Dynamic three-dimensional freehand echocardiography using raw digital ultrasound data

A VS ultrasound diagnostic system with kidney image evaluation functions

PURPOSE

An inevitable feature of ultrasound-based diagnoses is that the quality of the ultrasound images produced depends directly on the skill of the physician operating the probe. This is because physicians have to constantly adjust the probe position to obtain a cross section of the target organ, which is constantly shifting due to patient respiratory motions. Therefore, we developed an ultrasound diagnostic robot that works in cooperation with a visual servo system based on deep learning that will help alleviate the burdens imposed on physicians.

METHODS

Our newly developed robotic ultrasound diagnostic system consists of three robots: an organ tracking robot (OTR), a robotic bed, and a robotic supporting arm. Additionally, we used different image processing methods (YOLOv5s and BiSeNet V2) to detect the target kidney location, as well as to evaluate the appropriateness of the obtained ultrasound images (ResNet 50). Ultimately, the image processing results are transmitted to the OTR for use as motion commands.

RESULTS

In our experiments, the highest effective tracking rate (0.749) was obtained by YOLOv5s with Kalman filtering, while the effective tracking rate was improved by about 37% in comparison with cases without such filtering. Additionally, the appropriateness probability of the ultrasound images obtained during the tracking process was also the highest and most stable. The second highest tracking efficiency value (0.694) was obtained by BiSeNet V2 with Kalman filtering and was a 75% improvement over the case without such filtering.

CONCLUSION

While the most efficient tracking achieved is based on the combination of YOLOv5s and Kalman filtering, the combination of BiSeNet V2 and Kalman filtering was capable of detecting the kidney center of gravity closer to the kidney's actual motion state. Furthermore, this model could also measure the cross-sectional area, maximum diameter, and other detailed information of the target kidney, which meant it is more practical for use in actual diagnoses.

Transcatheter treatment for tricuspid valve disease

Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.

Freehand 3-D Ultrasound Imaging: A Systematic Review

Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.

3D ultrasound reconstruction algorithms from analog and digital data

Freehand 3D ultrasound is increasingly being introduced in the clinic for diagnostics and image-assisted interventions. Various algorithms exist for combining 2D images of regular ultrasound probes to 3D volumes, being either voxel-, pixel- or function-based. Previously, the most commonly used input to 3D ultrasound reconstruction has been digitized analog video. However, recent scanners that offer access to digital image frames exist, either as processed or unprocessed data. To our knowledge, no comparison has been performed to determine which data source gives the best reconstruction quality. In the present study we compared both reconstruction algorithms and data sources using novel comparison methods for detecting potential differences in image quality of the reconstructed volumes. The ultrasound scanner used in this study was the Sonix RP from Ultrasonix Medical Corp (Richmond, Canada), a scanner that allow third party access to unprocessed and processed digital data. The ultrasound probe used was the L14-5/38 linear probe. The assessment is based on a number of image criteria: detectability of wire targets, spatial resolution, detectability of small barely visible structures, subjective tissue image quality, and volume geometry. In addition we have also performed the more "traditional" comparison of reconstructed volumes by removing a percentage of the input data. By using these evaluation methods and data from the specific scanner, the results showed that the processed video performed better than the digital scan-line data, digital video being better than analog video. Furthermore, the results showed that the choice of video source was more important than the choice of tested reconstruction algorithms.

