An in vitro model and its application for the study of carotid Doppler spectral broadening

A blood-mimicking fluid with cholesterol as scatter particles for wall-less carotid artery phantom applications

Aim of the study: At present, there are few scatter particles used in preparing blood-mimicking fluids, such as nylon, sephadex, polystyrene microsphere, and poly(4-methystyrene). In this study, we present cholesterol as a new scatter particle for blood-mimicking fluid preparation. Materials and methods: The procedure for the preparation of the proposed blood-mimicking fluid involved the use of propylene glycol, D(+)-Glucose and distilled water to form a ternary mixture fluid, with cholesterol used as scatter particles. Polyethylene glycol was first used as part of the mixture fluid but the acoustic and physical properties were not suitable, leading to its replacement with D(+)-Glucose, which is soluble in water and has a higher density. A common carotid artery wall-less phantom was also produced to assess the flow properties. Results: The prepared blood-mimicking fluid with new scatter particles has a density of 1.067 g/cm³, viscosity of 4.1 mPa.s, speed of sound 1600 m/s, and attenuation of 0.192 dB/cm at 5 MHz frequency. Peak systolic velocity, end diastolic velocity and mean velocity measurements were gotten to be 40.2 ± 2.4 cm/s, 9.9 ± 1.4 cm/s, and 24.0 ± 1.8 cm/s, respectively. Conclusion: Based on the results obtained, the blood-mimicking fluid was found suitable for ultrasound applications in carotid artery wall-less phantoms because of its good acoustic and physical properties.

Specification and Evaluation of Plasticizer Migration Simulants for Human Blood Products: A Delphi Study

Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant–plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig’s blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.

Compatibility and Validation of a Recent Developed Artificial Blood through the Vascular Phantom Using Doppler Ultrasound Color- and Motion-mode Techniques

Background:

Doppler technique is a technology that can raise the predictive, diagnostic, and monitoring abilities in blood flow and suitable for researchers. The application depends on Doppler shift (shift frequencies), wherein the movement of red blood cells away from the probe is determined by the decrease or increase in the ultrasound (US) frequency.

Methods:

In this experiment, the clinical US (Hitachi Avious [HI] model) system was used as a primary instrument for data acquisition and test the compatibility, efficacy, and validation of artificial blood (blood-mimicking fluid [BMF]) by color- and motion-mode. This BMF was prepared for use in the Doppler flow phantom.

Results:

The motion of BMF through the vessel-mimicking material (VMM) was parallel and the flow was laminar and in the straight form (regular flow of BMF inside the VMM). Moreover, the scale of color velocity in the normal range at that flow rate was in the normal range.

Conclusion:

The new BMF that is being valid and effective in utilizing for US in vitro research applications. In addition, the clinical US ([HI] model) system can be used as a suitable instrument for data acquisition and test the compatibility, efficacy, and validation at in vitro applications (BMF, flow phantom components).

A novel roller pump for physiological flow

Having physiological correct flow waveforms is a key feature for experimental studies of blood flow, especially in the process of developing and testing a new medical device such as stent, mechanical heart valve, or any implantable medical device that involves circulation of blood through the device. It is also a critical part of a perfusion system for cardiopulmonary bypass and extracorporeal membrane oxygenation procedures. This study investigated the feasibility of a novel roller pump for use in experimental flow phantoms. Flow rates of carotid flow profile measured directly with the ultrasonic flow meter matched well with the reference flow rates programmed into the machine with similarity index of 0.97 and measured versus programmed flow rates at specific time‐points of peak systolic velocity (PSV): 0.894 vs 0.880, end systolic velocity (ESV): 0.333 vs 0.319, and peak diastolic velocity (PDV): 0.514 vs 0.520 L/min. Flow rates derived from video analysis of the pump motion for carotid, suprarenal, and infrarenal flows also matched well with references with similarity indices of 0.99, 0.99, and 0.96, respectively. Measured flow rates (mean/standard deviation) at PSV, ESV, and PDV time‐points for carotid: 0.883/0.016 vs 0.880, 0.342/0.007 vs 0.319, and 0.485/0.009 vs 0.520; suprarenal: 3.497/0.014 vs 3.500, 0.004/0.003 vs 0, and 1.656/0.073 vs 1.453; infrarenal: 4.179/0.024 vs 4.250, −1.147/0.015 vs −1.213, and 0.339/0.017 vs 0.391 L/min, respectively. The novel roller pump is suitable for benchtop testing of physiological flow.

