An Interposed Pad in Open-Chest Echocardiographic Porcine Scans for Mimicking Ultrasound Signal Attenuation in a Human Chest.

Opening a chest in an experimental echocardiographic animal study eliminates ultrasound signal attenuation by the chest wall. We developed a scanning technique that involves the use of an attenuative pad created from a mixture of urethane and titanium dioxide. The pad was interposed within transmission gel between the transducer face and cardiac surface in open-chest scans in a porcine model. Comparative measurements of left ventricular echogenicity without and with the pad demonstrate that the pad reproducibly causes ultrasound signal attenuation that closely mimics chest attenuation in clinical transthoracic echocardiographic studies.

Ultrasonic method to characterize shear wave propagation in micellar fluids.

Viscoelastic micellar fluid characteristics have been measured with mechanically generated shear waves and showed good agreement to shear oscillatory methods. In this paper, shear waves in wormlike micellar fluids using ultrasound were successfully generated and detected. Micellar fluids of different concentrations (100, 200, 300, and 400 mM) were studied with ultrasound-based and conventional rheology methods. The measured micellar fluid complex modulus from oscillatory shear tests between 0.001 and 15.91 Hz was characterized with an extended Maxwell fluid model. The elastic and viscous parameters found using rheological testing were used to estimate shear wave phase velocity over a frequency range from 100 to 500 Hz, and compared to shear wave velocity measured with ultrasound-based methods with a mean absolute error 0.02 m/s. The shear wave frequency content was studied and an increase in shear wave center frequency was found as a function of micellar fluid concentration. Moreover, the bias found in the shear wave group velocity with respect to rheological measurement is attributed to the micellar fluid viscous component. Finally, the shear wave phase velocity evaluated at the center frequency agreed well with the rheological measurements.

In vivo thyroid vibro-acoustography: a pilot study.

BACKGROUND: The purpose of this study was to evaluate the utility of a noninvasive ultrasound-based method, vibro-acoustography (VA), for thyroid imaging and determine the feasibility and challenges of VA in detecting nodules in thyroid. METHODS: Our study included two parts. First, in an in vitro study, experiments were conducted on a number of excised thyroid specimens randomly taken from autopsy. Three types of images were acquired from most of the specimens: X-ray, B-mode ultrasound, and vibro-acoustography. The second and main part of the study includes results from performing VA and B-mode ultrasound imaging on 24 human subjects with thyroid nodules. The results were evaluated and compared qualitatively. RESULTS: In vitro vibro-acoustography images displayed soft tissue structures, microcalcifications, cysts and nodules with high contrast and no speckle. In this group, all of US proven nodules and all of X-ray proven calcifications of thyroid tissues were detected by VA. In vivo results showed 100% of US proven calcifications and 91% of the US detected nodules were identified by VA, however, some artifacts were present in some cases. CONCLUSIONS: In vitro and in vivo VA images show promising results for delineating the detailed structure of the thyroid, finding nodules and in particular calcifications with greater clarity compare to US. Our findings suggest that, with further development, VA may be a suitable imaging modality for clinical thyroid imaging.

Breast vibro-acoustography: initial results show promise.

INTRODUCTION: Vibro-acoustography (VA) is a recently developed imaging modality that is sensitive to the dynamic characteristics of tissue. It detects low-frequency harmonic vibrations in tissue that are induced by the radiation force of ultrasound. Here, we have investigated applications of VA for in vivo breast imaging. METHODS: A recently developed combined mammography-VA system for in vivo breast imaging was tested on female volunteers, aged 25 years or older, with suspected breast lesions on their clinical examination. After mammography, a set of VA scans was acquired by the experimental device. In a masked assessment, VA images were evaluated independently by 3 reviewers who identified mass lesions and calcifications. The diagnostic accuracy of this imaging method was determined by comparing the reviewers' responses with clinical data. RESULTS: We collected images from 57 participants: 7 were used for training and 48 for evaluation of diagnostic accuracy (images from 2 participants were excluded because of unexpected imaging artifacts). In total, 16 malignant and 32 benign lesions were examined. Specificity for diagnostic accuracy was 94% or higher for all 3 reviewers, but sensitivity varied (69% to 100%). All reviewers were able to detect 97% of masses, but sensitivity for detection of calcification was lower (≤ 72% for all reviewers). CONCLUSIONS: VA can be used to detect various breast abnormalities, including calcifications and benign and malignant masses, with relatively high specificity. VA technology may lead to a new clinical tool for breast imaging applications.

