Estimation of displacement location for enhanced strain imaging

Influence of Power-Weighted Center of Echo Signal Within Window Function on Local Strain Rate Distribution in Left Ventricular Wall

OBJECTIVE

The deviation of the power-weighted center of the echo signal from the geometric center within the velocity estimation window for calculating strain rate (SR) causes an estimation error. This study aimed to confirm whether an erroneous multilayer pattern in the SR distribution of the left ventricular wall could be corrected by considering the power-weighted center of the echo signal.

METHODS

The SR distributions were measured locally in the transmural direction around the pre-ejection and early diastolic phases in healthy volunteers. The estimation error related to the power-weighted center of the echo signal was corrected using a previously proposed method, and the effectiveness of the correction was confirmed based on the accuracy of the estimated myocardial displacement.

RESULTS

The SR distribution in early diastole was observed as multilayers of low- and high-amplitude negative SRs. However, this multilayer pattern disappeared after correction. In the pre-ejection phase, multilayers of positive and negative SRs were observed in the SR distributions with and without correction. This correction was sufficiently effective in accurately tracking the local peak of the echo signal.

CONCLUSION

The multilayer pattern of low- and high-amplitude positive or negative SRs is caused by estimation errors related to the power-weighted center of the echo signal. The multilayer pattern of positive and negative SRs might not be caused by these errors and might relate to the actual change in myocardial thickness because the estimation errors do not convert the negative (positive) SR to positive (negative) in a homogeneous negative (positive) SR distribution.

Artifacts detection-based adaptive filtering to noise reduction of strain imaging

Strain imaging in medical ultrasound is the imaging modality of elastic properties of biological tissue. In general, strain image will suffer from artifacts noise, which degrades lesion detectability and increases the likelihood of misdiagnosis. How to both suppress artifacts effectively and preserve the structure is vital for diagnosis and also for image post-processing. The bilateral filtering can reduce artifact noise and, at the same time, maintain the tissue structure. However, the balance between noise suppression and edge preservation often makes the threshold selection difficult. This paper is to solve the problem of difficult threshold selection in bilateral filtering. The probability distribution function of amplitude modulation noise in this paper is derived from the statistics of uncompressed speckle. The statistical model of artifact formation is useful for designing an adaptive fast bilateral filter for artifact reduction in ultrasound strain imaging. Both simulation and phantom testing show that the proposed method can improve the quality of ultrasonic strain imaging. Furthermore, the elastographic signal-to-noise ratio was increased by 129.91% and 52.36% for simulated and phantom strain images. The elastographic contrast-to-noise ratio was increased by 521.42% and 218.07% for simulated and phantom strain images, respectively. As indicated by the profiles, the proposed method produces a better result for the purpose of visualization.

Diverging beam with synthetic aperture technique for rotation elastography: preliminary experimental results

Rotation Elastogram (RE) is a 2D spatial distribution map of the estimated local rigid-body rotation undergone by a target when subjected to an external compression, which is one of the recent variants in elastographic imaging. A recent study has shown that inclusion-contrast in RE is independent of inclusion-background modulus contrast and thus may be helpful in distinguishing between barely-stiff benign and malignant lesions. However, estimation of quality RE requires not only precise axial displacement estimates but also lateral displacement estimates. The widely used conventional focused beamforming technique using linear array (CFB-LA) provides better lateral resolution only over the depth of focus, which still results in poorer quality lateral displacement estimates compared to the axial displacement estimates. As an alternative to overcome this depth-dependent lateral resolution and obtain an improved lateral resolution, synthetic aperture-based approaches have been proposed in literature. Recently, we developed a synthetic aperture-based method, diverging beam with synthetic aperture technique (DB-SAT) that was aimed to not only reduce the ultrasound system complexity, but also provide improved lateral resolution throughout the depth of imaging and at higher frame-rate than that is possible in CFB-LA. In this paper, we report the preliminary experimental findings on the use of DB-SAT on RE and compare the resultant image quality against that obtained using often-employed CFB-LA and the synthetic transmit aperture (STA) technique. The investigation was done on tissue-mimicking phantoms and using contrast-to-noise ratio (CNR) as the metric for performance evaluation. The estimated CNR values from the REs obtained using CFB-LA, STA, and DB-SAT were 2.69  ±  0.81, 1.35  ±  0.22, and 14.71  ±  9.83, respectively, for inclusion present at 55 mm depth. The obtained results clearly demonstrated that the quality of RE can be improved significantly, especially at larger depth, using DB-SAT compared to that obtained using CFB-LA and STA technique.

