Propagation speed of sound assessment in the layers of the guinea-pig esophagus in vitro by means of acoustic microscopy

Mechanical experimentation of the gastrointestinal tract: a systematic review

The gastrointestinal (GI) organs of the human body are responsible for transporting and extracting nutrients from food and drink, as well as excreting solid waste. Biomechanical experimentation of the GI organs provides insight into the mechanisms involved in their normal physiological functions, as well as understanding of how diseases can cause disruption to these. Additionally, experimental findings form the basis of all finite element (FE) modelling of these organs, which have a wide array of applications within medicine and engineering. This systematic review summarises the experimental studies that are currently in the literature (n = 247) and outlines the areas in which experimentation is lacking, highlighting what is still required in order to more fully understand the mechanical behaviour of the GI organs. These include (i) more human data, allowing for more accurate modelling for applications within medicine, (ii) an increase in time-dependent studies, and (iii) more sophisticated in vivo testing methods which allow for both the layer- and direction-dependent characterisation of the GI organs. The findings of this review can also be used to identify experimental data for the readers' own constitutive or FE modelling as the experimental studies have been grouped in terms of organ (oesophagus, stomach, small intestine, large intestine or rectum), test condition (ex vivo or in vivo), number of directions studied (isotropic or anisotropic), species family (human, porcine, feline etc.), tissue condition (intact wall or layer-dependent) and the type of test performed (biaxial tension, inflation-extension, distension (pressure-diameter), etc.). Furthermore, the studies that investigated the time-dependent (viscoelastic) behaviour of the tissues have been presented.

Quantitative ultrasound in cancer imaging

Ultrasound is a relatively inexpensive, portable, and versatile imaging modality that has a broad range of clinical uses. It incorporates many imaging modes, such as conventional gray-scale "B-mode" imaging to display echo amplitude in a scanned plane; M-mode imaging to track motion at a given fixed location over time; duplex, color, and power Doppler imaging to display motion in a scanned plane; harmonic imaging to display nonlinear responses to incident ultrasound; elastographic imaging to display relative tissue stiffness; and contrast-agent imaging with simple contrast agents to display blood-filled spaces or with targeted agents to display specific agent-binding tissue types. These imaging modes have been well described in the scientific, engineering, and clinical literature. A less well-known ultrasonic imaging technology is based on quantitative ultrasound (QUS), which analyzes the distribution of power as a function of frequency in the original received echo signals from tissue and exploits the resulting spectral parameters to characterize and distinguish among tissues. This article discusses the attributes of QUS-based methods for imaging cancers and providing improved means of detecting and assessing tumors. The discussion will include applications to imaging primary prostate cancer and metastatic cancer in lymph nodes to illustrate the methods.

Three-dimensional high-frequency characterization of cancerous lymph nodes

High-frequency ultrasound (HFU) offers a means of investigating biologic tissue at the microscopic level. High-frequency, three-dimensional (3-D) quantitative-ultrasound (QUS) methods were developed to characterize freshly-dissected lymph nodes of cancer patients. Three-dimensional ultrasound data were acquired from lymph nodes using a 25.6-MHz center-frequency transducer. Each node was inked prior to tissue fixation to recover orientation after sectioning for 3-D histologic evaluation. Backscattered echo signals were processed using 3-D cylindrical regions-of-interest to yield four QUS estimates associated with tissue microstructure (i.e., effective scatterer size, acoustic concentration, intercept and slope). QUS estimates were computed following established methods using two scattering models. In this study, 46 lymph nodes acquired from 27 patients diagnosed with colon cancer were processed. Results revealed that fully-metastatic nodes could be perfectly differentiated from cancer-free nodes using slope or scatterer-size estimates. Specifically, results indicated that metastatic nodes had an average effective scatterer size (i.e., 37.1 +/- 1.7 microm) significantly larger (p < 0.05) than that in cancer-free nodes (i.e., 26 +/- 3.3 microm). Therefore, the 3-D QUS methods could provide a useful means of identifying small metastatic foci in dissected lymph nodes that might not be detectable using current standard pathology procedures.