In vivo vibroacoustography of large peripheral arteries.

OBJECTIVE: Vibroacoustography allows imaging of objects on the basis of their acoustic signal emitted during low-frequency (kHz) vibrations produced by 2 intersecting ultrasound beams at slightly different frequencies. This study tested the feasibility of using vibroacoustography to distinguish between normal and calcified femoral arteries in a pig model. MATERIALS AND METHODS: Thirteen normal porcine femoral arteries, 7 with experimentally induced arterial calcifications, and 1 control artery injected with saline only were scanned in vivo. Images were obtained at 45 kHz using a 3 MHz confocal transducer. The acoustic emission signal was detected with a hydrophone placed on the animal's limb. Images were reconstructed on the basis of the amplitude of the acoustic emission signal. Vessel patency, vessel dimensions, and the extent of calcified plaques were confirmed in vivo by angiography and conventional ultrasound. Excised arteries were reexamined with vibroacoustography, X-ray radiography, and histology. RESULTS: In vivo, vibroacoustography produced high-resolution, speckle-free images with a high level of anatomic detail. Measurements of femoral artery diameter were similar by vibroacoustography and conventional ultrasound (mean difference +/- SD, 0.1 +/- 0.4 mm). Calcified plaque area measured by different methods was comparable (vibroacoustography, in vivo: 1.0 +/- 0.9 cm; vibroacoustography in vitro: 1.1 +/- 0.6 cm2; X-ray radiography: 0.9 +/- 0.6 cm2). The reproducibility of measurements was high. Sensitivity and specificity for detecting calcifications were 100% and 86%, respectively, and positive and negative predictive values were 77% and 100%, respectively. CONCLUSIONS: Vibroacoustography provides accurate and reproducible measurements of femoral arteries and vascular calcifications in living animals.

Unambiguous Identification and Visualization of an Acoustically Active Catheter by Ultrasound Imaging in Real Time: Theory, Algorithm, and Phantom Experiments.

OBJECTIVE: Ultrasound-guided biopsies and minimally invasive procedures have been used in numerous medical applications, including catheter guidance. The biggest challenge for catheter guidance by ultrasound lies in distinguishing the catheter from neighboring tissue, as well as the ability to differentiate the catheter body from its tip. METHODS: In our previous work, we introduced a functional prototype of an acoustically active catheter, in which a miniature piezoelectric crystal allowed accurate localization of the catheter tip by pulsed wave (PW) Doppler imaging and Doppler spectrogram. In this paper, the theory behind the symmetric Doppler shift due to the interaction of ultrasound wave with a vibrating piezoelectric crystal is explained. The theory is validated in an experimental continuous flow phantom setup. A novel algorithm, symmetric frequency detection algorithm, is presented for identification and visualization of the catheter tip in real time along with B-mode and PW Doppler. RESULTS: The catheter tip is identified with a distinct color differentiable from common Doppler colors with a frame rate varying from 22 to 50 Hz. The catheter tip can be visualized in a small region of 2.4 mm in the elevational direction. CONCLUSION: The algorithm can be implemented in most clinical ultrasound machines with minor additions to the PW Doppler processing algorithm. The algorithm is optimized to be robust for a variety of blood flow velocities and is shown to perform well when the signal from the blood is on par in amplitude with the catheter signal. SIGNIFICANCE: Unambiguous and distinct visualization of catheter tip facilitates real-time tracking of the catheter and aids minimally invasive procedures.

Probe Oscillation Shear Wave Elastography: Initial In Vivo Results in Liver.

