A review of calibration techniques for freehand 3-D ultrasound systems

Elevation Resolution Enhancement Oriented 3D Ultrasound Imaging

Three-dimensional (3D) ultrasound imaging can be accomplished by reconstructing a sequence of two-dimensional (2D) ultrasound images. However, 2D ultrasound images usually suffer from low resolution in the elevation direction, thereby impacting the accuracy of 3D reconstructed results. The lateral resolution of 2D ultrasound is known to significantly exceed the elevation resolution. By combining scanning sequences acquired from orthogonal directions, the effects of poor elevation resolution can be mitigated through a composite reconstructing process. Moreover, capturing ultrasound images from multiple perspectives necessitates a precise probe positioning method with a wide angle of coverage. Optical tracking is popularly used for probe positioning for its high accuracy and environment-robustness. In this paper, a novel large-angle accurate optical positioning method is used for enhancing resolution in 3D ultrasound imaging through orthogonal-view scanning and composite reconstruction. Experiments on two phantoms proved that our method could significantly improve reconstruction accuracy in the elevation direction of the probe compared with single-angle parallel scanning. The results indicate that our method holds the potential to improve current 3D ultrasound imaging techniques.

Free scan real time 3D ultrasound imaging with shading artefacts removal

Ultrasound imaging (USI) is a widely adopted imaging method in clinical diagnosis owing to its low cost, convenience, and safety. However, due to the complex acoustic attenuation, two-dimensional (2D) USI lacks the capability to achieve a clear imaging result when the target is shaded by high echo tissues. This paper proposes a three-dimensional (3D) free-scan real-time ultrasound imaging (FRUSI) method. By integrating 2D ultrasound image sequences around the region of interest (ROI) with a real-time and spatially accurate probe tracking method, the proposed FRUSI system provides clear and accurate ultrasound images for medical study. The experiment results on reconstruction precision and accuracy show the potential ability of our proposed system to provide high-quality 3D ultrasound imaging. Moreover, previously shaded targets can be discerned clearly in the same scan plane in both phantom studies and in vivo studies on the human finger joint. The performance of the proposed FRUSI system has demonstrated its potential value for clinical diagnosis to provide high ultrasound imaging quality and rich details in spatial information. Due to the convenient setup, the FRUSI system might potentially be expanded to other ultrasound imaging modalities.

Comparative analysis of conventional ultrasound and shear wave elastography features in primary breast diffuse large B-cell lymphoma

BACKGROUND

Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare subtype of non-Hodgkin lymphoma that accounts for < 3% of extranodal lymphomas and 1% of breast tumors. Its diagnosis and management are challenging because of its rarity, heterogeneity, and aggressive behavior. Conventional ultrasound (US) is the first-line imaging modality for breast lesions; however, it has limited specificity and accuracy for PB-DLBCL. Shear wave elastography (SWE) is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.

AIM

To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.

METHODS

We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment. We analyzed conventional US features (shape, margin, orientation, echo, posterior acoustic features, calcification, and vascularity) and SWE features (mean elasticity value, standard deviation, minimum elasticity value, maximum elasticity value, and lesion-to-fat ratio) of the PB-DLBCL lesions. Using receiver operating characteristic curve analysis, we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features. We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.

RESULTS

The results showed that the PB-DLBCL lesions were mostly irregular in shape (84.4%), microlobulated or spiculated in margins (75%), parallel in orientation (65.6%), hypoechoic in echo (87.5%), and had posterior acoustic enhancement (65.6%). Calcification was rare (6.3%) and vascularity was variable (31.3% avascular, 37.5% hypovascular, and 31.3% hypervascular). The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions (113.4 ± 46.9 kPa vs 27.8 ± 16.4 kPa, P < 0.001). The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa, with a sensitivity of 93.8%, specificity of 92.9%, positive predictive value of 93.8%, negative predictive value of 92.9%, and accuracy of 93.3%. The mean elasticity value was also significantly correlated with Ki-67 expression level (r = 0.612, P < 0.001), which is a marker of tumor proliferation and aggressiveness. Survival analysis showed that patients with higher mean elasticity values (> 54.5 kPa) had worse overall survival (OS) and progression-free survival (PFS) than those with lower mean elasticity values (< 54.5 kPa) (P = 0.038 for OS and P = 0.027 for PFS).

CONCLUSION

Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL. SWE excels in distinguishing PB-DLBCL from benign breast lesions, reflects tumor proliferation and aggressiveness, and improves disease management.

Supervised segmentation for guiding peripheral revascularization with forward-viewing, robotically steered ultrasound guidewire

BACKGROUND

Approximately 500 000 patients present with critical limb ischemia (CLI) each year in the U.S., requiring revascularization to avoid amputation. While peripheral arteries can be revascularized via minimally invasive procedures, 25% of cases with chronic total occlusions are unsuccessful due to inability to route the guidewire beyond the proximal occlusion. Improvements to guidewire navigation would lead to limb salvage in a greater number of patients.

PURPOSE

Integrating ultrasound imaging into the guidewire could enable direct visualization of routes for guidewire advancement. In order to navigate a robotically-steerable guidewire with integrated imaging beyond a chronic occlusion proximal to the symptomatic lesion for revascularization, acquired ultrasound images must be segmented to visualize the path for guidewire advancement.

METHODS

The first approach for automated segmentation of viable paths through occlusions in peripheral arteries is demonstrated in simulations and experimentally-acquired data with a forward-viewing, robotically-steered guidewire imaging system. B-mode ultrasound images formed via synthetic aperture focusing (SAF) were segmented using a supervised approach (U-net architecture). A total of 2500 simulated images were used to train the classifier to distinguish the vessel wall and occlusion from viable paths for guidewire advancement. First, the size of the synthetic aperture resulting in the highest classification performance was determined in simulations (90 test images) and compared with traditional classifiers (global thresholding, local adaptive thresholding, and hierarchical classification). Next, classification performance as a function of the diameter of the remaining lumen (0.5 to 1.5 mm) in the partially-occluded artery was tested using both simulated (60 test images at each of 7 diameters) and experimental data sets. Experimental test data sets were acquired in four 3D-printed phantoms from human anatomy and six ex vivo porcine arteries. Accuracy of classifying the path through the artery was evaluated using microcomputed tomography of phantoms and ex vivo arteries as a ground truth for comparison.

