A review of tissue substitutes for ultrasound imaging

A Training Course for Simulating Head and Neck Ultrasound-Guided Procedures Using a Gelatin Phantom Model

OBJECTIVES

Ultrasound (US)-guided procedures can be used in the evaluation and treatment of neck masses. However, these procedures need to be practiced before being executed on humans. The aim of this study is to evaluate the efficacy of a training program using a gelatin phantom to practice US-guided procedures.

METHODS

This program included a lecture and practice with a gelatin phantom. We recruited doctors from different hospitals to practice US-guided procedures, including fine-needle aspiration (FNA), core needle biopsy (CNB), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA). We used a questionnaire with a 5-point scale to evaluate the effectiveness of practicing US-guided procedures under a gelatin phantom.

RESULTS

Forty-four doctors participated, and 37 of them completed the questionnaires. After training, the mean (SD) scores of the doctors were 4.68 (0.47) for "Satisfaction with this course," 4.54 (0.61) for "Ease in practicing FNA&CNB using the phantom," 4.49 (0.61) for "Ease in practicing PEI using the phantom," 4.49 (0.65) for "Ease in practicing RFA using the phantom," and 4.57 (0.55) for "The course effectively familiarizing participants with US-guided procedures." Participants without experience in US examination had higher scores than those with previous US experience, but the difference was not statistically significant.

CONCLUSION

A combination of lectures and hands-on practice of US-guided procedures using a gelatin phantom is an effective educational method for doctors interested in head and neck US. After the training program, doctors gained a better understanding of the necessary steps and skills required for these procedures. They can correctly insert the instruments into the target lesion and perform different US-guided procedures.

Tissue-Mimicking Material Fabrication and Properties for Multiparametric Ultrasound Phantoms: A Systematic Review

Medical imaging has allowed for significant advancements in the field of ultrasound procedures over the years. However, each imaging modality exhibits distinct limitations that differently affect their accuracy. It is imperative to ensure the quality of each modality to identify and eliminate these limitations. To achieve this, a tissue-mimicking material (TMM) phantom is utilised for validation. This study aims to perform a systematic analysis of tissue-mimicking materials used for creating ultrasound phantoms. We reviewed 234 studies on the use of TMM phantoms in ultrasound that were published from 2013 to 2023 from two research databases. Our focus was on studies that discussed TMMs' properties and fabrication for ultrasound, elastography, and flow phantoms. The screening process led to the selection of 16 out of 234 studies to include in the analysis. The TMM ultrasound phantoms were categorised into three groups based on the solvent used; each group offers a broad range of physical properties. The water-based material most closely aligns with the properties of ultrasound. This study provides important information about the materials used for ultrasound phantoms. We also compared these materials to real human tissues and found that PVA matches most of the human tissues the best.

Gelatin-Based Liver Phantoms for Training Purposes: A Cookbook Approach

Background: Patients with liver pathology benefit from image-guided interventions. Training for interventional procedures is recommended to be performed on liver phantoms until a basic proficiency is reached. In the last 40 years, several attempts have been made to develop materials to mimic the imaging characteristics of the human liver in order to create liver phantoms. There is still a lack of accessible, reproducible and cost-effective soft liver phantoms for image-guided procedure training. Methods: Starting from a CT-scan DICOM file, we created a 3D-printed liver mold using InVesalius (Centro de Tecnologia da informação Renato Archer CTI, InVesalius 3 open-source software, Campinas, Brazil) for segmentation, Autodesk Fusion 360 with Netfabb (Autodesk software company, Fusion 360 2.0.19426 with Autodesk Netfabb Premium 2023.0 64-Bit Edition, San Francisco, CA, USA) for 3D modeling and Stratasys Fortus 380 mc 3D printer (Stratasys 3D printing company, Fortus 380 mc 3D printer, Minneapolis, MN, USA). Using the 3D-printed mold, we created 14 gelatin-based liver phantoms with 14 different recipes, using water, cast sugar and dehydrated gelatin, 32% fat bovine milk cream with intravenous lipid solution and technical alcohol in different amounts. We tested all these phantoms as well as ex vivo pig liver and human normal, fatty and cirrhotic liver by measuring the elasticity, shear wave speed, ultrasound attenuation, CT-scan density, MRI signal intensity and fracture force. We assessed the results of the testing performed, as well as the optical appearance on ultrasound, CT and MRI, in order to find the best recipe for gelatin-based phantoms for image-guided procedure training. Results: After the assessment of all phantom recipes, we selected as the best recipe for transparent phantoms one with 14 g of gelatin/100 mL water and for opaque phantom, the recipes with 25% cream. Conclusions: These liver gelatin-based phantom recipes are an inexpensive, reproducible and accessible alternative for training in image-guided and diagnostic procedures and will meet most requirements for valuable training.

Agarose as a Tissue Mimic for the Porcine Heart, Kidney, and Liver: Measurements and a Springpot Model

Agarose gels are often used as a tissue mimic. The goal of this work was to determine the appropriate agarose concentrations that result in mechanical properties that match three different porcine organs. Strain tests were carried out with an amplitude varying from 0.01% to 10% at a frequency of 1 Hz on a range of agarose concentrations and porcine organs. Frequency sweep tests were performed from 0.1 Hz to a maximum of 9.5 Hz at a shear strain amplitude of 0.1% for agarose and porcine organs. In agarose samples, the effect of pre-compression of the samples up to 10% axial strain was considered during frequency sweep tests. The experimental measurements from agarose samples were fit to a fractional order viscoelastic (springpot) model. The model was then used to predict stress relaxation in response to a step strain of 0.1%. The prediction was compared to experimental relaxation data, and the results agreed within 12%. The agarose concentrations (by mass) that gave the best fit were 0.25% for the liver, 0.3% for the kidney, and 0.4% for the heart. At a frequency of 0.1 Hz and a shear strain of 0.1%, the agarose concentrations that best matched the shear storage modulus of the porcine organs were 0.4% agarose for the heart, 0.3% agarose for the kidney, and 0.25% agarose for the liver.

A Dynamic Ultrasound Phantom with Tissue-Mimicking Mechanical and Acoustic Properties

Tissue-mimicking phantoms are valuable tools that aid in improving the equipment and training available to medical professionals. However, current phantoms possess limited utility due to their inability to precisely simulate multiple physical properties simultaneously, which is crucial for achieving a system understanding of dynamic human tissues. In this work, novel materials design and fabrication processes to produce various tissue-mimicking materials (TMMs) for skin, adipose, muscle, and soft tissue at a human scale are developed. Target properties (Young's modulus, density, speed of sound, and acoustic attenuation) are first defined for each TMM based on literature. Each TMM recipe is developed, associated mechanical and acoustic properties are characterized, and the TMMs are confirmed to have comparable mechanical and acoustic properties with the corresponding human tissues. Furthermore, a novel sacrificial core to fabricate a hollow, ellipsoid-shaped bladder phantom complete with inlet and outlet tubes, which allow liquids to flow through and expand this phantom, is adopted. This dynamic bladder phantom with realistic mechanical and acoustic properties to human tissues in combination with the developed skin, soft tissue, and subcutaneous adipose tissue TMMs, culminates in a human scale torso tank and electro-mechanical system that can be systematically utilized for characterizing various medical imaging devices.

An AlScN Piezoelectric Micromechanical Ultrasonic Transducer-Based Power-Harvesting Device for Wireless Power Transmission

Ultrasonic wireless power transfer technology (UWPT) represents a key technology employed for energizing implantable medical devices (IMDs). In recent years, aluminum nitride (AlN) has gained significant attention due to its biocompatibility and compatibility with complementary metal-oxide-semiconductor (CMOS) technology. In the meantime, the integration of scandium-doped aluminum nitride (Al90.4%Sc9.6%N) is an effective solution to address the sensitivity limitations of AlN material for both receiving and transmission capabilities. This study focuses on developing a miniaturized UWPT receiver device based on AlScN piezoelectric micro-electromechanical transducers (PMUTs). The proposed receiver features a PMUT array of 2.8 × 2.8 mm2 comprising 13 × 13 square elements. An acoustic matching gel is applied to address acoustic impedance mismatch when operating in liquid environments. Experimental evaluations in deionized water demonstrated that the power transfer efficiency (PTE) is up to 2.33%. The back-end signal processing circuitry includes voltage-doubling rectification, energy storage, and voltage regulation conversion sections, which effectively transform the generated AC signal into a stable 3.3 V DC voltage output and successfully light a commercial LED. This research extends the scope of wireless charging applications and paves the way for further device miniaturization by integrating all system components into a single chip in future implementations.

