Assessment of viscous and elastic properties of sub-wavelength layered soft tissues using shear wave spectroscopy: theoretical framework and in vitro experimental validation

In elastography, quantitative imaging of soft tissue elastic properties is provided by local shear wave speed estimation. Shear wave imaging in a homogeneous medium thicker than the shear wavelength is eased by a simple relationship between shear wave speed and local shear modulus. In thin layered organs, the shear wave is guided and thus undergoes dispersive effects. This case is encountered in medical applications such as elastography of skin layers, corneas, or arterial walls. In this work, we proposed and validated shear wave spectroscopy as a method for elastic modulus quantification in such layered tissues. Shear wave dispersion curves in thin layers were obtained by finite-difference simulations and numerical solving of the boundary conditions. In addition, an analytical approximation of the dispersion equation was derived from the leaky Lamb wave theory. In vitro dispersion curves obtained from phantoms were consistent with numerical studies (deviation <1.4%). The least-mean-squares fitting of the dispersion curves enables a quantitative and accurate (error < 5% of the transverse speed) assessment of the elasticity. Dispersion curves were also found to be poorly influenced by shear viscosity. This phenomenon allows independent recovery of the shear modulus and the viscosity, using, respectively, the dispersion curve and the attenuation estimation along the propagation axis.

Theoretical and phantom based investigation of the impact of sound speed and backscatter variations on attenuation slope estimation

Quantitative ultrasound features such as the attenuation slope, sound speed and scatterer size, have been utilized to evaluate pathological variations in soft tissues such as the liver and breast. However, the impact of variations in the sound speed and backscatter due to underlying fat content or fibrotic changes, on the attenuation slope has not been addressed. Both numerical and acoustically uniform tissue-mimicking experimental phantoms are used to demonstrate the impact of sound speed variations on attenuation slope using clinical real-time ultrasound scanners equipped with linear array transducers. Radiofrequency data at center frequencies of 4 and 5 MHz are acquired for the experimental and numerical phantoms respectively. Numerical phantom sound speeds between 1480 and 1600 m/s in increments of 20 m/s for attenuation coefficients of 0.3, 0.4, 0.5, 0.6, and 0.7 dB/cm/MHz are simulated. Variations in the attenuation slope when the backscatter intensity of the sample is equal, 3 dB higher, and 3 dB lower than the reference is also evaluated. The sound speed for the experimental tissue-mimicking phantoms were 1500, 1540, 1560 and 1580 m/s respectively, with an attenuation coefficient of 0.5 dB/cm/MHz. Radiofrequency data is processed using three different attenuation estimation algorithms, i.e. the reference phantom, centroid downshift, and a hybrid method. In both numerical and experimental phantoms our results indicate a bias in attenuation slope estimates when the reference phantom sound speed is higher (overestimation) or lower (underestimation) than that of the sample. This bias is introduced via a small spectral shift in the normalized power spectra of the reference and sample with different sound speeds. The hybrid method provides the best estimation performance, especially for sample attenuation coefficient values lower than that of the reference phantom. The performance of all the methods deteriorates when the attenuation coefficient of the reference phantom is lower than that of the sample. In addition, the hybrid method is the least sensitive to sample backscatter intensity variations.

Use of cis-[18F]fluoro-proline for assessment of exercise-related collagen synthesis in musculoskeletal connective tissue

Protein turnover in collagen rich tissue is influenced by exercise, but can only with difficulty be studied in vivo due to use of invasive procedure. The present study was done to investigate the possibility of applying the PET-tracer, cis-[¹⁸F]fluoro-proline (cis-Fpro), for non-invasive assessment of collagen synthesis in rat musculoskeletal tissues at rest and following short-term (3 days) treadmill running. Musculoskeletal collagen synthesis was studied in rats at rest and 24 h post-exercise. At each session, rats were PET scanned at two time points following injection of cis-FPro: (60 and 240 min p.i). SUV were calculated for Achilles tendon, calf muscle and tibial bone. The PET-derived results were compared to mRNA expression of collagen type I and III. Tibial bone had the highest SUV that increased significantly (p<0.001) from the early (60 min) to the late (240 min) PET scan, while SUV in tendon and muscle decreased (p<0.001). Exercise had no influence on SUV, which was contradicted by an increased gene expression of collagen type I and III in muscle and tendon. The clearly, visible uptake of cis-Fpro in the collagen-rich musculoskeletal tissues is promising for multi-tissue studies in vivo. The tissue-specific differences with the highest basal uptake in bone are in accordance with earlier studies relying on tissue incorporation of isotopic-labelled proline. A possible explanation of the failure to demonstrate enhanced collagen synthesis following exercise, despite augmented collagen type I and III transcription, is that SUV calculations are not sensitive enough to detect minor changes in collagen synthesis. Further studies including kinetic compartment modeling must be performed to establish whether cis-Fpro can be used for non-invasive in-vivo assessment of exercise-induced changes in musculoskeletal collagen synthesis.

[Finite element analysis in simulations of ultrasonic elastography]

In this paper, the soft tissue strain under different circumstances was analyzed by using the finite element analysis (FEA) and the Matlab's toolbox. The scope of application of ultrasonic elastography was estimated in theory. The results of analysis indicated the limitation of ultrasonic elastography, and its application prospects. In addition, some characteristics of breast cancers, which are meaningful in clinics, may be estimated using this method.

Sonographic measurements of the thickness of the soft tissues of the interscapular region in a population of normal young adults

BACKGROUND

To use sonography (US) to measure the interscapular soft-tissue thickness and to determine any correlation with anthropometric indices.

METHODS

Fifty-five healthy young adults (21 men and 34 women) with a mean age of 22.1 ± 3.0 years (range, 18-35) were enrolled. High-resolution US was used to measure the bilateral soft-tissue thickness near the medial border of the scapula. Anthropometric indices, including body weight, height, and circumferences of chest, waist, and hip, were also measured.

RESULTS

On the right side, mean values ± standard deviation for the thickness of the trapezius, rhomboid, and posterior serratus muscles in millimeters were 4.9 ± 1.0, 6.3 ± 2.3, and 3.5 ± 1.4, respectively, for men and 3.4 ± 0.8, 3.8 ± 1.7, and 2.2 ± 1.5, respectively, for women. The thickness of each muscle was significantly greater in men than in women (p < 0.05). For both genders, no significant differences in the soft-tissue thicknesses were found between both sides. Based on the anthropometric indices, body weight was the only significant contributor to the soft-tissue thickness.

CONCLUSIONS

US is a practical tool for measuring soft-tissue thickness in the interscapular region. Body weight and soft-tissue thickness are closely associated.

Automated detection of the arterial inner walls of the common carotid artery based on dynamic B-mode signals

In this paper we propose a novel scheme able to automatically detect the intima and adventitia of both near and far walls of the common carotid artery in dynamic B-mode RF (radiofrequency) image sequences, with and without plaques. Via this automated system the lumen diameter changes along the heart cycle can be detected. Three image sequences have been tested and all results are compared to manual tracings made by two professional experts. The average errors for near and far wall detection are 0.058 mm and 0.067 mm, respectively. This system is able to analyze arterial plaques dynamically which is impossible to do manually due to the tremendous human workload involved.