A novel roller pump for physiological flow

Having physiological correct flow waveforms is a key feature for experimental studies of blood flow, especially in the process of developing and testing a new medical device such as stent, mechanical heart valve, or any implantable medical device that involves circulation of blood through the device. It is also a critical part of a perfusion system for cardiopulmonary bypass and extracorporeal membrane oxygenation procedures. This study investigated the feasibility of a novel roller pump for use in experimental flow phantoms. Flow rates of carotid flow profile measured directly with the ultrasonic flow meter matched well with the reference flow rates programmed into the machine with similarity index of 0.97 and measured versus programmed flow rates at specific time‐points of peak systolic velocity (PSV): 0.894 vs 0.880, end systolic velocity (ESV): 0.333 vs 0.319, and peak diastolic velocity (PDV): 0.514 vs 0.520 L/min. Flow rates derived from video analysis of the pump motion for carotid, suprarenal, and infrarenal flows also matched well with references with similarity indices of 0.99, 0.99, and 0.96, respectively. Measured flow rates (mean/standard deviation) at PSV, ESV, and PDV time‐points for carotid: 0.883/0.016 vs 0.880, 0.342/0.007 vs 0.319, and 0.485/0.009 vs 0.520; suprarenal: 3.497/0.014 vs 3.500, 0.004/0.003 vs 0, and 1.656/0.073 vs 1.453; infrarenal: 4.179/0.024 vs 4.250, −1.147/0.015 vs −1.213, and 0.339/0.017 vs 0.391 L/min, respectively. The novel roller pump is suitable for benchtop testing of physiological flow.

A Review of Suspension-Scattered Particles Used in Blood-Mimicking Fluid for Doppler Ultrasound Imaging

Doppler ultrasound imaging system description and calibration need blood-mimicking fluids (BMFs) for the test target of medical ultrasound diagnostic tools, with known interior features and acoustic and physical properties of this fluid (BMF). Physical and acoustical properties determined in the International Electrotechnical Commission (IEC) standard are specified as constant values, the materials used in the BMF preparation should have values similar to the IEC standard values. However, BMF is ready-made commercially from a field of medical usage, which may not be appropriate in the layout of ultrasound system or for an estimate of novel imaging mechanism. It is often eligible to have the capability to make sound properties and mimic blood arrangement for specific applications. In this review, sufficient BMF materials, liquids, and measures are described which have been generated by utilizing diverse operation mechanism and materials that have sculptured a range of biological systems.

Development of a range of anatomically realistic renal artery flow phantoms

Computer-aided modelling techniques were used to generate a range of anatomically realistic phantoms of the renal artery from medical images of a 64-slice CT data set acquired from a healthy volunteer. From these data, models of a normal healthy renal artery and diseased renal arteries with 30%, 50%, 70% and 85% stenoses were generated. Investment casting techniques and a low melting point alloy were used to create the vessels with varying degrees of stenosis. The use of novel inserts significantly reduced the time, materials and cost required in the fabrication of these anatomically realistic phantoms. To prevent residual metal remaining in the final phantom lumens a technique employing clingfilm was used to remove all molten metal from the lumen. These novel flow phantoms developed using efficient methods for producing vessels with various degrees of stenosis can provide a means of evaluation of current and emerging ultrasound technology.

