Convex array vector velocity imaging using transverse oscillation and its optimization

Fourier-based beamforming for 3D plane wave imaging and application in vector flow imaging using selective compounding

Objective. Ultrafast ultrasound imaging using planar or diverging waves for transmission is a promising approach for efficient 3D imaging with matrix arrays. This technique has advantages for B-mode imaging and advanced techniques, such as 3D vector flow imaging (VFI). The computation load of the cross-beam technique is associated with the number of transmit anglesmand receive anglesn. The full velocity vector is obtained using the least square fashion. However, the beamforming is repeatedm × ntimes using a conventional time-domain delay-and-sum (DAS) beamformer. In the 3D case, the collection and processing of data from different beams increase the amount of data that must be processed, requiring more storage capacity and processing power. Furthermore, the large computation complexity of DAS is another major concern. These challenges translate into longer computational times, increased complexity in data processing, and difficulty in real-time applications.Approach. In response to this issue, this study proposes a novel Fourier domain beamformer for 3D plane wave imaging, which significantly increases the computational speed. Additionally, a selective compounding strategy is proposed for VFI, which reduces the beamforming process fromm × ntom(wheremandnrepresent the number of transmission and reception, respectively), effectively shortening the processing time. The underlying principle is to decompose the receive wavefront into a series of plane waves with different slant angles. Each slant angle can produce a sub-volume for coherent or selective compounding. This method does not rely on the assumption that the plane wave is perfect and the results show that our proposed beamformer is better than DAS in terms of resolution and image contrast. In the case of velocity estimation, for the Fourier-based method, only Tx angles are assigned in the beamformer and the selective compounding method produces the final image with a specialized Rx angle.Main results. Simulation studies andin vitroexperiments confirm the efficacy of this new method. The proposed beamformer shows improved resolution and contrast performance compared to the DAS beamformer for B-mode imaging, with a suppressed sidelobe level. Furthermore, the proposed technique outperforms the conventional DAS method, as evidenced by lower mean bias and standard deviation in velocity estimation for VFI. Notably, the computation time has been shortened by 40 times, thus promoting the real-time application of this technique. The efficacy of this new method is verified through simulation studies andin vitroexperiments and evaluated by mean bias and standard deviation. Thein vitroresults reveal a better velocity estimation: the mean bias is 2.3%, 3.4%, and 5.0% forvx,vy, andvz, respectively. The mean standard deviation is 1.8%, 1.7%, and 3.4%. With DAS, the evaluated mean bias is 9.8%, 4.6%, and 6.7% and the measured mean standard deviation is 7.5%, 2.5%, and 3.9%.Significance. In this work, we propose a novel Fourier-based method for both B-mode imaging and functional VFI. The new beamformer is shown to produce better image quality and improved velocity estimation. Moreover, the new VFI computation time is reduced by 40 times compared to conventional methods. This new method may pave a new way for real-time 3D VFI applications.

Intra-Cardiac Flow from Geometry Prescribed Computational Fluid Dynamics: Comparison with Ultrasound Vector Flow Imaging

PURPOSE

This paper investigates the accuracy of blood flow velocities simulated from a geometry prescribed computational fluid dynamics (CFD) pipeline by applying it to a dynamic heart phantom. The CFD flow patterns are compared to a direct flow measurement by ultrasound vector flow imaging (VFI). The hypothesis is that the simulated velocity magnitudes are within one standard deviation of the measured velocities.

METHODS

The CFD pipeline uses computed tomography angiography (CTA) images with 20 volumes per cardiac cycle as geometry input. Fluid domain movement is prescribed from volumetric image registration using the CTA image data. Inlet and outlet conditions are defined by the experimental setup. VFI is systematically measured in parallel planes, and compared to the corresponding planes in the simulated time dependent three dimensional fluid velocity field.

RESULTS

The measured VFI and simulated CFD have similar flow patterns when compared qualitatively. A quantitative comparison of the velocity magnitude is also performed at specific regions of interest. These are evaluated at 11 non-overlapping time bins and compared by linear regression giving R2 = 0.809, SD = 0.060 m/s, intercept = - 0.039 m/s, and slope = 1.09. Excluding an outlier at the inlet, the correspondence between CFD and VFI improves to: R2 = 0.823, SD = 0.048 m/s, intercept = -0.030 m/s, and slope = 1.01.

