Proposed standard thermal test object for medical ultrasound

A standard test phantom for the performance assessment of magnetic resonance guided high intensity focused ultrasound (MRgHIFU) thermal therapy devices

Purpose: Test objects for High Intensity Focused Ultrasound (HIFU) are required for the standardization and definition of treatment, Quality Assurance (QA), comparison of results between centers and calibration of devices. This study describes a HIFU test object which provides temperature measurement as a function of time, in a reference material compatible with Magnetic Resonance (MR) and ultrasound.Materials and methods: T-Type fine wire thermocouples were used as sensors and 5 correction methods for viscous heating artifacts were assessed. The phantom was tested in a MR-HIFU Philips Sonalleve device over a period of 12 months, demonstrating stability and validity to evaluate the performance of the device.Results: The study furnished useful information regarding the MR-HIFU sessions and highlighted potential limitations of the existing QA and monitoring methods. The importance of temperature monitoring along the whole acoustic path was demonstrated as MR Thermometry readings differed in the three MR plane views (coronal, sagittal, transverse), in particular when the focus was near a soft-tissue/bone interface, where there can be an MR signal loss with significant temperature and thermal dose underestimation (138% variation between the three plane views).Conclusions: The test object was easy to use and has potential as a valid tool for training, QA, research and development for MR guided HIFU and potentially ultrasound guided devices.

Numerical modeling of ultrasound heating for the correction of viscous heating artifacts in soft tissue temperature measurements

Measuring temperature during focused ultrasound (FUS) procedures is critical for characterization, calibration, and monitoring to ultimately ensure safety and efficacy. Despite the low cost and the high spatial and temporal resolutions of temperature measurements using thermocouples, the viscous heating (VH) artifact at the thermocouple-tissue interface requires reading corrections for correct thermometric analysis. In this study, a simulation pipeline is proposed to correct the VH artifact arising from temperature measurements using thermocouples in FUS fields. The numerical model consists of simulating a primary source of heating due to ultrasound absorption and a secondary source of heating from viscous forces generated by the thermocouple in the FUS field. Our numerical validation found that up to 90% of the measured temperature rise was due to VH effects. Experimental temperature measurements were performed using thermocouples embedded in fresh chicken breast samples. Temperature corrections were demonstrated for single high-intensity FUS pulses at 3.1 MHz and for multiple pulses (3.1 MHz, 100 Hz, and 500 Hz pulse repetition frequency). The VH accumulated during sonications and produced a temperature increase of 3.1 °C and 15.3 °C for the single and multiple pulse sequences, respectively. The methodology presented here enables the decoupling of the temperature increase generated by absorption and VH. Thus, more reliable temperature measurements can be extracted from thermocouple measurements by correcting for VH.

Therapeutic ultrasound in physical medicine and rehabilitation: characterization and assessment of its physical effects on joint-mimicking phantoms

The aim of the study described here was to quantitatively assess thermal and mechanical effects of therapeutic ultrasound (US) by sonicating a joint-mimicking phantom, made of muscle-equivalent material, using clinical US equipment. The phantom contains two bone disks simulating a deep joint (treated at 1 MHz) and a superficial joint (3 MHz). Thermal probes were inserted in fixed positions. To test the mechanical (cavitational) effects, we used a latex balloon filled with oxygen-loaded nanobubbles; the dimensions of the oxygen-loaded nanobubbles were determined before and after sonication. Significant increases in temperature (up to 17°C) with fixed field using continuous waves were detected both in front of and behind the bones, depending on the US mode (continuous wave vs. pulsed wave) and on the treatment modality (fixed vs. massage). We found no significant differences in mechanical effects. Although limited by the in vitro design (no blood perfusion, no metabolic compensation), the results can be used to guide operators in their choice of the best US treatment modality for a specific joint.

