of the beam. Panel a shows a linear array transducer (a flat rectangular element with multiple small ridges/elements along one edge) producing a flat, rectangular parallel-sided scanning field, illustrating that a linear array creates a rectangular image with parallel scan lines. Panel b shows a curved (convex) array transducer producing a wide, fan-shaped scanning field that curves outward, with scan lines radiating from a curved transducer face, illustrating that a curved/convex array produces a wider field of view with a curved near-field edge. Panel c shows a phased array or sector transducer producing a narrow-necked, wide fan-shaped scanning field that radiates outward from a small, flat transducer face.

Figure 2-18: Diagram illustrating the relationship between ultrasound pulse-echo signals and A-mode and B-mode display formats. The top section is a side-view schematic, from right to left: a transducer probe (black, with coiled cable) sending a “Pulse” (leftward arrow) through purple curved tissue, through a purple “Organ” structure (shown as an hourglass-shaped purple mass with a lighter halo), to a purple “Vertebra” (bony structure) at the far left. An “Echo” (rightward arrow) returns from the structures back to the transducer, which then sends the signal “To Scan Display” (indicated by an arrow pointing right at the top). Four vertical dashed lines drop down from key reflection points: the front and back surfaces of the organ, the transducer/tissue interface, and the vertebra, marking the depths at which echoes are generated. The middle section is called “A-Mode Display.” A waveform plot labeled “Signal Strength” (y-axis) over “Time” (x-axis) shows four peaks of varying heights aligned with the four dashed lines from the top diagram. The tallest peaks correspond to the vertebra (strongest reflector, leftmost peak) and the transducer-side interface (rightmost peak), while two shorter peaks in between correspond to the front and back of the organ, illustrating that A-mode displays echo strength as peak amplitude at each corresponding depth/time. Bottom section, “B-Mode Display”: A black horizontal bar shows four white dots of varying brightness/size at the same four time positions as the peaks above, illustrating that B-mode converts the same amplitude information into brightness-coded dots along a single scan line, with stronger echoes (taller A-mode peaks) appearing as brighter, larger dots.

Figure 2-20: Echocardiography screen displaying an M-mode measurement. In the upper portion, a small two-dimensional fan-shaped grayscale echo image shows a four-chamber view of the heart, marked with a green “V” at the top and depth markers at 5 and 10 cm along the side. A vertical green dotted line through this image indicates the M-mode cursor placement through the tricuspid annulus. Below this, the main M-mode tracing displays a repeating wave pattern over time, showing the up-and-down motion of the tricuspid annulus along the y-axis (depth in cm, ranging from 0 to 14) against time on the x-axis (in seconds, from −4 to 0, with a scale of 50 mm/s). A blue dotted measurement line with cross markers spans from a peak to a trough of one wave cycle, with the measurement result displayed in the upper left as “1 TAPSE 3.1 cm” indicating the measured excursion distance of 3.1 cm. A green ECG trace runs along the bottom of the image, synchronized with the M-mode tracing, showing regular QRS complexes with a heart rate of 59 bpm displayed in the lower right corner.

Figure 2-22: Diagram illustrating the human circulatory system’s two main loops, labeled “Pulmonary Circuit” (upper loop) and “Systemic Circuit” (lower loop), with color-coded blood vessels. At the top, lungs (shown in pink) are connected to a cross-sectional heart illustration (shown in the middle, with red and blue chambers representing oxygenated and deoxygenated sides) via looping red and blue vessels. The “Pulmonary Circuit” label points to this upper loop, where blue vessels carry deoxygenated blood from the heart to the lungs (with upward-pointing arrows on the blue vessels), and red vessels return oxygenated blood from the lungs back to the heart (with downward-pointing arrows on the red vessels). Below the heart, a human body silhouette (shown without skin detail, just blood vessel branching) is connected via similar looping red and blue vessels, labeled “Systemic Circuit.” Here, red vessels carry oxygenated blood from the heart down to the body’s tissues, and blue vessels return deoxygenated blood from the body back up to the heart. A key in the lower right explains the color coding: red = “Oxygen-rich, CO₂-poor blood” and blue = “Oxygen-poor, CO₂-rich blood.”

Figure 2-23: Line graph titled (via axis labels) showing blood pressure (mm Hg, y-axis: 0–120) across different segments of the vascular system (x-axis: Aorta, Elastic Arteries, Muscular Arteries, Arterioles, Capillaries, Venules, Medium and Large Veins, Venae Cavae). A red oscillating line representing pulsatile arterial pressure begins around 105 mm Hg in the aorta, fluctuating between systolic peaks near 120 mm Hg and diastolic troughs near 75–80 mm Hg through the elastic and muscular arteries. Three gray reference curves run alongside this oscillating line, labeled “Systolic Pressure” (upper curve, the peak of each pulse), “Mean Arterial Pressure” (middle curve, a smoothed average around 90–95 mm Hg), and “Diastolic Pressure” (lower curve, the trough of each pulse). Through the arterioles, the pulsations rapidly dampen and the pressure drops steeply from approximately 75 mm Hg to about 30 mm Hg, with the line transitioning from red to purple, indicating loss of pulsatility. Through the capillaries, pressure continues to decline smoothly to approximately 15 mm Hg, with the line color shifting from purple to blue. The pressure remains low and relatively flat (around 10–15 mm Hg) through the venules and medium/large veins, gradually declining to near 0 mm Hg by the venae cavae.