3-D ultrasound volume reconstruction using the direct frame interpolation method

A new method for 3-D ultrasound volume reconstruction using tracked freehand 3-D ultrasound is proposed. The method is based on solving the forward volume reconstruction problem using direct interpolation of high-resolution ultrasound B-mode image frames. A series of ultrasound B-mode image frames (an image series) is acquired using the freehand scanning technique and position sensing via optical tracking equipment. The proposed algorithm creates additional intermediate image frames by directly interpolating between two or more adjacent image frames of the original image series. The target volume is filled using the original frames in combination with the additionally constructed frames. Compared with conventional volume reconstruction methods, no additional filling of empty voxels or holes within the volume is required, because the whole extent of the volume is defined by the arrangement of the original and the additionally constructed B-mode image frames. The proposed direct frame interpolation (DFI) method was tested on two different data sets acquired while scanning the head and neck region of different patients. The first data set consisted of eight B-mode 2-D frame sets acquired under optimal laboratory conditions. The second data set consisted of 73 image series acquired during a clinical study. Sample volumes were reconstructed for all 81 image series using the proposed DFI method with four different interpolation orders, as well as with the pixel nearest-neighbor method using three different interpolation neighborhoods. In addition, volumes based on a reduced number of image frames were reconstructed for comparison of the different methods' accuracy and robustness in reconstructing image data that lies between the original image frames. The DFI method is based on a forward approach making use of a priori information about the position and shape of the B-mode image frames (e.g., masking information) to optimize the reconstruction procedure and to reduce computation times and memory requirements. The method is straightforward, independent of additional input or parameters, and uses the high-resolution B-mode image frames instead of usually lower-resolution voxel information for interpolation. The DFI method can be considered as a valuable alternative to conventional 3-D ultrasound reconstruction methods based on pixel or voxel nearest-neighbor approaches, offering better quality and competitive reconstruction time.

Real-time visualized freehand 3D ultrasound reconstruction based on GPU

Visualized freehand 3-D ultrasound reconstruction offers to image incremental reconstruction during acquisition and guide users to scan interactively for high-quality volumes. We originally used the graphics processing unit (GPU) to develop a visualized reconstruction algorithm that achieves real-time level. Each newly acquired image was transferred to the memory of the GPU and inserted into the reconstruction volume on the GPU. The partially reconstructed volume was then rendered using GPU-based incremental ray casting. After visualized reconstruction, hole-filling was performed on the GPU to fill remaining empty voxels in the reconstruction volume. We examine the real-time nature of the algorithm using in vitro and in vivo datasets. The algorithm can image incremental reconstruction at speed of 26-58 frames/s and complete 3-D imaging in the acquisition time for the conventional freehand 3-D ultrasound.

High-resolution real-time three-dimensional acoustic imaging system with a reflector

PURPOSE

We propose an acoustic real-time three-dimensional (3-D) diagnostic imaging system based on a hybrid array-reflector configuration that realizes high time and spatial resolutions with a modest computational load.

METHODS

All the elements on a small dense array were excited with proper time delays to transmit a broad beam similar to that of a single transmitter element. The echo was gathered by a concave reflector and received by the dense array. The image of the target was reconstructed by numerical back projection from the defocused image distributed on the array. With this scheme, images of the whole measurement area can be reconstructed from a single transmit and receive event.

RESULTS

The number of elements can be reduced to about 1/8.2 that of a dense 2-D array of a digital beamforming system having the same spatial resolution. By weighting individual elements, the sidelobe level could be suppressed to less than -21 dB. The maximum theoretical frame rate is 5000 3-D images/s. This method has a higher signal-to-noise ratio than that of defocused multi-element digital beamforming methods, overcoming conventional phased array performance.

CONCLUSION

The proposed scheme is suited for purposes that require high time and spatial resolutions, such as cardiology.

Freehand 3D ultrasound reconstruction algorithms--a review

Three-dimensional (3D) ultrasound (US) is increasingly being introduced in the clinic, both for diagnostics and image guidance. Although dedicated 3D US probes exist, 3D US can also be acquired with the still frequently used two-dimensional (2D) US probes. Obtaining 3D volumes with 2D US probes is a two-step process. First, a positioning sensor must be attached to the probe; second, a reconstruction of a 3D volume can be performed into a regular voxel grid. Various algorithms have been used for performing 3D reconstruction based on 2D images. Up till now, a complete overview of the algorithms, the way they work and their benefits and drawbacks due to various applications has been missing. The lack of an overview is made clear by confusions about algorithm and group names in the existing literature. This article is a review aimed at explaining and categorizing the various algorithms into groups, according to algorithm implementation. The algorithms are compared based on published data and our own laboratory results. Positive and practical uses of the various algorithms for different applications are discussed, with a focus on image guidance.

