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Thermal index

Dr Matt A. Morgan ◉ et al.

The thermal index (TI) is intended as a measure of an ultrasound beam's thermal bioeffects. It is often displayed on ultrasound screens (along with the mechanical index).

Absorption of sound waves may cause heating in tissue. The thermal index depends on:

a measure of time-averaged acoustic power
assumptions of the properties of the tissue being heated
assumptions about the path of the ultrasound beam

If beam focusing is unchanged, then the TI is directly related to the output power of the system:

Thermal index = W_p / W_deg

W_p: relevent (attenuated) acoustic power at the depth of interest
W_deg: estimated power necessary to raise the tissue equilibirum temperature by one degree C

So, if the acoustic power of the ultrasound beam is enough to raise the tissue temperature by one degree C, then the TI = 1.0. It should be noted that this is a relative risk of heating, not an absolute scale of tissue heating.

The thermal index at the skin surface, and in other special circumstances, is calculated differently ².

The clinical relevance of the thermal index most often comes into play with imaging of the embryo. Color and spectral Doppler imaging calls for increased levels of ultrasound output power, and this in turn increases the thermal index. The use of color and spectral Doppler is discouraged when imaging an embryo to avoid crossing a theoretical TI threshold. Current guidelines recommend a TI <1.0 for first trimester screening (11 weeks to 13 weeks, 6 days) with exposure time to Doppler imaging for as little as possible, preferably less than 5-10 minutes.

The TI (and MI) have been widely adopted in the radiology community as proxies for ultrasound bioeffects, but some recent discussion in ultrasound societies suggest that both indices may need revision to more accurately represent potential bioeffects ².

The thermal index may be displayed in some ultrasound systems as:

TI_S: thermal index in soft tissue
TI_B: thermal index for bone at the focus
TI_C: thermal index for cranial bone

The conventional TI is not valid for 3D ultrasound or elastography.

