Elastography for breast cancer diagnosis using radiation force: system development and performance evaluation

Rapid scanning wide-field clutter elimination in epi-optoacoustic imaging using comb LOVIT

Epi-style optoacoustic (OA) imaging provides flexibility by integrating the irradiation optics and ultrasound receiver, yet clutter generated by optical absorption near the probe obscures deep OA sources. Localised vibration tagging (LOVIT) retrieves OA signal from images that are acquired with and without a preceding ultrasonic pushing beam: Radiation force leads to a phase shift of signals coming from the focal area resulting in their visibility in a difference image, whereas clutter from outside the pushing beam is eliminated. Disadvantages of a single-focus approach are residual clutter from inside the pushing beam above the focus, and time-intensive scanning of the focus to retrieve a large field-of-view. To speed up acquisition, we propose to create multiple foci in parallel, forming comb-shaped ARF patterns. By subtracting OA images obtained with interleaved combs, this technique moreover results in greatly improved clutter reduction in phantoms mimicking optical, acoustic and elastic properties of breast tissue.

Computed ultrasound tomography in echo mode for imaging speed of sound using pulse-echo sonography: proof of principle

The limitations of diagnostic echo ultrasound have motivated research into novel modalities that complement ultrasound in a multimodal device. One promising candidate is speed of sound imaging, which has been found to reveal structural changes in diseased tissue. Transmission ultrasound tomography shows speed of sound spatially resolved, but is limited to the acoustically transparent breast. We present a novel method by which speed-of-sound imaging is possible using classic pulse-echo equipment, facilitating new clinical applications and the combination with state-of-the art diagnostic ultrasound. Pulse-echo images are reconstructed while scanning the tissue under various angles using transmit beam steering. Differences in average sound speed along different transmit directions are reflected in the local echo phase, which allows a 2-D reconstruction of the sound speed. In the present proof-of-principle study, we describe a contrast resolution of 0.6% of average sound speed and a spatial resolution of 1 mm (laterally) × 3 mm (axially), suitable for diagnostic applications.

Skin imaging in systemic sclerosis

Fibrotic involvement of the skin is a cardinal feature of systemic sclerosis (SSc). The extent of skin involvement is associated with internal organ involvement, coinciding with more severe disease course and poor prognosis. A palpation-based semi-quantitative score, the modified Rodnan skin score, is widely used for the assessment of skin involvement, but it is entailed by significant limitations. More objective approaches to measure skin involvement employing imaging have been explored continuously in the past decades and are currently advancing. Here, we review the use of different imaging techniques for the assessment of skin involvement in patients with SSc, focusing mainly on ultrasound, magnetic resonance imaging, and optical coherence tomography.

Clutter elimination for deep clinical optoacoustic imaging using localised vibration tagging (LOVIT)

This paper investigates a novel method which allows clutter elimination in deep optoacoustic imaging. Clutter significantly limits imaging depth in clinical optoacoustic imaging, when irradiation optics and ultrasound detector are integrated in a handheld probe for flexible imaging of the human body. Strong optoacoustic transients generated at the irradiation site obscure weak signals from deep inside the tissue, either directly by propagating towards the probe, or via acoustic scattering. In this study we demonstrate that signals of interest can be distinguished from clutter by tagging them at the place of origin with localised tissue vibration induced by the acoustic radiation force in a focused ultrasonic beam. We show phantom results where this technique allowed almost full clutter elimination and thus strongly improved contrast for deep imaging. Localised vibration tagging by means of acoustic radiation force is especially promising for integration into ultrasound systems that already have implemented radiation force elastography.

Preliminary investigation into the use of ultrasound elastography during brain tumour resection

Introduction

Differentiation of brain tumours from normal brain, during surgical resection is, in part, based on their differing mechanical properties. Brain tumours have variable stiffness characteristics. Surgical evaluations on stiffness are, at best, subjective. Ultrasound elastography is a non-invasive method for imaging mechanical properties of tissues such as stiffness at depth. It is hypothesized that this technique may assist in differentiating tumour from the brain in an intraoperative setting.