Doppler ultrasound compatible plastic material for use in rigid flow models

A technique for the rapid but accurate fabrication of multiple flow phantoms with variations in vascular geometry would be desirable in the investigation of carotid atherosclerosis. This study demonstrates the feasibility and efficacy of implementing numerically controlled direct-machining of vascular geometries into Doppler ultrasound (DUS)-compatible plastic for the easy fabrication of DUS flow phantoms. Candidate plastics were tested for longitudinal speed of sound (SoS) and acoustic attenuation at the diagnostic frequency of 5 MHz. Teflon was found to have the most appropriate SoS (1376 +/- 40 m s(-1) compared with 1540 m s(-1) in soft tissue) and thus was selected to construct a carotid bifurcation flow model with moderate eccentric stenosis. The vessel geometry was machined directly into Teflon using a numerically controlled milling technique. Geometric accuracy of the phantom lumen was verified using nondestructive micro-computed tomography. Although Teflon displayed a higher attenuation coefficient than other tested materials, Doppler data acquired in the Teflon flow model indicated that sufficient signal power was delivered throughout the depth of the vessel and provided comparable velocity profiles to that obtained in the tissue-mimicking phantom. Our results indicate that Teflon provides the best combination of machinability and DUS compatibility, making it an appropriate choice for the fabrication of rigid DUS flow models using a direct-machining method.

Evaluation of guidewire path reproducibility

The number of minimally invasive vascular interventions is increasing. In these interventions, a variety of devices are directed to and placed at the site of intervention. The device used in almost all of these interventions is the guidewire, acting as a monorail for all devices which are delivered to the intervention site. However, even with the guidewire in place, clinicians still experience difficulties during the interventions. As a first step toward understanding these difficulties and facilitating guidewire and device guidance, we have investigated the reproducibility of the final paths of the guidewire in vessel phantom models on different factors: user, materials and geometry. Three vessel phantoms (vessel diameters approximately 4 mm) were constructed having tortuousity similar to the internal carotid artery from silicon tubing and encased in Sylgard elastomer. Several trained users repeatedly passed two guidewires of different flexibility through the phantoms under pulsatile flow conditions. After the guidewire had been placed, rotational c-arm image sequences were acquired (9 in. II mode, 0.185 mm pixel size), and the phantom and guidewire were reconstructed (512(3), 0.288 mm voxel size). The reconstructed volumes were aligned. The centerlines of the guidewire and the phantom vessel were then determined using region-growing techniques. Guidewire paths appear similar across users but not across materials. The average root mean square difference of the repeated placement was 0.17 +/- 0.02 mm (plastic-coated guidewire), 0.73 +/- 0.55 mm (steel guidewire) and 1.15 +/- 0.65 mm (steel versus plastic-coated). For a given guidewire, these results indicate that the guidewire path is relatively reproducible in shape and position.

Simulation and validation of arterial ultrasound imaging and blood flow

We reviewed the simulation and validation of arterial ultrasound imaging and blood flow assessment. The physical process of ultrasound imaging and measurement is complex, especially in disease. Simulation of physiological flow in a phantom with tissue equivalence of soft tissue, vessel wall and blood is now achievable. Outstanding issues are concerned with production of anatomical models, simulation of arterial disease, refinement of blood mimics to account for non-Newtonian behavior and validation of velocity measurements against an independent technique such as particle image velocimetry. String and belt phantoms offer simplicity of design, especially for evaluation of velocity estimators, and have a role as portable test objects. Electronic injection and vibrating test objects produce nonphysiologic Doppler signals, and their role is limited. Computational models of the ultrasound imaging and measurement process offer considerable flexibility in their ability to alter multiple parameters of both the propagation medium and ultrasound instrument. For these models, outstanding issues are concerned with the inclusion of different tissue types, multilayer arteries, inhomogeneous tissues and diseased tissues.

