Method for Designing Multielement Fully Populated Random Phased Arrays for Ultrasound Surgery Applications

Treatment envelope of transcranial histotripsy: challenges and strategies to maximize the treatment location profile

A 750 kHz, 360-element ultrasound array has been built for transcranial histotripsy applications. This study aims to evaluate its performance to determine whether this array is adequate for treating a wide range of brain locations through a human skull. Treatment location profiles in 2 excised human skulls were experimentally characterized based on passive cavitation mapping. Full-wave acoustic simulations were performed in 8 human skulls to analyze the ultrasound propagation at shallow targets in skulls with different properties. Results showed that histotripsy successfully generated cavitation from deep to shallow targets within 5 mm from the skull surface in the skull with high SDR and small thickness, whereas in the skull with low SDR and large thickness, the treatment envelope was limited up to 16 mm from the skull surface. Simulation results demonstrated that the treatment envelope was highly dependent on the skull acoustic properties. Pre-focal pressure hotspots were observed in both simulation and experiments when targeting near the skull. For each skull, the acoustic pressure loss increases significantly for shallow targets compared to central targets due to high attenuation, large incident angles, and pre-focal pressure hotspots. Strategies including array design optimization, pose optimization, and amplitude correction, are proposed to broaden the treatment envelope. This study identifies the capabilities and limitations of the 360-element transcranial histotripsy array and suggests strategies for designing the next-generation transcranial histotripsy array to expand the treatment location profile for a future clinical trial.

Therapeutic ultrasound transducer technology and monitoring techniques: a review with clinical examples

The exponential growth of therapeutic ultrasound applications demonstrates the power of the technology to leverage the combinations of transducer technology and treatment monitoring techniques to effectively control the preferred bioeffect to elicit the desired clinical effect.Objective: This review provides an overview of the most commonly used bioeffects in therapeutic ultrasound and describes existing transducer technologies and monitoring techniques to ensure treatment safety and efficacy.Methods and materials: Literature reviews were conducted to identify key choices that essential in terms of transducer design, treatment parameters and procedure monitoring for therapeutic ultrasound applications. Effective combinations of these options are illustrated through descriptions of several clinical indications, including uterine fibroids, prostate disease, liver cancer, and brain cancer, that have been successful in leveraging therapeutic ultrasound to provide effective patient treatments.Results: Despite technological constraints, there are multiple ways to achieve a desired bioeffect with therapeutic ultrasound in a target tissue. Visualizations of the interplay of monitoring modality, bioeffect, and applied acoustic parameters are presented that demonstrate the interconnectedness of the field of therapeutic ultrasound. While the clinical indications explored in this review are at different points in the clinical evaluation path, based on the ever expanding research being conducted in preclinical realms, it is clear that additional clinical applications of therapeutic ultrasound that utilize a myriad of bioeffects will continue to grow and improve in the coming years.Conclusions: Therapeutic ultrasound will continue to improve in the next decades as the combination of transducer technology and treatment monitoring techniques will continue to evolve and be translated in clinical settings, leading to more personalized and efficient therapeutic ultrasound mediated therapies.

Treatment Planning and Aberration Correction Algorithm for HIFU Ablation of Renal Tumors

High-intensity focused ultrasound (HIFU) applications for thermal or mechanical ablation of renal tumors often encounter challenges due to significant beam aberration and refraction caused by oblique beam incidence, inhomogeneous tissue layers, and presence of gas and bones within the beam. These losses can be significantly mitigated through sonication geometry planning, patient positioning, and aberration correction using multielement phased arrays. Here, a sonication planning algorithm is introduced, which uses the simulations to select the optimal transducer position and evaluate the effect of aberrations and acoustic field quality at the target region after aberration correction. Optimization of transducer positioning is implemented using a graphical user interface (GUI) to visualize a segmented 3-D computed tomography (CT)-based acoustic model of the body and to select sonication geometry through a combination of manual and automated approaches. An HIFU array (1.5 MHz, 256 elements) and three renal cell carcinoma (RCC) cases with different tumor locations and patient body habitus were considered. After array positioning, the correction of aberrations was performed using a combination of backpropagation from the focus with an ordinary least squares (OLS) optimization of phases at the array elements. The forward propagation was simulated using a combination of the Rayleigh integral and k-space pseudospectral method (k-Wave toolbox). After correction, simulated HIFU fields showed tight focusing and up to threefold higher maximum pressure within the target region. The addition of OLS optimization to the aberration correction method yielded up to 30% higher maximum pressure compared to the conventional backpropagation and up to 250% higher maximum pressure compared to the ray-tracing method, particularly in strongly distorted cases.

