Doppler ultrasound imaging of magnetically vibrated brachytherapy seeds

EM-enhanced US-based seed detection for prostate brachytherapy

PURPOSE

Intraoperative dosimetry in low-dose-rate (LDR) permanent prostate brachytherapy requires accurate localization of the implanted seeds with respect to the prostate anatomy. Transrectal Ultrasound (TRUS) imaging, which is the main imaging modality used during the procedure, is not sufficiently robust for accurate seed localization. We present a method for integration of electromagnetic (EM) tracking into LDR prostate brachytherapy procedure by fusing it with TRUS imaging for seed localization.

METHOD

Experiments were conducted on five tissue mimicking phantoms in a controlled environment. The seeds were implanted into each phantom using an EM-tracked needle, which allowed recording of seed drop locations. After each needle, we reconstructed a 3D ultrasound (US) volume by compounding a series of 2D US images acquired during retraction of an EM-tracked TRUS probe. Then, a difference image was generated by nonrigid registration and subtraction of two consecutive US volumes. A US-only seed detection method was used to detect seed candidates in the difference volume, based on the signature of the seeds. Finally, the EM-based positions of the seeds were used to detect the false positives of the US-based seed detection method and also to estimate the positions of the missing seeds. After the conclusion of the seed implant process, we acquired a CT image. The ground truth for seed locations was obtained by localizing the seeds in the CT image and registering them to the US coordinate system.

RESULTS

Compared to the ground truth, the US-only detection algorithm achieved a localization error mean of 1.7 mm with a detection rate of 85%. By contrast, the EM-only seed localization method achieved a localization error mean of 3.7 mm with a detection rate of 100%. By fusing EM-tracking information with US imaging, we achieved a localization error mean of 1.8 mm while maintaining a 100% detection rate without any false positives.

CONCLUSIONS

Fusion of EM-tracking and US imaging for prostate brachytherapy can combine high localization accuracy of US-based seed detection with the robustness and high detection rate of EM-based seed localization. Our phantom experiments serve as a proof of concept to demonstrate the potential value of integrating EM-tracking into LDR prostate brachytherapy.

Remote Electromagnetic Vibration of Steerable Needles for Imaging in Power Doppler Ultrasound

Robotic needle steering systems for minimally invasive medical procedures require complementary medical imaging systems to track the needles in real time. Ultrasound is a promising imaging modality because it offers relatively low-cost, real-time imaging of the needle. Previous methods applied vibration to the base of the needle using a voice coil actuator, in order to make the needle visible in power Doppler ultrasound. We propose a new method for needle tip vibration, using electromagnetic actuation of small permanent magnets placed inside the needle to improve needle tip visibility in power Doppler imaging. Robotic needle insertion experiments using artificial tissue and ex vivo porcine liver showed that the electromagnetic tip vibration method can generate a stronger Doppler response compared to the previous base vibration method, resulting in better imaging at greater needle depth in tissue. It also eliminates previous issues with vibration damping along the shaft of the needle.

A hybrid transducer to evaluate stomach emptying by ultrasound and susceptometric measurements: an in vivo feasibility study

Gastric emptying reflects a diversity of important physiological functions. Alternating current biosusceptometry (ACB) is an inexpensive, radiation-free, and minimally invasive method to evaluate gastric emptying, but its response depends on the spatial distribution of the magnetized material and does not provide precise anatomical information. The hybrid transducer, which combines ACB and an ultrasound probe, is an alternative to improve susceptometry measurements, namely the spatial localization of the magnetized source. In this study, initial stomach emptying, in rats, was monitored with the aid of the hybrid transducer. Yogurt mixed with ferrite particles was injected into the rat's stomach. The hybrid transducer was placed on the rat's abdomen during experiments, and the susceptometry signal and magnetomotive ultrasound (MMUS) images were saved and postprocessed. MMUS highlighted the movement of magnetic particles due to magnetic force from ACB excitation coils, and showed the rat's stomach location. In this feasibility study, we monitored the stomach emptying of 4 rats for 20 min. The mean relative ACB signal decayed by 4.6 ± 0.1%, and the mean relative area of MMUS images decreased by 4.5 ± 0.2%, after 20 min postingestion of the magnetic meal due to stomach emptying. In a second experiment, 3-D MMUS images from axial sequences were obtained by spatially translating the hybrid transducer, providing details of the stomach wall, which may enable minimally invasive detection of abnormalities. In conclusion, the MMUS image increased ACB spatial resolution and furnished additional anatomical information.

