The effect of phase cancellation on estimates of calcaneal broadband ultrasound attenuation in vivo

Backscatter measurement of cancellous bone using the ultrasound transit time spectroscopy

Recently, ultrasound transit time spectroscopy (UTTS) was proposed as a promising method for bone quantitative ultrasound measurement. Studies have showed that UTTS could estimate the bone volume fraction and other trabecular bone structure in ultrasonic through-transmission measurements. The goal of this study was to explore the feasibility of UTTS to be adapted in ultrasonic backscatter measurement and further evaluate the performance of backscattered ultrasound transit time spectrum (BS-UTTS) in the measurement of cancellous bone density and structure. First, taking ultrasonic attenuation into account, the concept of BS-UTTS was verified on ultrasonic backscatter signals simulated from a set of scatterers with different positions and intensities. Then, in vitro backscatter measurements were performed on 26 bovine cancellous bone specimens. After a logarithmic compression of the BS-UTTS, a linear fitting of the log-compressed BS-UTTS versus ultrasonic propagated distance was performed and the slope and intercept of the fitted line for BS-UTTS were determined. The associations between BS-UTTS parameters and cancellous bone features were analyzed using simple linear regression. The results showed that the BS-UTTS could make an accurate deconvolution of the backscatter signal and predict the position and intensity of the simulated scatterers eliminating phase interference, even the simulated backscatter signal was with a relatively low signal-to-noise ratio. With varied positions and intensities of the scatterers, the slope of the fitted line for the log-compressed BS-UTTS versus ultrasonic propagated distance (i.e., slope of BS-UTTS for short) yield a high agreement (r2 = 99.84%-99.96%) with ultrasonic attenuation in simulated backscatter signal. Compared with the high-density cancellous bone, the low-density specimen showed more abundant backscatter impulse response in the BS-UTTS. The slope of BS-UTTS yield a significant correlation with bone mineral density (r = 0.87; p < 0.001), BV/TV (r = 0.87; p < 0.001), and cancellous bone microstructures (r up to 0.87; p < 0.05). The intercept of BS-UTTS was also significantly correlated with bone densities (r = -0.87; p < 0.001) and trabecular structures (|r|=0.43-0.80; p < 0.05). However, the slope of the BS-UTTS underestimated attenuation when measurements were performed experimentally. In addition, a significant non-linear relationship was observed between the measured attenuation and the attenuation estimated by the slope of the BS-UTTS. This study demonstrated that the UTTS method could be adapted to ultrasonic backscatter measurement of cancellous bone. The derived slope and intercept of BS-UTTS could be used in the measurement of bone density and microstructure. The backscattered ultrasound transit time spectroscopy might have potential in the diagnosis of osteoporosis in the clinic.

Comparison of quantitative ultrasonography and dual X-ray absorptiometry for bone status assessment in South African children living with HIV

Children living with HIV (CLHIV) have decreased bone mineral content (BMC) and density (BMD), increasing risk for fracture and future osteoporosis. While DXA is the gold-standard for bone assessments, it lacks availability in resource-constrained settings (RCS). Quantitative ultrasound (QUS) offers an alternative owing to its portability, low cost, ease of handling, and lack of ionizing radiation. While QUS has detected reduced bone quality in CLHIV, the relationship between QUS and DXA in this population remains unexplored. At baseline and 12 months, BMC and BMD of the whole body, lumbar spine, and radius were measured by DXA in a longitudinal cohort of CLHIV in Johannesburg, South Africa. Calcaneal speed of sound (SOS) and broadband ultrasound attenuation (BUA) and radius SOS were obtained by QUS, and calcaneal stiffness index (SI) was calculated. Spearman correlations, with and without HIV stratification, were performed between QUS and DXA measurements at each visit and for absolute difference in measurements between visits. At baseline and 12-months, calcaneal BUA and SI displayed strong positive correlations with DXA, with only modest correlations between radial QUS and DXA at baseline. Longitudinal measures of QUS did not correlate with DXA. At both baseline and 12-months, individuals with DXA whole-body BMD z-score < -1 displayed significantly lower calcaneal BUA and SI. Cross-sectionally, calcaneal QUS correlates strongly with whole body DXA and may represent a viable diagnostic alternative in RCS. Longitudinally, the two methods do not correlate well, possibly reflecting that each method assesses distinct aspects of bone architecture.

