A miniaturized catheter 2-D array for real-time, 3-D intracardiac echocardiography

An Ultrasound Matrix Transducer for High-Frame-Rate 3-D Intra-cardiac Echocardiography

OBJECTIVE

Described here is the development of an ultrasound matrix transducer prototype for high-frame-rate 3-D intra-cardiac echocardiography.

METHODS

The matrix array consists of 16 × 18 lead zirconate titanate elements with a pitch of 160 µm × 160 µm built on top of an application-specific integrated circuit that generates transmission signals and digitizes the received signals. To reduce the number of cables in the catheter to a feasible number, we implement subarray beamforming and digitization in receive and use a combination of time-division multiplexing and pulse amplitude modulation data transmission, achieving an 18-fold reduction. The proposed imaging scheme employs seven fan-shaped diverging transmit beams operating at a pulse repetition frequency of 7.7 kHz to obtain a high frame rate. The performance of the prototype is characterized, and its functionality is fully verified.

RESULTS

The transducer exhibits a transmit efficiency of 28 Pa/V at 5 cm per element and a bandwidth of 60% in transmission. In receive, a dynamic range of 80 dB is measured with a minimum detectable pressure of 10 Pa per element. The element yield of the prototype is 98%, indicating the efficacy of the manufacturing process. The transducer is capable of imaging at a frame rate of up to 1000 volumes/s and is intended to cover a volume of 70° × 70° × 10 cm.

CONCLUSION

These advanced imaging capabilities have the potential to support complex interventional procedures and enable full-volumetric flow, tissue, and electromechanical wave tracking in the heart.

3D Printing and processing of miniaturized transducers with near-pristine piezoelectric ceramics for localized cavitation

The performance of ultrasonic transducers is largely determined by the piezoelectric properties and geometries of their active elements. Due to the brittle nature of piezoceramics, existing processing tools for piezoelectric elements only achieve simple geometries, including flat disks, cylinders, cubes and rings. While advances in additive manufacturing give rise to free-form fabrication of piezoceramics, the resultant transducers suffer from high porosity, weak piezoelectric responses, and limited geometrical flexibility. We introduce optimized piezoceramic printing and processing strategies to produce highly responsive piezoelectric microtransducers that operate at ultrasonic frequencies. The 3D printed dense piezoelectric elements achieve high piezoelectric coefficients and complex architectures. The resulting piezoelectric charge constant, d₃₃, and coupling factor, k_t, of the 3D printed piezoceramic reach 583 pC/N and 0.57, approaching the properties of pristine ceramics. The integrated printing of transducer packaging materials and 3D printed piezoceramics with microarchitectures create opportunities for miniaturized piezoelectric ultrasound transducers capable of acoustic focusing and localized cavitation within millimeter-sized channels, leading to miniaturized ultrasonic devices that enable a wide range of biomedical applications.

2-D Array Design and Fabrication With Pitch-Shifting Interposer at Frequencies From 4 MHz up to 10 MHz

High element density and strict constraints of the element's size have significantly limited the design and fabrication of 2-D ultrasonic arrays, especially fully sampled 2-D arrays. Recently, 3-D printing technology has been one of the most rapidly developing fields. Along with the great progress of 3-D printing technology, complex and detailed 3-D structures have become readily available with a short iteration cycle, which allows us to reduce the complexity of routing and helps to ameliorate assembly problems in 2-D ultrasound array fabrication. In this work, we designed and fabricated 2-D ultrasound arrays for an array of applications with a pitch-shifting interposer, which allowed us to fit different array designs with the same circuit design and significantly reduce the requirements in routing and connection for 2-D array fabrication at frequencies from 4 to 10 MHz. Results demonstrated that this design would make 2-D arrays more available and affordable.

Imaging Scheme for 3-D High-Frame-Rate Intracardiac Echography: A Simulation Study

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is normally treated by RF ablation. Intracardiac echography (ICE) is widely employed during RF ablation procedures to guide the electrophysiologist in navigating the ablation catheter, although only 2-D probes are currently clinically used. A 3-D ICE catheter would not only improve visualization of the atrium and ablation catheter, but it might also provide the 3-D mapping of the electromechanical wave (EW) propagation pattern, which represents the mechanical response of cardiac tissue to electrical activity. The detection of this EW needs 3-D high-frame-rate imaging, which is generally only realizable in tradeoff with channel count and image quality. In this simulation-based study, we propose a high volume rate imaging scheme for a 3-D ICE probe design that employs 1-D micro-beamforming in the elevation direction. Such a probe can achieve a high frame rate while reducing the channel count sufficiently for realization in a 10-Fr catheter. To suppress the grating-lobe (GL) artifacts associated with micro-beamforming in the elevation direction, a limited number of fan-shaped beams with a wide azimuthal and narrow elevational opening angle are sequentially steered to insonify slices of the region of interest. An angular weighted averaging of reconstructed subvolumes further reduces the GL artifacts. We optimize the transmit beam divergence and central frequency based on the required image quality for EW imaging (EWI). Numerical simulation results show that a set of seven fan-shaped transmission beams can provide a frame rate of 1000 Hz and a sufficient spatial resolution to visualize the EW propagation on a large 3-D surface.

Ultrasound-gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility

PURPOSE

Cardiovascular disease (CVD) is a leading cause of death worldwide, with coronary artery disease (CAD) accounting for nearly half of all CVD deaths. The current gold standard for CAD diagnosis is catheter coronary angiography (CCA), an invasive, expensive procedure. Computed tomography coronary angiography (CTCA) represents an attractive non-invasive alternative to CCA, however, CTCA requires gated acquisition of CT data during periods of minimal cardiac motion (quiescent periods) to avoid non-diagnostic scans. Current gating methods either expose patients to high levels of radiation (retrospective gating) or lead to high rates of non-diagnostic scans (prospective gating) due to the challenge of predicting cardiac quiescence based on ECG alone. Alternatively, ultrasound (US) imaging has been demonstrated as an effective indicator of cardiac quiescence, however, ultrasound transducers produce prominent streak artifacts that disrupt CTCA scans. In this study, a proof-of-concept array transducer with improved CT-compatibility was developed for utilization in an integrated US-CTCA system.

