A Poly-vinyl Alcohol (PVA)-based phantom and training tool for use in simulated Transrectal Ultrasound (TRUS) guided prostate needle biopsy procedures.

Trans-rectal ultrasound-guided needle biopsy is a well-established diagnosis technique for prostate cancer. To enhance the needle manoeuvring skills under ultrasound (US) guidance, it is preferable to train medical practitioners in needle biopsy on tissue-mimicking phantoms. This phantom should mimic the morphology as well as mechanical and acoustic properties of the human male pelvic region to provide a surgical experience and feedback. In this study, polyvinyl alcohol (PVA) was used and evaluated for prostate phantom development, that is stiffness tunable, US-compatible and durable phantom material. Three samples, each with 5%, 10%, and 15% concentration of PVA material, were prepared, and their mechanical and shrinkage characteristics were investigated. The anatomy of male pelvic region was used to develop an anatomically correct phantom. Later US-guided needle biopsy was performed on the phantom. The range of elastic moduli of the PVA samples was 2∼146 kPa. Their elastic moduli and volumes were found to remain statistically close from seventh to eighth freeze-thaw cycle (p>0.05). Initial US scans of the phantom resulted in satisfactory B-mode images, with a clear distinction between the prostate and its surrounding organs. This study demonstrated the applicability of PVA hydrogel as a phantom material for training in US-guided needle biopsy.

Toward Quantitative and Operator-independent Quasi-static Ultrasound Elastography: An Ex Vivo Feasibility Study.

It is known that the elasticity of liver reduces progressively in the case of diffuse liver disease. Currently, the diagnosis of diffuse liver disease requires a biopsy, which is an invasive procedure. In this paper, we evaluate and report a noninvasive method that can be used to quantify liver stiffness using quasi-static ultrasound elastography approach. Quasi-static elastography is popular in clinical applications where the qualitative assessment of relative tissue stiffness is enough, whereas its potential is relatively underutilized in liver imaging due to lack of local stiffness contrast in the case of diffuse liver disease. Recently, we demonstrated an approach of using a calibrated reference layer to produce quantitative modulus elastograms of the target tissue in simulations and phantom experiments. In a separate work, we reported the development of a compact handheld device to reduce inter- and intraoperator variability in freehand elastography. In this work, we have integrated the reference layer with a handheld controlled compression device and evaluate it for quantitative liver stiffness imaging application. The performance of this technique was assessed on ex vivo goat liver samples. The Young's modulus values obtained from indentation measurements of liver samples acted as the ground truth for comparison. The results from this work demonstrate that by combining the handheld device along with reference layer, the estimated Young's modulus value approaches the ground truth with less error compared with that obtained using freehand compression (8% vs. 15%). The results suggest that the intra- and interoperator reproducibility of the liver elasticity also improved when using the handheld device. Elastography with a handheld compression device and reference layer is a reliable and simple technique to provide a quantitative measure of elasticity.

Actuator-assisted Subpitch Translation-capable Transducer for Elastography: Preliminary Performance Assessment.

In conventional linear array (CLA)-based elastography tissue compression in one direction (e.g., axial) leads to an expansion in all other directions (lateral, elevation). Therefore, the estimation of the lateral displacements and strains may provide additional information on the tissue mechanical properties. However, these are not exploited fully due to the inherent limitation in lateral sampling. Recently, a method named actuator-assisted beam translation (ABT) was demonstrated to address this issue, wherein the focused beam was translated at subpitch locations using an external bench-top setup. However, because such bench-top setup may be impractical for routine clinical use, an ultrasound transducer was customized to have an internal actuator. The performance of the customized transducer was studied through experiments on phantoms for rotation elastography application, which requires precise lateral displacement estimation. Furthermore, the results obtained from ABT was compared against the currently practiced spatial displacement compounding (SDC) method, which is known to yield better quality lateral displacement estimates than conventional approaches. The results show that the ABT method yields a full-width half-maximum (FWHM) value, taken from the lateral profile across a point scatterer, which is 65% and 24% smaller than that obtained using CLA and SDC methods, respectively. Furthermore, the contrast-to-noise ratio (CNR) estimated from rotation elastogram obtained using ABT method is better by 300% and 35% compared with that obtained by using CLA and SDC methods, respectively. Furthermore, the results demonstrate an additional advantage of having larger field of view (FoV) for the ABT method compared with spatial compounding approach.

