Development of a Wireless and Near Real-Time 3D Ultrasound Strain Imaging System

Volumetric B-mode ultrasound and Doppler Imaging: Automatic Tracking With One Single Camera

Vascular diseases may occur in the upper extremities, and the lesions can span the entire length of the blood vessel. One of the most popular methods to identify vascular disorders is ultrasound Doppler imaging. However, traditional two-dimensional (2D) ultrasound Doppler imaging cannot capture the entire length of a long vessel in one image. Medical professionals often have to painstakingly reconstruct three-dimensional (3D) data using 2D ultrasound images to locate the lesions, especially for large blood vessels. 3D ultrasound Doppler imaging can display the morphological structure of blood vessels and the distribution of lesions more directly, providing a more comprehensive view compared to 2D imaging. In this work, we propose a wide-range 3D volumetric ultrasound Doppler imaging system with dual modality, in which a high-definition camera is adopted to automatically track the movement of the ultrasound transducer, simultaneously capturing a corresponding sequence of 2D ultrasound Doppler images. We conducted experiments on human arms using our proposed system and separately with X-ray computerized tomography (X-CT). The comparison results prove the potential value of our proposed system in the diagnosis of arm vascular diseases.

Long-term Dependency for 3D Reconstruction of Freehand Ultrasound Without External Tracker

OBJECTIVE

Reconstructing freehand ultrasound in 3D without any external tracker has been a long-standing challenge in ultrasound-assisted procedures. We aim to define new ways of parameterising long-term dependencies, and evaluate the performance.

METHODS

First, long-term dependency is encoded by transformation positions within a frame sequence. This is achieved by combining a sequence model with a multi-transformation prediction. Second, two dependency factors are proposed, anatomical image content and scanning protocol, for contributing towards accurate reconstruction. Each factor is quantified experimentally by reducing respective training variances.

RESULTS

1) The added long-term dependency up to 400 frames at 20 frames per second (fps) indeed improved reconstruction, with an up to 82.4% lowered accumulated error, compared with the baseline performance. The improvement was found to be dependent on sequence length, transformation interval and scanning protocol and, unexpectedly, not on the use of recurrent networks with long-short term modules; 2) Decreasing either anatomical or protocol variance in training led to poorer reconstruction accuracy. Interestingly, greater performance was gained from representative protocol patterns, than from representative anatomical features.

CONCLUSION

The proposed algorithm uses hyperparameter tuning to effectively utilise long-term dependency. The proposed dependency factors are of practical significance in collecting diverse training data, regulating scanning protocols and developing efficient networks.

SIGNIFICANCE

The proposed new methodology with publicly available volunteer data and code for parametersing the long-term dependency, experimentally shown to be valid sources of performance improvement, which could potentially lead to better model development and practical optimisation of the reconstruction application.

Robotic ultrasound imaging: State-of-the-art and future perspectives

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques. Additionally, we present the challenges that the scientific community needs to face in the coming years in order to achieve its ultimate goal of developing intelligent robotic sonographer colleagues. These colleagues are expected to be capable of collaborating with human sonographers in dynamic environments to enhance both diagnostic and intraoperative imaging.

A real-time freehand 3D ultrasound imaging method for scoliosis assessment

Real‐time 3D ultrasound has gained popularity in many fields because it can provide interactive feedback to help acquire high‐quality images or to conduct timely diagnosis. However, no comprehensive study has been reported on such an imaging method for scoliosis evaluation due to the complexity of this application. Meanwhile, the use of radiation‐free assessment of scoliosis is becoming increasingly popular. This study developed a real‐time 3D ultrasound imaging method for scoliosis assessment based on an incremental imaging method. In vivo experiments involving 36 patients with scoliosis were performed to test the performance of the proposed method. This new imaging method achieved a mean incremental frame rate of 82.7 ± 11.0 frames/s. The high repeatability of the intra‐operator test (intraclass correlation coefficient [ICC] = 0.92) and inter‐operator test (ICC = 0.91) demonstrated that the new method was very reliable. The result of spinous process angles obtained by the new method was linearly correlated (y = 0.97x, R² = 0.88) with that obtained by conventional 3D reconstruction. These results suggested that the newly developed imaging method can provide real‐time ultrasound imaging for scoliosis evaluation while preserving the comparative image quality of the conventional 3D reconstruction method.