Electrical impedance of acupuncture meridians: the relevance of subcutaneous collagenous bands

Background

The scientific basis for acupuncture meridians is unknown. Past studies have suggested that acupuncture meridians are physiologically characterized by low electrical impedance and anatomically associated with connective tissue planes. We are interested in seeing whether acupuncture meridians are associated with lower electrical impedance and whether ultrasound-derived measures – specifically echogenic collagenous bands - can account for these impedance differences.

Methods/Results

In 28 healthy subjects, we assessed electrical impedance of skin and underlying subcutaneous connective tissue using a four needle-electrode approach. The impedances were obtained at 10 kHz and 100 kHz frequencies and at three body sites - upper arm (Large Intestine meridian), thigh (Liver), and lower leg (Bladder). Meridian locations were determined by acupuncturists. Ultrasound images were obtained to characterize the anatomical features at each measured site. We found significantly reduced electrical impedance at the Large Intestine meridian compared to adjacent control for both frequencies. No significant decrease in impedance was found at the Liver or Bladder meridian. Greater subcutaneous echogenic densities were significantly associated with reduced impedances in both within-site (meridian vs. adjacent control) and between-site (arm vs. thigh vs. lower leg) analyses. This relationship remained significant in multivariable analyses which also accounted for gender, needle penetration depth, subcutaneous layer thickness, and other ultrasound-derived measures.

Conclusion/Significance

Collagenous bands, represented by increased ultrasound echogenicity, are significantly associated with lower electrical impedance and may account for reduced impedances previously reported at acupuncture meridians. This finding may provide important insights into the nature of acupuncture meridians and the relevance of collagen in bioelectrical measurements.

Clinical value of 18F-fluorodeoxyglucose positron emission tomography in patients with connective tissue disease

Connective tissue diseases represent a heterogeneous group of immunologically mediated inflammatory disorders with a large variety of affected organs other than the lung. (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is widely used in oncology but may also be valuable in patients with infections or inflammatory disease. The purpose of this article was to assess the clinical value of (18)F-FDG PET in patients with connective tissue disease. Our experience demonstrates that (18)F-FDG PET is a unique imaging technique for assessing the metabolic activity throughout the body in those with a connective tissue disease. The technique appears to be a promising imaging modality for detecting coexistent neoplastic diseases and other autoimmune disorders.

Assessment of the use of a diffuser in propagation-based x-ray phase contrast imaging

A rotating random-phase-screen diffuser is sometimes employed on synchrotron x-ray imaging beamlines to ameliorate field-of-view inhomogeneities due to electron-beam instabilities and beamline optics phase artifacts. The ideal result is a broader, more uniformly illuminated beam intensity for cleaner coherent x-ray images. The spinning diffuser may be modeled as an ensemble of transversely random thin phase screens, with the resulting set of intensity maps over the detector plane being incoherently averaged over the ensemble. Whilst the coherence width associated with the source is unaffected by the diffuser, the magnitude of the complex degree of second-order coherence may be significantly reduced [K. S. Morgan, S. C. Irvine, Y. Suzuki, K. Uesugi, A. Takeuchi, D. M. Paganin, and K. K. W. Siu, Opt. Commun. 283, 216 (2010)]. Through use of a computational model and experimental data obtained on x-ray beamline BL20XU at SPring-8, Japan, we investigate the effects of such a diffuser on the quality of Fresnel diffraction fringes in propagation-based x-ray phase contrast imaging. We show that careful choice of diffuser characteristics such as thickness and fiber size, together with appropriate placement of the diffuser, can result in the ideal scenario of negligible reduction in fringe contrast whilst the desired diffusing properties are retained.

Photoacoustic imaging of clinical metal needles in tissue

The ability to visualize and track temporarily or permanently implanted metal devices is important in many applications ranging from diagnosis to therapy. Specifically, reliable imaging of metal needles is required in today's clinical settings. Currently, ultrasound is utilized to image a needle inserted into tissue in real time. However, the diagnostic value and tracking ability of these images depends highly on the orientation of the needle, and also its proximity to regions of interest in the tissue. We examine the use of photoacoustic imaging combined with current ultrasound imaging methods to obtain high-contrast images of commonly used needles in the body. Experiments were performed using 21 G and 30 G needles inserted into ex vivo porcine tissue and tissue-mimicking phantoms. The needles and surrounding tissue were imaged using an ultrasound imaging system interfaced with the pulsed laser source necessary for photoacoustic imaging. The results suggest that photoacoustic imaging, combined with ultrasound imaging, is capable of real-time, high-contrast, and high-spatial-resolution visualization of metal implants within anatomical landmarks of the background tissue.

Radiographic anatomy of the soft tissue attachments of the equine stifle

REASONS FOR PERFORMING STUDY

Radiography is a very important aspect of equine stifle imaging. The precise radiographic anatomy of the soft tissue structures of the equine stifle has not been described previously.

OBJECTIVE

To describe the anatomical relationship between sites of attachment of soft tissue structures of the equine stifle and their locations on standard radiographic views.

METHODS

The sites of bony attachments of the tendons, ligaments and fibrous portion of the joint capsules of equine stifles were determined by gross dissection. These sites of attachment were transposed onto one set of bones deprived of soft tissue and mapped using radiopaque markers. This specimen was then radiographed in the standard radiographic projections (lateromedial, caudocranial and caudal 60 degrees lateral-craniomedial oblique) to determine the position of the attachment sites on the radiographs.

RESULTS

Two radiographic maps were drawn per radiographic projection, one for the attachment sites of the ligaments and tendons and one for the attachment sites of the joint capsules.

CONCLUSIONS AND POTENTIAL RELEVANCE

The radiographic maps of the precise position of the soft tissue attachments of the tendons, ligaments and joint capsules of the equine stifle should assist interpretation of equine stifle radiographs.

Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

BACKGROUND

Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.

METHODS

In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.

RESULTS

There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had approximately 25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p<0.01 and p<0.001 respectively).

CONCLUSION

This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.

Speckle tracking ultrasound for assessment of the relative motion of flexor tendon and subsynovial connective tissue in the human carpal tunnel

The objective of this study was to compare tissue Doppler imaging and speckle tracking ultrasound to assess the relative motion of flexor tendon and surrounding subsynovial connective tissue (SSCT). Twenty normal human wrists were imaged with an ultrasound scanner. The two ultrasound methods measured the excursion and maximum velocity of the tendon and SSCT while subjects gripped three different sized acrylic tubes and these were correlated with tendon excursions estimated from finger joint angle changes. The maximum velocity ratio (=SSCT/tendon velocity) and the shear index (=[(Tendon excursion-SSCT excursion)/Tendon excursion]x100%) were calculated. The intraclass correlation coefficient was higher for joint angle/speckle tracking tendon excursion (0.642) than for joint angle/tissue Doppler excursion (0.377). The speckle tracking method could also discriminate differences in maximum velocity ratio and shear index for different tube sizes. We conclude that speckle tracking may be useful in assessing the relative motion of tendon and SSCT.