Figure 2-25: Diagram showing velocity profiles for fluid flow through a pipe or channel of diameter “D” (marked with a vertical double-headed arrow on the left), comparing three flow regimes plotted as v(y,z) against a horizontal x-axis and vertical y-axis. Three curved profile lines are shown, each bulging outward from the vertical y-axis at the center (x=0 plane) and narrowing back toward the axis at the top and bottom (walls of the channel), representing velocity distribution across the channel’s cross-section. “Laminar” (solid curve, the widest/most parabolic bulge) shows the classic parabolic velocity profile typical of laminar flow, with velocity highest at the center and decreasing smoothly toward the walls. “Turbulent, Glatt,” a dashed line, shows a flatter, more blunted profile compared to laminar flow, with velocity more uniform across the center and a steeper drop near the walls. “Turbulent, Rauh” shown as a dash-dot curve shows an even flatter profile than turbulent-smooth flow, reflecting the effect of a rough surface increasing flow disruption near the walls.

Figure 3-1: Diagram illustrating three standard imaging planes used to visualize the uterus, shown both as individual cross-sectional shapes (top row) and as intersecting planes through a 3D anatomical illustration (bottom). Plane A is a flattened oval purple shape with a black elliptical lumen in the center. Plane B is an elongated, curved purple shape with a black crescent-shaped lumen. Plane C is a rounded triangular purple shape with a black Y- or T-shaped lumen at its center. The bottom illustration is a 3D rendering of the uterus and fallopian tubes (purple, with ovaries shown in light gray at each end of the tubes) with three intersecting flat planes overlaid to show their orientation relative to the organ: “Plane A” (a horizontal/transverse plane cutting across the uterine body), “Plane B” (a plane angled along the longitudinal axis of the uterus), and “Plane C” (a plane oriented to capture the coronal view through the fundus), each plane corresponding to the cross-sectional shapes shown in the boxes above.

Figure 3-3: Diagram illustrating a three-step process for reconstructing a 4D (3D + time) image of a cyclically contracting object using ultrasound. Step 1, “Contracting Object Scanned in Three Consecutive Slices” shows a transducer probe (black, with coiled cable) scanning three adjacent gray slices, numbered 3, 2, and 1 from left to right, each representing a separate spatial slice acquired at a different time. In step 2, arrows point from each slice (3, 2, 1) down to a corresponding vertical column of four colored segments, representing the same slice captured at four different phases of the contraction cycle: green (0 sec), blue (1 sec), red (2 sec), and pink (3 sec). A label notes “Time from Beginning of Cycle” with “Cycle Duration = 4 Seconds,” meaning each column shows the full cycle captured at that slice position. Step 3, “Combining Frames from Identical Phases from Consecutive Slices” shows horizontal arrows that point leftward from each colored segment in the middle and right columns toward matching colored segments in the left column, illustrating that frames from the same phase of the cycle (e.g., all “0 sec” green frames) are combined across the three slices to reconstruct a complete 3D volume at each individual time point, ultimately producing a moving 4D dataset.

Figure 4-1: The upper portion shows a grayscale longitudinal image of the proximal right internal carotid artery, with a color Doppler box overlaid showing blood flow: a large orange/red curved vessel indicating flow toward the transducer, with small blue regions at the edges indicating flow away from the transducer. A white angled line represents the pulsed-wave (PW) Doppler sampling line, with a sample gate marker placed within the vessel. The bottom half of the screen shows the pulsed-wave Doppler spectral waveform tracing over time (displayed inverted, with peaks pointing upward despite negative-direction flow, as noted by “Inv” on the right), showing four repeating waveform cycles with sharp systolic peaks reaching approximately 60–65 (likely cm/s) followed by lower, broader diastolic flow. The waveform is displayed on a scale from −40 to 120 with a sweep speed of 66 mm/s.

Figure 6-2: Anatomical illustration of the shoulder joint, anterior view, showing bones, muscles, tendons, and ligaments in cross-section beneath the skin (shown in tan). Labeled bony structures include the “Clavicle” (upper center), “Scapula” (large bone behind the muscles, left side), “Acromion” (bony projection at the top of the scapula), and “Coracoid Process” (bony projection extending forward from the scapula). Labeled muscles (shown in red) include “Supraspinatus m.” (upper left, partially visible above the joint), “Subscapularis m.” (large muscle fanning across the lower scapula), “Teres Major m.” (lower edge of the scapular muscle mass), and “Biceps m., Long Head” (the muscle belly running down the upper arm on the right). Labeled ligaments and tendons (shown in light blue/lavender) include the “Trapezoid Ligament” and “Conoid Ligament” (connecting the clavicle to the coracoid process), the “Acromioclavicular Joint” (where the clavicle meets the acromion), the “Coracoacromial Ligament” (spanning between the coracoid process and acromion), the “Subdeltoid Bursa” (a blue fluid-filled sac beneath the acromion), the “Infraspinatus Tendon” and “Pectoralis Major Tendon” (attaching near the upper arm bone), the “Biceps Tendon” (running down through the joint into the long head of the biceps), and the “Pectoralis Minor Tendon” (upper left, attaching near the coracoid process).