Mechanisms of Interaction of Ultrasound With Cancellous Bone: A Review

Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of attenuation and sound speed in cancellous bone. This review discusses fundamental mechanisms underlying the interaction between ultrasound and cancellous bone. Because of its two-phase structure (mineralized trabecular network embedded in soft tissue-marrow), its anisotropy, and its inhomogeneity, cancellous bone is more difficult to characterize than most soft tissues. Experimental data for the dependencies of attenuation, sound speed, dispersion, and scattering on ultrasound frequency, bone mineral density, composition, microstructure, and mechanical properties are presented. The relative roles of absorption, scattering, and phase cancellation in determining attenuation measurements in vitro and in vivo are delineated. Common speed of sound metrics, which entail measurements of transit times of pulse leading edges (to avoid multipath interference), are greatly influenced by attenuation, dispersion, and system properties, including center frequency and bandwidth. However, a theoretical model has been shown to be effective for correction for these confounding factors in vitro and in vivo. Theoretical and phantom models are presented to elucidate why cancellous bone exhibits negative dispersion, unlike soft tissue, which exhibits positive dispersion. Signal processing methods are presented for separating "fast" and "slow" waves (predicted by poroelasticity theory and supported in cancellous bone) even when the two waves overlap in time and frequency domains. Models to explain dependencies of scattering on frequency and mean trabecular thickness are presented and compared with measurements. Anisotropy, the effect of the fluid filler medium (marrow in vivo or water in vitro), phantoms, computational modeling of ultrasound propagation, acoustic microscopy, and nonlinear properties in cancellous bone are also discussed.

The dependence of broadband ultrasound attenuation on phase interference in thin plates of variable thickness and curvature: a comparison of experimental measurement and computer simulation

The measurement of broadband ultrasound attenuation describes the linear increase in ultrasound attenuation with frequency (dB/MHz); this is generally performed at the calcaneus, consisting of a high proportion of metabolically active cancellous bone. Although broadband ultrasound attenuation is not routinely implemented within clinical management since it cannot provide a reliable estimation of bone mineral density and hence clinical definition of osteopenia and osteoporosis, it offers a reliable means to predict osteoporotic fracture risk. One of the potential factors that can influence the accuracy of broadband ultrasound attenuation measurement is the effect of cortical end plates. This study aimed to explore this, performing a comparison of experimental study and computer simulation prediction. A total of three categories of thin discs were three-dimensional (3D) printed to replicate cortical shells of (1) variable constant thickness (planar), (2) variable constant thickness (curved), and (3) variable thickness. A through-transmission technique was used, where two single-element, unfocused, 1 MHz broadband transducers, as utilised clinically, were positioned coaxially in a cylindrical holder and immersed in water. Both quantitative and qualitative analyses demonstrated that broadband ultrasound attenuation measurements of the 'planar' and 'curved' discs were not statistically different (p-values > 0.01). A cyclic relationship between broadband ultrasound attenuation and disc thickness was observed; this was replicated within a computer simulation of phase interference created by a double-reflection echo within each disc (R² = 97.0%). Variable-thickness discs provided broadband ultrasound attenuation measurements ranging between 31.6 ± 0.1 and 40.60 ± 0.1 dB/MHz. Again applying the double-reflection echo simulation, a high level of agreement between experimental and simulation was recorded (R² = 93.4%). This study indicates that the cortical end plate can significantly affect the broadband ultrasound attenuation measurement of cancellous bone as a result of phase interference and, therefore, warrants further investigation to minimise its effect on clinical assessment.

Ultrasound temporal-spatial phase-interference in complex composite media; a comparison of experimental measurement and simulation prediction