A novel filter for accurate estimation of fluid pressure and fluid velocity using poroelastography

Fluid pressure and fluid velocity carry important information for cancer diagnosis, prognosis and treatment. Recent work has demonstrated that estimation of these parameters is theoretically possible using ultrasound poroelastography. However, accurate estimation of these parameters requires high quality axial and lateral strain estimates from noisy ultrasound radio frequency (RF) data. In this paper, we propose a filtering technique combining two efficient filters for removal of noise from strain images, i.e., Kalman and nonlinear complex diffusion filters (NCDF). Our proposed filter is based on a novel noise model, which takes into consideration both additive and amplitude modulation noise in the estimated strains. Using finite element and ultrasound simulations, we demonstrate that the proposed filtering technique can significantly improve image quality of lateral strain elastograms along with fluid pressure and velocity elastograms. Technical feasibility of the proposed method on an in vivo set of data is also demonstrated. Our results show that the CNRe of the lateral strain, fluid pressure and fluid velocity as estimated using the proposed technique is higher by at least 10.9%, 51.3% and 334.4% when compared to the results obtained using a Kalman filter only, by at least 8.9%, 27.6% and 219.5% when compared to the results obtained using a NCDF only and by at least 152.3%, 1278% and 742% when compared to the results obtained using a median filter only for all SNRs considered in this study.

Understanding the Contrast Mechanism in Rotation Elastogram: A Parametric Study

Ultrasound elastography has been found to be useful in different clinical applications. For example, in breast imaging, axial strain elastography provides information related to tissue stiffness, which is used to characterize breast lesions as either benign or malignant. In addition, these lesions also differ in their bonding properties. Benign breast lesions are loosely bonded and malignant breast lesions are firmly bonded to the surrounding tissues. Therefore, only benign breast lesions will rotate/slip on the application of deformation. This rotation of lesions can be visualized with rotation elastography, which utilizes axial and lateral shear strain components. The contrast obtained in rotation elastography depends on various mechanical as well as ultrasound elastography parameters. However, there is no reported work that provides an understanding of the influence of these parameters on the visualized rotation contrast. In this work, the authors studied the rotation contrast by varying the mechanical parameters such as the inclusion b/a ratio, relative inclusion-background Young's modulus, amount of applied deformation and orientation of the inclusion. First, the authors performed finite-element analysis to understand the fundamental rotation contrast of the inclusion. Next, rotation elastograms obtained from ultrasound simulations in Field II and experiments on tissue-mimicking phantoms were investigated. Mean contrast was used as a metric to evaluate the quality of rotation elastograms in finite-element analysis, and contrast-to-noise ratio was used in Field II simulations and phantom experiments. The results indicate that rotation contrast was observed only in the case of loosely bonded inclusions. Further, the rotation contrast was found to depend on the inclusion asymmetry and its orientation with respect to the axis of deformation. Interestingly, it was found that a loosely bonded inclusion contrasts with surrounding tissue in rotation elastography, even in the absence of any inclusion-background modulus contrast.

