Quantitative transmission ultrasound tomography: Imaging and performance characteristics

A Multireader Multicase (MRMC) Receiver Operating Characteristic (ROC) Study Evaluating Noninferiority of Quantitative Transmission (QT) Ultrasound to Digital Breast Tomosynthesis (DBT) on Detection and Recall of Breast Lesions

RATIONALE AND OBJECTIVES

Quantitative transmission (QT) imaging is an emerging volumetric ultrasound modality for women too young for mammography. QT images tissue without overlap seen in mammography, thereby can potentially improve breast mass detection and characterization and noncancer recall. We compared radiologists' interpretation of QT vs digital breast tomosynthesis (DBT) with a multireader multicase observer performance study.

MATERIALS AND METHODS

Study subjects received screening DBT and QT scans in HIPAA-compliant, institutional review board-approved prospective case-collection studies at four clinical sites. Twenty-four Mammography Quality Standards Act-qualified radiologists interpreted 177 cases (66 with cancer, atypia, or solid mass and 111 normal or with nonsolid benign abnormality), first QT, then 2 weeks later DBT synthesized 2D-views. Readers reported up to three findings per case and for each finding a recall or no recall decision and confidence of that decision. The study hypothesis was area under receiver operating characteristic curve (AUC) of QT was noninferior to DBT. Sensitivity and specificity were also compared.

RESULTS

AUC of QT (0.746 ± 0.028, mean ± SD) was noninferior to DBT (0.700 ± 0.028) for AUC difference margin of -0.05 (P < .05). AUC difference was 0.046 ± 0.028 (95% CI: [-0.008, 0.101]). Sensitivity was 70.6 ± 7.2% for QT and 85.2 ± 6.4% for DBT, specificity was 60.1 ± 12.3% vs 37.2 ± 11.0%, and both differences were statistically significant. Of a total of 21 cases of cysts, readers recommended recall, on average, in 1.1 ± 1.4 cases with QT, but not with DBT, and 10.6 ± 2.2 cases with DBT, but not with QT.

CONCLUSION

QT can be a potential alternative to mammography for breast cancer screening of women too young to undergo mammography.

Breast Glandular and Ductal Volume Changes during the Menstrual Cycle: A Study in 48 Breasts Using Ultralow-Frequency Transmitted Ultrasound Tomography/Volography

The aim of this study was to show for the first time that low-frequency 3D-transmitted ultrasound tomography (3D UT, volography) can differentiate breast tissue types using tissue properties, accurately measure glandular and ductal volumes in vivo, and measure variation over time. Data were collected for 400 QT breast scans on 24 women (ages 18-71), including four (4) postmenopausal subjects, 6-10 times over 2+ months of observation. The date of onset of menopause was noted, and the cases were further subdivided into three (3) classes: pre-, post-, and peri-menopausal. The ducts and glands were segmented using breast speed of sound, attenuation, and reflectivity images and followed over several menstrual cycles. The coefficient of variation (CoV) for glandular tissue in premenopausal women was significantly larger than for postmenopausal women, whereas this is not true for the ductal CoV. The glandular standard deviation (SD) is significantly larger in premenopausal women vs. postmenopausal women, whereas this is not true for ductal tissue. We conclude that ducts do not appreciably change over the menstrual cycle in either pre- or post-menopausal subjects, whereas glands change significantly over the cycle in pre-menopausal women, and 3D UT can differentiate ducts from glands in vivo.

Full waveform inversion using frequency shift envelope-based global correlation norm for ultrasound computed tomography

Many studies have been carried out on ultrasound computed tomography (USCT) for its ability to offer quantitative measurements of tissue sound speed. Full waveform inversion (FWI) is a technique for reconstructing high-resolution sound speed images by iteratively minimizing the difference between the observed ultrasound data and the synthetic data based on the waveform equation. However, FWI suffers from cycle-skipping, which usually causes FWI convergence at a local minimum. Cycle-skipping occurs when the phase difference between the observed data and the synthetic data exceeds half a cycle. The simplest way to avoid cycle-skipping is to use low-frequency information for reconstruction. Nevertheless, in imaging systems, the response bandwidth of the probe is limited, and reliable low-frequency information often exceeds the response band. Therefore, it is a challenge to perform FWI imaging and avoid cycle-skipping problems without low-frequency information. In this paper, we propose a frequency shift envelope-based global correlation norm (FSEGCN), where an artificial source wavelet with a lower frequency is adopted to calculate synthetic data. FSEGCN compared with FWI, envelope inversion (EI), global correlation norm (GCN), envelope-based global correlation norm (EGCN) through concentric circle phantom without low-frequency information. The experimental results demonstrated the capability of the proposed method to recover the sound speed close to the exact model in the absence of low-frequency information, whereas FWI, EI, GCN, and EGCN cannot. Experiments on phantoms of the human head and calf show that artificial source wavelets can reduce image artifacts and enhance reconstruction robustness, when original low-frequency information is absent.

Breast Tomographic Ultrasound: The Spectrum from Current Dense Breast Cancer Screenings to Future Theranostic Treatments

This review provides unique insights to the scientific scope and clinical visions of the inventors and pioneers of the SoftVue breast tomographic ultrasound (BTUS). Their >20-year collaboration produced extensive basic research and technology developments, culminating in SoftVue, which recently received the Food and Drug Administration's approval as an adjunct to breast cancer screening in women with dense breasts. SoftVue's multi-center trial confirmed the diagnostic goals of the tissue characterization and localization of quantitative acoustic tissue differences in 2D and 3D coronal image sequences. SoftVue mass characterizations are also reviewed within the standard cancer risk categories of the Breast Imaging Reporting and Data System. As a quantitative diagnostic modality, SoftVue can also function as a cost-effective platform for artificial intelligence-assisted breast cancer identification. Finally, SoftVue's quantitative acoustic maps facilitate noninvasive temperature monitoring and a unique form of time-reversed, focused US in a single theranostic device that actually focuses acoustic energy better within the highly scattering breast tissues, allowing for localized hyperthermia, drug delivery, and/or ablation. Women also prefer the comfort of SoftVue over mammograms and will continue to seek out less-invasive breast care, from diagnosis to treatment.