The propagation of ultrasound through solid:liquid complex composite media such as cancellous bone suffers from a lack of a comprehensive understanding of the dependence upon density and structure. Assuming that a propagating ultrasound wave may be considered as an array of parallel sonic rays, we may determine the transit time of each by the relative proportion of the two constituents. A transit time spectrum (TTS) describes the proportion of sonic rays having a particular transit time between the minimum (tmin) and maximum (tmax) values; representing, for example, entire bone tissue and marrow respectively in the case of cancellous bone. Langton has proposed that the primary ultrasound attenuation mechanism in such media is phase-interference. The phase-interference of two or more ultrasound pulses detected at a phase-sensitive transducer has both temporal and spatial components. The temporal component is primarily dependent upon the transit time difference (dt) between the pulses and the propagating pulse-length (PL). The spatial component is primarily dependent upon the lateral separation (ds) of the detectedpulses of differing transit time and the lateral dimension of the ultrasound receive transducer aperture (dL). The aim of the paper was to explore these temporal and spatial dependencies through a comparison of experimental measurement and computer simulation in solid:liquid models of varying temporal and spatial complexity. Transmission measurements at nominal ultrasound frequencies of 1MHz and 5MHz were performed, thereby investigating the dependency upon period. The results demonstrated an overall agreement between experimental measurement and computer simulation of 87±16% and 85±12% for temporal and spatial components respectively. It is envisaged that a comprehensive understanding of ultrasound propagation through complex structures such as cancellous bone could provide an improved non-invasive tool for osteoporosis assessment.

Solid volume fraction estimation of bone:marrow replica models using ultrasound transit time spectroscopy

The acceptance of broadband ultrasound attenuation (BUA) for the assessment of osteoporosis suffers from a limited understanding of both ultrasound wave propagation through cancellous bone and its exact dependence upon the material and structural properties. It has recently been proposed that ultrasound wave propagation in cancellous bone may be described by a concept of parallel sonic rays; the transit time of each ray defined by the proportion of bone and marrow propagated. A Transit Time Spectrum (TTS) describes the proportion of sonic rays having a particular transit time, effectively describing the lateral inhomogeneity of transit times over the surface aperture of the receive ultrasound transducer. The aim of this study was to test the hypothesis that the solid volume fraction (SVF) of simplified bone:marrow replica models may be reliably estimated from the corresponding ultrasound transit time spectrum. Transit time spectra were derived via digital deconvolution of the experimentally measured input and output ultrasonic signals, and compared to predicted TTS based on the parallel sonic ray concept, demonstrating agreement in both position and amplitude of spectral peaks. Solid volume fraction was calculated from the TTS; agreement between true (geometric calculation) with predicted (computer simulation) and experimentally-derived values were R(2)=99.9% and R(2)=97.3% respectively. It is therefore envisaged that ultrasound transit time spectroscopy (UTTS) offers the potential to reliably estimate bone mineral density and hence the established T-score parameter for clinical osteoporosis assessment.

Conventional, Bayesian, and Modified Prony's methods for characterizing fast and slow waves in equine cancellous bone

Conventional, Bayesian, and the modified least-squares Prony's plus curve-fitting (MLSP + CF) methods were applied to data acquired using 1 MHz center frequency, broadband transducers on a single equine cancellous bone specimen that was systematically shortened from 11.8 mm down to 0.5 mm for a total of 24 sample thicknesses. Due to overlapping fast and slow waves, conventional analysis methods were restricted to data from sample thicknesses ranging from 11.8 mm to 6.0 mm. In contrast, Bayesian and MLSP + CF methods successfully separated fast and slow waves and provided reliable estimates of the ultrasonic properties of fast and slow waves for sample thicknesses ranging from 11.8 mm down to 3.5 mm. Comparisons of the three methods were carried out for phase velocity at the center frequency and the slope of the attenuation coefficient for the fast and slow waves. Good agreement among the three methods was also observed for average signal loss at the center frequency. The Bayesian and MLSP + CF approaches were able to separate the fast and slow waves and provide good estimates of the fast and slow wave properties even when the two wave modes overlapped in both time and frequency domains making conventional analysis methods unreliable.

Fast and slow wave detection in bovine cancellous bone in vitro using bandlimited deconvolution and Prony's method

Fast and slow waves were detected in a bovine cancellous bone sample for thicknesses ranging from 7 to 12 mm using bandlimited deconvolution and the modified least-squares Prony's method with curve fitting (MLSP + CF). Bandlimited deconvolution consistently isolated two waves with linear-with-frequency attenuation coefficients as evidenced by high correlation coefficients between attenuation coefficient and frequency: 0.997 ± 0.002 (fast wave) and 0.986 ± 0.013 (slow wave) (mean ± standard deviation). Average root-mean-squared (RMS) differences between the two algorithms for phase velocities were 5 m/s (fast wave, 350 kHz) and 13 m/s (slow wave, 750 kHz). Average RMS differences for signal loss were 1.6 dB (fast wave, 350 kHz) and 0.4 dB (slow wave, 750 kHz). Phase velocities for thickness = 10 mm were 1726 m/s (fast wave, 350 kHz) and 1455 m/s (slow wave, 750 kHz). Results show support for the model of two waves with linear-with frequency attenuation, successful isolation of fast and slow waves, good agreement between bandlimited deconvolution and MLSP + CF as well as with a Bayesian algorithm, and potential variations of fast and/or slow wave properties with bone sample thickness.