Figure 6-3: Four-panel photo set demonstrating shoulder ultrasound technique alongside corresponding scan images. Top left: A photograph showing a clinician’s hand holding a curved ultrasound transducer against a patient’s shoulder, with gel applied to the skin, while the patient lies on an exam table with a pillow. Top right: A photograph showing a clinician’s hand holding a linear ultrasound transducer against a different patient’s upper arm/shoulder area, with visible ultrasound gel applied, the patient wearing a white tank top. Bottom left: A grayscale ultrasound image showing soft tissue structures, including branching linear echogenic (bright) structures running through darker tissue, consistent with tendon or muscle fiber architecture in cross-section. Bottom right: A grayscale ultrasound image showing a curved, layered echogenic structure with some color artifact (faint rainbow speckling) running diagonally across the image, consistent with a tendon or muscle structure viewed in longitudinal section.

Figure 6-9: Anatomical illustration of the elbow joint shown from three views: anterior (left, large) and two lateral/medial side views (right, smaller). The left, anterior view shows the elbow joint beneath the skin (tan), with labeled bony structures including the “Humerus” (upper bone), “Lateral and Medial Supracondylar Ridge,” “Lateral Epicondyle,” “Medial Epicondyle,” “Radius,” and “Ulna” (the two forearm bones). Labeled soft tissue structures (shown in light blue) include the “Joint Capsule” (covering the joint), “Radial Collateral Ligament” (lateral side), “Ulnar Collateral Ligament” (medial side), “Anular Ligament of Radius” (wrapping around the proximal radius), and the “Biceps Brachii Tendon” (descending into the forearm). The top right, lateral view shows the elbow from the side, with labeled structures including “Triceps Brachii Tendon” (posterior), “Joint Capsule,” “Anular Ligament of Radius,” “Biceps Brachii Tendon” (anterior), “Radius,” “Ulna,” “Radial Collateral Ligament,” and “Subcutaneous Olecranon Bursa” (shown as a blue sac near the olecranon/elbow tip). The bottom right, medial view shows the elbow from the opposite side, with labeled structures including “Anular Ligament of Radius,” “Radius,” “Ulna,” “Ulnar Collateral Ligament,” and “Subcutaneous Olecranon Bursa” (again shown as a blue sac near the olecranon).

Figure 6-10: Three-panel anatomical illustration of the anterior (flexor) forearm musculature, shown at progressively deeper dissection layers from left to right. The left panel (superficial layer) shows the elbow and forearm with skin removed, labeling muscles including “Biceps Brachii” and “Triceps Brachii” (upper arm, near the elbow), “Brachialis,” “Medial Epicondyle,” “Pronator Teres,” “Brachioradialis,” “Flexor Carpi Radialis,” “Palmaris Longus,” “Flexor Carpi Ulnaris,” and the “Flexor Retinaculum” and “Pronator Quadratus” near the wrist, with light blue tendons extending into the hand. The middle panel (intermediate layer, after removing some superficial muscles) shows the “Biceps Brachii Tendon” inserting near the “Radius” and “Ulna” bones (visible in red and orange, representing blood vessels/nerves near the bone), with “Pronator Teres,” “Brachioradialis,” “Flexor Carpi Ulnaris,” “Flexor Digitorum Superficialis,” “Flexor Pollicis Longus,” and “Flexor Digitorum Profundus” labeled, showing the deeper muscle bellies and their tendons extending toward the hand. The right panel (deep layer, after removing flexor digitorum superficialis) shows the deepest muscle layer with “Brachioradialis” and “Supinator” labeled near the elbow, and “Flexor Digitorum Superficialis (cut)” shown as a cut tendon stump, alongside “Flexor Digitorum Profundus,” “Flexor Pollicis Longus,” and “Pronator Quadratus” near the wrist, revealing the deepest flexor muscles and their corresponding tendons running into the fingers and thumb.

Figure 6-15: Two-panel anatomical illustration of the hand, showing skeletal/musculoskeletal structures on the left and neurovascular/soft tissue structures on the right. The left panel shows the bones of the hand with brackets labeling the three bone groups: “Phalanges” (finger bones), “Metacarpals” (palm bones), and “Carpals” (wrist bones), all grouped under “Bones.” Additional labels point to “Joints” (between phalanges), “Ligaments” (light blue zigzag patterns along the finger joints), “Tendons” (light blue/gray structures running into the fingers), “Muscles” (red muscle belly in the palm/thumb area), and “Synovial Lining” (blue-shaded area near the wrist, representing the joint lining). The right panel shows the same hand with blood vessels (dark red, running up the wrist and into the fingers) labeled “Blood Vessels,” nerves (yellow/orange, running parallel to the vessels) labeled “Nerves,” “Volar Plates” (light blue oval structures at the finger joints on the palm side), and “Tendon Sheaths” (gray woven/coiled structures surrounding tendons near the fingertips), grouped under a bracket on the right.