RESULTS

An aperture size of 3.8 mm resulted in the best-performing classification based on sensitivity and Jaccard index, with a significant increase in Jaccard index (p < 0.05) as aperture diameter increased. In comparing the performance of the supervised classifier and traditional classification strategies with simulated test data, sensitivity and F1 score for U-net were 0.95 ± 0.02 and 0.96 ± 0.01, respectively, compared to 0.83 ± 0.03 and 0.41 ± 0.13 for the best-performing conventional approach, hierarchical classification. In simulated test images, sensitivity (p < 0.05) and Jaccard index both increased with increasing artery diameter (p < 0.05). Classification of images acquired in artery phantoms with remaining lumen diameters ≥ 0.75 mm resulted in accuracies > 90%, while mean accuracy decreased to 82% when artery diameter decreased to 0.5 mm. For testing in ex vivo arteries, average binary accuracy, F1 score, Jaccard index, and sensitivity each exceeded 0.9.

CONCLUSIONS

Segmentation of ultrasound images of partially-occluded peripheral arteries acquired with a forward-viewing, robotically-steered guidewire system was demonstrated for the first-time using representation learning. This could represent a fast, accurate approach for guiding peripheral revascularization.

Forming Large Effective Ultrasound Arrays Using the Swept Synthetic Aperture Technique

Ultrasound image quality is intrinsically linked to the hardware used to collect image data. For deep abdominal imaging, diffraction-limited resolution prevents the detection of small targets such as cancerous lesions. Larger ultrasound arrays produce finer lateral image resolution and improved image quality. We introduced a method called "swept synthetic aperture" (SSA) imaging to synthetically create large effective arrays with reduced complexity of both transducer and scanner hardware. A commercial 2-D transducer array and ultrasound scanner were used to form a large effective aperture. Array position and orientation were carefully prescribed throughout a sweep of the transducer using mechanical fixtures to rigidly control the motion. Calibration of the mechanical fixture was measured using a point target phantom and applied in post-processing. Improvements in resolution and contrast as functions of aperture size were measured from point and lesion target phantoms, respectively. SSA imaging presents a technique to both evaluate the performance of large array designs in the presence of clutter-inducing body wall targets and achieve high-quality imaging from reduced-complexity ultrasound hardware.

Improvement of 3-D Ultrasound Spine Imaging Technique Using Fast Reconstruction Algorithm

Three-dimensional (3-D) freehand ultrasound (US) imaging has been applied to the investigation of spine deformity. However, it is a challenge for the current 3-D imaging reconstruction algorithms to achieve a balance between image quality and computation time. The objectives of this article are to implement a new fast reconstruction algorithm that can fulfill the request of immediate demonstration and processing for high-quality 3-D spine imaging, and to evaluate the reliability and accuracy of scoliotic curvature measurement when using the algorithm. The fast dot-projection (FDP) algorithm was applied for voxel-based nearest neighbor (VNN), multiple plane interpolation (MPI), and pixel nearest neighbor (PNN) protocols to reduce the reconstruction time. The 3-D image volume was reconstructed from the datasets acquired from scoliotic subjects. The computational cost, image characteristics, and statistical analyses of curve measurements were compared and evaluated among different reconstruction protocols. The results illustrated that the 3-D spine images using the FDP-MPI4 algorithm showed higher brightness (20%), contrast (14%), and signal-to-noise ratio (SNR) (26%) than FDP-VNN. The measurement performed by trainee rater exhibited significant improvement in measurement reliability and accuracy using FDP-MPI4 in comparison with FDP-VNN ( ), and the intraclass correlation coefficient (ICC) of interrater measurement increased from 0.88 to 0.96. The FDP-PNN method could acquire and reconstruct spine images simultaneously and present the results in 1-2 min, which showed the potential to provide the approximate real-time visualization for fast screening.

In Situ Visualization for 3D Ultrasound-Guided Interventions with Augmented Reality Headset

Augmented Reality (AR) headsets have become the most ergonomic and efficient visualization devices to support complex manual tasks performed under direct vision. Their ability to provide hands-free interaction with the augmented scene makes them perfect for manual procedures such as surgery. This study demonstrates the reliability of an AR head-mounted display (HMD), conceived for surgical guidance, in navigating in-depth high-precision manual tasks guided by a 3D ultrasound imaging system. The integration between the AR visualization system and the ultrasound imaging system provides the surgeon with real-time intra-operative information on unexposed soft tissues that are spatially registered with the surrounding anatomic structures. The efficacy of the AR guiding system was quantitatively assessed with an in vitro study simulating a biopsy intervention aimed at determining the level of accuracy achievable. In the experiments, 10 subjects were asked to perform the biopsy on four spherical lesions of decreasing sizes (10, 7, 5, and 3 mm). The experimental results showed that 80% of the subjects were able to successfully perform the biopsy on the 5 mm lesion, with a 2.5 mm system accuracy. The results confirmed that the proposed integrated system can be used for navigation during in-depth high-precision manual tasks.

Tattoo tomography: Freehand 3D photoacoustic image reconstruction with an optical pattern

Purpose

Photoacoustic tomography (PAT) is a novel imaging technique that can spatially resolve both morphological and functional tissue properties, such as vessel topology and tissue oxygenation. While this capacity makes PAT a promising modality for the diagnosis, treatment, and follow-up of various diseases, a current drawback is the limited field of view provided by the conventionally applied 2D probes.

Methods

In this paper, we present a novel approach to 3D reconstruction of PAT data (Tattoo tomography) that does not require an external tracking system and can smoothly be integrated into clinical workflows. It is based on an optical pattern placed on the region of interest prior to image acquisition. This pattern is designed in a way that a single tomographic image of it enables the recovery of the probe pose relative to the coordinate system of the pattern, which serves as a global coordinate system for image compounding.

Results

To investigate the feasibility of Tattoo tomography, we assessed the quality of 3D image reconstruction with experimental phantom data and in vivo forearm data. The results obtained with our prototype indicate that the Tattoo method enables the accurate and precise 3D reconstruction of PAT data and may be better suited for this task than the baseline method using optical tracking.

Conclusions

In contrast to previous approaches to 3D ultrasound (US) or PAT reconstruction, the Tattoo approach neither requires complex external hardware nor training data acquired for a specific application. It could thus become a valuable tool for clinical freehand PAT.