Automatic multi-view pose estimation in focused cardiac ultrasound

Focused cardiac ultrasound (FoCUS) is a valuable point-of-care method for evaluating cardiovascular structures and function, but its scope is limited by equipment and operator's experience, resulting in primarily qualitative 2D exams. This study presents a novel framework to automatically estimate the 3D spatial relationship between standard FoCUS views. The proposed framework uses a multi-view U-Net-like fully convolutional neural network to regress line-based heatmaps representing the most likely areas of intersection between input images. The lines that best fit the regressed heatmaps are then extracted, and a system of nonlinear equations based on the intersection between view triplets is created and solved to determine the relative 3D pose between all input images. The feasibility and accuracy of the proposed pipeline were validated using a novel realistic in silico FoCUS dataset, demonstrating promising results. Interestingly, as shown in preliminary experiments, the estimation of the 2D images' relative poses enables the application of 3D image analysis methods and paves the way for 3D quantitative assessments in FoCUS examinations.

Fluidic Ultrasound Generation for Non-Destructive Testing

Air-coupled ultrasonic testing (ACU) is a pioneering technique in non-destructive testing (NDT). While contact testing and fluid immersion testing are standard methods in many applications, the adoption of ACU is progressing slowly, especially in the low ultrasonic frequency range. A main reason for this development is the difficulty of generating high amplitude ultrasonic bursts with equipment that is robust enough to be applied outside a laboratory environment. This paper presents the fluidic ultrasonic transducer as a solution to this challenge. This novel aeroacoustic source uses the flow instability of a sonic jet in a bistable fluidic switch to generate ultrasonic bursts up to 60 kHz with a mean peak pressure of 320 Pa. The robust design allows operation in adverse environments, independent of the operating fluid. Non-contact through-transmission experiments are conducted on four materials and compared with the results of conventional transducers. For the first time, it is shown that the novel fluidic ultrasonic transducer provides a suitable acoustic signal for NDT tasks and has potential of furthering the implementation of ACU in industrial applications.

High-quality Agar and Polyacrylamide Tumor-mimicking Phantom Models for Magnetic Resonance-guided Focused Ultrasound Applications

Background

Tissue-mimicking phantoms (TMPs) have been used extensively in clinical and nonclinical settings to simulate the thermal effects of focus ultrasound (FUS) technology in real tissue or organs. With recent technological developments in the FUS technology and its monitoring/guided techniques such as ultrasound-guided FUS and magnetic resonance-guided FUS (MRgFUS) the need for TMPs are more important than ever to ensure the safety of the patients before being treated with FUS for a variety of diseases (e.g., cancer or neurological). The purpose of this study was to prepare a tumor-mimicking phantom (TUMP) model that can simulate competently a tumor that is surrounded by healthy tissue.

Methods

The TUMP models were prepared using polyacrylamide (PAA) and agar solutions enriched with MR contrast agents (silicon dioxide and glycerol), and the thermosensitive component bovine serum albumin (BSA) that can alter its physical properties once thermal change is detected, therefore offering real-time visualization of the applied FUS ablation in the TUMPs models. To establish if these TUMPs are good candidates to be used in thermoablation, their thermal properties were characterized with a custom-made FUS system in the laboratory and a magnetic resonance imaging (MRI) setup with MR-thermometry. The BSA protein's coagulation temperature was adjusted at 55°C by setting the pH of the PAA solution to 4.5, therefore simulating the necrosis temperature of the tissue.

Results

The experiments carried out showed that the TUMP models prepared by PAA can change color from transparent to cream-white due to the BSA protein coagulation caused by the thermal stress applied. The TUMP models offered a good MRI contrast between the TMPs and the TUMPs including real-time visualization of the ablation area due to the BSA protein coagulation. Furthermore, the T2-weighted MR images obtained showed a significant change in T2 when the BSA protein is thermally coagulated. MR thermometry maps demonstrated that the suggested TUMP models may successfully imitate a tumor that is present in soft tissue.

Conclusion

The TUMP models developed in this study have numerous uses in the testing and calibration of FUS equipment including the simulation and validation of thermal therapy treatment plans with FUS or MRgFUS in oncology applications.

Characterization of the concentration of agar-based soft tissue mimicking phantoms by impact analysis

In various medical fields, a change of soft tissue stiffness is associated with its physio-pathological evolution. While elastography is extensively employed to assess soft tissue stiffness in vivo, its application requires a complex and expensive technology. The aim of this study is to determine whether an easy-to-use method based on impact analysis can be employed to determine the concentration of agar-based soft tissue mimicking phantoms. Impact analysis was performed on soft tissue mimicking phantoms made of agar gel with a mass concentration ranging from 1% to 5%. An indicator Δt is derived from the temporal variation of the impact force signal between the hammer and a small beam in contact with the sample. The results show a non-linear decrease of Δt as a function of the agar concentration (and thus of the sample stiffness). The value of Δt provides an estimation of the agar concentration with an error of 0.11%. This sensitivity of the impact analysis based method to the agar concentration is of the same order of magnitude than results obtained with elastography techniques. This study opens new paths towards the development of impact analysis for a fast, easy and relatively inexpensive clinical evaluation of soft tissue elastic properties.

Systematic quantification of differences in shear wave elastography estimates between linear-elastic and viscoelastic material assumptionsa)

Quantitative, accurate, and standardized metrics are important for reliable shear wave elastography (SWE)-based biomarkers. For over two decades, the linear-elastic material assumption has been employed in SWE modes. In recent years, viscoelasticity estimation methods have been adopted in a few clinical systems. The current study aims to systematically quantify differences in SWE estimates obtained using linear-elastic and viscoelastic material assumptions. An acousto-mechanical simulation framework of acoustic radiation force impulse-based SWE was created to elucidate the effect of material viscosity and shear modulus on SWE estimates. Shear modulus estimates exhibited errors up to 72% when a numerical viscoelastic phantom was assessed as linearly elastic. Shear modulus estimates of polyvinyl alcohol phantoms between rheometry and SWE following the Kelvin-Voigt viscoelastic model assumptions were not significantly different. However, the percentage difference in shear modulus estimates between rheometry and SWE using the linear-elastic assumption was 50.1%-62.1%. In ex vivo liver, the percentage difference in shear modulus estimates between linear-elastic and viscoelastic methods was 76.1%. These findings provide a direct and systematic quantification of the potential error introduced when viscoelastic tissues are imaged with SWE following the linear-elastic assumption. This work emphasizes the need to utilize viscoelasticity estimation methods for developing robust quantitative imaging biomarkers.

High-resolution acoustic mapping of tunable gelatin-based phantoms for ultrasound tissue characterization

Background: The choice of gelatin as the phantom material is underpinned by several key advantages it offers over other materials in the context of ultrasonic applications. Gelatin exhibits spatial and temporal uniformity, which is essential in creating reliable tissue-mimicking phantoms. Its stability ensures that the phantom's properties remain consistent over time, while its flexibility allows for customization to match the acoustic characteristics of specific tissues, in addition to its low levels of ultrasound scattering. These attributes collectively make gelatin a preferred choice for fabricating phantoms in ultrasound-related research. Methods: We developed gelatin-based phantoms with adjustable parameters and conducted high-resolution measurements of ultrasound wave attenuation when interacting with the gelatin phantoms. We utilized a motorized acoustic system designed for 3D acoustic mapping. Mechanical evaluation of phantom elasticity was performed using unconfined compression tests. We particularly examined how varying gelatin concentration influenced ultrasound maximal intensity and subsequent acoustic attenuation across the acoustic profile. To validate our findings, we conducted computational simulations to compare our data with predicted acoustic outcomes. Results: Our results demonstrated high-resolution mapping of ultrasound waves in both gelatin-based phantoms and plain fluid environments. Following an increase in the gelatin concentration, the maximum intensity dropped by 30% and 48% with the 5 MHz and 1 MHz frequencies respectively, while the attenuation coefficient increased, with 67% more attenuation at the 1 MHz frequency recorded at the highest concentration. The size of the focal areas increased systematically as a function of increasing applied voltage and duty cycle yet decreased as a function of increased ultrasonic frequency. Simulation results verified the experimental results with less than 10% deviation. Conclusion: We developed gelatin-based ultrasound phantoms as a reliable and reproducible tool for examining the acoustic and mechanical attenuations taking place as a function of increased tissue elasticity and stiffness. Our experimental measurements and simulations gave insight into the potential use of such phantoms for mimicking soft tissue properties.