A feasibility study of temperature rise measurement in a tissue phantom as an alternative way for characterization of the therapeutic high intensity focused ultrasonic field

The feasibility that temperature field measurements in vitro as an alternative way to characterize the high intensity focused ultrasound (HIFU) field used in therapeutic applications has been explored in a phantom study. Thermocouples (copper-constantan, diameter 0.125 mm) are embedded in a phantom filled with tissue mimicking material that simulates the thermal and acoustic properties of soft-tissue. The temperature rises as a function of ultrasound exposure time near the focus of a HIFU transducer (1.1 MHz, active radius a=32 mm, geometric focal length=62 mm) of various acoustic powers up to 30 W are measured and compared with predicted values using a simple nonlinear Gaussian model. The experimental results can be explained well by the model if no acoustic cavitation takes place. When the acoustic power become higher (>5 W) and the local temperature elevation >15 degrees C and the local temperature is >40 degrees C at the focal point, cavitation vapor bubbles appear. The presence of the cavitation bubbles may increase the temperature rise rate initially. The bubble aggregates may form along the beam axis under sonication and then eventually makes the temperature elevation reach a saturated value. When acoustic cavitation occurs, the bubble-assisted enhancement of the initial temperature rise (exposure time t<2s) can still be predicted by the theory.

A heterogeneous nonlinear attenuating full-wave model of ultrasound

A full-wave equation that describes nonlinear propagation in a heterogeneous attenuating medium is solved numerically with finite differences in the time domain (FDTD). Three-dimensional solutions of the equation are verified with water tank measurements of a commercial diagnostic ultrasound transducer and are shown to be in excellent agreement in terms of the fundamental and harmonic acoustic fields and the power spectrum at the focus. The linear and nonlinear components of the algorithm are also verified independently. In the linear nonattenuating regime solutions match results from Field II, a well established software package used in transducer modeling, to within 0.3 dB. Nonlinear plane wave propagation is shown to closely match results from the Galerkin method up to 4 times the fundamental frequency. In addition to thermoviscous attenuation we present a numerical solution of the relaxation attenuation laws that allows modeling of arbitrary frequency dependent attenuation, such as that observed in tissue. A perfectly matched layer (PML) is implemented at the boundaries with a numerical implementation that allows the PML to be used with high-order discretizations. A -78 dB reduction in the reflected amplitude is demonstrated. The numerical algorithm is used to simulate a diagnostic ultrasound pulse propagating through a histologically measured representation of human abdominal wall with spatial variation in the speed of sound, attenuation, nonlinearity, and density. An ultrasound image is created in silico using the same physical and algorithmic process used in an ultrasound scanner: a series of pulses are transmitted through heterogeneous scattering tissue and the received echoes are used in a delay-and-sum beam-forming algorithm to generate a images. The resulting harmonic image exhibits characteristic improvement in lesion boundary definition and contrast when compared with the fundamental image. We demonstrate a mechanism of harmonic image quality improvement by showing that the harmonic point spread function is less sensitive to reverberation clutter.

New echocardiographic imaging method based on the bandwidth of the ultrasound Doppler signal with applications in blood/tissue segmentation in the left ventricle

A new imaging method, Bandwidth Imaging, which is related to the bandwidth of the ultrasound Doppler signal is proposed as a classification function for blood and tissue signal in transthoracial echocardiography in the left ventricle. An in vivo experiment is presented, where the apparent error rate of Bandwidth Imaging is compared with the apparent error rate of Second-Harmonic Imaging on 15 healthy men. The apparent error rates are calculated from the 16 myocardial wall segments defined in [M.D., Cerqueira, N.J. Weissman, V. Dilsizian, A.K. Jacobs, S. Kaul, W.K. Laskey, D.J. Pennell, J.A. Rumberger, T. Ryan, M.S. Verani, Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart, Circulation (2002) 539-542]. A hypothesis test of Bandwidth Imaging having lower apparent error rate than Second-Harmonic Imaging is proved for a p-value of 0.94 in three segments in end diastole and in one segment in end systole. When data was averaged by a structural element of five radial, three lateral and four temporal samples the numbers of segments increased to nine in end diastole and to six in end systole. This experiment indicates that Bandwidth Imaging can supply additional information for automatic border detection routines on endocardium.

Detection of optical and mechanical property inhomogeneities in tissue mimicking phantoms using an ultrasound assisted optical probe

We discuss the issue of separating contributions from mechanical and optical properties of a moderately scattering tissue phantom to the modulation depth (M) of intensity autocorrelation measured in an ultrasound-assisted optical tomography system using axial and transverse illuminations. For axial illumination, M is affected by both the displacement and absorption coefficient, more prominently by displacement. But transverse illumination has very little contribution from displacement of scattering centers. Since displacement is related to the elastic property of the insonified region, we show that there is a possibility of separating the contributions from elastic and optical properties of the insonified region using axial and transverse illuminations. The main conclusions of our study using moderately scattering phantoms are: 1. axial illumination is the best for mapping storage modulus inhomogeneities, but M is also affected by optical absorption; 2. transverse illumination is the best for mapping absorption inhomogeneities; and 3. for the practically relevant case of an inclusion with larger storage modulus and absorption, both illuminations produced large contrast in M. When the scattering coefficient is high, the angle dependence of illumination is lost and the present method is shown to fail to separate these contributions based on direction of illumination.

Modeling the impact of soft tissue on axial transmission measurements of ultrasonic guided waves in human radius

Recent in vitro and simulation studies have shown that guided waves measured at low ultrasound frequencies (f=200 kHz) can characterize both material properties and geometry of the cortical bone wall. In particular, a method for an accurate cortical thickness estimation from ultrasound velocity data has been presented. The clinical application remains, however, a challenge as the impact of a layer of soft tissue on top of the bone is not yet well established, and this layer is expected to affect the dispersion and relative intensities of guided modes. The present study is focused on the theoretical modeling of the impact of an overlying soft tissue. A semianalytical method and finite-difference time domain simulations were used. The models developed were shown to predict consistently real in vivo data on human radii. As a conclusion, clinical guided wave data are not consistent with in vitro data or related in vitro models, but use of an adequate in vivo model, such as the one introduced here, is necessary. A theoretical model that accounts for the impact of an overlying soft tissue could thus be used in clinical applications.

Dual-frequency ultrasound--new pulse-echo technique for bone densitometry

Quantitative ultrasound has been suggested for screening of osteoporosis. Most commercial ultrasound devices are based on the through-transmission measurement of calcaneus, which is not a typical fracture site. In contrast to through-transmission measurements, reflection and backscattering measurements may be conducted at typical fracture sites such as vertebra and proximal femur. At these regions, soft tissues overlying bones affect reliability of the measurements. In this study, a novel dual-frequency ultrasound (DFUS) pulse-echo technique is introduced for reduction of the errors induced by soft tissues. First, DFUS was validated using elastomer samples. For further validation, human trabecular bone samples (n = 25) covered with heterogeneous soft tissues were measured at frequencies of 2.25 MHz and 5.0 MHz. The DFUS technique reduced (p < 0.01) the mean error induced by soft tissue from 58.6% to -4.9% and from 127.4% to 23.8% in broadband ultrasound backscattering and integrated reflection coefficient (at 5.0 MHz), respectively. To conclude, the DFUS, being the first ultrasound technique capable of determination of the composition and thickness of the soft tissue overlying the bone, may enhance the accuracy of clinical ultrasound measurements. Thereby, DFUS shows a significant clinical potential.