The discrimination of stenosed carotid bifurcation models with smooth and irregular plaque surface. Part I. Laser and ultrasonic Doppler flow studies

Irregular carotid lesion surface is considered as a factor increasing the risk of the cerebral embolism. The objective of the study was to investigate the possibility to distinguish models of stenosed carotid bifurcation with lesion irregularity on the basis of the properties of flow velocity distributions. Two groups of elastic replicas of carotid bifurcations with different stenosis degree were investigated. Each group consisted of three models with different severity of plaque surface irregularity and one with smooth wall. Velocity data were collected using a one-component laser Doppler anemometer (LDA) system and a pulsed Doppler flowmeter. The LDA velocity distributions and Doppler spectral broadening index, turbulence intensity index and coefficient of skewness were analysed. The lesion irregularity resulted in change of the size and/or shape of reversed/reduced flow areas and of the position of the jet with respect to those observed in a smooth wall model. The flow features observed in the ultrasonic Doppler spectra were generally coherent with the axial LDA velocity distributions. Doppler spectral parameters demonstrated different sensitivities to the severity of the wall irregularity, however, the complexity of curves of these indices versus time did not allow to draw decisive conclusions and implied use of a more sensitive tool of analysis.

Duplex ultrasound for assessment of superior mesenteric artery blood flow

Duplex ultrasound (DU) is recognised as a valuable tool for the assessment of blood flow in many vascular territories. The application of this technique to the superior mesenteric artery (SMA) has increased rapidly throughout the last decade. The purpose of this review is to collate currently available information on the utility of SMA DU, both in terms of research and clinical practice. Research investigations have revealed low intra- and interobserver variability in the estimation of Doppler variables, while reliable evaluation of B-mode dimensions requires repeated measurements. SMA blood flow velocity has been found to be dependent upon changes in central haemodynamics and in peripheral resistance, which was documented in studies with hypotension, medication and post-prandially. Food intake induces mesenteric vasorelaxation reflected by a 10-fold increase in the diastolic velocity. This feature has been utilised in studies on mesenteric physiology, which confirmed parasympathetic activity during hypovolaemia, and showed that exercise increases splanchnic resistance and reduces its blood flow following a 50% reduction in the hepato-splenic and a 25% reduction in the mesenteric blood flow. Clinical studies have documented high sensitivity and specificity of DU in detection of disease in splanchnic arteries. Diastolic velocity was found to be the most accurate indicator of SMA stenosis, while an absent Doppler signal from a well visualised vessel has been found to be a reliable predictor of occlusion. The high predictive value of DU in the detection of mesenteric artery disease, together with its simplicity and non-invasiveness, suggests that DU should take precedence over arteriography in both clinical practice and laboratory investigations.

A real vessel phantom for flow imaging: 3-D Doppler ultrasound of steady flow

Vascular phantoms are used to assess the capabilities of various imaging techniques, such as x-ray CT and angiography, and B-mode, power Doppler, and colour Doppler ultrasound (US). They should, therefore, accurately mimic the vasculature, blood, and surrounding tissue, in regard to both imaging properties and vessel geometry. In the past, a variety of walled and wall-less vessel models have been used. However, these models only approximate the true vessel geometry, and generally lack pathologic features such as plaques or calcifications. To amend these deficiencies, we have developed a real vessel phantom for US and x-ray studies, which comprises a fixed human vessel specimen, cannulated onto two acrylic tubes, and embedded in agar in an acrylic box. Earlier, we demonstrated a good overall correlation between x-ray angiography, CT, and 3-D B-mode US images of this phantom. Here, we extend its use to flow imaging with 3-D power and 3-D colour Doppler US.