Use of real-time ultrasonography as an alternative method for early detection, confirmation and evaluation of rat pregnancy

Researchers sometimes face difficulties in the diagnosis of pregnancy and assessment of embryonic development. Ultrasonography (US) is a non-invasive imaging method with minimal side effects on the subjects or operators. It provides real-time evaluation of the physiology of rapidly moving structures (i.e., heart) and facilitates evaluation of fetal tissue development. US discerns tissues based on composition, making it the imaging method of choice for abdominal examination. In this study we used real-time US as an alternative method for early diagnosis of pregnancy in rats. Sixty-four Wistar rats aged 16-20 wk were examined, and day 8 was the earliest point at which pregnancy could be detected. We constructed a detailed timeline of embryonic features detectable by US on days 8 to 19. We trust this index will be a valuable tool. More refined work toward a more detailed "atlas" will help to reduce animal sacrifice during embryonic development studies.

Experimental study on temperature rise of acoustic radiation force elastography

INTRODUCTION

Acoustic radiation force (ARF) elastography is potentially useful for imaging the elasticity of human tissue. Because a "push wave" that is used to generate ARF is a long burst wave comparable to that used in regular clinical imaging, detailed investigation of its safety is required.

MATERIALS AND METHODS

We focus on the transient temperature rise in the far field, where the beam paths are overlapped. Soft tissue mimicking a phantom and bone samples were exposed to a 2-MHz plane wave for 20 s. The temperature rises in the far field were measured using a thermocouple. The temperature rises at 1 ms, the time required for the displacement measurement, were estimated by fitting the experimental results. The results showed that the thermosensitivity of the bone was 36 times higher than that of the phantom, and the use of a repeated push wave may have exceeded the allowable maximum temperature rise, 1°C, on the bone surface.

CONCLUSION

In conclusion, the imaging area, including the path of the push wave, should be carefully checked and the time interval for consecutive use should be adjusted to prevent thermal risk on the surface of the bone.

Three-dimensional printing (3DP) of neonatal head phantom for ultrasound: thermocouple embedding and simulation of bone

A neonatal head phantom, comprising of an ellipsoidal geometry and including a circular aperture for simulating the fontanel was designed and fabricated, in order to allow an objective assessment of thermal rise in tissues during trans-cranial ultrasonic scanning of pre-term neonates. The precise position of a series of thermocouples was determined on the basis of finite-element analysis, which identified crucial target points for the thermal monitoring within the phantom geometry. Three-Dimensional Printing (3DP) was employed for the manufacture of the skull phantom, which was subsequently filled with dedicated brain-mimic material. A novel 3DP material combination was found to be able to mimic the acoustic properties of neonatal skull bone. Similarly, variations of a standard recipe for tissue mimic were examined, until one was found to mimic the brain of an infant. A specific strategy was successfully pursued to embed a thermocouple within the 3DP skull phantom during the manufacturing process. An in-process machine vision system was used to assess the correct position of the deposited thermocouple inside the fabricated skull phantom. An external silicone-made skin-like covering completed the phantom and was manufactured through a Direct Rapid Tooling (DRT) technique.

Dual-mode IVUS transducer for image-guided brain therapy: preliminary experiments

In this study, we investigated the feasibility of using 3.5-Fr intravascular ultrasound (IVUS) catheters for minimally-invasive, image-guided hyperthermia treatment of tumors in the brain. Feasibility was demonstrated by: (1) retro-fitting a commercial 3.5-Fr IVUS catheter with a 5 × 0.5 × 0.22 mm PZT-4 transducer for 9-MHz imaging and (2) testing an identical transducer for therapy potential with 3.3-MHz continuous-wave excitation. The imaging transducer was compared with a 9-Fr, 9-MHz ICE catheter when visualizing the post-mortem ovine brain and was also used to attempt vascular access to an in vivo porcine brain. A net average electrical power input of 700 mW was applied to the therapy transducer, producing a temperature rise of +13.5°C at a depth of 1.5 mm in live brain tumor tissue in the mouse model. These results suggest that it may be feasible to combine the imaging and therapeutic capabilities into a single device as a clinically-viable instrument.