Sonographic criteria for the confirmation of implant rotation and the development of an implant-capsule-interaction ("interface") in anatomically formed textured breast implants with texturised Biocell-surface

AIM

In comparison to round breast implants, anatomically formed implants have a broader indication spectrum in augmentation surgery for the formation of a natural breast shape. In order to achieve a long-term result, it is necessary for anatomically formed breast implants to remain secured in the position desired and planned initially. In the case of textured implants of a certain pore size and depth, this can be aided by the development of a stabilising implant-capsule-interaction (interface). The aim of this study was to investigate whether there are sonographic criteria for verifying the position of anatomically formed breast implants and the development of a stable interface.

MATERIAL AND METHODS

628 patients underwent breast implant surgery and were followed up clinically as well as sonographically at the Frauenklinik und Institut für Asthetische Chirugie am St. Josefs-Hospital, Wiesbaden. 228 implants (Style 410 Inamed McGhain) were evaluated after a mean of 27 months postoperatively. Only cosmetic augmentations were included in the results. Verification of the implant position was conducted by palpation as well as by sonography. Statistical analysis was performed using the McNemar-Test (Chi-squared test).

RESULTS

Two marker points on the anterior side of the implant capsule in the lower hemisphere, which are designed for intraoperative position monitoring by palpation, could be reproduced sonographically in all cases and the position of the breast implant could thereby by determined. Two cases of clinically apparent implant rotation of more than 90 degrees around the vertical axis were discovered in this way. The sonographical identification of the development of a stable interface between the implant and the periprosthetic capsule is possible when sonographic criteria of the "parasternal movement layer" are met. The sonographic outcome is significantly superior to palpation.

CONCLUSION

Breast sonography used for the clinical follow-up of patients with anatomically formed breast implants represents an efficient diagnostic supplement with clinical relevance.

Regularization for ultrasonic measurements of tissue displacement vector and strain tensor

In this report, we present the regularization results of displacement vector measurement by the multidimensional cross-spectrum phase gradient method (MCSPGM), multidimensional autocorrelation method (MAM), and multidimensional Doppler method (MDM) without lateral modulation. In addition to the results of spatially variant regularization in displacement vector measurement using displacement variances, the results of displacement component-dependent regularization are presented. That is, according to the measurement accuracy of displacement components, the regularization is properly applied to the respective displacement components. For instance, only the regularization on the lateral displacement is effective. That is, for the lateral nonmodulation case, the accuracies and stabilities of lateral/elevational displacement measurements significantly increase. In conjunction, the convergence speed of phase matching also increases. The demonstrated measurements of the displacement vector distributions in experiments using inhomogeneous shear modulus agar phantoms confirm that displacement-componentdependent regularization enables better strain tensor measurement and shear modulus reconstruction from the viewpoints of accuracy and stability. The contrast-to-noise ratio (CNR) is useful to set regularization parameters properly for the displacement regularization, whereas the CNR is useless for shear modulus regularization in the sense that the accuracy of reconstruction value cannot be evaluated.

Elasticity reconstruction from displacement and confidence measures of a multi-compressed ultrasound RF sequence

Ultrasound elasticity imaging shows promise as a new way for early detection of cancers by assessing the elastic characteristics of soft tissue. So far the commonly used approach involves solving the so-called inverse elasticity problem of recovering elastic parameters from displacement measurements. We propose a finite-elementbased nonlinear scheme to estimate the elasticity distribution of soft tissue from multi-compressed ultrasound radio frequency (RF) data. An experimental ultrasound workstation has been developed to acquire multi-compressed data. A composite probe was employed as the compression plate. The contact forces and torques were acquired at the same time as imaging. Axial displacements under different static loads are estimated from the RF data before and after deformation using a cross-correlation technique. The confidence of displacement estimates is employed as a weighting factor in solving the objective function describing the inverse elasticity reconstruction problem. A novel splitand- merge strategy is employed over the image sequence in which strain images are used to provide a priori knowledge of the relative stiffness distribution of the tissue to constrain the inverse problem solution. The experimental study has allowed us to investigate the performance of our approach in the controlled environment of simulated and phantom data. For a simulated single inclusion model with 5% axial displacement estimation error, the L2-error between the target and the reconstructed Young's modulus was found to be about 1%. In vivo validation of the proposed method has been carried out and some preliminary results are presented.

Narrowband shear wave generation by a Finite-Amplitude radiation force: The fundamental component

A highly localized source of low-frequency shear waves can be created by the modulated radiation force resulting from two intersecting quasi-continuous-wave ultrasound beams of slightly different frequencies. In contrast to most other radiation force-based methods, these shear waves can be narrowband. Consequently, different frequency-dependent effects will not significantly affect their spectrum as they propagate within a viscoelastic medium, thereby enabling the viscoelastic shear properties of the medium to be determined at any given modulation frequency. This can be achieved by tracking the shear wave phase delay and change in amplitude over a specific distance. In this paper we explore the properties of short duration (dynamic) low-frequency shear wave propagation and study how the shear displacement field depends on the excitation conditions. Our investigations make use of the approximate Green's functions for viscoelastic media, and the evolution of such waves is studied in the spatiotemporal domain from a theoretical perspective. Although nonlinearities are included in our confocal source model, just the properties of the fundamental shear component are examined in this paper. We examine how the shear wave propagation is affected by the shear viscosity, the coupling wave, the spatial distribution of the force, the shear speed, and the duration of the modulated wave. A method is proposed for estimating the shear viscosity of a viscoelastic medium. In addition, it is shown how the Voigt model paremeters can be extracted from the frequency-dependent speed and attenuation.

2-D locally regularized tissue strain estimation from radio-frequency ultrasound images: theoretical developments and results on experimental data

In this paper, a 2-D locally regularized strain estimation method for imaging deformation of soft biological tissues from radio-frequency (RF) ultrasound (US) data is introduced. Contrary to most 2-D techniques that model the compression-induced local displacement as a 2-D shift, our algorithm also considers a local scaling factor in the axial direction. This direction-dependent model of tissue motion and deformation is induced by the highly anisotropic resolution of RF US images. Optimal parameters are computed through the constrained maximization of a similarity criterion defined as the normalized correlation coefficient. Its value at the solution is then used as an indicator of estimation reliability, the probability of correct estimation increasing with the correlation value. In case of correlation loss, the estimation integrates an additional constraint, imposing local continuity within displacement and strain fields. Using local scaling factors and regularization increase the method's robustness with regard to decorrelation noise, resulting in a wider range of precise measurements. Results on simulated US data from a mechanically homogeneous medium subjected to successive uniaxial loadings demonstrate that our method is theoretically able to accurately estimate strains up to 17%. Experimental strain images of phantom and cut specimens of bovine liver clearly show the harder inclusions.