Fabrication, Acoustic Characterization and Phase Reference-Based Calibration Method for a Single-Sided Multi-Channel Ultrasonic Actuator

The ultrasonic actuator can be used in medical applications because it is label-free, biocompatible, and has a demonstrated history of safe operation. Therefore, there is an increasing interest in using an ultrasonic actuator in the non-contact manipulation of micromachines in various materials and sizes for therapeutic applications. This research aims to design, fabricate, and characterize a single-sided transducer array with 56 channels operating at 500 kHz, which provide benefits in the penetration of tissue. The fabricated transducer is calibrated using a phase reference calibration method to reduce position misalignment and phase discrepancies caused by acoustic interaction. The acoustic fields generated by the transducer array are measured in a 300 mm × 300 mm × 300 mm container filled with de-ionized water. A hydrophone is used to measure the far field in each transducer array element, and the 3D holographic pattern is analyzed based on the scanned acoustic pressure fields. Next, the phase reference calibration is applied to each transducer in the ultrasonic actuator. As a result, the homogeneity of the acoustic pressure fields surrounding the foci area is improved, and the maximum pressure is also increased in the twin trap. Finally, we demonstrate the capability to trap and manipulate micromachines with acoustic power by generating a twin trap using both optical camera and ultrasound imaging systems in a water medium. This work not only provides a comprehensive study on acoustic actuators but also inspires the next generation to use acoustics in medical applications.

Design, Implementation, and Medical Applications of 2-D Ultrasound Sparse Arrays

An ultrasound sparse array consists of a sparse distribution of elements over a 2-D aperture. Such an array is typically characterized by a limited number of elements, which in most cases is compatible with the channel number of the available scanners. Sparse arrays represent an attractive alternative to full 2-D arrays that may require the control of thousands of elements through expensive application-specific integrated circuits (ASICs). However, their massive use is hindered by two main drawbacks: the possible beam profile deterioration, which may worsen the image contrast, and the limited signal-to-noise ratio (SNR), which may result too low for some applications. This article reviews the work done for three decades on 2-D ultrasound sparse arrays for medical applications. First, random, optimized, and deterministic design methods are reviewed together with their main influencing factors. Then, experimental 2-D sparse array implementations based on piezoelectric and capacitive micromachined ultrasonic transducer (CMUT) technologies are presented. Sample applications to 3-D (Doppler) imaging, super-resolution imaging, photo-acoustic imaging, and therapy are reported. The final sections discuss the main shortcomings associated with the use of sparse arrays, the related countermeasures, and the next steps envisaged in the development of innovative arrays.

A Modular, Kerf-Minimizing Approach for Therapeutic Ultrasound Phased Array Construction

A novel method for fabricating a modular, kerf-minimizing histotripsy phased array was developed and tested. The method utilizes arbitrarily shaped elements, 3-D printing, water jet cutting, and a thin, 125- [Formula: see text] electrically insulating epoxy coating to maximize aperture utilization while allowing for replacement of individual transducer modules. The method was used to fabricate a 750-kHz truncated circular aperture array (165 mm ×234 mm) transducer with a focal length of 142 mm. The aperture was segmented into 260 arc-shaped modular elements, each approximately 11.5 mm ×11.5 mm, arranged in concentric rings. The resulting aperture utilization was 92%. The full-width-half-maximum (FWHM) focal zone of the array was measured to be 1.6 mm ×1.1 mm ×4.5 mm, and the FWHM electrical steering range was measured to be 38.5 mm ×33 mm 40 mm. The array was estimated to be capable of generating approximately 120-MPa peak negative pressure at the geometric focus. In addition, the array was used to ablate a 5-cm3 volume of tissue with electric focal steering.