A coupling, stabilizing, and shaping strategy for breast ultrasound computed tomography (USCT) with a ring array transducer

Breast ultrasound computed tomography (USCT) has been gradually promoted to clinical application after years of rapid development. Compared with the traditional handheld ultrasound scanning method, the scanning plane of USCT is fixed at the coronal plane, and the scanning path is designed in advance; the acoustic window is not in direct contact with the breast, a lot of coupling medium (usually degassed water is used to fill the gaps between the probe and breast. The clinical application of breast USTC faces challenges: (1) the processes of water degassing, heating, filling, draining, and cleaning prolong the entire scan cycle and reduce patient throughput. (2) The breast is not stabilized and slight movements of the breast may cause motion artifacts in the USCT images. (3) The non-normal incidence of ultrasound into the breast causes reflected and transmitted signals received with a low signal-to-noise ratio (SNR) or even unable to be detected. This article proposes a coupling, stabilizing, and shaping strategy for the clinical application of USCT with a ring array transducer. The solid gel coupling agent (SGCA) is applied for coupling, and a set of SGCA moldings is designed to stabilize and shape the breast during scanning, the breast shape and size which vary from person to person are simplified into several models. The preparation time is reduced to less than 1 min by replacing disposable moldings. The results show that the breast after shaping is close to round in the coronal plane, and slopes of the breast skin are limited in the sagittal and transverse planes, the breast subcutaneous tissue (fat and glands) has a better contrast-to-noise ratio (CNR) and can be better distinguished in the reflection images than that of the breast without shaping. The mean value of the raw beamformed data which represents the reflection signal amplitude of breast subcutaneous tissue after shaping shows 1.5 times that of the breast without shaping, the signal-to-noise ratio (SNR) of the raw transmission signal data after breast shaping is overall higher than that of the breast without shaping. The application of SGCA moldings for breast coupling, stabilizing, and shaping also benefits establishing a standardized scanning process, the standardized diagnosis of the breast lesion, and the localization of breast lesions.

Whole-Body Imaging Using Low Frequency Transmission Ultrasound

RATIONALE AND OBJECTIVES

To indicate that 3D low-frequency ultrasound tomography with 3D data acquisition (volography) is a safe, low-cost, high-resolution, whole-body meso-scale medical imaging modality that gives high-resolution quantitatively accurate clinically relevant images.

MATERIALS AND METHODS

We compare the speed of sound accuracy in various organs in situ. We validate our 3D ultrasound tomography images using MRI and gross section anatomy as ground truth in 10-day old piglets. Data acquisition is accomplished with the QT Scanner at ∼1 MHz center frequency, and array transceivers for reflection data @3.6 MHz. Images are generated with unique model-based 3D ultrasound tomography algorithms. In reflection, we use 3D refraction-corrected ray tracing to allow 360° compounding with sub-mm resolution. Four 10-12 day old pigs were anesthetized and whole-body images were acquired via low-frequency transmitted ultrasound and 3T MRI.

RESULTS

Tissue values were within an average of 1.07% (0.5%) of the literature values. We also show the detailed correlation of our images with MRI images in axial, coronal, and sagittal views. Volography images of a piglet show high resolution and quantitative accuracy, showing more contrast &resolution than 3T MRI, including the kidney showing medulla, cortex and fibrous cover, and small intestines with ileal lumen detail visible.

CONCLUSION

We establish that 3D ultrasound tomography (volography), yields high-resolution quantitatively accurate images whole-body images in presence of bone and air which are potentially clinically useful but have not appeared in the literature.

A Forward Model Incorporating Elevation-Focused Transducer Properties for 3-D Full-Waveform Inversion in Ultrasound Computed Tomography

Ultrasound computed tomography (USCT) is an emerging medical imaging modality that holds great promise for improving human health. Full-waveform inversion (FWI)-based image reconstruction methods account for the relevant wave physics to produce high spatial resolution images of the acoustic properties of the breast tissues. A practical USCT design employs a circular ring-array comprised of elevation-focused ultrasonic transducers, and volumetric imaging is achieved by translating the ring-array orthogonally to the imaging plane. In commonly deployed slice-by-slice (SBS) reconstruction approaches, the 3-D volume is reconstructed by stacking together 2-D images reconstructed for each position of the ring-array. A limitation of the SBS reconstruction approach is that it does not account for 3-D wave propagation physics and the focusing properties of the transducers, which can result in significant image artifacts and inaccuracies. To perform 3-D image reconstruction when elevation-focused transducers are employed, a numerical description of the focusing properties of the transducers should be included in the forward model. To address this, a 3-D computational model of an elevation-focused transducer is developed to enable 3-D FWI-based reconstruction methods to be deployed in ring-array-based USCT. The focusing is achieved by applying a spatially varying temporal delay to the ultrasound pulse (emitter mode) and recorded signal (receiver mode). The proposed numerical transducer model is quantitatively validated and employed in computer simulation studies that demonstrate its use in image reconstruction for ring-array USCT.