3-D ultrasound-guided robotic needle steering in biological tissue

Robotic needle steering systems have the potential to greatly improve medical interventions, but they require new methods for medical image guidance. Three-dimensional (3-D) ultrasound is a widely available, low-cost imaging modality that may be used to provide real-time feedback to needle steering robots. Unfortunately, the poor visibility of steerable needles in standard grayscale ultrasound makes automatic segmentation of the needles impractical. A new imaging approach is proposed, in which high-frequency vibration of a steerable needle makes it visible in ultrasound Doppler images. Experiments demonstrate that segmentation from this Doppler data is accurate to within 1-2 mm. An image-guided control algorithm that incorporates the segmentation data as feedback is also described. In experimental tests in ex vivo bovine liver tissue, a robotic needle steering system implementing this control scheme was able to consistently steer a needle tip to a simulated target with an average error of 1.57 mm. Implementation of 3-D ultrasound-guided needle steering in biological tissue represents a significant step toward the clinical application of robotic needle steering.

A hybrid transducer to magnetically and ultrasonically evaluate magnetic fluids

Ultrasound, magnetic fields, and optical techniques have been explored for clinical diagnosis and therapy. However, these techniques have limitations. In this study, we constructed and characterized a transducer to magnetically and ultrasonically investigate samples labeled with magnetic particles. The transducer is a hybrid system consisting of an ac biosusceptometer (ACB) and an ultrasonic transducer. The basic operation principle consisted of measuring the magnetization and microvibrations of ferromagnetic particles (37 and 70 μm) mixed in yogurt and excited by an external alternating magnetic field generated by the ACB's excitation coils. The vibration of the ferromagnetic particles was measured in phantoms using a Doppler ultrasonic transducer; we verified the sensitivity to detecting the vibrations at low concentrations of ferromagnetic material (~1%). The responses of the susceptometer and Doppler ultrasound linearly depended on the voltage level applied to the magnetizing coils at low ferromagnetic particle concentrations (⩽ 5%). We also conducted a repeatability test on the prototype, which indicated a deviation of 0.94% and 0.25% in the Doppler and susceptometric measurements, respectively. We can conclude that the hybrid transducer technique has potential clinical applications.

Seed localization in ultrasound and registration to C-arm fluoroscopy using matched needle tracks for prostate brachytherapy

We propose a novel fiducial-free approach for the registration of C-arm fluoroscopy to 3-D ultrasound images of prostate brachytherapy implants to enable dosimetry. The approach involves the reliable detection of a subset of radioactive seeds from 3-D ultrasound, and the use of needle tracks in both ultrasound and fluoroscopy for registration. Seed detection in ultrasound is achieved through template matching in 3-D radio frequency ultrasound signals, followed by thresholding and spatial filtering. The resulting subset of seeds is registered to the complete reconstruction of the brachytherapy implant from multiple C-arm fluoroscopy views. To compensate for the deformation caused by the ultrasound probe, simulated warping is applied to the seed cloud from fluoroscopy. The magnitude of the applied warping is optimized within the registration process. The registration is performed in two stages. First, the needle track projections from fluoroscopy and ultrasound are matched. Only the seeds in the matched needles are then used as fiducials for point-based registration. We report results from a physical phantom with a realistic implant (average postregistration seed distance of 1.6 ± 1.2 mm) and from five clinical patient datasets (average error: 2.8 ± 1.5 mm over 128 detected seeds). We conclude that it is feasible to use RF ultrasound data, template matching, and spatial filtering to detect a reliable subset of brachytherapy seeds from ultrasound to enable registration to fluoroscopy for dosimetry.

Ultrasound-fluoroscopy registration for prostate brachytherapy dosimetry

Prostate brachytherapy is a treatment for prostate cancer using radioactive seeds that are permanently implanted in the prostate. The treatment success depends on adequate coverage of the target gland with a therapeutic dose, while sparing the surrounding tissue. Since seed implantation is performed under transrectal ultrasound (TRUS) imaging, intraoperative localization of the seeds in ultrasound can provide physicians with dynamic dose assessment and plan modification. However, since all the seeds cannot be seen in the ultrasound images, registration between ultrasound and fluoroscopy is a practical solution for intraoperative dosimetry. In this manuscript, we introduce a new image-based nonrigid registration method that obviates the need for manual seed segmentation in TRUS images and compensates for the prostate displacement and deformation due to TRUS probe pressure. First, we filter the ultrasound images for subsequent registration using thresholding and Gaussian blurring. Second, a computationally efficient point-to-volume similarity metric, an affine transformation and an evolutionary optimizer are used in the registration loop. A phantom study showed final registration errors of 0.84 ± 0.45 mm compared to ground truth. In a study on data from 10 patients, the registration algorithm showed overall seed-to-seed errors of 1.7 ± 1.0 mm and 1.5 ± 0.9 mm for rigid and nonrigid registration methods, respectively, performed in approximately 30s per patient.