Viscoelastic Characterization of Phantoms for Ultrasound Elastography Created Using Low- and High-Viscosity Poly(vinyl alcohol) with Ethylene Glycol as the Cryoprotectant

Ultrasound elastography enables noninvasive characterization of the tissue mechanical properties. Phantoms are widely used in ultrasound elastography for developing, testing, and validating imaging techniques. Creating phantoms with a range of viscoelastic properties relevant to human organs and pathological conditions remains an active area of research. Poly(vinyl alcohol) (PVA) cryogel phantoms offer a long shelf life, robustness, and convenient handling and storage. The goal of this study was to develop tunable phantoms using PVA with a clinically relevant range of viscoelastic properties. We combined low- and high-viscosity PVA to tune the viscoelastic properties of the phantom. Further, phantoms were created with an ethylene glycol-based cryoprotectant to determine whether it reduces the variability in the viscoelastic properties. Scanning electron microscopy (SEM) was performed to evaluate the differences in microstructure between phantoms. The density, longitudinal sound speed, and acoustic attenuation spectra (5-20 MHz) of the phantoms were measured. The phantoms were characterized using a shear wave viscoelastography approach assuming the Kelvin-Voigt model. Microstructural differences were revealed by SEM between phantoms with and without a cryoprotectant and with different PVA mixtures. The longitudinal sound speed and attenuation power-law fit exponent of the phantoms were within the clinical range (1510-1571 m/s and 1.23-1.38, respectively). The measured shear modulus (G) ranged from 3.3 to 17.7 kPa, and the viscosity (η) ranged from 2.6 to 7.3 Pa·s. The phantoms with the cryoprotectant were more homogeneous and had lower shear modulus and viscosity (G = 2.17 ± 0.2 kPa; η = 2.0 ± 0.05 Pa·s) than those without a cryoprotectant (G = 3.93 ± 0.7 kPa; η = 2.6 ± 0.14 Pa·s). Notably, phantoms with relatively constant viscosities and varying shear moduli were achieved by this method. These findings advance the development of well-characterized viscoelastic phantoms for use in elastography.

An anthropomorphic thyroid phantom for ultrasound-guided radiofrequency ablation of nodules

BACKGROUND

Needle-based procedures, such as fine needle aspiration and thermal ablation, are often applied for thyroid nodule diagnosis and therapeutic purposes, respectively. With blood vessels and nerves nearby, these procedures can pose risks in damaging surrounding critical structures.

PURPOSE

The development and validation of innovative strategies to manage these risks require a test object with well-characterized physical properties. For this work, we focus on the application of ultrasound-guided thermal radiofrequency ablation.

METHODS

We have developed a single-use anthropomorphic phantom mimicking the thyroid and surrounding anatomical and physiological structures that are relevant to ultrasound-guided thermal ablation. The phantom was composed of a mixture of polyacrylamide, water, and egg white extract and was cast using molds in multiple steps. The thermal, acoustical, and electrical characteristics were experimentally validated. The ablation zones were analyzed via non-destructive T2 -weighted magnetic resonance imaging scans utilizing the relaxometry changes of coagulated egg albumen, and the temperature distribution was monitored using an array of fiber Bragg grating sensors.

RESULTS

The physical properties of the phantom were verified both on ultrasound as well as in terms of the phantom response to thermal ablation. The final temperature achieved (92°C), the median percentage of the nodule ablated (82.1%), the median volume ablated outside the nodule (0.8 mL), and the median number of critical structures affected (0) were quantified.

CONCLUSION

An anthropomorphic phantom that can provide a realistic model for development and training in ultrasound-guided needle-based thermal interventions for thyroid nodules has been presented.

A method for measuring the angle between left atrial and left ventricular long axes using 3D echocardiography

BACKGROUND

Left ventricle (LV) optimized views are routinely used for left atrial (LA) volume and strain measurements on 2D echocardiography. This might be a source of the error because of the variation of the angle between the left atrial and left ventricle long axes (LA-LV angle), leading to foreshortening of the LA.

METHODS

We investigated two novel parameters: the angle between the left atrial and left ventricle long axes (LA-LV angle) and its deviation from the 4-chamber plane. To accurately measure the angles in 3D space, these measurements were performed using 3D echocardiography. We developed a method for the measurement based on marking anatomic points of reference in the 3D echocardiogram and measuring the angles between these points. We used three types of phantoms made of wood and agar-agar to investigate the repeatability and reproducibility of these measurements and performed measurements on human subjects.

RESULTS

The ultrasound measurements were in excellent agreement with the true angles of the phantoms: LA-LV angle bias was .5 degrees (95% CI -1.8 to +2.7) in the wooden phantoms and 1.2 degrees (-.7 to +3.1) in the agar-agar phantoms, while the angle deviation from the 4-chamber plane was -.9 degrees (-4.3 to +4.1) in the wooden phantoms and .0 degrees (-3.3 to +3.3) in the agar-agar phantoms. The measurements demonstrated good repeatability and reproducibility (Pearson correlation coefficients ranging from .91 to .99). The measurements from human hearts showed good repeatability (Pearson correlation was .81 for repeated LA-LV angle measurements and .97 for repeated measurements of the deviation from the 4-chamber plane).

CONCLUSION

The measurement of the LA-LV angle is a feasible tool to investigate one eventual error of 2D echocardiography.

Non-invasive technologies for heart failure, systolic and diastolic dysfunction modeling: a scoping review

The growing global prevalence of heart failure (HF) necessitates innovative methods for early diagnosis and classification of myocardial dysfunction. In recent decades, non-invasive sensor-based technologies have significantly advanced cardiac care. These technologies ease research, aid in early detection, confirm hemodynamic parameters, and support clinical decision-making for assessing myocardial performance. This discussion explores validated enhancements, challenges, and future trends in heart failure and dysfunction modeling, all grounded in the use of non-invasive sensing technologies. This synthesis of methodologies addresses real-world complexities and predicts transformative shifts in cardiac assessment. A comprehensive search was performed across five databases, including PubMed, Web of Science, Scopus, IEEE Xplore, and Google Scholar, to find articles published between 2009 and March 2023. The aim was to identify research projects displaying excellence in quality assessment of their proposed methodologies, achieved through a comparative criteria-based rating approach. The intention was to pinpoint distinctive features that differentiate these projects from others with comparable objectives. The techniques identified for the diagnosis, classification, and characterization of heart failure, systolic and diastolic dysfunction encompass two primary categories. The first involves indirect interaction with the patient, such as ballistocardiogram (BCG), impedance cardiography (ICG), photoplethysmography (PPG), and electrocardiogram (ECG). These methods translate or convey the effects of myocardial activity. The second category comprises non-contact sensing setups like cardiac simulators based on imaging tools, where the manifestations of myocardial performance propagate through a medium. Contemporary non-invasive sensor-based methodologies are primarily tailored for home, remote, and continuous monitoring of myocardial performance. These techniques leverage machine learning approaches, proving encouraging outcomes. Evaluation of algorithms is centered on how clinical endpoints are selected, showing promising progress in assessing these approaches' efficacy.