Robust Imaging of Speed of Sound Using Virtual Source Transmission

Speed of sound (SoS) is a novel imaging biomarker for assessing the biomechanical characteristics of soft tissues. SoS imaging in the pulse-echo mode using conventional ultrasound (US) systems with hand-held transducers has the potential to enable new clinical uses. Recent work demonstrated that diverging waves (DWs) from a single element (SE) transmit to outperform plane-wave sequences. However, SE transmits have severely limited power and hence produce a low signal-to-noise ratio (SNR) in echo data. We herein propose Walsh-Hadamard (WH) coded and virtual-source (VS) transmit sequences for the improved SNR in SoS imaging. We additionally present an iterative method of estimating beamforming (BF) SoS in the medium, which otherwise confounds SoS reconstructions due to beamforming inaccuracies in the images used for reconstruction. Through numerical simulations, phantom experiments, and in vivo imaging data, we show that WH is not robust against motion, which is often unavoidable in clinical imaging scenarios. Our proposed VS sequence is shown to provide the highest SoS reconstruction performance, especially robust to motion artifacts. In phantom experiments, despite having a comparable SoS root-mean-square error (RMSE) of 17.5-18.0 m/s at rest, with a minor axial probe motion of ≈ 0.67 mm/s the RMSE for SE, WH, and VS already deteriorate to 20.2, 105.4, and 19.0 m/s, respectively, showing that WH produces unacceptable results, not robust to motion. In the clinical data, the high SNR and motion resilience of VS sequences are seen to yield superior contrast compared to SE and WH sequences.

Deep Learning Ultrasound Computed Tomography Under Sparse Sampling

Ultrasound computed tomography (USCT) is a fast-emerging imaging modality that is expected to help detect and characterize breast tumors by quantifying the distribution of the speed of sound (SOS) and acoustic attenuation in breast tissue. High-quality quantitative SOS reconstruction in USCT requires a large number of transducers, which incurs high system costs and slow computation. In contrast, sparsely distributed arrays are low-cost and fast but significantly degrade image quality. Thus, we propose a framework to achieve high-quality SOS reconstruction under sparse sampling based on a convolutional neural network (SRSS-Net) with faster computation. We first apply the bent-ray algorithm to sparsely sampled data and then apply the SRSS-Net to efficiently improve the image quality. Experimental results on synthetic and real datasets demonstrate that the proposed SRSS-Net provides reconstructions that are superior to those of state-of-the-art methods in terms of artifact suppression, structural preservation, quantitative restoration, and computational speed. As demonstrated in our experiments, the fine-tuning training strategy is suggested when applying SRSS-Net to real-world circumstances. The imaging and computational performance of SRSS-Net on the inhomogeneous breast phantom further demonstrates that SRSS-Net has great potential in real-time breast cancer detection.

Low frequency 3D transmission ultrasound tomography: technical details and clinical implications

A novel 3D ultrasound tomographic (3D UT) method (called volography) that creates a speed of sound (SOS) map and a reflection modality that is co-registered are reviewed and shown to be artifact free even in the presence of high contrast and thus shown to be applicable for breast, orthopedic and pediatric clinical use cases. The 3D UT images are almost isotropic with mm resolution and the reflection image is compounded over 360 degrees to create sub-mm resolution in plane.

METHODS

The physics of ultrasound scattering requires 3D modeling and the concomitant high computational cost is ameliorated with a bespoke algorithm (paraxial approximation - discussed here) and Nvidia GPUs. The resulting reconstruction times are tabulated for clinical relevance. The resulting SOS map is used to create a refraction corrected reflection image at ∼3.6 MHz center frequency. The transmission data are highly redundant, collected over 360 degrees and at 2 mm levels by true matrix receiver arrays yielding 3D data. The high resolution SOS and attenuation maps and reflection images are used in a segmentation algorithm that optimally utilizes this information to segment out glandular, ductal, connective tissue, fat and skin. These volumes are used to estimate breast density, an important correlate to cancer.

RESULTS

Multiple SOS images of breast, knee and segmentations of breast glandular and ductal tissue are shown. Spearman rho is calculated between our volumetric breast density estimates and Volpara™ from mammograms, as 0.9332. Multiple timing results are shown and indicate the variability of the reconstruction times with breast size and type but are ∼30 minutes for average size breast. The timing results with the 3D algorithm indicate ∼60 minute reconstruction times for pediatrics with two Nvidia GPUs. Characteristic variations of the glandular and ductal volumes over time are shown. The SOS from QT images are compared with literature values. The results of a multi-reader multi-case (MRMC) study are shown that compares the 3D UT with full field digital mammography and resulted in an average increase in ROC AUC of 10%. Orthopedic (knee) 3D UT images compared with MRI indicate regions of zero signal in the MRI are clearly displayed in the QT image. Explicit representation of the acoustic field is shown, indicating its 3D nature. An image of in vivo breast with the chest muscle is shown and speed of sound agreement with literature values are tabulated. Reference is made to a recently published paper validating pediatric imaging.

CONCLUSIONS

The high Spearman rho indicates a monotonic (not necessarily linear) relation between our method and industry gold standard Volpara™ density. The acoustic field verifies the need for 3D modeling. The MRMC study, the orthopedic images, breast density study, and references, all indicate the clinical utility of the SOS and reflection images. The QT image of the knee shows its ability to monitor tissue the MRI cannot. The included references and images herein indicate the proof of concept for 3D UT as a viable and valuable clinical adjunct in pediatric and orthopedic situations in addition to the breast imaging.

open-UST: An Open-Source Ultrasound Tomography Transducer Array System

Fast imaging methods are needed to promote clinical adoption of ultrasound tomography (UST), and more widely available UST hardware could support the experimental validation of new measurement configurations. In this work, an open-source 256-element transducer ring array was developed (morganjroberts.github. io/open-UST) and manufactured using rapid prototyping, for only £2k. Novel manufacturing techniques were used, resulting in a 1.17° mean beam axis skew angle, a [Formula: see text] mean element position error, and a [Formula: see text] deviation in matching layer thickness. The nominal acoustic performance was measured using hydrophone scans and watershot data, and the 61.2 dB signal-to-noise ratio (SNR), 55.4° opening angle, 10.2 mm beamwidth, and 54% transmit-receive bandwidth (-12 dB) were found to be similar to existing systems and compatible with state-of-the-art full-waveform-inversion image reconstruction methods. The interelement variation in acoustic performance was typically < 10% without using normalization, meaning that the elements can be modeled identically during image reconstruction, removing the need for individual source definitions based on hydrophone measurements. Finally, data from a phantom experiment were successfully reconstructed. These results demonstrate that the open-UST system is accessible for users and is suitable for UST imaging research.