METHODS

Alternative materials were tested radiographically and acoustically to replace the radiopaque acoustic backings utilized in low frequency (1-4 MHz) cardiac US transducers. The results of this testing were used to develop alternative acoustic backings consisting of varying concentrations of aluminum oxide in an epoxy matrix via simulations. On the basis of these simulations, single element test transducers designed to operate at 2.5 MHz were fabricated, and the performance of these devices was characterized via acoustic and radiographic testing with micro-computed tomography (micro-CT). Finally, a first proof-of-concept cardiac phased array transducer was developed and its US imaging performance was evaluated. Micro-CT images of the developed US array with improved CT-compatibility were compared with those of a conventional array.

RESULTS

Materials testing with micro-CT identified an acoustic backing with a measured radiopacity of 1008 HU, more than an order of magnitude lower than that of the acoustic backing (24,000 HU) typically used in cardiac transducers operating in the 1-4 MHz range. When utilized in a simulated transducer design, this acoustic backing yielded a -6-dB fractional bandwidth of 57%, similar to the 54% bandwidth of the transducer with the radiopaque acoustic backing. The developed 2.5 MHz, single element transducer based on these simulations exhibited a fractional bandwidth of 51% and signal-to-noise ratio (SNR) of 14.7 dB. Finally, the array transducer developed with the acoustic backing having decreased radiopacity exhibited a 56% fractional bandwidth and 10.4 dB single channel SNR, with penetration depth >10 cm in phantom and in vivo imaging using the full array.

CONCLUSIONS

The first attempt at developing a CT-compatible ultrasound transducer is described. The developed CT-compatible transducer exhibits improved radiographic compatibility relative to conventional cardiac array transducers with similar SNR, bandwidth, and penetration depth for US imaging, according to phantom and in vivo cardiac imaging. A CT-compatible US transducer might be used to identify cardiac quiescence and prospectively gate CTCA acquisition, reducing challenges associated with current gating approaches, specifically relatively high rates of non-diagnostic scans for prospective ECG gating and high radiation dose for retrospective gating.

Sparse Convolutional Beamforming for 3-D Ultrafast Ultrasound Imaging

Real-time 3-D ultrasound (US) provides a complete visualization of inner body organs and blood vasculature, crucial for diagnosis and treatment of diverse diseases. However, 3-D systems require massive hardware due to the huge number of transducer elements and consequent data size. This increases cost significantly and limit both frame rate and image quality, thus preventing the 3-D US from being common practice in clinics worldwide. A recent study presented a technique called sparse convolutional beamforming algorithm (SCOBA), which obtains improved image quality while allowing notable element reduction in the context of 2-D focused imaging. In this article, we build upon previous work and introduce a nonlinear beamformer for 3-D imaging, called COBA-3D, consisting of 2-D spatial convolution of the in-phase and quadrature received signals. The proposed technique considers diverging-wave transmission and achieves improved image resolution and contrast compared with standard delay-and-sum beamforming while enabling a high frame rate. Incorporating 2-D sparse arrays into our method creates SCOBA-3D: a sparse beamformer that offers significant element reduction and, thus, allows performing 3-D imaging with the resources typically available for 2-D setups. To create 2-D thinned arrays, we present a scalable and systematic way to design 2-D fractal sparse arrays. The proposed framework paves the way for affordable ultrafast US devices that perform high-quality 3-D imaging, as demonstrated using phantom and ex-vivo data.

Co-Integrated PIN-PMN-PT 2-D Array and Transceiver Electronics by Direct Assembly Using a 3-D Printed Interposer Grid Frame

Tiled modular 2-D ultrasound arrays have the potential for realizing large apertures for novel diagnostic applications. This work presents an architecture for fabrication of tileable 2-D array modules implemented using 1-3 composites of high-bandwidth (BW) PIN-PMN-PT single-crystal piezoelectric material closely coupled with high-voltage CMOS application-specific integrated circuit (ASIC) electronics for buffering and multiplexing functions. The module, which is designed to be operated as a λ -pitch 1.75-D array, benefits from an improved electromechanical coupling coefficient and increased Curie temperature and is assembled directly on top of the ASIC silicon substrate using an interposer backing. The interposer consists of a novel 3-D printed acrylic frame that is filled with conducting and acoustically absorbing silver epoxy material. The ASIC comprises a high-voltage switching matrix with locally integrated buffering and is interfaced to a Verasonics Vantage 128, using a local field programmable gate array (FPGA) controller. Multiple prototype 5 ×6 element array modules have been fabricated by this process. The combined acoustic array and ASIC module was configured electronically by programming the switches to operate as a 1-D array with elements grouped in elevation for imaging and pulse-echo testing. The resulting array configuration had an average center frequency of 4.55 MHz, azimuthal element pitch of [Formula: see text], and exhibited average -20-dB pulsewidth of 592 ns and average -6-dB fractional BW of 77%.

Simultaneous transmission and reception on all elements of an array: binary code excitation

Pulse-echo arrays are used in radar, sonar, seismic, medical and non-destructive evaluation. There is a trend to produce arrays with an ever-increasing number of elements. This trend presents two major challenges: (i) often the size of the elements is reduced resulting in a lower signal-to-noise ratio (SNR) and (ii) the time required to record all of the signals that correspond to every transmit-receive path increases. Coded sequences with good autocorrelation properties can increase the SNR while orthogonal sets can be used to simultaneously acquire all of the signals that correspond to every transmit-receive path. However, a central problem of conventional coded sequences is that they cannot achieve good autocorrelation and orthogonality properties simultaneously due to their length being limited by the location of the closest reflectors. In this paper, a solution to this problem is presented by using coded sequences that have receive intervals. The proposed approach can be more than one order of magnitude faster than conventional methods. In addition, binary excitation and quantization can be employed, which reduces the data throughput by roughly an order of magnitude and allows for higher sampling rates. While this concept is generally applicable to any field, a 16-element system was built to experimentally demonstrate this principle for the first time using a conventional medical ultrasound probe.

