17-6 Acoustic Output 
of Thermal or Mechanical effect. More specifically, they were designed to assist in the 
implementation of the ALARA principle. As an operator changes a given system control, 
the potential effect of the change in output will be indicated. However, the Thermal Index 
is not the same as temperature rise in the body, for several reasons. First of all, in order to 
provide a single display index to you, a number of simplifying assumptions had to be 
made. The biggest assumption was the use of the attenuating formula described above, 
which is much lower than the actual value for most tissues within the body. Scanning 
through muscle or organ tissue, for example, will produce much higher attenuation than 
0.3 dB/cm/MHz. There were also significant simplifications made for the thermal 
properties of tissue. Therefore, scanning through highly perfused tissue, such as the heart 
or vasculature, will produce significantly less thermal effect than that suggested by the 
Thermal Index.   
Similarly, the Mechanical Index was derived to indicate the relative possibility of 
mechanical (cavitation) effects. The MI is based on the derated peak-rarefactional 
pressure and the center frequency of the ultrasound wave. The actual peak-rarefactional 
pressure is affected by the actual attenuation caused by tissue in the path between the 
transducer and the focal point. Again, all solid tissues within the body have higher 
attenuation than the proscribed 0.3 dB/cm/MHz value, and therefore, the actual 
peak-rarefactional pressure will be lower. Further, the actual peak-rarefactional pressure 
will change depending upon the region of the body being scanned. 
For these reasons, the TI and MI displays should only be used to assist the operator in 
implementing ALARA at the time of the patient examination. 
17.8  Measurement Uncertainty 
I
spta
  28.5 % 
I
sppa
  28.5 % 
Center frequency (f
c
)  2% 
Total power (W)  28.5 % 
  (5.1% for Scan-mode and Combined-mode) 
Peak-rarefactional pressure  14.7 % 
 
17.9  References for Acoustic Power and 
Safety 
1.  “Bioeffects and Safety of Diagnostic Ultrasound” issued by AIUM in 1993 
2.  “Medical Ultrasound Safety” issued by AIUM in 1994 
3.  "Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment, 
Revision 3" issued by AIUM/NEMA in 2004 
4.  "Standard for real-time display of thermal and mechanical acoustic output indices on 
diagnostic ultrasound equipment, Revision 2" issued by AIUM/NEMA in 2004 
5.  "Information for Manufacturers Seeking Marketing Clearance of Diagnostic 
Ultrasound Systems and Transducers" issued by FDA in 2008. 
6.  “Medical electrical equipment – Part 2-37: Particular requirements for the safety of 
ultrasonic medical diagnostic and monitoring equipment” issued by IEC in 2005.