Quantitative quasi-static ultrasound elastography using reference layer: Ex-vivo study.

It is well-documented in the literature that changes in tissue elasticity are generally correlated with disease condition. In the case of diffuse liver disease, the elasticity of the liver reduces progressively. However, this change does not clearly manifest in conventional ultrasound examinations. Although quasi-static elastography is popular in clinical applications where qualitative assessment of relative tissue stiffness is enough, its potential is relatively underutilized in liver imaging due to the need for quantitative stiffness value. Recently, it was demonstrated that using a reference layer of known stiffness, one could produce quantitative modulus elastograms of the target tissue using quasi-static elastography using simulations and phantom experiments. Here, we examined the performance of this approach on ex-vivo goat liver samples and compare the estimated modulus values to that obtained from indentation measurements. The results suggest that using this approach of reference layer yields Young's modulus values within 10% error compared to the ground truth.

Towards quantitative quasi-static ultrasound elastography using a reference layer for liver imaging application: A preliminary assessment.

Changes in tissue elasticity are generally correlated with pathological phenomena. For example, diffuse liver disease progressively reduces the elasticity of the liver. Quasi-static elastography is popular in clinical applications to visualize regions with different relative stiffness. However, the limitation of this technique is that it provides only qualitative information. To overcome this, we investigate the use of a calibrated reference layer, sandwiched between the transducer and the tissue surface, to quantitatively image the unknown modulus of the examined tissue. The performance of the method was studied through simulations and experiments on agar-gelatin phantoms having Young's modulus within a range appropriate for the liver application. Furthermore, we explored the translational capability of the proposed method to work with existing commercially-available ultrasound scanners having elastography option. The Young's modulus value of the phantom estimated from quantitative elastography in simulation and experiment was compared against the corresponding ground-truth modulus value obtained from COMSOL and Universal Testing Machine (UTM) results, respectively. The results obtained for the compressive elastic modulus of the underlying phantom using quasi-static ultrasound elastography was found to be within 6% and 11% in simulation and experiments, respectively, to the corresponding ground-truth values.

Strategies to Obtain Subpitch Precision in Lateral Motion Estimation in Ultrasound Elastography.

In elastography, conventional linear array (CLA)-based RF data acquisition provides more accurate displacement measurements in the direction of beam propagation (axial direction) when compared to the perpendicular direction (lateral). Obtaining good quality lateral displacement estimates in ultrasound (US) elastography will lead to several benefits such as obtaining accurate inverse solutions, improving shear strain elastogram quality, getting good quality poroelastograms, and obtaining reliable rotation elastograms. For accomplishing high-precision lateral displacement estimation (LDE), one of the popular methods is by interpolating additional A-lines in between neighboring RF A-lines. We describe a method wherein true RF A-lines (not interpolated) are acquired and augmented at subpitch locations using CLA transducer, instead of interpolating the data, and using this new frame data for further image formation and/or processing to yield better lateral resolution and LDE. We demonstrate the proposed method by translating the US beam of CLA transducer in subpitch range by the following two approaches: 1) actuator-assisted beam translation and 2) electronic translation of subaperture of a CLA by activating odd and even number of consecutive elements sequentially, referred to as electronic beam translation. The performances of the different methods were studied through simulations and experiments on phantoms. The results demonstrate that these methods yield better quality LDE compared to those obtained from interpolation of RF A-lines. These methods may provide affordable ways to obtain subpitch precision LDE using CLA.