An Assessment of the Imaging Performance of Hand-Held Ultrasound Scanners Using the Edinburgh Pipe Phantom.

OBJECTIVE: Although hand-held ultrasound devices (HHUSDs) are currently used for a diverse range of diagnostic and interventional applications the imaging performance of such scanners is rarely considered. The aim of this study was to assess the imaging performance of a wide-range of HHUSDs and compare their imaging performance to cart-based systems utilized for the same clinical applications. METHODS: The grayscale imaging performances of 19 HHUSDs from eight different manufacturers, manufactured between 2016 and 2021, were measured using a figure-of-merit known as the resolution integral. The imaging performance of the HHUSDs were compared to 142 cart-based ultrasound scanners. RESULTS: The HHUSD with the overall highest resolution integral (66) was a Butterfly (Burlington, MA, USA) wired phased array for small parts applications, followed by a Philips (Bothell, WA, USA) Lumify wired curvilinear transducer (57) for abdominal applications, a Butterfly wired phased array (56) for abdominal applications, a GE (Freiburg, Baden-Wurttemberg, Germany) VScan Air wireless linear array (56) for small parts applications, and a Healcerion (Seoul, Korea) Sonon 300L wireless linear array (56) for small parts applications. A GE VScan Extend wired phased array had the highest resolution integral (44) for cardiac applications. CONCLUSIONS: The Butterfly phased array had the highest resolution integral of all the 19 HHUSDs, although this value is still less than the majority of cart-based cardiac and abdominal ultrasound scanners manufactured from 2010 to 2017. Clinical users of HHUSDs should be mindful of the limitations in imaging performance of hand-held ultrasound devices.

The Imaging Performance of Diagnostic Ultrasound Scanners Using the Edinburgh Pipe Phantom to Measure the Resolution Integral - 15 Years of Experience.

The grayscale imaging performance of a total of 368 different scanner/transducer combinations from 39 scanner manufacturers measured over a period of 15 years is presented. Performance was measured using the resolution integral, a single figure-of-merit to quantify ultrasound imaging performance. The resolution integral was measured using the Edinburgh Pipe Phantom. Transducers included single element, linear, phased, curvilinear and multi-row arrays. Our results demonstrate that the resolution integral clearly differentiates between transducers with varying levels of performance. Two further parameters were also derived from the resolution integral: characteristic resolution and depth of field. We demonstrate that these two parameters can successfully characterize individual transducer performance and differentiate between transducers designed for different clinical and preclinical applications. In conclusion, the resolution integral is an effective metric to quantify and monitor grayscale imaging performance in clinical practice.

Evaluation of Intravascular Ultrasound Catheter-Based Transducers Using the Resolution Integral.

Intravascular ultrasound (IVUS) catheters are a specialist imaging modality used in the assessment of cardiovascular disease. The ultrasound transducer may either be of single-element mechanical or phased-array design. Because of their design and operating frequencies (10-45 MHz), evaluation of the imaging performance is not possible with commercially available ultrasound test objects. An existing test object, the Edinburgh Pipe Phantom, was modified to allow measurement of resolution integral (R), depth of field (Lr) and characteristic resolution (Dr) of IVUS catheters. In total, seven IVUS catheters, from two manufacturers and of both single-element mechanical and phased-array design, were tested to provide a measure of performance over different frequencies and technologies. Measurements of R for the tested IVUS catheters ranged from 11.9 to 18.8. The modified Edinburgh Pipe Phantom therefore allows catheter-based ultrasound probes to be evaluated scientifically and their performance to be seen in relation to other similar ultrasound technologies such as pre-clinical ultrasound and endoscopic ultrasound.

Acoustic Properties of Small Animal Soft Tissue in the Frequency Range 12-32 MHz.