Adaptive mesh refinement for elastic modulus reconstruction in elastography

Meshes play a crucial role in determining the accuracy of the elastic modulus reconstruction in the elastography when the finite element method is employed. In this article, we propose an adaptive mesh refinement strategy which can ensure the coincidence of the meshes with the shape of the inclusions in the observed tissue. This strategy is based on the intensity distribution of the strain image where the variance of the strain distribution in each element of the meshes is used to measure the homogeneity of the element, that is, the larger the strain variance is the more inhomogeneous the element will be and hence more detailed information will be included in this element. For more accurate reconstruction of such detailed information, mesh refinement procedure is implemented in such elements. Besides, two refinement steps are employed for the reconstruction to improve the fitness of the reconstructed image and the observed tissue. Simulation results show that the two-stage adaptive mesh refinement algorithm performs well without needing any prior information about the internal geometric shape in tissue. Not only Young’s moduli of models but also shapes of the inclusions can be reconstructed perfectly and quickly with our proposed method.

Rotation Elastogram Estimation Using Synthetic Transmit-aperture Technique: A Feasibility Study

It is well-documented in literature that benign breast lesions, such as fibroadenomas, are loosely bonded to their surrounding tissue and tend to slip under a small quasi-static compression, whereas malignant lesions being firmly bonded to their surrounding tissue do not slip. Recent developments in quasi-static ultrasound elastography have shown that an image of the axial-shear strain distribution can provide information about the bonding condition at the lesion-surrounding tissue boundary. Further studies analyzing the axial-shear strain elastograms revealed that nonzero axial-shear strain values appear inside the lesion, referred to as fill-in, only when a lesion is loosely bonded and asymmetrically oriented to the axis of compression. It was argued that the fill-in observed in axial-shear strain elastogram is a surrogate of the actual rigid-body rotation undergone by such a benign lesion due to slip boundary condition. However, it may be useful and perhaps easy to interpret, if the actual rigid-body rotation of the lesion can itself be visualized directly. To estimate this rotation tensor and its spatial distribution map (called a Rotation Elastogram [RE]), it would be necessary to improve the quality of lateral displacement estimates. Recently, it has been shown in the context of Non-Invasive Vascular Elastography (NIVE) that the Synthetic Transmit Aperture (STA) technique can be adapted for elastography to improve the lateral displacement estimates. Therefore, the focus of this work was to investigate the feasibility of employing the STA technique to improve the lateral displacement estimation and assess the resulting improvement in the RE quality. This investigation was done using both simulation and experimental studies. The image quality metric of contrast-to-noise ratio (CNR) was used to evaluate the quality of rotation elastograms. The results demonstrate that the contrast appeared in RE only in the case of loosely bonded inclusion, and the quality of RE improved considerably by employing the STA technique.

Advances in ultrasound elasticity imaging

The most troublesome of ultrasonic B-mode imaging is the difficulty of accurately diagnosing cancers, benign tumors, and cysts because they appear similar to each other in B-mode images. The human soft tissue has different physical characteristics of ultrasound depending on whether it is normal or not. In particular, cancers in soft tissue tend to be harder than the surrounding tissue. Thus, ultrasound elasticity imaging can be advantageously used to detect cancers. To measure elasticity, a mechanical force is applied to a region of interest, and the degree of deformation measured is rendered as an image. Depending on the method of applying stress and measuring strain, different elasticity imaging modalities have been reported, including strain imaging, sonoelastography, vibro-acoustography, transient elastography, acoustic radiation force impulse imaging, supersonic imaging, and strain-rate imaging. In this paper, we introduce various elasticity imaging methods and explore their technical principles and characteristics.