A 3-D Ultrasound Wearable Array Prognosis System With Advanced Imaging Capabilities

In the last few decades, the medical and healthcare scientific communities have focused their attention on the use or development of real-time monitoring devices and remote control systems. New generations of wearable, portable, and implantable devices offer better and more accurate measurements/prognosis for those that suffer from diseases and/or disabilities. Thus, there are still challenging issues of current ultrasound imaging (USI) systems, such as low-quality ultrasound images, slow time response to emergencies, and location-based operation. Thus, in response to these challenges, we present a new low-cost, portable/wearable 3-D array ultrasound prognosis system with advanced imaging capabilities that offer high-resolution (HR) accurate results in a near real-time response. The USI unique features are based on 2-D array transducers with 3-D overlapping capabilities and a new image enhancement methodology compatible with the system's structural characteristics to compensate for any loss of image quality. This system will offer an alternative way of ultrasound examination, independent of the radiologist's skills, that is, a system to be capable of automatic scanning of the volume of interest (VOI) without the guidance of the radiologist.

Compact and Wireless Freehand 3D Ultrasound Real-time Spine Imaging System: A pilot study

The 3D ultrasound reconstruction technology has led to a rapid development of ultrasound spine imaging in recent decades. However, the current imaging apparatus is bulky and not portable. The objective of this study is to develop a new compact and wireless system to offer the real-time visualized spine images during data acquisition. A portable and WI-FI based ultrasound scanner and a compact EM tracking system were assembled to acquire ultrasound transverse frames with location information which could be reconstructed into 3D spine image volume in real-time. The validation was implemented on the 2D coronal images of vertebra phantoms, and the in vivo data acquisition and reconstruction were demonstrated on volunteers. The result showed that the new system could provide reconstructed spine images in real time and the average errors of the reconstructed images were about 1mm (approximate to image pixel size).

Dual-mode ultrasound radiomics and intrinsic imaging phenotypes for diagnosis of lymph node lesions

Background

The ultrasonic diagnosis of lymph node lesions is usually based on a small number of subjective visual features from a single ultrasonic modality, which limits diagnostic accuracy. Therefore, our study aimed to propose a computerized method for using dual-mode ultrasound radiomics and the intrinsic imaging phenotypes for accurately differentiating benign, lymphomatous, and metastatic lymph nodes.

Methods

A total of 543 lymph nodes from 538 patients were examined with both B-mode ultrasonography and elastography. The data set was randomly divided into a training set of 407 nodes and a validation set of 136 nodes. First, we extracted 430 radiomic features from dual-mode images. Then, we combined the least absolute shrinkage and selection operator with the analysis of variance to select several typical features. We retrieved the intrinsic imaging phenotypes by using a hierarchical clustering of all radiomics features, and we integrated the phenotypes with the selected features for the classification of benign, lymphomatous, and metastatic nodes.

Results

The areas under the receiver operating characteristic curves (AUCs) on the validation set were 0.960 for benign vs. lymphomatous, 0.716 for benign vs. metastatic, 0.933 for lymphomatous vs. metastatic, and 0.856 for benign vs. malignant.

Conclusions

The radiomics features and intrinsic imaging phenotypes derived from the dual-mode ultrasound can capture the distinctions between benign, lymphomatous, and metastatic nodes and are valuable in node differentiation.

An Improved Region-Growing Motion Tracking Method Using More Prior Information for 3-D Ultrasound Elastography

Three-dimensional (3-D) ultrasound elastography can provide 3-D tissue stiffness information that may be used during clinical diagnoses. In the framework of strain elastography, motion tracking plays an important role. In this study, an improved 3-D region-growing motion tracking (RGMT) algorithm based on a concept of exterior boundary points was developed. In principle, the proposed method first determines displacement at some seed points by strictly checking the local correlation and continuity in the neighborhood of those seeds. Subsequent displacement estimation is then conducted from these initial seeds to obtain displacements associated with other locations. This RGMT algorithm is designed to use more known information-including displacements and correlation values of all known-displacement neighboring points-to estimate the displacement of an unknown-displacement point, whereas previous RGMT methods employed information from only one such point. The algorithm was tested on 3-D ultrasound volumetric data acquired from a simulation, a tissue-mimicking phantom, and five human subjects. Motion-compensated cross correlations (MCCCs), strain contrast, and displacement Laplacian values (representing smoothness of an estimated displacement field) were calculated and used to evaluate the merits of the proposed RGMT method. Compared with a previously published RGMT method, the results show that the proposed RGMT method can provide smaller displacement errors and smoother displacements and improve strain contrast while maintaining reasonably high MCCC values, indicating good motion tracking quality. The proposed method is also computationally more efficient. In summary, our preliminary results demonstrated that the proposed RGMT algorithm is capable of obtaining high-quality 3-D strain elastographic data using modified clinical equipment.