Quality assurance phantoms are made of tissue-mimicking materials (TMMs) the acoustic properties of which mimic those of soft tissue. However, the acoustic properties of many soft tissue types have not been measured at ultrasonic frequencies >9 MHz. With the increasing use of high-frequency ultrasound for both clinical and pre-clinical applications, it is of increasing interest to ensure that TMMs accurately reflect the acoustic properties of soft tissue at these higher frequencies. In this study, the acoustic properties of ex vivo brain, liver and kidney samples from 50 mice were assessed in the frequency range 12-32 MHz. Measurements were performed within 6 min of euthanasia in a phosphate-buffered saline solution maintained at 37.2 ± 0.2 °C. The measured mean values for the speed of sound for all organs were found to be higher than the International Electrotechnical Commission guideline recommended value for TMMs. The attenuation coefficients measured for brain, liver and kidney samples were compared with the results of previous studies at lower frequencies. Only the measured kidney attenuation coefficient was found to be in good agreement with the International Electrotechnical Commission guideline. The information provided in this study can be used as a baseline on which to manufacture a TMM suitable for high-frequency applications.

Broadband Acoustic Measurement of an Agar-Based Tissue-Mimicking-Material: A Longitudinal Study.

Commercially available ultrasound quality assurance test phantoms rely on the long-term acoustic stability of the tissue-mimicking-material (TMM). Measurement of the acoustic properties of the TMM can be technically challenging, and it is important to ensure its stability. The standard technique is to film-wrap samples of TMM and to measure the acoustic properties in a water bath. In this study, a modified technique was proposed whereby the samples of TMM are measured in a preserving fluid that is intended to maintain their characteristics. The acoustic properties were evaluated using a broadband pulse-echo substitution technique over the frequency range 4.5-50 MHz at 0, 6 and 12 months using both techniques. For both techniques, the measured mean values for the speed of sound and attenuation were very similar and within the International Electrotechnical Commission-recommended value. However, the results obtained using the proposed modified technique exhibited greater stability over the 1-y period compared with the results acquired using the standard technique.

Pipe Phantoms With Applications in Molecular Imaging and System Characterization.

Pipe (vessel) phantoms mimicking human tissue and blood flow are widely used for cardiovascular related research in medical ultrasound. Pipe phantom studies require the development of materials and liquids that match the acoustic properties of soft tissue, blood vessel wall, and blood. Over recent years, pipe phantoms have been developed to mimic the molecular properties of the simulated blood vessels. In this paper, the design, construction, and functionalization of pipe phantoms are introduced and validated for applications in molecular imaging and ultrasound imaging system characterization. There are three major types of pipe phantoms introduced: 1) a gelatin-based pipe phantom; 2) a polydimethylsiloxane-based pipe phantom; and 3) the "Edinburgh pipe phantom." These phantoms may be used in the validation and assessment of the dynamics of microbubble-based contrast agents and, in the case of a small diameter tube phantom, for assessing imaging system spatial resolution/contrast performance. The materials and procedures required to address each of the phantoms are described.

Quality assurance testing of transoesophageal echocardiography probes.

INTRODUCTION: In response to an ultrasound imaging issue with transoesophageal echocardiography probes, a testing protocol was developed to check features pertinent to the operation of these probes. The imaging problem was detected in multiple probes of the same make and model. METHODS: Over a two-year period, a series of 26 probes of this model were tested at acceptance, then three to six months later before being replaced due to a defect. A range of visual, mechanical and electrical tests were performed. Image tests comprised low-contrast penetration measurements and a comparison of phantom images at regular intervals to highlight artefacts in both B-mode and colour Doppler imaging. RESULTS: Of the 26 defective probes replaced, 7 suffered mechanical/electrical problems, 5 of which prevented imaging results being obtained. Low-contrast penetration reduction of greater than 5% occurred in 14 probes. B-mode artefacts were observed on 12 probes and Doppler noise artefacts on 6 probes. No faults were found on five probes. The manufacturer addressed the imaging problem identified and of the seven subsequent probes supplied, only one suffered an imaging fault. CONCLUSIONS: The implementation of a quality assurance protocol for transoesophageal echocardiography probes resulted in cost savings on replacements/repairs. When provided with the evidence gathered, the manufacturer supplied 23 probes under warranty or as loan equipment. The regular testing of the probes substantially reduced the impact of downtime and poor diagnosis from this equipment on the clinical service.