Optimization of a random linear ultrasonic therapeutic array based on a genetic algorithm

Given their advantage of suppressing grating lobes, randomly arranged linear arrays have potential for use in ultrasonic treatment. The current work proposes a method based on genetic algorithm to optimize the random arrangement of array elements, so that the suppression effect of grating lobes can be significantly improved with reduced calculating time. The maximum and average kerfs of array elements are used as genes, and the ratio of the maximum to the secondary maximum sound pressure at the focal plane is used as the optimized target. Typically, the calculation requirements of the current method can be reduced to ∼ 25% of the traversing method. We further discuss how the kerf width, the effective ratio of element areas and the ratio of focal distance to array aperture affect the suppression of grating lobes. For a typical linear array with 32 elements (1-MHz operating frequency, 1.5-mm element width and 150-mm focal distance), the results suggest that the grating lobes are suppressed well when (1) the ratio of maximum width to average width of the element is between 5 and 8, (2) the ratio of the effective element area to the area of the whole array is between 0.5 and 0.9, and (3) the ratio of the effective emission aperture to the actual emission aperture of the array is as large as possible. Based on optimized parameters, an experimental array was fabricated and the measured results of corresponding sound field were entirely consistent with the simulated results (Given her role as an Associate Editor of this journal, Juan Tu had no involvement in the peer-review of articles for which she was an author and had no access to information regarding the peer-review. Full responsibility for the peer-review process for this article was delegated to another Editor of this journal.).

Multiple-Focus Patterns of Sparse Random Array Using Particle Swarm Optimization for Ultrasound Surgery

This study aims to investigate the feasibility and potential of sparse random arrays driven by the particle swarm optimization (PSO) algorithm to generate multiple-focus patterns and a large scanning range without grating lobes, which extends the scanning range of focused ultrasound in the treatment of brain tumors, opening the blood-brain barrier, and neuromodulation. Operating at 1.1 MHz, a random spherical array with 200 square elements (sparseness 58%) and a sparse random array with 660 square elements (sparseness 41%) driven by PSO are employed to simulate different focus patterns. With the same radius of curvature and diameter of transducer and element size, the scanning range of the off-axis single focus of a random 200-element array is two times that of an ordinary array using symmetric arrangement. The focal volume of multiple-focus patterns of the random array is 18 times that of the single focus. The single focus of the sparse random array with 660 elements could steer up to ±23 mm in the radial direction, without grating lobes. The maximum distance between two foci in a multiple-focus "S"-shaped deflection is approximately 25 mm. Simulation results illustrate the capability of a focused beam steered in 3-D space. Multiple-focus patterns could significantly increase the focal volume and shorten the treatment time for large target volumes. Simulation results show the feasibility and potential of the method combining PSO with a sparse random array to generate flexible focus patterns that can adapt to different needs in different tissue treatments.

Development and Validation of Independent Dual-Focusing Transducer for Internal Inspection of Tubes

Controllable and focused ultrasonic beams in 3-D cylindrical space are essential when inspecting tubes or tubular objects. In this article, we develop an independent dual-focusing (IDF) array ultrasonic transducer composed of 64 prefocused elements and validate the feasibility of this design. Using k-Wave toolbox based on the k-space pseudospectral method, we simulate the acoustic pressure fields in the time domain and analyze beam profiles in circumferential-radial plane, axial-radial plane and 3-D space. The simulation results prove that the structure of IDF array transducer with the designed delay laws is capable of forming focused beam. A four-element aperture with 15 mm element radius shows narrow beams on both the circumferential and axial directions. On the basis of the simulation results, we fabricate a prototype transducer, test its electrical and acoustical performance, and implement internal inspection of a tube with an inner diameter of 13 mm. The echoes of four-element aperture show a higher amplitude than others, and this is consistent with the simulation. The eight longitudinal grooves and eight ring grooves of no more than 0.5 mm width are applied in inspection experiments, and the results demonstrate that the detection sensitivity of the IDF transducer can reach 0.2 mm in both the circumferential and axial directions. The results demonstrate that forming regulable and focused beam in 3-D cylindrical space is feasible using the IDF array which can be applied when inspecting tubes.

