Use of an acoustic transponder for US visualization of biopsy needles

Intraoperative Needle Tip Tracking with an Integrated Fibre-Optic Ultrasound Sensor

Ultrasound is an essential tool for guidance of many minimally-invasive surgical and interventional procedures, where accurate placement of the interventional device is critical to avoid adverse events. Needle insertion procedures for anaesthesia, fetal medicine and tumour biopsy are commonly ultrasound-guided, and misplacement of the needle may lead to complications such as nerve damage, organ injury or pregnancy loss. Clear visibility of the needle tip is therefore critical, but visibility is often precluded by tissue heterogeneities or specular reflections from the needle shaft. This paper presents the in vitro and ex vivo accuracy of a new, real-time, ultrasound needle tip tracking system for guidance of fetal interventions. A fibre-optic, Fabry-Pérot interferometer hydrophone is integrated into an intraoperative needle and used to localise the needle tip within a handheld ultrasound field. While previous, related work has been based on research ultrasound systems with bespoke transmission sequences, the new system-developed under the ISO 13485 Medical Devices quality standard-operates as an adjunct to a commercial ultrasound imaging system and therefore provides the image quality expected in the clinic, superimposing a cross-hair onto the ultrasound image at the needle tip position. Tracking accuracy was determined by translating the needle tip to 356 known positions in the ultrasound field of view in a tank of water, and by comparison to manual labelling of the the position of the needle in B-mode US images during an insertion into an ex vivo phantom. In water, the mean distance between tracked and true positions was 0.7 ± 0.4 mm with a mean repeatability of 0.3 ± 0.2 mm. In the tissue phantom, the mean distance between tracked and labelled positions was 1.1 ± 0.7 mm. Tracking performance was found to be independent of needle angle. The study demonstrates the performance and clinical compatibility of ultrasound needle tracking, an essential step towards a first-in-human study.

Enhanced Photoacoustic Visualisation of Clinical Needles by Combining Interstitial and Extracorporeal Illumination of Elastomeric Nanocomposite Coatings

Ultrasound (US) image guidance is widely used for minimally invasive procedures, but the invasive medical devices (such as metallic needles), especially their tips, can be poorly visualised in US images, leading to significant complications. Photoacoustic (PA) imaging is promising for visualising invasive devices and peripheral tissue targets. Light-emitting diodes (LEDs) acting as PA excitation sources facilitate the clinical translation of PA imaging, but the image quality is degraded due to the low pulse energy leading to insufficient contrast with needles at deep locations. In this paper, photoacoustic visualisation of clinical needles was enhanced by elastomeric nanocomposite coatings with superficial and interstitial illumination. Candle soot nanoparticle-polydimethylsiloxane (CSNP-PDMS) composites with high optical absorption and large thermal expansion coefficients were applied onto the needle exterior and the end-face of an optical fibre placed in the needle lumen. The excitation light was delivered at the surface by LED arrays and through the embedded optical fibre by a pulsed diode laser to improve the visibility of the needle tip. The performance was validated using an ex-vivo tissue model. An LED-based PA/US imaging system was used for imaging the needle out-of-plane and in-plane insertions over approach angles of 20 deg to 55 deg. The CSNP-PDMS composite conferred substantial visual enhancements on both the needle shaft and the tip, with an average of 1.7- and 1.6-fold improvements in signal-to-noise ratios (SNRs), respectively. With the extended light field involving extracorporeal and interstitial illumination and the highly absorbing coatings, enhanced visualisation of the needle shaft and needle tip was achieved with PA imaging, which could be helpful in current US-guided minimally invasive surgeries.

A Real-time Color Doppler Marker for Echocardiographic Guidance of an Acoustically Active Extracorporeal Membrane Oxygenation Cannula

B-mode ultrasound imaging guidance of cannulas can be compromised by noise, artifacts, and echogenicity that is not distinctive from that of surrounding anatomy. We have modified a venovenous extracorporeal membrane oxygenation cannula by embedding piezoelectric crystals into each of its 3 blood flow ports. Each vibrating crystal acoustically interacts with a Doppler imaging signal and produces an instantaneous color marker. The aim of this study was to compare identification of the extracorporeal membrane oxygenation cannula ports by B-mode imaging versus the color Doppler marker. Unlike B-mode imaging, the color Doppler marker identified the corresponding port even in highly challenging closed-chest scans in anesthetized pigs. The method could improve guidance accuracy of cannulas by ultrasound scans.