Full-Waveform Inversion for Breast Ultrasound Tomography Using Line-Shape Modeled Elements

OBJECTIVE

The objective of the work described here was to incorporate the spatial shapes of the transducer elements into the framework of the full-waveform inversion.

METHODS

An element is treated as its cross-section in the 2-D imaging plane, that is, a line segment. The elements are not simply modeled as a set of point sources on their surface to avoid staircasing artifacts. By use of the Fourier collocation method, an element is spatially represented as the discrete convolution between its spatial distribution and a band-limited delta function. The excitation pulses on the emitters and recorded signals on the receivers are then weighted based on the discrete convolution results. Digital and physical experiments are implemented to validate the method.

DISCUSSION

It is meaningful to model the shapes of the elements if their spatial sizes are similar to or larger than the acoustic wavelengths. It should, however, be noted that because this article focuses on 2-D imaging, the inter-plane effects are not considered.

CONCLUSION

The approach helps reduce the root mean square errors and increase the structural similarity of the reconstructed images. It also helps to improve the stability of convergence and to accelerate the convergence speed.

Reconstruction of thermoacoustic emission sources induced by proton irradiation using numerical time reversal

Objective.Mapping of dose delivery in proton beam therapy can potentially be performed by analyzing thermoacoustic emissions measured by ultrasound arrays. Here, a method is derived and demonstrated for spatial mapping of thermoacoustic sources using numerical time reversal, simulating re-transmission of measured emissions into the medium.Approach.Spatial distributions of thermoacoustic emission sources are shown to be approximated by the analytic-signal form of the time-reversed acoustic field, evaluated at the time of the initial proton pulse. Given calibration of the array sensitivity and knowledge of tissue properties, this approach approximately reconstructs the acoustic source amplitude, equal to the product of the time derivative of the radiation dose rate, mass density, and Grüneisen parameter. This approach was implemented using two models for acoustic fields of the array elements, one modeling elements as line sources and the other as rectangular radiators. Thermoacoustic source reconstructions employed previously reported measurements of emissions from proton energy deposition in tissue-mimicking phantoms. For a phantom incorporating a bone layer, reconstructions accounted for the higher sound speed in bone. Dependence of reconstruction quality on array aperture size and signal-to-noise ratio was consistent with previous acoustic simulation studies.Main results.Thermoacoustic source distributions were successfully reconstructed from acoustic emissions measured by a linear ultrasound array. Spatial resolution of reconstructions was significantly improved in the azimuthal (array) direction by incorporation of array element diffraction. Source localization agreed well with Monte Carlo simulations of energy deposition, and was improved by incorporating effects of inhomogeneous sound speed.Significance.The presented numerical time reversal approach reconstructs thermoacoustic sources from proton beam radiation, based on straightforward processing of acoustic emissions measured by ultrasound arrays. This approach may be useful for ranging and dosimetry of clinical proton beams, if acoustic emissions of sufficient amplitude and bandwidth can be generated by therapeutic proton sources.

Clinical Importance of 3D Volography in Breast Imaging

The clinical applications of the volography algorithm and concomitant refraction-corrected reflection algorithm as described in Chap. 10 are discussed here. Comparisons with an H&E stained image, discussion of glandular tissue visibility, related biomarkers, segmentation accuracy and capabilities, microcalcification and cyst detection and analysis, and various VGA and clinical studies show the unique capabilities of the method. The accuracy of the fibroglandular segmentation and its relevance to breast density in imaging is mentioned. The compatibility with artificial intelligence (AI) is shown and clinical results discussed, concluding that low-frequency 3D ultrasound volography is a powerful 3D ultrasound imaging technique for microanatomic and quantitative features of the breast with good potential for AI utilization to provide an imaging technique that will quantitatively improve clinical performance.

Ultrasound Tomography

Ultrasound tomography (USCT) is a promising imaging modality, mainly aiming at early diagnosis of breast cancer. It provides three-dimensional, reproducible images of higher quality than conventional ultrasound methods and additionally offers quantitative information on tissue properties. This chapter provides an introduction to the background and history of USCT, followed by an overview of image reconstruction algorithms and system design. It concludes with a discussion of current and future applications as well as limitations and their potential solutions.

Full Wave Inversion and Inverse Scattering in Ultrasound Tomography/Volography

Ultrasound breast tomography has been around for more than 40 years. Early approaches to reconstruction focused on simple algebraic reconstructions and bent ray techniques. These approaches were not able to provide high-quality and high spatial-resolution images. The advent of inverse scattering approaches resulted in a shift in image reconstruction approaches for breast tomography and a subsequent improvement in image quality. Full wave inverse solvers were developed to improve the reconstruction times without sacrificing image quality. The development of GPUs has markedly decreased the time for reconstruction using inverse scatting approaches. The development of fully 3D image solvers and hardware capable of capturing out of plane scattering have resulted in further improvement in breast tomography. This chapter discusses the state-of-the-art in ultrasound breast tomography, its history, the theory behind inverse scattering, approximations that are included to improve convergence, 3D image reconstruction, and hardware implementation of the constructions.

Feasibility of ultrasound tomography-guided localized mild hyperthermia using a ring transducer: Ex vivo and in silico studies

BACKGROUND

As of 2022, breast cancer continues to be the most diagnosed cancer worldwide. This problem persists within the United States as well, as the American Cancer Society has reported that ∼12.5% of women will be diagnosed with invasive breast cancer over the course of their lifetime. Therefore, a clinical need continues to exist to address this disease from a treatment and therapeutic perspective. Current treatments for breast cancer and cancers more broadly include surgery, radiation, and chemotherapy. Adjuncts to these methods have been developed to improve the clinical outcomes for patients. One such adjunctive treatment is mild hyperthermia therapy (MHTh), which has been shown to be successful in the treatment of cancers by increasing effectiveness and reduced dosage requirements for radiation and chemotherapies. MHTh-assisted treatments can be performed with invasive thermal devices, noninvasive microwave induction, heating and recirculation of extracted patient blood, or whole-body hyperthermia with hot blankets.