Combined ultrasonic thermal ablation with interleaved ARFI image monitoring using a single diagnostic curvilinear array: a feasibility study

The goal of this work is to demonstrate the feasibility of using a diagnostic ultrasound system (Siemens Antares and CH6-2 curvilinear array) to ablate ex vivo liver with a custom M-mode sequence and monitor the resulting tissue stiffening with 2-D Acoustic Radiation Force Impulse (ARFI) imaging. Images were taken before and after ablation, as well as in 5- s intervals during the ablation sequence in order to monitor the ablation lesion formation temporally. Ablation lesions were generated at depths up to 1.5 cm from the surface of the liver and were not visible in B-mode. ARFI images showed liver stiffening with heating that corresponded to discolored regions in gross pathology. As expected, the contrast of ablation lesions in ARFI images is observed to increase with ablation lesion size. This study demonstrated the ability of a diagnostic system using custom beam sequences to localize an ablation site, heat the site to the point of irreversible damage and monitor the formation of the ablation lesion with ARFI imaging.

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.

Ultrasound-induced contraction of the carotid artery in vitro

Ultrasound is known to produce a range of nonlethal responses in cells and tissues. Frequencies in the kilohertz ultrasound range have been shown to produce relaxation in large arteries. The present work explores the effects of insonation at MHz frequencies, representative of those used diagnostically and therapeutically, in an in vitro preparation of the carotid artery. Fresh 12.7 mm wide rings of equine common carotid artery obtained from the abattoir were mounted in a purpose-made myograph. They were immersed in a bath of Krebs-Ringer buffer at 37 degrees C and were positioned at the focus of an ultrasound beam from a weakly focused 3.2 MHz source. Continuous wave insonation produced contraction. The tension increased rapidly over the first 2 min, followed by a slower increase for the duration of the exposure up to 15 min. At a power of 145 mW a maximum contractile stress of 0.04 +/- 0.03 mN/mm(2) (mean +/- SD, n = 77) was measured, which was approximately 4% of the maximum wall stress generated by noradrenaline (0.1 mM). The magnitude of the response was weakly dependent on power in the range 72-145 mW and was not significantly different for pulsed and continuous wave stimulation where time averaged power was constant. The response was unaffected by mechanical removal of the endothelium. The ultrasound beam generated insufficient radiation force to produce a measurable effect and streaming at the vessel surface was very small compared with flow rates known to produce physiologic effects. The temperature rise at the beam focus was approximately 0.3 degrees C and we hypothesise that this contributes to the observed response, probably through changes in ion channel activity in smooth muscle cell membranes. (E-mail: e.martin@exeter.ac.uk).

Acoustic dose and acoustic dose-rate

Acoustic dose is defined as the energy deposited by absorption of an acoustic wave per unit mass of the medium supporting the wave. Expressions for acoustic dose and acoustic dose-rate are given for plane-wave conditions, including temporal and frequency dependencies of energy deposition. The relationship between the acoustic dose-rate and the resulting temperature increase is explored, as is the relationship between acoustic dose-rate and radiation force. Energy transfer from the wave to the medium by means of acoustic cavitation is considered, and an approach is proposed in principle that could allow cavitation to be included within the proposed definitions of acoustic dose and acoustic dose-rate.

A Fabry-Perot fiber-optic ultrasonic hydrophone for the simultaneous measurement of temperature and acoustic pressure

A dual sensing fiber-optic hydrophone that can make simultaneous measurements of acoustic pressure and temperature at the same location has been developed for characterizing ultrasound fields and ultrasound-induced heating. The transduction mechanism is based on the detection of acoustically- and thermally-induced thickness changes in a polymer film Fabry-Perot interferometer deposited at the tip of a single mode optical fiber. The sensor provides a peak noise-equivalent pressure of 15 kPa (at 5 MHz, over a 20 MHz measurement bandwidth), an acoustic bandwidth of 50 MHz, and an optically defined element size of 10 microm. As well as measuring acoustic pressure, temperature changes up to 70 degrees C can be measured, with a resolution of 0.34 degrees C. To evaluate the thermal measurement capability of the sensor, measurements were made at the focus of a high-intensity focused ultrasound (HIFU) field in a tissue mimicking phantom. These showed that the sensor is not susceptible to viscous heating, is able to withstand high intensity fields, and can simultaneously acquire acoustic waveforms while monitoring induced temperature rises. These attributes, along with flexibility, small physical size (OD approximately 150 microm), immunity to Electro-Magnetic Interference (EMI), and low sensor cost, suggest that this type of hydrophone may provide a practical alternative to piezoelectric based hydrophones.