Real-Time Crawling Wave Sonoelastography for Human Muscle Characterization: Initial Results

Imaging of musculoskeletal tissue dynamics is currently an exploratory field with the goal of aiding rehabilitation and performance evaluation of pathological or asymptomatic patients. In this pilot study, initial elasticity assessments of the biceps brachii were conducted in a novel crawling wave sonoelastography (CWS) system implemented on a research ultrasound instrument with graphical processing unit capabilities, displaying quantitative elasticity values at 4 frames per second. The CWS system computes the tissue stiffness with the generation of an interference pattern from external vibrators, which can overcome depth limitations of imaging systems with internal excitation sources. Validation on gelatin-based phantoms reported low bias of elasticity values (4.7%) at low excitation frequencies. Preliminary results on in vivo muscle characterization are in accordance with average elasticity values for relaxed and contracted tissues found in the literature, as well as for a range of weight loads.

Evaluation of Brain Tumor in Small Animals Using Plane Wave-Based Power Doppler Imaging

Precisely evaluating the characteristics of a glioma tumor in vivo is challenging when performing surgical resection clinically. The infiltration characteristics of a tumor make precise resection difficult because of uncertainties about the surrounding vasculature and the relationships with functional structures. Magnetic resonance imaging is routinely used to distinguish the area of a glioma, but it cannot resolve details of the vascular network around or inside the tumor. Ultrasound imaging is a real-time imaging modality that has been applied clinically in intra-operative surgery, and the sensitivity of flow measurements in the brain is improved by ultrafast plane wave imaging. This study applies a plane wave-based power Doppler imaging method to visualize the blood flow distribution in glioma models in vivo. This new imaging method makes it possible to delineate the flow structure of a glioma tumor in the brain of a small animal. The tumor can be distinguished from normal brain tissue, and different sections of the tumor contain different flow structures. The normalized blood flow intensities (mean ± standard deviation) within regions of interest were 0.33 ± 0.13, 0.72 ± 0.15, 0.36 ± 0.23 and 0.06 ± 0.07 for the type I normal rat, type I glioma rat, type II normal rat and type II glioma rat, respectively. Quantification analysis verified the feasibility of using this plane wave-based Doppler imaging method to evaluate brain tumors in small animals.

Assessment of Mechanical Properties of Tissue in Breast Cancer-Related Lymphedema Using Ultrasound Elastography

Breast cancer-related lymphedema is a consequence of a malfunctioning lymphatic drainage system resulting from surgery or some other form of treatment. In the initial stages, minor and reversible increases in the fluid volume of the arm are evident. As the stages progress over time, the underlying pathophysiology dramatically changes with an irreversible increase in arm volume most likely due to a chronic local inflammation leading to adipose tissue hypertrophy and fibrosis. Clinicians have subjective ways to stage the degree and severity such as the pitting test which entails manually comparing the elasticity of the affected and unaffected arms. Several imaging modalities can be used but ultrasound appears to be the most preferred because it is affordable, safe, and portable. Unfortunately, ultrasonography is not typically used for staging lymphedema, because the appearance of the affected and unaffected arms is similar in B-mode ultrasound images. However, novel ultrasound techniques have emerged, such as elastography, which may be able to identify changes in mechanical properties of the tissue related to detection and staging of lymphedema. This paper presents a novel technique to compare the mechanical properties of the affected and unaffected arms using quasi-static ultrasound elastography to provide an objective alternative to the current subjective assessment. Elastography is based on time delay estimation (TDE) from ultrasound images to infer displacement and mechanical properties of the tissue. We further introduce a novel method for TDE by incorporating higher order derivatives of the ultrasound data into a cost function and propose a novel optimization approach to efficiently minimize the cost function. This method works reliably with our challenging patient data. We collected radio frequency ultrasound data from both arms of seven patients with stage 2 lymphedema, at six different locations in each arm. The ratio of strain in skin, subcutaneous fat, and skeletal muscle divided by strain in the standoff gel pad was calculated in the unaffected and affected arms. The p -values using a Wilcoxon sign-rank test for the skin, subcutaneous fat, and skeletal muscle were 1.24×10^-5 , 1.77×10^-8 , and 8.11×10^-7 respectively, showing differences between the unaffected and affected arms with a very high level of significance.