PURPOSE

One common method for inducing MHTh is by using microwave for heat induction and magnetic resonance imaging for temperature monitoring. However, this leads to a complex, expensive, and inaccessible therapy platform. Therefore, in this work we aim to show the feasibility of a novel all-acoustic MHTh system that uses focused ultrasound (US) to induce heating while also using US tomography (UST) to provide temperature estimates. Changes in sound speed (SS) have been shown to be strongly correlated with temperature changes and can therefore be used to indirectly monitor heating throughout the therapy. Additionally, these SS estimates allow for heterogeneous SS-corrected phase delays when heating complex and heterogeneous tissue structures.

METHODS

Feasibility to induce localized heat in tissue was investigated in silico with a simulated breast model, including an embedded tumor using continuous wave US. Here, both heterogenous acoustic and thermal properties were modeled in addition to blood perfusion. We further demonstrate, with ex vivo tissue phantoms, the feasibility of using ring-based UST to monitor temperature by tracking changes in SS. Two phantoms (lamb tissue and human abdominal fat) with latex tubes containing varied temperature flowing water were imaged. The measured SS of the water at each temperature were compared against values that are reported in literature.

RESULTS

Results from ex vivo tissue studies indicate successful tracking of temperature under various phantom configurations and ranges of water temperature. The results of in silico studies show that the proposed system can heat an acoustically and thermally heterogenous breast model to the clinically relevant temperature of 42°C while accounting for a reasonable time needed to image the current cross section (200 ms). Further, we have performed an initial in silico study demonstrating the feasibility of adjusting the transmit waveform frequency to modify the effective heating height at the focused region. Lastly, we have shown in a simpler 2D breast model that MHTh level temperatures can be maintained by adjusting the transmit pressure intensity of the US ring.

CONCLUSIONS

This work has demonstrated the feasibility of using a 256-element ring array transducer for temperature monitoring; however, future work will investigate minimizing the difference between measured SS and the values shown in literature. A hypothesis attributes this bias to potential volumetric average artifacts from the ray-based SS inversion algorithm that was used, and that moving to a waveform-based SS inversion algorithm will greatly improve the SS estimates. Additionally, we have shown that an all-acoustic MHTh system is feasible via in silico studies. These studies have indicated that the proposed system can heat a tumor within a heterogenous breast model to 42°C within a narrow time frame. This holds great promise for increasing the accessibility and reducing the complexity of a future all-acoustic MHTh system.

Diffuse ultrasound computed tomography

An alternative approach to acquire transmission travel time data is proposed, exploiting the geometry of devices commonly used in ultrasound computed tomography for medical imaging or non-destructive testing with ultrasonic waves. The intent is to (i) shorten acquisition time for devices with a large number of emitters, (ii) to eliminate the calibration step, and (iii) to suppress instrument noise. Inspired by seismic ambient field interferometry, the method rests on the active excitation of diffuse ultrasonic wavefields and the extraction of deterministic travel time information by inter-station correlation. To reduce stochastic errors and accelerate convergence, ensemble interferograms are obtained by phase-weighted stacking of observed and computed correlograms, generated with identical realizations of random sources. Mimicking an imaging setup, the accuracy of the travel time measurements as a function of the number of emitters and random realizations can be assessed both analytically and with spectral-element simulations for phantoms mimicking the model parameter distribution. The results warrant tomographic reconstructions with straight- or bent-ray approaches, where the effect of inherent stochastic fluctuations can be made significantly smaller than the effect of subjective choices on regularisation. This work constitutes a first conceptual study and a necessary prelude to future implementations.

Analysis of the Refraction Effect in Ultrasound Breast Tomography

Ultrasound breast tomography (UBT) is a promising quantitative imaging method. It allows for precise analysis of ultrasound velocity distribution, which is related to tissue density and elasticity, enabling cancer detection. Only a few centers around the world have a prototype of the device for in vivo breast ultrasound tomography imaging. The quality of images reconstructed from measurements of ultrasound pulse transit times is adversely affected by the refraction of beam rays on the breast immersed in water. Refraction can be reduced using waveform tomography, ray-tracing, and ray-linking methods. However, this requires the acquisition of a pre-reconstructed pattern and is limited by extreme computational costs. In this study, the effect of refraction on transit time measurements of ultrasound passing through the female breast was analyzed under immersion conditions in water. It was found that the refraction causes the highest measurement errors in the area of the water/breast interface, and these can be reduced by adjusting the water temperature and changing the breast geometry. The results allow us to improve the quality of breast images reconstructed using an efficient transformation algorithm that assumes rectilinear ultrasound propagation paths between transmitters and receivers. In vivo breast studies were performed on the developed hybrid UBT scanner.

Different Types of Ultrasound Probes Usage for Multi-Angle Conventional 3D Ultrasound Compound Imaging: A Breast Phantom Study

Three-dimensional automated breast ultrasound (ABUS) systems seem to offer excellent results in breast cancer screening tests and its early detection, comparable to handheld ultrasound B-mode scanning, with the benefit of saving physician time and reducing handheld ultrasound issues. Nevertheless, the ABUS systems are not very popular, due to the cost and very narrow application. The multi-angle conventional 3D ultrasound compound imaging method (MACUI) is intended for use with standard B-mode scanners in order to reduce cost but preserve the advantages of ABUS systems. The rotational probe movement is utilized in order to collect images for the three-dimensional reconstruction of the scanned tissue’s anatomy. The authors evaluate the capabilities to increase the scanned volume and quality of reconstructions, which are limited in current MACUI implementations, with a probe tilt and shift. The study shows and discusses the results of the imaging using different probes available for SmartUs Telemed B-Mode scanner at different scanning geometry in order to determine the capabilities of such an ultrasound imaging system. The results discussed in the paper highlight the benefits in quality improvement and scanning area obtained with tilted and shifted probes, as well as the advantages of using a relatively simple convex probe that does not incorporate software beam steering over more advanced devices.