Ultrasonic Needle Tracking with a Fibre-Optic Ultrasound Transmitter for Guidance of Minimally Invasive Fetal Surgery

Ultrasound imaging is widely used for guiding minimally invasive procedures, including fetal surgery. Visualisation of medical devices such as medical needles is critically important and it remains challenging in many clinical contexts. During in-plane insertions, a needle can have poor visibility at steep insertion angles and at large insertion depths. During out-of-plane insertions, the needle tip can have a similar ultrasonic appearance to the needle shaft when it intersects with the ultrasound imaging plane. When the needle tip is not accurately identified, it can damage critical structures, with potentially severe consequences, including loss of pregnancy. In this paper, we present a tracking system to directly visualise the needle tip with an ultrasonic beacon. The waves transmitted by the beacon were received by an external ultrasound imaging probe. Pairs of co-registered images were acquired in rapid succession with this probe: a photoacoustic image obtained with the system in receive-only mode, and a conventional B-mode ultrasound image. The beacon comprised a custom elastomeric nanocomposite coating at the distal end of an optical fibre, which was positioned within the lumen of a commercial 22 gauge needle. Delivery of pulsed light to the coating resulted in the photoacoustic generation of ultrasonic waves. The measured tracking accuracies in water in the axial and lateral dimensions were 0.39±0.19 mm and 1.85±0.29 mm, respectively. To obtain a preliminary indication of the clinical potential of this ultrasonic needle tracking system, needle insertions were performed in an in vivo fetal sheep model. The results demonstrate that ultrasonic needle tracking with a fibre-optic transmitter is feasible in a clinically realistic fetal surgery environment, and that it could be useful to guide minimally invasive procedures by providing accurate visualisation of the medical device tip.

Acoustically Active Catheter for Intracardiac Navigation by Color Doppler Ultrasonography

Navigation of intracardiac catheters by echocardiography is challenging because of the fundamental limitations of B-mode ultrasonography. We describe a catheter fitted with a piezoelectric crystal, which vibrates and produces an instantaneous marker in color flow Doppler scans. The navigation learning curve was explored first in six pigs. Accuracy and precision of targeting with the navigation marker "off" (i.e., B-mode imaging) and "on" were assessed in another six pigs. Paired comparisons confirmed significantly (p = 0.04) shorter mean distances achieved in each pig with the color Doppler marker. Pooled (mean ± standard deviation) distance of the catheter tip from the target crystal was 5.27 ± 1.62 mm by B-mode guidance and 3.66 ± 1.45 mm by color Doppler marker navigation. Dye injection targeted into the ischemic border zone was successful in 8 of 10 pigs. Intracardiac catheter navigation with color Doppler ultrasonography is more accurate compared with conventional guidance by B-mode imaging.

Coded excitation ultrasonic needle tracking: An in vivo study

PURPOSE

Accurate and efficient guidance of medical devices to procedural targets lies at the heart of interventional procedures. Ultrasound imaging is commonly used for device guidance, but determining the location of the device tip can be challenging. Various methods have been proposed to track medical devices during ultrasound-guided procedures, but widespread clinical adoption has remained elusive. With ultrasonic tracking, the location of a medical device is determined by ultrasonic communication between the ultrasound imaging probe and a transducer integrated into the medical device. The signal-to-noise ratio (SNR) of the transducer data is an important determinant of the depth in tissue at which tracking can be performed. In this paper, the authors present a new generation of ultrasonic tracking in which coded excitation is used to improve the SNR without spatial averaging.

METHODS

A fiber optic hydrophone was integrated into the cannula of a 20 gauge insertion needle. This transducer received transmissions from the ultrasound imaging probe, and the data were processed to obtain a tracking image of the needle tip. Excitation using Barker or Golay codes was performed to improve the SNR, and conventional bipolar excitation was performed for comparison. The performance of the coded excitation ultrasonic tracking system was evaluated in an in vivo ovine model with insertions to the brachial plexus and the uterine cavity.