Detecting failed elements on phased array ultrasound transducers using the Edinburgh Pipe Phantom.

AIMS: Imaging faults with ultrasound transducers are common. Failed elements on linear and curvilinear array transducers can usually be detected with a simple image uniformity or 'paperclip' test. However, this method is less effective for phased array transducers, commonly used in cardiac imaging. The aim of this study was to assess whether the presence of failed elements could be detected through measurement of the resolution integral (R) using the Edinburgh Pipe Phantom. METHODS: A 128-element paediatric phased array transducer was studied. Failed elements were simulated using layered polyvinyl chloride (PVC) tape as an attenuator and measurements of resolution integral were carried out for several widths of attenuator. RESULTS: All widths of attenuator greater than 0.5 mm resulted in a significant reduction in resolution integral and low contrast penetration measurements compared to baseline (p < 0.05). CONCLUSIONS: Measurements of resolution integral and low contrast penetration both have the potential to be used as straightforward and inexpensive tests to detect failed elements on phased array transducers. Particularly encouraging is the result for low contrast penetration as this is a quick and simple measurement to make and can be performed with many different test objects, thus enabling 'in-the-field' checks.

Assessing the imaging capabilities of radial mechanical and electronic echo-endoscopes using the resolution integral.

Over the past decade there have been significant advances in endoscopic ultrasound (EUS) technology. Although there is an expectation that new technology will deliver improved image quality, there are few methods or phantoms available for assessing the capabilities of mechanical and electronic EUS systems. The aim of this study was to investigate the possibility of assessing the imaging capability of available EUS technologies using measurements of the resolution integral made with an Edinburgh Pipe Phantom. Various radial EUS echo-endoscopes and probes were assessed using an Edinburgh Pipe Phantom. Measurements of the resolution integral (R), depth of field (LR) and characteristic resolution (DR) were made at all operating frequencies. The mean R value for Fuji miniprobes was 16.0. The GF-UM20 and GF-UM2000 mechanical radial scopes had mean R values of 24.0 and 28.5, respectively. The two electronic radial echo-endoscopes had similar mean R values of 34.3 and 34.6 for the Olympus GF-UE260 and Fujinon EG-530 UR scopes, respectively. Despite being older technology, the mechanical GF-UM2000 scope had superior characteristic resolution (DR), but could not compare with the depths of field (LR) delivered by the current generation of electronic radial scopes, especially at the standard operating frequencies of 7.5 and 12 MHz.

A setup for the assessment of the effect of tubular confinement on the acoustic response of microbubbles.

Ultrasound contrast agents are gas filled microbubbles which produced enhanced echoes in ultrasound imaging thus allowing the acquisition of detailed information on the path of blood. It is theoretically known that the size of a vessel affects the behavior of a microbubble, which could potentially be used to discriminate different sized vessels. This information would be useful in the monitoring of neovascularization in tumor growth or treatment. However, currently it is not possible to identify the vessel diameter by any means of signal processing of microbubble echoes. In order to assess microbubble behavior when confined in tubes we compared the acoustic backscatter from biSphere™ microbubbles both free in water and flowing in 200 µm diameter tubes that are similar in size to arterioles. Experimental systems that allow the interrogation of individual microbubbles were designed and modified to allow investigation of both free microbubbles and those in tubes. Unprocessed single microbubble RF data were collected, allowing the calculation of both the fundamental and second harmonic components of the backscattered signal. Microbubbles confined in tubes had lower amplitude response compared to unconfined microbubbles. On consecutive insonations of the same microbubble, free microbubbles produced echoes above noise more often than confined microbubbles. This setup may be used to investigate microbubble behavior in a range of smaller tubes with diameters similar to capillaries thus enabling signal processing design for vessel differentiation.

The Resolution Integral - a tool for characterising the performance of diagnostic ultrasound scanners.

In this paper, we describe how the resolution integral can be used as a tool for characterising the grey-scale imaging of diagnostic ultrasound scanners. The definitions of resolution integral, characteristic resolution and depth of field are discussed in relation to grey-scale imaging performance, together with a method of measuring these parameters using the Edinburgh Pipe Phantom. We show how the characteristic resolution and depth of field can be used to quantify the differences between transducers designed for different applications and how they are useful in identifying and quantifying changes in the performance of individual transducers.