Quantitative Sound Speed Imaging of Cortical Bone and Soft Tissue: Results From Observational Data Sets

This work presents the first quantitative ultrasonic sound speed images of ex vivo limb cross-sections containing both soft tissue and bone using Full Waveform Inversion (FWI) with level set (LS) and travel time regularization. The estimated bulk sound speed of bone and soft tissue are within 10% and 1%, respectively, of ground truth estimates. The sound speed imagery shows muscle, connective tissue and bone features. Typically, ultrasound tomography (UST) using FWI is applied to imaging breast tissue properties (e.g. sound speed and density) that correlate with cancer. With further development, UST systems have the potential to deliver volumetric operator independent tissue property images of limbs with non-ionizing and portable hardware platforms. This work addresses the algorithmic challenges of imaging the sound speed of bone and soft tissue by combining FWI with LS regularization and travel time methods to recover soft tissue and bone sound speed with improved accuracy and reduced soft tissue artifacts when compared to conventional FWI. The value of leveraging LS and travel time methods is realized by evidence of improved bone geometry estimates as well as promising convergence properties and reduced risk of final model errors due to un-modeled shear wave propagation. Ex vivo bulk measurements of sound speed and MRI cross-sections validates the final inversion results.

Ultrasound and Photoacoustic Imaging of Breast Cancer: Clinical Systems, Challenges, and Future Outlook

Presently, breast cancer diagnostic methods are dominated by mammography. Although drawbacks of mammography are present including ionizing radiation and patient discomfort, not many alternatives are available. Ultrasound (US) is another method used in the diagnosis of breast cancer, commonly performed on women with dense breasts or in differentiating cysts from solid tumors. Handheld ultrasound (HHUS) and automated breast ultrasound (ABUS) are presently used to generate reflection images which do not contain quantitative information about the tissue. This limitation leads to a subjective interpretation from the sonographer. To rectify the subjective nature of ultrasound, ultrasound tomography (UST) systems have been developed to acquire both reflection and transmission UST (TUST) images. This allows for quantitative assessment of tissue sound speed (SS) and acoustic attenuation which can be used to evaluate the stiffness of the lesions. Another imaging modality being used to detect breast cancer is photoacoustic tomography (PAT). Utilizing much of the same hardware as ultrasound tomography, PAT receives acoustic waves generated from tissue chromophores that are optically excited by a high energy pulsed laser. This allows the user to ideally produce chromophore concentration maps or extract other tissue parameters through spectroscopic PAT. Here, several systems in the area of TUST and PAT are discussed along with their advantages and disadvantages in breast cancer diagnosis. This overview of available systems can provide a landscape of possible intersections and future refinements in cancer diagnosis.

Design and Implementation of a Modular and Scalable Research Platform for Ultrasound Computed Tomography

Increasing attention has been attracted to the research of ultrasound computed tomography (USCT). This article reports the design considerations and implementation details of a novel USCT research system named UltraLucid, which aims to provide a user-friendly platform for researchers to develop new algorithms and conduct clinical trials. The modular design strategy is adopted to make the system highly scalable. A prototype has been assembled in our laboratory, which is equipped with a 2048-element ring transducer, 1024 transmit (TX) channels, 1024 receive (RX) channels, two servers, and a control unit. The prototype can acquire raw data from 1024 channels simultaneously using a modular data acquisition and a transfer system, consisting of 16 excitation and data acquisition (EDAQ) boards. Each EDAQ board has 64 independent TX and RX channels and 4-Gb Ethernet interfaces for raw data transmission. The raw data can be transferred to two servers at a theoretical rate of 64 Gb/s. Both servers are equipped with a 10.9-TB solid-state drive (SSD) array that can store raw data for offline processing. Alternatively, after processing by onboard field-programmable gate arrays (FPGAs), the raw data can be processed online using multicore central processing units (CPUs) and graphics processing units (GPUs) in each server. Through control software running on the host computer, the researchers can configure parameters for transmission, reception, and data acquisition. Novel TX-RX scheme and coded imaging can be implemented. The modular hardware structure and the software-based processing strategy make the system highly scalable and flexible. The system performance is evaluated with phantoms and in vivo experiments.

An Exploratory Multi-reader, Multi-case Study Comparing Transmission Ultrasound to Mammography on Recall Rates and Detection Rates for Breast Cancer Lesions

BACKGROUND

Three-dimensional Quantitative Transmission (QT) ultrasound imaging is an emerging modality for improving the detection and diagnosis of breast cancer. QT ultrasound has high resolution and high contrast to noise ratio, making it effective in evaluating breast tissue. This study compares radiologists' performance of noncancer recall rates and lesion detection rates using QT Ultrasound versus full-field digital mammography (FFDM) in a cross section of female subjects.

MATERIALS AND METHODS

In this multi-reader multi-case (MRMC) study, we examined retrospective data from two clinical trials conducted at five sites. All subjects received FFDM and QT scans within 90 days. Data were analyzed in a reader study with full factorial design involving 22 radiologists and 108 breast cases (42 normal, 39 pathology-confirmed benign, and 27 pathology-confirmed cancer cases). The main results used a random-reader random-case analysis adjusted for location bias performed after a primary predefined random-reader fixed-case analysis.

RESULTS

The readers' mean rate of detecting lesions of any type was 4% higher (p-value > 0.05) with QT imaging. The mean non-cancer recall rate improved significantly, showing a decrease of 16% with QT (p-value = 0.03), at the expense of a 2% decrease in the mean cancer recall rate (p-value >0.05) in comparison to FFDM. Combining performance on cancer and noncancer recall rates, the mean area under the receiver operator curve of confidence scores improved significantly by 10% with QT (p-value = 0.01).