Doppler backscatter properties of a blood-mimicking fluid for Doppler performance assessment

The Doppler backscatter properties of a blood-mimickig fluid (BMF) were studied to evaluate its suitability for use in a Doppler flow test object. Measurements were performed using a flow rig with C-flex tubing and BMF flow produced by a roller pump or a gear pump. A SciMed Doppler system was used to measure the backscattered Doppler power with a root-mean-square power meter connected to the audio output. Studies investigated the dependence of the backscattered Doppler power of the BMF with: circulation time; batch and operator preparations; storage; sieve size; flow speed; and pump type. A comparison was made with human red blood cells resuspended in saline. The backscatter properties are stable and within International Electrotechnical Commission requirements. The BMF is suitable for use in a test object for Doppler performance assessment.

Validation of a new blood-mimicking fluid for use in Doppler flow test objects

A blood-mimicking fluid (BMF) suitable for use in Doppler flow test objects is described and characterised. The BMF consists of 5 microns diameter nylon scattering particles suspended in a fluid base of water, glycerol, dextran and surfactant. The acoustical properties of various BMF preparations were measured under uniform flow to study the effects of particle size, particle concentration, surfactant concentration, flow rate and stability. The physical properties, (density, viscosity and particle size), and acoustical properties (velocity, backscatter and attenuation) of the BMF are within draft International Electrotechnical Commission requirements.

A real vessel phantom for imaging experimentation

Vascular phantoms are used to evaluate imaging techniques such as ultrasound (US), CT, and angiography. They are expected to mimic the vasculature, surrounding tissue, and blood, and therefore must meet specific requirements on the mimicking materials, with respect to x-ray attenuation and acoustic properties (velocity, attenuation). In the past, researchers have used a variety of vessel models, including walled (typically latex tube) and wall-less phantoms (obtained by moulding a lumen in a block of agar). These models lacked the exact geometry of human vessels as well as pathologic features such as plaques and calcifications. To overcome these disadvantages, this paper describes a real vessel phantom for US and x-ray studies. The phantom consists of an agar-filled acrylic box containing a formaldehyde fixed section of a real human vessel (obtained at autopsy) cannulated onto two acrylic tubes. This phantom was evaluated by comparing the images obtained with x-ray angiography, CT, and 3-D B-mode US. The images show good overall correlation based on the location of the geometrical features within the phantom, such as lumen, plaques, and calcifications. Discrepancies, artifacts, and difficulties were minor, and are discussed. The use of a real vessel, with its natural geometry and pathology, makes this phantom attractive for evaluation of imaging techniques including projection radiography, CT and US, and for extending its use to MR and US based flow studies.

Defining the limitations of measurements from Doppler spectral recordings

PURPOSE

The purpose of this study was to determine whether Doppler measurements of peak velocity and four other quantitative measures of spectral shape are affected significantly by the site of the Doppler recording in relation to the location of the maximum stenosis.

METHOD

Continuous-wave and pulsed Doppler recordings were made distal to a 70% (area reduction or 45% diameter reduction) asymmetric stenosis in an in vitro flow model under steady and pulsatile flow conditions. Recordings were taken at six different locations proximal and distal to the stenosis. A photochromic dye technique was used to visualize the actual flow field in the model.

RESULTS

Distal to the stenosis, the flow visualization results demonstrated a strong radial and axial variation of the velocity field and thus explained why the Doppler measurements of peak frequency and spectral broadening were strongly dependent on the recording site. The peak frequency was maximum within the throat of the stenosis and returned to the prestenotic value five tube diameters distal to the stenosis. Other measurements of spectral broadening and spectral shape varied greatly depending on the location of the recording site in the poststenotic region. Higher order spectral moments such as the coefficient of kurtosis were found to exhibit large temporal variability, which makes them inappropriate as diagnostic indicators.

CONCLUSIONS

Because of the complex nature of the poststenotic flow field, these results clearly demonstrate that no single Doppler measurement can accurately quantify the severity of a stenosis. Of the Doppler measurements only peak velocity is related to the severity of stenosis. Reproducible peak velocity measurements are obtained only if the Doppler sample volume is positioned at or very near the throat of the stenosis and at an appropriate radial site that may not necessarily be at the center of the vessel.