Viscoelastic property measurement in thin tissue constructs using ultrasound

We present a dual-element concave ultrasound transducer system for generating and tracking of localized tissue displacements in thin tissue constructs on rigid substrates. The system is comprised of a highly focused PZT-4 5-MHz acoustic radiation force (ARF) transducer and a confocal 25-MHz polyvinylidene fluoride imaging transducer. This allows for the generation of measurable displacements in tissue samples on rigid substrates with thickness values down to 500 microm. Impulse-like and longer duration sine-modulated ARF pulses are possible with intermittent M-mode data acquisition for displacement tracking. The operations of the ARF and imaging transducers are strictly synchronized using an integrated system for arbitrary waveform generation and data capture with a shared timebase. This allows for virtually jitter-free pulse-echo data well suited for correlation-based speckle tracking. With this technique we could faithfully capture the entire dynamics of the tissue axial deformation at pulse-repetition frequency values up to 10 kHz. Spatio-temporal maps of tissue displacements in response to a variety of modulated ARF beams were produced in tissue-mimicking elastography phantoms on rigid substrates. The frequency response was measured for phantoms with different modulus and thickness values. The frequency response exhibited resonant behavior with the resonance frequency being inversely proportional to the sample thickness. This resonant behavior can be used in obtaining high-contrast imaging using magnitude and phase response to sinusoidally modulated ARF beams. Furthermore, a second order forced harmonic oscillator (FHO) model was shown to capture this resonant behavior. Based on the FHO model, we used the extended Kalman filter (EKF) for tracking the apparent modulus and viscosity of samples subjected to dc and sinusoidally modulated ARF. The results show that the stiffness (apparent modulus) term in the FHO is largely time-invariant and can be estimated robustly using the EKF. On the other hand, the damping (apparent viscosity) is time varying. These findings were confirmed by comparing the magnitude response of the FHO (with parameters obtained using the EKF) with the measured ones for different thin tissue constructs.

Ultrasonic scattering by a fluid cylinder of elliptic cross section, including viscous effects

This paper analyzes acoustic scattering by a viscous compressible fluid cylinder of elliptic cross section submerged in an unbounded viscous nonheat-conducting compressible fluid medium. The classical method of eigenfunction expansion along with the appropriate wave field expansions and the pertinent boundary conditions are used to develop a solution in the form of infinite series involving Mathieu and modified Mathieu functions of complex arguments. The complications arising due to the nonorthogonality of angular Mathieu functions corresponding to distinct wave numbers in addition to the problems associated with the appearance of additional angular-dependent terms in the boundary conditions are all avoided in an elegant manner by expansion of the angular Mathieu functions in terms of transcendental functions and subsequent integration, leading to a linear set of independent equations in terms of the unknown scattering coefficients. A multiprecision code was developed for computing the Mathieu functions of complex argument in terms of complex Fourier coefficients that are themselves calculated by numerically solving appropriate sets of eigen-systems. The numerical results point to the imperative influence of fluid viscosity in notable reduction of pressure amplitudes at intermediate and high frequencies. They also reveal the central role of the cross sectional ellipticity in conjunction with the angle of incidence in altering the pressure directivities. Limiting cases are considered, and fair agreements with well-known solutions are obtained.

Regularization of tissue shear modulus reconstruction using strain variance

An effective setting method (that is, a method using the variances of strain tensor component measurements) is described for the properly spatially varied regularization parameters for our shear modulus reconstruction. At each position, the respective strain variances can be experimentally evaluated using plural field measurements or single field measurement, for example, when using all crosscorrelation- based methods, by using the Ziv-Zakai Lower Bound (ZZLB). The demonstrated regularization by the single field measurement using the cross-spectrum phase gradient method (MCSPGM) in experiments confirms that the use of the axial strain variance estimated by the echo signal-to-noise ratio and correlations (the combined SNRc) effectively stabilizes the 1-D reconstruction on an agar phantom and a human in vivo liver carcinoma during interstitial microwave thermal treatment. The regularization yields a spatially uniform stability in reconstruction.

Phase-based ultrasonic deformation estimation

Deformation estimation is the foundation of emerging techniques for imaging the mechanical properties of soft tissues. We present theoretical analysis and experimental results from an investigation of phase-based ultrasonic deformation estimators. Numerous phase-based algorithm variants were tested quantitatively on simulated RF data from uniform scatterer fields, subject to a range of uniform strain deformations. Particular attention is paid to a new algorithm, weighted phase separation, the performance of which is demonstrated in application to in vivo freehand strain imaging. Good results support the theory that underlies the new algorithm, and more generally highlight the factors that should be considered in the design of high performance deformation estimators for practical applications. For context, note that this represents progress with an algorithm class that is suitable for real-time applications, yet has already been shown quantitatively to offer greater accuracy over a wide range of scanning conditions than adaptive companding methods based on correlation coefficient or sum of absolute differences.

[Soft tissue balancing in valgus gonarthrosis]

Implanting a condylar knee in patients with valgus deformity is challenging both for the surgeon and in terms of clinical instrumentation. Valgus deformity - defined as an anatomic angle >10 degrees - consists of a bony and a soft tissue component. Frequently, the lateral femoral condyle is hypoplastic and can create a secondary osteochondral lesion on the tibial plateau. Concomitantly, there is a soft tissue contracture of the lateral side with an elongation of the medial collateral ligament. Correction of the deformity and restoration of anatomic alignment should be achieved to maximize the longevity of the replaced components. Soft tissue balancing is crucial for successful treatment. This is achieved if a symmetrical flexion and extension gap together with a centralized patella position is obtained. We describe our surgical approach to address valgus deformities in primary total knee arthroplasty with special emphasize on a stepwise release of tight lateral capsular and ligamentous structures controlled by a knee balancer.

Acoustoelasticity in soft solids: assessment of the nonlinear shear modulus with the acoustic radiation force

The assessment of viscoelastic properties of soft tissues is enjoying a growing interest in the field of medical imaging as pathologies are often correlated with a local change of stiffness. To date, advanced techniques in that field have been concentrating on the estimation of the second order elastic modulus (mu). In this paper, the nonlinear behavior of quasi-incompressible soft solids is investigated using the supersonic shear imaging technique based on the remote generation of polarized plane shear waves in tissues induced by the acoustic radiation force. Applying a theoretical approach of the strain energy in soft solid [Hamilton et al., J. Acoust. Soc. Am. 116, 41-44 (2004)], it is shown that the well-known acoustoelasticity experiment allowing the recovery of higher order elastic moduli can be greatly simplified. Experimentally, it requires measurements of the local speed of polarized plane shear waves in a statically and uniaxially stressed isotropic medium. These shear wave speed estimates are obtained by imaging the shear wave propagation in soft media with an ultrafast echographic scanner. In this situation, the uniaxial static stress induces anisotropy due to the nonlinear effects and results in a change of shear wave speed. Then the third order elastic modulus (A) is measured in agar-gelatin-based phantoms and polyvinyl alcohol based phantoms.

Anatomo-radiological study of the superficial musculo-aponeurotic system of the face

The aim of the study was to analyse the appearance of the superficial muscolo-aponeurotic system (SMAS) in radiological images (Magnetic Resonance -MR- and Computed tomography -CT- scans, 10M, 10F randomly selected) in the three regions of the face (the parotid and cheek regions and the nasolabial fold). In axial CT images, the SMAS appears as a relatively hyperdense tortuous line between the hypodense superficial fibroadipose tissue (SAT) and the hypodense deep adipose tissue (DAT). In parotid region SAT is well represented (mean thickness 4.32 +/- 2.9 mm), whereas DAT is very thin (0.33 +/- 0.48 mm); SMAS appears as a thin hyperdense line, close to the parotid gland (0.76 +/- 0.43 mm). In cheek region, SAT is well represented (5.57 +/- 1.17 mm), whereas DAT is thinner (2.94 +/- 0.62 mm), and SMAS is well recognisable (1.69 +/- 0.52 mm). At the level of the nasolabial fold, the SAT is poorly represented (0.37 +/- 0.06 mm); the SMAS continues in the mimic muscles (2.41 +/- 0.05 mm), and DAT shows a mean thickness of 2.15 +/- 0.63 mm. In the MR examination, the SMAS appears as a thin continuous line hypointense in the T1-and T2-weighted sequence, from parotid region to nasolabial fold, comprising mimic muscles in the anterior region of the cheek and at the level of the nasolabial fold. No significative differences in thickness between CT and MR were found. Our anatomo-radiological study confirms that the subcutaneous architecture of the face consists of multiple layers of tissues that connect facial muscles with the dermis. This pattern of arrangement shows a progressive centrifugal thinning towards the adjacent regions.