Methods

This study evaluated the feasibility of the intraoperative use of ultrasound elastography during brain tumour resection. A total of 24 patients were recruited for the study. Surgical findings on tumour stiffness were compared with the elastogram findings. Furthermore, visibility of the brain-tumour interface on ultrasound echography compared with ultrasound elastography was analysed.

Results

Ultrasound elastography was found to have a sensitivity of 100% and specificity of 75% at detecting that tumour had a different stiffness to the brain when compared with surgical findings. The technique was also found to have a 100% sensitivity and specificity at the detection of intratumoral stiffness heterogeneity compared with surgical findings. The presence of fluid-filled cysts limited the quality of the elastograms. Ultrasound elastography did not detect the brain-tumour interface as accurately as conventional echography.

Conclusion

These findings suggest that ultrasound elastography in combination with conventional B-mode ultrasound may be a useful adjunct to differentiate tumour from the brain.

Review of ultrasound elastography quality control and training test phantoms

While the rapid development of ultrasound elastography techniques in recent decades has sparked its prompt implementation in the clinical setting adding new diagnostic information to conventional imaging techniques, questions still remain as to its full potential and efficacy in the hospital environment. A limited number of technical studies have objectively assessed the full capabilities of the different elastography approaches, perhaps due, in part, to the scarcity of suitable tissue-mimicking materials (TMMs) and appropriately designed phantoms available. Few commercially available elastography phantoms possess the necessary test target characteristics or mechanical properties observed clinically, or indeed reflect the lesion-to-background elasticity ratio encountered during clinical scanning. Thus, while some phantoms may prove useful, they may not fully challenge the capabilities of the different elastography techniques, proving limited when it comes to quality control (QC) and/or training purposes. Although a variety of elastography TMMs, such as agar and gelatine dispersions, co-polymer in oil and poly(vinyl) alcohol cryogel, have been developed for specific research purposes, such work is yet to produce appropriately designed phantoms to adequately challenge the variety of current commercially available elastography applications. Accordingly, there is a clear need for the further development of elastography TMMs and phantoms to keep pace with the rapid developments in elastography technology, to ensure that the performance of these new diagnostic approaches are validated, and for clinical training purposes.

Acoustic radiation force-driven assessment of myocardial elasticity using the displacement ratio rate (DRR) method

A noninvasive method of characterizing myocardial stiffness could have significant implications in diagnosing cardiac disease. Acoustic radiation force (ARF)-driven techniques have demonstrated their ability to discern elastic properties of soft tissue. For the purpose of myocardial elasticity imaging, a novel ARF-based imaging technique, the displacement ratio rate (DRR) method, was developed to rank the relative stiffnesses of dynamically varying tissue. The basis and performance of this technique was demonstrated through numerical and phantom imaging results. This new method requires a relatively small temporal (<1 ms) and spatial (tenths of mm(2)) sampling window and appears to be independent of applied ARF magnitude. The DRR method was implemented in two in vivo canine studies, during which data were acquired through the full cardiac cycle by imaging directly on the exposed epicardium. These data were then compared with results obtained by acoustic radiation force impulse (ARFI) imaging and shear wave velocimetry, with the latter being used as the gold standard. Through the cardiac cycle, velocimetry results portray a range of shear wave velocities from 0.76-1.97 m/s, with the highest velocities observed during systole and the lowest observed during diastole. If a basic shear wave elasticity model is assumed, such a velocity result would suggest a period of increased stiffness during systole (when compared with diastole). Despite drawbacks of the DRR method (i.e., sensitivity to noise and limited stiffness range), its results predicted a similar cyclic stiffness variation to that offered by velocimetry while being insensitive to variations in applied radiation force.