Correspondence - Characterization of the effective performance of a high-frequency annular-array-based imaging system using anechoic-pipe phantoms.

A resolution integral (RI) method based on anechoic- pipe, tissue-mimicking phantoms was used to compare the detection capabilities of high-frequency imaging systems based on a single-element transducer, a state-of-the-art 256-element linear array, or a 5-element annular array. All transducers had a central frequency of 40 MHz with similar conventionally measured axial and lateral resolutions (about 50 and 85 µm, respectively). Using the RI metric, the annular array achieved the highest performance (RI = 60), followed by the linear array (RI = 47), and the single-element transducer (RI = 24). Results showed that the RI metric could be used to efficiently quantify the effective transducer performance and compare the image quality of different systems.

The speed of sound and attenuation of an IEC agar-based tissue-mimicking material for high frequency ultrasound applications.

This study characterized the acoustic properties of an International Electromechanical Commission (IEC) agar-based tissue mimicking material (TMM) at ultrasound frequencies in the range 10-47 MHz. A broadband reflection substitution technique was employed using two independent systems at 21°C ± 1°C. Using a commercially available preclinical ultrasound scanner and a scanning acoustic macroscope, the measured speeds of sound were 1547.4 ± 1.4 m∙s(-1) and 1548.0 ± 6.1 m∙s(-1), respectively, and were approximately constant over the frequency range. The measured attenuation (dB∙cm(-1)) was found to vary with frequency f (MHz) as 0.40f + 0.0076f(2). Using this polynomial equation and extrapolating to lower frequencies give values comparable to those published at lower frequencies and can estimate the attenuation of this TMM in the frequency range up to 47 MHz. This characterisation enhances understanding in the use of this TMM as a tissue equivalent material for high frequency ultrasound applications.

A comparison of the imaging performance of high resolution ultrasound scanners for preclinical imaging.

Nine ultrasound transducers from six ultrasound scanners were assessed for their utility for preclinical ultrasound imaging. The transducers were: L8-16, L10-22 (Diasus; Dynamic Imaging Ltd., Livingston, UK); L17-5, L15-7io (iU22; Philips, Seattle, WA, USA), HFL38/13-6 (MicroMaxx; Sonosite Inc., Bothell, WA, USA); il3Lv (Vivid 5; GE, Fairfield, CT, USA), RMV 704 (Vevo 770; Visualsonics Inc., Toronto, Canada) and MS550S, MS550D (Vevo 2100; Visualsonics Inc.). A quantitative analysis of the ultrasound images from all nine transducers employed measurements of the resolution integral as an indication of the versatility and technology of the ultrasound scanners. Two other parameters derived from the resolution integral, the characteristic resolution and depth of field, were used to characterise imaging performance. Six of these transducers were also assessed qualitatively by ultrasonically scanning 59 female common marmosets (Callithrix jacchus) yielding a total of 215 scans. The quantitative measurements for each of the transducers were consistent with the results obtained in the qualitative in vivo assessment. Over a 0-10 mm imaging depth, the values of the resolution integral, characteristic resolution and depth of field, measured using the Edinburgh Pipe Phantom, ranged in magnitude from 7-72, 93-930 µm and 3.3-9.2 mm respectively. The largest resolution integrals were obtained using the Vevo 770 and Vevo 2100 scanners. The Edinburgh Pipe Phantom provides a quantitative method of characterising the imaging performance of preclinical imaging scanners.

The effect of back reflections on the acoustic power delivered by physiotherapy ultrasound machines.

