A buoyancy method for the measurement of total ultrasound power generated by HIFU transducers

AAPM Task Group 241: A medical physicist's guide to MRI-guided focused ultrasound body systems

Magnetic resonance-guided focused ultrasound (MRgFUS) is a completely non-invasive technology that has been approved by FDA to treat several diseases. This report, prepared by the American Association of Physicist in Medicine (AAPM) Task Group 241, provides background on MRgFUS technology with a focus on clinical body MRgFUS systems. The report addresses the issues of interest to the medical physics community, specific to the body MRgFUS system configuration, and provides recommendations on how to successfully implement and maintain a clinical MRgFUS program. The following sections describe the key features of typical MRgFUS systems and clinical workflow and provide key points and best practices for the medical physicist. Commonly used terms, metrics and physics are defined and sources of uncertainty that affect MRgFUS procedures are described. Finally, safety and quality assurance procedures are explained, the recommended role of the medical physicist in MRgFUS procedures is described, and regulatory requirements for planning clinical trials are detailed. Although this report is limited in scope to clinical body MRgFUS systems that are approved or currently undergoing clinical trials in the United States, much of the material presented is also applicable to systems designed for other applications.

Measurement of the temperature-dependent output of lead zirconate titanate transducers

The effect of temperature and electrical drive conditions on the output of lead zirconate titanate (PZT) transducers is of particular interest in ultrasound metrology and medical ultrasound applications. In this work, the temperature-dependent output of two single-element PZT transducers was measured between 22 °C and 46 °C. Two independent measurement methods were used, namely radiation force balance measurements and laser vibrometry. When driven at constant voltage using a 50 Ω matched signal generator and amplifier using continuous wave (CW) or quasi-CW excitation, the output of the two transducers increased on average by 0.6 % per degree, largely due to an increase in transducer efficiency with temperature. The two measurement methods showed close agreement. Similar trends were observed when using single cycle excitation with the same signal chain. However, when driven using a pulser (which is not electrically matched), the two transducers exhibited different behaviour depending on their electrical impedance. Accounting for the temperature-dependent output of PZT transducers could have implications for many areas of ultrasound metrology, for example, in therapeutic ultrasound where a coupling fluid at an increased or decreased temperature is often used.

Focused ultrasound transducer spatial peak intensity estimation: a comparison of methods

Characterisation of the spatial peak intensity at the focus of high intensity focused ultrasound transducers is difficult because of the risk of damage to hydrophone sensors at the high focal pressures generated. Hill et al (1994 Ultrasound Med. Biol. 20 259-69) provided a simple equation for estimating spatial-peak intensity for solid spherical bowl transducers using measured acoustic power and focal beamwidth. This paper demonstrates theoretically and experimentally that this expression is only strictly valid for spherical bowl transducers without a central (imaging) aperture. A hole in the centre of the transducer results in over-estimation of the peak intensity. Improved strategies for determining focal peak intensity from a measurement of total acoustic power are proposed. Four methods are compared: (i) a solid spherical bowl approximation (after Hill et al 1994 Ultrasound Med. Biol. 20 259-69), (ii) a numerical method derived from theory, (iii) a method using measured sidelobe to focal peak pressure ratio, and (iv) a method for measuring the focal power fraction (FPF) experimentally. Spatial-peak intensities were estimated for 8 transducers at three drive powers levels: low (approximately 1 W), moderate (~10 W) and high (20-70 W). The calculated intensities were compared with those derived from focal peak pressure measurements made using a calibrated hydrophone. The FPF measurement method was found to provide focal peak intensity estimates that agreed most closely (within 15%) with the hydrophone measurements, followed by the pressure ratio method (within 20%). The numerical method was found to consistently over-estimate focal peak intensity (+40% on average), however, for transducers with a central hole it was more accurate than using the solid bowl assumption (+70% over-estimation). In conclusion, the ability to make use of an automated beam plotting system, and a hydrophone with good spatial resolution, greatly facilitates characterisation of the FPF, and consequently gives improved confidence in estimating spatial peak intensity from measurement of acoustic power.