Fast Acoustic Steering Via Tilting Electromechanical Reflectors (FASTER): A Novel Method for High Volume Rate 3-D Ultrasound Imaging

The 3-D ultrasound imaging is essential for a wide range of clinical applications in diagnostic and interventional cardiology, radiology, and obstetrics for prenatal imaging. 3-D ultrasound imaging is also pivotal for advancing technical developments of emerging imaging technologies, such as elastography, blood flow imaging, functional ultrasound (fUS), and super-resolution microvessel imaging. At present, however, existing 3-D ultrasound imaging methods suffer from low imaging volume rate, suboptimal imaging quality, and high costs associated with 2-D ultrasound transducers. Here, we report a novel 3-D ultrasound imaging technique, fast acoustic steering via tilting electromechanical reflectors (FASTER), which provides both high imaging quality and fast imaging speed while at low cost. Capitalizing upon unique water immersible and fast-tilting microfabricated mirror to scan ultrafast plane waves in the elevational direction, FASTER is capable of high volume rate, large field-of-view (FOV) 3-D imaging with conventional 1-D transducers. In this article, we introduce the fundamental concepts of FASTER and present a series of calibration and validation studies for FASTER 3-D imaging. In a wire phantom and tissue-mimicking phantom study, we demonstrated that FASTER was capable of providing spatially accurate 3-D images with a 500-Hz imaging volume rate and an imaging FOV with a range of 48° (20 mm at 25-mm depth) in the elevational direction. We also showed that FASTER had comparable imaging quality with conventional mechanical translation-based 3-D imaging. The principles and results presented in this study establish the technical foundation for the new paradigm of high volume rate 3-D ultrasound imaging based on ultrafast plane waves and fast-tilting, water-immersible microfabricated mirrors.

Compact and Wireless Freehand 3D Ultrasound Real-time Spine Imaging System: A pilot study

The 3D ultrasound reconstruction technology has led to a rapid development of ultrasound spine imaging in recent decades. However, the current imaging apparatus is bulky and not portable. The objective of this study is to develop a new compact and wireless system to offer the real-time visualized spine images during data acquisition. A portable and WI-FI based ultrasound scanner and a compact EM tracking system were assembled to acquire ultrasound transverse frames with location information which could be reconstructed into 3D spine image volume in real-time. The validation was implemented on the 2D coronal images of vertebra phantoms, and the in vivo data acquisition and reconstruction were demonstrated on volunteers. The result showed that the new system could provide reconstructed spine images in real time and the average errors of the reconstructed images were about 1mm (approximate to image pixel size).

A Novel Ultrasound Probe Spatial Calibration Method Using a Combined Phantom and Stylus

Intra-operative ultrasound (US) is a popular imaging modality for its non-radiative and real-time advantages. However, it is still challenging to perform an interventional procedure under two-dimensional (2-D) US image guidance. Accordingly, the trend has been to perform three-dimensional (3-D) US image guidance by equipping the US probe with a spatial position tracking device, which requires accurate probe calibration for determining the spatial position between the B-scan image and the tracked probe. In this report, we propose a novel probe spatial calibration method by developing a calibration phantom combined with the tracking stylus. The calibration phantom is custom-designed to simplify the alignment between the stylus tip and the B-scan image plane. The spatial position of the stylus tip is tracked in real time, and its 2-D image pixel location is extracted and collected simultaneously. Gaussian distribution is used to model the spatial position of the stylus tip and the iterative closest point-based optimization algorithm is used to estimate the spatial transformation that matches these two point sets. Once the probe is calibrated, its trajectory and the B-scan image are collected and used for the volume reconstruction in our freehand 3-D US imaging system. Experimental results demonstrate that the probe calibration approach results in less than 1-mm mean point reconstruction accuracy. It requires less than 5 min for an inexperienced user to complete the probe calibration procedure with minimal training. The mockup test shows that the 3-D images are geometrically correct with 0.28°-angle accuracy and 0.40-mm distance accuracy.

Verification of needle guidance accuracy in pelvic phantom using registered ultrasound and MRI images for intracavitary/interstitial gynecologic brachytherapy

Purpose

In combined intracavitary/interstitial (IC/IS) gynecologic brachytherapy, trackers attached to interstitial needles of localize real-time needle trajectories, and intraoperative ultrasound (US) images provide updated anatomy information during needle insertions. To achieve an effective visualization and image guidance, real-time needle trajectories and US images can be unified in preoperative magnetic resonance imaging (MRI) image space together. This study evaluates the rigid registration accuracy between US images and MRI images as well as the registration accuracy between US images and real-time needle trajectories in a pelvic phantom.

Material and methods

A method for US probe calibration and accomplished rigid registration between MRI images and US images was proposed. An IC/IS applicator was designed. Micro electromagnetic sensor to track and localize real-time needle trajectories in 3D MRI image space was used. Marker validation to test the accuracy of US probe calibration and pelvic phantom validation to test the registration accuracy between US images and MRI images was conducted as well as and pelvic phantom study to verify the registration accuracy between real-time needle trajectories and needle trajectories in registered US images.

Results

US probe calibration accuracy was 0.80 ±0.23 mm (n = 60). Registration accuracy between US images and MRI images were 1.01 ±0.22 mm in the axial plane (n = 60) and 1.14 ±0.20 mm in the sagittal plane (n = 24). Registration accuracy between real-time needle trajectories and needle trajectories in registered US images were 1.25 ±0.31 mm (n = 40) and 1.61 ±0.28 degrees (n = 5), respectively.

Conclusions

In this study, we showed that under ideal conditions, rigid registration between MRI images and US images obtained high accuracy for real-time image guidance. Additionally, registered US images provided accurate image guidance during visual needle insertion in IC/IS gynecologic brachytherapy to achieve a combination of effective visualization and image guidance.

Evaluation of 3D ultrasound for image guidance

PURPOSE

In this paper we compared two different 3D ultrasound (US) modes (3D free-hand mode and 3D wobbler mode) to see which is more suitable to perform the 3D-US/3D-US registration for clinical guidance applications. The typical errors with respect to their impact on the final localization error were evaluated step by step.

METHODS

Multi-point target and Hand-eye calibration methods were used for 3D US calibration together with a newly designed multi-cone phantom. Pointer based and image based methods were used for 2D US calibration. The calibration target error was computed by using a different multi-cone phantom. An egg-shaped phantom was used as ground truth to compare distortions for both 3D modes along with the measurements of the volume. Finally, we compared 3D ultrasound images acquired by 3D wobbler mode and 3D free-hand mode with respect to their 3D-US/3D-US registration accuracy using both, phantom and patient data. A theoretical step by step error analysis was performed and compared to empirical data.

RESULTS

Target registration errors based on the calibration with the 3D Multi-point and 2D pointer/image method have been found to be comparable (∼1mm). They both outperformed the 3D Hand-eye method (error >2mm). Volume measurements with the 3D free-hand mode were closest to the ground truth (around 6% error compared to 9% with the 3D wobbler mode). Additional scans on phantoms showed a 3D-US/3D-US registration error below 1 mm for both, the 3D free-hand mode and the 3D wobbler mode, respectively. Results with patient data showed greater error with the 3D free-hand mode (6.50mm - 13.37mm) than with the 3D wobbler mode (2.99 ± 1.54 mm). All the measured errors were found to be in accordance to their theoretical upper bounds.