A transputer-based physiological signal processing system. Part 1--System design

This paper, the first of two, details the design and in-vitro testing of a transputer-based physiological signal processing system. The heart of the system is a transputer-based digital signal processing (DSP) board which can act as a stand-alone spectrum analyser, designed to operate in the audio-frequency band up to 25 kHz. The board comprises a T800 processor, two A100 transversal filters, 12 bit A-D circuitry capable of sampling up to 48 kHz, memory and address mapper. The initial application of the system is for the detection of early arterial disease. For this the DSP board is harnessed to the front end of a multigate pulsed Doppler ultrasound scanner operating at 4.8 MHz insonation frequency and incorporating a vessel wall tracking unit. The complete system performs a Fourier transform on the backscattered signals, providing spectral information on discrete areas of flow (0.6 mm3) across the vessel lumen in real time. This first paper describes the hardware, and the second describes the performance testing of the system on the bench and an assessment of its ability to detect low grade stenoses during steady flow.

A wall-less vessel phantom for Doppler ultrasound studies

Doppler ultrasound flow measurement techniques are often validated using phantoms that simulate the vasculature, surrounding tissue and blood. Many researchers use rubber tubing to mimic blood vessels because of the realistic acoustic impedance, robust physical properties and wide range of available sizes. However, rubber tubing has a very high acoustic attenuation, which may introduce artefacts into the Doppler measurements. We describe the construction of a wall-less vessel phantom that eliminates the highly attenuating wall and reduces impedance mismatches between the vessel lumen and tissue mimic. An agar-based tissue mimic and a blood mimic are described and their acoustic attenuation coefficients and velocities are characterised. The high attenuation of the latex rubber tubing resulted in pronounced shadowing in B-mode images; however, an image of a wall-less vessel phantom did not show any shadowing. We show that the effects of the highly attenuating latex rubber vessels on Doppler amplitude spectra depend on the vessel diameter and ultrasound beam width. In this study, only small differences were observed in spectra obtained from 0.6 cm inside diameter thin-wall latex, thick-wall latex and wall-less vessel phantoms. However, a computer model predicted that the spectrum obtained from a 0.3-cm inside diameter latex-wall vessel would be significantly different than the spectrum obtained from a wall-less vessel phantom, thus resulting in an overestimation of the average fluid velocity. These results suggest that care must be taken to ensure that the Doppler measurements are not distorted by the highly attenuating wall material. In addition, the results show that a wall-less vessel phantom is preferable when measuring flow in small vessels.

The validity of Doppler-derived spectral analysis in the presence of multiple stenoses

It has been suggested that mathematical analysis of ultrasonic Doppler spectral waveforms allows non-invasive quantification of arterial stenoses proximal to the Doppler probe. Less emphasis has been placed on the influence of distal stenoses or distance to the ultrasonic probe. A bench-top electromechanical model with multiple stenoses was constructed to evaluate the effects on spectral waveforms of variations in the severity of proximal and distal stenosis, length of stenoses, distance between stenoses, and distance between ultrasonic probe and stenoses. The following analytic indices, descriptive of spectral waveforms, were evaluated: pulsatility index, spectral broadening index, Laplace damping factor, mode frequency, mean frequency, arithmetic mean frequency, maximum envelope frequency and minimum envelope frequency. All these indices, except the mode frequency, were influenced by the degree of distal as well as proximal stenosis. They were also affected by the distance between the Doppler probe and the upstream and downstream stenoses. The length of stenoses did not influence the flow waveform. Of the model variables, the distal stenosis had the greatest influence on the calculated indices. However, none of the analytic techniques could detect a stenosis smaller than a 70% reduction in cross-sectional area. It was concluded that Doppler-derived spectral waveforms between sequential stenoses are inevitably influenced by events other than the degree of proximal stenosis alone. Therefore, ultrasonic spectral waveforms obtained at a single point of the arterial tree in patients with multi-segment arterial disease should be interpreted with caution.