Congruence of imaging estimators and mechanical measurements of viscoelastic properties of soft tissues

Biomechanical properties of soft tissues are important for a wide range of medical applications, such as surgical simulation and planning and detection of lesions by elasticity imaging modalities. Currently, the data in the literature is limited and conflicting. Furthermore, to assess the biomechanical properties of living tissue in vivo, reliable imaging-based estimators must be developed and verified. For these reasons, we developed and compared two independent quantitative methods--crawling wave estimator (CRE) and mechanical measurement (MM) for soft tissue characterization. The CRE method images shear wave interference patterns from which the shear wave velocity can be determined and hence the Young's modulus can be obtained. The MM method provides the complex Young's modulus of the soft tissue from which both elastic and viscous behavior can be extracted. This article presents the systematic comparison between these two techniques on the measurement of gelatin phantom, veal liver, thermal-treated veal liver and human prostate. It was observed that the Young's moduli of liver and prostate tissues slightly increase with frequency. The experimental results of the two methods are highly congruent, suggesting CRE and MM methods can be reliably used to investigate viscoelastic properties of other soft tissues, with CRE having the advantages of operating in nearly real time and in situ.

Effect of local simvastatin application on mandibular defects

Osteoinductive characteristics of bone grafts are important for enhancing osseous healing at grafted defect sites. The cholesterol-lowering drug simvastatin has been shown to stimulate bone formation by increasing the gene expression of bone morphogenetic protein-2 and vascular endothelial growth factor. The purpose of this study was to determine the effect of local simvastatin application on bone defect healing and compare the amount of new bone produced by simvastatin gelatin sponge graft with that produced by a gelatin sponge graft and with natural healing. Twenty-one bone defects at 3 mm diameter were created in the angulus mandible region of Wistar albino rats. In the experimental group, nine defects were grafted with simvastatin dissolved in water mixed with a gelatin sponge. In the control groups, eight defects were grafted with water mixed with a gelatin sponge alone (active control) and six were left empty (passive control). Animals were killed on day 14 and the defects were prepared for radiologic and histologic assessment. Density of the regenerate was evaluated by peripheral quantitative computed tomography. The density of the experimental group was 240% more than the passive control group and 190% more than the active control group (P < 0.01). Histologic examination also showed more new bone formation in the experimental group than control groups. In conclusion, the simvastatin gelatin sponge enhanced bone defect healing in the mandible of rats.

Extraction of mechanical properties of foot plantar tissues using ultrasound indentation associated with genetic algorithm

This paper demonstrates the use of ultrasound indentation technique for estimating the mechanical properties of foot plantar tissues in virtue of the reconstruction of the force response using genetic algorithm (GA) from an indentation test based on a quasi-linear viscoelastic (QLV) model. The indentation test on the plantar tissues covering the right first metatarsal head of a normal subject was carried out to verify the feasibility of the GA for the extraction of the tissue properties. The QLV properties of the plantar tissues were determined by the GA with a fixed Poisson's ratio. Such results were then compared with those obtained using a classical optimization method. Moreover, the GA was further employed to simultaneously determine the QLV properties as well as the Poisson's ratio of the plantar tissues. The correlations between the QLV properties and the Poisson's ratio are discussed.

A shape-guided deformable model with evolutionary algorithm initialization for 3D soft tissue segmentation

We present a novel method for the segmentation of volumetric images, which is especially suitable for highly variable soft tissue structures. Core of the algorithm is a statistical shape model (SSM) of the structure of interest. A global search with an evolutionary algorithm is employed to detect suitable initial parameters for the model, which are subsequently optimized by a local search similar to the Active Shape mechanism. After that, a deformable mesh with the same topology as the SSM is used for the final segmentation: While external forces strive to maximize the posterior probability of the mesh given the local appearance around the boundary, internal forces governed by tension and rigidity terms keep the shape similar to the underlying SSM. To prevent outliers and increase robustness, we determine the applied external forces by an algorithm for optimal surface detection with smoothness constraints. The approach is evaluated on 54 CT images of the liver and reaches an average surface distance of 1.6 +/- 0.5 mm in comparison to manual reference segmentations.

Elasticity imaging of polymeric media

Viscoelastic properties of soft tissues and hydropolymers depend on the strength of molecular bonding forces connecting the polymer matrix and surrounding fluids. The basis for diagnostic imaging is that disease processes alter molecular-scale bonding in ways that vary the measurable stiffness and viscosity of the tissues. This paper reviews linear viscoelastic theory as applied to gelatin hydrogels for the purpose of formulating approaches to molecular-scale interpretation of elasticity imaging in soft biological tissues. Comparing measurements acquired under different geometries, we investigate the limitations of viscoelastic parameters acquired under various imaging conditions. Quasi-static (step-and-hold and low-frequency harmonic) stimuli applied to gels during creep and stress relaxation experiments in confined and unconfined geometries reveal continuous, bimodal distributions of respondance times. Within the linear range of responses, gelatin will behave more like a solid or fluid depending on the stimulus magnitude. Gelatin can be described statistically from a few parameters of low-order rheological models that form the basis of viscoelastic imaging. Unbiased estimates of imaging parameters are obtained only if creep data are acquired for greater than twice the highest retardance time constant and any steady-state viscous response has been eliminated. Elastic strain and retardance time images are found to provide the best combination of contrast and signal strength in gelatin. Retardance times indicate average behavior of fast (1-10 s) fluid flows and slow (50-400 s) matrix restructuring in response to the mechanical stimulus. Insofar as gelatin mimics other polymers, such as soft biological tissues, elasticity imaging can provide unique insights into complex structural and biochemical features of connectives tissues affected by disease.

Dynamic morphometric characterization of local connective tissue network structure in humans using ultrasound

Background

In humans, connective tissue forms a complex, interconnected network throughout the body that may have mechanosensory, regulatory and signaling functions. Understanding these potentially important phenomena requires non-invasive measurements of collagen network structure that can be performed in live animals or humans. The goal of this study was to show that ultrasound can be used to quantify dynamic changes in local connective tissue structure in vivo. We first performed combined ultrasound and histology examinations of the same tissue in two subjects undergoing surgery: in one subject, we examined the relationship of ultrasound to histological images in three dimensions; in the other, we examined the effect of a localized tissue perturbation using a previously developed robotic acupuncture needling technique. In ten additional non-surgical subjects, we quantified changes in tissue spatial organization over time during needle rotation vs. no rotation using ultrasound and semi-variogram analyses.