Physiotherapy ultrasound is used widely for the treatment of soft tissue injuries. The ultrasonic treatment heads are all highly resonant devices and may therefore be sensitive to the levels of acoustic back reflection that they experience. However, the extent to which reflections affect acoustic power during clinical use has not been reported in the literature and is not addressed in current technical standards. This study investigated the effect of physiological levels of acoustic reflection on 29 physiotherapy treatment heads from a total of 21 machines and 6 manufacturers. A range of membranes were constructed and used to mimic the levels of acoustic reflections that occur during treatment. The results obtained showed that almost half of the heads tested (45%) had deviations in acoustic power of more than 15% compared with free-field measurements. Four heads (17%) had deviations in power of more than 25%. We recommend that the susceptibility of physiotherapy ultrasound machines to acoustic reflections be addressed in the relevant technical standards. Also, it is appropriate for tests to be carried out during design and manufacture, and by the purchaser during their acceptance testing.

Nanomechanics of biocompatible hollow thin-shell polymer microspheres.

The nanomechanical properties of biocompatible thin-shell hollow polymer microspheres with approximately constant ratio of shell thickness to microsphere diameter were measured by nanocompression tests in aqueous conditions. These microspheres encapsulate an inert gas and are used as ultrasound contrast agents by releasing free microbubbles in the presence of an ultrasound field as a result of free gas leakage from the shell. The tests were performed using an atomic force microscope (AFM) employing the force-distance curve technique. An optical microscope, on which the AFM was mounted, was used to guide the positioning of tipless cantilevers on top of individual microspheres. We performed a systematic study using several cantilevers with spring constants varying from 0.08 to 2.3 N/m on a population of microspheres with diameters from about 2 to 6 microm. The use of several cantilevers with various spring constants allowed a systematic study of the mechanical properties of the microsphere thin shell at different regimes of force and deformation. Using thin-shell mechanics theory for small deformations, the Young's modulus of the thin wall material was estimated and was shown to exhibit a strong size effect: it increased as the shell became thinner. The Young's modulus of thicker microsphere shells converged to the expected value for the macroscopic bulk material. For high applied forces, the force-deformation profiles showed a reversible and/or irreversible nonlinear behavior including "steps" and "jumps" which were attributed to mechanical instabilities such as buckling events.

A numerical investigation of the resonance of gas-filled microbubbles: resonance dependence on acoustic pressure amplitude.

The general Keller-Herring equation for free gas bubbles is augmented by specific terms to describe the elasticity, viscosity and thickness of the encapsulating shell in ultrasound contrast agent microbubbles. A numerical investigation that analyses the acoustic backscatter from bubbles is employed to identify resonance frequencies that can be compared, for increasing driving pressure amplitude, with linear approximations obtained via analytical considerations. Calculations for bubbles of the size employed in diagnostic ultrasound, between 2 and 6 mum diameter, that are immersed in water and blood and exposed to monochromatic insonation, causing the bubbles to undergo stable cavitation, reveal that the resonance frequency diverges from the linear approximation as the pressure amplitude is increased. The shift in resonance, to lower frequency values, is found to be more pronounced for larger bubbles with the calculated value differing by up to 40% from the linear approximation. The results of this simulation might be potentially useful in preparation of formulations of ultrasound contrast agents with the specifically desired features, such as for instance resonance frequency.

Doppler colour flow imaging and flow quantification with a novel forward-viewing intravascular ultrasound system.

The aim of this work was to investigate the potential of a novel forward-viewing intravascular ultrasound (IVUS) system for flow quantification and colour flow imaging combined with B-mode imaging. A stiff 3.8-mm diameter catheter was used to scan a 72 degrees sector ahead of its tip. Operating at 30 MHz, the catheter was integrated with an IVUS scanner and a radiofrequency (RF) data-acquisition system. RF data were software processed for producing B-mode images and deriving velocity estimates. Steady flow in the range of 45 to 146 mL/min toward the catheter, was used in wall-less tissue-mimicking phantoms simulating healthy lumen (8-mm diameter), 30% diameter symmetrical stenosis and 37% diameter eccentric stenosis. The system provided colour flow images and good estimation of peak velocity and volumetric flows (within 1% to 9% and 16% to 48%, respectively, of calculated values) at 5 to 7 mm distal to the catheter. A sector forward-viewing IVUS imaging/Doppler system is suitable for combined anatomical and functional assessment of stenosed vessels.