Acoustic radiation force contrast in MRI: detection of calcifications in tissue-mimicking phantoms

PURPOSE

Mammography is a widely used tool for the screening of breast cancer, and calcifications are a common finding in most mammograms. The location, size, number, morphology, and distribution of calcifications are an important information to differentiate a benign lesion from probably malignant pathologies. Calcifications are not detectable with a standard dynamic contrast enhanced breast MRI. The authors present a novel method for the detection and imaging of calcifications in breast tissue without ionizing radiation or contrast agents.

METHODS

Measurements of localized tissue displacement in phantoms due to applied acoustic radiation force were performed. This displacement was imaged with a displacement sensitive spin-echo MRI sequence. Pieces of eggshell that represent calcifications were embedded in tissue-mimicking agarose phantoms. The sizes of the calcifications were 0.8 x 0.8 x 0.4, 1.5 x 1.5 x 0.4, and 2 x 3 x 0.4 mm3. The calcifications were scanned with ultrasound (U.S.) at 2.5 MHz and intensities up to I(spta) =7.18 W/cm2. The U.S. beam was moved inside the phantom by a computer-controlled three-dimensional hydraulic positioning system. The U.S. beam was scanned over the two smaller calcifications with the displacement sensitivity of the MRI sequence parallel to the U.S. beam path. Grayscale coded maps of the displacement scans are presented. For the 0.8 x 0.8 x 0.4 mm3 calcification, the U.S. intensities were varied. Finite element simulations were performed to verify if the experiments complied with theory.

RESULTS

The authors found that the displacement caused by the U.S. is increased at the position of the calcification. The area of increased displacement is at least twice as large as the calcification itself. The simulations show this increase in displacement and area at the position of the calcification. When changing the displacement sensitivity direction to perpendicular to the U.S. beam, a crossed black and white four-leaf clover is visible at the position of the calcification.

CONCLUSIONS

The U.S. is scattered and reflected by the calcifications. This leads to the increased displacement which is transmitted to the surrounding material because of the elastic coupling between the calcification and the agarose material. Due to the high differences in acoustic impedance and elastic properties between the surrounding tissue and the calcification, even the detection of pieces smaller than the resolution of the MRI scanner is possible. The acoustic radiation force contrast in MR phase-difference images offers a positive signal for calcifications from a smooth background in phantoms. This method offers a possibility of differentiating qualitatively and quantitatively hard calcifications from stiffer inclusions such as tumors.

Ultrasonic elastography in clinical quantitative assessment of fatty liver

AIM: To investigate the clinical application of ultrasonic elastography in quantitative assessment of fatty liver grading.

METHODS: A total of 105 patients with fatty liver were divided into mild group (n = 46), moderate group (n = 39), and severe group (n = 20). Forty-five healthy individuals served as a normal control group. All patients who underwent routine ultrasound scan and further ultrasonic elastography were evaluated accordingly to the evaluation standards for ultrasonic elastography. The ratio of surface areas of blue region/total surface area in the desired region was measured.

RESULTS: Ultrasonic elastography technique, in comparison to traditional ultrasound, had a rather high consistence in grading of fatty liver [κ value = (95.3%-63.6%)/(1%-63.6%) = 0.87, P = 0.001]. The score of ultrasonic elastography increased with the severity of fatty liver with a sensitivity of 97.14% and a specificity of 91.11%. A significant difference was found in the ratio of surface areas of blue regions between different groups (P < 0.05).

CONCLUSION: Ultrasonic elastography can be used in quantitative assessment of the severity of fatty liver.