Shear wave elastography methods are able to accurately measure tissue stiffness, allowing these techniques to monitor the progression of hepatic fibrosis. While many methods rely on acoustic radiation force to generate shear waves for 2-D imaging, probe oscillation shear wave elastography (PROSE) provides an alternative approach by generating shear waves through continuous vibration of the ultrasound probe while simultaneously detecting the resulting motion. The generated shear wave field in in vivo liver is complicated, and the amplitude and quality of these shear waves can be influenced by the placement of the vibrating probe. To address these challenges, a real-time shear wave visualization tool was implemented to provide instantaneous visual feedback to optimize probe placement. Even with the real-time display, it was not possible to fully suppress residual motion with established filtering methods. To solve this problem, the shear wave signal in each frame was decoupled from motion and other sources through the use of a parameter-free empirical mode decomposition before calculating shear wave speeds. This method was evaluated in a phantom as well as in in vivo livers from five volunteers. PROSE results in the phantom as well as in vivo liver correlated well with independent measurements using the commercial General Electric Logiq E9 scanner.

Vibration mode imaging.

A new method for imaging the vibration mode of an object is investigated. The radiation force of ultrasound is used to scan the object at a resonant frequency of the object. The vibration of the object is measured by laser and the resulting acoustic emission from the object is measured by a hydrophone. It is shown that the measured signal is proportional to the value of the mode shape at the focal point of the ultrasound beam. Experimental studies are carried out on a mechanical heart valve and arterial phantoms. The mode images on the valve are made by the hydrophone measurement and confirmed by finite-element method simulations. Compared with conventional B-scan imaging on arterial phantoms, the mode imaging can show not only the interface of the artery and the gelatin, but also the vibration modes of the artery. The images taken on the phantom surface suggest that an image of an interior artery can be made by vibration measurements on the surface of the body. However, the image of the artery can be improved if the vibration of the artery is measured directly. Imaging of the structure in the gelatin or tissue can be enhanced by small bubbles and contrast agents.

Harmonic vibro-acoustography.

Vibro-acoustography is an imaging method that uses the radiation force of two interfering ultrasound beams of slightly different frequency to probe an object. An image is made using the acoustic emission resulted from the object vibration at the difference frequency. In this paper, the feasibility of imaging objects at twice the difference frequency (harmonic acoustic emission) is studied. Several possible origins of harmonic acoustic emission are explored. As an example, it is shown that microbubbles close to resonance can produce significant harmonic acoustic emission due to its high nonlinearity. Experiments demonstrate that, compared to the fundamental acoustic emission, harmonic acoustic emission greatly improves the contrast between microbubbles and other objects in vibro-acoustography (an improvement of 17-23 dB in these experiments). Applications of this technique include imaging the nonlinearity of the object and selective detection of microbubbles for perfusion imaging. The impact of microbubble destruction during the imaging process also is discussed.

Lung Ultrasound Surface Wave Elastography: A Pilot Clinical Study.

A lung ultrasound surface wave elastography (LUSWE) technique is developed to measure superficial lung tissue elastic properties. The purpose of this paper was to translate LUSWE into clinical studies for assessing patients with interstitial lung disease (ILD) and present the pilot data from lung measurements on 10 healthy subjects and 10 patients with ILD. ILD includes multiple lung disorders in which the lung tissue is distorted and stiffened by tissue fibrosis. Chest radiography and computed tomography are the most commonly used techniques for assessing lung disease, but they are associated with radiation and cannot directly measure lung elastic properties. LUSWE provides a noninvasive and nonionizing technique to measure the elastic properties of superficial lung tissue. LUSWE was used to measure regions of both lungs through six intercostal spaces for patients and healthy subjects. The data are presented as wave speed at 100, 150, and 200 Hz at the six intercostal spaces. As an example, the surface wave speeds are, respectively, 1.88 ± 0.11 m/s at 100 Hz, 2.74 ± 0.26 m/s at 150 Hz, and 3.62 ± 0.13 m/s at 200 Hz for a healthy subject in the upper right lung; this is in comparison to measurements from an ILD patient of 3.3 ± 0.37 m/s at 100 Hz, 4.38 ± 0.33 m/s at 150 Hz, and 5.24 ± 0.44 m/s at 200 Hz in the same lung space. Significant differences in wave speed between healthy subjects and ILD patients were found. LUSWE is a safe and noninvasive technique which may be useful for assessing ILD.

Automated Compression Device for Viscoelasticity Imaging.