Figure 6-17: Cross-sectional anatomical diagram of the dorsal wrist at the level of the distal radius and ulna, showing the six extensor tendon compartments arranged around the bones. The two purple bony structures are labeled “Ulna” (smaller, left) and “Radius” (larger, right), with “Lister’s Tubercle” marked as a bony prominence on the radius between the tendon compartments. Around the bones, black dots within gray oval compartments represent individual tendon cross-sections, labeled from ulnar to radial side: “Extensor Carpi Ulnaris” (over the ulna), “Extensor Digiti Minimi” (between ulna and radius), “Extensor Digitorum” (four tendons labeled 5, 4, 3, 2, corresponding to the four fingers, positioned over the radius), “Extensor Indicis” (a separate tendon near the Extensor Digitorum group, also over the radius), “Extensor Pollicis Longus” (just past Lister’s Tubercle), “Extensor Carpi Radialis Brevis” and “Extensor Carpi Radialis Longus” (two tendons grouped together on the radial side), and “Extensor Pollicis Brevis” and “Abductor Pollicis Longus” (two tendons grouped together at the most radial/volar edge).

Figure 6-21: Anatomical illustration of the posterior pelvis and hip region, showing the bony pelvis, sacrum, and proximal femurs (shown in tan/peach), with overlying muscles (shown in coral/red) on one side and ligaments (shown in light blue/lavender) on the other side, providing an asymmetric comparison view. On the left side of the image, large red muscle bundles run from the lower spine and pelvis down toward the femur, representing posterior hip muscles such as the gluteal and deep external rotator muscles. On the right side, a single large coral muscle mass covers the hip joint and extends down the thigh, with light blue ligamentous structures visible spanning between the sacrum, pelvis, and femoral head, representing structures such as the sacroiliac and sacrospinous/sacrotuberous ligaments. The sacrum is visible at the top center between the two ilia, showing its characteristic foramina (small oval openings), with the spine extending upward and red erector muscles flanking it. The proximal femurs extend downward on each side, with the femoral heads seated within the hip joints (acetabula).

Figure 6-27: Lateral cross-sectional anatomical illustration of the knee joint, showing bones, cartilage, tendons, bursae, and soft tissue structures. Labeled bony structures include the “Femur” (upper bone, shown in tan/peach), “Patella” (kneecap, shown as a rounded tan structure anteriorly), and “Tibia” (lower bone). Labeled musculotendinous structures include the “Quadriceps Femoris” (muscle belly, shown in red/salmon at the top), and the “Quadriceps Femoris Tendon” (orange/yellow tendon connecting the muscle to the patella and continuing distally). Labeled bursae (shown in blue/dark blue) include the “Suprapatellar Bursa” (above the patella, between the quadriceps tendon and femur), “Prepatellar Bursa” (in front of the patella), “Superficial Infrapatellar Bursa” (below the patella, superficial), “Deep Infrapatellar Bursa” (below the patella, deep, between the patellar tendon and tibia), and “Bursa under Lateral Head of Gastrocnemius” (posterior, behind the lateral femoral condyle). Labeled joint structures include the “Joint Capsule” (blue outer layer enclosing the joint), “Synovial Membrane” (inner lining of the joint capsule), “Joint Cavity” (the space within), “Articular Cartilage” (covering the joint surfaces), “Meniscus” (wedge-shaped fibrocartilage between the femur and tibia), and “Infrapatellar Fat Pad” (soft tissue below the patella).

Figure 7-4: Echocardiography screen displaying a tissue Doppler imaging (TDI) spectral tracing. In the upper portion, a small two-dimensional fan-shaped grayscale echo image shows an apical view of the heart, marked with a yellow “V” at the top and depth markers at 5, 10, and 15 cm along the side, with a dotted line indicating the Doppler cursor placement, and a small sample gate (marked with yellow brackets) positioned within the myocardium. A color scale bar in the upper right shows a tissue velocity range from −0.63 to +0.63 (likely m/s), using a green-blue-black-red-yellow color gradient typical of tissue Doppler imaging. Below the echo image, the main spectral tracing (displayed in yellow on black) shows a repeating sawtooth-like waveform pattern across three cardiac cycles, each consisting of a sharp upward systolic peak followed by two downward deflections, plotted against a velocity scale (in m/s, ranging from approximately −0.5 to 1.0) on the right side, consistent with myocardial tissue velocity during systole and diastole (S, E’, and A’ waves). A green ECG trace runs along the bottom of the image, synchronized with the Doppler tracing, showing regular QRS complexes with a heart rate of 70 bpm displayed in the lower right corner (“70 HR”). The time scale at the bottom reads “100 mm/s” with time markers from −2.0 to 0.0 seconds.

Figure 10-1: Anatomical diagram of the human venous system shown as a front-facing full-body outline, with veins illustrated in blue throughout the body and the heart shown in red at the center of the chest. Labeled structures from head to foot include, in the neck and chest: “Sigmoid Sinus,” “External Jugular,” “Internal Jugular,” “Inferior Thyroid,” “Subclavian,” “Internal Thoracic,” “Pulmonary Arteries,” and “Inferior Vena Cava.” In the upper limbs: “Axillary,” “Cephalic,” “Brachial,” “Intercostal,” “Basilic,” “Median Cubital,” “Thoracoepigastric,” “Median Antebrachial,” “Ulnar,” “Inferior Epigastric,” “Deep Palmar Arch,” “Superficial Palmar Arch,” and “Palmar Digital.” In the trunk and abdomen: “Hepatic,” “Renal,” “Abdominal Vena Cava,” “Testicularis,” “Common Iliac,” “Internal Iliac,” “External Iliac,” and “Perforating Branches.” In the lower limbs: “External Pudendal,” “Deep Femoral,” “Great Saphenous,” “Accessory Saphenous,” “Femoral,” “Popliteal,” “Superior Genicular,” “Inferior Genicular,” “Small Saphenous,” “Anterior Tibial,” “Posterior Tibial,” “Deep Plantar,” “Dorsal Venous,” and “Dorsal Digital.”