New design for an endoesophageal sector- based array for the treatment of atrial fibrillation: a parametric simulation study

Atrial fibrillation (AF) is the most frequent and sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PV) in the left atrium (LA) of the heart has proved to be an effective cure for the AF. The ablation consists mainly of the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In this article, a parametric study was carried out to establish an optimal configuration of endesophageal ultrasound phased arrays intended to treat the AF. The devices are spherical-surface sections truncated at 15 mm, with a depth of 4 mm, and they are cut in concentric-rings, each composed of independently driven sectors. The number of independent elements (N(e)) was minimized for different values of ratio of pressure amplitude of the secondary lobe over the main lobe (eta) of 0.35, 0.4, 0.45, and 0.5 inside a volume of interest (VOI). After assuming a Cartesian system with the origin in the center of the device, the VOI was defined as the prism enclosed by the coordinates (-12, 10, -9) mm and (12, 37, 9) mm. The VOI has its center at (0, 23.5, 0) mm and is large enough to contain all the targets identified in the Visible Human Project Male specimen. Operating at 1 MHz, eta and N(e)were calculated in function of the element size and focal length (F). Four devices for each value of eta were found. After keeping values of F and normalized dimensions of the independent elements in terms of wavelength, higher frequencies were considered: 1.25 MHz, 1.5 MHz, and 2 MHz. In total, 16 device configurations were obtained. Realistic modeling of lesion formation in the heart chamber showed that the 16 configurations were able to produce the typical lesion used to treat the AF while preserving surrounding structures. At higher frequencies, lower power was required, and a greater number of array elements was required. For an exposure of 5 s and a maximum temperature of 70 degrees C, the average (+/-s.d.) acoustical intensity at transducer surface varied from 22.3(+/-5.8) W/cm(2) for a device with F = 98 mm at 1 MHz to 5.8(+/-1.2) W/cm(2) for a device with F = 186 mm at 2 MHz, while requiring 319 and 2093 elements, respectively, and achieving values of eta of 0.5 and 0.41, respectively. For the intended application, the selected devices implied a better focusing when compared with more traditional planar 2-D arrays, while requiring less power and fewer independent elements.

Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PVs) in the left atrium (LA) of the heart has been proven as an effective cure of AF. The ablation consists mainly in the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In the present numerical study, the feasibility of producing the required circumferential lesion with an endoesophageal ultrasound probe is investigated. The probe operates at 1 MHz and consists of a 2D array with enough elements (114 x 20) to steer the acoustic field electronically in a volume comparable to the LA. Realistic anatomical conditions of the thorax were considered from the segmentation of histological images of the thorax. The cardiac muscle and the blood-filled cavities in the heart were identified and considered in the sound propagation and thermal models. The influence of different conditions of the thermal sinking in the LA chamber was also studied. The circumferential ablation of the PVs was achieved by the sum of individual lesions induced with the proposed device. Different scenarios of lesion formation were considered where ultrasound exposures (1, 2, 5 and 10 s) were combined with maximal peak temperatures (60, 70 and 80 degrees C). The results of this numerical study allowed identifying the limits and best conditions for controlled lesion formation in the LA using the proposed device. A controlled situation for the lesion formation surrounding the PVs was obtained when the targets were located within a distance from the device in the range of 26 +/- 7 mm. When combined with a maximal temperature of 70 degrees C and an exposure time between 5 and 10 s, this distance ensured preservation of the esophageal structures, controlled lesion formation and delivery of an acoustic intensity at the transducer surface that is compatible with existing materials. With a peak temperature of 70 degrees C, the device and setup presented here induced highly localized lesions with a lesion volume varying from 10 +/- 4 to 18 +/- 7 mm(3) for an ultrasound exposure between 5 and 10 s, respectively, while the intensity varied from 26 +/- 7 to 20 +/- 6 W cm(-2).