Noninvasive measurement of tissue viscoelastic properties is gaining more attention for screening and diagnostic purposes. Recently, measuring dynamic response of tissue under a constant force has been studied for estimation of tissue viscoelastic properties in terms of retardation times. The essential part of such a test is an instrument that is capable of creating a controlled axial force and is suitable for clinical applications. Such a device should be lightweight, portable, and easy to use for patient studies to capture tissue dynamics under external stress. In this paper, we present the design of an automated compression device for studying the creep response of materials with tissue-like behaviors. The device can be used to apply a ramp-and-hold force excitation for a predetermined duration of time and it houses an ultrasound probe for monitoring the creep response of the underlying tissue. To validate the performance of the device, several creep tests were performed on tissue-mimicking phantoms, and the results were compared against those from a commercial mechanical testing instrument. Using a second-order Kelvin-Voigt model and surface measurement of the forces and displacements, retardation times T1 and T2 were estimated from each test. These tests showed strong agreement between our automated compression device and the commercial mechanical testing system, with an average relative error of 2.9% and 12.4%, for T1 and T2, respectively. Also, we present the application of compression device to measure local retardation times for four different phantoms with different size and stiffness.

Quantifying spasticity in individual muscles using shear wave elastography.

Spasticity is common following stroke; however, high subject variability and unreliable measurement techniques limit research and treatment advances. Our objective was to investigate the use of shear wave elastography (SWE) to characterize the spastic reflex in the biceps brachii during passive elbow extension in an individual with spasticity. The patient was a 42-year-old right-hand-dominant male with history of right middle cerebral artery-distribution ischemic infarction causing spastic left hemiparesis. We compared Fugl-Meyer scores (numerical evaluation of motor function, sensation, motion, and pain), Modified Ashworth scores (most commonly used clinical assessment of spasticity), and SWE measures of bilateral biceps brachii during passive elbow extension. We detected a catch that featured markedly increased stiffness of the brachialis muscle during several trials of the contralateral limb, especially at higher extension velocities. SWE was able to detect velocity-related increases in stiffness with extension of the contralateral limb, likely indicative of the spastic reflex. This study offers optimism that SWE can provide a rapid, real-time, quantitative technique that is readily accessible to clinicians for evaluating spasticity.

Vibrometry: a novel noninvasive application of ultrasonographic physics to estimate wall stress in native aneurysms.

Our objective was to test vibrometry as a means to measure changes in aneurysm sac pressure in an in vitro aneurysm model. Explanted porcine abdominal aortas and nitrile rubber tubes were used to model an aneurysm sac. An ultrasound beam was used to vibrate the surface of the aneurysm model. The motion generated on the surface was detected either by reflected laser light or by a second ultrasound probe. This was recorded at different aneurysm pressures. The phase of the propagating wave was measured to assess changes in velocity and to see if there was a correlation with aneurysm pressure. The cumulative phase shift detected by laser or Doppler correlated well with increasing hydrostatic pressure in both the rubber and the porcine aorta model. The square of the mean pressure correlated well with the cumulative phase shift when dynamic pressure was generated by a pump. However, the pulse pressure was poorly correlated with the cumulative phase shift. Noninvasive measurement of changes in aortic aneurysm sac tension is feasible in an in vitro setting using the concept of vibrometry. This could potentially be used to noninvasively detect wall stress in native aneurysms and endotension after endovascular aneurysm repair (EVAR) and to predict the risk of rupture.

Probe Oscillation Shear Elastography (PROSE): A High Frame-Rate Method for Two-Dimensional Ultrasound Shear Wave Elastography.