Dual-mode intracranial catheter integrating 3D ultrasound imaging and hyperthermia for neuro-oncology: feasibility study

In this study, we investigated the feasibility of an intracranial catheter transducer with dual-mode capability of real-time 3D (RT3D) imaging and ultrasound hyperthermia, for application in the visualization and treatment of tumors in the brain. Feasibility is demonstrated in two ways: first by using a 50-element linear array transducer (17 mm x 3.1 mm aperture) operating at 4.4 MHz with our Volumetrics diagnostic scanner and custom, electrical impedance-matching circuits to achieve a temperature rise over 4 degrees C in excised pork muscle, and second, by designing and constructing a 12 Fr, integrated matrix and linear-array catheter transducer prototype for combined RT3D imaging and heating capability. This dual-mode catheter incorporated 153 matrix array elements and 11 linear array elements diced on a 0.2 mm pitch, with a total aperture size of 8.4 mm x 2.3 mm. This 3.64 MHz array achieved a 3.5 degrees C in vitro temperature rise at a 2 cm focal distance in tissue-mimicking material. The dual-mode catheter prototype was compared with a Siemens 10 Fr AcuNav catheter as a gold standard in experiments assessing image quality and therapeutic potential and both probes were used in an in vivo canine brain model to image anatomical structures and color Doppler blood flow and to attempt in vivo heating.

Comparison of one-dimensional and two-dimensional least-squares strain estimators for phased array displacement data

In this study, the performances of one-dimensional and two-dimensional least-squares strain estimators (LSQSE) are compared. Furthermore, the effects of kernel size are examined using simulated raw frequency data of a widely-adapted hard lesion/soft tissue model. The performances of both methods are assessed in terms of root-mean-squared errors (RMSE), elastographic signal-to-noise ratio (SNRe) and contrast-to-noise ratio (CNRe). RMSE analysis revealed that the 2D LSQSE yields better results for phased array data, especially for larger insonification angles. Using a 2D LSQSE enabled the processing of unfiltered displacement data, in particular for the lateral/horizontal strain components. The SNRe and CNRe analysis showed an improvement in precision and almost no loss in contrast using 2D LSQSE. However, the RMSE images for different kernel sizes revealed that the optimal 2D kernel size depends on the region-of-interest and showed that the LSQ kernel size should be limited to avoid loss in resolution.

Investigation of the viscous heating artefact arising from the use of thermocouples in a focused ultrasound field

Accurate temperature measurements in therapeutic ultrasound fields are necessary for understanding damage mechanisms, verification of thermal modelling and calibration of non-invasive clinical thermometry. However, artefactual heating, primarily due to viscous forces which result from motion relative to the surrounding tissue, occurs when metal thermocouples are used in an ultrasound field. The magnitude and time dependence of this artefact has been characterized by comparison with novel thin-film thermocouples (TFTs) at 1-2 cm focal depths in fresh degassed ex vivo bovine liver. High-intensity focused ultrasound exposures (1.7 MHz; free-field spatial-peak temporal-average intensities 40-600 W cm(-2)) were used. Subtraction of the TFT data from that obtained for other thermocouples yielded the time dependence of the viscous heating artefact. This was found to be intensity independent up to 600 W cm(-2) (below the threshold for cavitation and lesion formation) and remained significant at radial distances out to the first side lobe in the focal plane. The contribution of viscous heating to cooling was also found to be significant for at least 5 s after the end of insonation. The ratio of viscous artefact to absorptive heating after 5 s was: 1.76 +/- 0.07 for a fine-wire, 0.45 +/- 0.07 and 1.93 +/- 0.07 for two different sheathed-wires and 0.24 +/- 0.07 for a needle thermocouple.

