Numerical analysis of uncertainties in dual frequency bone ultrasound technique

Summation of Ossification Ratios of Radius, Ulna and Femur: A New Parameter to Evaluate Bone Age by Ultrasound

Radiographic bone age (BA) assessment is reviewer dependent or time consuming. We aimed to clarify the correlation between sonographic ossification ratios (ORs, the ratio of ossification center and epiphysis diameters) of bones and radiographic BA and then to develop a repeatable parameter for BA assessment by ultrasound. The distal ends of the radius and ulna, medial epicondyle of the femur, medial tibial condyle, medial malleolus and lateral malleolus in 271 consecutive patients (132 boys and 139 girls) aged 0.1-19.0 y were imaged by ultrasound. The ORs of these bones were measured sonographically. The highest Pearson correlation r was that between the sum of the ORs of radius, ulna and femur (RUF) calculated from ultrasound images and the radiographic BA (0.97 in boys and 0.96 in girls). The entire process of collecting data and calculating the ORs of RUF took 2.6 ± 0.6 min. The ORs of RUF obtained with ultrasound have potential as an easy-to-perform and efficient quantitative assessment of BA.

Mechanisms of Interaction of Ultrasound With Cancellous Bone: A Review

Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of attenuation and sound speed in cancellous bone. This review discusses fundamental mechanisms underlying the interaction between ultrasound and cancellous bone. Because of its two-phase structure (mineralized trabecular network embedded in soft tissue-marrow), its anisotropy, and its inhomogeneity, cancellous bone is more difficult to characterize than most soft tissues. Experimental data for the dependencies of attenuation, sound speed, dispersion, and scattering on ultrasound frequency, bone mineral density, composition, microstructure, and mechanical properties are presented. The relative roles of absorption, scattering, and phase cancellation in determining attenuation measurements in vitro and in vivo are delineated. Common speed of sound metrics, which entail measurements of transit times of pulse leading edges (to avoid multipath interference), are greatly influenced by attenuation, dispersion, and system properties, including center frequency and bandwidth. However, a theoretical model has been shown to be effective for correction for these confounding factors in vitro and in vivo. Theoretical and phantom models are presented to elucidate why cancellous bone exhibits negative dispersion, unlike soft tissue, which exhibits positive dispersion. Signal processing methods are presented for separating "fast" and "slow" waves (predicted by poroelasticity theory and supported in cancellous bone) even when the two waves overlap in time and frequency domains. Models to explain dependencies of scattering on frequency and mean trabecular thickness are presented and compared with measurements. Anisotropy, the effect of the fluid filler medium (marrow in vivo or water in vitro), phantoms, computational modeling of ultrasound propagation, acoustic microscopy, and nonlinear properties in cancellous bone are also discussed.

Backscatter-difference Measurements of Cancellous Bone Using an Ultrasonic Imaging System

Backscatter-difference measurements may be used to detect changes in bone caused by osteoporosis. The backscatter-difference technique measures the power difference between two portions of an ultrasonic backscatter signal. The goal of this study is to evaluate the feasibility of using an ultrasonic imaging system to perform backscatter-difference measurements of bone. Ultrasonic images and backscatter signals were acquired from 24 specimens of human cancellous bone. The signals were analyzed in the frequency domain to determine the normalized mean backscatter-difference (nMBD) and in the time domain to determine the normalized backscatter amplitude ratio (nBAR). The images were analyzed to determine the normalized pixel value difference (nPVD), which measures the difference in average pixel brightness between regions of interest placed at two different depths in the image. All three parameters were found to increase with bone mineral density. The signal-based parameters, nMBD and nBAR, correlated well with bone mineral density, yielding linear correlation coefficients that ranged from 0.74 to 0.87. The image based parameter, nPVD, performed somewhat less well, yielding correlation coefficients that ranged from 0.42 to 0.81. These results suggest that ultrasonic imaging systems may be used to perform backscatter-difference measurements for the purpose of ultrasonic bone assessment.

Radial quantitative ultrasound and dual energy x-ray absorptiometry: intermethod agreement for bone status assessment in children

Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = −1.4 to 2.6). With a cut-off value of −1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.

On ultrasound waves guided by bones with coupled soft tissues: a mechanism study and in vitro calibration

The influence of soft tissues coupled with cortical bones on precision of quantitative ultrasound (QUS) has been an issue in the clinical bone assessment in conjunction with the use of ultrasound. In this study, the effect arising from soft tissues on propagation characteristics of guided ultrasound waves in bones was investigated using tubular Sawbones phantoms covered with a layer of mimicked soft tissue of different thicknesses and elastic moduli, and an in vitro porcine femur in terms of the axial transmission measurement. Results revealed that presence of soft tissues can exert significant influence on the propagation of ultrasound waves in bones, leading to reduced propagation velocities and attenuated wave magnitudes compared with the counterparts in a free bone in the absence of soft tissues. However such an effect is not phenomenally dependent on the variations in thickness and elastic modulus of the coupled soft tissues, making it possible to compensate for the coupling effect regardless of the difference in properties of the soft tissues. Based on an in vitro calibration, this study proposed quantitative compensation for the effect of soft tissues on ultrasound waves in bones, facilitating development of high-precision QUS.