Sparse Convolutional Beamforming for Ultrasound Imaging

The standard technique used by commercial medical ultrasound systems to form B-mode images is delay and sum (DAS) beamforming. However, DAS often results in limited image resolution and contrast that are governed by the center frequency and the aperture size of the ultrasound transducer. A large number of elements lead to improved resolution but at the same time increase the data size and the system cost due to the receive electronics required for each element. Therefore, reducing the number of receiving channels while producing high-quality images is of great importance. In this paper, we introduce a nonlinear beamformer called COnvolutional Beamforming Algorithm (COBA), which achieves significant improvement of lateral resolution and contrast. In addition, it can be implemented efficiently using the fast Fourier transform. Based on the COBA concept, we next present two sparse beamformers with closed-form expressions for the sensor locations, which result in the same beam pattern as DAS and COBA while using far fewer array elements. Optimization of the number of elements shows that they require a minimal number of elements that are on the order of the square root of the number used by DAS. The performance of the proposed methods is tested and validated using simulated data, phantom scans, and in vivo cardiac data. The results demonstrate that COBA outperforms DAS in terms of resolution and contrast and that the suggested beamformers offer a sizable element reduction while generating images with an equivalent or improved quality in comparison with DAS.

4-D ICE: A 2-D Array Transducer With Integrated ASIC in a 10-Fr Catheter for Real-Time 3-D Intracardiac Echocardiography

We developed a 2.5 ×6.6 mm ² 2 -D array transducer with integrated transmit/receive application-specific integrated circuit (ASIC) for real-time 3-D intracardiac echocardiography (4-D ICE) applications. The ASIC and transducer design were optimized so that the high-voltage transmit, low-voltage time-gain control and preamp, subaperture beamformer, and digital control circuits for each transducer element all fit within the 0.019-mm ² area of the element. The transducer assembly was deployed in a 10-Fr (3.3-mm diameter) catheter, integrated with a GE Vivid E9 ultrasound imaging system, and evaluated in three preclinical studies. The 2-D image quality and imaging modes were comparable to commercial 2-D ICE catheters. The 4-D field of view was at least 90 ^° ×60 ^° ×8 cm and could be imaged at 30 vol/s, sufficient to visualize cardiac anatomy and other diagnostic and therapy catheters. 4-D ICE should significantly reduce X-ray fluoroscopy use and dose during electrophysiology ablation procedures. 4-D ICE may be able to replace transesophageal echocardiography (TEE), and the associated risks and costs of general anesthesia, for guidance of some structural heart procedures.

In vivo real-time 3-D intracardiac echo using PMUT arrays

Piezoelectric micromachined ultrasound transducer (PMUT) matrix arrays were fabricated containing novel through-silicon interconnects and integrated into intracardiac catheters for in vivo real-time 3-D imaging. PMUT arrays with rectangular apertures containing 256 and 512 active elements were fabricated and operated at 5 MHz. The arrays were bulk micromachined in silicon-on-insulator substrates, and contained flexural unimorph membranes comprising the device silicon, lead zirconate titanate (PZT), and electrode layers. Through-silicon interconnects were fabricated by depositing a thin-film conformal copper layer in the bulk micromachined via under each PMUT membrane and photolithographically patterning this copper layer on the back of the substrate to facilitate contact with the individually addressable matrix array elements. Cable assemblies containing insulated 45-AWG copper wires and a termination silicon substrate were thermocompression bonded to the PMUT substrate for signal wire interconnection to the PMUT array. Side-viewing 14-Fr catheters were fabricated and introduced through the femoral vein in an adult porcine model. Real-time 3-D images were acquired from the right atrium using a prototype ultrasound scanner. Full 60° × 60° volume sectors were obtained with penetration depth of 8 to 10 cm at frame rates of 26 to 31 volumes per second.

Double Ring Array Catheter for In Vivo Real-Time 3D Ultrasound

We developed new forward-viewing matrix transducers consisting of double ring arrays of 118 total PZT elements integrated into catheters used to deploy medical interventional devices. Our goal is 3D ultrasound guidance of medical device implantation to reduce x-ray fluoroscopy exposure. The double ring arrays were fabricated on inner and outer custom polyimide flexible circuits with inter-element spacing of 0.20 mm and then wrapped around an 11 French (Fr) catheter to produce a 15 Fr catheter (outer diameter [O.D.]). We used a braided cabling technology to connect the elements to the Volumetrics Medical Imaging (VMI) real-time 3D ultrasound scanner. Transducer performance yielded an average -6 dB fractional bandwidth of 49% ± 11% centered at 4.4 MHz for 118 elements. Real-time 3D cardiac scans of the in vivo pig model yielded good image quality including en face views of the tricuspid valve and real-time 3D guidance of an endo-myocardial biopsy catheter introduced into the left ventricle.

Acoustic radiation force impulse imaging (ARFI) on an IVUS circular array

Our long-term goal is the detection and characterization of vulnerable plaque in the coronary arteries of the heart using intravascular ultrasound (IVUS) catheters. Vulnerable plaque, characterized by a thin fibrous cap and a soft, lipid-rich necrotic core is a precursor to heart attack and stroke. Early detection of such plaques may potentially alter the course of treatment of the patient to prevent ischemic events. We have previously described the characterization of carotid plaques using external linear arrays operating at 9 MHz. In addition, we previously modified circular array IVUS catheters by short-circuiting several neighboring elements to produce fixed beamwidths for intravascular hyperthermia applications. In this paper, we modified Volcano Visions 8.2 French, 9 MHz catheters and Volcano Platinum 3.5 French, 20 MHz catheters by short-circuiting portions of the array for acoustic radiation force impulse imaging (ARFI) applications. The catheters had an effective transmit aperture size of 2 mm and 1.5 mm, respectively. The catheters were connected to a Verasonics scanner and driven with pushing pulses of 180 V p-p to acquire ARFI data from a soft gel phantom with a Young's modulus of 2.9 kPa. The dynamic response of the tissue-mimicking material demonstrates a typical ARFI motion of 1 to 2 microns as the gel phantom displaces away and recovers back to its normal position. The hardware modifications applied to our IVUS catheters mimic potential beamforming modifications that could be implemented on IVUS scanners. Our results demonstrate that the generation of radiation force from IVUS catheters and the development of intravascular ARFI may be feasible.