Optical tracking of acoustic radiation force impulse-induced dynamics in a tissue-mimicking phantom

Optical tracking was utilized to investigate the acoustic radiation force impulse (ARFI)-induced response, generated by a 5-MHz piston transducer, in a translucent tissue-mimicking phantom. Suspended 10-microm microspheres were tracked axially and laterally at multiple locations throughout the field of view of an optical microscope with 0.5-microm displacement resolution, in both dimensions, and at frame rates of up to 36 kHz. Induced dynamics were successfully captured before, during, and after the ARFI excitation at depths of up to 4.8 mm from the phantom's proximal boundary. Results are presented for tracked axial and lateral displacements resulting from on-axis and off-axis (i.e., shear wave) acquisitions; these results are compared to matched finite element method modeling and independent ultrasonically based empirical results and yielded reasonable agreement in most cases. A shear wave reflection, generated by the proximal boundary, consistently produced an artifact in tracked displacement data later in time (i.e., after the initial ARFI-induced displacement peak). This tracking method provides high-frame-rate, two-dimensional tracking data and thus could prove useful in the investigation of complex ARFI-induced dynamics in controlled experimental settings.

Shear wave spectroscopy for in vivo quantification of human soft tissues visco-elasticity

In vivo assessment of dispersion affecting the propagation of visco-elastic waves in soft tissues is key to understand the rheology of human tissues. In this paper, the ability of the supersonic shear imaging (SSI) technique to generate planar shear waves propagating in tissues is fully exploited. First, by strongly limiting shear wave diffraction in the imaging plane, this imaging technique enables to discriminate between the usually concomitant influences of both medium rheological properties and diffraction affecting the shear wave dispersion. Second, transient propagation of these plane shear waves in soft tissues can be measured using echographic images acquired at very high frame. In vitro and in vivo experiments demonstrate that dispersion curves, which characterize the rheological behavior of tissues by measuring the frequency dependence of shear wave speed and attenuation, can be recovered in the 75-600 Hz frequency range. Based on a phase difference algorithm, the dispersion curves are computed in 1 cm2 regions of interest from the acquired propagation movie. In vivo measurements in Biceps Brachii muscle and liver of three healthy volunteers show important differences in the rheological behavior of these different tissues. Liver tissue appears to be much more dispersive with a phase velocity ranging from approximately 1.5 m/s at 75 Hz to approximately 3 m/s at 500 Hz whereas muscle tissue shows an important anisotropy, shear waves propagating longitudinally to the muscular fibers are almost nondispersive while those propagating transversally are very dispersive with a shear wave speed ranging from 0.5 to 2 m/s between 75 and 500 Hz. The estimation of dispersion curves is local and can be performed separately in different regions of the organ. This signal processing approach based on the SSI modality introduces the new concept of in vivo shear wave spectroscopy (SWS) that could become an additional tool for tissue characterization. This paper demonstrates the in vivo ability of this SWS to quantify both local shear elasticity and dispersion in real time.

Subtraction elastography for the evaluation of ablation-induced lesions: a feasibility study

Different noninvasive or minimally invasive therapeutic ablation procedures can produce tissue necrosis associated with local-stiffness increase. Although elastography has been proved as a potential evaluation tool for many kinds of ablation-induced lesions, the application of subtraction technique in elastography to enhance the visualization of the ablation lesions has rarely been reported. In this paper, subtraction elastography is proposed to evaluate the ablation-induced lesions. Three models are constructed to simulate different kinds of ablated inclusions. The simulation results showed that subtraction elastography is superior to conventional elastography in detecting the ablation-induced lesions with higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The artifacts induced by elastographic signal processing algorithms can be largely reduced in subtraction elastography. In addition, subtraction elastography is less influenced by the stiff background and can provide more reliable boundary information about the lesion than conventional elastography. Furthermore, the feasibility of subtraction elastography is validated by an in vitro experiment of ethanol-induced hepatic lesions. The preliminary results of this work suggest that subtraction elastography may be a good option for the evaluation of ablationinduced lesions.