Speed of sound in rubber-based materials for ultrasonic phantoms

PURPOSE

In this work we provide measurements of speed of sound (SoS) and acoustic impedance (Z) of some doped/non-doped rubber-based materials dedicated to the development of ultrasound phantoms. These data are expected to be useful for speeding-up the preparation of multi-organ phantoms which show similar echogenicity to real tissues.

METHODS

Different silicones (Ecoflex, Dragon-Skin Medium) and polyurethane rubbers with different liquid (glycerol, commercial detergent, N-propanol) and solid (aluminum oxide, graphene, steel, silicon powder) inclusions were prepared. SoS of materials under investigation was measured in an experimental setup and Z was obtained by multiplying the density and the SoS of each material. Finally, an anatomically realistic liver phantom has been fabricated selecting some of the tested materials.

RESULTS

SoS and Z evaluation for different rubber materials and formulations are reported. The presence of liquid additives appears to increase the SoS, while solid inclusions generally reduce the SoS. The ultrasound images of realized custom fabricated heterogeneous liver phantom and a real liver show remarkable similarities.

CONCLUSIONS

The development of new materials' formulations and the knowledge of acoustic properties, such as speed of sound and acoustic impedance, could improve and speed-up the development of phantoms for simulations of ultrasound medical procedures.

Comparison between experimental and computational methods for the acoustic and thermal characterization of therapeutic ultrasound fields

For high intensity therapeutic ultrasound (HITU) devices, pre-clinical testing can include measurement of power, pressure/intensity and temperature distribution, acoustic and thermal simulations, and assessment of targeting accuracy and treatment monitoring. Relevant International Electrotechnical Commission documents recently have been published. However, technical challenges remain because of the often focused, large amplitude pressure fields encountered. Measurement and modeling issues include using hydrophones and radiation force balances at HITU power levels, validation of simulation models, and tissue-mimicking material (TMM) development for temperature measurements. To better understand these issues, a comparison study was undertaken between simulations and measurements of the HITU acoustic field distribution in water and TMM and temperature rise in TMM. For the specific conditions of this study, the following results were obtained. In water, the simulated values for p+ and p- were 3% lower and 10% higher, respectively, than those measured by hydrophone. In TMM, the simulated values for p+ and p- were 2% and 10% higher than those measured by hydrophone, respectively. The simulated spatial-peak temporal-average intensity values in water and TMM were greater than those obtained by hydrophone by 3%. Simulated and measured end-of-sonication temperatures agreed to within their respective uncertainties (coefficients of variation of approximately 20% and 10%, respectively).

Relationship between acoustic power and acoustic radiation force on absorbing and reflecting targets for spherically focusing radiators

Total acoustic output power is an important parameter required by standards for most ultrasonic medical equipment including high-intensity focused ultrasound (HIFU) systems. Radiation force balances are routinely used; however, radiation force is not strictly dependent on the ultrasound power but, rather, on the wave momentum resolved in one direction. Consequently, measurements based on radiation force become progressively less accurate as the ultrasound wave deviates further from a true plane wave. HIFU transducers can be very strongly focused with F-numbers less than one: under these conditions, the uncertainty associated with use of the radiation force method becomes very significant. International Standards IEC 61161 and IEC 62555 suggest plane-wave correction factors for unfocused transducers radiating onto an ideal absorbing target and focusing corrections for focused transducers radiating onto ideal absorbing targets and onto conical reflecting targets (IEC 61161). Previous models have relied on calculations based on the Rayleigh integral, which is not strictly correct for curved sources. In the work described here, an approach combining finite element methods with a discretization of the Helmholtz equation was developed, making it possible to model the boundary condition at the structure/fluid interface more correctly. This has been used to calculate the relationship between radiation force and total power for both absorbing and conical reflecting targets for transducers ranging from planar to an F-number of 0.5 (hemispherical) and to compare with the recommendations of IEC 61161 and IEC 62555.