Time-domain separation of interfering waves in cancellous bone using bandlimited deconvolution: simulation and phantom study

In through-transmission interrogation of cancellous bone, two longitudinal pulses ("fast" and "slow" waves) may be generated. Fast and slow wave properties convey information about material and micro-architectural characteristics of bone. However, these properties can be difficult to assess when fast and slow wave pulses overlap in time and frequency domains. In this paper, two methods are applied to decompose signals into fast and slow waves: bandlimited deconvolution and modified least-squares Prony's method with curve-fitting (MLSP + CF). The methods were tested in plastic and Zerdine(®) samples that provided fast and slow wave velocities commensurate with velocities for cancellous bone. Phase velocity estimates were accurate to within 6 m/s (0.4%) (slow wave with both methods and fast wave with MLSP + CF) and 26 m/s (1.2%) (fast wave with bandlimited deconvolution). Midband signal loss estimates were accurate to within 0.2 dB (1.7%) (fast wave with both methods), and 1.0 dB (3.7%) (slow wave with both methods). Similar accuracies were found for simulations based on fast and slow wave parameter values published for cancellous bone. These methods provide sufficient accuracy and precision for many applications in cancellous bone such that experimental error is likely to be a greater limiting factor than estimation error.

An experimental study on the ultrasonic wave propagation in cancellous bone: waveform changes during propagation

Wave propagation in a trabecular bone was experimentally investigated using an acoustic tube. For the purposes of this study, a cubic sample was gradually filed so the waveform change due to the sample thickness could be observed. The initial sample showed clear two-wave separation. As the sample became thinner, the fast and slow waves gradually overlapped. The apparent frequencies and amplitudes of the fast waves obtained from the time domain data decreased significantly for the smaller thicknesses. This indicates an increase in the apparent attenuation at the initial stage of the propagation. Next the authors investigated the distribution of the ultrasonic field after the transmission through the cancellous bone sample. In addition to a large aperture receiver, a needle-type ultrasonic transducer was used to observe the ultrasonic field. Within an area of the same size of the large transducer, the waveforms retrieved with the needle sensor exhibited high spatial variations; however, the averaged waveform in the plane was similar to the waveform obtained with the large aperture receiver. This indicates that the phase cancellation effect on the surface of the large aperture receiver can be one of the reasons for the strong apparent attenuation observed at the initial stages of the propagation.

Experimental and computer simulation validation of ultrasound phase interference created by lateral inhomogeneity of transit time in replica bone: marrow composite models

The measurement of broadband ultrasound attenuation in cancellous bone for the assessment of osteoporosis follows a parabolic-type dependence with bone volume fraction, having minima values corresponding to both entire bone and entire marrow. Langton has recently proposed that the primary attenuation mechanism is phase interference due to variations in propagation transit time through the test sample as detected over the phase-sensitive surface of the receive ultrasound transducer. This fundamentally simple concept assumes that the propagation may be considered as an array of parallel ‘sonic rays’. The transit time of each ray is defined by the proportion of bone and marrow propagated, being a minimum (tmin) solely through bone and a maximum (tmax) solely through marrow, from which a transit time spectrum, may be defined describing the proportion of sonic rays having a particular transit time.

The aim of this study was to test the hypothesis that there is a dependence of phase interference upon the lateral inhomogeneity of transit time by comparing experimental measurements and computer simulation predictions of ultrasound propagation through a range of relatively simplistic solid:liquid models.

From qualitative and quantitative comparison of the experimental and computer simulation results, there is an extremely high degree of agreement of 94.2%–99.0% between the two approaches. This combined experimental and computer simulation study has successfully demonstrated that lateral inhomogeneity of transit time has significant potential for phase interference to occur if a phase-sensitive receive ultrasound transducer is implemented as in most commercial ultrasound bone analysis devices.