Image quality, tissue heating, and frame rate trade-offs in acoustic radiation force impulse imaging

The real-time application of acoustic radiation force impulse (ARFI) imaging requires both short acquisition times for a single ARFI image and repeated acquisition of these frames. Due to the high energy of pulses required to generate appreciable radiation force, however, repeated acquisitions could result in substantial transducer face and tissue heating. We describe and evaluate several novel beam sequencing schemes which, along with parallel-receive acquisition, are designed to reduce acquisition time and heating. These techniques reduce the total number of radiation force impulses needed to generate an image and minimize the time between successive impulses. We present qualitative and quantitative analyses of the trade-offs in image quality resulting from the acquisition schemes. Results indicate that these techniques yield a significant improvement in frame rate with only moderate decreases in image quality. Tissue and transducer face heating resulting from these schemes is assessed through finite element method modeling and thermocouple measurements. Results indicate that heating issues can be mitigated by employing ARFI acquisition sequences that utilize the highest track-to-excitation ratio possible.

Radio-frequency ablation electrode displacement elastography: a phantom study

This article describes the evaluation of a novel method of tissue displacement for use in the elastographic visualization of radio-frequency (rf) ablation-induced lesions. The method involves use of the radio-frequency ablation electrode as a displacement device, which provides localized compression in the region of interest. This displacement mechanism offers the advantage of easy in vivo implementation since problems such as excessive lateral and elevational displacements present when using external compression are reduced with this approach. The method was tested on a single-inclusion tissue-mimicking phantom containing a radio-frequency ablation electrode rigidly attached to the inclusion center. Full-frame rf echo signals were acquired from the phantom before and after electrode displacements ranging from 0.05 to 0.2 mm. One-dimensional cross-correlation analysis between pre- and postcompression signals was used to measure tissue displacements, and strains were determined by computing the gradient of the displacement. The strain contrast, contrast-to-noise ratio, and signal-to-noise ratio were estimated from the resulting strain images. Comparisons are drawn between the elastographically measured dimensions and those known a priori for the single-inclusion phantom. Electrode displacement elastography was found to slightly underestimate the inclusion dimensions. The method was also tested on a second tissue-mimicking phantom and on in vitro rf-ablated lesions in canine liver tissue. The results validate previous in vivo findings that electrode displacement elastography is an effective method for monitoring rf ablation.

Mechanical imaging of the breast

In this paper, we analyze the physical basis for elasticity imaging of the breast by measuring breast skin stress patterns that result from a force sensor array pressed against the breast tissue. Temporal and spatial changes in the stress pattern allow detection of internal structures with different elastic properties and assessment of geometrical and mechanical parameters of these structures. The method entitled mechanical imaging is implemented in the breast mechanical imager (BMI), a compact device consisting of a hand held probe equipped with a pressure sensor array, a compact electronic unit, and a touchscreen laptop computer. Data acquired by the BMI allows calculation of size, shape, consistency/hardness, and mobility of detected lesions. The BMI prototype has been validated in laboratory experiments on tissue models and in an ongoing clinical study. The obtained results prove that the BMI has potential to become a screening and diagnostic tool that could largely supplant clinical breast examination through its higher sensitivity, quantitative record storage, ease-of-use, and inherent low cost.

A novel motion compensation algorithm for acoustic radiation force elastography

A novel method of physiological motion compensation for use with radiation force elasticity imaging has been developed. The method utilizes a priori information from finite element method models of the response of soft tissue to impulsive radiation force to isolate physiological motion artifacts from radiation force-induced displacement fields. The new algorithmis evaluated in a series of clinically realistic imaging scenarios, and its performance is compared to that achieved with previously described motion compensation algorithms. Though not without limitations, the new model-based motion compensation algorithm performs favorably in many circumstances and may be a logical choice for use with in vivo abdominal imaging.