Quality assurance for clinical high intensity focused ultrasound fields

As the use of HIFU in the clinic becomes more widespread there is an ever increasing need to standardise quality assurance protocols, an important step in facilitating the wider acceptance of HIFU as a therapeutic modality. This article reviews pertinent aspects of HIFU treatment delivery, encompassing the closely related aspects of quality assurance and calibration. Particular attention is given to the description and characterisation of relevant acoustic field parameters and the measurement of acoustic power. Where appropriate, recommendations are made.

Acoustic power measurement of high-intensity focused ultrasound transducer using a pressure sensor

The acoustic power of high-intensity focused ultrasound (HIFU) is an important parameter that should be measured prior to each treatment to guarantee effective and safe outcomes. A new calibration technique was developed that involves estimating the pressure distribution, calculating the acoustic power using an underwater pressure blast sensor, and compensating the contribution of harmonics to the acoustic power. The output of a clinical extracorporeal HIFU system (center frequency of ~1 MHz, p+ = 2.5-57.2 MPa, p(-) = -1.8 to -13.9 MPa, I(SPPA) = 513-22,940 W/cm(2), -6 dB size of 1.6 × 10 mm: lateral × axial) was measured using this approach and then compared with that obtained using a radiation force balance. Similarities were found between each method at acoustic power ranging from 18.2 W to 912 W with an electrical-to-acoustic conversion efficiency of ~42%. The proposed method has advantages of low weight, smaller size, high sensitivity, quick response, high signal-to-noise ratio (especially at low power output), robust performance, and easy operation of HIFU exposimetry measurement.

Lorentz-force hydrophone characterization

A Lorentz-force hydrophone consists of a thin wire placed inside a magnetic field. When under the influence of an ultrasound pulse, the wire vibrates and an electrical signal is induced by the Lorentz force, which is proportional to the pulse amplitude. In this study, a compact prototype of such a hydrophone is introduced and characterized, and the previously developed hydrodynamic model is refined. It is shown that the wire tension has a negligible effect on the measurement of pressure. The frequency response of the hydrophone reaches 1 MHz for wires with diameters between 70 and 400 μm. The hydrophone exhibits a directional response such that the signal amplitude differs by less than 3 dB as the angle of the incident ultrasound pulse varies from -20° and +20°. The linearity of the measured signal is confirmed across the 50 kPa to 10 MPa pressure range, and an excellent resistance to cavitation is observed. This hydrophone is of interest for high-pressure ultrasound measurements including high-intensity focused ultrasound (HIFU) and ultrasonic measurements in difficult environments.

A comparison of acoustic cavitation detection thresholds measured with piezo-electric and fiber-optic hydrophone sensors

A Fabry-Perot interferometer fiber-optic hydrophone (FOH) was investigated for use as an acoustic cavitation detector and compared with a piezo-ceramic passive cavitation detector (PCD). Both detectors were used to measure negative pressure thresholds for broadband emissions in 3% agar and ex vivo bovine liver simultaneously. FOH-detected half- and fourth-harmonic emissions were also studied. Three thresholds were defined and investigated: (i) onset of cavitation; (ii) 100% probability of cavitation; and (iii) a time-integrated threshold where broadband signals integrated over a 3-s exposure duration, averaged over 5-10 repeat exposures, become statistically significantly greater than noise. The statistical sensitiviy of FOH broadband detection was low compared with that of the PCD (0.43/0.31 in agar/liver). FOH-detected fourth-harmonic data agreed best with PCD broadband (sensitivity: 0.95/0.94, specificity: 0.89/0.76 in agar/liver). The FOH has potential as a cavitation detector, particularly in applications where space is limited or during magnetic resonance-guided studies.