Intracardiac echocardiography: evolving use in interventional cardiology

Intracardiac echocardiography (ICE) uses a catheter-based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia. Intracardiac echocardiography is generally well tolerated and provides adequate images and sufficient information for the procedure performed. In the cardiac catheterization laboratory, ICE is routinely used for patent foramen ovale, atrial septal defect, and ventricular septal defect closures, allowing adequate percutaneous placement of septal occluders. It is now being considered in the current era of transcatheter aortic valve implantation necessitating improved imaging approaches for accurate placement. It is also routinely used for trans-septal punctures during mitral valvuloplasty and, more recently, with the advent of left atrial appendage closure devices. This article provides a comprehensive review of the current technology for ICE and its growing applications in the realm of interventional cardiology.

Top-orthogonal-to-bottom-electrode (TOBE) CMUT arrays for 3-D ultrasound imaging

Two-dimensional ultrasound arrays hold great promise for 3-D imaging; however, wiring of each channel becomes impractical for large arrays or for small-footprint catheter probes for which the number of wires must be limited. Capacitive micromachined ultrasound transducers offer a promising solution for such 2-D array applications, but channel routing is still non-trivial. A top-orthogonal-to-bottom-electrode (TOBE) 2-D CMUT array architecture is presented along with row-column addressing schemes for low-channel-count 3-D ultrasound imaging. An N × N TOBE array is capable of obtaining 3-D images using only 2N channels. An interfacing scheme is presented in which transmit-receive signals are routed along rows while bias voltages are applied along columns, effectively allowing for single-element transmit/receive control. Simulations demonstrated potentially finer resolution and improved side lobe suppression over a previously published row-column-based imaging method. Laser vibrometer testing was done to measure membrane displacement in air and confirmed that single-element air-coupled actuation in transmit mode could be achieved using our proposed interfacing scheme. Acoustic testing was also performed in both transmit and receive modes to characterize the ability of the proposed interfacing scheme to achieve dominant-element transmission and reception in immersion operation. It was seen that membrane displacement in both modes was indeed largely confined to the active area.

The use of echocardiography in congenital heart surgery and intervention

Echocardiography has revolutionized the management of pediatric and adult heart disease, especially in the diagnosis of congenital heart defects. Although the early methods of echocardiography (M-mode and Doppler imaging) were limited in their ability to define the defect in question, the advent of 2D, and now 3D, imaging have clearly equaled or surpassed traditional methods of diagnosis (e.g., noninvasively obtained plain chest radiographs and electrocardiograms) and invasive tests (e.g., cardiac catheterization and angiography). Confidence in the images obtained using echocardiography has continued to increase, with many patients referred for corrective or palliative surgery on the basis of echocardiographic imaging alone. Echocardiography has eliminated the need, decreased the frequency, or improved the timing or performance of invasive studies in other patients. Specifically, it is used to definitively diagnose a cardiac defect and any associated lesions. It will also provide quantitative information for the assessment of the hemodynamic severity of the lesion. This review outlines the manner in which echocardiography is used to plan and guide congenital heart surgery or intervention, along with some of the advantages and disadvantages (pitfalls) of which to be aware. The use of echocardiography within the cardiac catheterization or surgical theater, as well as in the intensive care unit, is discussed, as is the use of echocardiography as a means of monitoring recovery and follow-up following cardiac surgery. Finally, the authors discuss who is best qualified or suited to perform these tests.

Ring array transducers for real-time 3-D imaging of an atrial septal occluder

We developed new miniature ring array transducers integrated into interventional device catheters such as used to deploy atrial septal occluders. Each ring array consisted of 55 elements operating near 5 MHz with interelement spacing of 0.20 mm. It was constructed on a flat piece of copper-clad polyimide and then wrapped around an 11 French O.D. catheter. We used a braided cabling technology from Tyco Electronics Corporation to connect the elements to the Volumetric Medical Imaging (VMI) real-time 3-D ultrasound scanner. Transducer performance yielded a -6 dB fractional bandwidth of 20% centered at 4.7 MHz without a matching layer vs. average bandwidth of 60% centered at 4.4 MHz with a matching layer. Real-time 3-D rendered images of an en face view of a Gore Helex septal occluder in a water tank showed a finer texture of the device surface from the ring array with the matching layer.

A fast slam approach to freehand 3-d ultrasound reconstruction for catheter ablation guidance in the left atrium

We present a method for real-time, freehand 3D ultrasound (3D-US) reconstruction of moving anatomy, with specific application towards guiding the catheter ablation procedure in the left atrium. Using an intracardiac echo (ICE) catheter with a pose (position/orientation) sensor mounted to its tip, we continually mosaic 2D-ICE images of a left atrium phantom model to form a 3D-US volume. Our mosaicing strategy employs a probabilistic framework based on simultaneous localization and mapping (SLAM), a technique commonly used in mobile robotics for creating maps of unexplored environments. The measured ICE catheter tip pose provides an initial estimate for compounding 2D-ICE image data into the 3D-US volume. However, we simultaneously consider the overlap-consistency shared between 2D-ICE images and the 3D-US volume, computing a "corrected" tip pose if need be to ensure spatially-consistent reconstruction. This allows us to compensate for anatomic movement and sensor drift that would otherwise cause motion artifacts in the 3D-US volume. Our approach incorporates 2D-ICE data immediately after acquisition, allowing us to continuously update the registration parameters linking sensor coordinates to 3D-US coordinates. This, in turn, enables real-time localization and display of sensorized therapeutic catheters within the 3D-US volume for facilitating procedural guidance.

A 10-Fr ultrasound catheter with integrated micromotor for 4-D intracardiac echocardiography

We developed prototype real-time 3-D intracardiac echocardiography catheters with integrated micromotors, allowing internal oscillation of a low-profile 64-element, 6.2-MHz phased-array transducer in the elevation direction. Components were designed to facilitate rotation of the array, including a low-torque flexible transducer interconnect and miniature fixtures for the transducer and micromotor. The catheter tip prototypes were integrated with two-way deflectable 10-Fr catheters and used in in vivo animal testing at multiple facilities. The 4-D ICE catheters were capable of imaging a 90° azimuth by up to 180° elevation field of view. Volume rates ranged from 1 vol/sec (180° elevation) to approximately 10 vol/sec (60° elevation). We successfully imaged electrophysiology catheters, atrial septal puncture procedures, and detailed cardiac anatomy. The elevation oscillation enabled 3-D visualization of devices and anatomy, providing new clinical information and perspective not possible with current 2-D imaging catheters.

