Contrast-enhanced imaging of SPIO-labeled platelets using magnetomotive ultrasound

A Finite Element Analysis Model for Magnetomotive Ultrasound Elastometry Magnet Design with Experimental Validation

Objective

Magnetomotive ultrasound (MMUS) using magnetic nanoparticle contrast agents has shown promise for thrombosis imaging and quantitative elastometry via magnetomotive resonant acoustic spectroscopy (MRAS). Young's modulus measurements of smaller, stiffer thrombi require an MRAS system capable of generating forces at higher temporal frequencies. Solenoids with fewer turns, and thus less inductance, could improve high frequency performance, but the reduced force may compromise results. In this work, a computational model capable of predicting improved MRAS magnet configurations optimized for elastometry is presented and validated.

Approach

Finite element analysis (FEA) was used to model the force and inductance of MRAS systems. The simulations incorporated both solenoid electromagnets and permanent magnets in three-dimensional steady-state, frequency domain, and time domain studies.

Main results

The model successfully predicted a configuration in which permanent magnets could be used to increase the force supplied by an existing MRAS system. Accordingly, the displacement measured in a magnetically labeled validation phantom increased by a factor of 2.2 ± 0.3 when the force was predicted to increase by a factor of 2.2 ± 0.2. The model additionally identified a new solenoid configuration consisting of four smaller coils capable of providing sufficient force at higher driving frequencies.

Significance

These results indicate two methods by which MRAS systems could be designed to deliver higher frequency magnetic forces without the need for experimental trial and error. Either the number of turns within each solenoid could be reduced while permanent magnets are added at precise locations, or a larger number of smaller solenoids could be used. These findings overcome a key challenge toward the goal of thrombosis elastometry via MMUS.

Pulse generators for enhanced magnetomotive ultrasound: Toward a cost-effective imaging for tissue characterization

Magnetomotive ultrasound (MMUS) stands out as a promising and effective ultrasound-based method for detecting magnetic nanoparticles (MNPs) within tissues. This innovative technique relies on the precise estimation of micrometric displacements induced by the interaction of an external magnetic field with MNPs. Pulsed MMUS has emerged as a strategic alternative to address limitations associated with harmonic excitation, such as heat generation in amplifiers and coils, frequency-dependent tissue mechanical responses, and prolonged magnetic field rise times. Despite the growing interest in MMUS, the devices conventionally employed to excite the coil are not specifically tailored to generate intense magnetic fields while minimizing interference with the transient behavior of induced displacements. To bridge this gap, our work introduces the design and fabrication of two pulse generators: one based on a capacitor-discharge circuit and the other on a resonant-inverter circuit. We evaluated the performance of these pulse generators by considering parameters such as the magnetic field generated, rise and fall times, and their ability to supply sustained current for varied pulse widths across different pulse repetition frequencies. Furthermore, we carried out a practical MMUS implementation using tissue-mimicking phantoms, demonstrating the capability of both devices to achieve magnetic fields of up to 1 T and average displacements of 25 µm within the phantom. In addition, we estimated the shear wave velocity, effective shear modulus, and their temperature-dependent variations. Our findings highlight the versatility and efficacy of the proposed pulse generators and emphasize their potential as low-cost platforms for theranostic applications, enabling the assessment of targeted entities within biological tissues.

Elastometry of clot phantoms via magnetomotive ultrasound-based resonant acoustic spectroscopy

Objective. An ultrasound-based system capable of both imaging thrombi against a dark field and performing quantitative elastometry could allow for fast and cost-effective thrombosis diagnosis, staging, and treatment monitoring. This study investigates a contrast-enhanced approach for measuring the Young’s moduli of thrombus-mimicking phantoms. Approach. Magnetomotive ultrasound (MMUS) has shown promise for lending specific contrast to thrombi by applying a temporally modulated force to magnetic nanoparticle (MNP) contrast agents and measuring resulting tissue displacements. However, quantitative elastometry has not yet been demonstrated in MMUS, largely due to difficulties inherent in measuring applied magnetic forces and MNP densities. To avoid these issues, in this work magnetomotive resonant acoustic spectroscopy (MRAS) is demonstrated for the first time in ultrasound. Main results. The resonance frequencies of gelatin thrombus-mimicking phantoms are shown to agree within one standard deviation with finite element simulations over a range of phantom sizes and Young’s moduli with less than 16% error. Then, in a proof-of-concept study, the Young’s moduli of three phantoms are measured using MRAS and are shown to agree with independent compression testing results. Significance. The MRAS results were sufficiently precise to differentiate between thrombus phantoms with clinically relevant Young’s moduli. These findings demonstrate that MRAS has potential for thrombus staging.