Volume stitching in three-dimensional echocardiography: distortion analysis and extension to real time

Three-dimensional (3D) echocardiography is challenging due to limitation of the data acquisition rate caused by the speed of sound. ECG-gated stitching of data from several cardiac cycles is a possible technique to achieve higher resolution. The aim of this work is two-fold: it is, firstly, to provide a method for real-time presentation of stitched echocardiographic images acquired over several cardiac cycles and, secondly, to demonstrate that the geometrical distortion of the images is decreased when stitching is applied to 3D ultrasonic data of the left ventricle (LV). We present a volume stitching algorithm that merges data from N consecutive heart cycles into an assembled data volume. The assembly is performed in real time, making immediate volume rendering of the full volume possible. In-vivo images acquired with this technique are presented. Through simulations with a kinematic model of the LV wall, geometrical distortion and volume estimation errors due to long image capture time was quantified for 3D recordings of the LV. Curves showing the variation throughout the cardiac cycle of the maximal geometrical distortion in the LV walls are presented, as well as curves showing the volume estimates compared with the true LV volume of the model. We conclude that real-time display of stitched 3D ultrasound data is feasible and that it is an adequate technique for increasing the volume acquisition rate at a given spatial resolution. Furthermore, the geometrical distortion decreases substantially for data with higher volume rate and, for a full scan of the LV, stitching over at least four cycles is recommended.

Temporal calibration of freehand three-dimensional ultrasound using image alignment

All freehand 3-D ultrasound systems have some latency between the acquisition of an image and its associated position. Previously, estimation of latency has been made by tracking a phantom in a sequence of images and correlating its motion to that recorded by the position sensor. However, tracking-based temporal calibration uses the assumption that latency is constant between scans. This paper presents a new method for temporal calibration that avoids this assumption. Temporal calibration is performed on the scan data by finding the latency at which the best alignment of the 2-D images within the reconstructed volume occurs. The mean voxel intensity variance is used as a global measure of the quality of alignment within the volume and is minimized with respect to latency for each scan. The new method is compared with previous methods using an ultrasound phantom. Finally, integration of temporal calibration with existing spatial calibration methods is discussed.

A review of calibration techniques for freehand 3-D ultrasound systems

Three-dimensional (3-D) ultrasound (US) is an emerging new technology with numerous clinical applications. Ultrasound probe calibration is an obligatory step to build 3-D volumes from 2-D images acquired in a freehand US system. The role of calibration is to find the mathematical transformation that converts the 2-D coordinates of pixels in the US image into 3-D coordinates in the frame of reference of a position sensor attached to the US probe. This article is a comprehensive review of what has been published in the field of US probe calibration for 3-D US. The article covers the topics of tracking technologies, US image acquisition, phantom design, speed of sound issues, feature extraction, least-squares minimization, temporal calibration, calibration evaluation techniques and phantom comparisons. The calibration phantoms and methods have also been classified in tables to give a better overview of the existing methods.

A review of calibration techniques for freehand 3-D ultrasound systems

Three-dimensional (3-D) ultrasound (US) is an emerging new technology with numerous clinical applications. Ultrasound probe calibration is an obligatory step to build 3-D volumes from 2-D images acquired in a freehand US system. The role of calibration is to find the mathematical transformation that converts the 2-D coordinates of pixels in the US image into 3-D coordinates in the frame of reference of a position sensor attached to the US probe. This article is a comprehensive review of what has been published in the field of US probe calibration for 3-D US. The article covers the topics of tracking technologies, US image acquisition, phantom design, speed of sound issues, feature extraction, least-squares minimization, temporal calibration, calibration evaluation techniques and phantom comparisons. The calibration phantoms and methods have also been classified in tables to give a better overview of the existing methods.