Nanoparticle Dynamics in Composite Hydrogels Exposed to Low-Frequency Focused Ultrasound

Pulsed focused ultrasound (FUS) in combination with microbubbles has been shown to improve delivery and penetration of nanoparticles in tumors. To understand the mechanisms behind this treatment, it is important to evaluate the contribution of FUS without microbubbles on increased nanoparticle penetration and transport in the tumor extracellular matrix (ECM). A composite agarose hydrogel was made to model the porous structure, the acoustic attenuation and the hydraulic conductivity of the tumor ECM. Single-particle tracking was used as a novel method to monitor nanoparticle dynamics in the hydrogel during FUS exposure. FUS exposure at 1 MHz and 1 MPa was performed to detect any increase in nanoparticle diffusion or particle streaming at acoustic parameters relevant for FUS in combination with microbubbles. Results were compared to a model of acoustic streaming. The nanoparticles displayed anomalous diffusion in the hydrogel, and FUS with a duty cycle of 20% increased the nanoparticle diffusion coefficient by 23%. No increase in diffusion was found for lower duty cycles. FUS displaced the hydrogel itself at duty cycles above 10%; however, acoustic streaming was found to be negligible. In conclusion, pulsed FUS alone cannot explain the enhanced penetration of nanoparticles seen when using FUS and microbubbles for nanoparticle delivery, but it could be used as a tool to enhance diffusion of particles in the tumor ECM.

Custom-made flow phantoms for quantitative ultrasound microvessel imaging

Morphologically realistic flow phantoms are essential experimental tools for quantitative ultrasound-based microvessel imaging. As new quantitative flow imaging tools are developed, the need for more complex vessel-mimicking phantoms is indisputable. In this article, we propose a method for fabricating phantoms with sub-millimeter channels consisting of branches and curvatures in various shapes and sizes suitable for quantifying vessel morphological features. We used different tissue-mimicking materials (TMMs) compatible with ultrasound imaging as the base and metal wires of different diameters (0.15-1.25 mm) to create wall-less channels. The TMMs used are silicone rubber, plastisol, conventional gelatin, and medical gelatin. Mother channels in these phantoms were made in diameters of 1.25 mm or 0.3 mm and the daughter channels in diameters 0.3 mm or 0.15 mm. Bifurcations were created by soldering wires together at branch points. Quantitative parameters were assessed, and accuracy of measurements from the ground truth were determined. Channel diameters were seen to have increased (76-270%) compared to the initial state in the power Doppler images, partly due to blood mimicking fluid pressure. Amongst the microflow phantoms made from the different TMMs, the medical gelatin phantom was selected as the best option for microflow imaging, fulfilling the objective of being easy to fabricate with high transmittance while having a speed of sound and acoustic attenuation close to human tissue. A flow velocity of 0.85 ± 0.01 mm/s, comparable to physiological flow velocity was observed in the smallest diameter phantom (medical gelatin branch) presented here. We successfully constructed more complex geometries, including tortuous and multibranch channels using the medical gelatin as the TMM. We anticipate this will create new avenues for validating quantitative ultrasound microvessel imaging techniques.

Evaluation of physical properties and image of polyvinyl chloride as breast tissue equivalence for dual-modality (mammography and ultrasound)

TMP is gradually becoming a fundamental element for quality assurance and control in ionizing and non-ionizing radiation imaging modalities as well as in the development of different techniques. This study aimed to evaluate and obtain polyvinyl chloride tissue mimicking material for dual-modality breast phantoms in mammography and ultrasound. Breast tissue equivalence was evaluated based on X-ray attenuation properties, speed of sound, attenuation, and acoustic impedance. There are six samples of PVC-plasticizer material with variations of PVC concentration and additives. The evaluation of X-ray attenuation was carried out using mammography from 23 to 35 kV, while the acoustic properties were assessed with mode A ultrasound and a transducer frequency of 5 MHz. A breast phantom was created from TMP material with tissue equivalence and was then evaluated using mammography as well as ultrasound to analyze its image quality. The results showed that samples A (PVC 5%, DOP 95%), B (PVC 7%, DOP 93%), C (PVC 10%, DOP 90%), E (PVC 7%, DOP 90%, graphite 3%), and F (PVC 7%, DOP 90%, silicone oil 3%) have the closest equivalent to the ACR breast phantom material with a different range of 0.01-1.39 in the 23-35 kV range. Based on the evaluation of the acoustic properties of ultrasound, A had high similarity to fat tissue with a difference of 0.03 (dB cm- 1 MHz- 1) and 0.07 (106 kg m- 2 s- 1), while B was close to the glandular tissue with a difference of 9.2 m s- 1. Multilayer breast phantom images' results showed gray levels in mammography and ultrasound modalities. Therefore, this study succeeded in establishing TMP material for mammography and ultrasound. It can also be used for simple quality assurance and control programs.

An Implantable Wireless System for Remote Hemodynamic Monitoring of Heart Failure Patients

This article presents an implantable wireless system for remote hemodynamic monitoring, which enables direct, continuous (24/7), and simultaneous measurement of pulmonary arterial pressure (PAP) and cross-sectional area (CSA) of the artery. The implantable device, which measures 3.2 mm × 2 mm × 10 mm, comprises a piezoresistive pressure sensor, an ASIC implemented in 180-nm CMOS, a piezoelectric ultrasound (US) transducer, and a nitinol anchoring loop. An energy-efficient pressure monitoring system, which employs duty-cycling and spinning excitation technique, achieves 0.44 mmHg resolution in a pressure range from -135 mmHg to +135 mmHg and consumes 1.1 nJ conversion energy. The artery diameter monitoring system utilizes the inductive characteristic of the implant's anchoring loop and achieves 0.24 mm resolution within a diameter range of 20 mm to 30 mm, four times higher than echocardiography lateral resolution. The wireless US power and data platform enables simultaneous power and data transfer employing a single piezoelectric transducer in the implant. The system is characterized with an 8.5 cm tissue phantom and achieves a US link efficiency of 1.8%. The uplink data is transmitted by using an ASK modulation scheme parallel to the power transfer and achieves a modulation index of 26%. The implantable system is tested in an in-vitro experimental setup, which emulates the arterial blood flow, and accurately detects fast pressure peaks for systolic and diastolic pressure changes at both 1.28 MHz and 1.6 MHz US powering frequencies, with corresponding uplink data rates of 40 kbps and 50 kbps.

Characterization of a fat tissue mimicking material for high intensity focused ultrasound applications

PURPOSE

Tissue-mimicking materials (TMMs) have a prominent role in validating new high intensity focused ultrasound (HIFU) therapies. Agar-based TMMs are often developed mimicking the thermal properties of muscle tissue, while TMMs simulating fat tissue properties are rarely developed. Herein, twelve agar-based TMMs were iteratively developed with varied concentrations of agar, water, glycerol and propan-2-ol, and characterized for their suitability in emulating the thermal conductivity of human fat tissue.

METHODS

Varied agar concentrations (2%, 4%, 6%, 8%, 12%, 16% and 20% w/v) were utilized for developing seven water-based TMMs, while a 20% w/v agar concentration was utilized for developing two water/alcohol-based TMMs (50% v/v water and 50% v/v either glycerol or propan-2-ol) and three alcohol-based TMMs (varied glycerol and propan-2-ol concentrations). Thermal conductivity was measured for all TMMs, and the tissue mimicking material (TMM) exhibiting thermal conductivity closest to human fat was considered the optimum fat TMM and was further characterized using ultrasound (US) and Magnetic Resonance Imaging (MRI).

RESULTS

For the seven water-based TMMs an inverse linear trend was observed between thermal conductivity and increased agar concentration, being between 0.524 and 0.445 W/m K. Alcohol addition decreased thermal conductivity of the two water/alcohol-based TMMs to about 0.33 W/m K, while in the alcohol-based TMMs, increased concentrations of propan-2-ol emerged as a modifier of thermal conductivity. The optimum fat TMM (33.3% v/v glycerol and 66.7% v/v propan-2-ol) exhibited a 0.231 W/m K thermal conductivity, and appeared hypoechoic on US images and with increased brightness on T1-Weighted MRI images.

CONCLUSION

The optimum fat TMM emulates the thermal conductivity of human fat tissue and exhibits a fat-like appearance on US and MRI images. The TMM is cost-effective and has a long lifespan and possesses great potential for use in HIFU applications as a fat TMM.