CONCLUSION

While both 3D volume methods showed comparable results with respect to 3D-US/3D-US registration for phantom images, for patient data registrations the 3D wobbler mode is superior to the 3D free-hand mode. The effect of all error sources could be estimated by theoretical derivations.

Design of a Volumetric Imaging Sequence Using a Vantage-256 Ultrasound Research Platform Multiplexed With a 1024-Element Fully Sampled Matrix Array

Ultrasound imaging using a matrix array allows real-time multi-planar volumetric imaging. To enhance image quality, the matrix array should provide fast volumetric ultrasound imaging with spatially consistent focusing in the lateral and elevational directions. However, because of the significantly increased data size, dealing with massive and continuous data acquisition is a significant challenge. We have designed an imaging acquisition sequence that handles volumetric data efficiently using a single 256-channel Verasonics ultrasound research platform multiplexed with a 1024-element matrix array. The developed sequence has been applied for building an ultrasonic pupilometer. Our results demonstrate the capability of the developed approach for structural visualization of an ex vivo porcine eye and the temporal response of the modeled eye pupil with moving iris at the volume rate of 30 Hz. Our study provides a fundamental ground for researchers to establish their own volumetric ultrasound imaging platform and could stimulate the development of new volumetric ultrasound approaches and applications.

A Novel Design of N-Fiducial Phantom for Automatic Ultrasound Calibration

Background:

Freehand ultrasound (US) is a technique used to acquire three-dimensional (3D) US images using a tracked 2D US probe. Calibrating the probe with a proper calibration phantom improves the precision of the technique and allows several applications in computer-assisted surgery. N-fiducial phantom is widely used due to the robustness of precise fabrication and convenience of use. In principle, the design supports single-frame calibration by providing at least three noncollinear points in 3D space at once. Due to this requirement, most designs contain multiple N-fiducials in unpatterned and noncollinear arrangements. The unpatterned multiple N-fiducials appearing as scattered dots in the US image are difficult to extract, and the extracted data are usually contaminated with noise. In practice, the extraction mostly relied on manual interventions, and calibration with N-fiducial phantom has not yet achieved high accuracy with single or few frame calibrations due to noise contamination.

Aims:

In this article, we propose a novel design of the N-fiducial US calibration phantom to enable automatic feature extraction with comparable accuracy to multiple frame calibration.

Materials and Methods:

Along with the design, the Random Sample Consensus (RANSAC) algorithm was used for feature extraction with both 2D and 3D models estimation. The RANSAC feature extraction algorithm was equipped with a closed-form calibration method to achieve automatic calibration.

Results:

The accuracy, precision, and shape reconstruction errors of the calibration acquired from the experiment were significantly matched with the previous literature reports.

Conclusions:

The results showed that our proposed method has a high efficiency to perform automatic feature extraction compared to conventional extraction performed by humans.

Reconstruction and positional accuracy of 3D ultrasound on vertebral phantoms for adolescent idiopathic scoliosis spinal surgery

PURPOSE

Determine the positional, rotational and reconstruction accuracy of a 3D ultrasound system to be used for image registration in navigation surgery.

METHODS

A custom 3D ultrasound for spinal surgery image registration was developed using Optitrack Prime 13-W motion capture cameras and a SonixTablet Ultrasound System. Temporal and spatial calibration was completed to account for time latencies between the two systems and to ensure accurate motion tracking of the ultrasound transducer. A mock operating room capture volume with a pegboard grid was set up to allow phantoms to be placed at a variety of predetermined positions to validate accuracy measurements. Five custom-designed ultrasound phantoms were 3D printed to allow for a range of linear and angular dimensions to be measured when placed on the pegboard.

RESULTS

Temporal and spatial calibration was completed with measurement repeatabilities of 0.2 mm and 0.5° after calibration. The mean positional accuracy was within 0.4 mm, with all values within 0.5 mm within the critical surgical regions and 96% of values within 1 mm within the full capture volume. All orientation values were within 1.5°. Reconstruction accuracy was within 0.6 mm and 0.9° for geometrically shaped phantoms and 0.5 and 1.9° for vertebrae-mimicking phantoms.

CONCLUSIONS

The accuracy of the developed 3D ultrasound system meets the 1 mm and 5° requirements of spinal surgery from this study. Further repeatability studies and evaluation on vertebrae are needed to validate the system for surgical use.

Phantom with multiple active points for ultrasound calibration

Accurate tracking and localization of ultrasound (US) images are used in various computer-assisted interventions. US calibration is a preoperative procedure to recover the transformation bridging the tracking sensor and the US image coordinate systems. Although many calibration phantom designs have been proposed, a limitation that hinders the resulted calibration accuracy is US elevational beam thickness. Previous studies have proposed an active-echo (AE)-based calibration concept to overcome this limitation by utilizing dynamic active US feedback from a single PZT element-based phantom, which assists in placing the phantom within the US elevational plane. However, the process of searching elevational midplane is time-consuming and requires dedicated hardware to enable "AE" functionality. Extending this active phantom, we present a US calibration concept and associated mathematical framework enabling fast and accurate US calibration using multiple "active" points. The proposed US calibration can simplify the calibration procedure by minimizing the number of times midplane search is performed and shortening calibration time. This concept is demonstrated with a configuration mechanically tracking a US probe using a robot arm. We validated the concept through simulation and experiment, and achieved submillimeter calibration accuracy. This result indicates that the multiple active-point phantom has potential to provide superior calibration performance for applications requiring high tracking accuracy.

Versatile Low-Cost Volumetric 3-D Ultrasound Platform for Existing Clinical 2-D Systems

Ultrasound imaging has indications across many areas of medicine, but the need for training and the variability in skill and acquired image quality among 2-D ultrasound users have limited its wider adoption and utilization. Low-cost volumetric ultrasound with a known frame of reference has the potential to lower these operator-dependent barriers and enhance the clinical utility of ultrasound imaging. In this paper, we improve upon our previous research-scanner-based prototype to implement a versatile volumetric imaging platform for existing clinical 2-D ultrasound systems. We present improved data acquisition and image reconstruction schemes to increase quality, streamline workflow, and provide real-time visual feedback. We present initial results using the platform on a Vimedix simulator, as well as on phantom and in vivo targets using a variety of clinical ultrasound systems and probes.