Breast-lesion Segmentation Combining B-Mode and Elastography Ultrasound

Breast ultrasound (BUS) imaging has become a crucial modality, especially for providing a complementary view when other modalities (i.e., mammography) are not conclusive in the task of assessing lesions. The specificity in cancer detection using BUS imaging is low. These false-positive findings often lead to an increase of unnecessary biopsies. In addition, increasing sensitivity is also challenging given that the presence of artifacts in the B-mode ultrasound (US) images can interfere with lesion detection. To deal with these problems and improve diagnosis accuracy, ultrasound elastography was introduced. This paper validates a novel lesion segmentation framework that takes intensity (B-mode) and strain information into account using a Markov Random Field (MRF) and a Maximum a Posteriori (MAP) approach, by applying it to clinical data. A total of 33 images from two different hospitals are used, composed of 14 cancerous and 19 benign lesions. Results show that combining both the B-mode and strain data in a unique framework improves segmentation results for cancerous lesions (Dice Similarity Coefficient of 0.49 using B-mode, while including strain data reaches 0.70), which are difficult images where the lesions appear with blurred and not well-defined boundaries.

Strain estimation by a Fourier Series-based extrema tracking algorithm for elastography

In this paper, a new strain estimator using extrema tracking based on Fourier Series expansion (ETBFS) is proposed for ultrasonic elastography. In this method, the extremum is determined by solving an equation constructed by obtaining the first order derivative of the Fourier Series expansion and setting it to zero. Unlike other tracking algorithms, the ETBFS method can locate the extrema of radio frequency (RF) signals exactly between two adjacent sampling points and achieve a sub-sample accuracy without additional explicit interpolation. The correspondence between the located extrema in the pre- and post-compressed RF signal segments are constructed with a fine matching technique, with which the displacements and strains are estimated. Experimental results on a finite-element-modeling (FEM) simulation phantom show that the new proposed method can provide a more accurate displacement estimation than the standard cross-correlation (CC)-based method and the scale-invariant keypoints tracking (SIKT) algorithm. Moreover, performance analysis in terms of elastographic signal-to-noise ratio (SNRe), elastographic contrast-to-noise ratio (CNRe) and the real-versus-estimated strain error (RESE) also indicate that the dynamic range of the strain filter and its sensitivity can be improved with this new method.

A class of kernel based real-time elastography algorithms

In this paper, a novel real-time kernel-based and gradient-based Phase Root Seeking (PRS) algorithm for ultrasound elastography is proposed. The signal-to-noise ratio of the strain image resulting from this method is improved by minimizing the cross-correlation discrepancy between the pre- and post-compression radio frequency signals with an adaptive temporal stretching method and employing built-in smoothing through an exponentially weighted neighborhood kernel in the displacement calculation. Unlike conventional PRS algorithms, displacement due to tissue compression is estimated from the root of the weighted average of the zero-lag cross-correlation phases of the pair of corresponding analytic pre- and post-compression windows in the neighborhood kernel. In addition to the proposed one, the other time- and frequency-domain elastography algorithms (Ara et al., 2013; Hussain et al., 2012; Hasan et al., 2012) proposed by our group are also implemented in real-time using Java where the computations are serially executed or parallely executed in multiple processors with efficient memory management. Simulation results using finite element modeling simulation phantom show that the proposed method significantly improves the strain image quality in terms of elastographic signal-to-noise ratio (SNRe), elastographic contrast-to-noise ratio (CNRe) and mean structural similarity (MSSIM) for strains as high as 4% as compared to other reported techniques in the literature. Strain images obtained for the experimental phantom as well as in vivo breast data of malignant or benign masses also show the efficacy of our proposed method over the other reported techniques in the literature.