Modelling of magnetic microbubbles to evaluate contrast enhanced magnetomotive ultrasound in lymph nodes - a pre-clinical study

OBJECTIVES

Despite advances in MRI the detection and characterisation of lymph nodes in rectal cancer remains complex, especially when assessing the response to neoadjuvant treatment. An alternative approach is functional imaging, previously shown to aid characterisation of cancer tissues. We report proof of concept of the novel technique Contrast-Enhanced Magneto-Motive Ultrasound (CE-MMUS) to recover information relating to local perfusion and lymphatic drainage, and interrogate tissue mechanical properties through magnetically induced deformations.

METHODS

The feasibility of the proposed application was explored using a combination of experimental animal and phantom ultrasound imaging, along with finite element analysis. First, contrast-enhanced ultrasound imaging on one wild type mouse recorded lymphatic drainage of magnetic microbubbles after bolus injection. Second, tissue phantoms were imaged using MMUS to illustrate the force- and elasticity dependence of the magnetomotion. Third, the magnetomechanical interactions of a magnetic microbubble with an elastic solid were simulated using finite element software.

RESULTS

Accumulation of magnetic microbubbles in the inguinal lymph node was verified using contrast enhanced ultrasound, with peak enhancement occurring 3.7 s post-injection. The magnetic microbubble gave rise to displacements depending on force, elasticity, and bubble radius, indicating an inverse relation between displacement and the latter two.

CONCLUSION

Combining magnetic microbubbles with MMUS could harness the advantages of both techniques, to provide perfusion information, robust lymph node delineation and characterisation based on mechanical properties.

ADVANCES IN KNOWLEDGE

(a) Lymphatic drainage of magnetic microbubbles visualised using contrast-enhanced ultrasound imaging and (b) magnetomechanical interactions between such bubbles and surrounding tissue could both contribute to (c) robust detection and characterisation of lymph nodes.

Characterization of Viscoelastic Media Combining Ultrasound and Magnetic-Force Induced Vibrations on an Embedded Soft Magnetic Sphere

We report a method to locally assess the complex shear modulus of a viscoelastic medium. The proposed approach is based on the application of a magnetic force to a millimeter-sized steel sphere embedded in the medium and the subsequent monitoring of its dynamical response. A coil is used to create a magnetic field inducing the displacement of the sphere located inside a gelatin phantom. Then, a phased-array system using 3 MHz ultrasound probe operating in pulse-echo mode is used to track the displacement of the sphere. Experiments were conducted on several samples and repeated as a function of phantom temperature. The dynamic response of the sphere measured experimentally is in good agreement with Kelvin-Voigt theory. Since the magnetic force is not affected by weak diamagnetic media, our proposal results in an accurate estimation of the force acting on the inclusion. Consequently, the estimated viscoelastic parameters show excellent robustness and the elastic modulus agrees with the measurements using a quasi-static indentation method, obtaining errors below 10% in the whole temperature range. The use of the macroscopic inclusion limits the direct application of this method in a biomedical context, but it provides a robust estimation of the elastic modulus that can be used for material characterization in industrial applications.

Single Magnetic Particle Motion in Magnetomotive Ultrasound: An Analytical Model and Experimental Validation

Magnetomotive Ultrasound (MMUS) is an emerging imaging modality, in which magnetic nanoparticles (MNPs) are used as contrast agents. MNPs are driven by a time-varying magnetic force, and the resulting movement of the surrounding tissue is detected with a signal processing algorithm. However, there is currently no analytical model to quantitatively predict this magnetically-induced displacement. Toward the goal of predicting motion due to forces on the distribution of MNPs, in this work, a model originally derived from the Navier-Stokes equation for the motion of a single magnetic particle subject to a magnetic gradient force is presented and validated. Displacement amplitudes for a spatially inhomogeneous and temporally sinusoidal force were measured as a function of force amplitude and Young's modulus, and the predicted linear and inverse relationships were confirmed in gelatin phantoms, respectively, with three out of four data sets exhibiting R² ≥ 0.88 . The mean absolute uncertainty between the predicted displacement magnitude and experimental results was 14%. These findings provide a means by which the performance of MMUS systems may be predicted to verify that systems are working to theoretical limits and to compare results across laboratories.