A Methodology for Non-Invasive 3-D Surveillance of Arteriovenous Fistulae Using Freehand Ultrasound

OBJECTIVE

Surveillance techniques for arteriovenous fistulae are required to maintain functional vascular access, with two-dimensional duplex ultrasound the most widely used imaging modality. This paper presents a surveillance method for an arteriovenous fistula using a freehand three-dimensional (3-D) ultrasound system. A patient-case study highlights the applicability in a clinical environment.

METHODS

The freehand ultrasound system uses optical tracking to determine the vascular probe location, and as the probe is swept down a patient's arm, each B-mode slice is spatially arranged to be post-processed as a volume. The volume is segmented to obtain the 3-D vasculature for high detail analysis.

RESULTS

The results follow a patient with stenosis, undergoing surgery to have a stent placement. A surveillance scan was taken pre-surgery, postsurgery, and at a two-month follow-up. Vasculature changes are quantified using detailed analysis, and the benefits of using 3-D imaging are shown through 3-D printing and visualization.

CONCLUSION AND SIGNIFICANCE

Non-invasive 3-D surveillance of arteriovenous fistulae is possible, and a patient-specific geometry was created using ultrasound and optical tracking. Access to this non-invasive 3-D surveillance technique will enable future studies to determine patient-specific remodeling behavior, in terms of geometry and hemodynamics over time.

Actuator-Assisted Calibration of Freehand 3D Ultrasound System

Freehand three-dimensional (3D) ultrasound has been used independently of other technologies to analyze complex geometries or registered with other imaging modalities to aid surgical and radiotherapy planning. A fundamental requirement for all freehand 3D ultrasound systems is probe calibration. The purpose of this study was to develop an actuator-assisted approach to facilitate freehand 3D ultrasound calibration using point-based phantoms. We modified the mathematical formulation of the calibration problem to eliminate the need of imaging the point targets at different viewing angles and developed an actuator-assisted approach/setup to facilitate quick and consistent collection of point targets spanning the entire image field of view. The actuator-assisted approach was applied to a commonly used cross wire phantom as well as two custom-made point-based phantoms (original and modified), each containing 7 collinear point targets, and compared the results with the traditional freehand cross wire phantom calibration in terms of calibration reproducibility, point reconstruction precision, point reconstruction accuracy, distance reconstruction accuracy, and data acquisition time. Results demonstrated that the actuator-assisted single cross wire phantom calibration significantly improved the calibration reproducibility and offered similar point reconstruction precision, point reconstruction accuracy, distance reconstruction accuracy, and data acquisition time with respect to the freehand cross wire phantom calibration. On the other hand, the actuator-assisted modified “collinear point target” phantom calibration offered similar precision and accuracy when compared to the freehand cross wire phantom calibration, but it reduced the data acquisition time by 57%. It appears that both actuator-assisted cross wire phantom and modified collinear point target phantom calibration approaches are viable options for freehand 3D ultrasound calibration.

Combining intraoperative ultrasound brain shift correction and augmented reality visualizations: a pilot study of eight cases

We present our work investigating the feasibility of combining intraoperative ultrasound for brain shift correction and augmented reality (AR) visualization for intraoperative interpretation of patient-specific models in image-guided neurosurgery (IGNS) of brain tumors. We combine two imaging technologies for image-guided brain tumor neurosurgery. Throughout surgical interventions, AR was used to assess different surgical strategies using three-dimensional (3-D) patient-specific models of the patient's cortex, vasculature, and lesion. Ultrasound imaging was acquired intraoperatively, and preoperative images and models were registered to the intraoperative data. The quality and reliability of the AR views were evaluated with both qualitative and quantitative metrics. A pilot study of eight patients demonstrates the feasible combination of these two technologies and their complementary features. In each case, the AR visualizations enabled the surgeon to accurately visualize the anatomy and pathology of interest for an extended period of the intervention. Inaccuracies associated with misregistration, brain shift, and AR were improved in all cases. These results demonstrate the potential of combining ultrasound-based registration with AR to become a useful tool for neurosurgeons to improve intraoperative patient-specific planning by improving the understanding of complex 3-D medical imaging data and prolonging the reliable use of IGNS.

Freehand 3-D Ultrasound Imaging: A Systematic Review

Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.

Ultrasound Aided Vertebral Level Localization for Lumbar Surgery

Localization of the correct vertebral level for surgical entry during lumbar hernia surgery is not straightforward. In this paper, we develop and evaluate a solution using free-hand 2-D ultrasound (US) imaging in the operation room (OR). Our system exploits the difference in spinous process shapes of the vertebrae. The spinous processes are pre-operatively outlined and labeled in a lateral lumbar X-ray of the patient. Then, in the OR the spinous processes are imaged with 2-D sagittal US, and are automatically segmented and registered with the X-ray shapes. After a small number of scanned vertebrae, the system robustly matches the shapes, and propagates the X-ray label to the US images. The main contributions of our work are: we propose a deep convolutional neural network-based bone segmentation algorithm from US imaging that outperforms state of the art methods in both performance and speed. We present a matching strategy that determines the levels of the spinal processes being imaged. And lastly, we evaluate the complete procedure on 19 clinical data sets from two hospitals, and two observers. The final labeling was correct in 92% of the cases, demonstrating the feasibility of US-based surgical entry point detection for spinal surgeries.

Active phantoms: a paradigm for ultrasound calibration using phantom feedback

In ultrasound (US)-guided medical procedures, accurate tracking of interventional tools is crucial to patient safety and clinical outcome. This requires a calibration procedure to recover the relationship between the US image and the tracking coordinate system. In literature, calibration has been performed on passive phantoms, which depend on image quality and parameters, such as frequency, depth, and beam-thickness as well as in-plane assumptions. In this work, we introduce an active phantom for US calibration. This phantom actively detects and responds to the US beams transmitted from the imaging probe. This active echo (AE) approach allows identification of the US image midplane independent of image quality. Both target localization and segmentation can be done automatically, minimizing user dependency. The AE phantom is compared with a crosswire phantom in a robotic US setup. An out-of-plane estimation US calibration method is also demonstrated through simulation and experiments to compensate for remaining elevational uncertainty. The results indicate that the AE calibration phantom can have more consistent results across experiments with varying image configurations. Automatic segmentation is also shown to have similar performance to manual segmentation.

First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules

PURPOSE

Percutaneous radiofrequency ablation (RFA) of thyroid nodules is an alternative to surgical resection that offers the benefits of minimal scars for the patient, lower complication rates, and shorter treatment times. Ultrasound (US) is the preferred modality for guiding these procedures. The needle is usually kept within the US scanning plane to ensure needle visibility. However, this restricts flexibility in both transducer and needle movement and renders the procedure difficult, especially for inexperienced users. Existing navigation solutions often involve electromagnetic (EM) tracking, which requires placement of an external field generator (FG) in close proximity of the intervention site in order to avoid distortion of the EM field. This complicates the clinical workflow as placing the FG while ensuring that it neither restricts the physician's workspace nor affects tracking accuracy is awkward and time-consuming.