CONCLUSION

The direct comparison of flow patterns shows that the proposed CFD pipeline provide realistic flow patterns in a well-controlled experimental setup. The demanded accuracy is obtained close to the inlet and outlet, but not in locations far from these.

Optimization of 3-D Divergence-Free Flow Field Reconstruction Using 2-D Ultrasound Vector Flow Imaging

3-D blood vector flow imaging is of great value in understanding and detecting cardiovascular diseases. Currently, 3-D ultrasound vector flow imaging requires 2-D matrix probes, which are expensive and suffer from suboptimal image quality. Our recent study proposed an interpolation algorithm to obtain a divergence-free reconstruction of the 3-D flow field from 2-D velocities obtained by high-frame-rate ultrasound particle imaging velocimetry (High Frame Rate echo-Particle Imaging Velocimetry, also known as HFR Ultrasound Imaging Velocimetry (UIV)), using a 1-D array transducer. The aim of this work was to significantly improve the accuracy and reduce the time-to-solution of our previous approach, thereby paving the way for clinical translation. More specifically, accuracy was improved by optimising the divergence-free basis to reduce Runge phenomena near domain boundaries, and time-to-solution was reduced by demonstrating that under certain conditions, the resulting system could be solved using widely available and highly optimised generalised minimum residual algorithms. To initially illustrate the utility of the approach, coarse 2-D subsamplings of an analytical unsteady Womersely flow solution and a steady helical flow solution obtained using computational fluid dynamics were used successfully to reconstruct full flow solutions, with 0.82% and 4.8% average relative errors in the velocity field, respectively. Subsequently, multiplane 2-D velocity fields were obtained through HFR UIV for a straight-tube phantom and a carotid bifurcation phantom, from which full 3-D flow fields were reconstructed. These were then compared with flow fields obtained via computational fluid dynamics in each of the two configurations, and average relative errors of 6.01% and 12.8% in the velocity field were obtained. These results reflect 15%-75% improvements in accuracy and 53- to 874-fold acceleration of reconstruction speeds for the four cases, compared with the previous divergence-free flow reconstruction method. In conclusion, the proposed method provides an effective and fast method to reconstruct 3-D flow in arteries using a 1-D array transducer.

Pediatric Transthoracic Cardiac Vector Flow Imaging - A Preliminary Pictorial Study

Purpose Conventional pediatric echocardiography is crucial for diagnosing congenital heart disease (CHD), but the technique is impaired by angle dependency. Vector flow imaging (VFI) is an angle-independent noninvasive ultrasound alternative for blood flow assessment and can assess complex flow patterns not visible on conventional Doppler ultrasound.

Materials and Methods 12 healthy newborns and 3 infants with CHD were examined with transthoracic cardiac VFI using a conventional ultrasound scanner and a linear array.

Results VFI examinations revealed common cardiac flow patterns among the healthy newborns, and flow changes among the infants with CHD not previously reported with conventional echocardiography.

Conclusion For assessment of cardiac flow in the normal and diseased pediatric heart, VFI may provide additional information compared to conventional echocardiography and become a useful diagnostic tool.

High-Frame-Rate Contrast-Enhanced Ultrasound for Velocimetry in the Human Abdominal Aorta

Treatment of abdominal aortic (AA) aneurysms and stenotic lesions may be improved by analyzing their associated blood-flow patterns. Angle-independent blood-flow patterns in the AA can be obtained by combining echo-particle image velocimetry (ePIV) with high-frame-rate (HFR) contrast-enhanced ultrasonography. However, ePIV performance is affected by ultrasound contrast agent (UCA) concentration, microbubble stability, and tissue clutter. In this study, we assessed the influence of acoustic pressure and UCA concentration on image quality for ePIV analysis. We also compared amplitude modulation (AM) and singular value decomposition (SVD) as tissue suppression strategies for ePIV. Fourteen healthy volunteers were imaged in the region of the distal AA. We tested four different UCA bolus volumes (0.25, 0.5, 0.75, and 1.5 mL) and four different acoustic output pressures (mechanical indices: 0.01, 0.03, 0.06, and 0.09). As image quality metrics, we measured contrast-to-background ratio, bubble disruption ratio, and maximum normalized cross-correlation value during ePIV. At mechanical indices ≥ 0.06, we detected severe bubble destruction, suggesting that very low acoustic pressures should be used for ePIV. SVD was able to suppress tissue clutter better than AM. The maximum tracking correlation was affected by both UCA concentration and flow rate, where at high flow rates, lower UCA concentrations resulted in slightly higher correlation values but more signal drop-outs during late diastole. HFR ePIV was successfully performed in the AA of healthy volunteers and shows promise for future studies in patients.

Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) Characterized with Velocity Ratios using Vector Velocity Ultrasound

Purpose

Atherosclerotic arteries are challenging to evaluate quantitatively using spectral Doppler ultrasound because of the turbulent flow conditions that occur in relation to the atherosclerotic stenoses. Vector velocity ultrasound is angle independent and provides flow information, which could potentially improve the diagnosis of arterial stenoses. The purpose of the study is to distinguish significant stenoses in the superficial femoral artery (> 50% diameter reduction) from non-significant stenoses based on velocity ratios derived from the commercially available vector velocity ultrasound technique Vector Flow Imaging (VFI).

Materials and Methods

Velocity ratios (intrastenotic blood flow velocity divided by pre- or poststenotic velocity) from a total of 16 atherosclerotic stenoses and plaques in the superficial femoral artery of 11 patients were obtained using VFI. The stenosis degree, expressed as percentage diameter reduction of the artery, was determined from digital subtraction angiography and compared to the velocity ratios.

Results

A velocity ratio of 2.5 was found to distinguish clinically relevant stenoses with>50% diameter reduction from clinically non-relevant stenoses with<50% diameter reduction and the difference was statistically significant.

Conclusion

The study indicates that VFI is a potential future tool for the evaluation of arterial stenoses.

Real-Time 2-D Phased Array Vector Flow Imaging

Echocardiography examination of the blood flow is currently either restricted to 1-D techniques in real-time or experimental offline 2-D methods. This paper presents an implementation of transverse oscillation for real-time 2-D vector flow imaging (VFI) on a commercial BK Ultrasound scanner. A large field-of-view (FOV) sequence for studying flow dynamics at 11 frames per second (fps) and a sequence for studying peak systolic velocities (PSVs) with a narrow FOV at 36 fps were validated. The VFI sequences were validated in a flow rig with continuous laminar parabolic flow and in a pulsating flow pump system before being tested in vivo, where measurements were obtained on two healthy volunteers. Mean PSV from 11 cycles was 155 cms^-1 with a precision of ±9.0% for the pulsating flow pump. In vivo, PSV estimated in the ascending aorta was 135 cms^-1 ± 16.9% for eight cardiac cycles. Furthermore, in vivo flow dynamics of the left ventricle and in the ascending aorta were visualized. In conclusion, angle independent 2-D VFI on a phased array has been implemented in real time, and it is capable of providing quantitative and qualitative flow evaluations of both the complex and fully transverse flow.

Vector Flow Imaging Compared with Pulse Wave Doppler for Estimation of Peak Velocity in the Portal Vein

The study described here investigated whether angle-independent vector flow imaging (VFI) technique estimates peak velocities in the portal vein comparably to pulsed wave Doppler (PWD). Furthermore, intra- and inter-observer agreement was assessed in a substudy. VFI and PWD peak velocities were estimated with from intercostal and subcostal views for 32 healthy volunteers, and precision analyses were conducted. Blinded to estimates, three physicians rescanned 10 volunteers for intra- and inter-observer agreement analyses. The precision of VFI and PWD was 18% and 28% from an intercostal view and 23% and 77% from a subcostal view, respectively. Bias between VFI and PWD was 0.57 cm/s (p = 0.38) with an intercostal view and 9.89 cm/s (p <0.001) with a subcostal view. Intra- and inter-observer agreement was highest for VFI (inter-observer intra-class correlation coefficient: VFI 0.80, PWD 0.3; intra-observer intra-class correlation coefficient: VFI 0.90, PWD 0.69). Regardless of scan view, VFI was more precise than PWD.

Vector and Doppler Ultrasound Velocities Evaluated in a Flow Phantom and the Femoropopliteal Vein

Ultrasound is used for evaluating the veins of the lower extremities. Operator and angle dependency limit spectral Doppler ultrasound (SDUS). The aim of the study was to compare peak velocity measurements in a flow phantom and the femoropopliteal vein of 20 volunteers with the angle-independent vector velocity technique vector flow imaging (VFI) and SDUS. In the flow phantom, VFI underestimated velocity (p = 0.01), with a lower accuracy of 5.5% (p = 0.01) and with no difference in precision, that is, error factor, compared with SDUS (VFI: 1.02 vs. SDUS: 1.02, p = 0.58). In vivo, VFI estimated lower velocities (femoral: p = 0.001; popliteal: p = 0.001) with no difference in precision compared with SDUS (femoral: VFI 1.09 vs. SDUS 1.14, p = 0.37; popliteal: VFI 1.13 vs. SDUS 1.06, p = 0.09). In conclusion, the precise VFI technique can be used to characterize venous hemodynamics of the lower extremities despite its underestimation of velocities.