Fetal thermal effects of diagnostic ultrasound

Processes that can produce a biological effect with some degree of heating (ie, about 1 degrees C above the physiologic temperature) act via a thermal mechanism. Investigations with laboratory animals have documented that pulsed ultrasound can produce elevations of temperature and damage in biological tissues in vivo, particularly in the presence of bone (intracranial temperature elevation). Acoustic outputs used to induce these adverse bioeffects are within the diagnostic range, although exposure times are usually considerably longer than in clinical practice. Conditions present in early pregnancy, such as lack of perfusion, may favor bioeffects. Thermally induced teratogenesis has been shown in many animal studies, as well as several controlled human studies; however, human studies have not shown a causal relationship between diagnostic ultrasound exposure during pregnancy and adverse biological effects to the fetus. All human epidemiologic studies, however, were conducted with commercially available devices predating 1992, that is, with acoustic outputs not exceeding a spatial-peak temporal-average intensity of 94 mW/cm2. Current limits in the United States allow a spatial-peak temporal-average intensity of 720 mW/cm2 for fetal applications. The synergistic effect of a raised body temperature (febrile status) and ultrasound insonation has not been examined in depth. Available evidence, experimental or epidemiologic, is insufficient to conclude that there is a causal relationship between obstetric diagnostic ultrasound exposure and obvious adverse thermal effects to the fetus. However, very subtle effects cannot be ruled out and indicate a need for further research, although research in humans may be extremely difficult to realize.

Surface heating by transvaginal transducers

OBJECTIVE

This safety study was designed to investigate tissue heating close to the surface of transvaginal ultrasound transducers, with the objective of assessing the validity of manufacturing safety standards set by the International Electrotechnical Commission (IEC).

METHODS

The transducers investigated in this study were held in contact with a layered soft-tissue mimicking material (TMM), and the temperature increase was measured at various depths using a miniature thermocouple. The temperature rise at 200 s was recorded, and the measured profiles of temperature rise with depth were compared with profiles predicted from both analytical and numeric models. Two transvaginal transducers of different manufacturers were investigated, operating in B-mode imaging, color-flow imaging and pulsed Doppler modes, using scanner settings giving acoustic output power towards the upper end of that available.

RESULTS

The greatest heating always occurred at the interface between the transducer and the TMM, and it reduced to about 0.1 times the surface temperature rise at a depth of 1 cm. A local maximum was observed in pulsed Doppler mode. A three-dimensional finite-element model which accounted for transducer dimensions gave a better prediction of temperature increase than a simple analytical model. The temperature profiles were compared with the depth of fetal tissue measured from a small survey of clinical scans.

CONCLUSIONS

It is provisionally concluded that the transducer surface temperature rise of 6 degrees C allowed to manufacturers by the IEC may give rise to an associated worst-case contribution to temperature rise due to the transducer, in fetal tissue, of between 0.5 and 1 degrees C at 1-cm depth. The contribution to tissue heating at 2 cm and deeper is negligible. Published by John Wiley & Sons, Ltd.

Metrology for ultrasonic applications

This paper provides a review of current metrological capability applied to the characterisation of the acoustic output of equipment used within medical ultrasonic applications. Key measurement devices, developed to underpin metrology in this area, are the radiation force balance, used to determine total output power, and the piezo-electric hydrophone, used to resolve the spatial and temporal distribution of acoustic pressure. The measurement infrastructure in place within the United Kingdom ensuring users are able to carry out traceable measurements of these quantities in a meaningful way, is described. This includes the relevant primary standards, the way international equivalence of national standards is demonstrated and the routes by which the standards are disseminated to the user community. Emerging measurement techniques that may in future lead to improved measurement capability, are also briefly discussed.