Estimation of fast and slow wave properties in cancellous bone using Prony's method and curve fitting

The presence of two longitudinal waves in poroelastic media is predicted by Biot's theory and has been confirmed experimentally in through-transmission measurements in cancellous bone. Estimation of attenuation coefficients and velocities of the two waves is challenging when the two waves overlap in time. The modified least squares Prony's (MLSP) method in conjuction with curve-fitting (MLSP + CF) is tested using simulations based on published values for fast and slow wave attenuation coefficients and velocities in cancellous bone from several studies in bovine femur, human femur, and human calcaneus. The search algorithm is accelerated by exploiting correlations among search parameters. The performance of the algorithm is evaluated as a function of signal-to-noise ratio (SNR). For a typical experimental SNR (40 dB), the root-mean-square errors (RMSEs) for one example (human femur) with fast and slow waves separated by approximately half of a pulse duration were 1 m/s (slow wave velocity), 4 m/s (fast wave velocity), 0.4 dB/cm MHz (slow wave attenuation slope), and 1.7 dB/cm MHz (fast wave attenuation slope). The MLSP + CF method is fast (requiring less than 2 s at SNR = 40 dB on a consumer-grade notebook computer) and is flexible with respect to the functional form of the parametric model for the transmission coefficient. The MLSP + CF method provides sufficient accuracy and precision for many applications such that experimental error is a greater limiting factor than estimation error.

Effects of phase cancellation and receiver aperture size on broadband ultrasonic attenuation for trabecular bone in vitro

Phase cancellation in ultrasound due to large receiver size has been proposed as a contributing factor to the inaccuracy of estimating broadband ultrasound attenuation (BUA), which is used to characterize bone quality. Transducers with aperture size ranging from 2 to 5 mm have been used in previous attempts to study the effect of phase cancellation. However, these receivers themselves are susceptible to phase cancellation because aperture size is close to one center wavelength (about 3 mm at 500 KHz in water). This study uses an ultra small receiver (aperture size: 0.2 mm) in conjunction with a newly developed two-dimensional (2-D) synthetic array system to investigate the effects of phase cancellation and receiver aperture size on BUA estimations of bone tissue. In vitro ultrasound measurements were conducted on 54 trabecular bone samples (harvested from sheep femurs) in a confocal configuration with a focused transmitter and synthesized focused receivers of different aperture sizes. Phase sensitive (PS) and phase insensitive (PI) detections were performed. The results show that phase cancellation does have a significant effect on BUA. The normalized BUA (nBUA) with PS is 8.1% higher than PI nBUA while PI BUA is well correlated with PS BUA. Receiver aperture size also influences the BUA reading for both PI and PS detection and smaller receiver aperture tends to result in higher BUA readings. The results also indicate that the receiver aperture size used in the confocal configuration with PI detection should at least equal the aperture of the transmitter to capture most of the energy redistributed by the interference and diffraction from the trabecular bone.

Determining attenuation properties of interfering fast and slow ultrasonic waves in cancellous bone

Previous studies have shown that interference between fast waves and slow waves can lead to observed negative dispersion in cancellous bone. In this study, the effects of overlapping fast and slow waves on measurements of the apparent attenuation as a function of propagation distance are investigated along with methods of analysis used to determine the attenuation properties. Two methods are applied to simulated data that were generated based on experimentally acquired signals taken from a bovine specimen. The first method uses a time-domain approach that was dictated by constraints imposed by the partial overlap of fast and slow waves. The second method uses a frequency-domain log-spectral subtraction technique on the separated fast and slow waves. Applying the time-domain analysis to the broadband data yields apparent attenuation behavior that is larger in the early stages of propagation and decreases as the wave travels deeper. In contrast, performing frequency-domain analysis on the separated fast waves and slow waves results in attenuation coefficients that are independent of propagation distance. Results suggest that features arising from the analysis of overlapping two-mode data may represent an alternate explanation for the previously reported apparent dependence on propagation distance of the attenuation coefficient of cancellous bone.