Progress in ring array transducers for real-time 3D ultrasound guidance of cardiac interventional devices

As a treatment for aortic stenosis, several companies have recently introduced prosthetic heart valves designed to be deployed through a catheter using an intravenous or transapical approach. This procedure can either take the place of open heart surgery with some ofthe devices or delay it with others. Real-time 3D ultrasound could enable continuous monitoring of these structures before, during and after deployment. We have developed a 2D ring array integrated with a 30 French catheter that is used for transapical prosthetic heart valve implantation. The transducer array was built using three 46 cm long flex circuits from MicroConnex (Snoqualmie, WA) which terminate in an interconnect that plugs directly into our system cable; thus, no cable soldering is required. This transducer consists of 210 elements at 0.157 mm interelement spacing and operates at 5 MHz. Average measured element bandwidth was 26% and average round-trip 50 ohm insertion loss was -58.1 dB after correcting for diffractive losses. The transducer was wrapped around the 1 cm diameter lumen of a heart-valve deployment catheter. Prosthetic heart valve images were obtained in water-tank studies.

Low-voltage coded excitation utilizing a miniaturized integrated ultrasound system employing piezoelectric 2-D arrays

We describe the development of an integrated, miniaturized ultrasound system designed for use with low-voltage piezoelectric transducer arrays. The technology targets low-frequency NDT and medium- to high-frequency sonar applications, at 1.2 MHz frequency. We have constructed a flexible, reconfigurable, low cost building block capable of 3-D beam forming. The tessellation of multiple building blocks permits formation of scalable 2-D macro-arrays of increased size and varying shape. This differs from conventional ultrasound solutions by integrating the entire system in a single module. No long RF cables are required to link the array elements to the electronics. The close coupling of the array and electronics assists in achieving adequate receive signal amplitudes with differential transmission voltages as low as +/- 3.3 V, although the system can be used at higher voltages. The system has been characterized by identifying flat-bottomed holes as small as 1 mm in diameter located at depths up to 190 mm in aluminum, and holes as small as 3 mm in diameter at a depth of 160 mm in cast iron. The results confirm the ability of the highly integrated system to obtain reflections from the targets despite the +/- 3.3 V excitation voltage by exploiting coding in low-voltage ultrasound.

New fabrication techniques for ring-array transducers for real-time 3D intravascular ultrasound

We have previously described miniature 2D array transducers integrated into a Cook Medical, Inc. vena cava filter deployment device. While functional, the fabrication technique was very labor intensive and did not lend itself well to efficient fabrication of large numbers of devices. We developed two new fabrication methods that we believe can be used to efficiently manufacture these types of devices in greater than prototype numbers. One transducer consisted of 55 elements operating near 5 MHz. The interelement spacing is 0.20 mm. It was constructed on a flat piece of copper-clad polyimide and then wrapped around an 11 French catheter of a Cook Medical, Inc. inferior vena cava (IVC) filter deployment device. We used a braided wiring technology from Tyco Electronics Corp. to connect the elements to our real-time 3D ultrasound scanner. Typical measured transducer element bandwidth was 20% centered at 4.7 MHz and the 50 Omega round trip insertion loss was --82 dB. The mean of the nearest neighbor cross talk was -37.0 dB. The second method consisted of a 46-cm long single layer flex circuit from MicroConnex that terminates in an interconnect that plugs directly into our system cable. This transducer had 70 elements at 0.157 mm interelement spacing operating at 4.8 MHz. Typical measured transducer element bandwidth was 29% and the 50 Omega round trip insertion loss was -83 dB. The mean of the nearest neighbor cross talk was -33.0 dB.

An integrated circuit with transmit beamforming flip-chip bonded to a 2-D CMUT array for 3-D ultrasound imaging

State-of-the-art 3-D medical ultrasound imaging requires transmitting and receiving ultrasound using a 2-D array of ultrasound transducers with hundreds or thousands of elements. A tight combination of the transducer array with integrated circuitry eliminates bulky cables connecting the elements of the transducer array to a separate system of electronics. Furthermore, preamplifiers located close to the array can lead to improved receive sensitivity. A combined IC and transducer array can lead to a portable, high-performance, and inexpensive 3-D ultrasound imaging system. This paper presents an IC flip-chip bonded to a 16 x 16-element capacitive micromachined ultrasonic transducer (CMUT) array for 3-D ultrasound imaging. The IC includes a transmit beamformer that generates 25-V unipolar pulses with programmable focusing delays to 224 of the 256 transducer elements. One-shot circuits allow adjustment of the pulse widths for different ultrasound transducer center frequencies. For receiving reflected ultrasound signals, the IC uses the 32-elements along the array diagonals. The IC provides each receiving element with a low-noise 25-MHz-bandwidth transimpedance amplifier. Using a field-programmable gate array (FPGA) clocked at 100 MHz to operate the IC, the IC generated properly timed transmit pulses with 5-ns accuracy. With the IC flip-chip bonded to a CMUT array, we show that the IC can produce steered and focused ultrasound beams. We present 2-D and 3-D images of a wire phantom and 2-D orthogonal cross-sectional images (Bscans) of a latex heart phantom.

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

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

Experimental studies with a 9F forward-looking intracardiac imaging and ablation catheter

OBJECTIVE

The purpose of this study was to develop a high-resolution, near-field-optimized 14-MHz, 24-element broad-bandwidth forward-looking array for integration on a steerable 9F electrophysiology (EP) catheter.

METHODS

Several generations of prototype imaging catheters with bidirectional steering, termed microlinear (ML), were built and tested as integrated catheter designs with EP sensing electrodes near the tip. The wide-bandwidth ultrasound array was mounted on the very tip, equipped with an aperture of only 1.2 by 1.58 mm. The array pulse echo performance was fully simulated, and its construction offered shielding from ablation noise. Both ex vivo and in vivo imaging with a porcine animal model were performed.