Figure 10-2: Anatomical illustration of the venous system of the lower leg, shown in lateral view. Blue vessels depict the venous network from the thigh down to the foot, with white arrows indicating the direction of blood flow upward toward the heart. Labeled structures include the Femoral Vein and Perforating Vein in the upper thigh, the Great Saphenous Vein along the medial aspect of the leg, the Popliteal Segment of the Femoral Vein behind the knee, the Small Saphenous Vein and a second Perforating Vein in the lower leg, and the Dorsal Venous Arch and Superficial Plantar Venous Plexus in the foot. Muscles are shown in pink-red. An inset circle in the upper left shows a close-up illustration of a venous valve, labeled ‘Valve,’ depicting two leaflets within the vein lumen directing flow upward.

Figure 10-18: Duplex ultrasound image labeled ‘RIGHT ATV SAG AUG’ showing the right anterior tibial vein in sagittal view with augmentation. The upper panel displays a color Doppler image with a band of blue flow signal in the upper portion of the color box indicating venous flow in the anterior tibial vein, and adjacent orange and red flow signal in the lower portion indicating the accompanying anterior tibial artery. A Doppler angle correction line is visible crossing the color flow box at approximately 2 to 3 cm depth. The lower panel shows the corresponding pulsed wave spectral Doppler waveform deflecting below the baseline, displaying continuous low-amplitude phasic venous flow with a prominent augmentation peak deflecting deeper below the baseline near the center of the waveform, consistent with a normal venous flow response to augmentation maneuver in the anterior tibial vein. A color flow velocity scale on the right ranges from positive 4.8 to negative 4.8 cm/s.

Figure 10-20: The upper panel displays a color Doppler image with a large area of blue flow signal representing venous flow in the common femoral vein and great saphenous vein junction, with a focal area of red and orange flow signal in the upper left, and a small round red and orange structure near the center of the. A Doppler angle correction line is visible crossing the color flow box. A label in the upper right reads ‘R GSV SFJ 1.13 s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with bidirectional flow both above and below the baseline, displaying augmentation peaks above the baseline and reflux deflections below, consistent with venous flow assessment at the saphenofemoral junction. A color flow velocity scale on the right ranges from positive 4.8 to negative 4.8 cm/s.

Figure 10-26: The upper panel displays a color Doppler image with a broad band of blue flow signal running horizontally near the top of the color box, indicating venous flow within the small saphenous vein at approximately 0.7 cm depth. Deeper soft tissue layers including fascial planes are visible below the color flow region. A Doppler angle correction line is visible crossing the color flow box. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with low-amplitude continuous flow deflecting below the baseline in the left portion of the waveform, and a prominent augmentation peak deflecting deeper below the baseline near the center, consistent with a normal venous flow response to augmentation maneuver at the saphenopopliteal junction. A color flow velocity scale on the right ranges from positive 4.8 to negative 4.8 cm/s.

Complete Venous Duplex Doppler Ultrasound Examination Template:

Figure 10-27: Anatomical illustration of the systemic arterial system shown in anterior view of the full body, with all major arteries depicted in red. Labeled structures from head to foot include: in the head and neck, the Occipital, Angular, Internal Carotid, External Carotid, Left Common Carotid, Right Common Carotid, and Innominate arteries; in the thorax, the Arch of Aorta, Subclavian, Pulmonary, Lateral Thoracic, Axillary, Brachial, Right Coronary, and Left Coronary arteries; in the abdomen, the Aorta, Celiac, Splenic, Renal, Superior Mesenteric, and Inferior Mesenteric arteries; in the pelvis, the Common Iliac, Internal Iliac, and External Iliac arteries; in the upper extremities, the Radial, Ulnar, Digital, Palmar Arch Deep, and Palmar Arch Superficial arteries; in the thigh, the Femoral, Deep Femoral, Deep Medial Circumflex Femoral arteries; in the lower leg, the Popliteal, Anterior Tibial, Posterior Tibial, and Peroneal arteries; and in the foot, the Arcuate, Dorsal Metatarsal, and Dorsal Pedis arteries.

Figure 10-36: The upper panel displays a color Doppler image with a broad band of red flow signal filling the vessel lumen, indicating arterial flow toward the transducer, with a small area of blue flow signal visible at the left edge suggesting a small adjacent vessel. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the vessel. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 103 cm/s, End Diastolic Velocity (EDV) 21.4 cm/s, Minimum Diastolic Velocity (MDV) -21.4 cm/s, and Resistive Index (RI) 0.79. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and continuous diastolic flow deflecting above the baseline, consistent with normal common carotid artery flow pattern. The velocity scale on the right ranges from positive 24 to negative 24 cm/s. Machine settings displayed on the left include exam type Carotid Exam, probe model L12-3ERGO, frequency 19Hz, 2D at 41%, color flow settings at 4.0MHz, and pulsed wave settings at 3.6MHz with a sample volume of 1.0mm at a depth of 1.8cm. Thermal index and mechanical index values of TIS 0.2 and MI 0.7 are displayed in the upper right. The sweep speed is 66mm/s.