Tissue Doppler gated (TDOG) dynamic three-dimensional ultrasound imaging of the fetal heart

Dynamic three-dimensional (3D) ultrasound imaging of the fetal heart is difficult due to the absence of an electrocardiogram (ECG) signal for synchronization between loops. In this study we introduce tissue Doppler gating (TDOG), a technique in which tissue Doppler data are used to calculate a gating signal. We have applied this cardiac gating method to dynamic 3D reconstructions of the heart of eight fetuses aged 20-24 weeks. The gating signal was derived from the amplitude and frequency contents of the tissue Doppler signal. We used this signal as a replacement for ECG in a 3D-volume reconstruction and visualization, utilizing techniques established in ECG-gated 3D echocardiography. The reliability of the TDOG signal for fetal cardiac cycle detection was experimentally investigated. Simultaneous recordings of tissue Doppler of the heart and continuous wave (CW) spectral Doppler of the umbilical artery (UA) were performed using two independent ultrasound systems, and the TDOG signal from one system was compared to the Doppler spectrum data from the other system. Each recording consisted of a two-dimensional (2D) sector scan, transabdominally and slowly tilted by the operator, covering the fetal heart over approximately 40 cardiac cycles. The total angle of the sweep was estimated by recording a separate loop through the center of the heart, in the elevation direction of the sweep.3D reconstruction and visualization were performed with the EchoPAC-3D software (GE Medical Systems). The 3D data were visualized by showing simultaneous cineloops of three 2D slices, as well as by volume projections running in cineloop. Synchronization of B-mode cineloops with the TDOG signal proved to be sufficiently accurate for reconstruction of high-quality dynamic 3D data. We show one example of a B-mode recording with a frame rate of 96 frames/s over 20 seconds. The reconstruction consists of 31 volumes, each with 49 tilted frames. With the fetal heart positioned 5-8 cm from the transducer, the sampling distances were approximately 0.15 mm in the beam direction, 0.33 degrees approximately 0.37 mm azimuth and 0.45 degrees approximately 0.51 mm elevation. From this single dataset we were able to generate a complete set of classical 2D views (such as four-chamber, three-vessel and short-axis views as well as those of the ascending aorta, aortic and ductal arches and inferior and superior venae cavae) with high image quality adequate for clinical use.

Probe calibration for freehand 3-D ultrasound

Ultrasound (US) probe calibration establishes the rigid body transformation between the US image and a tracking device attached to the probe. This is an important requirement for correct 3-D reconstruction of freehand US images and, thus, for accurate surgical navigation based on US. In this study, we evaluated three methods for probe calibration, based on a single-point phantom, a wire-cross phantom requiring 2-D alignment and a wire phantom for freehand scanning. The processing of acquired data is fairly common to these methods and, to a great extent, based on automated procedures. The evaluation is based on quality measures in 2-D and 3-D reconstructed data. With each of the three methods, we calibrated a linear-array probe, a phased-array sector probe and an intraoperative probe. The freehand method performed best, with a 3-D navigation accuracy of 0.6 mm for one of the probes. This indicates that clinical accuracy in the order of 1 mm may be achieved in US-based surgical navigation.

In vivo analysis of aortic valve dynamics by transesophageal 3-dimensional echocardiography with high temporal resolution

OBJECTIVES

Knowledge of aortic valve function has been obtained from experimental studies. The aim of the present study was to investigate characteristics of aortic valve motion in humans.

METHODS

Fifty-six patients were studied: 19 with normal valve and good systolic left ventricular function (Group NL), 12 with normal valve and reduced left ventricular function (Group CMP), and 25 with aortic stenosis and good left ventricular function (Group AS). The frame rate was doubled (50 Hz) compared with previous 3-dimensional systems. A mean of 38 +/- 9 images were acquired per cardiac cycle, with 14 +/- 4 images during the systole. The changes in shape and orifice area were analyzed over time.