RESULTS

Coded excitation significantly increased the SNRs of the tracking images, as compared with bipolar excitation. During an insertion to the brachial plexus, the SNR was increased by factors of 3.5 for Barker coding and 7.1 for Golay coding. During insertions into the uterine cavity, these factors ranged from 2.9 to 4.2 for Barker coding and 5.4 to 8.5 for Golay coding. The maximum SNR was 670, which was obtained with Golay coding during needle withdrawal from the brachial plexus. Range sidelobe artifacts were observed in tracking images obtained with Barker coded excitation, and they were visually absent with Golay coded excitation. The spatial tracking accuracy was unaffected by coded excitation.

CONCLUSIONS

Coded excitation is a viable method for improving the SNR in ultrasonic tracking without compromising spatial accuracy. This method provided SNR increases that are consistent with theoretical expectations, even in the presence of physiological motion. With the ultrasonic tracking system in this study, the SNR increases will have direct clinical implications in a broad range of interventional procedures by improving visibility of medical devices at large depths.

A new sensor technology for 2D ultrasound-guided needle tracking

2D Ultrasound (US) is becoming the preferred modality for image-guided interventions due to its low cost and portability. However, the main limitation is the limited visibility of surgical tools. We present a new sensor technology that can easily be embedded on needles that are used for US-guided interventions. Two different types of materials are proposed to be used as sensor--co-polymer and PZT. The co-polymer technology is particularly attractive due to its plasticity, allowing very thin depositions (10-20 μm) on a variety of needle shapes. Both sensors receive acoustic energy and convert it to an electrical signal. The precise location of the needle can then be estimated from this signal, to provide real-time feedback to the clinician. We evaluated the feasibility of this new technology using (i) a 4DOF robot in a water tank; (ii) extensive ex vivo experiments; and (iii) in vivo studies. Quantitative robotic studies indicated that the co-polymer is more robust and stable when compared to PZT. In quantitative experiments, the technology achieved a tracking accuracy of 0.14 ± 0.03mm, significantly superior to competing technologies. The technology also proved success in near-real clinical studies on tissue data. This sensor technology is non-disruptive of existing clinical workflows, highly accurate, and is cost-effective. Initial clinician feedback shows great potential for large scale clinical impact.

Acoustically active injection catheter guided by ultrasound: navigation tests in acutely ischemic porcine hearts

Catheters are increasingly used therapeutically and investigatively. With complex usage comes a need for more accurate intracardiac localization than traditional guidance can provide. An injection catheter navigated by ultrasound was designed and then tested in an open-chest model of acute ischemia in eight pigs. The catheter is made "acoustically active" by a piezo-electric crystal near its tip, electronically controlled, vibrating in the audio frequency range and uniquely identifiable using pulsed-wave Doppler. Another "target" crystal was sutured to the epicardium within the ischemic region. Sonomicrometry was used to measure distances between the two crystals and then compared with measurements from 2-D echocardiographic images. Complete data were obtained from seven pigs, and the correlation between sonomicrometry and ultrasound measurements was excellent (p < 0.0001, ρ = 0.9820), as was the intraclass correlation coefficient (0.96) between two observers. These initial experimental results suggest high accuracy of ultrasound navigation of the acoustically active catheter prototype located inside the beating left ventricle.

Electrolytic echo enhancement: a novel method to make needles more reflective to ultrasound

INTRODUCTION

This study examines the effect of augmenting the ultrasound reflectivity of needles using a novel electrolytic echo enhancement method.

METHODS

Needles were connected by a lead to the negative terminal of a 4.5 V direct current source. A grounding pad, connected to the positive terminal, was positioned on the undersurface of an ex vivo ox liver phantom. During needle insertion into the liver, electrolysis was induced creating a layer of gas on the needle electrode.

RESULTS

Analysis of images showed a significant increase in needle brightness using electrolytic echo enhancement. Brightness was found to increase by a factor of ×3.6 compared with controls (P < 0.001).