Figure 10-37: The upper panel displays a color Doppler image with a large area of red and orange flow signal filling the bulbous proximal internal carotid artery lumen, indicating arterial flow toward the transducer, with small areas of blue flow signal visible along the upper vessel wall suggesting flow separation or reversal within the carotid bulb. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the vessel at approximately 1.6 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 64.3 cm/s, End Diastolic Velocity (EDV) 15.6 cm/s, Minimum Diastolic Velocity (MDV) -13.6 cm/s, and Resistive Index (RI) 0.76. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and continuous positive diastolic flow above the baseline, consistent with normal low-resistance internal carotid artery flow pattern. Machine settings displayed on the left include exam type Carotid Exam, probe model L12-3ERGO, frequency 18Hz, 2D at 44%, color flow settings at 4.0MHz with wall filter 130Hz, and pulsed wave settings at 3.6MHz with a sample volume of 1.0mm. Thermal index and mechanical index values of TIS 0.2 and MI 0.7 are displayed in the upper right. The sweep speed is 66mm/s.

Figure 10-38: The upper panel displays a color Doppler image with a broad band of red flow signal filling the common carotid artery lumen indicating arterial flow toward the transducer, with a thin band of blue flow signal visible along the superior wall representing a superficial vessel running parallel. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the vessel at approximately 1.9 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 115 cm/s, End Diastolic Velocity (EDV) 24.0 cm/s, Minimum Diastolic Velocity (MDV) 20.1 cm/s, and Resistive Index (RI) 0.79. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and continuous positive diastolic flow above the baseline, displaying a classic common carotid artery waveform pattern with a prominent systolic upstroke and maintained diastolic flow. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s. Machine settings displayed on the left include exam type Carotid Exam, probe model L12-3ERGO, frequency 21Hz, 2D at 41%, color flow settings at 4.0MHz with wall filter 99Hz, and pulsed wave settings at 3.6MHz with a sample volume of 1.0mm at a depth of 1.9cm. Thermal index and mechanical index values of TIS 0.2 and MI 0.7 are displayed in the upper right. The sweep speed is 66mm/s.

Figure 10-39: The upper panel displays a color Doppler image with a small focal area of red flow signal indicating arterial flow toward the transducer within the vertebral artery, visible between adjacent vertebral bony acoustic shadows that create hypoechoic bands in the surrounding tissue. A small blue signal is visible to the left representing a nearby vessel. A Doppler angle correction line is visible crossing the color flow box with the sample volume marker positioned within the vessel at approximately 2 to 3 cm depth. Doppler indices are partially visible on the right, showing PSV, EDV, MDV, and RI values that are partially cut off at the image edge. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and continuous positive diastolic flow above the baseline, consistent with normal low-resistance vertebral artery flow pattern. Depth markers on the right range from 2 to 3 cm.

Figure 10-40: The upper panel displays a color Doppler image with a broad band of red flow signal filling the external carotid artery lumen indicating arterial flow toward the transducer, with a small focal area of blue flow signal visible to the right representing a nearby vessel. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the vessel at approximately 1.7 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 147 cm/s, End Diastolic Velocity (EDV) 19.7 cm/s, Minimum Diastolic Velocity (MDV) -17.2 cm/s, and Resistive Index (RI) 0.87. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with tall sharp systolic peaks and low diastolic flow, with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with the characteristic high-resistance external carotid artery waveform pattern. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s. Machine settings displayed on the left include exam type Carotid Exam, probe model L12-3ERGO, frequency 21Hz, 2D at 44%, color flow settings at 4.0MHz with wall filter 130Hz, and pulsed wave settings at 3.6MHz with a sample volume of 1.0mm at a depth of 1.7cm. Thermal index and mechanical index values of TIS 0.2 and MI 0.7 are displayed in the upper right. The sweep speed is 66mm/s.

Table 10-1: Criteria for Assessing Internal Carotid Artery Stenosis.

*Plaque estimate (diameter reduction) with gray-scale and color Doppler US.

Figure 10-47: Two-panel ultrasound image labeled ‘Right CFA SAG’ showing the right common femoral artery in sagittal view. The left panel displays a grayscale image with two parallel anechoic tubular structures running horizontally, representing the common femoral artery above and the common femoral vein below, without color Doppler applied. The right panel displays the corresponding color Doppler image with the same two structures now color-coded: the superior vessel, the common femoral artery, is shown in red and orange indicating arterial flow toward the transducer, and the inferior vessel, the common femoral vein, is shown in solid blue indicating venous flow away from the transducer. Small blue foci are visible at the interface between the two vessels suggesting flow aliasing or a small perforating vessel. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s