Quiz questions

References

Ultrasound - general index

ultrasound (introduction)
ultrasound physics
- basic physics
  - absorption
  - acoustic impedance
  - attenuation
  - decibel
  - propagation speed
  - reflection
  - refraction
  - scattering
- transducers
  - ultrasound frequencies
  - piezoelectric effect
  - linear array
  - convex array
  - phased array
  - beam focusing
  - beam steering
  - gain
  - time gain compensation
  - power output
  - focal zone
  - dynamic range
  - frame rate
  - line density
  - frame averaging (frame persistence)
  - ultrasound image resolution
    - axial resolution
    - lateral resolution
    - elevational (azimuthal) resolution
    - temporal resolution
- imaging modes and display
  - pulse-echo imaging
  - real-time imaging
  - Doppler imaging
    - Doppler effect
    - color Doppler
    - power Doppler
    - B flow
    - color box
    - Doppler angle
    - pulse repetition frequency and scale
    - wall filter
    - color write priority
    - packet size (dwell time)
    - resistive index
    - pulsatility index
  - panoramic imaging
  - compound imaging
  - harmonic imaging
  - elastography
  - scanning modes
    - 2D ultrasound
    - 3D ultrasound
    - 4D ultrasound
    - M-mode
- ultrasound artifacts
  - acoustic shadowing
  - acoustic enhancement
  - beam width artifact
  - reverberation artifact
    - comet tail artifact
      - color comet tail artifact
    - ring down artifact
  - mirror image artifact
  - side lobe artifact
  - speed displacement artifact
  - refraction artifact
  - multipath artifact
  - anisotropy
  - electrical interference artifact
  - Doppler artifacts
    - aliasing
    - tissue vibration
    - spectral broadening
    - blooming
    - motion (flash) artifact
    - twinkle artifact
    - acoustic streaming
- biological effects of ultrasound
  - mechanical index
  - thermal index
- history of ultrasound
obstetric ultrasound
- other
- placenta
- second trimester
  - fetal biometry
    - basic biometry
  - fetal morphology assessment
    - fetal echocardiography views
  - soft markers
    - nuchal fold thickness
    - ventriculomegaly
    - absent nasal bone
      - hypoplastic nasal bone
    - echogenic intracardiac focus
    - choroid plexus cysts
    - echogenic bowel
    - aberrant right subclavian artery
  - amnioreduction
  - echogenic fetal bowel
  - umbilical artery Doppler assessment
    - absent umbilical arterial end diastolic flow
    - reversal of umbilical arterial end diastolic flow
- chorionic villus sampling (CVS) and amniocentesis
- nuchal translucency
- failed early pregnancy
- subchorionic hematoma
- multiple gestations
- ectopic pregnancy
- first trimester and early pregnancy
gynecologic ultrasound
- acute pelvic pain
- chronic pelvic pain
- uterus
- ovaries
  - ovarian torsion
  - pelvic inflammatory disease
    - tubo-ovarian abscess complex
  - ovarian cysts and masses
  - paraovarian cyst
  - polycystic ovaries
  - ovarian hyperstimulation syndrome
  - post-hysterectomy ovary
- cervix
- fallopian tube
- other
  - pelvic congestion syndrome
  - peritoneal inclusion cyst
vascular ultrasound
- carotids
  - internal carotid artery
  - cartoid stenosis
- extremities
  - ankle brachial index
- mesenteric vessels
  - chronic mesenteric ischemia
- other
  - fibrin sheath
  - tardus parvus
breast ultrasound
- benign and malignant characteristics of breast lesions at ultrasound
- hyperechoic breast lesions on ultrasound
- differential diagnosis of dilated ducts on breast imaging
musculoskeletal ultrasound
- technique/artifacts
  - anisotropy
- ultrasound of arthropathies
  - musculoskeletal manifestations of rheumatoid arthritis
- skin/soft tissue ultrasound
  - lipoma
  - parasitic infection
    - scrotal filariasis
    - filarial dance sign
- other
  - sonographic features of malignant lymph nodes
  - sonography of peripheral nerves
- pediatric musculoskeletal ultrasound
  - ultrasound classification of developmental dysplasia of the hip
    - alpha angle
    - beta angle
- ankle/foot ultrasound
  - Morton neuroma
- knee ultrasound
  - Baker cyst (popliteal cyst)
  - infrapatellar bursitis
- hip ultrasound
  - Morel-Lavallee lesion
- hand ultrasound
  - gamekeeper thumb
  - glomus tumor
- wrist ultrasound
- elbow ultrasound
- shoulder ultrasound
  - sonographic evaluation of rotator cuff tears
liver ultrasound
- liver
  - focal
  - diffuse
  - hepatic vasculature
  - other
    - hepatic trauma on ultrasound
- liver transplant
  - hepatic arterial resistive index
- biliary
gallbladder ultrasound
- diffuse gallbladder wall thickening (differential)
- focal gallbladder wall thickening (differential)
- gallstones
  - twinkling artifact
  - wall-echo-shadow sign
- gallbladder sludge
  - hepatisation of the gallbladder
- acute cholecystitis
- chronic cholecystitis
- gallbladder polyp
- gallbladder cholecystoses
  - adenomyomatosis
  - gallbladder wall cholesterolosis
    - strawberry gallbladder
- porcelain gallbladder
- gallbladder carcinoma
- gallbladder metastases
- gallbladder lymphoma
- gallbladder volvulus / torsion
- variants
- variants and anomalies
pancreatic ultrasound
- pancreatitis
  - acute
  - chronic
  - pseudocyst
- pancreatic necrosis
- pancreatic abscess
- pancreatic carcinoma
- pancreatic endocrine tumors / islet cell tumors
- cystic pancreatic neoplasms
- intraductal papillary mucinous neoplasm (IPMN)
- pancreatic metastases
- pancreatic lymphoma
- pancreatic trauma
- pancreas transplant
gastrointestinal ultrasound
- appendicitis
- hyperechoic bowel
- inguinal hernia
renal ultrasound
- hydronephrosis
- renal stone
- focal lesion
- diffuse
  - pyelonephritis
  - renal abscess
- renal vascular
  - renal artery stenosis
- renal transplant ultrasound
- other
  - renal trauma
bladder ultrasound
- bladder wall thickening
- bladder diverticulum
- bladder calculi
- ureterocele
- pseudoureterocele
- schistosomiasis
testicular and scrotal ultrasound
- other
- epididymis
- paratesticular lesions
- bilateral testicular lesion
- unilateral testicular lesion
  - testicular torsion
  - orchitis
  - testicular rupture
  - germ cell tumor of the testis
    - testicular seminoma
    - non seminomatous germ cell tumors
      - mixed germ cell tumor
      - yolk sac tumor (endodermal sinus tumor)
      - embryonal cell carcinoma
      - choriocarcinoma
      - testicular teratoma
      - testicular epidermoid (teratoma with ectodermal elements only)
    - burned out testis tumor
  - sex cord / stromal tumors of the testis
    - Leydig cell tumor
prostate ultrasound
- transrectal ultrasound (TRUS)
- prostate carcinoma
- prostatitis
other lower genitourinary ultrasound
- urachal cyst
- urethra
- penis
  - Peyronie's disease
  - priapism
neck and thyroid ultrasound
- thyroid
- parathyroid
echocardiography
- echocardiographic modalities
  - transthoracic echocardiography (TTE)
  - transesophageal echocardiography (TEE)
  - three dimensional (3D) echocardiography
  - epicardial echocardiography
  - contrast enhanced echocardiography
  - fetal echocardiography
  - speckle tracking echocardiography
- physics and imaging modes
  - grey-scale (B-mode)
  - motion mode (M-mode)
  - color flow Doppler (CFD)
  - spectral Doppler
    - pulsed wave Doppler (PWD)
    - continuous wave Doppler (CWD)
  - tissue Doppler imaging (TDI)
- left ventricular systolic and diastolic function
  - structure and morphology
  - systolic function
  - diastolic function
- right ventricular assessment
  - structure and morphology
  - right ventricular (RV) dysfunction
- right and left atria
  - right atrial enlargement
  - left atrial enlargement
- valvular structure and function
  - mitral valve
    - mitral regurgitation
    - mitral stenosis
  - aortic valve
    - aortic stenosis
    - aortic regurgitation
  - pulmonic valve
    - pulmonic regurgitation
    - pulmonic stenosis
  - tricuspid valve
    - tricuspid regurgitation
    - tricuspid stenosis
- hemodynamics
- pericardium
  - pericardial effusion
  - constrictive pericarditis
- cardiomyopathies
- congenital heart disease
  - echocardiographic approach
  - deductive echocardiography
- great vessels
  - thoracic aorta
    - thoracic aortic aneurysm
    - thoracic aortic dissection
  - main pulmonary artery
    - pulmonary embolism
  - inferior vena cava
    - collapsability index
    - distensibility index
  - superior vena cava
pediatric ultrasound
- intussusception
- appendicitis
- vesicoureteric reflux grading
- transcranial ultrasound
ultrasound interventions
- ultrasound-guided biopsy
- ultrasound-guided percutaneous drainage
  - thoracentesis
- ultrasound-guided musculoskeletal interventions
  - joint injection
  - nerve blocks
    - interscalene brachial plexus block
- ultrasound-guided intravenous cannulation
contrast-enhanced ultrasound
- liver
- kidney

Article information

rID: 32611

Section: Physics

Tag: ultrasound, safety

Synonyms or Alternate Spellings:

TI

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