Engineering and Development of a Tissue Model for the Evaluation of Microneedle Penetration Ability, Drug Diffusion, Photothermal Activity, and Ultrasound Imaging: A Promising Surrogate to Ex Vivo and In Vivo Tissues

Driven by regulatory authorities and the ever-growing demands from industry, various artificial tissue models have been developed. Nevertheless, there is no model to date that is capable of mimicking the biomechanical properties of the skin whilst exhibiting the hydrophilicity/hydrophobicity properties of the skin layers. As a proof-of-concept study, tissue surrogates based on gel and silicone are fabricated for the evaluation of microneedle penetration, drug diffusion, photothermal activity, and ultrasound bioimaging. The silicone layer aims to imitate the stratum corneum while the gel layer aims to mimic the water-rich viable epidermis and dermis present in in vivo tissues. The diffusion of drugs across the tissue model is assessed, and the results reveal that the proposed tissue model shows similar behavior to a cancerous kidney. In place of typical in vitro aqueous solutions, this model can also be employed for evaluating the photoactivity of photothermal agents since the tissue model shows a similar heating profile to skin of mice when irradiated with near-infrared laser. In addition, the designed tissue model exhibits promising results for biomedical applications in optical coherence tomography and ultrasound imaging. Such a tissue model paves the way to reduce the use of animals testing in research whilst obviating ethical concerns.

Natural ballistic gelatine ultrasound phantoms are suitable to be used for student education and can be produced cheaply and effectively

Practical experience in ultrasonography at medical and veterinary schools is difficult to achieve using live models due to ethical considerations. A solution to this problem has been the creation of synthetic ultrasound phantoms that allow simulation of both ultrasound scans and ultrasound-guided procedures. Whilst commercially available phantoms are expensive in a resource-limited environment, it would be desirable to create affordable, reusable, homemade phantoms which could be used to aid student learning. Recent studies have indicated that ballistic gelatine is an excellent material for this. A prospective, experimental study was performed with three ultrasound phantoms for student use. Vascular, bladder, and liver parenchymal models were produced with a natural ballistic gel, along with instructions for their construction and maintenance. Model efficacy was evaluated by assessing students' performance in completing a set of tasks when performing ultrasound on a dog. Group one received training with the models, group two received prior training without the models and the group three received no training. Entry and exit questionnaires assessed students' confidence in ultrasound scanning having used the models. Student questionnaires showed that students enjoyed using the models and found them more useful than existing teaching aids. It was also found that the models produced better practical skills in students that trained with them, in comparison to existing teaching. The models were easy to make, produced good images, and are reusable.

Evaluating acoustic and thermal properties of a plaque phantom

PURPOSE

The aim of this study is to evaluate the acoustic and thermal properties of a plaque phantom. This is very important for the effective implementation of ultrasound not only in diagnosis but especially in treatment for the future.

MATERIAL AND METHODS

An evaluation of acoustic and thermal properties of plaque phantoms to test their suitability mainly for ultrasound imaging and therapy was presented. The evaluation included measurements of the acoustic propagation speed using pulse-echo technique, ultrasonic attenuation coefficient using through transmission immersion technique, and absorption coefficient. Moreover, thermal properties (thermal conductivity, volumetric specific heat capacity and thermal diffusivity) were measured with the transient method using a needle probe.

RESULTS

It was shown that acoustic and thermal properties of atherosclerotic plaque phantoms fall well within the range of reported values for atherosclerotic plaque and slightly different for thermal diffusivity and volumetric specific heat capacity for soft tissues. The mean value of acoustic and thermal properties and their standard deviation of plaque phantoms were 1523 ± 23 m/s for acoustic speed, 0.50 ± 0.02 W/mK for thermal conductivity, 0.30 ± 0.21 db/cm-MHz for ultrasonic absorption coefficient and 1.63 ± 0.46 db/cm-MHz for ultrasonic attenuation coefficient.

CONCLUSIONS

This study demonstrated that acoustic and thermal properties of atherosclerotic plaque phantoms were within the range of reported values. Future studies should be focused on the optimum recipe of the atherosclerotic plaque phantoms that mimics the human atherosclerotic plaque (agar 4% w/v, gypsum 10% w/v and butter 10% w/v) and can be used for HIFU therapy.

Highly Bright Near-Infrared Chemiluminescent Probes for Cancer Imaging and Laparotomy

Near-infrared (NIR) chemiluminescence imaging holds potential for sensitive imaging of cancer due to its low background; however, few NIR chemiluminophores are available, which share the drawback of low chemiluminescence quantum yields (Φ_CL ). Herein, we report the synthesis of NIR chemiluminophores for cancer imaging and laparotomy. Molecular engineering of the electron-withdrawing group at the para-position of the phenol-dioxetane leads to a highly bright NIR chemiluminophore (DPT), showing the Φ_CL (4.6×10^-2  Einstein mol^-1 ) that is 3 to 5-fold higher than existing NIR chemiluminophores. By caging the phenol group of DPT with a cathepsin B (CatB) responsive moiety, an activatable chemiluminescence probe (DPT_CB ) is developed for real-time turn-on detection of deeply buried tumor tissues in living mice. Due to its high brightness, DPT_CB permits accurate chemiluminescence-guided laparotomy.

Characterizing Viscoelastic Polyvinyl Alcohol Phantoms for Ultrasound Elastography

Ultrasound phantoms mimic the acoustic and mechanical properties of native tissues. Polyvinyl alcohol (PVA) phantoms are used extensively as models for validating ultrasound elastography approaches. However, the viscous properties of PVA phantoms have not been investigated adequately. Glycerol is a viscous liquid that has been reported to increase the speed of sound of phantoms. This study aims to assess the acoustic and viscoelastic properties of PVA phantoms and PVA mixed with glycerol at varying concentrations. The phantoms were fabricated with 10% w/v PVA in water with varying concentrations of glycerol (10%, 15% and 20% v/v) and 2% w/v silicon carbide particles as acoustic scatterers. The phantoms were subjected to either one, two, or three 24-h freeze-thaw cycles. The longitudinal sound speeds of all PVA phantoms were measured, and ranged from 1529 to 1660 m/s. Attenuation spectroscopy was performed in the range of 5 to 20 MHz. The measured attenuation followed a power-law relationship with frequency, wherein the power-law fit constants and exponents ranged from 0.02 to 0.1 dB/cm/MHzⁿ and from 1.6 to 1.9, respectively. These results were in agreement with previous reports for soft tissues. Viscoelasticity of PVA phantoms was assessed using rheometry. The estimated values of shear modulus and viscosity using the Kelvin-Voigt and Kelvin-Voigt fractional derivative models were within the range of previously-reported tissue-mimicking phantoms and soft tissues. The number of freeze-thaw cycles were shown to alter the viscosity of PVA phantoms, even in the absence of glycerol. Scanning electron microscopy images of PVA phantoms without glycerol showed a porous hydrogel network, in contrast to those of PVA-glycerol phantoms with non-porous structure. Phantoms fabricated in this study possess tunable acoustic and viscoelastic properties within the range reported for healthy and diseased soft tissues. This study demonstrates that PVA phantoms can be manufactured with glycerol for applications in ultrasound elastography.

Nakagami statistics-based photoacoustic spectroscopy used for label-free assessment of bone tissue

Quick identification of abnormal molecular metabolism of bone tissues is challenging. Photoacoustic (PA) spectroscopy techniques have great potential in molecular imaging. However, most of them are amplitude-dependent and easily affected by the light deposition, especially for bone tissues with high optical scattering. In this Letter, we propose a Nakagami statistics-based PA spectroscopy (NSPS) method for characterizing molecules in bone tissues. We indicate that the NSPS curve can intelligently identify changes in the content of molecules in bone tissues, with a high disturbance-resisting ability. The NSPS has remarkable potential for use in the early and rapid detection of bone diseases.

Low-Cost Pseudo-Anthropomorphic PVA-C and Cellulose Lung Phantom for Ultrasound-Guided Interventions

A low-cost custom-made pseudo-anthropomorphic lung phantom, offering a model for ultrasound-guided interventions, is presented. The phantom is a rectangular solidstructure fabricated with polyvinyl alcohol cryogel (PVA-C) and cellulose to mimic the healthy parenchyma. The pathologies of interest were embedded as inclusions containing gaseous, liquid, or solid materials. The ribs were 3D-printed using polyethylene terephthalate, and the pleura was made of a bidimensional reticle based on PVA-C. The healthy and pathological tissues were mimicked to display acoustic and echoic properties similar to that of soft tissues. Theflexible fabrication process facilitated the modification of the physical and acoustic properties of the phantom. The phantom's manufacture offers flexibility regarding the number, shape, location, and composition of the inclusions and the insertion of ribs and pleura. In-plane and out-of-plane needle insertions, fine needle aspiration, and core needle biopsy were performed under ultrasound image guidance. The mimicked tissues displayed a resistance and recoil effect typically encountered in a real scenario for a pneumothorax, abscesses, and neoplasms. The presented phantom accurately replicated thoracic tissues (lung, ribs, and pleura) and associated pathologies providing a useful tool for training ultrasound-guided procedures.