Phase-based direct average strain estimation for elastography

In this paper, a phase-based direct average strain estimation method is developed. A mathematical model is presented to calculate axial strain directly from the phase of the zero-lag cross-correlation function between the windowed precompression and stretched post-compression analytic signals. Unlike phase-based conventional strain estimators, for which strain is computed from the displacement field, strain in this paper is computed in one step using the secant algorithm by exploiting the direct phase-strain relationship. To maintain strain continuity, instead of using the instantaneous phase of the interrogative window alone, an average phase function is defined using the phases of the neighboring windows with the assumption that the strain is essentially similar in a close physical proximity to the interrogative window. This method accounts for the effect of lateral shift but without requiring a prior estimate of the applied strain. Moreover, the strain can be computed both in the compression and relaxation phases of the applied pressure. The performance of the proposed strain estimator is analyzed in terms of the quality metrics elastographic signal-to-noise ratio (SNRe), elastographic contrast-to-noise ratio (CNRe), and mean structural similarity (MSSIM), using a finite element modeling simulation phantom. The results reveal that the proposed method performs satisfactorily in terms of all the three indices for up to 2.5% applied strain. Comparative results using simulation and experimental phantom data, and in vivo breast data of benign and malignant masses also demonstrate that the strain image quality of our method is better than the other reported techniques.

On the precision of time-of-flight shear wave speed estimation in homogeneous soft solids: initial results using a matrix array transducer

A system capable of tracking radiation-force-induced shear wave propagation in a 3-D volume using ultrasound is presented. In contrast to existing systems, which use 1-D array transducers, a 2-D matrix array is used for tracking shear wave displacements. A separate single-element transducer is used for radiation force excitation. This system allows shear wave propagation in all directions away from the push to be observed. It is shown that for a limit of 64 tracking beams, by placing the beams at the edges of the measurement region of interest (ROI) at multiple directions from the push, time-of- flight (TOF) shear wave speed (SWS) measurement uncertainty can theoretically be reduced by 40% compared with equally spacing the tracking beams within the ROI along a single plane, as is typical when using a 1-D array for tracking. This was verified by simulation, and a reduction of 30% was experimentally observed on a homogeneous phantom. Analytical expressions are presented for the relationship between TOF SWS measurement uncertainty and various shear wave imaging parameters. It is shown that TOF SWS uncertainty is inversely proportional to ROI size, and inversely proportional to the square root of the number of tracking locations for a given distribution of beam locations relative to the push. TOF SWS uncertainty is shown to increase with the square of the SWS, indicating that TOF SWS measurements are intrinsically less precise for stiffer materials.

Filter-based compounded delay estimation with application to strain imaging

Ultrasonic wave interference produces local fluctuations in both the envelope, known as speckle, and phase of echoes. Furthermore, such fluctuations are correlated in space, and subsequent motion estimation from the envelope and/or phase signal produces patterned, correlated errors. Compounding, or combining information from multiple decorrelated looks, reduces such effects. We propose using a filter bank to create multiple looks to produce a compounded motion estimate. In particular, filtering in the lateral direction is shown to preserve delay estimation accuracy in the filtered sub-bands while creating decorrelation between sub-bands at the expense of some lateral resolution. For Gaussian apodization, we explicitly compute the induced signal decorrelation produced by Gabor filters. Furthermore, it is shown that lateral filtering is approximately equivalent to steering, in which filtered sub-bands correspond to signals extracted from shifted sub-apertures. Field II simulation of a point spread function verifies this claim. We use phase zero and its variants as displacement estimators for our compounded result. A simplified deformation model is used to provide computer simulations of deforming an elastic phantom. Simulations demonstrate root mean square error (RMSE) reduction in both displacement and strain of the compounded result over conventional and its laterally blurred versions. Then we apply the methods to experimental data using a commercial elastic phantom, demonstrating an improvement in strain SNR.

Real-time quasi-static ultrasound elastography

Ultrasound elastography is a technique used for clinical imaging of tissue stiffness with a conventional ultrasound machine. It was first proposed two decades ago, but active research continues in this area to the present day. Numerous clinical applications have been investigated, mostly related to cancer imaging, and though these have yet to prove conclusive, the technique has seen increasing commercial and clinical interest. This paper presents a review of the most widely adopted, non-quantitative, techniques focusing on technical innovations rather than clinical applications. The review is not intended to be exhaustive, concentrating instead on placing the various techniques in context according to the authors' perspective of the field.