RESULTS

The array pulse echo performance was concordant with Krimholtz-Leedom-Matthaei model simulation. Three generations of prototype devices were tested in the right atrium and ventricle in 4 acute pig studies for the following characteristics: (1) image quality, (2) anatomic identification, (3) visualization of other catheter devices, and (4) for a mechanism for stabilization when imaging ablation. The ML catheter is capable of both low-artifact ablation imaging on a standard clinical imaging system and high-frame rate myocardial wall strain rate imaging for detecting changes in cardiac mechanics associated with ablation.

CONCLUSIONS

The imaging resolution performance of this very small array device, together with its penetration beyond 2 cm, is excellent considering its very small array aperture. The forward-looking intracardiac catheter has been adapted to work easily on an existing commercial imaging platform with very minor software modifications.

The ultrasound brain helmet: feasibility study of multiple simultaneous 3D scans of cerebral vasculature

We describe early stage experiments to test the feasibility of an ultrasound brain helmet to produce multiple simultaneous real-time three-dimensional (3D) scans of the cerebral vasculature from temporal and suboccipital acoustic windows of the skull. The transducer hardware and software of the Volumetrics Medical Imaging (Durham, NC, USA) real-time 3D scanner were modified to support dual 2.5 MHz matrix arrays of 256 transmit elements and 128 receive elements which produce two simultaneous 64 degrees pyramidal scans. The real-time display format consists of two coronal B-mode images merged into a 128 degrees sector, two simultaneous parasagittal images merged into a 128 degrees x 64 degrees C-mode plane and a simultaneous 64 degrees axial image. Real-time 3D color Doppler scans from a skull phantom with latex blood vessel were obtained after contrast agent injection as a proof of concept. The long-term goal is to produce real-time 3D ultrasound images of the cerebral vasculature from a portable unit capable of internet transmission thus enabling interactive 3D imaging, remote diagnosis and earlier therapeutic intervention. We are motivated by the urgency for rapid diagnosis of stroke due to the short time window of effective therapeutic intervention.

Intracardiac echocardiography in congenital heart disease

The use of intracardiac echocardiography (ICE) in congenital heart disease has become well established over the past 7 years since its introduction into clinical imaging. The greatest experience has been to guide percutaneous device closures of secundum atrial septal defects and patent foramen ovale, with excellent safety and clinical results. However, ICE has also been used for the evaluation and management of many other congenital heart defects given its unique blood/transducer interface and close proximity to relevant cardiac anatomy. Clinical application of ICE is expanding, with the current ICE catheters being used as micro-transesophageal echo probes, and three-dimensional prototypes already developed and tested in animal models. It is expected that ICE will further increase in use with refinements in technology and greater operator experience, aiding the management of complex congenital heart disease.

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

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

Fabrication and evaluation of fully-sampled, two-dimensional transducer array for "Sonic Window" imaging system

A low-cost, fully-sampled, 3600 element 2D transducer array operating at 5 MHz and designed for use in a hand-held ultrasound system is described here. Four array configurations are presented--(1) array with both matching and pedestal backing layers, (2) array with a matching layer but no backing pedestal, (3) array with a backing pedestal but no matching layer, and (4) array with neither matching layer nor backing pedestal. Each array was characterized in terms of impedance measurements, pulse-echo response, and experimental beamprofile. Comparative finite element analysis simulations are also presented. Average estimated active element yield for the four arrays was 94%. The array with pedestal layer proved the most promising, providing a 26% bandwidth and a 1.7 dB improvement in sensitivity with respect to the array with neither pedestal nor matching layer. Although this bandwidth is acceptable for our specific application (C-scan imaging), reverberations within the substrate material remain a potential challenge. We are currently working to fabricate a custom PCB material to address this concern, and may also consider using a pre-compensated transmit waveform or matched digital filter approach to further reduce the effects of such reverberations.

Real-time 3-D ultrasound guidance of interventional devices

We have previously developed 2-D array transducers for many real-time volumetric imaging applications. These applications include transducers operating up to 7 MHz for transthoracic imaging, up to 15 MHz for intracardiac echocardiography (ICE), 5 MHz for transesophageal echocardiography (TEE) and intracranial imaging, and 7 MHz for laparoscopic ultrasound imaging (LUS). Now we have developed a new generation of miniature ring-array transducers integrated into the catheter deployment kits of interventional devices to enable real-time 3-D ultrasound scanning for improved guidance of minimally invasive procedures. We have constructed 3 new ring transducers. The first consists of 54 elements operating at 5 MHz. Typical measured transducer element bandwidth was 25%, and the 50 Ohm round trip insertion loss was -65 dB. Average nearest neighbor cross talk was -23.8 dB. The second is a prototype 108-element transducer operating at 5 MHz. The third is a prototype 108-element ring array with a transducer center frequency of 8.9 MHz and a -6 dB bandwidth of 25%. All transducers were integrated with an 8.5 French catheter sheath of a Cook Medical, Inc. vena cava filter deployment device.

Ultrasound current source density imaging

Surgery to correct severe heart arrhythmias usually requires detailed maps of the cardiac activation wave prior to ablation. The pinpoint electrical mapping procedure is laborious and limited by its spatial resolution (5-10 mm). We propose ultrasound current source density imaging (UCSDI), a direct 3-D imaging technique that potentially facilitates existing mapping procedures with superior spatial resolution. The technique is based on a pressure-induced change in resistivity known as the acoustoelectric (AE) effect, which is spatially confined to the ultrasound focus. AE-modulated voltage recordings are used to map and reconstruct current densities. In this preliminary study, we tested UCSDI under controlled conditions and compared it with conventional electrical mapping techniques. A 2-D dipole field was produced by a pair of electrodes in a bath of 0.9% NaCl solution. Boundary electrodes detected the AE signal while a 7.5-MHz focused ultrasound transducer was scanned across the bath. UCSDI located the current source and sink to within 1 mm of their actual positions. A future UCSDI system potentially provides real-time 3-D images of the cardiac activation wave coregistered with anatomical ultrasound and would greatly facilitate corrective procedures for heart abnormalities.