Three-dimensional finite element model of the two-layered oesophagus, including the effects of residual strains and buckling of mucosa

This study was carried out to develop a two-layered finite element model of the oesophagus. The outer muscle and inner mucosal layer were constructed individually with different mechanical properties and zero-stress opening angles. With the model, two simulations were performed. First, the distention of oesophageal wall under the pressurized state was investigated, from which the effects of residual strains on the stress distribution were evaluated. Second, the buckling modes were determined using a linear eigenvalue analysis. The self-contact capability in ABAQUS was applied to simulate the folding of mucosa under the muscle contraction. The first simulation indicated that, by taking the residual strains into account, the mucosa undertook a very small portion of stress and the luminal pressure almost transmitted completely to the outer muscle layer. On the other hand, the folding of mucosa was shown to be able to reduce the contractile force of circular muscle to maintain the lumen closure. In conclusion, the preliminary study demonstrated the feasibility of simulating the oesophageal peristaltic transport using finite element analysis.

Noninvasive transesophageal cardiac thermal ablation using a 2-D focused, ultrasound phased array: a simulation study

This simulation study proposes a noninvasive, transesophageal cardiac-thermal ablation using a planar ultrasound phased array (1 MHz, 60 x 10 mm2, 0.525 mm interelement spacing, 114 x 20 elements). Thirty-nine foci in cardiac muscle were defined at 20, 40, and 60-mm distances and at various angles from the transducer surface to simulate the accessible posterior left atrial wall through the esophageal wall window. The ultrasound pressure distribution and the resulting thermal effect in a volume of 60 x 80 x 80 mm3, including esophagus and cardiac muscle, were simulated for each focus. For 1, 10, and 20-s sonications with 60 degrees C and 70 degrees C peak temperatures in cardiac muscle and without thermal damage in esophageal wall, the transducer acoustic powers were 105-727, 28-117, 21-79 W and 151-1044, 40-167, 30-114 W, respectively. The simulated lesions (thermal dose in equivalent minutes at 43 degrees C > or = 240 minutes) at these foci had lengths of 1-6, 3-11, 3-13 mm and 3-15, 5-19, 6-23 mm, respectively, and widths of 1-4, 2-7, 3-9 mm and 3-9, 4-13, 4-17 mm, respectively. As a first step toward feasibility, controllable tissue coagulation in cardiac tissue without damage to the esophagus was demonstrated numerically.

A simple phantom for learning EUS-guided FNA

BACKGROUND

The learning curve for EUS-guided FNA (EUS-FNA) is formidable. Development of a phantom to assist in teaching the technique may be beneficial. This study assessed the feasibility of using a low-cost phantom made of commonly available materials to practice EUS-FNA.

METHODS

A 2500-mL barium enema bag was modified by running a plastic tube (3-mm inner diameter) through it and sealing one end. One hundred grams of standard agar were suspended in 4 liters of tap water. The broth was heated slowly to boiling. The dissolved agar was then transferred to the barium enema bag after mixing in diced carrots, elbow macaroni, peas, and fingertips of surgical gloves filled with 5 mL of normal saline solution (6 of each) to simulate solid and cystic lesions. Immersion of the phantom in a basin of water provided acoustic coupling. One end of the 3-mm plastic tubing was attached to the nozzle of a water jet device and the other end to its reservoir to create a closed system allowing water recirculation. A linear array echoendoscope and a fine needle were used to perform EUS-FNA. The analysis is descriptive.

OBSERVATIONS

The phantom was readily made with inexpensive components (total cost <$50). With refrigeration the phantom was used repetitively during a 4-month period. It produced EUS images with an echotexture comparable with liver. The solid and cystic components resembled hepatic cysts and solid masses encountered when performing EUS in humans. Under EUS-guidance, fine-needle aspirates of selected lesions could be performed allowing targeting, aspiration, and sampling of selected lesions. The Doppler flow effect allowed examination of a simulated vascular structure during FNA.

CONCLUSIONS

Once validated, an EUS phantom made of simple components may become an invaluable educational tool for teaching EUS-FNA. Further studies are needed to determine how it affects the skills of gastroenterologists with and without EUS experience.