External Power-Driven Microrobotic Swarm: From Fundamental Understanding to Imaging-Guided Delivery

Untethered micro/nanorobots have been widely investigated owing to their potential in performing various tasks in different environments. The significant progress in this emerging interdisciplinary field has benefited from the distinctive features of those tiny active agents, such as wireless actuation, navigation under feedback control, and targeted delivery of small-scale objects. In recent studies, collective behaviors of these tiny machines have received tremendous attention because swarming agents can enhance the delivery capability and adaptability in complex environments and the contrast of medical imaging, thus benefiting the imaging-guided navigation and delivery. In this review, we summarize the recent research efforts on investigating collective behaviors of external power-driven micro/nanorobots, including the fundamental understanding of swarm formation, navigation, and pattern transformation. The fundamental understanding of swarming tiny machines provides the foundation for targeted delivery. We also summarize the swarm localization using different imaging techniques, including the imaging-guided delivery in biological environments. By highlighting the critical steps from understanding the fundamental interactions during swarm control to swarm localization and imaging-guided delivery applications, we envision that the microrobotic swarm provides a promising tool for delivering agents in an active, controlled manner.

A Novel Theranostic Platform: Integration of Magnetomotive and Thermal Ultrasound Imaging With Magnetic Hyperthermia

OBJECTIVE

Nanotheranostic systems integrate therapeutic and diagnostic procedures using nanotechnology. This type of approach has enabled the development of methods for early detection and treatment of different pathologies. Magnetic hyperthermia (MH) has been proposed as an alternative or complementary method of cancer therapy. However, challenges such as delivering and localizing the magnetic nanoparticles (MNPs) within tissues and monitoring the temperature during the treatment hinder this technique to be effectively translated into a clinical routine. Therefore, in this study a theranostic platform has been proposed and examined to address two main issues, localizing MNPs and real-time temperature monitoring, for preclinical MH.

METHODS

The system integrates magnetomotive (MMUS) and thermal ultrasound imaging with MH. An ultrasound device was used to acquire MMUS images to detect MNPs, and ultrasound thermometry to monitor the temperature. This platform was designed such that a single coil generated the magnetic field for MMUS and MH. The feasibility of the system was examined using a tissue mimicking phantom containing an inclusion filled with zinc substituted magnetite NPs.

RESULTS

These MNPs were effectively used as contrast agent for MMUS and to generate heat during MH. In addition to localizing MNPs, real-time two-dimensional temperature maps were obtained with substantial concordance (ρ_c > 0.97) with invasive measurements using fiber optic thermometer. The heating rate was proportional to the displacements in MMUS (r = 0.92).

CONCLUSION

Ultrasound thermometry was successfully used to monitor the temperature during MH. In addition, it was shown that acquiring MMUS images prior to MH can qualitatively predict the temperature distribution of the MNP-laden regions.

Magnetomotive Ultrasound Imaging Systems: Basic Principles and First Applications

This review discusses magnetomotive ultrasound, which is an emerging technique that uses superparamagnetic iron oxide nanoparticles as a contrast agent. The key advantage of using nanoparticle-based contrast agents is their ability to reach extravascular targets, whereas commercial contrast agents for ultrasound comprise microbubbles confined to the blood stream. This also extends possibilities for molecular imaging, where the contrast agent is labeled with specific targeting molecules (e.g., antibodies) so that pathologic tissue may be visualized directly. The principle of action is that an external time-varying magnetic field acts to displace the nanoparticles lodged in tissue and thereby their immediate surrounding. This movement is then detected with ultrasound using frequency- or time-domain analysis of echo data. As a contrast agent already approved for magnetic resonance imaging (MRI) by the US Food and Drug Administration, there is a shorter path to clinical translation, although safety studies of magnetomotion are necessary, especially if particle design is altered to affect biodistribution or signal strength. The external modulated magnetic field may be generated by electromagnets, permanent magnets, or a combination of the two. The induced nanoparticle motion may also reveal mechanical material properties of tissue, healthy or diseased, one of several interesting potential future aspects of the technique.