Figure 10-48: The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the common femoral artery lumen indicating arterial flow toward the transducer, and an adjacent band of blue flow signal below representing the common femoral vein. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 1.6 cm depth. Doppler indices are displayed on the right labeled ‘R CFA’: Peak Systolic Velocity (PSV) 143 cm/s, End Diastolic Velocity (EDV) 10.5 cm/s, and Resistive Index (RI) 0.93. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with tall sharp systolic peaks and minimal diastolic flow near the baseline with brief diastolic flow reversal, consistent with a normal high-resistance triphasic lower extremity arterial waveform pattern. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 10-50: Two-panel ultrasound image labeled ‘Right Prof A SAG’ showing the right profunda femoris artery in sagittal view. The left panel displays a grayscale image with a single anechoic tubular structure running diagonally from upper left to lower right at approximately 1.5 cm depth, representing the profunda femoris artery in longitudinal section, without color Doppler applied. The right panel displays the corresponding color Doppler image with the same vessel now filled with a solid red and orange color signal indicating arterial flow toward the transducer, with the vessel walls clearly defined against the surrounding grayscale soft tissue. A small focal red dot is visible adjacent to the lower left margin of the vessel, suggesting a small perforating vessel or artifact. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-51: The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the profunda femoris artery lumen indicating arterial flow toward the transducer, with small blue flow signals visible at the left edge representing adjacent venous structures. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 1.6 cm depth. Doppler indices are displayed on the right labeled ‘R Prox PFA’ (Right Proximal Profunda Femoris Artery): Peak Systolic Velocity (PSV) 63.0 cm/s, End Diastolic Velocity (EDV) 11.3 cm/s, and Resistive Index (RI) 0.82. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and low diastolic flow near the baseline, consistent with a normal high-resistance lower extremity arterial waveform. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 10-54: The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the superficial femoral artery lumen indicating arterial flow toward the transducer. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 1.9 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 131 cm/s and End Diastolic Velocity (EDV) 13.5 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with tall sharp systolic peaks, a brief early diastolic flow reversal component visible below the baseline, and low late diastolic flow, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the proximal superficial femoral artery. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s. Machine settings displayed on the left include exam type Arterial LE (Lower Extremity), probe model L12-3ERGO, frequency 20Hz, 2D at 48%, color flow settings at 5.0MHz with wall filter 140Hz, and pulsed wave settings at 3.6MHz with a sample volume of 1.5mm at a depth of 1.9cm.

Figure 10-56: The left panel displays a grayscale image with two parallel anechoic tubular structures running horizontally at approximately 1.5 to 2.5 cm depth, representing the superficial femoral artery above and the superficial femoral vein below in longitudinal section, without color Doppler applied. The right panel displays the corresponding color Doppler image with the same two structures now color-coded: the superior vessel, the superficial femoral artery, is shown as a broad band of red and orange flow signal indicating arterial flow toward the transducer, with small focal blue aliasing signals visible within the arterial lumen, and the inferior vessel, the superficial femoral vein, is shown as a broad band of solid blue flow signal indicating venous flow away from the transducer. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-57: The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the superficial femoral artery lumen, with multiple focal areas of blue aliasing signal scattered throughout the color box indicating elevated flow velocities or turbulence, and a small blue structure visible below the vessel representing an adjacent vein. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 2.0 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 134 cm/s and End Diastolic Velocity (EDV) 18.2 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with tall sharp systolic peaks and low diastolic flow near the baseline with brief diastolic flow reversal, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the mid superficial femoral artery. The velocity scale on the right ranges from approximately positive 160 to negative 40 cm/s. Machine settings displayed on the left include exam type Arterial LE (Lower Extremity), probe model L12-3ERGO, frequency 17Hz, 2D at 48%, color flow settings at 5.0MHz with wall filter 140Hz, and pulsed wave settings at 3.6MHz with a sample volume of 1.5mm at a depth of 2.0cm.