METHODS

The EchoTrack concept overcomes these issues by combining the US probe and the EM FG in one modality, simultaneously providing both real-time US and tracking data without requiring the placement of an external FG for tracking. We propose a system and workflow to use EchoTrack for RFA of thyroid nodules.

RESULTS

According to our results, the overall error of the EchoTrack system resulting from errors related to tracking and calibration is below 2 mm. Navigated thyroid RFA with the proposed concept is clinically feasible. Motion of internal critical structures relative to external markers can be up to several millimeters in extreme cases.

CONCLUSIONS

The EchoTrack concept with its simple setup, flexibility, improved needle visualization, and additional guidance information has high potential to be clinically used for thyroid RFA.

Brain shift in neuronavigation of brain tumors: A review

PURPOSE

Neuronavigation based on preoperative imaging data is a ubiquitous tool for image guidance in neurosurgery. However, it is rendered unreliable when brain shift invalidates the patient-to-image registration. Many investigators have tried to explain, quantify, and compensate for this phenomenon to allow extended use of neuronavigation systems for the duration of surgery. The purpose of this paper is to present an overview of the work that has been done investigating brain shift.

METHODS

A review of the literature dealing with the explanation, quantification and compensation of brain shift is presented. The review is based on a systematic search using relevant keywords and phrases in PubMed. The review is organized based on a developed taxonomy that classifies brain shift as occurring due to physical, surgical or biological factors.

RESULTS

This paper gives an overview of the work investigating, quantifying, and compensating for brain shift in neuronavigation while describing the successes, setbacks, and additional needs in the field. An analysis of the literature demonstrates a high variability in the methods used to quantify brain shift as well as a wide range in the measured magnitude of the brain shift, depending on the specifics of the intervention. The analysis indicates the need for additional research to be done in quantifying independent effects of brain shift in order for some of the state of the art compensation methods to become useful.

CONCLUSION

This review allows for a thorough understanding of the work investigating brain shift and introduces the needs for future avenues of investigation of the phenomenon.

Analysis of refractive artifacts by reconstructed three-dimensional ultrasound imaging

PURPOSE

Refractive artifacts are frequently encountered in clinical settings, and they have been analyzed on the basis of conventional two-dimensional (2-D) ultrasound (US) images, but this method is restricted to monoplane data and is limited by its inability to assess the three-dimensional (3-D) structure of refractive artifacts. The aim of this study was to evaluate the role of reconstructed 3-D US images in the analysis of refractive artifacts.

METHODS

The following representative refractive artifacts were analyzed on the basis of reconstructed 3-D US images: (a) a distorted image of a fine tube behind a cyst (balloon); (b) a deformed image of the bottom of a balloon; and (c) a duplication artifact due to the acoustic lens effect.

RESULTS

(a) A tube was imaged as a fine echogenic line with two points of sudden interruption, unlike a curved needle, which was imaged without interruption. (b) 3-D US allowed us to visualize the mode of deformity in the image of the bottom of a fluid-filled balloon in a water bath. When the acoustic velocity in the fluid was greater than that in the surrounding water, the bottom of the balloon appeared to be shrunken. When the acoustic velocity in the fluid was less than that in the surrounding water, the bottom of the balloon appeared to be swollen. (c) When we placed two pieces of white chicken meat in front of a fine needle, the needle was duplicated in the resulting image. In this case, the needle appeared to be vague and fuzzy. In this case, 3-D US did not add further information to the 2-D images.

CONCLUSIONS

Our study suggests that reconstructed 3-D US images provide a better understanding of the mode of refractive artifacts than do 2-D US images.

User-friendly freehand ultrasound calibration using Lego bricks and automatic registration

PURPOSE

As an inexpensive, noninvasive, and portable clinical imaging modality, ultrasound (US) has been widely employed in many interventional procedures for monitoring potential tissue deformation, surgical tool placement, and locating surgical targets. The application requires the spatial mapping between 2D US images and 3D coordinates of the patient. Although positions of the devices (i.e., ultrasound transducer) and the patient can be easily recorded by a motion tracking system, the spatial relationship between the US image and the tracker attached to the US transducer needs to be estimated through an US calibration procedure. Previously, various calibration techniques have been proposed, where a spatial transformation is computed to match the coordinates of corresponding features in a physical phantom and those seen in the US scans. However, most of these methods are difficult to use for novel users.

METHODS

We proposed an ultrasound calibration method by constructing a phantom from simple Lego bricks and applying an automated multi-slice 2D-3D registration scheme without volumetric reconstruction. The method was validated for its calibration accuracy and reproducibility.

RESULTS

Our method yields a calibration accuracy of [Formula: see text] mm and a calibration reproducibility of 1.29 mm.

CONCLUSION

We have proposed a robust, inexpensive, and easy-to-use ultrasound calibration method.

Multimodal acquisition of articulatory data: Geometrical and temporal registration

Acquisition of dynamic articulatory data is of major importance for studying speech production. It turns out that one technique alone often is not enough to get a correct coverage of the whole vocal tract at a sufficient sampling rate. Ultrasound (US) imaging has been proposed as a good acquisition technique for the tongue surface because it offers a good temporal sampling, does not alter speech production, is cheap, and is widely available. However, it cannot be used alone and this paper describes a multimodal acquisition system which uses electromagnetography sensors to locate the US probe. The paper particularly focuses on the calibration of the US modality which is the key point of the system. This approach enables US data to be merged with other data. The use of the system is illustrated via an experiment consisting of measuring the minimal tongue to palate distance in order to evaluate and design Magnetic Resonance Imaging protocols well suited for the acquisition of three-dimensional images of the vocal tract. Compared to manual registration of acquisition modalities which is often used in acquisition of articulatory data, the approach presented relies on automatic techniques well founded from geometrical and mathematical points of view.