A Prototype Therapy System for Boiling Histotripsy in Abdominal Targets Based on a 256-Element Spiral Array

Boiling histotripsy (BH) uses millisecond-long ultrasound (US) pulses with high-amplitude shocks to mechanically fractionate tissue with potential for real-time lesion monitoring by US imaging. For BH treatments of abdominal organs, a high-power multielement phased array system capable of electronic focus steering and aberration correction for body wall inhomogeneities is needed. In this work, a preclinical BH system was built comprising a custom 256-element 1.5-MHz phased array (Imasonic, Besançon, France) with a central opening for mounting an imaging probe. The array was electronically matched to a Verasonics research US system with a 1.2-kW external power source. Driving electronics and software of the system were modified to provide a pulse average acoustic power of 2.2 kW sustained for 10 ms with a 1-2-Hz repetition rate for delivering BH exposures. System performance was characterized by hydrophone measurements in water combined with nonlinear wave simulations based on the Westervelt equation. Fully developed shocks of 100-MPa amplitude are formed at the focus at 275-W acoustic power. Electronic steering capabilities of the array were evaluated for shock-producing conditions to determine power compensation strategies that equalize BH exposures at multiple focal locations across the planned treatment volume. The system was used to produce continuous volumetric BH lesions in ex vivo bovine liver with 1-mm focus spacing, 10-ms pulselength, five pulses/focus, and 1% duty cycle.

3D synthetic aperture imaging with a therapeutic spherical random phased array for transcostal applications

Experimental validation of a synthetic aperture imaging technique using a therapeutic random phased array is described, demonstrating the dual nature of imaging and therapy of such an array. The transducer is capable of generating both continuous wave high intensity beams for ablating the tumor and low intensity ultrasound pulses to image the target area. Pulse-echo data is collected from the elements of the phased array to obtain B-mode images of the targets. Since therapeutic arrays are optimized for therapy only with concave apertures having low f-number and large directive elements often coarsely sampled, imaging can not be performed using conventional beamforming. We show that synthetic aperture imaging is capable of processing the acquired RF data to obtain images of the field of interest. Simulations were performed to compare different synthetic aperture imaging techniques to identify the best algorithm in terms of spatial resolution. Experimental validation was performed using a 1 MHz, 256-elements, spherical random phased array with 130 mm radius of curvature. The array was integrated with a research ultrasound scanner via custom connectors to acquire raw RF data for variety of targets. Imaging was implemented using synthetic aperture beamforming to produce images of a rib phantom and ex vivo ribs. The array was shown to resolve spherical targets within ±15 mm of either side of the axis in the focal plane and obtain 3D images of the rib phantom up to ±40 mm of either side of the central axis and at a depth of 3-9 cm from the array surface. The lateral and axial full width half maximum was 1.15 mm and 2.75 mm, respectively. This study was undertaken to emphasize that both therapy and image guidance with a therapeutic random phased array is possible and such a system has the potential to address some major limitations in the existing high intensity focused ultrasound (HIFU) systems. The 3D images obtained with a therapeutic array can be used to identify and locate strong scattering objects aiding to image guidance and treatment planning of the HIFU procedure.

Ultrasound for the Brain: A Review of Physical and Engineering Principles, and Clinical Applications

The emergence of new ultrasound technologies has improved our understanding of the brain functions and offered new opportunities for the treatment of brain diseases. Ultrasound has become a valuable tool in preclinical animal and clinical studies as it not only provides information about the structure and function of brain tissues but can also be used as a therapy alternative for brain diseases. High-resolution cerebral flow images with high sensitivity can be acquired using novel functional ultrasound and super-resolution ultrasound imaging techniques. The noninvasive treatment of essential tremors has been clinically approved and it has been demonstrated that the ultrasound technology can revolutionize the currently existing treatment methods. Microbubble-mediated ultrasound can remotely open the blood-brain barrier enabling targeted drug delivery in the brain. More recently, ultrasound neuromodulation received a great amount of attention due to its noninvasive and deep penetration features and potential therapeutic benefits. This review provides a thorough introduction to the current state-of-the-art research on brain ultrasound and also introduces basic knowledge of brain ultrasound including the acoustic properties of the brain/skull and engineering techniques for ultrasound. Ultrasound is expected to play an increasingly important role in the diagnosis and therapy of brain diseases.

Histotripsy: The Next Generation of High-Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

This article reviews the most current methods and technological aspects of high-intensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.

Generating an Adjustable Focused Field With an Annular Shape Using a Cylindrical Acoustic Transducer Array

We present the focusing structure of a cylindrical acoustic transducer array consisting of many annular piezoelectric wafer elements operating in the radial vibration mode. Using Huygens' principle, we calculated the delay parameters associated with the excitation signal of each element. Given the respective delay rules, the array transducer produces an adjustable acoustic focused field in the form of a 3-D circular ring. From a theoretical analysis, we designed and fabricated an array transducer with 64 elements and measured its actual field distribution. Simulation and actual experimental results show that the proposed circular cylindrical array transducer controls the annular acoustic focused field well. The sound field intensity of the annular focus region is related to the number of excited array elements, and the radial and axial positions of the annular focus region obey the delay rules of the excitation signal. These acoustic field control methods may be applied in ultrasound detection when scanning a circular sound field.