Noise reduction for ultrasonic elastography using transmit-side frequency compounding: a preliminary study

Ultrasonic elastography is an imaging technique providing information about the relative stiffness of biological tissues. In general, elastography suffers from noise artifacts, which degrade lesion detectability and increase the likelihood of misdiagnosis. This paper proposes a method called transmit- side frequency compounding for elastography (TSFC). Beamforming is modified to transmit frames with N alternating center frequencies. Pairs of frames with the same center frequency are used to calculate sub-elastograms that are then averaged to produce one compounded elastogram. Simulation results based on an uniformly elastic tissue model demonstrate the decorrelation among sub-elastograms and the improvement in elastographic signal-to-noise ratio (SNRe) achieved by compounding sub-elastograms. An elastic phantom experiment further validates the noise reduction obtained by the proposed technique.

A new method for the acquisition of ultrasonic strain image volumes

This article presents a new method for acquiring three-dimensional (3-D) volumes of ultrasonic axial strain data. The method uses a mechanically-swept probe to sweep out a single volume while applying a continuously varying axial compression. Acquisition of a volume takes 15-20 s. A strain volume is then calculated by comparing frame pairs throughout the sequence. The method uses strain quality estimates to automatically pick out high quality frame pairs, and so does not require careful control of the axial compression. In a series of in vitro and in vivo experiments, we quantify the image quality of the new method and also assess its ease of use. Results are compared with those for the current best alternative, which calculates strain between two complete volumes. The volume pair approach can produce high quality data, but skillful scanning is required to acquire two volumes with appropriate relative strain. In the new method, the automatic quality-weighted selection of image pairs overcomes this difficulty and the method produces superior quality images with a relatively relaxed scanning technique.

A motion estimation refinement framework for real-time tissue axial strain estimation with freehand ultrasound

Ultrasound elastography has become a wellknown optional imaging method for the diagnosis of tissue abnormalities in various body parts. It images the elasticity of compliant tissues by estimating the local displacements and strains using pre- and post-compression RF echo signals. In this paper, taking the RF signal as image intensity and RF samples as pixels, we present a motion estimation framework to compute the axial tissue displacements and strains. This method takes advantage of both the block matching algorithm (BMA) and local optical flow techniques. For two frames of RF signals, coarse motion estimates are first computed using BMA. The motion estimates obtained are then used to warp the first frame toward the second one, thus making the warped frame more spatially correlated to the second one. Next, the Lucas-Kanade optical flow method is employed to compute the residual motion between the warped frame and the original second frame, with inherent sub-pixel precision. Finally, the displacements from the two steps are combined. The warp-and-refine procedure can be iterated if the residual motion is larger than a predefined empirical threshold. To test its feasibility, we first applied the method to simulated data. The results show that our method is robust to relatively large motions and is capable of generating accurate motion estimation with subsample spatial resolution. These methods have been deployed and are being tested on a commercialized ultrasound machine that previously did not have elastography functions. Quality real-time display of elastography along with freehand scanning has been accomplished. The proposed framework provides an alternative method for motion estimation with good performance, and it can potentially be improved using hardware to realize the BMA.

3-D ultrasonic strain imaging using freehand scanning and a mechanically-swept probe

This paper compares 2 approaches to 3-D ultrasonic axial strain imaging: a tracked ultrasound probe swept manually over a volume, and a mechanically-swept 3-D probe. We find that high-quality data are more easily obtained using the 3-D probe, but the freehand approach may be more practical in certain scanning situations.