Electromagnetic tracking-based freehand 3D quasi-static elastography with 1D linear array: a phantom study

Recent developments in hardware and scanning protocols have advanced conventional 2D quasi-static elastography to 3D level, which provides an intuitive visualization of lesions. A 2D linear array or scanning mechanism is typically required for 3D quasi-static elastography, requiring expensive and specifically designed hardware. In this study, we propose a novel method based on a commercial electromagnetic tracking system for freehand 3D quasi-static elastography with 1D linear array. Phantom experiments are performed to validate the feasibility of the proposed method. During data acquisition, the probe contacts the surface of an elasticity phantom and moves in the elevational direction, while applying sinusoidal-like axial compression to the phantom. For each frame of ultrasound data, the 3D coordinates and orientations of the probe are obtained from an electromagnetic tracking system. A correlation-based algorithm is adopted to obtain a series of axial strain images. Volumetric strain data are reconstructed by using the recorded 3D coordinates and orientations of the probe corresponding to each strain image. The diameters of inclusions are then obtained from the slice plots of the volumetric strain data. The volumes of inclusions are estimated from the isosurface plots. The experimental result shows that the volume estimation of the inclusions has good accuracy, with errors within 2%, while the diameters of the inclusions estimated from three orthogonal planes have larger errors up to 18%. In conclusion, the present framework would promise a reliable and effective solution for freehand 3D quasi-static elastography with 1D linear array.

2.5-D Extended Field-of-View Ultrasound

Recently, the growing emphasis on medical ultrasound (US) has led to a rapid development of US extended field-of-view (EFOV) techniques. US EFOV techniques can be classified into three categories: 2-D US EFOV, 3-D US, and 3-D US EFOV. In this paper, we propose a novel EFOV method called 2.5-D US EFOV that combines both the advantages of the 2-D US EFOV and the 3-D US by generating a panorama on a curved image plane guided by a curved scanning trajectory of the US probe. In 2.5-D US EFOV, the real-time position and orientation of the US image plane can be recorded via an electromagnetic spatial sensor attached to the probe. The scanning direction is not necessarily straight and can be curved according to the regions of interest (ROI). To form the curved panorama, an image cutting method is proposed. Finally, the curved panorama is rendered in a 3-D space using a surface rendering based on a texture mapping technique. This allows 3-D measurements of lines and angles. Phantom experiments demonstrated that 2.5-D US EFOV images could show anatomical structures of ROI accurately and rapidly. The overall average errors for the distance and angle measurements are -0.097 ± 0.128 cm (-1% ± 1.2%) and 1.50° ± 1.60° (1.9% ± 2%), respectively. A typical extended US image can be reconstructed from 321 B-scans images within 3 s. The satisfying quantitative result on the spinal tissues of a scoliosis subject demonstrates that our system has potential applications in the assessment of musculoskeletal issues.

Fully Automatic Three-Dimensional Ultrasound Imaging Based on Conventional B-Scan

Robotic ultrasound systems have turned into clinical use over the past few decades, increasing precision and quality of medical operations. In this paper, we propose a fully automatic scanning system for three-dimensional (3-D) ultrasound imaging. A depth camera was first used to obtain the depth data and color data of the tissue surface. Based on the depth image, the 3-D contour of the tissue was rendered and the scan path of ultrasound probe was automatically planned. Following the scan path, a 3-D translating device drove the probe to move on the tissue surface. Simultaneously, the B-scans and their positional information were recorded for subsequent volume reconstruction. In order to stop the scanning process when the pressure on the skin exceeded a preset threshold, two force sensors were attached to the front side of the probe for force measurement. In vitro and in vivo experiments were conducted for assessing the performance of the proposed system. Quantitative results show that the error of volume measurement was less than 1%, indicating that the system is capable of automatic ultrasound scanning and 3-D imaging. It is expected that the proposed system can be well used in clinical practices.