Results

3-D renditions of ultrasound images showed longitudinal echogenic sheets that matched with collagenous sheets seen in histological preparations. Rank correlations between serial 2-D ultrasound and corresponding histology images resulted in high positive correlations for semi-variogram ranges computed parallel (r = 0.79, p < 0.001) and perpendicular (r = 0.63, p < 0.001) to the surface of the skin, indicating concordance in spatial structure between the two data sets. Needle rotation caused tissue displacement in the area surrounding the needle that was mapped spatially with ultrasound elastography and corresponded to collagen bundles winding around the needle on histological sections. In semi-variograms computed for each ultrasound frame, there was a greater change in the area under the semi-variogram curve across successive frames during needle rotation compared with no rotation. The direction of this change was heterogeneous across subjects. The frame-to-frame variability was 10-fold (p < 0.001) greater with rotation than with no rotation indicating changes in tissue structure during rotation.

Conclusion

The combination of ultrasound and semi-variogram analyses allows quantitative assessment of dynamic changes in the structure of human connective tissue in vivo.

Tissue strain imaging using a wavelet transform-based peak search algorithm

A new method is proposed to estimate the motion and relative local compression between two successive ultrasound RF signals under different compression states. The algorithm uses the continuous wavelet transform to locate the peaks in the RF signals. The estimated peaks in the pre- and post-compression signals are assigned to each other by a peak matching technique with the goal of minimizing the number of false matches. The method allows local shifts of the tissue to be estimated. The method has been tested in one-dimensional simulations and phantom experiments. The signal-to-noise ratio and the rms error are shown to be better than for the standard cross-correlation method (CC). The new estimator remains unbiased for up to 10% strain which is a larger range than that of CC. The maximum signal-to-noise ratio is 3 times as high as that of the CC method, showing higher sensitivity as well. The method is computationally efficient, achieving 0.7 msec/RF line on a standard personal computer.

The accuracy of computer-assisted surgical planning in soft tissue prediction following orthognathic surgery

BACKGROUND

The purpose of the present study was to evaluate the accuracy of a computer-assisted imaging system in predicting the soft tissue response following orthognathic surgery.

METHODS

The study sample consisted of 11 adult patients with a mean age of 23.5 years. The preoperative and postoperative lateral cephalograms were obtained after orthodontic preparation and immediately before surgery and at least 1 year after surgery. The computer-generated soft tissue image and the actual surgical outcome were compared to evaluate the accuracy of the imaging system.

RESULTS

In the sagittal plane, the tip of nose was the most accurate site and the largest difference was shown in the upper lip. The lower lip was noted to be the least accurate and the subnasale the most accurate region in the vertical plane. Predictions were found to be more accurate for the sagittal plane when compared with those for the vertical plane.

CONCLUSIONS

Computer-assisted visual treatment objectives was proved to be satisfactory in predicting the soft tissue outcome following orthognathic surgery.

Automatic segmentation of jaw tissues in CT using active appearance models and semi-automatic landmarking

Preoperative planning systems are commonly used for oral implant surgery. One of the objectives is to determine if the quantity and quality of bone is sufficient to sustain an implant while avoiding critical anatomic structures. We aim to automate the segmentation of jaw tissues on CT images: cortical bone, trabecular core and especially the mandibular canal containing the dental nerve. This nerve must be avoided during implant surgery to prevent lip numbness. Previous work in this field used thresholds or filters and needed manual initialization. An automated system based on the use of Active Appearance Models (AAMs) is proposed. Our contribution is a completely automated segmentation of tissues and a semi-automatic landmarking process necessary to create the AAM model. The AAM is trained using 215 images and tested with a leave-4-out scheme. Results obtained show an initialization error of 3.25% and a mean error of 1.63mm for the cortical bone, 2.90 mm for the trabecular core, 4.76 mm for the mandibular canal and 3.40 mm for the dental nerve.

Ultrasound motion estimation using a hierarchical feature weighting algorithm

The quality of ultrasonic images is usually influenced by speckle noises and the temporal decorrelation of the speckle patterns. Most traditional motion estimation algorithms are not suitable for speckle tracking in medical ultrasonic images which usually have a low signal-to-noise ratio (SNR). This paper proposes a new motion estimation algorithm that is designed for assessing the dense velocity fields of soft tissue motion in a sequence of ultrasonic B-mode images. We design a hierarchical maximum a posteriori estimator together with an adaptive feature weighted mechanism to estimate the motion field from an ultrasonic image sequence. The proposed method was compared with several existing motion estimation methods via a series of experiments with synthetic speckle image sequences. Performance was also tested on in vivo ultrasonic images. The experimental results show that motion can be assessed with better accuracy than other methods for synthetic speckle images and a good correspondence with clinicians' observations has also been achieved for clinical ultrasonic images.

PSF dedicated to estimation of displacement vectors for tissue elasticity imaging with ultrasound

This paper investigates a new approach devoted to displacement vector estimation in ultrasound imaging. The main idea is to adapt the image formation to a given displacement estimation method to increase the precision of the estimation. The displacement is identified as the zero crossing of the phase of the complex cross-correlation between signals extracted from the lateral direction of the ultrasound RF image. For precise displacement estimation, a linearity of the phase slope is needed as well as a high phase slope. Consequently, a particular point spread function (PSF) dedicated to this estimator is designed. This PSF, showing oscillations in the lateral direction, leads to synthesis of lateral RF signals. The estimation is included in a 2-D displacement vector estimation method. The improvement of this approach is evaluated quantitatively by simulation studies. A comparison with a speckle tracking technique is also presented. The lateral oscillations improve both the speckle tracking estimation and our 2-D estimation method. Using our dedicated images, the precision of the estimation is improved by reducing the standard deviation of the lateral displacement error by a factor of 2 for speckle tracking and more than 3 with our method compared to using conventional images. Our method performs 7 times better than speckle tracking. Experimentally, the improvement in the case of a pure lateral translation reaches a factor of 7. Finally, the experimental feasibility of the 2-D displacement vector estimation is demonstrated on data acquired from a Cryogel phantom.

3D soft tissue imaging with a mobile C-arm

We introduce a clinical prototype for 3D soft tissue imaging to support surgical or interventional procedures based on a mobile C-arm. An overview of required methods and materials is followed by first clinical images of animals and human patients including dosimetry. The mobility and flexibility of 3D C-arms gives free access to the patient and therefore avoids relocation of the patient between imaging and surgical intervention. Image fusion with diagnostic data (MRI, CT, PET) is demonstrated and promising applications for brachytherapy, RFTT and others are discussed.

An incremental neural network for tissue segmentation in ultrasound images

This paper presents an incremental neural network (INeN) for the segmentation of tissues in ultrasound images. The performances of the INeN and the Kohonen network are investigated for ultrasound image segmentation. The elements of the feature vectors are individually formed by using discrete Fourier transform (DFT) and discrete cosine transform (DCT). The training set formed from blocks of 4x4 pixels (regions of interest, ROIs) on five different tissues designated by an expert is used for the training of the Kohonen network. The training set of the INeN is formed from randomly selected ROIs of 4x4 pixels in the image. Performances of both 2D-DFT and 2D-DCT are comparatively examined for the segmentation of ultrasound images.