[Anatomic joint models for eco-guided interventionism training manufacture]

INTRODUCTION

Eco-guided interventionism has changed the way Physical Medicine and Rehabilitation specialists deal with musculoskeletal pain and other problems such as spasticity. The implementation of the Eco-Guided Intervention Units improves the results of the usual minimally invasive treatments in our speciality's clinical practice. The biggest drawback of this practice is the long learning curve and the difficulty of practice during training courses.

OBJECTIVE

To develop a system of phantoms that allow the practice of interventionism in anatomical models by shortening learning times and improving certainty by achieving the objective of interventionist practice.

METHODS

Describes the method of manufacturing three-dimensional models of joints with images obtained from computerized axial tomography, and their subsequent inclusion in gelatin's made molds, which allow to obtain phantoms, similar to real joint models, that allow to study using ultrasound techniques, and the practice of eco-guided interventionism.

CONCLUSION

Three-dimensional joint models made with gelatin are useful in the practice and learning of joint eco-guided interventionism techniques.

Tissue-Mimicking Materials for Ultrasound-Guided Needle Intervention Phantoms: A Comprehensive Review

Ultrasound-guided needle interventions are common procedures in medicine, and tissue-mimicking phantoms are widely used for simulation training to bridge the gap between theory and clinical practice in a controlled environment. This review assesses tissue-mimicking materials from 24 studies as candidates for a high-fidelity ultrasound phantom, including methods for evaluating relevant acoustic and mechanical properties and to what extent the reported materials mimic the superficial layers of biological tissue. Speed of sound, acoustic attenuation, Young's modulus, hardness, needle interaction forces, training efficiency and material limitations were systematically evaluated. Although gelatin and agar have the closest acoustic values to tissue, mechanical properties are limited, and strict storage protocols must be employed to counteract dehydration and microbial growth. Polyvinyl chloride (PVC) has superior mechanical properties and is a suitable alternative if durability is desired and some ultrasound realism to human tissue may be sacrificed. Polyvinyl alcohol (PVA), while also requiring hydration, performs well across all categories. Furthermore, we propose a framework for the evaluation of future ultrasound-guided needle intervention tissue phantoms to increase the fidelity of training programs and thereby improve clinical performance.

Phantoms for Quantitative Ultrasound

Tissue-mimicking materials and phantoms have an important role in quantitative ultrasound. These materials allow for investigation of new techniques with the ability to design materials with properties that are stable over time and available for repeated measurements to refine techniques and analysis algorithms. This chapter presents an overview of the history of phantoms, methods of creation of materials with a variety of acoustic properties, and methods of measurement of those properties. It includes a section addressing the measurement of variance in those techniques using interlaboratory comparisons. There is a wide range of existing tissue-mimicking materials that exhibit properties similar to those of most soft tissues. Ongoing work is part of the expansion of QUS as materials are developed to better mimic specific tissues, geometries, or pathologies.

A High-Sensitivity Bowel Sound Electronic Monitor Based on Piezoelectric Micromachined Ultrasonic Transducers

Bowel sounds contain some important human physiological parameters which can reflect information about intestinal function. In this work, in order to realize real-time monitoring of bowel sounds, a portable and wearable bowel sound electronic monitor based on piezoelectric micromachined ultrasonic transducers (PMUTs) is proposed. This prototype consists of a sensing module to collect bowel sounds and a GUI (graphical user interface) based on LabVIEW to display real-time bowel sound signals. The sensing module is composed of four PMUTs connected in parallel and a signal conditioning circuit. The sensitivity, noise resolution, and non-linearity of the bowel sound monitor are measured in this work. The result indicates that the designed prototype has high sensitivity (-142.69 dB), high noise resolution (50 dB at 100 Hz), and small non-linearity. To demonstrate the characteristic of the designed electronic monitor, continuous bowel sound monitoring is performed using the electronic monitor and a stethoscope on a healthy human before and after a meal. Through comparing the experimental results and analyzing the signals in the time domain and frequency domain, this bowel sound monitor is demonstrated to record bowel sounds from the human intestine. This work displays the potential of the sensor for the daily monitoring of bowel sounds.

Feasibility of Fetal Proximal Lateral Cerebral Ventricle Measurement

OBJECTIVES

Measuring the posterior horn of the lateral ventricle in the fetus during ultrasound scans may be challenging. We aimed to examine this measurement feasibility, in relation to gestational age.

METHODS

A cross-sectional study was conducted, including nonanomalous fetuses, in which both lateral ventricles measured less than 10 mm during anomaly scans. The measurements were performed according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines. Success rate of measuring both ventricles was assessed at different gestational ages. Association between lateral ventricle width with contralateral ventricle width, gender, gestational age, and fetal head position were assessed.

RESULTS

A total of 156 cases were recruited. The lateral ventricle distal to the probe was measured in all cases. In 10 cases proximal lateral ventricle could not be adequately measured (failed proximal ventricle measurement group). In 146 scans both ventricle measurements were available. All 10 cases of failed proximal ventricle measurement were in third trimester (30-38 weeks). Success rate of measurement of both ventricles was 100%, 96.2%, 71.4%, and 37.5% for gestational week 14-29, 30-32, 33-35, and 36-38, respectively (P <.001). Proximal lateral ventricle width was strongly associated with the distal ventricle width (B = 0.422, 95% confidence interval 0.29, 0.555, P <.001), but not with head position, fetal gender, or gestational age.

CONCLUSIONS

Measurement of the proximal lateral ventricle is feasible in most cases, even during late third trimester scans. Efforts should be made to visualize both ventricles in every evaluation of the fetal brain.

Ultrasonic photoacoustic emitter of graphene-nanocomposites film on a flexible substrate

Photoacoustic devices generating high-amplitude and high-frequency ultrasounds are attractive candidates for medical therapies and on-chip bio-applications. Here, we report the photoacoustic response of graphene nanoflakes - Polydimethylsiloxane composite. A protocol was developed to obtain well-dispersed graphene into the polymer, without the need for surface functionalization, at different weight percentages successively spin-coated onto a Polydimethylsiloxane substrate. We found that the photoacoustic amplitude scales up with optical absorption reaching 11 MPa at ∼ 228 mJ/cm² laser fluence. We observed a deviation of the pressure amplitude from the linearity increasing the laser fluence, which indicates a decrease of the Grüneisen parameter. Spatial confinement of high amplitude (> 40 MPa, laser fluence > 55 mJ/cm²) and high frequency (Bw-6db ∼ 21.5 MHz) ultrasound was achieved by embedding the freestanding film in an optical lens. The acoustic gain promotes the formation of cavitation microbubbles for moderate fluence in water and in tissue-mimicking material. Our results pave the way for novel photoacoustic medical devices and integrated components.

Investigation of silk as a phantom material for ultrasound and photoacoustic imaging

Comprehensive characterization of biomedical imaging systems require phantoms that are easy to fabricate and can mimic human tissue. Additionally, with the arrival of engineered tissues, it is key to develop phantoms that can mimic bioengineered samples. In ultrasound and photoacoustic imaging, water-soluble phantom materials such as gelatin undergo rapid degradation while polymer-based materials such as polyvinyl alcohol are not conducive for generating bioengineered tissues that can incorporate cells. Here we propose silk protein-based hydrogels as an ultrasound and photoacoustic phantom material that has potential to provide a 3D environment for long-term sustainable cell growth. Common acoustic, optical, and biomechanical properties such as ultrasound attenuation, reduced scattering coefficient, and Young's modulus were measured. The results indicate that silk acoustically mimics many tissue types while exhibiting similar reduced optical scattering in the wavelength range of 400-1200 nm. Furthermore, silk-based materials can be stored long-term with no change in acoustic and optical properties, and hence can be utilized to assess the performance of ultrasound and photoacoustic systems.

