Principles and techniques of ultrasound‐based elasticity imaging will be presented, including quasistatic strain imaging, shear wave elasticity imaging, and their implementations in available systems. Deeper exploration of quasistatic methods, including elastic relaxation, and their applications, advantages, artifacts and limitations will be discussed. Transient elastography based on progressive and standing shear waves will be explained in more depth, along with applications, advantages, artifacts and limitations, as will measurement of complex elastic moduli. Comparisons will be made between ultrasound radiation force techniques, MR elastography, and the simple A mode plus mechanical plunger technique. Progress in efforts, such as that by the Quantitative Imaging Biomarkers Alliance, to reduce the differences in the elastic modulus reported by different commercial systems will be explained.Dr. Hall is on an Advisory Board for Siemens Ultrasound and has a research collaboration with them, including joint funding by R01CA140271 for nonlinear elasticity imaging.Learning Objectives: Be reminded of the long history of palpation of tissue elasticity for critical medical diagnosis and the relatively recent advances to be able to image tissue strain in response to an applied force. Understand the differences between shear wave speed elasticity measurement and imaging and understand the factors affecting measurement and image frame repletion rates. Understand shear wave propagation effects that can affect measurements, such as essentially lack of propagation in fluids and boundary effects, so important in thin layers. Know characteristics of available elasticity imaging phantoms, their uses and limitations. Understand thermal and cavitational limitations affecting radiation force‐based shear wave imaging. Have learning and references adequate to for you to use in teaching elasticity imaging to residents and technologists. Be able to explain how elasticity measurement and imaging can contribute to diagnosis of breast and prostate cancer, staging of liver fibrosis, age estimation of deep veinous fhrombosis, confirmation of thermal lesions in the liver after RF ablation.
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