3-D ultrasound guidance of surgical robotics using catheter transducers: feasibility study

The goal of this study was to test the feasibility of using a real-time 3-D (RT3D) ultrasound scanner with matrix array catheter probes to guide a surgical robot. We tested the accuracy of using 3-D catheter transducers with the 3-D measurement software of the scanner to direct automatically a robot arm that touched two needle tips together within a water tank and inside a vascular graft. RMS measurement error ranged from 2.4 to 3.4 mm for two catheter designs.

The acoustic lens design and in vivo use of a multifunctional catheter combining intracardiac ultrasound imaging and electrophysiology sensing

A multifunctional 9F intracardiac imaging and electrophysiology mapping catheter was developed and tested to help guide diagnostic and therapeutic intracardiac electrophysiology (EP) procedures. The catheter tip includes a 7.25-MHz, 64-element, side-looking phased array for high resolution sector scanning. Multiple electrophysiology mapping sensors were mounted as ring electrodes near the array for electrocardiographic synchronization of ultrasound images. The catheter array elevation beam performance in particular was investigated. An acoustic lens for the distal tip array designed with a round cross section can produce an acceptable elevation beam shape; however, the velocity of sound in the lens material should be approximately 155 m/s slower than in tissue for the best beam shape and wide bandwidth performance. To help establish the catheter's unique ability for integration with electrophysiology interventional procedures, it was used in vivo in a porcine animal model, and demonstrated both useful intracardiac echocardiographic visualization and simultaneous 3-D positional information using integrated electroanatomical mapping techniques. The catheter also performed well in high frame rate imaging, color flow imaging, and strain rate imaging of atrial and ventricular structures.

Integration of 2D CMUT arrays with front-end electronics for volumetric ultrasound imaging

For three-dimensional (3D) ultrasound imaging, connecting elements of a two-dimensional (2D) transducer array to the imaging system's front-end electronics is a challenge because of the large number of array elements and the small element size. To compactly connect the transducer array with electronics, we flip-chip bond a 2D 16 x 16-element capacitive micromachined ultrasonic transducer (CMUT) array to a custom-designed integrated circuit (IC). Through-wafer interconnects are used to connect the CMUT elements on the top side of the array with flip-chip bond pads on the back side. The IC provides a 25-V pulser and a transimpedance preamplifier to each element of the array. For each of three characterized devices, the element yield is excellent (99 to 100% of the elements are functional). Center frequencies range from 2.6 MHz to 5.1 MHz. For pulse echo operation, the average - 6-dB fractional bandwidth is as high as 125%. Transmit pressures normalized to the face of the transducer are as high as 339 kPa and input-referred receiver noise is typically 1.2 to 2.1 mPa/pHz. The flip-chip bonded devices were used to acquire 3D synthetic aperture images of a wire-target phantom. Combining the transducer array and IC, as shown in this paper, allows for better utilization of large arrays, improves receive sensitivity, and may lead to new imaging techniques that depend on transducer arrays that are closely coupled to IC electronics.

Real-time 3-d intracranial ultrasound with an endoscopic matrix array transducer

A transducer originally designed for transesophageal echocardiography (TEE) was adapted for real-time volumetric endoscopic imaging of the brain. The transducer consists of a 36 x 36 array with an interelement spacing of 0.18 mm. There are 504 transmitting and 252 receive channels placed in a regular pattern in the array. The operating frequency is 4.5 MHz with a -6 dB bandwidth of 30%. The transducer is fabricated on a 10-layer flexible circuit from Microconnex (Snoqualmie, WA, USA). The purpose of this study is to evaluate the clinical feasibility of real-time 3-D intracranial ultrasound with this device. The Volumetrics Medical Imaging (Durham, NC, USA) 3-D scanner was used to obtain images in a canine model. A transcalvarial acoustic window was created under general anesthesia in the animal laboratory by placing a 10-mm burr hole in the high parietal calvarium of a 50-kg canine subject. The burr-hole was placed in a left parasagittal location to avoid the sagittal sinus, and the transducer was placed against the intact dura mater for ultrasound imaging. Images of the lateral ventricles were produced, including real-time 3-D guidance of a needle puncture of one ventricle. In a second canine subject, contrast-enhanced 3-D Doppler color flow images were made of the cerebral vessels including the complete Circle of Willis. Clinical applications may include real-time 3-D guidance of cerebrospinal fluid extraction from the lateral ventricles and bedside evaluation of critically ill patients where computed tomography and magnetic resonance imaging techniques are unavailable.

Integration of Trench-Isolated Through-Wafer Interconnects with 2D Capacitive Micromachined Ultrasonic Transducer Arrays

This paper presents a method to provide electrical connection to a 2D capacitive micromachined ultrasonic transducer (CMUT) array. The interconnects are processed after the CMUTs are fabricated on the front side of a silicon wafer. Connections to array elements are made from the back side of the substrate via highly conductive silicon pillars that result from a deep reactive ion etching (DRIE) process. Flip-chip bonding is used to integrate the CMUT array with an integrated circuit (IC) that comprises the front-end circuits for the transducer and provides mechanical support for the trench-isolated array elements. Design, fabrication process and characterization results are presented. The advantages when compared to other through-wafer interconnect techniques are discussed.

3-D ultrasound guidance of surgical robotics: a feasibility study

Laparoscopic ultrasound has seen increased use as a surgical aide in general, gynecological, and urological procedures. The application of real-time, three-dimensional (RT3D) ultrasound to these laparoscopic procedures may increase information available to the surgeon and serve as an additional intraoperative guidance tool. The integration of RT3D with recent advances in robotic surgery also can increase automation and ease of use. In this study, a 1-cm diameter probe for RT3D has been used laparoscopically for in vivo imaging of a canine. The probe, which operates at 5 MHz, was used to image the spleen, liver, and gall bladder as well as to guide surgical instruments. Furthermore, the three-dimensional (3-D) measurement system of the volumetric scanner used with this probe was tested as a guidance mechanism for a robotic linear motion system in order to simulate the feasibility of RT3D/robotic surgery integration. Using images acquired with the 3-D laparoscopic ultrasound device, coordinates were acquired by the scanner and used to direct a robotically controlled needle toward desired in vitro targets as well as targets in a post-mortem canine. The rms error for these measurements was 1.34 mm using optical alignment and 0.76 mm using ultrasound alignment.