Aortic Valve Stenosis Increases Helical Flow and Flow Complexity: A Study of Intra-Operative Cardiac Vector Flow Imaging

Aortic valve stenosis alters blood flow in the ascending aorta. Using intra-operative vector flow imaging on the ascending aorta, secondary helical flow during peak systole and diastole, as well as flow complexity of primary flow during systole, were investigated in patients with normal, stenotic and replaced aortic valves. Peak systolic helical flow, diastolic helical flow and flow complexity during systole differed between the groups (p < 0.0001), and correlated to peak systolic velocity (R = 0.94, 0.87 and 0.88, respectively). The study indicates that aortic valve stenosis increases helical flow and flow complexity, which are measurable with vector flow imaging. For assessment of aortic stenosis and optimization of valve surgery, vector flow imaging may be useful.

Directional Transverse Oscillation Vector Flow Estimation

A method for estimating vector velocities using transverse oscillation (TO) combined with directional beamforming is presented. In directional TO (DTO), a normal focused field is emitted and the received signals are beamformed in the lateral direction transverse to the ultrasound beam to increase the amount of data for vector velocity estimation. The approach is self-calibrating as the lateral oscillation period is estimated from the directional signal through a Fourier transform to yield quantitative velocity results over a large range of depths. The approach was extensively simulated using Field IIpro and implemented on the experimental Synthetic Aperture Real-time Ultrasound System (SARUS) scanner in connection with a BK Medical 8820e convex array transducer. Velocity estimates for DTO are found for beam-to-flow angles of 60°, 75°, and 90°, and vessel depths from 24 to 156 mm. Using 16 emissions, the standard deviation (SD) for angle estimation at depths ranging from 24 to 104 mm is between 6.01° and 0.93° with a mean SD of 2.8°. The mean relative SD for the lateral velocity component is 9.2% and the mean relative bias -3.4% or four times lower than for traditional TO. The approach also works for deeper lying vessels with a slight increase in SD to 15.7%, but a maintained bias of -3.5% from 126 to 156 mm. Data for a pulsating flow have also been acquired for 15 cardiac cycles using a CompuFlow 1000 pump. The relative SD was here 7.4% for a femoral artery waveform.

Ultrasonic 3-D Vector Flow Method for Quantitative In Vivo Peak Velocity and Flow Rate Estimation

Current clinical ultrasound (US) systems are limited to show blood flow movement in either 1-D or 2-D. In this paper, a method for estimating 3-D vector velocities in a plane using the transverse oscillation method, a 32×32 element matrix array, and the experimental US scanner SARUS is presented. The aim of this paper is to estimate precise flow rates and peak velocities derived from 3-D vector flow estimates. The emission sequence provides 3-D vector flow estimates at up to 1.145 frames/s in a plane, and was used to estimate 3-D vector flow in a cross-sectional image plane. The method is validated in two phantom studies, where flow rates are measured in a flow-rig, providing a constant parabolic flow, and in a straight-vessel phantom ( ∅=8 mm) connected to a flow pump capable of generating time varying waveforms. Flow rates are estimated to be 82.1 ± 2.8 L/min in the flow-rig compared with the expected 79.8 L/min, and to 2.68 ± 0.04 mL/stroke in the pulsating environment compared with the expected 2.57 ± 0.08 mL/stroke. Flow rates estimated in the common carotid artery of a healthy volunteer are compared with magnetic resonance imaging (MRI) measured flow rates using a 1-D through-plane velocity sequence. Mean flow rates were 333 ± 31 mL/min for the presented method and 346 ± 2 mL/min for the MRI measurements.