Variance mapping in colour flow imaging: what does it measure?

Flow disturbance is known to occur in association with high grade carotid stenosis and cause spectral broadening and fluttering in the Doppler spectral waveform distal to the stenosis. Colour flow variance mapping has been proposed as a means of documenting its presence. We prospectively evaluated this hypothesis by studying 15 patients with high grade (> 50%) stenotic lesions in the internal carotid artery. In all 15 cases, the site of increased variance on the colour Doppler map corresponded to the point of maximum velocity. In 10 cases of greater than 75% stenosis, the point of aliasing on the traditional colour Doppler map and the site of maximal variance occurred at the stenotic jet (length 7.3 +/- 2.3 mm) and not along the full length of disturbed flow (19.3 +/- 5.5 mm). In five patients with stenoses between 50-75% diameter narrowing, decreasing the colour Doppler pulse repetition frequency (PRF) created a region of abnormal variance corresponding to the site of aliasing. In all 15 stenoses, the site of maximum flow disturbance, defined as fluttering in the Doppler spectral waveform, was not apparent on the variance map. We conclude that the variance map does not reflect flow disturbance and is most likely to occur at sites of aliasing.

Effect of method and parameters of spectral analysis on selected indices of simulated Doppler spectra

The sensitivity of Doppler spectral indices (mean frequency, maximum frequency, spectral broadening index and turbulence intensity) to the conditions of spectral analysis (estimation method, data window, smoothing window or model order) increases with decreasing signal bandwidth and growing index complexity. The bias of spectral estimate has a more important effect on these indices than its variance. A too low order, in the case of autoregressive modeling and minimum variance methods, and excessive smoothing, in the case of the FFT method, result in increased errors of Doppler spectral indices. There is a trade-off between the errors resulting from a short data window and those due to insufficient temporal resolution.

On the Doppler signal from a steady flow asymmetrical stenosis model: effects of turbulence

A steady flow model with a 70% (by area) asymmetrical stenosis was used to examine how changing flow regimes (laminar to turbulent) affect the Doppler signal. Human red blood cells (RBCs) (Hct = 42%) in saline were employed at a flow rate corresponding to a Reynold's number of approximately 545. A dilute suspension of 4% fixed RBCs was also used for the purpose of backscattered power comparison. Measurements of the Doppler signal enabled the backscattered power, time domain statistics, frequency spectra, frequency domain statistics, various spectral indices, autocorrelation function and decorrelation time to be calculated as a function of distance from the stenosis. It is shown that the characteristics of the Doppler signal measured at each site provide information on the nature of the insonated flow field and these correlate well with those expected. The results demonstrate that the onset of turbulence not only affects the Doppler spectrum but also has a profound effect on the signal power, the decorrelation time and the signal statistics.

A flexible blood flow phantom capable of independently producing constant and pulsatile flow with a predictable spatial flow profile for ultrasound flow measurement validations

The validation of the ultrasound time-domain correlation method of measuring blood flow has required the development of a flexible blood flow phantom capable of generating predictable flow profiles under a wide variety of conditions. The purpose of the phantom is to generate flow with well-known flow properties and not to mimic actual in vivo vessels. This paper describes a flow phantom which can independently generate both constant and pulsatile flow over a wide range of flow rates with a spatially fully developed laminar flow profile. It incorporates a computer-controlled pulsatile pump, which can produce different temporal pulsatile waveforms. The flow phantom also supports multiple vessels, different vessel sizes, as well as different attenuating media. The fluid most commonly used in the phantom is Sephadex mixed with water, and the probability density function of ultrasound reflected from Sephadex is experimentally determined and compared with that of blood. Examples of different constant and pulsatile flow experiments using the phantom are presented.