Evaluation of 3D modality-independent elastography for breast imaging: a simulation study

This paper reports on the development and preliminary testing of a three-dimensional implementation of an inverse problem technique for extracting soft-tissue elasticity information via non-rigid model-based image registration. The modality-independent elastography (MIE) algorithm adjusts the elastic properties of a biomechanical model to achieve maximal similarity between images acquired under different states of static loading. A series of simulation experiments with clinical image sets of human breasts were performed to test the ability of the method to identify and characterize a radiographically occult stiff lesion. Because boundary conditions are a critical input to the algorithm, a comparison of three methods for semi-automated surface point correspondence was conducted in the context of systematic and randomized noise processes. The results illustrate that 3D MIE was able to successfully reconstruct elasticity images using data obtained from both magnetic resonance and x-ray computed tomography systems. The lesion was localized correctly in all cases and its relative elasticity found to be reasonably close to the true values (3.5% with the use of spatial priors and 11.6% without). In addition, the inaccuracies of surface registration performed with thin-plate spline interpolation did not exceed empiric thresholds of unacceptable boundary condition error.

Treatment monitoring and thermometry for therapeutic focused ultrasound

Therapeutic ultrasound is currently enjoying increasingly widespread clinical use especially for the treatment of cancer of the prostate, liver, kidney, breast, pancreas and bone, as well as for the treatment of uterine fibroids. The optimum method of treatment delivery varies between anatomical sites, but in all cases monitoring of the treatment is crucial if extensive clinical acceptance is to be achieved. Monitoring not only provides the operating clinician with information relating to the effectiveness of treatment, but can also provide an early alert to the onset of adverse effects in normal tissue. This paper reviews invasive and non-invasive monitoring methods that have been applied to assess the extent of treatment during the delivery of therapeutic ultrasound in the laboratory and clinic (follow-up after treatment is not reviewed in detail). The monitoring of temperature and, importantly, the way in which this measurement can be used to estimate the delivered thermal dose, is dealt with as a separate special case. Already therapeutic ultrasound has reached a stage of development where it is possible to attempt real-time feedback during exposure in order to optimize each and every delivery of ultrasound energy. To date, data from MR imaging have shown better agreement with the size of regions of damage than those from diagnostic ultrasound, but novel ultrasonic techniques may redress this balance. Whilst MR currently offers the best method for non-invasive temperature measurement, the ultrasound techniques under development, which could potentially offer more rapid visualisation of results, are discussed.

The impact of physiological motion on tissue tracking during radiation force imaging

The effect of physiological motion on the quality of radiation force elasticity images has been investigated. Experimental studies and simulated images were used to investigate the impact of motion effects on image quality metrics over a range of clinically realistic velocity and acceleration magnitudes. Evaluation criteria included motion filter effectiveness, image signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of a stiff inclusion embedded in a homogeneous background material. Two transmit frequencies (2.5 and 4.4 MHz) were analyzed and contrasted in terms of image quality over a range of target motions. Results indicate that situations may exist where liver and cardiac motion magnitudes lead to poor image quality, but optimized transducer orientations may help suppress motion artifacts if some a priori information concerning target motion characteristics is known. In the presence of significant target motion, utilizing a lower transmit frequency can improve SNR and CNR in elasticity images.

Transient elastography using impulsive ultrasound radiation force: a preliminary comparison with surface palpation elastography

The use of impulsive acoustic radiation force for transient strain imaging was investigated and compared with conventional elastography. A series of experiments were performed to evaluate the performances of the technique on gelatine phantoms containing inclusions and to determine a range of applications where radiation force elastography may be useful compared with static elastography. Slip boundaries and cylindrical inclusions of varying elastic modulus were placed in background materials. A focused ultrasound transducer was used to apply localised radiation force to a small volume of tissue mimic (100 mm3) for durations of 8 ms. A conventional real-time ultrasound imaging probe was used to obtain radio- frequency echo signals. The resulting strains were mapped using ultrasound correlation-based methods. The instantaneous strain immediately following cessation of the radiation force was observed at depth within homogeneous gels and within stiff inclusions. The highly localised and transient strain that is produced at depth permits the sensing of variations in tissue elastic properties that are difficult to detect with conventional elastography, due to greater independence from boundary conditions. In particular, radiation force elastograms were more homogeneous in the background and within the inclusions and displayed a superior contrast-transfer-efficiency, particularly for regions that had negative modulus contrast or that were disconnected from the background or the anterior medium by a low friction boundary.

