A simple calibration and evaluation phantom for ultrasound scanners

Tuning Viscoelasticity with Minor Changes in Speed of Sound in an Ultrasound Phantom Material

The acoustic properties of ultrasound phantom materials have always been important, but with new applications interrogating tissue mechanical properties, viscoelasticity has also become an interesting feature to consider. Along with Young's modulus, the viscous component of tissue is affected by certain diseases and can therefore be used as a biomarker. Furthermore, viscoelasticity varies between tissue types and individuals, and therefore it would be useful with a phantom material that reflects this physiological range. Here we describe a gel for ultrasound imaging with a range of mechanical properties given by mixing different ratios of two oil-based gels, clear ballistic and styrene-ethylene/butylene-styrene (SEBS). The gels were mixed in five different proportions, ranging from 0-100% of either gel. For each of the gel compositions, we measured time of flight to determine speed of sound, narrowband ultrasound transmission for attenuation, stress-relaxation for viscoelasticity, mass and volume. Analysis of the stress-relaxation data using the generalized Maxwell model suggests that the material can be described by five parameters, E₀, E₁, E₂, η₁ and η₂, and that each of these parameters decreases as more SEBS is incorporated into the mixed material. Instantaneous Young's modulus (the sum of E₀, E₁ and E₂ in our model) ranges between 49 and 117 kPa for the different ratios, similar to values reported for cancerous tissue. Despite the large span of obtainable mechanical properties, speed of sound is relatively constant regardless of composition, with mean value estimates (± 95 % CI) between 1438 ± 9 and 1455 ± 3 m/s for pure and mixed gels. This was attributed to a variation in density and Poisson's ratio, following from the relation linking them to speed of sound and elasticity. Furthermore, both speed of sound and attenuation were within a suitable range for ultrasound phantoms. Combining this ballistic gel with SEBS copolymer in oil allows for control of mechanical properties, both elastic and viscous as evaluated by the material model. Furthermore, it does so without compromising ease of use, longevity and safety of the pre-made gel.

Computer-assisted navigation applied to fetal cardiac intervention

BACKGROUND

Prenatal cardiac interventions (PCI) for human fetal aortic valve (AoV) stenosis can reduce left ventricular hypoplasia and restore ventricular growth and function. However, 'freehand' needle delivery from the maternal skin through the uterine wall, fetal chest and ventricular apex to cross the fetal AoV remains technically challenging and time intensive, and is the rate-limiting step in the procedure.

METHODS

We developed a computer-assisted navigation (CANav) system that tracks the position and orientation of a two-dimensional (2D) ultrasound image relative to the trajectory of an electromagnetic (EM) embedded needle and stylet. We tested the CANav system in vitro using a water bath phantom, then in vivo using adult rats and pregnant (fetal) sheep.

RESULTS

The CANav system accurately tracked the delivered needle position in both in vitro phantom and adult rat model experiments. We performed 22 PCI attempts with or without CANav in a fetal sheep model. Maternal laparotomy was required to adjust the fetal position in 50% of the procedures. The time required to deliver the needle from the skin into the left ventricle (LV) using CANav was 2.9 +/- 1.7 (range 2-7) min (n = 14) vs. 5.5 +/- 4.3 (range 1-12) min (n = 8) without CANav (p < 0.05). The time needed to cross the aortic valve once the needle was within the LV was similar with and without CANav (p = 0.19).

CONCLUSIONS

CANav reduces the PCI time required to accurately deliver a needle to the fetal heart. Adaptations of this technical approach may be relevant to other congenital cardiac conditions and ultrasound-guided medical procedures.