What is the primary interaction that occurs when sound waves encounter a smooth, flat surface?

When sound waves encounter a smooth, flat surface, the primary interaction is reflection. This means the sound waves bounce back towards the transducer, producing echoes that are used to create the ultrasound image. Reflection is most effective when the surface is smooth and perpendicular to the sound beam, allowing for the maximum return of sound waves to the transducer.

ARDMS Sonography Principles and Instrumentation guidelines

Zagzebski, J. A. (1996). Essentials of Ultrasound Physics.