Development of Scalable 2D Plane Array for Transcranial Ultrasonic Neuromodulation on Non-Human Primates: An Ex Vivo Study

Ultrasonic neuromodulation on large animals, like non-human primates, requires the array transducer to have a good steering ability to arbitrarily stimulate various brain locations. Moreover, due to the different sizes of the animal heads, the array is preferred to be conveniently adjustable to different aperture sizes. To meet these requirements, a scalable 2D plane array, which can consist of up to tens of 256-element square modules, has been designed and fabricated in this study. Arrays with large apertures, consisting of 12 and 48 modules (including 3072 and 12288 elements, respectively), have been assembled and tested. The square modules were driven at a center frequency of 1.04 MHz. The transcranial and steering abilities of the modules were verified in a water tank on an ex vivo macaque skull. A focused beam transmitted by single module could pass through the skull with its peak acoustic pressure reduced to 18.1% of that in the free-field, with an acceptable transverse steering range up to 10 mm. Moreover, a much smaller focal spot was obtained by simultaneous transmission using two vertical-placed modules. Compared to the single module, the focal zone axial size was reduced from 29.7 mm to 3.3 mm, and the "stripes" pattern in the focal zone caused by standing waves was eliminated using a difference-frequency transmitting strategy. Such scalable 2D plane array, which can provide a small-size focal spot and has a large steering range and an acceptable transcranial ability, can be useful in research on ultrasonic neuromodulation on non-human primates.

Simulation of nonlinear trans-skull focusing and formation of shocks in brain using a fully populated ultrasound array with aberration correction

Multi-element high-intensity focused ultrasound phased arrays in the shape of hemispheres are currently used in clinics for thermal lesioning in deep brain structures. Certain side effects of overheating non-targeted tissues and skull bones have been revealed. Here, an approach is developed to mitigate these effects. A specific design of a fully populated 256-element 1-MHz array shaped as a spherical segment (F-number, F_# = 1) and filled by randomly distributed equal-area polygonal elements is proposed. Capability of the array to generate high-amplitude shock fronts at the focus is tested in simulations by combining three numerical algorithms for linear and nonlinear field modeling and aberration correction. The algorithms are based on the combination of the Rayleigh integral, a linear pseudo-spectral time domain Kelvin-Voigt model, and nonlinear Westervelt model to account for the effects of inhomogeneities, aberrations, reflections, absorption, nonlinearity, and shear waves in the skull. It is shown that the proposed array can generate nonlinear waveforms with shock amplitudes >60 MPa at the focus deep inside the brain without exceeding the existing technical limitation on the intensity of 40 W/cm² at the array elements. Such shock amplitudes are sufficient for mechanical ablation of brain tissues using the boiling histotripsy approach and implementation of other shock-based therapies.

Focused Ultrasound for Neuromodulation

For more than 70 years, the promise of noninvasive neuromodulation using focused ultrasound has been growing while diagnostic ultrasound established itself as a foundation of clinical imaging. Significant technical challenges have been overcome to allow transcranial focused ultrasound to deliver spatially restricted energy into the nervous system at a wide range of intensities. High-intensity focused ultrasound produces reliable permanent lesions within the brain, and low-intensity focused ultrasound has been reported to both excite and inhibit neural activity reversibly. Despite intense interest in this promising new platform for noninvasive, highly focused neuromodulation, the underlying mechanism remains elusive, though recent studies provide further insight. Despite the barriers, the potential of focused ultrasound to deliver a range of permanent and reversible neuromodulation with seamless translation from bench to the bedside warrants unparalleled attention and scientific investment. Focused ultrasound boasts a number of key features such as multimodal compatibility, submillimeter steerable focusing, multifocal, high temporal resolution, coregistration, and the ability to monitor delivered therapy and temperatures in real time. Despite the technical complexity, the future of noninvasive focused ultrasound for neuromodulation as a neuroscience and clinical platform remains bright.