Prostate implant reconstruction from C-arm images with motion-compensated tomosynthesis

PURPOSE

Accurate localization of prostate implants from several C-arm images is necessary for ultrasound-fluoroscopy fusion and intraoperative dosimetry. The authors propose a computational motion compensation method for tomosynthesis-based reconstruction that enables 3D localization of prostate implants from C-arm images despite C-arm oscillation and sagging.

METHODS

Five C-arm images are captured by rotating the C-arm around its primary axis, while measuring its rotation angle using a protractor or the C-arm joint encoder. The C-arm images are processed to obtain binary seed-only images from which a volume of interest is reconstructed. The motion compensation algorithm, iteratively, compensates for 2D translational motion of the C-arm by maximizing the number of voxels that project on a seed projection in all of the images. This obviates the need for C-arm full pose tracking traditionally implemented using radio-opaque fiducials or external trackers. The proposed reconstruction method is tested in simulations, in a phantom study and on ten patient data sets.

RESULTS

In a phantom implanted with 136 dummy seeds, the seed detection rate was 100% with a localization error of 0.86 ± 0.44 mm (Mean ± STD) compared to CT. For patient data sets, a detection rate of 99.5% was achieved in approximately 1 min per patient. The reconstruction results for patient data sets were compared against an available matching-based reconstruction method and showed relative localization difference of 0.5 ± 0.4 mm.

CONCLUSIONS

The motion compensation method can successfully compensate for large C-arm motion without using radio-opaque fiducial or external trackers. Considering the efficacy of the algorithm, its successful reconstruction rate and low computational burden, the algorithm is feasible for clinical use.

Medical ultrasound: imaging of soft tissue strain and elasticity

After X-radiography, ultrasound is now the most common of all the medical imaging technologies. For millennia, manual palpation has been used to assist in diagnosis, but it is subjective and restricted to larger and more superficial structures. Following an introduction to the subject of elasticity, the elasticity of biological soft tissues is discussed and published data are presented. The basic physical principles of pulse-echo and Doppler ultrasonic techniques are explained. The history of ultrasonic imaging of soft tissue strain and elasticity is summarized, together with a brief critique of previously published reviews. The relevant techniques-low-frequency vibration, step, freehand and physiological displacement, and radiation force (displacement, impulse, shear wave and acoustic emission)-are described. Tissue-mimicking materials are indispensible for the assessment of these techniques and their characteristics are reported. Emerging clinical applications in breast disease, cardiology, dermatology, gastroenterology, gynaecology, minimally invasive surgery, musculoskeletal studies, radiotherapy, tissue engineering, urology and vascular disease are critically discussed. It is concluded that ultrasonic imaging of soft tissue strain and elasticity is now sufficiently well developed to have clinical utility. The potential for further research is examined and it is anticipated that the technology will become a powerful mainstream investigative tool.

Brachytherapy seed reconstruction with joint-encoded C-arm single-axis rotation and motion compensation

C-arm fluoroscopy images are frequently used for qualitative assessment of prostate brachytherapy. Three-dimensional seed reconstruction from C-arm images is necessary for intraoperative dosimetry and quantitative assessment. Seed reconstruction requires accurately known C-arm poses. We propose to measure the C-arm rotation angles and computationally compensate for inevitable C-arm motion to compute the pose. We compensate the translational motions of a C-arm, such as oscillation, sagging and wheel motion using a three-level optimization algorithm and obviate the need for full pose tracking using external trackers or fiducials. We validated our approach on simulated and 100 clinical data sets from 10 patients and gained on average, a seed matching rate of 98.5%, projection error of 0.33 mm (STD=0.21 mm) and computation time of 19.8s per patient, which must be considered as clinically excellent results. We also show that without motion compensation the reconstruction is likely to fail.

Registration between ultrasound and fluoroscopy or CT in prostate brachytherapy

PURPOSE

In prostate brachytherapy, transrectal ultrasound (TRUS) is used to visualize the anatomy, while implanted seeds can be visualized by fluoroscopy. Intraoperative dosimetry optimization is possible using a combination of TRUS and fluoroscopy, but requires localization of the fluoroscopy-derived seed cloud, relative to the anatomy as seen on TRUS. The authors propose to develop a method of registration of TRUS images and the implants reconstructed from fluoroscopy.

METHODS

A phantom was implanted with 48 seeds then imaged with TRUS and CT. Seeds were reconstructed from CT yielding a cloud of seeds. Fiducial-based ground-truth registration was established between the TRUS and CT. TRUS images are filtered, compounded, and registered to the reconstructed implants by using an intensity-based metric. The authors evaluated a volume-to-volume and point-to-volume registration scheme. In total, seven TRUS filtering techniques and three image similarity metrics were analyzed. The method was also tested on human subject data captured from a brachytherapy procedure.