A Robotic Ultrasound Scanner for Automatic Vessel Tracking and Three-Dimensional Reconstruction of B-Mode Images

Locating and evaluating the length and severity of a stenosis is very important for planning adequate treatment of peripheral arterial disease (PAD). Conventional ultrasound (US) examination cannot provide maps of entire lower limb arteries in 3-D. We propose a prototype 3D-US robotic system with B-mode images, which is nonionizing, noninvasive, and is able to track and reconstruct a continuous segment of the lower limb arterial tree between the groin and the knee. From an initialized cross-sectional view of the vessel, automatic tracking was conducted followed by 3D-US reconstructions evaluated using Hausdorff distance, cross-sectional area, and stenosis severity in comparison with 3-D reconstructions with computed tomography angiography (CTA). A mean Hausdorff distance of 0.97 ± 0.46 mm was found in vitro for 3D-US compared with 3D-CTA vessel representations. To evaluate the stenosis severity in vitro, 3D-US reconstructions gave errors of 3%-6% when compared with designed dimensions of the phantom, which are comparable to 3D-CTA reconstructions, with 4%-13% errors. The in vivo system's feasibility to reconstruct a normal femoral artery segment of a volunteer was also investigated. These results encourage further ergonomic developments to increase the robot's capacity to represent lower limb vessels in the clinical context.

A novel platform for electromagnetic navigated ultrasound bronchoscopy (EBUS)

Purpose

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is essential for lung cancer staging and distinction between curative and palliative treatment. Precise sampling is crucial. Navigation and multimodal imaging may improve the efficiency of EBUS-TBNA. We demonstrate a novel EBUS-TBNA navigation system in a dedicated airway phantom.

Methods

Using a convex probe EBUS bronchoscope (CP-EBUS) with an integrated sensor for electromagnetic (EM) position tracking, we performed navigated CP-EBUS in a phantom. Preoperative computed tomography (CT) and real-time ultrasound (US) images were integrated into a navigation platform for EM navigated bronchoscopy. The coordinates of targets in CT and US volumes were registered in the navigation system, and the position deviation was calculated.

Results

The system visualized all tumor models and displayed their fused CT and US images in correct positions in the navigation system. Navigating the EBUS bronchoscope was fast and easy. Mean error observed between US and CT positions for 11 target lesions (37 measurements) was \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$2.8\pm 1.0$$\end{document}2.8±1.0 mm, maximum error was 5.9 mm.

Conclusion

The feasibility of our novel navigated CP-EBUS system was successfully demonstrated. An EBUS navigation system is needed to meet future requirements of precise mediastinal lymph node mapping, and provides new opportunities for procedure documentation in EBUS-TBNA.

Panorama Ultrasound for Navigation and Guidance of Epidural Anesthesia

Despite the common use of epidural anesthesia in obstetrics and surgery, the procedure can be challenging, especially for obese patients. We propose the use of an ultrasound guidance system employing a transducer-mounted camera to create 3-D panorama ultrasound volumes of the spine, thereby allowing identification of vertebrae and selection of puncture site, needle trajectory and depth of insertion. The camera achieves absolute position estimation of the transducer with respect to the patient using a specialized marker strip attached to the skin surface. The guidance system is validated first on a phantom against a commercial optical tracking system and then in vivo by comparing panorama images from human subjects against independent measurements by an experienced sonographer. The results for measuring depth to the epidural space, intervertebral spacing and registration of interspinous gaps to the skin prove the potential of the system for improving guidance of epidural anesthesia. The tracking and visualization are implemented in real time using the 3D Slicer software package.

A closed-form differential formulation for ultrasound spatial calibration: single wall phantom

Calibration is essential in freehand 3-D ultrasound to find the spatial transformation from the image coordinates to the sensor coordinate system. Ease of use, simplicity, precision and accuracy are among the most important factors in ultrasound calibration, especially when aiming to make calibration more reliable for day-to-day clinical use. We introduce a new mathematical framework for the simple and popular single-wall calibration phantom with a plane equation pre-determination step and the use of differential measurements to obtain accurate measurements. The proposed method provides a novel solution for ultrasound calibration that is accurate and easy to perform. This method is applicable to both radiofrequency (RF) and B-mode data, and both linear and curvilinear transducers. For a linear L14-5 transducer, the point reconstruction accuracy (PRA) of reconstructing 370 points is 0.73 ± 0.23 mm using 100 RF images, whereas the triple N-wire PRA is 0.67 ± 0.20 mm using 100 B-mode images. For a curvilinear C5-2 transducer, the PRA using the proposed method is 0.86 ± 0.28 mm on 400 points using 100 RF images, whereas N-wire calibration gives a PRA of 0.80 ± 0.46 mm using 100 B-mode images. Therefore, the accuracy of the proposed variation of the single-wall method using RF data is practically similar to the N-wire method while offering a simpler phantom with no need for accurate design and construction.

A closed-form differential formulation for ultrasound spatial calibration: multi-wedge phantom

Calibration is essential in freehand 3-D ultrasound to find the spatial transformation from the image coordinates to the sensor coordinate system. Calibration accuracy has significant impact on image-guided interventions. We introduce a new mathematical framework that uses differential measurements to achieve high calibration accuracy. Accurate measurements of axial differences in ultrasound images of a multi-wedge phantom are used to calculate the calibration matrix with a closed-form solution. The multi-wedge phantom has been designed based on the proposed differential framework and can be mass-produced inexpensively using a 3-D printer. The proposed method enables easy, fast and highly accurate ultrasound calibration, which is essential for most current ultrasound-guided applications and also widens the range of new applications. The precision of the method using only a single image of the phantom is comparable to that of the standard N-wire method using 50 images. The method can also directly take advantage of the fine sampling rate of radiofrequency ultrasound data to achieve very high calibration accuracy. With 100 radiofrequency ultrasound images, the method achieves a point reconstruction error of 0.09 ± 0.39 mm.

Calibration for position tracking of swept motor 3-D ultrasound

Tracking the position and orientation of a 3-D ultrasound transducer has many clinical applications. Tracking requires calibration to find the transformation between the tracking sensor and the ultrasound coordinates. Typically the set of image slice data are scan converted to a Cartesian volume using assumed motor geometry and a single transformation to the sensor. We propose, instead, the calibration of individual slices using a 2-D calibration technique. A best fit to a subset of slices is performed to decrease data collection time compared with that for calibration of all slices, and to reduce the influence of random errors in individual calibrations. We compare our technique with four scan conversion-based techniques: 2-D N-wire on the center slice, N-wire using a 3-D volume, N-wire using a 3-D volume including the edge points and a new closed-form planar method using a 3-D volume. The proposed multi-slice technique produced the smallest point reconstruction error (0.82 mm using a tracked stylus).

