Increased heating by diagnostic ultrasound due to nonlinear propagation.

The heating of tissues by the absorption of ultrasound is an important safety consideration in the use of diagnostic ultrasound. This paper shows that models of ultrasonic heating for this situation need to take account of nonlinear propagation. Measurements were made of the temperature rise in a sample of tissue-mimicking gel, caused by the application of 3.6-MHz focused ultrasonic beams for 3 min. The propagation path to the focus was in water, to mimic the situation where the fetus is scanned through the full bladder. The effect of nonlinear propagation was seen by changing the pressure amplitude of the pulse, while altering the pulsing regime to preserve a constant spatial-peak temporal-average intensity of 1 W cm-2. When nonlinear distortion was present, an enhancement in the temperature rise was observed, which correlated with the value of the shock parameter. The enhancement ratio was typically up to a factor of 3, and the maximum temperature rise observed was 2 degrees C. This enhanced heating was seen both at the surface of the tissue-mimicking gel and after propagation through 23 mm of the material. Under conditions of nonlinear propagation, the maximum heating usually occurs in the prefocal region, rather than at the focus.