RESULTS

For volume-to-volume registration, noise reduction filter and normalized correlation metrics yielded the best result: An average of 0.54 +/- 0.11 mm seed localization error relative to ground truth. For point-to-volume registration, noise reduction combined with beam profile filter and mean squares metrics yielded the best result: An average of 0.38 +/- 0.19 mm seed localization error relative to the ground truth. In human patient data, C-arm fluoroscopy images showed 81 radioactive seeds implanted inside the prostate. A qualitative analysis showed clinically correct agreement between the seeds visible in TRUS and reconstructed from intraoperative fluoroscopy imaging. The measured registration error compared to the manually selected seed locations by the clinician was 2.86 +/- 1.26 mm.

CONCLUSIONS

Fully automated registration between TRUS and the reconstructed seeds performed well in ground-truth phantom experiments and qualitative observation showed adequate performance on early clinical patient data.

Detection of brachytherapy seeds using 3-D transrectal ultrasound

Detection of brachytherapy seeds plays a key role in dosimetry for prostate brachytherapy. However, seed localization using B-mode transrectal ultrasound (TRUS) still remains a challenge for prostate brachytherapy, mainly due to the small size of brachytherapy seeds in the relatively low-quality B-mode TRUS images. In this paper, we propose a new solution for brachytherapy seed detection using 3-D ultrasound. A 3-D reflected power image is computed from ultrasound RF signals, instead of conventional B-mode images. Then, implanted seeds are segmented in 3-D local search spaces that are determined by a priori knowledge, e.g., needle entry points and seed placements. Needle insertion tracks are also detected locally by the Hough transform. Experimental results show that the proposed solution works well for seed localization in a prostate phantom implanted according to a realistic treatment plan with 136 seeds from 26 needles.

Hybrid system for magnetic and acoustic measurement

In order to improve the spatial resolution of Biosusceptometry of Alternate Current (BAC), we are suggesting the coupling of a Doppler ultrasonic transducer with the BAC system. The Doppler transducer obtains information from the vibration of ferromagnetic particles immersed in a visco-elastic medium when it is excited by an alternating magnetic field. In this case, the same magnetic particles used as contrast for susceptometric measurement also will work as contrast for the Doppler measurement. In this work, we present the characterization of the hybrid system for susceptometric and acoustic measurements simultaneously. It was observed that the susceptometric and Doppler ultrasound signal have the same profile and maximum amplitude for frequency of magnetizing field about 200 Hz. When using ferrite particles as magnetic contrast mixed with yogurt as based material, the susceptometric and Doppler measurement have sensitivity for concentration of particles as low as 1%. The sensitivity of the Doppler is dependent of the gradient of magnetic field over the sample. In this work, the magnetic field 5 cm far from the face of the transducer was 70 microT/volts.

3-D ultrasound guidance of autonomous robot for location of ferrous shrapnel

Vibrations can be induced in ferromagnetic shrapnel by a variable electromagnet. Real time 3-D color Doppler ultrasound located the induced motion in a needle fragment and determined its 3-D position in the scanner coordinates. This information was used to guide a robot which moved a probe to touch the shrapnel fragment.

Quality assurance/quality control issues for intraoperative planning and adaptive repeat planning of image-guided prostate implants

The quality assurance/quality control purpose is this. We design a treatment plan, and we wish to be as certain as reasonably possible that the treatment is delivered as planned. In the case of conventionally planned prostate brachytherapy, implementing to the letter the implantation plan is rarely attainable and therefore can require adaptive replanning (a quality control issue). The reasons for this state of affairs include changes in the prostate shape and volume during implantation and treatment delivery (e.g., edema resolution) and unavoidable inaccuracy in the placement of the seeds in the prostate. As a result, quality-control activities (e.g., the need to monitor-ideally, on the fly-the target and urethral and rectal dosage) must be also addressed.

Detection of brachytherapy seeds using 3D ultrasound

Imaging and detection of brachytherapy seeds using transrectal ultrasound (TRUS) remains a challenge for prostate brachytherapy, mainly due to the small size of brachytherapy seeds in relatively low-quality B-mode TRUS images. In this paper, we propose a new solution for brachytherapy seed detection using 3D ultrasound. We use 3D reflected power images computed from ultrasound radio-frequency signals, instead of using conventional B-mode images. Then implanted seeds are detected in 3D local search spaces that are determined by a priori knowledge. Experimental results showed that the proposed solution works well for seed localization in the prostate phantom.