Mechanical property assessment of tissue-mimicking phantoms using remote palpation and optical read-out for amplitude of vibration and refractive index modulation

A coherent light beam is used to interrogate the focal region within a tissue-mimicking phantom insonified by an ultrasound transducer. The ultrasound-tagged photons exiting from the object carry with them information on local optical path length fluctuations caused by refractive index variations and medium vibration. Through estimation of the force distribution in the focal region of the ultrasound transducer, and solving the forward elastography problem for amplitude of vibration of tissue particles, we observe that the amplitude is directed along the axis of the transducer. It is shown that the focal region interrogated by photons launched along the transducer axis carries phase fluctuations owing to both refractive index variations and particle vibration, whereas the photons launched perpendicular to the transducer axis carry phase fluctuations arising mainly from the refractive index variations, with only smaller contribution from vibration of particles. Monte-Carlo simulations and experiments done on tissue-mimicking phantoms prove that as the storage modulus of the phantom is increased, the detected modulation depth in autocorrelation is reduced, significantly for axial photons and only marginally for the transverse-directed photons. It is observed that the depth of modulation is reduced to a significantly lower and constant value as the storage modulus of the medium is increased. This constant value is found to be the same for both axial and transverse optical interrogation. This proves that the residual modulation depth is owing to refractive index fluctuations alone, which can be subtracted from the overall measured modulation depth, paving the way for a possible quantitative reconstruction of storage modulus. Moreover, since the transverse-directed photons are not significantly affected by storage modulus variations, for a quantitatively accurate read-out of absorption coefficient variation, the interrogating light should be perpendicular to the focusing ultrasound transducer axis.

A novel method to obtain modulus image of soft tissues using ultrasound water jet indentation: a phantom study

The alteration of tissue stiffness is generally known to be associated with pathological changes. Ultrasound indentation is one of the methods that can be used to assess the mechanical properties of the soft tissues. It uses a flat-ended ultrasound transducer to directly contact the tissue to sense tissue deformation under an applied load. This paper introduced a novel noncontact ultrasound indentation system using water jet compression. The key idea was to utilize a water jet as the indenter as well as the coupling medium for propagation of the ultrasound beam. High frequency focused ultrasound (20 MHz) was used to measure the indentation deformation at a microscopic level. It has been demonstrated that the system could effectively assess the tissue-mimic phantoms with different stiffness. Water jet coupling allows the system to conduct C-scan on soft tissues rapidly and conveniently. By applying different pressures while taking C-scan sequences, the modulus images of the phantoms could be obtained based on the applied pressure and the phantom deformation and thickness. This paper presented the preliminary results on gel phantoms. The spatial resolution, the contrast resolution of the measurements and the reproducibility of the results were also discussed.

POSTERIOR JUXTASCLERAL INJECTION OF ANECORTAVE ACETATE

PURPOSE

To confirm juxtascleral delivery of anecortave acetate in rabbit eyes by ocular imaging techniques and to determine drug localization and distribution as a function of time after injection.

METHODS

Four female New Zealand white rabbits (weight, 2.5-3.0 kg) received a single juxtascleral posterior sub-Tenon capsule injection of 0.5 mL or 1 mL of 30 mg/mL anecortave acetate. Rabbit eyes were imaged with ultrasonography and magnetic resonance imaging (MRI) before injection, immediately after injection, and at 2 hours, 1 week, and 4 weeks after injection. Rabbit eyes were also imaged with b-mode ultrasonography during the juxtascleral injections.

RESULTS

Ultrasonography and MRI demonstrated that juxtascleral posterior sub-Tenon capsule injection of anecortave acetate effectively delivered the drug in direct apposition to the posterior pole of the rabbit eye. The drug remained in the juxtascleral site for at least 5 weeks. The drug was visualized clearly by MRI immediately after injection, decreasing in intensity thereafter. Cannula insertion and the drug delivery process were clearly visualized by real-time ultrasound analysis. Immediately after drug injection, ultrasonography indirectly localized anecortave acetate localization as an echolucent zone posterior to the scleral surface. At the later time points, however, the juxtascleral location of the drug was verified with ultrasonography as a relatively echogenic focus in the same location.

CONCLUSIONS

Juxtascleral administration of anecortave acetate via a posterior sub-Tenon capsule approach effectively delivered the drug to the desired position in direct apposition to the globe posteriorly. MRI and ultrasonography both demonstrated that anecortave acetate remained localized to this location for at least 5 weeks after initial injection.

A biplanar fluoroscopic approach for the measurement, modeling, and simulation of needle and soft-tissue interaction

A methodology for modeling the needle and soft-tissue interaction during needle insertion is presented. The approach consists of the measurement of needle and tissue motion using a dual C-arm fluoroscopy system. Our dual C-arm fluoroscopy setup allows real time 3-D extraction of the displacement of implanted fiducials in the soft tissue during needle insertion to obtain the necessary parameters for accurate modeling of needle and soft-tissue interactions. The needle and implanted markers in the tissue are tracked during the insertion and withdrawal of the needle at speeds of 1.016 mm/s, 12.7 mm/s and 25.4 mm/s. Both image and force data are utilized to determine important parameters such as the approximate cutting force, puncture force, the local effective modulus (LEM) during puncture, and the relaxation of tissue. We have also validated the LEM computed from our finite element model with arbitrary needle puncture tasks. Based on these measurements, we developed a model for needle insertion and withdrawal that can be used to generate a 1-DOF force versus position profile that can be experienced by a user operating a haptic device. This profile was implemented on a 7-DOf haptic device designed in our laboratory.

Modeling of needle-tissue interaction using ultrasound-based motion estimation

A needle-tissue interaction model is an essential part of every needle insertion simulator. In this paper, a new experimental method for the modeling of needle-tissue interaction is presented. The method consists of measuring needle and tissue displacements with ultrasound, measuring needle base forces, and using a deformation simulation model to identify the parameters of a needle-tissue interaction model. The feasibility of this non-invasive approach was demonstrated in an experiment in which a brachytherapy needle was inserted into a prostate phantom. Ultrasound radio-frequency data and the time-domain cross-correlation method, often used in ultrasound elastography, were used to generate the tissue displacement field during needle insertion. A three-parameter force density model was assumed for the needle-tissue interaction. With the needle displacement, tissue displacement and needle base forces as input data, finite element simulations were carried out to adjust the model parameters to achieve a good fit between simulated and measured data.

Anatomy of the anterior cruciate ligament with regard to its two bundles

The anterior cruciate ligament (ACL) consists of two major fiber bundles, namely the anteromedial and posterolateral bundle. When the knee is extended, the posterolateral bundle (PL) is tight and the anteromedial (AM) bundle is moderately lax. As the knee is flexed, the femoral attachment of the ACL becomes a more horizontal orientation; causing the AM bundle to tighten and the PL bundle to relax. There is some degree of variability for the femoral origin of the anterome-dial and posterolateral bundle. The anteromedial bundle is located proximal and anterior in the femoral ACL origin (high and deep in the notch when the knee is flexed at 90 degrees ); the posterolateral bundle starts in the distal and posterior aspect of the femoral ACL origin (shallow and low when the knee is flexed at 90 degrees ). In the frontal plane the anteromedial bundle origin is in the 10:30 clock position and the postero-lateral bundle origin in the 9:30 clock position. At the tibial insertion the ACL fans out to form the foot region. The anteromedial bundle insertion is in the anterior part of the tibial ACL footprint, the posterolateral bundle in the posterior part. While the anteromedial bundle is the primary restraint against anterior tibial translation, the posterolateral bundle tends to stabilize the knee near full extension, particularly against rotatory loads.