RESULTS

With normal valves, valve movement proceeded in 3 phases: rapid opening, slow closing, rapid closing. Stenotic valves showed a slower opening and closing movement. The times to maximum opening in Groups NL, CMP, AS were 76 +/- 30, 88 +/- 18 (P =.06), and 130 +/- 29 (P <.01) ms, respectively. It was inversely correlated to the maximum orifice area (r = -0.59, P <.001). The opening velocities in Groups NL, CMP, AS were 42 +/- 23, 28 +/- 9 (P <.05), and 5 +/- 2 (P <.001) cm(2)/s, respectively. There was a close correlation between the opening velocity and the maximum orifice area (r = 0.87, P <.001). Slow valve closings occurred at a velocity of 8.0 +/- 5.2, 5.3 +/- 2.0 (P =.21), 2.8 +/- 1.1 (P <.01) cm(2)/s, respectively, and rapid closings in Groups NL and CMP at 50 +/- 23, 29 +/- 8 (P <.01) cm(2)/s. The results show good agreement with experimental data.

CONCLUSION

Rapid aortic valve movement can be recorded by 3-dimensional echocardiography and analyzed quantitatively. Time and velocity indices of valve dynamics are influenced by valvular and myocardial factors. A comparable in vivo analysis is not possible with any other imaging procedure.

High-definition freehand 3-D ultrasound

This paper describes a high-definition freehand 3-D ultrasound (US) system, with accuracy surpassing that of previously documented systems. 3-D point location accuracy within a US data set can be achieved to within 0.5 mm. Such accuracy is possible through a series of novel system-design and calibration techniques. The accuracy is quantified using a purpose-built tissue-mimicking phantom, designed to create realistic clinical conditions without compromising the accuracy of the measurement procedure. The paper includes a thorough discussion of the various ways of measuring system accuracy and their relative merits; and compares, in this context, all recently documented freehand 3-D US systems.

Quantification of left ventricular volumes and ejection fraction using freehand transthoracic three-dimensional echocardiography: comparison with magnetic resonance imaging

OBJECTIVES

Our aim was to validate 3-dimensional echocardiography (3DE) for assessment of left ventricular (LV) end-diastolic volume, end-systolic volume (ESV), stroke volume, and ejection fraction (EF) using the freehand-acquisition method. Furthermore, LV volumes by breath hold-versus free breathing-3DE acquisition were assessed and compared with magnetic resonance imaging (MRI).

METHODS

From the apical position, a fan-like 3DE image was acquired during free breathing and another, thereafter, during breath hold. In 27 patients, 28 breath hold- and 24 free breathing-3DE images were acquired. A total of 17 patients underwent both MRI and 3DE. MRI contours were traced along the outer endocardial contour, including trabeculae, and along the inner endocardial contour, excluding trabeculae, from the LV volume.

RESULTS

All 28 (100%) breath hold- and 86% of free breathing-3DE acquisitions could be analyzed. Intraobserver variation (percentual bias +/- 2 SD) of end-diastolic volume, ESV, stroke volume, and EF for breath-hold 3DE was, respectively, 0.3 +/- 10.2%, 0.3 +/- 14.6%, 0.1 +/- 18.4%, and -0.1 +/- 5.8%. For free-breathing 3DE, findings were similar. A significantly better interobserver variability, however, was observed for breath-hold 3DE for ESV and EF. Comparison of breath-hold 3DE with MRI inner contour showed for end-diastolic volume, ESV, stroke volume, and EF, a percentual bias (+/- 2 SD) of, respectively, -13.5 +/- 26.9%, -17.7 +/- 47.8%, -10.6 +/- 43.6%, and -1.8 +/- 11.6%. Compared with the MRI outer contour, a significantly greater difference was observed, except for EF.