Ultrasound backscatter measurements of intact human proximal femurs--relationships of ultrasound parameters with tissue structure and mineral density

Ultrasound reflection and backscatter parameters are related to the mechanical and structural properties of bone in vitro. However, the potential of ultrasound reflection and backscatter measurements has not been tested with intact human proximal femurs ex vivo. We hypothesize that ultrasound backscatter can be measured from intact femurs and that the measured backscattered signal is associated with cadaver age, bone mineral density (BMD) and trabecular bone microstructure. In this study, human femoral bones of 16 male cadavers (47.0±16.1 years, range: 21-77 years) were investigated using pulse-echo ultrasound measurements at the femoral neck in the antero-posterior direction and at the trochanter major in the anteroposterior and lateromedial directions. Recently introduced ultrasound backscatter parameters, independent of cortical thickness, e.g., time slope of apparent integrated backscatter (TSAB) and mean of the backscatter difference technique (MBD) were obtained and compared with the structural properties of trabecular bone samples, extracted from the locations of ultrasound measurements. Moreover, more conventional backscatter parameters, e.g., apparent integrated backscatter (AIB) and frequency slope of apparent integrated backscatter (FSAB) were analyzed. Bone mineral density of the intact femurs was evaluated using dual energy X-ray absorptiometry (DXA). AIB and MDB measured from the femoral neck correlated significantly (p<0.01) with the neck BMD (R2=0.44 and 0.45), cadaver age (R2=0.61 and 0.41) and several structural parameters, e.g., bone volume fraction (R2=0.33 and 0.39, p<0.05 and p<0.01), respectively. To conclude, ultrasound backscatter parameters, measured from intact proximal femurs, are significantly related (p<0.05) to structural properties and mineral density of trabecular bone.

Effect of the cortex on ultrasonic backscatter measurements of cancellous bone

Ultrasonic backscatter techniques offer a promising new approach for detecting changes in bone caused by osteoporosis. However, several challenges impede clinical implementation of backscatter techniques. This study examines how the dense outer surface of bone (the cortex) affects backscatter measurements of interior regions of porous (cancellous) bone tissue. Fifty-two specimens of bone were prepared from 13 human femoral heads so that the same region of cancellous bone could be ultrasonically interrogated through the cortex or along directions that avoided the cortex. Backscatter signals were analyzed over a frequency range of 0.8-3.0 MHz to determine two ultrasonic parameters: apparent integrated backscatter (AIB) and frequency slope of apparent backscatter (FSAB). The term 'apparent' means that the parameters are sensitive to the frequency-dependent effects of diffraction and attenuation. Significant (p < 0.001) changes in AIB and FSAB indicated that measurements through the cortex decreased the apparent backscattered power and increased the frequency dependence of the power. However, the cortex did not affect the correlation of AIB and FSAB with the x-ray bone mineral density of the specimens. This suggests that results from many previous in vitro backscatter studies of specimens of purely cancellous bone may be extrapolated with greater confidence to in vivo conditions.

Effects of non-optimal focusing on dual-frequency ultrasound measurements of bone

In pulse-echo (PE) ultrasound measurements, the use of focused transducers is desirable for quantitative assessment of bone characteristics because of the attenuation in the overlying soft tissues. However, the variable thickness and composition of the soft tissue overlying bone affect the focal depth of the ultrasound beam and induce errors into the measurements. To compensate for the attenuation-related effects caused by the interfering soft tissue (i.e., fat and lean tissue), a dual-frequency ultrasound (DFUS) technique was recently introduced. The aim of this study was to investigate the effect of non-optimal focal depth of the ultrasound beam on the determination of the integrated reflection coefficient (IRC) of bone when overlaid by an interfering layer composed of oil and water. The feasibility of the DFUS-based correction of the IRC was evaluated through numerical simulations and experimental measurements. Even when the interfering layer-bone interface was out of focus, the total thickness of the interfering layer could be accurately determined with the technique. However, based on the simulations, the errors in the determination of the composition of the interfering layer increased (0.004 to 113.8%) with the increase in distance between the interfering layer-bone interface and the focus of the ultrasound beam. Attenuation compensation, based on the true composition of the interfering layer, resulted in an average relative error of 22.3% in the IRC values calculated from the simulations. Interestingly, the attenuation compensation with the interfering layer composition estimated using the DFUS technique resulted in a smaller average relative error of 14.9% in the IRC values. The simulations suggest that DFUS can reduce the errors induced by soft tissue in bone PE ultrasound measurements. The experimental measurements indicate that the accuracy of the IRC measurements is rather similar when using DFUS correction or correction based on the true composition of the interfering layer. However, the results suggest that accurate determination of soft tissue composition may be difficult without optimal focusing of the ultrasound beam on the soft tissue-bone interface.