Medical Imaging of Microrobots: Toward In Vivo Applications

Medical microrobots (MRs) have been demonstrated for a variety of non-invasive biomedical applications, such as tissue engineering, drug delivery, and assisted fertilization, among others. However, most of these demonstrations have been carried out in in vitro settings and under optical microscopy, being significantly different from the clinical practice. Thus, medical imaging techniques are required for localizing and tracking such tiny therapeutic machines when used in medical-relevant applications. This review aims at analyzing the state of the art of microrobots imaging by critically discussing the potentialities and limitations of the techniques employed in this field. Moreover, the physics and the working principle behind each analyzed imaging strategy, the spatiotemporal resolution, and the penetration depth are thoroughly discussed. The paper deals with the suitability of each imaging technique for tracking single or swarms of MRs and discusses the scenarios where contrast or imaging agent's inclusion is required, either to absorb, emit, or reflect a determined physical signal detected by an external system. Finally, the review highlights the existing challenges and perspective solutions which could be promising for future in vivo applications.

Modeling and Measurement of the Nonlinear Force on Nanoparticles in Magnetomotive Techniques

Magnetomotive (MM) ultrasound (US) imaging is the identification of tissue in which magnetic nanoparticle tracers are present by detecting a magnetically induced motion. Although the nanoparticles have a magnetization that depends nonlinearly on the external magnetic field, this has often been neglected, and the presence of resulting higher harmonics in the detected motion has not been reported yet. Here, the magnetization of nanoparticles in gelatin was modeled according to the Langevin theory of superparamagnetism. This nonlinear relationship has a fundamental effect on the resulting force and motion. However, the magnetic field must contain regions with a strong magnetic gradient and a low absolute magnetic field to allow the significant generation of higher harmonics in the force. To validate the model, an MM setup that has a constant magnetic gradient on one axis superimposed by a homogeneous time-varying magnetic field was used. After the magnetic characterization of the nanoparticles and calculations of the expected displacement in the setup, experiments were conducted. A laser Doppler vibrometer was used to quantify the small displacements at higher harmonics. The experimental results followed theoretical predictions. Deviations between model and experiment were attributed to a simplified mechanical modeling and temperature rise during measurements. It is concluded that in MM techniques, the nonlinear magnetization of nanoparticles must generally be considered to reconstruct quantitative parameters, to achieve optimum matching of fields and particles, or to exploit nanoparticle magnetization for tissue characterization. In addition, with the presented experimental setup, the magnetization properties of nanoparticles can be determined by MM techniques alone.

Inversion of displacement fields to quantify the magnetic particle distribution in homogeneous elastic media from magnetomotive ultrasound

Magnetomotive ultrasound (MMUS) contrasts superparamagnetic iron-oxide nanoparticles (SPIOs) that undergo submicrometer-scale displacements in response to a magnetic gradient force applied to an imaging sample. Typically, MMUS signals are defined in a way that is proportional to the medium displacement, rendering an indirect measure of the density distribution of SPIOs embedded within. Displacement-based MMUS, however, suffers from 'halo effects' that extend into regions without SPIOs due to their inherent mechanical coupling with the medium. To reduce such effects and to provide a more accurate representation of the SPIO density distribution, we propose a model-based inversion of MMUS displacement fields by reconstructing the body force distribution. Displacement fields are modelled using the static Navier-Cauchy equation for linear, homogeneous, and isotropic media, and the body force fields are, in turn, reconstructed by minimizing a regularized least-squares error functional between the modelled and the measured displacement fields. This reconstruction, when performed on displacement fields of two tissue-mimicking phantoms with cuboidal SPIO-laden inclusions, improved the range of errors in measured heights and widths of the inclusions from 54%-282% pre-inversion to-15%-20%. Likewise, the post-inversion contrast to noise ratios (CNRs) of the images were significantly larger than displacement-derived CNRs alone (p   =  0.0078, Wilcoxon signed rank test). Qualitatively, it was found that inversion ameliorates halo effects and increases overall detectability of the inclusion. These findings highlight the utility of model-based inversion as a tool for both signal processing and accurate characterization of the number density distribution of SPIOs in magnetomotive imaging.