Figure 10-59: The left panel displays a grayscale image with two parallel anechoic tubular structures running horizontally at approximately 1.5 to 2.5 cm depth, representing the distal superficial femoral artery above and the accompanying vein below in longitudinal section, without color Doppler applied. A small hyperechoic structure is visible at the lower left near 3 cm depth, possibly representing a calcification or adjacent tissue. The right panel displays the corresponding color Doppler image with the same two structures now color-coded: the superior vessel, the distal superficial femoral artery, is shown as a broad band of red and orange flow signal indicating arterial flow toward the transducer, with small focal blue aliasing signals visible at the right edge, and the inferior vessel is shown as a broad band of solid blue flow signal indicating venous flow away from the transducer. A small focal red signal is visible below the blue vessel representing a small adjacent perforating vessel. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-63: The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the popliteal artery lumen indicating arterial flow toward the transducer, with a small focal area of blue flow signal visible at the upper right edge of the color box representing the adjacent popliteal vein. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 2.6 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 80.4 cm/s and End Diastolic Velocity (EDV) 12.1 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and low diastolic flow near the baseline with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the popliteal artery. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 10-65: The left panel displays a grayscale image with a thin anechoic tubular structure running horizontally at approximately 1 cm depth, representing the posterior tibial artery in longitudinal section, with hyperechoic fascial layers visible above and below the vessel and deeper soft tissue structures visible at 2 to 3 cm depth, without color Doppler applied. The right panel displays the corresponding color Doppler image showing the posterior tibial artery as a narrow band of red and orange flow signal at approximately 1 cm depth within the color box, indicating arterial flow toward the transducer, with a small focal blue aliasing signal visible at the right edge. The surrounding deeper tissue appears anechoic and dark without additional color flow signal. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-66: The upper panel displays a color Doppler image with a narrow band of red and orange flow signal running horizontally within the color box at approximately 1.2 cm depth, indicating arterial flow in the posterior tibial artery toward the transducer. Multiple discrete red flow segments are visible along the vessel course, with the Doppler sample volume marker and angle correction line set at 60 degrees positioned within the artery. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 98.5 cm/s and End Diastolic Velocity (EDV) 16.7 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with tall sharp systolic peaks and low diastolic flow near the baseline with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the posterior tibial artery. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 10-68: The left panel displays a grayscale image with layered soft tissue structures and two thin parallel anechoic tubular structures visible at approximately 3.5 to 4 cm depth, representing the peroneal artery and accompanying veins in longitudinal section within the deep posterior compartment, without color Doppler applied. The right panel displays the corresponding color Doppler image with the same structures now color-coded within the color flow box at approximately 3 to 4 cm depth: a central band of red and orange flow signal indicates the peroneal artery with flow toward the transducer, flanked above and below by bands of blue flow signal indicating the paired peroneal veins with flow away from the transducer, displaying the classic three-vessel sandwich appearance of an artery with its paired venae comitantes. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-69: The upper panel displays a color Doppler image with a small color flow box positioned at approximately 3 to 4 cm depth, showing a focal red flow signal indicating the peroneal artery with flow toward the transducer, and an adjacent small blue flow signal representing an accompanying peroneal vein. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at approximately 4.3 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 37.8 cm/s and End Diastolic Velocity (EDV) 7.35 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with low-amplitude sharp systolic peaks and minimal diastolic flow near the baseline, with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the peroneal artery. The velocity scale on the right ranges from approximately positive 100 to negative 20 cm/s.

Figure 10-70: The left panel displays a grayscale image with layered soft tissue structures and two thin parallel anechoic tubular structures visible at approximately 2.5 to 3 cm depth, representing the anterior tibial artery and an accompanying vein in longitudinal section, without color Doppler applied. The right panel displays the corresponding color Doppler image with the same structures now color-coded within the color flow box at approximately 2.5 to 3 cm depth: a broad band of red and orange flow signal indicates the anterior tibial artery with flow toward the transducer, and a band of blue flow signal running parallel above it indicates the accompanying anterior tibial vein with flow away from the transducer. A Doppler angle correction line is visible crossing the right side of the color flow box. A color flow velocity scale on the right ranges from positive 24.1 to negative 24.1 cm/s.

Figure 10-71: The upper panel displays a color Doppler image with a narrow band of red and orange flow signal running diagonally within the color flow box at approximately 3.0 cm depth, indicating arterial flow in the anterior tibial artery toward the transducer. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 87.3 cm/s and End Diastolic Velocity (EDV) 13.7 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and low diastolic flow near the baseline with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the anterior tibial artery. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 10-73: Duplex ultrasound image labeled ‘Right DPA SAG’ showing the right dorsalis pedis artery in sagittal view with spectral Doppler. The upper panel displays a color Doppler image with a broad band of red and orange flow signal filling the dorsalis pedis artery lumen running horizontally at approximately 0.9 cm depth, indicating arterial flow toward the transducer in the superficial dorsal foot. The vessel walls are clearly defined and the lumen appears widely patent. A Doppler angle correction line set at 60 degrees is visible crossing the color flow box with the sample volume marker positioned within the artery at 0.9 cm depth. Doppler indices are displayed on the right: Peak Systolic Velocity (PSV) 82.6 cm/s and End Diastolic Velocity (EDV) 11.3 cm/s. The lower panel shows the corresponding pulsed wave spectral Doppler waveform with sharp systolic peaks and low diastolic flow near the baseline with brief diastolic flow reversal visible below the baseline between systolic peaks, consistent with a normal triphasic high-resistance lower extremity arterial waveform pattern in the dorsalis pedis artery. The velocity scale on the right ranges from approximately positive 120 to negative 40 cm/s.

Figure 11-6: Cross-sectional anatomical illustration of the upper abdomen at the level of the kidneys, showing labeled organs and structures within the abdominal cavity, outlined by skin (tan) and abdominal wall musculature. Labeled organs include the “Liver” (large pink/salmon-colored structure on the left side), “Stomach” (folded pink/salmon-colored structure on the upper right), “Spleen” (purple triangular structure on the right), “Right Kidney” and “Left Kidney” (dark maroon oval structures positioned posteriorly on each side). Labeled vascular structures include the “Portal Vein” (pointing to a vessel near the liver hilum), “Inferior Vena Cava” and “Aorta” (two red/dark red oval cross-sections positioned centrally between the kidneys), and the red ribbon-like vessel pathway connecting the liver region to the spleen. Labeled potential spaces and landmarks include the “Epiploic Foramen” (an opening near the liver), “Morrison’s Pouch” (the potential space between the liver and right kidney, a common site for fluid accumulation), “Splenorenal Recess” (the potential space near the spleen and left kidney), and the “Diaphragm” (the curved muscular boundary at the top of the abdominal cavity, shown as dark curved lines on the right side).