Reconstructive compounding for IVUS palpography

This study proposes a novel algorithm for luminal strain reconstruction from sparse irregularly sampled strain measurements. It is based on the normalized convolution (NC) algorithm. The novel extension comprises the multilevel scheme, which takes into account the variable sampling density of the available strain measurements during the cardiac cycle. The proposed algorithm was applied to restore luminal strain values in intravascular ultrasound (IVUS) palpography. The procedure of reconstructing and averaging the strain values acquired during one cardiac cycle forms a technique, coined as reconstructive compounding. The accuracy of strain reconstruction was initially tested on the luminal strain map, computed from 3 in vivo IVUS pullbacks. The high quality of strain restoration was observed after systematically removing up to 90% of the initial elastographic measurements. The restored distributions accurately reproduced the original strain patterns and the error did not exceed 5%. The experimental validation of the reconstructed compounding technique was performed on 8 in vivo IVUS pullbacks. It demonstrated that the relative decrease in number of invalid strain estimates amounts to 92.05 +/- 6.03% and 99.17 +/- 0.92% for the traditional and reconstructive strain compounding schemes, respectively. In conclusion, implementation of the reconstructive compounding scheme boosts the diagnostic value of IVUS palpography.

Uniform precision ultrasound strain imaging

Ultrasound strain imaging is becoming increasingly popular as a way to measure stiffness variation in soft tissue. Almost all techniques involve the estimation of a field of relative displacements between measurements of tissue undergoing different deformations. These estimates are often high resolution, but some form of smoothing is required to increase the precision, either by direct filtering or as part of the gradient estimation process. Such methods generate uniform resolution images, but strain quality typically varies considerably within each image, hence a trade-off is necessary between increasing precision in the low-quality regions and reducing resolution in the high-quality regions. We introduce a smoothing technique, developed from the nonparametric regression literature, which can avoid this trade-off by generating uniform precision images. In such an image, high resolution is retained in areas of high strain quality but sacrificed for the sake of increased precision in low-quality areas. We contrast the algorithm with other methods on simulated, phantom, and clinical data, for both 2-D and 3-D strain imaging. We also show how the technique can be efficiently implemented at real-time rates with realistic parameters on modest hardware. Uniform precision nonparametric regression promises to be a useful tool in ultrasound strain imaging.

A quality-guided displacement tracking algorithm for ultrasonic elasticity imaging

Displacement estimation is a key step in the evaluation of tissue elasticity by quasistatic strain imaging. An efficient approach may incorporate a tracking strategy whereby each estimate is initially obtained from its neighbours’ displacements and then refined through a localized search. This increases the accuracy and reduces the computational expense compared with exhaustive search. However, simple tracking strategies fail when the target displacement map exhibits complex structure. For example, there may be discontinuities and regions of indeterminate displacement caused by decorrelation between the pre- and post-deformation radio frequency (RF) echo signals. This paper introduces a novel displacement tracking algorithm, with a search strategy guided by a data quality indicator. Comparisons with existing methods show that the proposed algorithm is more robust when the displacement distribution is challenging.

Stable, intelligible ultrasonic strain imaging

BACKGROUND: Freehand quasistatic strain imaging can reveal qualitative information about tissue stiffness with good spatial accuracy. Clinical trials, however, repeatedly cite instability and variable signal-to-noise ratio as significant drawbacks. METHODS: This study investigates three post-processing strategies for quasistatic strain imaging. Normalisation divides the strain by an estimate of the stress field, the intention being to reduce sensitivity to variable applied stress. Persistence aims to improve the signal-to-noise ratio by time-averaging multiple frames. The persistence scheme presented in this article operates at the pixel level, weighting each frame's contribution by an estimate of the strain precision. Precision-based display presents the clinician with an image in which regions of indeterminate strain are obscured behind a colour wash. This is achieved using estimates of strain precision that are faithfully propagated through the various stages of signal processing. RESULTS AND DISCUSSION: The post-processing strategy is evaluated qualitatively on scans of a breast biopsy phantom and in vivo head and neck examinations. Strain images processed in this manner are observed to benefit from improved stability and signal-to-noise ratio. There are, however, limitations. In unusual though conceivable circumstances, the normalisation procedure might suppress genuine stiffness variations evident in the unprocessed strain images. In different circumstances, the raw strain images might fail to capture significant stiffness variations, a situation that no amount of post-processing can improve. CONCLUSION: The clinical utility of freehand quasistatic strain imaging can be improved by normalisation, precision-weighted pixel-level persistence and precision-based display. The resulting images are stable and generally exhibit a better signal-to-noise ratio than any of the original, unprocessed strain images.