Computer-controlled positive displacement pump for physiological flow simulation

A computer-controlled pump for use both in the study of vascular haemodynamics and in the calibration of clinical devices which measure blood flow is designed. The novel design of this pump incorporates two rack-mounted pistons, driven into opposing cylinders by a micro-stepping motor. This approach allows the production of nearly uninterrupted steady flow, as well as a variety of pulsatile waveforms, including waveforms with reverse flow. The capabilities of this pump to produce steady flow from 0.1 to 60 ml s-1, as well as sinusoidal flow and physiological flow, such as that found in the common femoral and common carotid arteries are demonstrated. Cycle-to-cycle reproducibility is very good, with an average variation of 0.1 ml s-1 over thousands of cycles.

Effect of quantitated stenoses on arterial sound spectrum analysis

Spectral analysis of carotid Doppler signals has been shown to be accurate in determining the degree of carotid artery stenosis when compared with arteriography. Since the Doppler angle and the amount of gain used during measurement may affect results, an in vitro study was performed measuring peak frequency, mode frequency, and percent window at various Doppler angles and gains to determine if these latter factors could affect results of the test. A spectrum analyzer with an 8 MHz continuous-wave Doppler probe was utilized. Seven cross-sectional area stenoses (0 to 100 percent) were applied to an undiseased bifurcated cadaver artery which was suspended in a saline bath and placed in a pulsatile circulatory system. At each stenosis, peak frequency, mode frequency, and percent window were measured at three Doppler angles (45 degrees, 60 degrees, and 75 degrees) at a constant gain and at three different gains (low, medium, and high) at a constant Doppler angle of 60 degrees. Arterial pressure was measured distal to the stenoses. Critical stenoses were present at greater than 82 percent area reduction. At a Doppler angle of 60 degrees and medium gain, correlation coefficients between percentage of stenosis and peak frequency, mode frequency, and percent window were 0.9520, 0.8369, and -0.9861, respectively. However, peak frequency and mode frequency actually decreased at stenotic areas of more than 82 percent and were similar to frequencies seen at stenotic areas of 61 percent. Peak frequency significantly decreased as Doppler angle increased, so there was an even greater overlap of peak frequency values at larger angles. Percent window did not appear to be affected by Doppler angle. At an angle of 60 degrees and different gains, there appeared to be very little overlap of percent window values between any stenoses. Peak frequency and mode frequency did not appear to be affected by gain. This study demonstrates an excellent correlation between percentage of stenosis and peak frequency and percent window. However, peak frequency was significantly affected by changes in Doppler angle and did not differentiate subcritical (61 percent) from critical (96 percent) stenoses. Percent window, however, was not significantly affected by Doppler angle or gain and was able to differentiate between all degrees of stenosis.

Limitations in the accuracy of peak frequency measurements in the diagnosis of carotid disease

Peak Doppler frequency is an index of the severity of carotid stenosis. Variability in this measurement is examined through in vitro and clinical studies. In vitro studies, using a carotid flow model, show that observers locate a stenosis and interpret the peak frequency differently, and each observer uses a different probe-vessel angle. Clinical studies support these findings. Comparison of 304 carotid Doppler studies with arteriograms demonstrates 90% overall clinical accuracy. Each observer has a consistent range of peak frequency measurements, yet the description of a discrete percent stenosis is limited by observer variability.

Spectral analysis of Doppler flow velocity signals: assessment of objectives, methods, and interpretation

The objective of this paper is to review the theoretical basis and clinical application of electrical impedance plethysmography in the noninvasive evaluation of peripheral arterial and venous disease. Theoretical, experimental and clinical studies have not demonstrated a direct relationship between electrical impedance changes and limb volume changes. Potential sources of error have also been identified. This has led to the development of clinical tests based on impedance plethysmography for the detection of peripheral arterial disease, venous insufficiency and venous outflow obstruction. Impedance plethysmography, using the method of venous occlusion, is presently the most commonly employed noninvasive method for the detection of deep venous thrombosis.