On the Performance of Time Domain Displacement Estimators for Magnetomotive Ultrasound Imaging

In magnetomotive (MM) ultrasound (US) imaging, magnetic nanoparticles (NPs) are excited by an external magnetic field and the tracked motion of the surrounding tissue serves as a surrogate parameter for the NP concentration. MMUS procedures exhibit weak displacement contrasts due to small forces on the NPs. Consequently, precise US-based displacement estimation is crucial in terms of a sufficiently high contrast-to-noise ratio (CNR) in MMUS imaging. Conventional MMUS detection of the NPs is based on samplewise evaluation of the phase of the in-phase and quadrature (IQ) data, where a low signal-to-noise ratio (SNR) in the data leads to strong phase noise and, thus, to an increased variance of the displacement estimate. This paper examines the performance of two time-domain displacement estimators (DEs) for MMUS imaging, which differ from conventional MMUS techniques by incorporating data from an axial segment. The normalized cross correlation (NCC) estimator and a recursive Bayesian estimator, incorporating spatial information from neighboring segments, weighted by the local SNR, are adapted for the small MMUS displacement magnitudes. Numerical simulations of MM-induced, time-harmonic bulk and Gaussian-shaped displacement profiles show that the two time-domain estimators yield a reduced estimation error compared to the phase-shift-based estimator. Phantom experiments, using our recently proposed magnetic excitation setup, show a 1.9-fold and 3.4-fold increase of the CNR in the MMUS images for the NCC and Bayes estimator compared to the conventional method, while the amount of required data is reduced by a factor of 100.

Blind Source Separation-Based Motion Detector for Imaging Super-Paramagnetic Iron Oxide (SPIO) Particles in Magnetomotive Ultrasound Imaging

In magnetomotive ultrasound (MMUS) imaging, an oscillating external magnetic field displaces tissue loaded with super-paramagnetic iron oxide (SPIO) particles. The induced motion is on the nanometer scale, which makes its detection and its isolation from background motion challenging. Previously, a frequency and phase locking (FPL) algorithm was used to suppress background motion by subtracting magnetic field off ( -off) from on ( -on) data. Shortcomings to this approach include long tracking ensembles and the requirement for -off data. In this paper, a novel blind source separation-based FPL (BSS-FPL) algorithm is presented for detecting motion using a shorter ensemble length (EL) than FPL and without -off data. MMUS imaging of two phantoms containing an SPIO-laden cubical inclusion and one control phantom was performed using an open-air MMUS system. When background subtraction was used, contrast and contrast to noise ratio (CNR) were, respectively, 1.20±0.20 and 1.56±0.34 times higher in BSS-FPL as compared to FPL-derived images for EL < 3.5 s. However, contrast and CNR were similar for BSS-FPL and FPL for EL ≥ 3.5 s. When only -on data was used, contrast and CNR were 1.94 ± 0.21 and 1.56 ± 0.28 times higher, respectively, in BSS-FPL as compared to FPL-derived images for all ELs. Percent error in the estimated width and height was 39.30% ± 19.98% and 110.37% ± 6.5% for FPL and was 7.30% ± 7.6% and 16.21% ± 10.29% for BSS-FPL algorithm. This paper is an important step toward translating MMUS imaging to in vivo application, where long tracking ensembles would increase acquisition time and -off data may be misaligned with -on due to physiological motion.

Effect of Model Thrombus Volume and Elastic Modulus on Magnetomotive Ultrasound Signal Under Pulsatile Flow

Direct ultrasonic imaging of arterial and venous thrombi could aid in diagnosis and treatment planning by providing rapid and cost-effective measurements of thrombus volume and elastic modulus. Toward this end, it was demonstrated that open-air magnetomotive ultrasound (MMUS) provides specific contrast to superparamagnetic iron oxide-labeled model thrombi embedded in gelatin-based blood vessel-mimicking flow phantoms. MMUS was performed on model thrombi in the presence of pulsatile flow that mimics cardiac-induced motion found in real vasculature. The MMUS signal and contrast-to-noise ratio (CNR) were measured across a range of physiologically relevant thrombus volumes and elastic moduli. Model thrombus volumes as small as 0.5 ml were shown to be detectable (CNR > 1) over the entire range of elastic moduli tested (3.5-40 kPa). It was also found that MMUS signal and CNR are increased with increasing thrombus volume ( ) and decreasing elastic modulus ( ), while variations in pulsatile flow rate had little effect. These findings demonstrate that MMUS has promise as a direct in vivo thrombosis imaging modality for quantifying thrombus volume and stiffness.