Inverse problems in cancellous bone: estimation of the ultrasonic properties of fast and slow waves using Bayesian probability theory

Quantitative ultrasonic characterization of cancellous bone can be complicated by artifacts introduced by analyzing acquired data consisting of two propagating waves (a fast wave and a slow wave) as if only one wave were present. Recovering the ultrasonic properties of overlapping fast and slow waves could therefore lead to enhancement of bone quality assessment. The current study uses Bayesian probability theory to estimate phase velocity and normalized broadband ultrasonic attenuation (nBUA) parameters in a model of fast and slow wave propagation. Calculations are carried out using Markov chain Monte Carlo with simulated annealing to approximate the marginal posterior probability densities for parameters in the model. The technique is applied to simulated data, to data acquired on two phantoms capable of generating two waves in acquired signals, and to data acquired on a human femur condyle specimen. The models are in good agreement with both the simulated and experimental data, and the values of the estimated ultrasonic parameters fall within expected ranges.

Characterization of the trabecular bone structure using frequency modulated ultrasound pulse

The objective of this study was to investigate the efficacy of modulated ultrasound signals in the measurement of bone properties as an early indicator of osteoporosis. Twenty-one trabecular bone cubes were harvested from sheep femoral condyles and the cube axes corresponded to the anatomic superior-inferior (SI), antero-posterior (AP), and medio-lateral (ML) orientations. Micro-CT measurements were made on those samples to obtain bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). Ultrasound tests were performed in the three orthogonal orientations using pulse and frequency modulated ultrasound. The comparison of the frequency modulated attenuation (FMA) with the broadband ultrasound attenuation (BUA) was made within the frequency band between 300 and 700 kHz. Results showed that FMA demonstrated higher correlations to the trabecular structure properties in the SI orientation (R(2)=0.84 for BV/TV, R(2)=0.77 for Tb.Th, R(2)=0.7 for Tb.Sp) than BUA (R(2)=0.30 for BV/TV, R(2)=0.27 for Tb.Th, R(2)=0.33 for Tb.Sp). In the AP orientation, FMA had higher correlation to Tr.Sp (R(2)=0.64) than BUA (R(2)=0.48), and relatively lower correlation to BV/TV (R(2)=0.48) and Tb.Th (R(2)=0.31) than BUA (R(2)=0.64 for BV/TV and R(2)=0.58 for Tb.Th). The results suggested that FMA could be a new ultrasound index for bone properties assessment.

Bone sonometry: reducing phase aberration to improve estimates of broadband ultrasonic attenuation

Previous studies suggest that phase cancellation at the receiving transducer can result in the overestimation of the frequency dependent ultrasonic attenuation of bone, a quantity that has been shown to correlate with bone mineral density and ultimately with osteoporotic fracture risk. Evidence supporting this interpretation is provided by phase insensitive processing of the data, which appear to reduce the apparent overestimates of attenuation. The present study was designed to clarify the components underlying phase aberration artifacts in such through-transmission measurements by conducting systematic studies of the simplest possible test objects capable of introducing phase aberration. Experimental results are presented for a Lexan phantom over the frequency range 300-700 kHz and a Plexiglas phantom over the 3-7 MHz range. Both phantoms were flat and parallel plates featuring a step discontinuity milled into one of their initially flat sides. The through-transmitted signals were received by a 0.6 mm diameter membrane hydrophone that was raster scanned over a grid coaxial with the transmitting transducer. Signals received by the pseudoarray were processed offline to emulate phase sensitive and phase insensitive receivers with different aperture diameters. The data processed phase sensitively were focused to demonstrate the results of planar, geometrical, and correlation-based aberration correction methods. Results are presented illustrating the relative roles of interference in the ultrasonic field and phase cancellation at the receiving transducer in producing phase aberration artifacts. It was found that artifacts due to phase cancellation or interference can only be minimized with phase insensitive summation techniques by choosing an appropriately large receiving aperture. Data also suggest the potentially confounding role of time-and frequency-domain artifacts on ultrasonic measurements and illustrate the advantages of two-dimensional receiving arrays in determining the slope of attenuation (nBUA) for the clinical assessment of osteoporosis.