CONCLUSION

Electrolytic echo enhancement has the potential to make ultrasound-guided procedures safer and quicker for patients and increase the confidence of operators in their ability to see the whole needle including its tip.

Accurate guidance of a catheter by ultrasound imaging and identification of a catheter tip by pulsed-wave Doppler

BACKGROUND

With the advent of numerous minimally invasive medical procedures, accurate catheter guidance has become imperative. We introduce and test an approach for catheter guidance by ultrasound imaging and pulsed-wave (PW) Doppler.

METHODS

A steerable catheter is fitted with a small piezoelectric crystal at its tip that actively transmits signals driven by a function generator. We call this an active-tip (AT) catheter. In a water tank, we immersed a "target" crystal and a rectangular matrix of four "reference" crystals. Two-dimensional (2D) ultrasound imaging was used for initial guidance and visualization of the catheter shaft, and then PW Doppler mode was used to identify the AT catheter tip and guide it to the simulated target that was also visible in the 2D ultrasound image. Ten guiding trials were performed from random initial positions of the AT catheter, each starting at approximately 8 cm from the target.

RESULTS

After the ten navigational trials, the average final distance of the catheter tip from the target was 2.4 ± 1.2 mm, and the range of distances from the trials was from a minimum of 1.0 mm to a maximum of 4.5 mm.

CONCLUSIONS

Although early in the development process, these quantitative in vitro results show promise for catheter guidance with ultrasound imaging and tip identification by PW Doppler.

Producing diffuse ultrasound reflections from medical instruments using a quadratic residue diffuser

Simultaneous visualization of tissue and surgical instruments is necessary during ultrasound-guided medical procedures. Standard minimally invasive instruments are typically metallic and act as strong specular scatterers. As a result, such instruments saturate the image or disappear according to the angle of incidence, obscuring nearby tissue and making it difficult to determine the instrument's precise location. The objective of this study was to produce diffusive reflections from the surface of surgical instruments for improved visualization in ultrasound. A surface profile based on a 2D quadratic residue diffuser (QRD) was employed, which has been demonstrated to reduce specular reflection in other acoustic applications. The backscattered echo amplitude from the diffusive surface at various angles of insonation was measured and compared to that from unmodified metal surfaces and heart tissue surfaces. The QRD resulted in an 8 dB reduction of the specular signal. Furthermore, the dynamic range for angles up to 75 degrees was less than 20 dB for the QRD and more than 65 dB for a flat surface. The QRD surface produces two beneficial results for the simultaneous imaging of instruments and tissue. First, the conspicuity of diffusive surfaces in ultrasound images is markedly improved in comparison with unmodified metal surfaces. Secondly, the echo amplitude of diffusive metal surfaces differs in mean and standard deviation from that of tissue facilitating image enhancement and segmentation.

Optimal set-up for ultrasound guided punctures using new scanner applications: an in-vitro study

OBJECTIVE

To investigate if US-visualisation of the needle tip echo during US-guided punctures could be improved by use of new technological applications.

METHOD

an US-guided 18 G Trocar needle was inserted into targets of a puncture phantom. The punctures were performed in series of 10 using different settings of the US-scanner (GE Logic 700 Expert). At 7-cm of puncture depth the quality of the echo was tested using four different settings; normal (N), N + automatic tissue optimising (ATO), coded harmonic imaging (CHI), CHI + ATO and at 13-cm of puncture depths six different settings; N, N + ATO, coded excitation (CE), CE+ATO, CHI, CHI+ATO. In total 100 (40 + 60) images were randomly numbered and read independently by three radiologists with regard to scoring of the quality of the echoes from the needle tip, needle shaft and the target.

RESULTS

US visualisation of the needle tip was significantly (P < 0.005) improved as compared to normal settings (N) when the settings of ATO and CE were used. CHI resulted in the lowest score. A high agreement between observers was registered. Similar results were registered with regard to scorings from the needle shaft and target.

CONCLUSION

Not only changes of needle designs and puncture techniques can enhance echoes from the needle but also changes in the settings of the US-scanner with the use of new technological applications can improve visualisation of the needle echo.