An intelligent interface for freehand strain imaging

We present a new, intelligent interface for freehand strain imaging, which has been designed to support clinical trials investigating the potential of ultrasonic strain imaging for diagnostic purposes across a broad range of target pathologies. The aim with this interface is to make scanning easier and to help clinicians learn the necessary scanning technique quickly, by providing real time feedback indicating the quality of the strain data as they are produced. The methods require a pixel-level indicator of estimation precision, which can be calculated in-line with strain estimation. This is exploited in novel approaches to normalisation, persistence and display. The effect of each component is indicated in the results with examples from in vitro and in vivo scanning. As well as providing real-time feedback, the images are easier to interpret because data at unacceptably low signal-to-noise ratios do not reach the display. Additionally, the level of noise in the displayed images is actually reduced compared with other methods that use the same strain estimates with the same level of persistence. The interface also considerably reduces the difficulty in producing volumes of strain data from freehand three-dimensional scans.

Dynamic resolution selection in ultrasonic strain imaging

Ultrasonic strain imaging promises to be a valuable tool in medical diagnostics. Reliability and ease-of-use have become important considerations. These depend on selection of appropriate imaging parameters. Two tasks are undertaken here. The tradeoff between resolution and estimation precision is examined closely to establish models for the relationships with imaging parameters and data properties. These models are then applied in a system that automatically sets the imaging parameters responsive to the data quality and the required estimation precision, so as to produce more meaningful images under varying scan conditions. The new system is applied to simulation, in vitro and in vivo data for validation. It reduces the complexity of the sonographer's role in strain imaging, and produces images of reliable quality even when the level of signal decorrelation varies throughout the ultrasound data.

Freehand ultrasound elastography with a 3-D probe

This paper presents the first near-real-time freehand ultrasound elastography system using a (3-D) mechanical probe. Acquisition is complete within two sec, and only an additional 20 sec are required for generation of a full 3-D strain volume. The strain is axial, with estimates of lateral and elevational tissue movement used to increase the accuracy of the axial strain measurement. This is the first time all system components have been extended to 3-D, i.e., 3-D windows are used to track displacement, which is tracked in all directions, and 3-D kernels are used for least-squares gradient estimates. Normalization of the freehand 3-D strain data is also applied across the whole volume. The system is tested using a novel research 3-D radiofrequency (RF) system with real-time control over the stepper motor driving the ultrasound probe, and real-time streaming of RF ultrasound data. The paper proves the concept, rather than making significant comments on the achievable accuracy in 3-D, although we demonstrate that the high performance of the 2-D techniques that we extend appears to carry through to in-vitro and in-vivo 3-D data. The result is a fast and high-resolution 3-D image of normalized axial strain. (E-mail: gmt11@eng.cam.ac.uk).

Phase-based ultrasonic deformation estimation

Deformation estimation is the foundation of emerging techniques for imaging the mechanical properties of soft tissues. We present theoretical analysis and experimental results from an investigation of phase-based ultrasonic deformation estimators. Numerous phase-based algorithm variants were tested quantitatively on simulated RF data from uniform scatterer fields, subject to a range of uniform strain deformations. Particular attention is paid to a new algorithm, weighted phase separation, the performance of which is demonstrated in application to in vivo freehand strain imaging. Good results support the theory that underlies the new algorithm, and more generally highlight the factors that should be considered in the design of high performance deformation estimators for practical applications. For context, note that this represents progress with an algorithm class that is suitable for real-time applications, yet has already been shown quantitatively to offer greater accuracy over a wide range of scanning conditions than adaptive companding methods based on correlation coefficient or sum of absolute differences.