Ultrasound shear wave elastography (SWE) utilizes the propagation of induced shear waves to characterize the shear modulus of soft tissue. Many methods rely on an acoustic radiation force (ARF) "push beam" to generate shear waves. However, specialized hardware is required to generate the push beams, and the thermal stress that is placed upon the ultrasound system, transducer, and tissue by the push beams currently limits the frame-rate to about 1 Hz. These constraints have limited the implementation of ARF to high-end clinical systems. This paper presents Probe Oscillation Shear Elastography (PROSE) as an alternative method to measure tissue elasticity. PROSE generates shear waves using a harmonic mechanical vibration of an ultrasound transducer, while simultaneously detecting motion with the same transducer under pulse-echo mode. Motion of the transducer during detection produces a "strain-like" compression artifact that is coupled with the observed shear waves. A novel symmetric sampling scheme is proposed such that pulse-echo detection events are acquired when the ultrasound transducer returns to the same physical position, allowing the shear waves to be decoupled from the compression artifact. Full field-of-view (FOV) two-dimensional (2D) shear wave speed images were obtained by applying a local frequency estimation (LFE) technique, capable of generating a 2D map from a single frame of shear wave motion. The shear wave imaging frame rate of PROSE is comparable to the vibration frequency, which can be an order of magnitude higher than ARF based techniques. PROSE was able to produce smooth and accurate shear wave images from three homogeneous phantoms with different moduli, with an effective frame rate of 300 Hz. An inclusion phantom study showed that increased vibration frequencies improved the accuracy of inclusion imaging, and allowed targets as small as 6.5 mm to be resolved with good contrast (contrast-to-noise ratio ≥ 19 dB) between the target and background.

Measurement of dynamic and static radiation force on a sphere.

Dynamic radiation force from ultrasound has found increasing applications in elasticity imaging methods such as vibro-acoustography. Radiation force that has both static and dynamic components can be produced by interfering two ultrasound beams of slightly different frequencies. This paper presents a method to measure both static and dynamic components of the radiation force on a sphere suspended by thin threads in water. Due to ultrasound radiation force, the sphere deflects to an equilibrant position and vibrates around it. The static radiation force is estimated from the deflection of the sphere. The dynamic radiation force is estimated from the calculated radiation impedance of the sphere and its vibration speed measured by a laser vibrometer. Experimental results on spheres of different size, vibrated at various frequencies, confirm the theoretical prediction that the dynamic and static radiation force on a sphere have approximately equal magnitudes [G. T. Silva, Phys. Rev. E 71, 056617 (2005)].

Evaluating the dynamic performance of a fibre optic pressure microsensor.

The dynamic performance of a new fibre optic sensor intended for measuring physiological fluid pressures is assessed in water. The sensor's sensitivity is evaluated at 23 degrees, 35 degrees and 37 degrees C against a Millar pressure catheter for sinusoidal pressure inputs with frequency ranging from 0.5 to 10 Hz. We found that sensitivity versus frequency is flat to 6 Hz and decreases slightly between 6 and 10 Hz. The sensitivity is slightly lower at 23 degrees C than at 37 degrees C. The reproducibility of measurements is excellent (two separate calibration tests in two consecutive days). The output of the fibre optic system used shows a constant time delay (0.13 s) for all frequencies tested. Experiments suggest that, with current sensor design, its immersion in degassed water prior to use ensures a reliable performance.

Noninvasive method for estimation of complex elastic modulus of arterial vessels.

Pulse wave velocity (PWV) is widely used for estimating the stiffness of an artery. It is well-known that a stiffened artery can be associated with various diseases and with aging. Usually, PWV is measured using the "foot-to-foot" method in which the travel time of the wave is measured over a distance. The "foot" of the pressure wave is not clear due to reflected waves and blood noise. Also, PWV is an average indicator of artery stiffness between the two measuring points and, therefore, does not identify local stiffness variations. We propose producing a bending wave in the arterial wall using low-frequency, localized ultrasound radiation force and measuring the wave velocity along the arterial wall. The wave velocity can be measured accurately over a few millimeters. A mathematical model for wave propagation along the artery is developed with which the Young's modulus of the artery can be determined from measured wave velocities. Experiments were conducted on a pig carotid artery cast in a tissue-mimicking gelatin. The wave velocity was measured by the phase change at a known distance for a given frequency. The measured wave velocity is about 3 m/s at 100 Hz and 6.5 m/s at 500 Hz. The real part of complex elastic modulus of the artery is estimated to be 300 kPa.

Diagnosis of small partial-thickness rotator cuff tears using vibro-acoustography.