An Acoustic Tracking Approach for Medical Ultrasound Image Simulator

Ultrasound examinations are a standard procedure in the clinical diagnosis of many diseases. However, the efficacy of an ultrasound examination is highly dependent on the skill and experience of the operator, which has prompted proposals for ultrasound simulation systems to facilitate training and education in hospitals and medical schools. The key technology of the medical ultrasound simulation system is the probe tracking method that is used to determine the position and inclination angle of the sham probe, since this information is used to display the ultrasound images in real time. This study investigated a novel acoustic tracking approach for an ultrasound simulation system that exhibits high sensitivity and is cost-effective. Five air-coupled ultrasound elements are arranged as a 1D array in front of a sham probe for transmitting the acoustic signals, and a 5 × 5 2D array of receiving elements is used to receive the acoustic signals from the moving transmitting elements. Since the patterns of the received signals can differ for different positions and angles of the moving probe, the probe can be tracked precisely by the acoustic tracking approach. After the probe position has been determined by the system, the corresponding ultrasound image is immediately displayed on the screen. The system performance was verified by scanning three different subjects as image databases: a simple commercial phantom, a complicated self-made phantom, and a porcine heart. The experimental results indicated that the tracking and angle accuracies of the presented acoustic tracking approach were 0.7 mm and 0.5°, respectively. The performance of the acoustic tracking approach is compared with those of other tracking technologies.

A Review on Real-Time 3D Ultrasound Imaging Technology

Real-time three-dimensional (3D) ultrasound (US) has attracted much more attention in medical researches because it provides interactive feedback to help clinicians acquire high-quality images as well as timely spatial information of the scanned area and hence is necessary in intraoperative ultrasound examinations. Plenty of publications have been declared to complete the real-time or near real-time visualization of 3D ultrasound using volumetric probes or the routinely used two-dimensional (2D) probes. So far, a review on how to design an interactive system with appropriate processing algorithms remains missing, resulting in the lack of systematic understanding of the relevant technology. In this article, previous and the latest work on designing a real-time or near real-time 3D ultrasound imaging system are reviewed. Specifically, the data acquisition techniques, reconstruction algorithms, volume rendering methods, and clinical applications are presented. Moreover, the advantages and disadvantages of state-of-the-art approaches are discussed in detail.

3D Quasi-Static Ultrasound Elastography With Plane Wave In Vivo

In biological tissue, an increase in elasticity is often a marker of abnormalities. Techniques such as quasi-static ultrasound elastography have been developed to assess the strain distribution in soft tissues in two dimensions using a quasi-static compression. However, as abnormalities can exhibit very heterogeneous shapes, a three dimensional approach would be necessary to accurately measure their volume and remove operator dependency. Acquisition of volumes at high rates is also critical to performing real-time imaging with a simple freehand compression. In this study, we developed for the first time a 3D quasi-static ultrasound elastography method with plane waves that estimates axial strain distribution in vivo in entire volumes at high volume rate. Acquisitions were performed with a 2D matrix array probe of 2.5 MHz frequency and 256 elements. Plane waves were emitted at a volume rate of 100 volumes/s during a continuous motorized and freehand compression. 3D B-mode volumes and 3D cumulative axial strain volumes were successfully estimated in inclusion phantoms and in ex vivo canine liver before and after a high intensity focused ultrasound ablation. We also demonstrated the in vivo feasibility of the method using freehand compression on the calf muscle of a human volunteer and were able to retrieve 3D axial strain volume at a high volume rate depicting the differences in stiffness of the two muscles which compose the calf muscle. 3D ultrasound quasi-static elastography with plane waves could become an important technique for the imaging of the elasticity in human bodies in three dimensions using simple freehand scanning.

Transverse and Oblique Long Bone Fracture Evaluation by Low Order Ultrasonic Guided Waves: A Simulation Study

Ultrasonic guided waves have recently been used in fracture evaluation and fracture healing monitoring. An axial transmission technique has been used to quantify the impact of the gap breakage width and fracture angle on the amplitudes of low order guided wave modes S0 and A0 under a 100 kHz narrowband excitation. In our two dimensional finite-difference time-domain (2D-FDTD) simulation, the long bones are modeled as three layers with a soft tissue overlay and marrow underlay. The simulations of the transversely and obliquely fractured long bones show that the amplitudes of both S0 and A0 decrease as the gap breakage widens. Fixing the crack width, the increase of the fracture angle relative to the cross section perpendicular to the long axis enhances the amplitude of A0, while the amplitude of S0 shows a nonmonotonic trend with the decrease of the fracture angle. The amplitude ratio between the S0 and A0 modes is used to quantitatively evaluate the fracture width and angles. The study suggests that the low order guided wave modes S0 and A0 have potentials for transverse and oblique bone fracture evaluation and fracture healing monitoring.