A High-Fidelity Agar-Based Phantom for Ultrasonography-Guided Brain Biopsy Simulation: A Novel Training Prototype with Visual Feedback

OBJECTIVE

A novel agar-based phantom was developed and assessed for ultrasonography (USG)-guided brain biopsy training. The phantom provides visual cues combined with sonologic cues, allowing multimodal training. Impact of multimodal training is evaluated through pretraining and posttraining trials.

METHODS

Twenty-five participants were divided based on experience with USG-based procedures into familiar (≥3 procedures performed in the past) (n = 14) and unfamiliar (<3 procedures performed) (n = 11). Agar phantoms with an opaque top and transparent middle layer were constructed in transparent glass bowls, each having 12 embedded targets. Participants underwent 2 supervised trials of USG-guided biopsy with aluminum foil covering the glass bowls, eliminating visual cues. Between 2 trials, participants underwent unsupervised self-training on a phantom without foil cover, providing visual cues. Performance was measured through insonation efficiency (EfI), biopsy efficiency (EfB), efficiency score (Ef), error score (Er), and performance score (PS). Scores were compared between and within the 2 groups before and after training. Impact of the self-training session on subjective comfort levels with the procedure was assessed through feedback forms.

RESULTS

Familiars had better pretraining EfB, Ef, Er, and PS (P < 0.001) compared with unfamiliars. After training, both performed similarly on all metrics. After training, familiars improved only in EfI (P = 0.001), with the unfamiliars showing significance in all metrics except EfI.

CONCLUSIONS

Simulation and phantom-based models can never supplant training through supervised skill application in vivo but our model supplements training by enabling technical skill acquisition, especially for beginners in USG-guided brain biopsy.

Using an Ultrasound Tissue Phantom Model for Hybrid Training of Deep Learning Models for Shrapnel Detection

Tissue phantoms are important for medical research to reduce the use of animal or human tissue when testing or troubleshooting new devices or technology. Development of machine-learning detection tools that rely on large ultrasound imaging data sets can potentially be streamlined with high quality phantoms that closely mimic important features of biological tissue. Here, we demonstrate how an ultrasound-compliant tissue phantom comprised of multiple layers of gelatin to mimic bone, fat, and muscle tissue types can be used for machine-learning training. This tissue phantom has a heterogeneous composition to introduce tissue level complexity and subject variability in the tissue phantom. Various shrapnel types were inserted into the phantom for ultrasound imaging to supplement swine shrapnel image sets captured for applications such as deep learning algorithms. With a previously developed shrapnel detection algorithm, blind swine test image accuracy reached more than 95% accuracy when training was comprised of 75% tissue phantom images, with the rest being swine images. For comparison, a conventional MobileNetv2 deep learning model was trained with the same training image set and achieved over 90% accuracy in swine predictions. Overall, the tissue phantom demonstrated high performance for developing deep learning models for ultrasound image classification.

Optimized Simultaneous Axial Multifocal Imaging via Frequency Multiplexed Focusing

Simultaneous axial multifocal imaging (SAMI) using a single acoustical transmission was developed to enhance the depth of field. This technique transmits a superposition of axial multifoci waveforms in a single transmission, thus increasing the frame rate. However, since all the waveforms are transmitted at a constant center frequency, there is a tradeoff between attenuation and lateral resolution when choosing a constant frequency for all the axial depths. In this work, we developed an optimized SAMI method by adding frequency dependence to each axial multifocus. By gradually increasing the frequency as a function of the focal depth, this method makes it possible to compensate for the gradually increasing F-number in order to achieve constant lateral resolution across the entire field of view. Alternatively, by gradually decreasing the axial multifoci frequencies as a function of depth, enhanced penetration depth and contrast are obtained. This method, termed frequency multiplexed SAMI (FM-SAMI), is described analytically and validated by resolution and contrast experiments performed on resolution targets, tissue-mimicking phantoms, and ex vivo biological samples. This is the first real-time implementation of a frequency multiplexing approach for axial multifoci imaging that facilitates high-quality imaging at an increased frame rate.

Micronized Recycle Rubber Particles Modified Multifunctional Polymer Composites: Application to Ultrasonic Materials Engineering

There is a growing interest in multifunctional composites and in the identification of novel applications for recycled materials. In this work, the design and fabrication of multiple particle-loaded polymer composites, including micronized rubber from end-of-life tires, is studied. The integration of these composites as part of ultrasonic transducers can further expand the functionality of the piezoelectric material in the transducer in terms of sensitivity, bandwidth, ringing and axial resolution and help to facilitate the fabrication and use of phantoms for echography. The adopted approach is a multiphase and multiscale one, based on a polymeric matrix with a load of recycled rubber and tungsten powders. A fabrication procedure, compatible with transducer manufacturing, is proposed and successfully used. We also proposed a modelling approach to calculate the complex elastic modulus, the ultrasonic damping and to evaluate the relative influence of particle scattering. It is concluded that it is possible to obtain materials with acoustic impedance in the range 2.35–15.6 MRayl, ultrasound velocity in the range 790–2570 m/s, attenuation at 3 MHz, from 0.96 up to 27 dB/mm with a variation of the attenuation with the frequency following a power law with exponent in the range 1.2–3.2. These ranges of values permit us to obtain most of the material properties demanded in ultrasonic engineering.

Evaluation of ultrasonic scattering in agar-based phantoms using 3D printed scattering molds

PURPOSE

Acoustic characterization of tissue mimicking materials in terms of attenuation, absorption, scattering and propagation velocity is essential for their utilisation in experiments, thus sparing the need for living tissues or cadavers. Although there is a vast literature regarding the acoustic characterization of such materials in terms of attenuation or propagation velocity, there is limited data regarding the quantification of the scattering coefficient. Herein stimulated the utilisation of four agar-based phantoms featuring different sizes of scattering agar-structures on one of their surfaces so as to provide experimental evaluation of the magnitude of scattering.

METHODS

The agar-based phantoms were developed with 6% w/v agar and 4% w/v silica and featured scatterers of sizes of 0-1 mm. The acoustic properties of propagation speed, impedance, insertion loss and attenuation were evaluated utilising the pulse-echo and through-transmission techniques. Scattering was deduced from the data.

RESULTS

The propagation speed measured at 2.7 MHz was in the range of 1531.23-1542.97 m/s. Respectively the attenuation as measured at 1.1 MHz was in the range of 1.216-1.546 dB/cm increasing with increased scatterer size. Respectively the scattering coefficient was in the range of 0.078-0.324 dB/cm. Moreover, the scattering coefficient was linearly dependent on frequency in the range of 0.8-2.1 MHz indicating a 6-23% effect of the total attenuation.

CONCLUSIONS

The experimental results demonstrate the utilisation of the procedure for quantification of the scattering coefficient of tissue mimicking materials thus improving the diagnostic and therapeutic uses of ultrasound.

Development of Tough Hydrogel Phantoms to Mimic Fibrous Tissue for Focused Ultrasound Therapies

Tissue-mimicking gels provide a cost-effective medium to optimize histotripsy treatment parameters with immediate feedback. Agarose and polyacrylamide gels are often used to evaluate treatment outcomes as they mimic the acoustic properties and stiffness of a variety of soft tissues, but they do not exhibit high toughness, a characteristic of fibrous connective tissue. To mimic pathologic fibrous tissue found in benign prostate hyperplasia (BPH) and other diseases that are potentially treatable with histotripsy, an optically transparent hydrogel with high toughness was developed that is a hybrid of polyacrylamide and alginate. The stiffness was established using shear wave elastography (SWE) and indentometry techniques and was found to be representative of human BPH ex vivo prostate tissue. Different phantom compositions and excised ex vivo BPH tissue samples were treated with a 700-kHz histotripsy transducer at different pulse repetition frequencies. Post-treatment, the hybrid gels and the tissue samples exhibited differential reduction in stiffness as measured by SWE. On B-mode ultrasound, partially treated areas were present as hyperechoic zones and fully liquified areas as hypoechoic zones. Phase contrast microscopy of the gel samples revealed liquefaction in regions consistent with the target lesion dimensions and correlated to findings identified in tissue samples via histology. The dose required to achieve liquefaction in the hybrid gel was similar to what has been observed in ex vivo tissue and greater than that of agarose of comparable or higher Young's modulus by a factor >10. These results indicate that the developed hydrogels closely mimic elasticities found in BPH prostate ex vivo tissue and have a similar response to histotripsy treatment, thus making them a useful cost-effective alternative for developing and evaluating different treatment protocols.