PURPOSE: Vibro-acoustography is a new imaging technique based on the dynamic radiation force of ultrasound. The purpose of this study was to apply this new imaging technique to the diagnosis of small partial-thickness rotator cuff tears and to determine how small of tears could be detected with this imaging technique. METHODS: Seven supraspinatus tendons excised from embalmed cadavers were used. Three different sizes of partial-thickness bursal-sided tears (1, 3, and 5 mm(3)) were created in each specimen. The intersection of two co-focused ultrasound beams of slightly different frequency was swept across the intended imaging area. The acoustic emission data were collected and used to form and display a vibro-acoustography image of the tendon. Vibro-acoustography images were read by two orthopedic surgeons. RESULTS: The rotator cuff tear could be detected by vibro-acoustography in all specimens. The diagnostic concordance rate was 90.5 % and the kappa coefficient value was 0.88, which resulted in a high concordance. The diagnostic concordance rate for the 1 mm tear was 71.3 %, which was low concordance (κ = 0.481), whereas that for the 3 and 5 mm tears was 100 %. CONCLUSIONS: We were able to detect a 3-mm tear by using vibro-acoustography. There is a possibility that this new imaging technique could become a useful imaging tool for the diagnosis of small partial-thickness rotator cuff tears.

Characterization of transverse isotropy in compressed tissue-mimicking phantoms.

Tissues such as skeletal muscle and kidneys have well-defined structure that affects the measurements of mechanical properties. As an approach to characterize the material properties of these tissues, different groups have assumed that they are transversely isotropic (TI) and measure the shear wave velocity as it varies with angle with respect to the structural architecture of the organ. To refine measurements in these organs, it is desirable to have tissue-mimicking phantoms that exhibit similar anisotropic characteristics. Some approaches involve embedding fibers into a material matrix. However, if a homogeneous solid is under compression due to a static stress, an acoustoelastic effect can manifest that makes the measured wave velocities change with the compression stress. We propose to exploit this characteristic to demonstrate that stressed tissue mimicking phantoms can be characterized as a TI material. We tested six phantoms made with different concentrations of gelatin and agar. Stress was applied by the weight of a water container centered on top of a plate on top of the phantom. A linear array transducer and a V-1 Verasonics system were used to induce and measure shear waves in the phantoms. The shear wave motion was measured using a compound plane wave imaging technique. Autocorrelation was applied to the received in-phase/quadrature data. The shear wave velocity, c, was estimated using a Radon transform method. The transducer was mounted on a rotating stage so measurements were made every 10° over a range of 0° to 360°, where the stress is applied along 0° to 180° direction. The shear moduli were estimated. A TI model was fit to the data and the fractional anisotropy was evaluated. This approach can be used to explore many configurations of transverse isotropy with the same phantom, simply by applying stress to the tissue-mimicking phantom.

Measurement of the ultrasound backscatter signal from three seed types as a function of incidence angle: application to permanent prostate brachytherapy.

PURPOSE: To measure the relative ultrasound backscatter of different seed types as a function of seed orientation and to evaluate the corresponding images of these seeds. METHODS AND MATERIALS: Three seed types were evaluated: OncoSeed (standard), EchoSeed (corrugated), and RAPID Strand(RS). Ultrasound images for angles of incidence varying from 90 degrees (perpendicular) to 20 degrees at 5MHz and 7.5MHz were produced by raster scanning the seeds in a degassed water bath. Seed images were visually inspected and analyzed using the integrated-optical-density (IOD) method. RESULTS: Corrugated seeds appear as contiguous objects over the range of frequencies and orientations examined, whereas standard seeds appear as contiguous objects from 90 degrees to 80 degrees only. The ranges and means of the backscattered IOD ratio of the seeds from 85 degrees to 20 degrees were: (corrugated vs. standard) 1.48 to 3.72 (2.32 +/- 0.62) for 5 MHz and 1.26 to 3.77 (2.19 +/- 0.84) for 7.5 MHz and (corrugated vs. RS) 1.21 to 9.53 (2.98 +/- 2.48) for 5 MHz and 1.008 to 10.86 (2.79 +/- 3.08) for 7.5 MHz. Backscattered signal increase ranged from 1.66 dB to 20.7 dB for the corrugated seed as compared to the other seeds. CONCLUSIONS: Corrugated seeds produce greater backscatter signal and a more readily identifiable seed image over a large range of seed orientation as compared with standard brachytherapy seeds.