CONCLUSIONS

3DE using the freehand method is fast and highly reproducible for (serial) LV volume and EF measurement, and, hence, ideally suited for clinical decision making and trials. Breath-hold 3DE is superior to free-breathing 3DE regarding image quality and reproducibility. Compared with MRI, 3DE underestimates LV volumes, but not EF, which is mainly explained by differences in endocardial contour tracing by MRI (outer contour) and 3DE (inner contour) of the trabecularized endocardium. Underestimation is reduced when breath-hold 3DE is compared with inner contour analysis of the MRI dataset.

Rapid freehand scanning three-dimensional echocardiography: accurate measurement of left ventricular volumes and ejection fraction compared with quantitative gated scintigraphy

This study was performed to assess clinical feasibility of rapid freehand scanning 3-dimensional echocardiography (3DE) for measuring left ventricular (LV) end-diastolic and -systolic volumes and ejection fraction using quantitative gated myocardial perfusion single photon emission computed tomography as the reference standard. We performed transthoracic 2-dimensional echocardiography and magnetic freehand 3DE using a harmonic imaging system in 15 patients. Data sets (3DE) were collected by slowly tilting the probe (fan-like scanning) in the apical position. The 3DE data were recorded in 10 to 20 seconds, and the analysis was performed within 2 minutes after transferring the raw digital ultrasound data from the scanner. For LV end-diastolic and -systolic volume measurements, there was a high correlation and good agreement (LV end-diastolic volume, r = 0.94, P <.0001, standard error of the estimates = 21.6 mL, bias = 6.7 mL; LV end-systolic volume, r = 0.96, P <.0001, standard error of the estimates = 14.8 mL, bias = 3.9 mL) between gated single photon emission computed tomography and 3DE. There was an overall underestimation of volumes with greater limits of agreement by 2-dimensional echocardiography. For LV ejection fraction, regression and agreement analysis also demonstrated high precision and accuracy (y = 0.82x + 5.1, r = 0.93, P <.001, standard error of the estimates = 7.6%, bias = 4.0%) by 3DE compared with 2-dimensional echocardiography. Rapid 3DE using a magnetic-field system provides precise and accurate measurements of LV volumes and ejection fraction in human beings

Three-dimensional echocardiographic determination of cardiac output at rest and under dobutamine stress: comparison with thermodilution measurements in the ischemic pig model

Determination of cardiac output is a potentially important clinical application of three-dimensional (3-D) echocardiography since it could replace invasive measurements with the Swan-Ganz-catheter. To date, there are no studies available to determine whether cardiac output measured by thermodilution can be predicted reliably under changing hemodynamic conditions. Fifteen pigs with ischemic myocardium were examined under four hemodynamic conditions at rest and under pharmacological stress with 5, 10, and 20 microg/kg/min dobutamine. The 3-D datasets were recorded by means of transesophageal echocardiography. The endocardial definition was enhanced by administering the contrast agent FS069 (Optison). Cardiac output was calculated as the product of stroke volume (end-diastolic - end-systolic volume) and heart rate. The invasive measurements were performed with a continuous thermodilution system. In general, there was moderate correlation between 3-D echocardiography and thermodilution(r = 0.72, P < 0.001). At rest, the 3-D echocardiographic measurements were slightly but significantly lower than the invasive measurements (mean difference 0.6 +/- 0.5L/min,P < 0.001). Under stress with 5, 10, and 20 microg/kg/min dobutamine, there was a marked increase in the deviation (1.3 +/- 0.5L/min,P < 0.001; 1.6 +/- 0.7 L/min,P < 0.001; and 2.1 +/- 1.1L/min,P < 0.001, respectively). The deviation was based on two factors: (1). Under stress, the decreasing number of frames per cardiac cycle acquired with 3-D echocardiography led to imprecise recording of end-diastolic and end-systolic volumes, and thus to an underestimation of cardiac output. At least 30 frames per cardiac cycle are needed to eliminate this effect. (2). There is a systematic difference between 3-D echocardiographic and invasive measurements, which is independent of the imaging rate. This is based on an overestimation of the true values by thermodilution. In conclusion, cardiac output can be determined correctly by 3-D echocardiography for normal heart rates at rest. At elevated heart rates, the temporal resolution of 3-D systems currently available is not adequate for reliable determination. In performing and evaluating future clinical comparative studies, the systematic difference between 3-D echocardiography and thermodilution, based on overestimation by thermodilution, must be taken into account.