Medical and non-medical protection standards for ultrasound and infrasound

Protection from inappropriate or hazardous exposure to ultrasound is controlled through international standards and national regulations. IEC standard 60601 part 1 establishes requirements for the mechanical, electrical, chemical and thermal safety for all electro-medical equipment. The associated part 2 standard for diagnostic medical ultrasonic equipment sets no upper limits on ultrasonic exposure. Instead, safety indices are defined that are intended to advise users on the degree of thermal and mechanical hazard. At present the display of these safety indices satisfies regulatory requirements in both the USA and Europe. Nevertheless there are reservations about the effectiveness of this approach to protection management. In the USA, there are national regulatory limits on diagnostic exposure, based on acoustic output from clinical equipment in use over 20 years ago. The IEC 60601 part 2 standard for therapeutic equipment sets 3 W cm(-2) as the limit on acoustic intensity. Transducer surface temperature is controlled for both diagnostic and therapy devices. For airborne ultrasound, interim guidelines on limits of human exposure published by the IRPA are now 2 decades old. A limit on sound pressure level of 100 dB for the general population is recommended. The absence of protection standards for infrasound relates to difficulties in measurement at these low frequencies.

Progress in medical ultrasound exposimetry

Biomedical applications of ultrasound have experienced tremendous growth over the past 50 years. Early work in thermal therapy and surgery soon was followed by diagnostic imaging and Doppler. Because patient safety was an important issue from the beginning, the study of methods for measuring exposure levels, and their relationship to possible biological effects, paralleled the growth of the various therapeutic and diagnostic techniques. The diverse conditions of use have presented a range of exposure measurement challenges, and the sensors and techniques used to evaluate ultrasound fields have had to evolve as new or expanded clinical applications have emerged. In this paper some of the more notable of these developments are presented and discussed. Topics covered include devices and techniques, methods of calibration, progress in standardization, and current problem areas, including the effects of nonlinear propagation. Some early methods are described, but emphasis is given to more recent work applicable to present and future uses of ultrasound in medicine and biology.

Thermal assessment of 40-MHz pulsed Doppler ultrasound in human eye

Tissue exposure to diagnostic pulsed Doppler ultrasound (US) can cause significant temperature rises. Temperature rise induced by US biomicroscopy (UBM) system (VS40, VisualSonics, Toronto, ON, Canada) was measured in ex vivo human and rabbit eyes with a 26-gauge K-type needle thermocouple. The operating frequency was 40 MHz with a free field I(SPTA) of 2.6 mW/cm(2) (B-mode) and 11.9 W/cm(2) (Doppler). Peak negative pressures were 5.22 MPa (B-mode) and 7.32 MPa (Doppler), resulting in MIs of 0.83 (B-mode) and 1.05 (Doppler mode). In Doppler mode, mean temperature rises of 2.27 degrees C and 1.93 degrees C were measured for the human lens and ciliary body after a 3-min insonation, vs. 2.66 degrees C for the rabbit lens. Our results indicate that US-induced temperature rise decreases with decreasing number of cycles, decreasing pulse-repetition frequency (PRF) or increased transmit attenuation, and is consistent with simple models of heating. To limit risk of temperature rises of 1 degrees C in human ciliary body, use of the maximum settings of 16 cycles (0.400 micros pulse duration), 20-kHz PRF should include 3-dB transmit attenuation, and exposure time should be limited. For insonation of the lens, exposure settings no higher than nine cycles (0.225-micros pulse duration) and 10-kHz PRF should be employed and exposure time limited to minimize risk of temperature increases of 1 degree C.