Real-time stereo 3D ultrasound

Real-time 3D ultrasound was developed at Duke University in 1991 and has since been used with a variety of transducers and shown effectiveness in clinical applications and in vivo animal imaging studies. Methods for displaying the 3D pyramid of data acquired by the system include selecting 2D image slices or integrating data into a volume rendered view. A third method, real-time stereo 3D imaging, is discussed here. The clinical commercial 3D system has been modified in our laboratory to display a real-time stereo image pair on the scanner display to be viewed through a stereoscope. This merges the pair into a single image, with a sensation of depth. Stereoscopic displays have previously been demonstrated to provide benefits, including improved depth judgments and increased perception of image quality in other applications. Previously-saved volumes of ultrasound data are shown in stereo 3D using the new system.

Real-time, 3-D ultrasound with multiple transducer arrays

Modifications were made to a commercial real-time, three-dimensional (3-D) ultrasound system for near simultaneous 3-D scanning with two matrix array transducers. As a first illustration, a transducer cable assembly was modified to incorporate two independent, 3-D intra-cardiac echo catheters, a 7 Fr (2.3 mm O.D.) side scanning catheter and a 14 Fr (4.7 mm O.D) forward viewing catheter with accessory port, each catheter using 85 channels operating at 5 MHz. For applications in treatment of atrial fibrillation, the goal is to place the sideviewing catheter within the coronary sinus to view the whole left atrium, including a pulmonary vein. Meanwhile, the forward-viewing catheter inserted within the left atrium is directed toward the ostium of a pulmonary vein for therapy using the integrated accessory port. Using preloaded, phasing data, the scanner switches between catheters automatically, at the push of a button, with a delay of about 1 second, so that the clinician can view the therapy catheter with the coronary sinus catheter and vice versa. Preliminary imaging studies in a tissue phantom and in vivo show that our system successfully guided the forward-viewing catheter toward a target while being imaged with the sideviewing catheter. The forward-viewing catheter then was activated to monitor the target while we mimicked therapy delivery. In the future, the system will switch between 3-D probes on a line-by-line basis and display both volumes simultaneously.

Finite-element analysis of temperature rise and lesion formation from catheter ultrasound ablation transducers

A model using finite-element analysis (FEA) has been developed to calculate the temperature rise in tissue from intracardiac ultrasound ablation catheters and to predict if this temperature rise is adequate for producing a lesion in the tissue. In the model, acoustic fields are simulated with Field II, and heat transfer is modeled with an FEA program. To validate the model, we compare its results to experimental results from an integrated, real-time three-dimensional (3-D) ultrasound imaging and ultrasound ablation catheter. The ultrasound ablation transducer is a ring transmitting at 10 MHz capable of producing an acoustic intensity of 16 W/cm2. It was used to ablate four lesions in tissue, and temperature rise as a function of time was monitored by embedded thermocouples. The average absolute difference between final temperatures predicted by FEA and those measured is 1.95 +/- 0.72 degrees C. Additionally, model and experimental lesion size are in good agreement. The model then is used to design a new ultrasound catheter with a 7.5 MHz linear phased array for ablation. Eight designs are modeled, and acoustic intensity, temperature rise, and ablation ability are compared.

Real-time 3D laparoscopic ultrasonography

We have previously described 2D array ultrasound transducers operating up to 10 MHz for applications including real time 3D transthoracic imaging, real time volumetric intracardiac echocardiography (ICE), real time 3D intravascular ultrasound (IVUS) imaging, and real time 3D transesophageal echocardiography (TEE). We have recently built a pair of 2D array transducers for real time 3D laparoscopic ultrasonography (3D LUS). These transducers are intended to be placed down a trocar during minimally invasive surgery. The first is a forward viewing 5 MHz, 11 x 19 array with 198 operating elements. It was built on an 8 layer multilayer flex circuit. The interelement spacing is 0.20 mm yielding an aperture that is 2.2 mm x 3.8 mm. The O.D. of the completed transducer is 10.2 mm and includes a 2 mm tool port. The average measured center frequency is 4.5 MHz, and the -6 dB bandwidth ranges from 15% to 30%. The 50 omega insertion loss, including Gore MicroFlat cabling, is -81.2 dB. The second transducer is a 7 MHz, 36 x 36 array with 504 operating elements. It was built upon a 10 layer multilayer flex circuit. This transducer is in the forward viewing configuration and the interelement spacing is 0.18 mm. The total aperture size is 6.48 mm x 6.48 mm. The O.D. of the completed transducer is 11.4 mm. The average measured center frequency is 7.2 MHz, and the -6 dB bandwidth ranges from 18% to 33%. The 50 omega insertion loss is -79.5 dB, including Gore MicroFlat cable. Real-time in vivo 3D images of canine hearts have been made including an apical 4-chamber view from a substernal access with the first transducer to monitor cardiac function. In addition, we produced real time 3D rendered images of the right pulmonary veins from a right parastemal access with the second transducer, which would be valuable in the guidance of cardiac ablation catheters for treatment of atrial fibrillation.

Real-time 3D transesophageal echocardiography

Transesophageal echocardiography (TEE) is an essential diagnostic tool in patients with poor transthoracic echocardiographic windows or when detailed imaging of structures distant from the chest wall is necessary. A real-time 3D TEE probe has been fabricated in our laboratory in order to increase the amount of information available during a transesophageal procedure. The 1 cm diameter esophageal probe utilizes a 2-dimensional, 5 MHz array at its tip with a 6.3 mm diameter aperture, including 504 active channels. The array has a periodic vernier geometry with an element pitch of 0.18 mm, built onto a multilayer flexible (MLF) interconnect circuit. In order to accommodate 504 channels within the device, a 1 m long Gore MicroFlat cable was utilized for wiring the MLF to the corresponding system connectors. Pulse-echo tests in a water tank have yielded a -6 dB bandwidth of 25.3%. Fully connected to the system through 3 m of cable, the probe shows an average 50 omega insertion loss of-85 dB with a standard deviation of 4 dB, as determined through pitch-catch measurements for a sampling of 10 elements. Using the completed 3D TEE probe with the Volumetrics Medical Imaging 3D scanner, real-time volumetric images of in vivo canine cardiac anatomy have been acquired, displaying atrial views, mitral valve function and interventional catheter guidance.