Anthropomorphic breast phantoms for testing elastography systems

Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment

This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 degrees C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii approximately 1.5 cm and length approximately 4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.

Measurement of viscoelastic properties of tissue-mimicking material using longitudinal wave excitation

This paper presents an experimental framework for the measurement of the viscoelastic properties of tissue-mimicking material. The novelty of the presented framework is in the use of longitudinal wave excitation and the study of the longitudinal wave patterns in finite media for the measurement of the viscoelastic properties. Ultrasound is used to track the longitudinal motions inside a test block. The viscoelastic parameters of the block are then estimated by 2 methods: a wavelength measurement method and a model fitting method. Connections are also made with shear elastography. The viscoelastic parameters are estimated for several homogeneous phantom blocks. The results from the new methods are compared with the conventional rheometry results.

Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations

Real-time elastography is a method for visualization of the elastic properties of soft tissue and may potentially enable differentiation between malignant and benign pathologic lesions. Our aim was to validate the method on a tissue-mimicking (TM) phantom and to evaluate the influence of different scanning parameters and investigator variability. A TM-phantom containing eight spherical inclusions with known storage modulus was examined using two different transducers on an ultrasound (US) scanner equipped with software for real-time elasticity imaging. The ultrasound transducers were moved vertically in a repetitive manner to induce strain. Two investigators performed series of standardized elastography scans applying a 0-4 categorical quality scale to evaluate the influence of seven parameters: dynamic range of elasticity, region-of-interest, frequency of transducer movement, rejection of elastogram noise, frame rate, persistence and smoothing. Subsequently, repeated examinations of four selected inclusions were performed using a visual analog scale (VAS) where investigators marked a 100 mm horizontal line representing the span in image quality based on experience from the first examination. The hardest and softest inclusions were imaged more clearly than the inclusions with elasticity more similar to the background material. Intraobserver agreement on elastogram quality was good (kappa: 0.67 - 0.75) and interobserver agreement average (kappa: 0.55 - 0.56) when using the categorical scale. The subsequent VAS evaluation gave intraclass-correlation coefficients for the two observers of 0.98 and 0.93, respectively, and an interclass-correlation coefficient of 0.93. Real-time elastography adequately visualized isoechoic inclusions with different elastic properties in a TM-phantom with acceptable intra- and interobserver agreement. Dynamic range of elasticity was the parameter with most impact on the elastographic visualization of inclusions.

Anthropomorphic phantoms for assessment of strain imaging methods involving saline-infused sonohysterography

Two anthropomorphic uterine phantoms were developed that allow assessment and comparison of strain imaging systems adapted for use with saline-infused sonohysterography (SIS). Tissue-mimicking (TM) materials consist of dispersions of safflower oil in gelatin. TM fibroids are stiffer than the TM myometrium/cervix, and TM polyps are softer. The first uterine phantom has 3-mm-diameter TM fibroids distributed randomly in TM myometrium. The second uterine phantom has a 5-mm and 8-mm spherical TM fibroid, in addition to a 5-mm spherical and a 12.5-mm-long (medicine capsule-shaped) TM endometrial polyp protruding into the endometrial cavity; also, a 10-mm spherical TM fibroid projects from the serosal surface. Strain images using the first phantom show the stiffer 3-mm TM fibroids in the myometrium. Results from the second uterine phantom show that, as expected, parts of inclusions projecting into the uterine cavity will appear very stiff, whether they are stiff or soft. Results from both phantoms show that although there is a five-fold difference in the Young's moduli values, there is not a significant difference in the strain in the transition from the TM myometrium to the TM fat. These phantoms allow for realistic comparison and evolution of SIS strain imaging techniques and can aid clinical personnel to develop skills for SIS strain imaging.

In vivo brain viscoelastic properties measured by magnetic resonance elastography

Magnetic resonance elastography (MRE) is a non-invasive imaging technique used to visualise and quantify mechanical properties of tissue, providing information beyond what can be currently achieved with standard MR sequences and could, for instance, provide new insight into pathological processes in the brain. This study uses the MRE technique at 3 T to extract the complex shear modulus for in vivo brain tissue utilizing a full three-dimensional approach to reconstruction, removing contributions of the dilatational wave by application of the curl operator. A calibrated phantom is used to benchmark the MRE measurements, and in vivo results are presented for healthy volunteers. The results provide data for in vivo brain storage modulus (G'), finding grey matter (3.1 kPa) to be significantly stiffer than white matter (2.7 kPa). The first in vivo loss modulus (G'') measurements show no significant difference between grey matter (2.5 kPa) and white matter (2.5 kPa).