Infrared mapping of ultrasound fields generated by medical transducers: feasibility of determining absolute intensity levels

Considerable progress has been achieved in the use of infrared (IR) techniques for qualitative mapping of acoustic fields of high intensity focused ultrasound (HIFU) transducers. The authors have previously developed and demonstrated a method based on IR camera measurement of the temperature rise induced in an absorber less than 2 mm thick by ultrasonic bursts of less than 1 s duration. The goal of this paper was to make the method more quantitative and estimate the absolute intensity distributions by determining an overall calibration factor for the absorber and camera system. The implemented approach involved correlating the temperature rise measured in an absorber using an IR camera with the pressure distribution measured in water using a hydrophone. The measurements were conducted for two HIFU transducers and a flat physiotherapy transducer of 1 MHz frequency. Corresponding correction factors between the free field intensity and temperature were obtained and allowed the conversion of temperature images to intensity distributions. The system described here was able to map in good detail focused and unfocused ultrasound fields with sub-millimeter structure and with local time average intensity from below 0.1 W/cm(2) to at least 50 W/cm(2). Significantly higher intensities could be measured simply by reducing the duty cycle.

Ultrasound imparted air-recoil resonance (UIAR) method for acoustic power estimation: theory and experiment

Ultrasound imparted air-recoil resonance (UIAR), a new method for acoustic power estimation, is introduced with emphasis on therapeutic high-intensity focused ultrasound (HIFU) monitoring applications. Advantages of this approach over existing practices include fast response; electrical and magnetic inertness, and hence MRI compatibility; portability; high damage threshold and immunity to vibration and interference; low cost; etc. The angle of incidence should be fixed for accurate measurement. However, the transducer-detector pair can be aligned in any direction with respect to the force of gravity. In this sense, the operation of the device is orientation independent. The acoustic response of a pneumatically coupled pair of Helmholtz resonators, with one of them acting as the sensor head, is used for the estimation of acoustic power. The principle is valid in the case of pulsed/ burst as well as continuous ultrasound exposure, the former being more sensitive and accurate. An electro-acoustic theory has been developed for describing the dynamics of pressure flow and resonance in the system considering various thermo- viscous loss mechanisms. Experimental observations are found to be in agreement with theoretical results. Assuming the window damage threshold (~10 J·mm(-2)) and accuracy of RF power estimation are the upper and lower scale-limiting factors, the performance of the device was examined for an RF power range of 5 mW to 100 W with a HIFU transducer operating at 1.70 MHz, and an average nonlinearity of ~1.5% was observed. The device is also sensitive to sub-milliwatt powers. The frequency response was analyzed at 0.85, 1.70, 2.55, and 3.40 MHz and the results are presented with respective theoretical estimates. Typical response time is in the millisecond regime. Output drift is about 3% for resonant and 5% for nonresonant modes. The principle has been optimized to demonstrate a general-purpose acoustic power meter.

Ex vivo evaluation of high-intensity focused ultrasound with ultrasonic-induced cavitation bubbles

PURPOSE

In high-intensity focused ultrasound (HIFU) comprising high-intensity burst ultrasound (triggering pulse) and medium-intensity continuous wave ultrasound (heating wave), optimizing the effects of the triggering pulse conditions on the coagulated volume may help to reduce treatment times.

METHODS

HIFU combined with a triggering pulse was applied to chicken deep pectoral muscles. The acoustic power of the heating wave was set to 36, 54, or 72 W. Four different triggering pulse conditions were used: heating wave only; or pulse widths and pulse repetition frequencies of 30 μs and 1 kHz, 300 μs, and 100 Hz, or 3 ms and 10 Hz.

RESULTS

Compared to the heating wave only condition, the coagulated volume was significantly larger under all conditions that included a triggering pulse. Significant differences were also observed in the ellipticity of the coagulated region between some conditions.

CONCLUSION

HIFU combined with a triggering pulse may play an important role in reducing treatment times.