CONCLUSION

This MRMC study indicates that QT improves non-cancer recall rates without substantially affecting cancer recall rates. The main limitation is the small number of cases from retrospective data. A larger prospective MRMC study is warranted for further assessment.

Speed-of-sound imaging using diverging waves

PURPOSE

Due to its safe, low-cost, portable, and real-time nature, ultrasound is a prominent imaging method in computer-assisted interventions. However, typical B-mode ultrasound images have limited contrast and tissue differentiation capability for several clinical applications.

METHODS

Recent introduction of imaging speed-of-sound (SoS) in soft tissues using conventional ultrasound systems and transducers has great potential in clinical translation providing additional imaging contrast, e.g., in intervention planning, navigation, and guidance applications. However, current pulse-echo SoS imaging methods relying on plane wave (PW) sequences are highly prone to aberration effects, therefore suboptimal in image quality. In this paper we propose using diverging waves (DW) for SoS imaging and study this comparatively to PW.

RESULTS

We demonstrate wavefront aberration and its effects on the key step of displacement tracking in the SoS reconstruction pipeline, comparatively between PW and DW on a synthetic example. We then present the parameterization sensitivity of both approaches on a set of simulated phantoms. Analyzing SoS imaging performance comparatively indicates that using DW instead of PW, the reconstruction accuracy improves by over 20% in root-mean-square-error (RMSE) and by 42% in contrast-to-noise ratio (CNR). We then demonstrate SoS reconstructions with actual US acquisitions of a breast phantom. With our proposed DW, CNR for a high contrast tumor-representative inclusion is improved by 42%, while for a low contrast cyst-representative inclusion a 2.8-fold improvement is achieved.

CONCLUSION

SoS imaging, so far only studied using a plane wave transmission scheme, can be made more reliable and accurate using DW. The high imaging contrast of DW-based SoS imaging will thus facilitate the clinical translation of the method and utilization in computer-assisted interventions such as ultrasound-guided biopsies, where B-Mode contrast is often to low to detect potential lesions.

Training Variational Networks With Multidomain Simulations: Speed-of-Sound Image Reconstruction

Speed-of-sound (SoS) has been shown as a potential biomarker for breast cancer imaging, successfully differentiating malignant tumors from benign ones. SoS images can be reconstructed from time-of-flight measurements from ultrasound images acquired using conventional handheld ultrasound transducers. Variational networks (VNs) have recently been shown to be a potential learning-based approach for optimizing inverse problems in image reconstruction. Despite earlier promising results, these methods, however, do not generalize well from simulated to acquired data, due to the domain shift. In this work, we present for the first time a VN solution for a pulse-echo SoS image reconstruction problem using diverging waves with conventional transducers and single-sided tissue access. This is made possible by incorporating simulations with varying complexity into training. We use loop unrolling of gradient descent with momentum, with an exponentially weighted loss of outputs at each unrolled iteration in order to regularize the training. We learn norms as activation functions regularized to have smooth forms for robustness to input distribution variations. We evaluate reconstruction quality on the ray-based and full-wave simulations as well as on the tissue-mimicking phantom data, in comparison with a classical iterative [limited-memory Broyden-Fletcher-Goldfarb-Shanno (L-BFGS)] optimization of this image reconstruction problem. We show that the proposed regularization techniques combined with multisource domain training yield substantial improvements in the domain adaptation capabilities of VN, reducing the median root mean squared error (RMSE) by 54% on a wave-based simulation data set compared to the baseline VN. We also show that on data acquired from a tissue-mimicking breast phantom, the proposed VN provides improved reconstruction in 12 ms.

Full wave 3D inverse scattering transmission ultrasound tomography in the presence of high contrast

We present here a quantitative ultrasound tomographic method yielding a sub-mm resolution, quantitative 3D representation of tissue characteristics in the presence of high contrast media. This result is a generalization of previous work where high impedance contrast was not present and may provide a clinically and laboratory relevant, relatively inexpensive, high resolution imaging method for imaging in the presence of bone. This allows tumor, muscle, tendon, ligament or cartilage disease monitoring for therapy and general laboratory or clinical settings. The method has proven useful in breast imaging and is generalized here to high-resolution quantitative imaging in the presence of bone. The laboratory data are acquired in ~ 12 min and the reconstruction in ~ 24 min-approximately 200 times faster than previously reported simulations in the literature. Such fast reconstructions with real data require careful calibration, adequate data redundancy from a 2D array of 2048 elements and a paraxial approximation. The imaging results show that tissue surrounding the high impedance region is artifact free and has correct speed of sound at sub-mm resolution.

Frequency-dependent attenuation reconstruction with an acoustic reflector

Attenuation of ultrasound waves varies with tissue composition, hence its estimation offers great potential for tissue characterization and diagnosis and staging of pathology. We recently proposed a method that allows to spatially reconstruct the distribution of the overall ultrasound attenuation in tissue based on computed tomography, using reflections from a passive acoustic reflector. This requires a standard ultrasound transducer operating in pulse-echo mode and a calibration protocol using water measurements, thus it can be implemented on conventional ultrasound systems with minor adaptations. Herein, we extend this method by additionally estimating and imaging the frequency-dependent nature of local ultrasound attenuation for the first time. Spatial distributions of attenuation coefficient and exponent are reconstructed, enabling an elaborate and expressive tissue-specific characterization. With simulations, we demonstrate that our proposed method yields a low reconstruction error of 0.04 dB/cm at 1 MHz for attenuation coefficient and 0.08 for the frequency exponent. With tissue-mimicking phantoms and ex-vivo bovine muscle samples, a high reconstruction contrast as well as reproducibility are demonstrated. Attenuation exponents of a gelatin-cellulose mixture and an ex-vivo bovine muscle sample were found to be, respectively, 1.4 and 0.5 on average, consistently from different images of their heterogeneous compositions. Such frequency-dependent parametrization could enable novel imaging and diagnostic techniques, as well as facilitate attenuation compensation of other ultrasound-based imaging techniques.