Shear strain imaging using shear deformations

In this article we investigate the generation of shear strain elastograms induced using a lateral shear deformation. Ultrasound simulation and experimental results demonstrate that the shear strain elastograms obtained under shear deformation exhibit significant differences between bound and unbound inclusions in phantoms, when compared to shear strain images induced upon an axial compression. A theoretical model that estimates the decorrelation between pre- and postdeformation radio frequency signals, as a function of extent of shear deformation, is also developed. Signal-to-noise ratios of shear strain elastograms obtained at different shear angles are investigated theoretically and verified using ultrasound simulations on a uniformly elastic phantom. For the simulation and experiment, a two-dimensinal block-matching-based algorithm is used to estimate the axial and lateral displacement. Shear strains are obtained from the displacement vectors using a least-squares strain estimator. Our results indicate that the signal-to-noise ratio (SNR) of shear strain images increases to reach a maximum and saturates, and then decreases with increasing shear angle. Using typical system parameters, the maximum achievable SNR for shear strain elastography is around 8 (18 dB), which is comparable to conventional axial strain elastography induced by axial compression. Shear strain elastograms obtained experimentally using single inclusion tissue-mimicking phantoms with both bound and unbound inclusions (mimicking cancerous masses and benign fibroadenomas, respectively) demonstrate the characteristic differences in the depiction of these inclusions on the shear strain elastograms.

MR elastography of breast lesions: understanding the solid/liquid duality can improve the specificity of contrast-enhanced MR mammography

The purpose of this analysis is to explore the potential diagnostic gain provided by the viscoelastic shear properties of breast lesions for the improvement of the specificity of contrast enhanced dynamic MR mammography (MRM). The assessment of viscoelastic properties is done via dynamic MR elastography (MRE) and it is demonstrated that the complex shear modulus of in vivo breast tissue follows within the frequency range of clinical MRE a power law behavior. Taking benefit of this frequency behavior, data are interpreted in the framework of the exact model for wave propagation satisfying the causality principle. This allows to obtain the exponent of the frequency power law from the complex shear modulus at one single frequency which is validated experimentally. Thereby, scan time is drastically reduced. It is observed that malignant tumors obtain larger exponents of the power law than benign tumors indicating a more liquid-like behavior. The combination of the Breast Imaging Reporting and Data System (BIRADS) categorization obtained via MRM with viscoelastic information leads to a substantial rise in specificity. Analysis of 39 malignant and 29 benign lesions shows a significant diagnostic gain with an increase of about 20% in specificity at 100% sensitivity.

Acoustical properties of selected tissue phantom materials for ultrasound imaging

This note summarizes the characterization of the acoustic properties of four materials intended for the development of tissue, and especially breast tissue, phantoms for the use in photoacoustic and ultrasound imaging. The materials are agar, silicone, polyvinyl alcohol gel (PVA) and polyacrylamide gel (PAA). The acoustical properties, i.e., the speed of sound, impedance and acoustic attenuation, are determined by transmission measurements of sound waves at room temperature under controlled conditions. Although the materials are tested for application such as photoacoustic phantoms, we focus here on the acoustic properties, while the optical properties will be discussed elsewhere. To obtain the acoustic attenuation in a frequency range from 4 MHz to 14 MHz, two ultrasound sources of 5 MHz and 10 MHz core frequencies are used. For preparation, each sample is cast into blocks of three different thicknesses. Agar, PVA and PAA show similar acoustic properties as water. Within silicone polymer, a significantly lower speed of sound and higher acoustical attenuation than in water and human tissue were found. All materials can be cast into arbitrary shapes and are suitable for tissue-mimicking phantoms. Due to its lower speed of sound, silicone is generally less suitable than the other presented materials.

A novel image formation method for ultrasonic strain imaging

This paper presents a new method for forming high-quality ultrasonic strain images. To achieve this goal, three radiofrequency echo frames are selected by an automated performance assessment method and used to generate two parent strain images located in the same physical grid from which a high quality composite strain image may be calculated by averaging. The automatic performance evaluation method combines the consistency among the two parent strain images and the accuracy of motion tracking into a single summary "displacement quality measure." The proposed algorithm is evaluated with datasets acquired from in vivo breast tissue data. Our results show that that the proposed strain formation method shows substantial potential to outperform other methods available in the literature.

Normal and shear strain estimation using beam steering on linear-array transducers

In current ultrasound elastography, only the axial component of the displacement vector is estimated and used to produce strain images. A method was recently proposed by our group to estimate both the axial and lateral components of a displacement vector following a uniaxial compression. Previous work evaluated the technique using both simulations and a mechanically translated phased array transducer. In this paper, we present initial results using beam steering on a linear array transducer attached to a commercial scanner to acquire echo signals for estimating 2-D displacement vectors. Single-inclusion and anthropomorphic breast phantoms with different boundary properties between the inclusion and background material are imaged by acquiring echo data along beam lines ranging from -15 degrees to 15 degrees relative to the compression direction. 1-D cross-correlation is used to calculate "angular displacements" in each acquisition direction, yielding axial and lateral components of the displacement vector. Strain tensor components are estimated from these displacements. Features on shear strain images generated for the inclusion phantom agree with those predicted using FEA analysis. Experimental results demonstrate the utility of this technique on clinical scanners. Shear strain tensors obtained using this method may provide useful information for the differentiation of benign from malignant tumors. For the linear array transducer used in this study, the optimum angular increment is around 3 degrees. However, more work is required for the selection of an appropriate value for the maximum beam angle for optimal performance of this technique.