Membrane hydrophone measurement and numerical simulation of HIFU fields up to developed shock regimes

For the characterization of high-intensity focused ultrasound (HIFU) fields, hydrophone measurements should be performed in water in the whole range of the radiated power; however, cavitation occurs at high output, leading to the destruction of the hydrophone. To avoid this problem, a new hydrophone with additional protective layers covering the electrodes was developed and tested in the experiments. A single-element 1-MHz focusing ultrasound source was used for detailed measurements of the acoustic field in the axial and lateral planes. Measurements were performed with a new membrane hydrophone up to the focal peak compressional and rarefactional pressures of 55.6 and of 12.8 MPa, respectively, when the shock front had already formed in the waveform. Numerical modeling for the beams of periodic waves with an initially uniform amplitude distribution was performed, based on the Khokhlov-Zabolotskaya-Kuznetsov equation. Numerical solutions were compared with the experimental data and found to be in good agreement (within 10%). The influences of the limited bandwidth and the spatial averaging effect of the hydrophone on the accurate measurements of the acoustic field parameters were also investigated.

Focusing of high-intensity ultrasound through the rib cage using a therapeutic random phased array

A method for focusing high-intensity ultrasound (HIFU) through a rib cage that aims to minimize heating of the ribs while maintaining high intensities at the focus (or foci) was proposed and tested theoretically and experimentally. Two approaches, one based on geometric acoustics and the other accounting for diffraction effects associated with propagation through the rib cage, were investigated theoretically for idealized source conditions. It is shown that for an idealized radiator, the diffraction approach provides a 23% gain in peak intensity and results in significantly less power losses on the ribs (1% vs. 7.5% of the irradiated power) compared with the geometric one. A 2-D 1-MHz phased array with 254 randomly distributed elements, tissue-mimicking phantoms and samples of porcine rib cages are used in experiments; the geometric approach is used to configure how the array is driven. Intensity distributions are measured in the plane of the ribs and in the focal plane using an infrared camera. Theoretical and experimental results show that it is possible to provide adequate focusing through the ribs without overheating them for a single focus and several foci, including steering at +/- 10-15 mm off and +/- 20 mm along the array axis. Focus splitting caused by the periodic spatial structure of ribs is demonstrated both in simulations and experiments; the parameters of splitting are quantified. The ability to produce thermal lesions with a split focal pattern in ex vivo porcine tissue placed beyond the rib phantom is also demonstrated. The results suggest that the method is potentially useful for clinical applications of HIFU, for which the rib cage lies between the transducer(s) and the targeted tissue.

Measurements, phantoms, and standardization

The last 25 years has seen a number of significant developments in the establishment of a measurement infrastructure supporting medical applications of ultrasound. This has allowed manufacturers and users of medical ultrasonic equipment to undertake and compare measurements of key parameters describing the magnitude or strength of the applied ultrasonic field in a meaningful and traceable way: for equipment development, standards compliance, and quality assurance purposes. This paper describes the current state of the art for measurement techniques used to determine the key properties of an ultrasonic field, principally acoustic pressure and acoustic power. Measurement tools and methodologies are described in detail, alongside considerations of how these are likely to develop, shaped by user need. The way that these measurement methods underpin a range of international and national specification standards enabling equipment manufacturers to demonstrate that their equipment is safe and fit for purpose is covered.

A random phased array device for delivery of high intensity focused ultrasound

Randomized phased arrays can offer electronic steering of a single focus and simultaneous multiple foci concomitant with low levels of secondary maxima and are potentially useful as sources of high intensity focused ultrasound (HIFU). This work describes laboratory testing of a 1 MHz random phased array consisting of 254 elements on a spherical shell of radius of curvature 130 mm and diameter 170 mm. Acoustic output power and efficiency are measured for a range of input electrical powers, and field distributions for various single- and multiple-focus conditions are evaluated by a novel technique using an infrared camera to provide rapid imaging of temperature changes on the surface of an absorbing target. Experimental results show that the array can steer a single focus laterally to at least +/-15 mm off axis and axially to more than +/-15 mm from the centre of curvature of the array and patterns of four and five simultaneous foci +/-10 mm laterally and axially whilst maintaining low intensity levels in secondary maxima away from the targeted area in good agreement with linear theoretical predictions. Experiments in which pork meat was thermally ablated indicate that contiguous lesions several cm(3) in volume can be produced using the patterns of multiple foci.