Zone-Shrinking Fresnel Zone Travel-Time Tomography for Sound Speed Reconstruction in Breast USCT

Many studies have been carried out on ultrasound computed tomography (USCT) for its potential application in breast imaging. The sound speed (SS) image modality in USCT can help doctors diagnose the breast cancer, as the tumor usually has a higher sound speed than normal tissues. Travel time is commonly used to reconstruct SS image. Raypath travel-time tomography (RTT) assumes that the sound wave travels through a raypath. RTT is computationally efficient but with low contrast to noise ratio (CNR). Fresnel zone travel-time tomography (FZTT) is based on the assumption that the sound wave travels through an area called the Fresnel zone. FZTT can provide SS image with high CNR but low accuracy due to the wide Fresnel zone. Here, we propose a zone-shrinking Fresnel zone travel-time tomography (ZSFZTT), where a weighting factor is adopted to shrink the Fresnel zone during the inversion process. Numerical phantom and in vivo breast experiments were performed with ZSFZTT, FZTT, and RTT. In the numerical experiment, the reconstruction biases of size by ZSFZTT, FZTT, and RTT were 0.2%~8.3%, 2.3%~31.7%, and 1.8%~25%; the reconstruction biases of relative SS value by ZSFZTT, FZTT, and RTT were 24.7%~42%, 53%~60.8%, and 30.3%~47.8%; and the CNR by ZSFZTT, FZTT, and RTT were 67.7~96.6, 68.5~98, and 1.7~2.7. In the in vivo breast experiment, ZSFZTT provided the highest CNR of 8.6 compared to 8.1 by FZTT and 1.9 by RTT. ZSFZTT improved the reconstruction accuracy of size and the relative reconstruction accuracy of SS value compared to FZTT and RTT while maintaining a high CNR similar to that of FZTT.

Recent technological advancements in thermometry

Thermometry is the key factor for achieving successful thermal therapy. Although invasive thermometry with a probe has been used for more than four decades, this method can only detect the local temperature within the probing volume. Noninvasive temperature imaging using a tomographic technique is ideal for monitoring hot-spot formation in the human body. Among various techniques, such as X-ray computed tomography, microwave tomography, echo sonography, and magnetic resonance (MR) imaging, the proton resonance frequency shift method of MR thermometry is the only method currently available for clinical practice because its temperature sensitivity is consistent in most aqueous tissues and can be easily observed using common clinical scanners. New techniques are being proposed to improve the robustness of this method against tissue motion. MR techniques for fat thermometry were also developed based on relaxation times. One of the latest non-MR techniques to attract attention is photoacoustic imaging.

[Dynamic imaging of melanoma development in nude mice using high-frequency ultrasound and optical coherence tomography]

OBJECTIVE

To investigate the application of high-frequency ultrasound (HFUS) and optical coherence tomography (OCT) for monitoring the progression of cutaneous melanoma (CM) in nude mice.

METHODS

Twenty 4-week-old nude mice were randomly divided into CM group (n=16) and control group (n=4). In CM group, A375 cell suspension were injected subcutaneously on the back of the nude mice, and only culture medium was injected in the control group. The tumor growth was monitored by gross observation and with HFUS and OCT on a daily basis. The tumor formation rate, time, and size were recorded and melanoma visibility was assessed quantitatively using the contrast- to-background-noise ratio (CNR). Twentyfour days after cell implantation, the tumors were dissected for pathological examination.

RESULTS

The tumor formation rate was 87.5% in CM group. OCT detected tumor formation at an earlier time than HFUS. With the growth of the tumor, HFUS detected spots or bands of strong echoes, and flattening of the upper dermis could be observed in OCT; the of HFUS and OCT were obviously enhanced over time (P &lt; 0.05). The tumor growth curve showed that OCT was more sensitive for measurement of the tumor thickness than HFUS. The length, depth and volume of the tumors measured by HFUS were significantly greater than those measured by OCT (P &lt; 0.05).

CONCLUSIONS

HFUS and OCT can monitor the dynamic development of cutaneous melanoma in nude mice, and their imaging performance differs in different stages of tumor development.

Quantitative assessment of breast density using transmission ultrasound tomography

Purpose

Breast density is important in the evaluation of breast cancer risk. At present, breast density is evaluated using two‐dimensional projections from mammography with or without tomosynthesis using either (a) subjective assessment or (b) a computer‐aided approach. The purpose of this work is twofold: (a) to establish an algorithm for quantitative assessment of breast density using quantitative three‐dimensional transmission ultrasound imaging; and (b) to determine how these quantitative assessments compare with both subjective and objective mammographic assessments of breast density.

Methods

We described and verified a threshold‐based segmentation algorithm to give a quantitative breast density (QBD) on ultrasound tomography images of phantoms of known geometric forms. We also used the algorithm and transmission ultrasound tomography to quantitatively determine breast density by separating fibroglandular tissue from fat and skin, based on imaged, quantitative tissue characteristics, and compared the quantitative tomography segmentation results with subjective and objective mammographic assessments.

Results

Quantitative breast density (QBD) measured in phantoms demonstrates high quantitative accuracy with respect to geometric volumes with average difference of less than 0.1% of the total phantom volumes. There is a strong correlation between QBD and both subjective mammographic assessments of Breast Imaging ‐ Reporting and Data System (BI‐RADS) breast composition categories and Volpara density scores — the Spearman correlation coefficients for the two comparisons were calculated to be 0.90 (95% CI: 0.71–0.96) and 0.96 (95% CI: 0.92–0.98), respectively.

Conclusions

The calculation of breast density using ultrasound tomography and the described segmentation algorithm is quantitatively accurate in phantoms and highly correlated with both subjective and Food and Drug Administration (FDA)‐cleared objective assessments of breast density.