Evaluation of the Transverse Oscillation Technique for Cardiac Phased Array Imaging: A Theoretical Study

The transverse oscillation (TO) technique can improve the estimation of tissue motion perpendicular to the ultrasound beam direction. TOs can be introduced using plane wave (PW) insonification and bilobed Gaussian apodization (BA) on receive (abbreviated as PWTO). Furthermore, the TO frequency of PWTO can be doubled after a heterodyning demodulation process is performed (abbreviated as PWTO*). This paper is concerned with identifying the limitations of the PWTO technique in the specific context of myocardial deformation imaging with phased arrays and investigating the conditions in which it remains advantageous over traditional focused (FOC) beamforming. For this purpose, several tissue phantoms were simulated using Field II, undergoing a wide range of displacement magnitudes and modes (lateral, axial, and rotational motions). The Cramer-Rao lower bound was used to optimize TO beamforming parameters and theoretically predict the fundamental tracking performance limits associated with the FOC, PWTO, and PWTO* beamforming scenarios. This framework was extended to also predict the performance for BA functions that are windowed by the physical aperture of the transducer, leading to higher lateral oscillations. It was found that windowed BA functions resulted in lower jitter errors compared with traditional BA functions. PWTO* outperformed FOC at all investigated signal-to-noise ratio (SNR) levels but only up to a certain displacement, with the advantage rapidly decreasing when the SNR increased. These results suggest that PWTO* improves lateral tracking performance, but only when interframe displacements remain relatively low. This paper concludes by translating these findings into a clinical environment by suggesting optimal scanner settings.

Ultrasound Vector Flow Imaging-Part I: Sequential Systems

This paper gives a review of the most important methods for blood velocity vector flow imaging (VFI) for conventional sequential data acquisition. This includes multibeam methods, speckle tracking, transverse oscillation, color flow mapping derived VFI, directional beamforming, and variants of these. The review covers both 2-D and 3-D velocity estimation and gives a historical perspective on the development along with a summary of various vector flow visualization algorithms. The current state of the art is explained along with an overview of clinical studies conducted and methods for presenting and using VFI. A number of examples of VFI images are presented, and the current limitations and potential solutions are discussed.

3-D Vector Flow Estimation With Row-Column-Addressed Arrays

Simulation and experimental results from 3-D vector flow estimations for a 62 + 62 2-D row-column (RC) array with integrated apodization are presented. A method for implementing a 3-D transverse oscillation (TO) velocity estimator on a 3-MHz RC array is developed and validated. First, a parametric simulation study is conducted, where flow direction, ensemble length, number of pulse cycles, steering angles, transmit/receive apodization, and TO apodization profiles and spacing are varied, to find the optimal parameter configuration. The performance of the estimator is evaluated with respect to relative mean bias ~B and mean standard deviation ~σ . Second, the optimal parameter configuration is implemented on the prototype RC probe connected to the experimental ultrasound scanner SARUS. Results from measurements conducted in a flow-rig system containing a constant laminar flow and a straight-vessel phantom with a pulsating flow are presented. Both an M-mode and a steered transmit sequence are applied. The 3-D vector flow is estimated in the flow rig for four representative flow directions. In the setup with 90° beam-to-flow angle, the relative mean bias across the entire velocity profile is (-4.7, -0.9, 0.4)% with a relative standard deviation of (8.7, 5.1, 0.8)% for ( v_x, v_y, v_z ). The estimated peak velocity is 48.5 ± 3 cm/s giving a -3% bias. The out-of-plane velocity component perpendicular to the cross section is used to estimate volumetric flow rates in the flow rig at a 90° beam-to-flow angle. The estimated mean flow rate in this setup is 91.2 ± 3.1 L/h corresponding to a bias of -11.1%. In a pulsating flow setup, flow rate measured during five cycles is 2.3 ± 0.1 mL/stroke giving a negative 9.7% bias. It is concluded that accurate 3-D vector flow estimation can be obtained using a 2-D RC-addressed array.

Intra-Operative Vector Flow Imaging Using Ultrasound of the Ascending Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves

Stenosis of the aortic valve gives rise to more complex blood flows with increased velocities. The angle-independent vector flow ultrasound technique transverse oscillation was employed intra-operatively on the ascending aorta of (I) 20 patients with a healthy aortic valve and 20 patients with aortic stenosis before (IIa) and after (IIb) valve replacement. The results indicate that aortic stenosis increased flow complexity (p < 0.0001), induced systolic backflow (p < 0.003) and reduced systolic jet width (p < 0.0001). After valve replacement, the systolic backflow and jet width were normalized (p < 0.52 and p < 0.22), but flow complexity was not (p < 0.0001). Flow complexity (p < 0.0001), systolic jet width (p < 0.0001) and systolic backflow (p < 0.001) were associated with peak systolic velocity. The study found that aortic stenosis changes blood flow in the ascending aorta and valve replacement corrects some of these changes. Transverse oscillation may be useful for assessment of aortic stenosis and optimization of valve surgery.