Thermal assessment of 40-MHz ultrasound at soft tissue-bone interfaces

Tissue exposure to diagnostic ultrasound (US) can cause significant temperature rises. However, little has been reported on thermal effects of high-frequency US, and guidelines for the use of US do not necessarily apply to higher frequencies. Temperature rise induced by US biomicroscopy (UBM) was measured in phantoms containing mouse skulls and in anesthetized mice and mice post mortem, with a 50-microm K-type thermocouple. The operating frequency was 40 MHz with a free field I(SPTA) of 2.6 mW/cm(2) (B-mode) and 11.9 W/cm(2) (Doppler). Peak negative pressures were 5.22 MPa (B mode) and 7.32 MPa (Doppler), resulting in a mechanical index (MI) of 0.83 (B-mode) and 1.05 (Doppler mode). In Doppler mode, mean temperature rises of 1.80 degrees C and 1.73 degrees C were measured for proximal and distal skull phantom surfaces after a 3-min insonation. In vivo, the proximal mouse skull surface showed a mean temperature rise of 2.1 degrees C, with no statistically significant differences post mortem. Our results indicate temperature rise from insonation of bone interfaces using similar exposure parameters should not cause adverse bioeffects.

Thermal contribution of compact bone to intervening tissue-like media exposed to planar ultrasound

The presence of bone in the ultrasound beam path raises concerns, both in diagnostic and therapeutic applications, because significant temperature elevations may be induced at nearby soft tissue-bone interfaces due the facts that ultrasound is (i) highly absorbed in bone and (ii) reflected at soft tissue-bone interfaces in various degrees depending on angle of incidence. Consequently, in ultrasonic thermal therapy, the presence of bone in the ultrasound beam path is considered a major disadvantage and it is usually avoided. However, based on clinical experience and previous theoretical studies, we hypothesized that the presence of bone in superficial unfocused ultrasound hyperthermia can actually be exploited to induce more uniform and enhanced (with respect to the no-bone situation) temperature distributions in superficial target volumes. In particular, we hypothesize that the presence of underlying bone in superficial target volume enhances temperature elevation not only by additional direct power deposition from acoustic reflection, but also from thermal diffusion from the underlying bone. Here we report laboratory results that corroborate previous computational studies and strengthen the above-stated hypothesis. Three different temperature measurement techniques, namely, thermometric (using fibre-optic temperature probes), thermographic (using an infrared camera) and magnetic resonance imaging (using proton resonance frequency shifts), were used in high-power short-exposure, and in low-power extended-exposure, experiments using a 19 mm diameter planar transducer operating at 1.0 and 3.3 MHz (frequencies of clinical relevance). The measurements were performed on three technique-specific phantoms (with and without bone inclusions) and experimental set-ups that resembled possible superficial ultrasound hyperthermia clinical situations. Results from all three techniques were in general agreement and clearly showed that significantly higher heating rates (greater than fourfold) were induced in soft tissue-like phantom materials adjacent (within approximately 5 mm) to a bovine bone as compared to similar experiments without bone inclusions. For low-power long-exposure experiments, where thermal conduction effects are significant, the thermal impact of bone reached at distances > 10 mm from the bone surface (upstream of the bone). Therefore, we hypothesize that underlying bone exposed to planar ultrasound hyperthermia creates a high-temperature thermal boundary at depth that compensates for beam attenuation, thus producing more uniform temperature distribution in the intervening tissue layers. With appropriate technology, this finding may lead to improved thermal doses in superficial treatment sites such as the chest wall and the head/neck.

Heating caused by selected pulsed Doppler and physiotherapy ultrasound beams measured using thermal test objects

OBJECTIVE

To assess the heating caused by selected pulsed Doppler and physiotherapy ultrasound beams by measurements made using thermal test objects.

METHOD

Thermal test objects were used to measure temperature rises in selected ultrasound fields. These were compared with theoretical predictions based on standard exposure measurements. A separate thermocouple was used to measure heating at the transducer surface.

RESULTS

Temperature rises of up to 6 degrees C were measured for Doppler fields using a thermal test object. The attenuation-corrected temperature rises that were measured generally agreed with calculated Thermal Indices. Temperature rises of up to 2 degrees C were observed for physiotherapy ultrasound fields in pulsed operation.

CONCLUSION

Significant overlap between the measured temperature rises of selected pulsed Doppler and physiotherapy ultrasound fields was observed.