The measurement of broadband ultrasonic attenuation in cancellous bone--a review of the science and technology

The measurement of broadband ultrasonic attenuation (BUA) in cancellous bone at the calcaneus was first described in 1984. The assessment of osteoporosis by BUA has recently been recognized by Universities UK, within its EurekaUK book, as being one of the "100 discoveries and developments in UK Universities that have changed the world" over the past 50 years, covering the whole academic spectrum from the arts and humanities to science and technology. Indeed, BUA technique has been clinically validated and is utilized worldwide, with at least seven commercial systems providing calcaneal BUA measurement. However, a fundamental understanding of the dependence of BUA upon the material and structural properties of cancellous bone is still lacking. This review aims to provide a science- and technology-orientated perspective on the application of BUA to the medical disease of osteoporosis.

Negative dispersion in bone: the role of interference in measurements of the apparent phase velocity of two temporally overlapping signals

In this study the attenuation coefficient and dispersion (frequency dependence of phase velocity) are measured using a phase sensitive (piezoelectric) receiver in a phantom in which two temporally overlapping signals are detected, analogous to the fast and slow waves typically found in measurements of cancellous bone. The phantom consisted of a flat and parallel Plexiglas plate into which a step discontinuity was milled. The phase velocity and attenuation coefficient of the plate were measured using both broadband and narrowband data and were calculated using standard magnitude and phase spectroscopy techniques. The observed frequency dependence of the phase velocity and attenuation coefficient exhibit significant changes in their frequency dependences as the interrogating ultrasonic field is translated across the step discontinuity of the plate. Negative dispersion is observed at specific spatial locations of the plate at which the attenuation coefficient rises linearly with frequency, a behavior analogous to that of bone measurements reported in the literature. For all sites investigated, broadband and narrowband data (3-7 MHz) demonstrate excellent consistency. Evidence suggests that the interference between the two signals simultaneously reaching the phase sensitive piezoelectric receiver is responsible for this negative dispersion.

The effect of phase cancellation on estimates of broadband ultrasound attenuation and backscatter coefficient in human calcaneus in vitro

Broadband ultrasound attenuation (BUA) is a clinically proven indicator of osteoporotic fracture risk. BUA measurements are typically performed in throughtransmission with single-element phase sensitive (PS) receivers and therefore can be compromised by phase cancellation artifact. Phase-insensitive (PI) receivers suppress phase cancellation artifact. To study the effect of phase cancellation on BUA measurements, through-transmission measurements were performed on 16 human calcaneus samples in vitro using a two-dimensional receiver array that enabled PS and PI BUA estimation. The means plus or minus standard deviations for BUA measurements were 22.1 +/- 15.8 dB/MHz (PS) and 17.6 +/- 7.2 dB/MHz (PI), suggesting that, on the average, approximately 20% of PS BUA values in vitro can be attributed to phase cancellation artifact. Therefore, although cortical plates are often regarded as the primary source of phase cancellation artifact, the heterogeneity of cancellous bone in the calcaneal interior may also be a significant source. Backscatter coefficient estimates in human calcaneus that are based on PS attenuation compensation overestimate 1) average magnitude of backscatter coefficient at 500 kHz by a factor of about 1.6 +/- 0.3 and 2) average exponent (n) of frequency dependence by about 0.34 +/- 0.12 (where backscatter coefficient is fit to a power law form proportional to frequency to the nth power).

Instrumentation for in vivo ultrasonic characterization of bone strength

Although it has been more than 20 years since the first recorded use of a quantitative ultrasound (QUS) technology to predict bone fragility, the field has not yet reached its maturity. QUS has the potential to predict fracture risk in several clinical circumstances and has the advantages of being nonionizing, inexpensive, portable, highly acceptable to patients, and repeatable. However, the wide dissemination of QUS in clinical practice is still limited and suffering from the absence of clinical consensus on how to integrate QUS technologies in bone densitometry armamentarium. Several critical issues need to be addressed to develop the role of QUS within rheumatology. These include issues of technologies adapted to measure the central skeleton, data acquisition, and signal processing procedures to reveal bone properties beyond bone mineral quantity and elucidation of the complex interaction between ultrasound and bone structure. This article reviews the state-of-the art in technological developments applied to assess bone strength in vivo. We describe generic measurement and signal processing methods implemented in clinical ultrasound devices, the devices and their practical use, and performance measures. The article also points out the present limitations, especially those related to the absence of standardization, and the lack of comprehensive theoretical models. We conclude with suggestions of future lines and trends in technology challenges and research areas such as new acquisition modes, advanced signal processing techniques, and modelization.