Combined Magnetomotive ultrasound, PET/CT, and MR imaging of 68Ga-labelled superparamagnetic iron oxide nanoparticles in rat sentinel lymph nodes in vivo

Current methods for intra-surgical guidance to localize metastases at cancer surgery are based on radioactive tracers that cause logistical challenges. We propose the use of a novel ultrasound-based method, magnetomotive ultrasound (MMUS) imaging that employ a nanoparticle-based contrast agent that also may be used for pre-operative PET/MRI imaging. Since MMUS is radiation free, this eliminates the dependence between pre- and intra-operative imaging and the radiation exposure for the surgical staff. This study investigates a hypothetical clinical scenario of pre-operative PET imaging, combined with intra-operative MMUS imaging, implemented in a sentinel lymph node (SLN) rat model. At one-hour post injection of ⁶⁸Ga-labelled magnetic nanoparticles, six animals were imaged with combined PET/CT. After two or four days, the same animals were imaged with MMUS. In addition, ex-vivo MRI was used to evaluate the amount of nanoparticles in each single SLN. All SLNs were detectable by PET. Four out of six SLNs could be detected with MMUS, and for these MMUS and MRI measurements were in close agreement. The MRI measurements revealed that the two SLNs undetectable with MMUS contained the lowest nanoparticle concentrations. This study shows that MMUS can complement standard pre-operative imaging by providing bedside real-time images with high spatial resolution.

Blind Source Separation - Based Motion Detector for Sub-Micrometer, Periodic Displacement in Ultrasonic Imaging

Sub-micrometer, periodic motion detection using blind source separation (BSS) via principal component analysis (PCA) is presented in the context of magnetomotive ultrasound (MMUS) imaging and Shearwave Dispersion Ultrasound Vibrometry (SDUV). In MMUS, an oscillating external magnetic field displaces tissue loaded with superparamagnetic iron oxide (SPIO) particles, whereas in SDUV, periodic tissue motion is induced using acoustic radiation force (ARF) to measure visco-elastic properties. BSS motion detection performance in MMUS imaging and SDUV was compared against frequency-phase locked (FPL) and normalized cross-correlation (NCC) motion detectors, respectively, in silico and in experimental phantoms. Parametric MMUS phantom images constructed using the BSS method had nearly twice the SNR of the corresponding images constructed using FPL method when a 0.043 mm or smaller kernel size was used. In FEM models of SDUV, the error in the BSS-estimated viscoelastic properties of simulated materials was < 10%, whereas the error was > 20% using NCC when the simulated SNR was 15 dB. In a calibrated elasticity phantom, the amplitude of the motion was ≤ 0.5 μm for a scanner power level ≤ 20%. The median percent error in BSS-derived shear modulus of the phantom was -6.8%, -1.55%, -17.11% for power level of 20%, 15%, and 10%, respectively. The corresponding NCC-derived errors were 29.90%, 127.1%, and 244.70%. These results suggest the relevance of using BSS for the detection of sub-micrometer, periodic motion in MMUS and SDUV imaging, particularly when SNR is less than 15 dB and/or induced displacements are less than 0.5 μm.

Multimodal detection of iron oxide nanoparticles in rat lymph nodes using magnetomotive ultrasound imaging and magnetic resonance imaging

Detection and removal of sentinel lymph nodes (SLN) is important in the diagnosis and treatment of cancer. The SLN is the first regional lymph node draining the primary tumor, and if the cancer has spread, it is most likely to find metastases in the SLN. In this study, we have for the first time been able to image the very same contrast agent, superparamagnetic iron oxide nanoparticles (SPIO-NPs), in rat SLNs by using both our frequency- and phase-gated magnetomotive ultrasound (MMUS) algorithm and conventional magnetic resonance imaging (MRI); MMUS post mortem, MRI in vivo. For both higher NP-concentration and smaller NPs, we found that the MMUS data showed a larger magnetomotive displacement (1.56 ± 0.43 and 1.94 ± 0.54 times larger, respectively) and that the MR-images were affected to a higher degree. The MMUS displacement also increased with lower excitation frequency (1.95 ± 0.64 times larger for 5 Hz compared with 15 Hz) and higher excitation voltage (2.95 ± 1.44 times larger for 30 V compared with 10 V). The results show that MMUS has potential to be used as bedside guidance during SLN surgery, imaging the same particles that were used in prior staging with other imaging techniques.