Ultrasonic attenuation of canine mammary tumours

BACKGROUND

Canine mammary tumours (CMTs) are the most common neoplasm appearing in female dogs and are considered the equivalent animal model of human breast cancer. However, in the literature, there is a gap for ultrasonic characterisation of these tumours. In this study, experimental measurements for acoustic attenuation and propagation speed of three surgically excised malignant CMTs were implemented.

METHODS

The three tumours were fixed in formaldehyde for up to 72 h and a total of five sample pieces were sectioned from the three tumours to account for the varied morphology observed along the tumours. The through-transmission and pulse-echo techniques were employed for experimental measurements of the acoustic attenuation and propagation speed.

RESULTS

Acoustic propagation speed of the five samples as measured at 2.7 MHz was in the range of 1568-1636 m/s. Correspondingly, acoustic attenuation was in the range of 1.95-3.45 dB/cm.MHz. Variations in both speed and attenuation were observed between samples acquired from the same tumour.

CONCLUSIONS

Present findings suggest that both acoustic attenuation and propagation speed of CMTs are higher than normal canine tissues due to increased heterogeneity and varied morphology visually observed between the tumour specimens and evidenced by histological examination. Nevertheless, experimental results could aid in enhancing the use of ultrasound in the diagnosis and treatment of CMTs as well as provide essential data for comparative oncology.

Thermochromic Tissue-Mimicking Phantoms for Thermal Ablation Based on Polyacrylamide Gel

In recent years, thermal ablation has played an increasingly important role in treating various tumors in the clinic. A practical thermochromic phantom model can provide a favorable platform for clinical thermotherapy training of young physicians or calibration and optimization of thermal devices without risk to animals or human participants. To date, many tissue-mimicking thermal phantoms have been developed and are well liked, especially the polyacrylamide gel (PAG)-based phantoms. This review summarizes the PAG-based phantoms in the field of thermotherapy, details their advantages and disadvantages and provides a direction for further optimization. The relevant physical parameters (such as electrical, acoustic, and thermal properties) of these phantoms are also presented in this review, which can assist operators in a deeper understanding of these phantoms and selection of the proper recipes for phantom fabrication.

Fabrication and Characterization of Tissue-Mimicking Phantoms for Ultrasound-Guided Cannulation Training

Tissue-mimicking materials (TMMs) have been investigated and used for decades as imaging phantoms in various medical applications. They are designed and fabricated to replicate certain biological tissue characteristics, a process often dictated by the target application. Moreover, TMMs have been utilized in some medical procedural training requiring the use of imaging modalities. One potential application for TMMs is ultrasound-guided cannulation training. Cannulation is a procedure that requires a level of dexterity to gain vascular access using ultrasound guidance while avoiding complications like vessel laceration and bleeding. However, an ideal phantom for this application is yet to be developed. This work investigates the development and characterization of high-fidelity phantoms for cannulation training. The mechanical (shore hardness, elastic modulus, and needle-interaction forces) and acoustic (B-mode ultrasound scans) properties of candidate materials were quantitatively compared with biological tissue. The evaluated materials included ballistic gel, plasticized polyvinyl chloride (PVC), silicone, gelatin, agar, and polyvinyl alcohol (PVA)- cryogel. Mechanical testing demonstrated that each material could replicate the Shore hardness and elasticity characteristics of different biological tissues (skin, fat, and muscle), with PVA and PVC showing tunability by varying composition or fabrication processes. Shore hardness (OO-range) for PVA ranged between 6.3 ± 1.0 to 59.3 ± 2.6 and PVC from 4.8 ± 0.7 to 14.6 ± 0.8. Ultrasound scans of PVA were the closest to human scans, both qualitatively (based on experts' opinion) and quantitatively (based on pixel intensity measurements). Modified mixtures of PVA are found to best serve as high-fidelity cannulation phantoms. Alternatively, PVC can be used to avoid troublesome fabrication processes of PVA.

Dual-Mode Tumor Imaging Using Probes That Are Responsive to Hypoxia-Induced Pathological Conditions

Hypoxia in solid tumors is associated with poor prognosis, increased aggressiveness, and strong resistance to therapeutics, making accurate monitoring of hypoxia important. Several imaging modalities have been used to study hypoxia, but each modality has inherent limitations. The use of a second modality can compensate for the limitations and validate the results of any single imaging modality. In this review, we describe dual-mode imaging systems for the detection of hypoxia that have been reported since the start of the 21st century. First, we provide a brief overview of the hallmarks of hypoxia used for imaging and the imaging modalities used to detect hypoxia, including optical imaging, ultrasound imaging, photoacoustic imaging, single-photon emission tomography, X-ray computed tomography, positron emission tomography, Cerenkov radiation energy transfer imaging, magnetic resonance imaging, electron paramagnetic resonance imaging, magnetic particle imaging, and surface-enhanced Raman spectroscopy, and mass spectrometric imaging. These overviews are followed by examples of hypoxia-relevant imaging using a mixture of probes for complementary single-mode imaging techniques. Then, we describe dual-mode molecular switches that are responsive in multiple imaging modalities to at least one hypoxia-induced pathological change. Finally, we offer future perspectives toward dual-mode imaging of hypoxia and hypoxia-induced pathophysiological changes in tumor microenvironments.

Augmented ultrasonography with implanted CMOS electronic motes

Modern clinical practice benefits significantly from imaging technologies and much effort is directed toward making this imaging more informative through the addition of contrast agents or reporters. Here, we report the design of a battery-less integrated circuit mote acting as an electronic reporter during medical ultrasound imaging. When implanted within the field-of-view of a brightness-mode (B-mode) ultrasound imager, this mote transmits information from its location through backscattered acoustic energy which is captured within the ultrasound image itself. We prototype and characterize the operation of such motes in vitro and in vivo. Performing with a static power consumption of less than 57 pW, the motes operate at duty cycles for receiving acoustic energy as low as 50 ppm. Motes within the same field-of-view during imaging have demonstrated signal-to-noise ratios of more than 19.1 dB at depths of up to 40 mm in lossy phantom. Physiological information acquired through such motes, which is beyond what is measurable with endogenous ultrasound backscatter and which is biogeographically located within an image, has the potential to provide an augmented ultrasonography.

Characterization of Acoustic, Cavitation, and Thermal Properties of Poly(vinyl alcohol) Hydrogels for Use as Therapeutic Ultrasound Tissue Mimics

The thermal and mechanical effects induced in tissue by ultrasound can be exploited for therapeutic applications. Tissue-mimicking materials (TMMs), reflecting different soft tissue properties, are required for experimental evaluation of therapeutic potential. In the study described here, poly(vinyl alcohol) (PVA) hydrogels were characterized. Hydrogels prepared using different concentrations (5%-20% w/w) and molecular weights of PVA ± cellulose scatterers (2.5%-10% w/w) were characterized acoustically (sound speed, attenuation) as a function of temperature (25°C-45°C), thermally (thermal conductivity, specific heat capacity) and in terms of their cavitation thresholds. Results were compared with measurements in fresh sheep tissue (kidney, liver, spleen). Sound speed depended most strongly on PVA concentration, and attenuation, on cellulose content. For the range of formulations investigated, the PVA gel acoustic properties (sound speed: 1532 ± 17 to 1590 ± 9 m/s, attenuation coefficient: 0.08 ± 0.01 to 0.37 ± 0.02 dB/cm) fell within those measured in fresh tissue. Cavitation thresholds for 10% PVA hydrogels (50% occurrence: 4.1-5.4 MPa, 75% occurrence: 5.4-8.2 MPa) decreased with increasing cellulose content. In summary, PVA cellulose composite hydrogels may be suitable mimics of acoustic, cavitation and thermal properties of soft tissue for a number of therapeutic ultrasound applications.