A high frequency amplitude-steered array for real-time volumetric imaging

Real-time three-dimensional acoustic imaging is difficult in water or tissue because of the slow speed of sound in these media. Conventional pulse-echo data collection, which uses at least one transmit pulse per line in the image, does not allow for the real-time update of a volume of data at practical ranges. Recently, a linear amplitude-steered array was presented that allows the collection of a plane of data with a single transmit pulse by spatially separating frequencies in the lateral direction. Later, by using a linear array with frequency separation in the vertical direction and rotating the array in the horizontal direction, volumetric data were collected with a small number of transmit pulses. By expanding the linear array to a two-dimensional array, data can now be collected for volumetric imaging in real time. In this study, the amplitude-steered array at the heart of a real-time volumetric sonar imaging system is described, giving the design of the array and describing how data are collected and processed to form images. An analysis of lateral resolution in the vertical and horizontal directions shows that resolution is improved in the direction of frequency separation over systems that use a broad transmit beam. Images from simulated data are presented.

Approach to 3-d ultrasound high resolution imaging for mechanically moving large-aperture transducer based upon Fourier transform

A new three-dimensional (3-D) acoustic image formation technique is proposed that is based on the transmission of wide bandwidth pulse signals and the application of the 3-D fast Fourier transform. A solution to the Helmholz wave equation has been obtained using the Born approximation. The solution contains analytical expressions for the spatial spectra of the transmit and receive radiation patterns for transducers of various geometries with lenses of fixed focal distances. It has been shown that the proposed algorithms allow for radiation patterns with constant widths at depths both behind and in front of the focal point, starting practically from the plane of the transducer. The theoretical and experimental investigations and computer simulation for both spherical and rectangular transducer shapes have been performed. The results were used to estimate the beamwidths and the side lobe levels. A variant of the linear array has been studied for cylindrical lens of a fixed focal distance moving in a lateral direction. It has been shown that, in this case, a high resolution (of the order of a few wavelengths) can be achieved along all three Cartesian coordinates at a very high scanning velocity. The influence of the moving scatterers' velocity in inhomogeneous medium on the spatial radiation pattern characteristics has been estimated.

Blood flow velocity profiles in the aortic annulus: a 3-dimensional freehand color flow Doppler imaging study

BACKGROUND

The use of a single sample volume in Doppler measurements of the velocity time integral (VTI) in the aortic annulus may introduce errors in calculations of stroke volumes, shunts, regurgitant fractions, and aortic valve area. To study the blood flow velocity distribution and assess this potential error, we used a dynamic 3-dimensional color flow Doppler imaging method.

METHODS AND RESULTS

Seventeen healthy volunteers were studied. The ultrasound data were captured from 10 to 20 heartbeats at a high frame rate (mean 57 frames per second) while freely tilting the transducer in the apical position. A magnetic position-sensor system recorded the spatial position and orientation of the probe. The raw digital ultrasound data were analyzed off-line with no loss of temporal resolution. Blood flow velocities were integrated across a spherical surface that tracked the aortic annulus during systole. The ratios of the systolic maximum to the systolic mean VTI ranged from 1.2 to 1.5 (mean 1.4). At the time of systolic peak flow, the ratios of the maximum to the mean velocity ranged from 1.1 to 2.0 (mean 1.5). The location of the maximum velocities and VTI showed individual variation.

CONCLUSION

The blood flow velocity profile was nonuniform. By using a single sample volume in Doppler measurements of the VTI in the aortic annulus, errors ranging from 20% to 50% may be introduced in calculations of stroke volumes.