Model-based correction of tissue compression for tracked ultrasound in soft tissue image-guided surgery

Acquisition of ultrasound data negatively affects image registration accuracy during image-guided therapy because of tissue compression by the probe. We present a novel compression correction method that models sub-surface tissue displacement resulting from application of a tracked probe to the tissue surface. Patient landmarks are first used to register the probe pose to pre-operative imaging. The ultrasound probe geometry is used to provide boundary conditions to a biomechanical model of the tissue. The deformation field solution of the model is inverted to non-rigidly transform the ultrasound images to an estimation of the tissue geometry before compression. Experimental results with gel phantoms indicated that the proposed method reduced the tumor margin modified Hausdorff distance (MHD) from 5.0 ± 1.6 to 1.9 ± 0.6 mm, and reduced tumor centroid alignment error from 7.6 ± 2.6 to 2.0 ± 0.9 mm. The method was applied to a clinical case and reduced the tumor margin MHD error from 5.4 ± 0.1 to 2.6 ± 0.1 mm and the centroid alignment error from 7.2 ± 0.2 to 3.5 ± 0.4 mm.

An error analysis perspective for patient alignment systems

PURPOSE

This paper analyses the effects of error sources which can be found in patient alignment systems. As an example, an ultrasound (US) repositioning system and its transformation chain are assessed. The findings of this concept can also be applied to any navigation system.

METHODS AND MATERIALS

In a first step, all error sources were identified and where applicable, corresponding target registration errors were computed. By applying error propagation calculations on these commonly used registration/calibration and tracking errors, we were able to analyse the components of the overall error. Furthermore, we defined a special situation where the whole registration chain reduces to the error caused by the tracking system. Additionally, we used a phantom to evaluate the errors arising from the image-to-image registration procedure, depending on the image metric used. We have also discussed how this analysis can be applied to other positioning systems such as Cone Beam CT-based systems or Brainlab's ExacTrac.

RESULTS

The estimates found by our error propagation analysis are in good agreement with the numbers found in the phantom study but significantly smaller than results from patient evaluations. We probably underestimated human influences such as the US scan head positioning by the operator and tissue deformation. Rotational errors of the tracking system can multiply these errors, depending on the relative position of tracker and probe.

CONCLUSIONS

We were able to analyse the components of the overall error of a typical patient positioning system. We consider this to be a contribution to the optimization of the positioning accuracy for computer guidance systems.

Ultrasound probe and needle-guide calibration for robotic ultrasound scanning and needle targeting

Image-to-robot registration is a typical step for robotic image-guided interventions. If the imaging device uses a portable imaging probe that is held by a robot, this registration is constant and has been commonly named probe calibration. The same applies to probes tracked by a position measurement device. We report a calibration method for 2-D ultrasound probes using robotic manipulation and a planar calibration rig. Moreover, a needle guide that is attached to the probe is also calibrated for ultrasound-guided needle targeting. The method is applied to a transrectal ultrasound (TRUS) probe for robot-assisted prostate biopsy. Validation experiments include TRUS-guided needle targeting accuracy tests. This paper outlines the entire process from the calibration to image-guided targeting. Freehand TRUS-guided prostate biopsy is the primary method of diagnosing prostate cancer, with over 1.2 million procedures performed annually in the U.S. alone. However, freehand biopsy is a highly challenging procedure with subjective quality control. As such, biopsy devices are emerging to assist the physician. Here, we present a method that uses robotic TRUS manipulation. A 2-D TRUS probe is supported by a 4-degree-of-freedom robot. The robot performs ultrasound scanning, enabling 3-D reconstructions. Based on the images, the robot orients a needle guide on target for biopsy. The biopsy is acquired manually through the guide. In vitro tests showed that the 3-D images were geometrically accurate, and an image-based needle targeting accuracy was 1.55 mm. These validate the probe calibration presented and the overall robotic system for needle targeting. Targeting accuracy is sufficient for targeting small, clinically significant prostatic cancer lesions, but actual in vivo targeting will include additional error components that will have to be determined.

An Autoclavable Steerable Cannula Manual Deployment Device: Design and Accuracy Analysis

Accessing a specific, predefined location identified in medical images is a common interventional task for biopsies and drug or therapy delivery. While conventional surgical needles provide little steerability, concentric tube continuum devices enable steering through curved trajectories. These devices are usually developed as robotic systems. However, manual actuation of concentric tube devices is particularly useful for initial transfer into the clinic since the Food and Drug Administration (FDA) and Institutional Review Board (IRB) approval process of manually operated devices is simple compared to their motorized counterparts. In this paper, we present a manual actuation device for the deployment of steerable cannulas. The design focuses on compactness, modularity, usability, and sterilizability. Further, the kinematic mapping from joint space to Cartesian space is detailed for an example concentric tube device. Assessment of the device's accuracy was performed in free space, as well as in an image-guided surgery setting, using tracked 2D ultrasound.

Registration of 3D ultrasound through an air-tissue boundary

In this study we evaluated a new method for registering three-dimensional ultrasound (3DUS) data to external coordinate systems. First, 3DUS was registered to the stereo endoscope of a da Vinci Surgical System by placing a registration tool against an air-tissue boundary so that the 3DUS could image ultrasound fiducials while the stereo endoscope could image camera markers on the same tool. The common points were used to solve the registration between the 3DUS and camera coordinate systems. The target registration error (TRE) when imaging through a PVC tissue phantom ranged from 3.85 1.76 mm to 1.82 1.03 mm using one to four registration tool positions. TRE when imaging through an ex-vivo liver tissue sample ranged from 2.36 1.01 mm to 1.51 0.70 mm using one to four registration tool positions. Second, using a similar method, 3DUS was registered to the kinematic coordinate system of a da Vinci Surgical System by using the da Vinci surgical manipulators to identify common points on an air-tissue boundary. TRE when imaging through a PVC tissue phantom was 0.95 0.38 mm. This registration method is simpler and potentially more accurate than methods using commercial motion tracking systems. This method may be useful in the future in augmented reality systems for laparoscopic and robotic-assisted surgery.

Automatic and robust calibration of optical detector arrays for biomedical diffuse optical spectroscopy

The design and testing of a new, fully automated, calibration approach is described. The process was used to calibrate an image-guided diffuse optical spectroscopy system with 16 photomultiplier tubes (PMTs), but can be extended to any large array of optical detectors and associated imaging geometry. The design goals were accomplished by developing a routine for robust automated calibration of the multi-detector array within 45 minutes. Our process was able to characterize individual detectors to a median norm of the residuals of 0.03 V for amplitude and 4.4 degrees in phase and achieved less than 5% variation between all the detectors at the 95% confidence interval for equivalent measurements. Repeatability of the calibrated data from the imaging system was found to be within 0.05 V for amplitude and 0.2 degrees for phase, and was used to evaluate tissue-simulating phantoms in two separate imaging geometries. Spectroscopic imaging of total hemoglobin concentration was recovered to within 5% of the true value in both cases. Future work will focus on streamlining the technology for use in a clinical setting with expectations of achieving accurate quantification of suspicious lesions in the breast.