Frame rate considerations for real-time abdominal acoustic radiation force impulse imaging

With the advent of real-time Acoustic Radiation Force Impulse (ARFI) imaging, elevated frame rates are both desirable and relevant from a clinical perspective. However, fundamental limitations on frame rates are imposed by thermal safety concerns related to incident radiation force pulses. Abdominal ARFI imaging utilizes a curvilinear scanning geometry that results in markedly different tissue heating patterns than those previously studied for linear arrays or mechanically-translated concave transducers. Finite Element Method (FEM) models were used to simulate these tissue heating patterns and to analyze the impact of tissue heating on frame rates available for abdominal ARFI imaging. A perfusion model was implemented to account for cooling effects due to blood flow and frame rate limitations were evaluated in the presence of normal, reduced and negligible tissue perfusions. Conventional ARFI acquisition techniques were also compared to ARFI imaging with parallel receive tracking in terms of thermal efficiency. Additionally, thermocouple measurements of transducer face temperature increases were acquired to assess the frame rate limitations imposed by cumulative heating of the imaging array. Frame rates sufficient for many abdominal imaging applications were found to be safely achievable utilizing available ARFI imaging techniques.

Characterizing acoustic attenuation of homogeneous media using focused impulsive acoustic radiation force

A new method to characterize a material's attenuation using acoustic radiation force is proposed. Comparison of displacement magnitudes generated in a homogeneous material by acoustic radiation force excitations can be used to estimate the material's attenuation when the excitations are applied over a range of focal depths while maintaining a constant lateral focal configuration. Acoustic attenuations are related to the inverse of the excitation focal depth that yields the greatest focal zone displacement for this protocol. Experimental studies in calibrated tissue-mimicking phantoms are presented to demonstrate the feasibility of this method. Attenuations ranging from 0.3-1.5 dB/cm/MHz were characterized over excitation focal depths ranging from 5-30 mm, with an accuracy of 0.1 +/- 0.15 dB/cm/MHz. As currently implemented, this method is limited to characterizing materials that have homogeneous material properties and acoustic attenuations. This method for characterizing acoustic attenuation can be performed using conventional diagnostic scanners without any additional hardware and could also be performed concurrently with acoustic radiation force-based imaging modalities to generate images of mechanical properties and attenuation that are spatially co-registered with B-mode images.

Computed tomography for imaging the breast

Despite the success of screening mammography contributing to the reduction of cancer mortality, a number of other imaging techniques are being studied for breast cancer screening. In our laboratory, a dedicated breast computed tomography (CT) system has been developed and is currently undergoing patient testing. The breast CT system is capable of scanning the breast with the woman lying prone on a tabletop, with the breast in the pendant position. A 360 degrees scan currently requires 16.6 s, and a second scanner with a 9-second scan time is nearly operational. Extensive effort was placed on computing the radiation dose to the breast under CT geometry, and the scan parameters are selected to utilize the same radiation dose levels as two-view mammography. A total of 55 women have been scanned, ten healthy volunteers in a Phase I trial, and 45 women with a high likelihood of having breast cancer in a Phase II trial. The breast CT process leads to the production of approximately three hundred 512 x 512 images for each breast. Subjective evaluation of the breast CT images reveals excellent anatomical detail, good depiction of microcalcifications, and exquisite visualization of the soft tissue components of the tumor when contrasted against adipose tissues. The use of iodine contrast injection dramatically enhances the visualization of tumors. While a thorough scientific investigation based upon observer performance studies is in progress, initial breast CT images do appear promising and it is likely that breast CT will play some role in breast cancer imaging.