Mutual information-based rigid and nonrigid registration of ultrasound volumes

We investigated the registration of ultrasound volumes based on the mutual information measure, a technique originally applied to multimodality registration of brain images. A prerequisite for successful registration is a smooth, quasi-convex mutual information surface with an unambiguous maximum. We discuss the necessary preprocessing to create such a surface for ultrasound volumes. Abdominal and thoracic organs imaged with ultrasound typically move relative to the exterior of the body and are deformable. Consequently, four specific instances of image registration involving progressively generalized transformations were studied: rigid-body, rigid-body + uniform scaling, rigid-body + nonuniform scaling, and affine. Registration was applied to clinically acquired volumetric images. The accuracy was comparable with the voxel dimension for all transformation modes, although it degraded as the transformation grew more complex. Likewise, the capture range became narrower with the complexity of transformation. As the use of real-time three-dimensional ultrasound becomes more prevalent, the method we present should work well for a variety of applications examining serial anatomic and physiologic changes. Developers of these clinical applications would match the deformation model of their problem to one of the four transformation models presented here.

Beam calibration without a phantom for creating a 3-D freehand ultrasound system

To create a freehand three-dimensional (3-D) ultrasound (US) system for image-guided surgical procedures, an US beam calibration process must be performed. The calibration method presented in this work does not use a phantom to define in 3-D space the pixel locations in the beam. Rather, the described method is based on the spatial relationship between an optically tracked pointer and a similarly tracked US transducer. The pointer tip was placed into the US beam, and US images, physical coordinates of the pointer and the transducer location were simultaneously recorded. US image coordinates of the pointer were mapped to the physical points using two different registration methods. Two sensitivity studies were performed to determine the location and number of points needed to calibrate the beam accurately. Results showed that the beam is most efficiently calibrated with approximately 20 points collected from throughout the beam. This method of beam calibration proved to be highly accurate, yielding registration errors of approximately 0.4 mm.

In vitro simulation and quantification of temporal jitter artifacts in ECG-gated dynamic three-dimensional echocardiography

The image quality of dynamic 3-D echocardiography is limited by temporal jitter artifacts that result from the asynchronous acquisition of video frames with the cardiac cycle. This paper analyzes the source and extent of these artifacts using in vitro studies. Dynamic 3-D images of a myocardial motion phantom were reconstructed and analyzed for eight cardiac motion patterns. The extent of temporal jitter artifacts was quantified, first, from the images by computing temporal jitter maps and, second, predicted from the motion waveforms. Temporal jitter appeared as a pattern of streak artifacts converging at the axis of rotation of the imaging plane, for the rotational scanning approach used in our study. The results of the experimental analysis techniques were compared with the waveform analysis using linear regression analysis. The least squares line showed good correlation between the data (r > 0.9) and its deviation from the line of identity was calculated to be <9%.

Volumetric blood flow measurement with the use of dynamic 3-dimensional ultrasound color flow imaging

We describe a new method for measuring blood volume flow with the use of freehand dynamic 3-dimensional echocardiography. During 10 to 20 cardiac cycles, the ultrasonographic probe was slowly tilted while its spatial position was continuously recorded with a magnetic position sensor system. The ultrasonographic data were acquired in color flow imaging mode, and the separate raw digital tissue and Doppler data were transferred to an external personal computer for postprocessing. From each time step in the reconstructed 3-dimensional data, one cross-sectional slice was extracted with the measured and recorded velocity vector components perpendicular to the slice. The volume flow rate through these slices was found by integrating the velocity vector components, and was independent of the angle between the actual flow direction and the measured velocity vector. Allowing the extracted surface to move according to the movement of anatomic structures, an estimate of the flow through the cardiac valves was achieved. The temporal resolution was preserved in the 3-dimensional reconstruction, and with a frame rate of up to 104 frames/s, the reconstruction jitter artifacts were reduced. Examples of in vivo blood volume flow measurement are given, showing the possibilities of measuring the cardiac output and analyzing blood flow velocity profiles.