Vector velocity volume flow estimation: Sources of error and corrections applied for arteriovenous fistulas

A method for vector velocity volume flow estimation is presented, along with an investigation of its sources of error and correction of actual volume flow measurements. Volume flow errors are quantified theoretically by numerical modeling, through flow phantom measurements, and studied in vivo. This paper investigates errors from estimating volumetric flow using a commercial ultrasound scanner and the common assumptions made in the literature. The theoretical model shows, e.g. that volume flow is underestimated by 15%, when the scan plane is off-axis with the vessel center by 28% of the vessel radius. The error sources were also studied in vivo under realistic clinical conditions, and the theoretical results were applied for correcting the volume flow errors. Twenty dialysis patients with arteriovenous fistulas were scanned to obtain vector flow maps of fistulas. When fitting an ellipsis to cross-sectional scans of the fistulas, the major axis was on average 10.2mm, which is 8.6% larger than the minor axis. The ultrasound beam was on average 1.5mm from the vessel center, corresponding to 28% of the semi-major axis in an average fistula. Estimating volume flow with an elliptical, rather than circular, vessel area and correcting the ultrasound beam for being off-axis, gave a significant (p=0.008) reduction in error from 31.2% to 24.3%. The error is relative to the Ultrasound Dilution Technique, which is considered the gold standard for volume flow estimation for dialysis patients. The study shows the importance of correcting for volume flow errors, which are often made in clinical practice.

Safety Assessment of Advanced Imaging Sequences II: Simulations

An automatic approach for simulating the emitted pressure, intensity, and mechanical index (MI) of advanced ultrasound imaging sequences is presented. It is based on a linear simulation of pressure fields using Field II, and it is hypothesized that linear simulation can attain the needed accuracy for predicting MI and I(spta.3) as required by FDA. The method is performed on four different imaging schemes and compared to measurements conducted using the SARUS experimental scanner. The sequences include focused emissions with an F-number of 2 with 64 elements that generate highly nonlinear fields. The simulation time is between 0.67 and 2.8 ms per emission and imaging point, making it possible to simulate even complex emission sequences in less than 1 s for a single spatial position. The linear simulations yield a relative accuracy on MI between -12.1% and 52.3% and for I(spta.3) between -38.6% and 62.6%, when using the impulse response of the probe estimated from an independent measurement. The accuracy is increased to between -22% and 24.5% for MI and between -33.2% and 27.0% for I(spta.3), when using the pressure response measured at a single point to scale the simulation. The spatial distribution of MI and I(ta.3) closely matches that for the measurement, and simulations can, therefore, be used to select the region for measuring the intensities, resulting in a significant reduction in measurement time. It can validate emission sequences by showing symmetry of emitted pressure fields, focal position, and intensity distribution.

Safety Assessment of Advanced Imaging Sequences I: Measurements

A method for rapid measurement of intensities (I(spta)), mechanical index (MI), and probe surface temperature for any ultrasound scanning sequence is presented. It uses the scanner's sampling capability to give an accurate measurement of the whole imaging sequence for all emissions to yield the true distributions. The method is several orders of magnitude faster than approaches using an oscilloscope, and it also facilitates validating the emitted pressure field and the scanner's emission sequence software. It has been implemented using the experimental synthetic aperture real-time ultrasound system (SARUS) scanner and the Onda AIMS III intensity measurement system (Onda Corporation, Sunnyvale, CA, USA). Four different sequences have been measured: a fixed focus emission, a duplex sequence containing B-mode and flow emissions, a vector flow sequence with B-mode and flow emissions in 17 directions, and finally a SA duplex flow sequence. A BK8820e (BK Medical, Herlev, Denmark) convex array probe is used for the first three sequences and a BK8670 linear array probe for the SA sequence. The method is shown to give the same intensity values within 0.24% of the AIMS III Soniq 5.0 (Onda Corporation, Sunnyvale, CA, USA) commercial intensity measurement program. The approach can measure and store data for a full imaging sequence in 3.8-8.2 s per spatial position. Based on I(spta), MI, and probe surface temperature, the method gives the ability to determine whether a sequence is within U.S. FDA limits, or alternatively indicate how to scale it to be within limits.